Low Birthweight Birth Research Articles

An international cohort study of birth outcomes associated with hospitalized acute respiratory infection during pregnancy

ObjectivesFindings during the 2009 pandemic suggest severe maternal infection with pandemic influenza had adverse perinatal health consequences. Limited data exist evaluating the perinatal health effects of severe seasonal influenza and non-influenza infections during pregnancy. MethodsA retrospective cohort of pregnant women from Australia, Canada, Israel, and the United States was established using birth records to identify pregnancies and birth outcomes and hospital and laboratory testing records to identify influenza and non-influenza associated acute respiratory or febrile illness (ARFI) hospitalizations. ARFI hospitalized women were matched to non-hospitalized women (1:4) by country and season of conception. Log-binomial regression was used to estimate the relative risk (aRR) of preterm birth (PTB), small-for-gestational-age (SGA), and low birthweight (LBW) birth, adjusting for pre-existing medical conditions, maternal age, and parity. Results950 pregnant women hospitalized with an ARFI were matched with 3,800 non-hospitalized pregnant women. Compared to non-hospitalized women, risk of PTB was greater among women hospitalized with influenza-associated ARFI (aRR: 1.57; 95% CI: 1.15–2.15) and non-influenza ARFI (aRR: 2.78; 95% CI: 2.12–3.65). Similar results were observed for LBW; there were no associations with SGA birth. ConclusionsARFI hospitalization during pregnancy was associated with increased risk of PTB and LBW.

Nėštumų ir gimdymų baigtys po pagalbinio apvaisinimo

Santrauka. Tyrimo tikslas. įvertinti moterų, pastojusių po pagalbinių apvaisinimo budų (PAB), neštumo, gimdymo eigą ir rezultatus bei išanalizuoti naujagimių baigtis. Tyrimo medžiaga ir metodai. 2016–2018 m. laikotarpiu retrospektyviai tirtos 427 pacientės, gimdžiusios Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikose (toliau – Kauno klinikos), suskirstytos į tiriamąją (n=215) bei kontrolinę (n=212) grupes. Tiriamoji grupė – tai moterys pastojusios po PAB, kontrolinė grupė – tai atsitiktinai atrinktos savaime pastojusios moterys. Analizuoti neštumo, gimdymo eigos ir naujagimių buklės duomenys remiantis gimdymo registro, gimdymo knygų ir ligos istorijomis. Rezultatai. Daugiavaisiai neštumai PAB grupeje sudarė 37,7 proc., o kontrolinėje grupėje – 10,4 proc., p<0,001. Neštumo komplikacijų: preeklampsijos (lengvos, sunkios), neščiųjų hipertenzijos, neščiųjų diabeto dažnis tarp grupių reikšmingai nesiskyrė, p>0,05. Placentos patologijos (įaugusi placenta ir placentos pirmeiga) dažnesnėsPAB grupėje, atitinkamai – p=0,012 ir p=0,004. Priešlaikinio vaisiaus dangalų plyšimo dažnis tarp grupių nesiskyrė. Vaisiaus ydų dažniai abiejose grupėse nesiskyrė, p=0,302. Cezario pjūvio operacijų (CPO) dažnis didesnis PAB grupėje ir siekia 49,8 proc., p=0,016. Placentos atšokos dažnis grupėse nesiskyrė. Apgar balų vidurkis 1 ir 5 min. grupėse nesiskyrė, p1<0,994 ir p5<0,484, tačiau PAB grupėje buvo didesnis neišnešiotų naujagimių, p=0,015, vaisiaus augimo sulėtejimo (VAS), p=0,005 bei mažesnis stambių vaisių dažnis, p=0,005. Išvados. Svarbiausios su PAB susijusios komplikacijos yra daugiavaisiai neštumai, CPO, su placenta susijusios patologijos, priešlaikinis gimdymas, vaisiaus augimo sulėtėjimas.

Maternal plasma lipid levels across pregnancy and the risks of small-for-gestational age and low birth weight: a cohort study from rural Gambia

BackgroundSub-optimal maternal lipid levels during pregnancy may be implicated in the pathophysiological mechanisms leading to low birth weight (LBW) and small-for-gestational-age (SGA). We aimed to determine whether maternal lipid levels across pregnancy were associated with birth weight and the risks of LBW and SGA in rural Gambia.MethodsThis secondary analysis of the ENID trial involved 573 pregnant women with term deliveries. Plasma levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) were analyzed at enrolment (mean (SD) = 13.9 (3.3) weeks gestation), 20 and 30 weeks gestation as continuous variables and percentile groups. Regression models with adjustment for confounders were used to examine associations between gestational lipid levels and birth weight and the risks of LBW (birth weight < 2500 g) and SGA (<10th percentile INTERGROWTH-21ST for birth weight).ResultsThere were 7.9% LBW and 32.5% SGA infants. At enrolment, every unit increase in HDL-c was associated with a 2.7% (P = 0.011) reduction in relative risk of LBW. At 20 weeks gestation, every unit increase in TC levels was associated with a 1.3% reduction in relative risk of LBW (P = 0.002). Low (<10th percentile) HDL-c at enrolment or at 20 weeks gestation was associated with a 2.6 (P = 0.007) and 3.0 (P = 0.003) times greater risk of LBW, respectively, compared with referent (10th─90th) HDL-c. High (>90th percentile) LDL-c at 30 weeks gestation was associated with a 55% lower risk of SGA compared with referent LDL-c (P = 0.017). Increased levels of TC (β = 1.3, P = 0.027) at 20 weeks gestation and of TC (β = 1.2, P = 0.006) and LDL-c (β = 1.5, P = 0.002) at 30 weeks gestation were all associated with higher birth weight.ConclusionsIn rural Gambia, lipid levels during pregnancy were associated with infant birth weight and the risks of LBW and SGA. Associations varied by lipid class and changed across pregnancy, indicating an adaptive process by which maternal lipids may influence fetal growth and birth outcomes.Trial registrationThis trial was registered as ISRCTN49285450 on: 12/11/2009.

Adolescent pregnancies: a 10-year single-center experience

Objectives: To investigate adolescent pregnacy rate in last decade and emphasize the perinatal outcomes. Methods: Our study was a retrospective investigation of all women with singleton pregnancies who gave birth at &amp;gt; 20 weeks gestation aged 13-16 years old (early aged adolescent pregnancy group, n = 107), aged 17-19 years old (late aged adolescent pregnancy group, n = 991) and aged 20-35 years old (control group, n = 1,098) at Ordu University School of Medicine, Training and Research Hospital Obstetrics and Gynecology Clinic between January 2008 and January 2018. The variables used to determine the perinatal outcomes were low birth weight (birth weight &amp;lt; 2,500 g), macrosomic fetus (birth weight &amp;gt; 4,000 g) and stillbirth (delivery of infant &amp;gt; 20 weeks gestation without cardiac activity) prevalences were investigated and compared between groups. Results: Adolescent birth ratio to all births was 4.4% (1,098/24,560). Low birth weight rate was higher in the late aged adolescent group (p &amp;lt; 0.001). Cesarean section rate was significantly lower in the adolescent age group (40.2% in early aged and 7.2% in late aged)) whereas rate was 56.3 % in the control group. We attributed this to the high parity in the control group and the surplus of the old cesarean section indication (p &amp;lt; 0.001). Conclusions: Adolescent pregnancy, especially late aged adolescents were found to be closely related with low birth weight but there was no significant difference with respect to stillbirth rate in adult age group. Skilled antenatal, childbirth and postnatal care is very necessary to reduce low birth weight and therefore perinatal mortality.

Sexual Orientation Disparities in Preconception Health.

Objective: In the United States, there have been very few improvements in adverse birth outcomes, such as infant mortality, low birthweight, and preterm birth in recent years. Health promotion before pregnancy (e.g., preconception care) has been increasingly recognized as an important strategy by which to improve these reproductive outcomes. As of yet, no research has examined sexual orientation disparities in preconception health which has important implications for birth outcomes in the United States, since sexual minority women (SMW) are more likely to report stillbirths, low birthweight, and preterm infants than heterosexual women. Methods: This study addresses this gap by utilizing data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine sexual orientation disparities in women's preconception health 1 and 3 years before a live birth (n = 3,133). Results: Our findings suggest that, even after controlling for maternal characteristics, SMW are more likely to report adverse health conditions and behaviors before pregnancy relative to heterosexual women 1 year before the survey, including higher odds of binge drinking, other substance use, having a sexually transmitted infection diagnosis, and depression. Conclusions: Despite new public health policies aimed at improved preconception health, our findings suggest that SMW are even more vulnerable to poor preconception health than their heterosexual counterparts, which has important implications for maternal and child health. This study provides important evidence for the need to invest in the reproductive health of SMW, particularly in the context of pregnancy.

Get the most out of your data

What is the best way to examine complex datasets involving large samples or patient groups with multiple confounding factors, many of which are inter-dependent? Traditional approaches have used multivariate regression that allows the investigator control over these confounding factors. Nonetheless, regression is less effective at using these inter-dependent interactions as part of the analysis. Latent class analysis (LCA) is a statistical approach to parse samples or patient subjects into class membership. The analysis can incorporate either categorical or continuous data. If one has a user-defined number of classes that are already anticipated, LCA can test that model. Alternatively, the best fit of the data to a derived number of class assignments and the characteristics (phenotypes) of these classes can be determined. In this volume of The Journal, Hendryx et al have used LCA to examine patterns of clinical, socioeconomic, behavioral, and psychosocial variables associated with low birthweight infants and preterm birth. They used data from the Australian Longitudinal Study on Women's Health, a large longitudinal study. Almost 10 000 live singleton births from almost 4000 women were linked to robust perinatal records and birth outcome data. The LCA revealed 5 groups of infants characterized by low education, recent drug use, stress/anxiety/depression, smoking, drinking, low education, multi-risk and a low risk control group. There were associations between individual classes with preterm delivery and others with low birth weight. Although logistic regression identified main effects not captured by LCA, the latent class analysis identified variable combinations not captured by the main effects analysis. Latent class analysis is a robust approach to complex datasets with the potential for great improvement in insights, interpretation, and implications of results. Hendryx et al provide us an example using a clinical problem with pediatric and perinatal relevance. Article page 42▸

County-level Variation in Low Birthweight and Preterm Birth: An Evaluation of State Medicaid Expansion Under the Affordable Care Act.

Rates of low birthweight and prematurity vary 2-fold across states in the United States, with increased rates among states with higher concentrations of racial minorities. Medicaid expansion may serve as a mechanism to reduce geographic variation within states that expanded, by improving health and access to care for vulnerable populations. The objective of this study was to identify the association of Medicaid expansion with changes in county-level geographic variation in rates of low birthweight and preterm births, overall and stratified by race/ethnicity. We compared changes in the coefficient of variation and the ratio of the 80th-to-20th percentiles using bootstrap samples (n=1000) of counties drawn separately for all births and for white, black, and Hispanic births, separately. County-level rates of low birthweight and preterm birth. Before Medicaid expansion, counties in expansion states were concentrated among quintiles with lower rates of adverse birth outcomes and counties in nonexpansion states were concentrated among quintiles with higher rates. In expansion states, county-level variation, measured by the coefficient of variation, declined for both outcomes among all racial/ethnic categories. In nonexpansion states, geographic variation reduced for both outcomes among Hispanic births and for low birthweight among white births, but increased for both outcomes among black births. The decrease in county-level variation in adverse birth outcomes among expansion states suggests improved equity in these states. Further reduction in geographic variation will depend largely on policies or interventions that reduce racial disparities in states that did and did not expand Medicaid.

Impact of Comprehensive Smoking Bans on the Health of Infants and Children

As evidence of the negative effects of environmental tobacco smoke (ETS) has mounted, an increasingly popular public policy response has been to impose restrictions on smoking through 100% smoke-free bans (comprehensive smoking bans). Yet sparse information exists regarding the impact these smoking bans at the state and local levels have on the health of children and infants. A rationale for expansion of smoke-free laws implicitly presumes that potential public health gains from reducing adult cigarette consumption and declines in adult ETS exposure extend to children. However, if smokers compensate by shifting their consumption of cigarettes from public venues that impose a comprehensive smoking ban to smoking at home, then these policies may have a harmful effect on children and infants. This study provides estimates of how comprehensive smoking bans impact the venue of smoking, and the health of children and infants. Using models that exploit state- and county-level changes to smoking ban legislation over time, estimates suggest that smoking bans have improved the health of both infants and children, mainly through implementation of more comprehensive bans. Further, we find no evidence of displacement among smokers (both smokers with and without children in the household), and actually find that the bans had a positive spillover effect in terms of reducing smoking inside the home – an effect which may further explain the improvement in infant and children’s health. Our effect magnitudes imply that expanding comprehensive coverage from 60% (current level) to 100% of the population can prevent between approximately 1,110 – 1,750 low birthweight births among low-educated mothers, resulting in economic cost savings of about $71 – $111 million annually. Health improvements among older children add to these economic benefits.

Effect of Nurse-led Programme on Knowledge Regarding Identi cation of Warning Signs in Low Birth Weight Babies among Post-natal Mothers in Selected Hospitals of Mangaluru

A healthy birth weight is extremely important for a newborn. It is estimated that 22 million infants are born yearly, out of which 16 percent are low birth weight (LBW) babies. In South Asia, India has the highest percentage of low birth babies. As per 2010-13 report, it was reported that the majority of the infants died before they completed 28 days of life and about 48.1 percent suffered from LBW and premature birth. Early detection of illness is an important step towards improving new-born survival. In this study to determine the effect of a nurse-led programme on the identi cation of warning signs in low birth weight babies among post-natal mothers, a pre-experimental research design was adopted with one group pre-test - post-test. Purposive sampling method was used for the selection of 50 post-natal mothers who delivered LBW babies. Among 50 mothers the mean pre-test knowledge score was 13.04 +1.97and post-test score was 17.30+ 2. To nd the effectiveness of video teaching programme paired “t” test was used. The obtained “t” value was -32.68 which was less than -2.042 and the p-value was

The Relationship between Pesticide Exposure and Umbilical Serum IGF-1 Levels and Low-birth Weight: A Case-control Study in Brebes, Indonesia.

Background: Birth weight is very important for long-term physical, mental, health, and brain development. Pesticide exposure is thought to interfere with fetal growth, among others, through disruption of the function of the insulin-like growth hormone-1 (IGF-1) hormone. Objective: To analyze the relationship between exposure to pesticides during pregnancy and low-birth weight (LBW) through the disruption of the IGF-1 hormone. Methods: In a case-control study, babies born with LBW (birth weight <2500 g) and those born later with normal birth weight (≥2500 g) at 2 hospitals in Brebes were chosen as cases and controls, respectively. Maternal pesticide exposure was measured by interview using a questionnaire. Umbilical serum IGF-I level was tested using the ELISA method. Results: There was a significant relationship between pesticide exposure during pregnancy and LBW (OR 6.8; 95% CI 2.0 to 22.9) and low umbilical serum IGF-1 levels (OR 3.6; 95% CI 1.2 to 11.1). There was a significant relationship between low umbilical serum IGF-1 levels and LBW (OR 8.9; 95% CI 2.4 to 32.1). Conclusion: There was a significant relationship between pesticide exposure during pregnancy and LBW through the umbilical serum IGF-1 reduction pathway.

Antibiotics for asymptomatic bacteriuria in pregnancy.

Asymptomatic bacteriuria is a bacterial infection of the urine without any of the typical symptoms that are associated with a urinary infection, and occurs in 2% to 15% of pregnancies. If left untreated, up to 30% of mothers will develop acute pyelonephritis. Asymptomatic bacteriuria has been associated with low birthweight and preterm birth. This is an update of a review last published in 2015. To assess the effect of antibiotic treatment for asymptomatic bacteriuria on the development of pyelonephritis and the risk of low birthweight and preterm birth. For this update, we searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) on 4 November 2018, and reference lists of retrieved studies. Randomised controlled trials (RCT) comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening. Trials using a cluster-RCT design and quasi-RCTs were eligible for inclusion, as were trials published in abstract or letter form, but cross-over studies were not. Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked for accuracy. We assessed the quality of the evidence using the GRADE approach. We included 15 studies, involving over 2000 women. Antibiotic treatment compared with placebo or no treatment may reduce the incidence of pyelonephritis (average risk ratio (RR) 0.24, 95% confidence interval (CI) 0.13 to 0.41; 12 studies, 2017 women; low-certainty evidence). Antibiotic treatment may be associated with a reduction in the incidence of preterm birth (RR 0.34, 95% CI 0.13 to 0.88; 3 studies, 327 women; low-certainty evidence), and low birthweight babies (average RR 0.64, 95% CI 0.45 to 0.93; 6 studies, 1437 babies; low-certainty evidence). There may be a reduction in persistent bacteriuria at the time of delivery (average RR 0.30, 95% CI 0.18 to 0.53; 4 studies; 596 women), but the results were inconclusive for serious adverse neonatal outcomes (average RR 0.64, 95% CI 0.23 to 1.79, 3 studies; 549 babies). There were very limited data on which to estimate the effect of antibiotics on other infant outcomes, and maternal adverse effects were rarely described. Overall, we judged only one trial at low risk of bias across all domains; the other 14 studies were assessed as high or unclear risk of bias. Many studies lacked an adequate description of methods, and we could only judge the risk of bias as unclear, but in most studies, we assessed at least one domain at high risk of bias. We assessed the quality of the evidence for the three primary outcomes with GRADE software, and found low-certainty evidence for pyelonephritis, preterm birth, and birthweight less than 2500 g. Antibiotic treatment may be effective in reducing the risk of pyelonephritis in pregnancy, but our confidence in the effect estimate is limited given the low certainty of the evidence. There may be a reduction in preterm birth and low birthweight with antibiotic treatment, consistent with theories about the role of infection in adverse pregnancy outcomes, but again, the confidence in the effect is limited given the low certainty of the evidence. Research implications identified in this review include the need for an up-to-date cost-effectiveness evaluation of diagnostic algorithms, and more evidence to learn whether there is a low-risk group of women who are unlikely to benefit from treatment of asymptomatic bacteriuria.

Relationship Between Pregnancy-Associated Malaria and Adverse Pregnancy Outcomes: a Systematic Review and Meta-Analysis.

Pregnancy-associated malaria (PAM) has been associated with adverse pregnancy outcomes like preterm birth (PTB) and low birthweight (LBW), which are among the leading causes of infant mortality globally. Rates of PTB and LBW are high in countries with a high burden of malaria. PAM may be a contributing factor to PTB and LBW, but is not well understood. We conducted a systematic review and meta-analysis of studies examining the relationship between PAM and PTB or LBW using PubMed. The title and abstract of all studies were screened by two reviewers, and the full text of selected studies was reviewed to ensure they met inclusion criteria. Information regarding study characteristics and of PTB and LBW births among women with and without PAM was abstracted for included studies. Our search terms yielded 2237 articles, of which 18 met our final inclusion criteria. Eight studies examined associations between PAM and PTB, and 10 examined associations between PAM and LBW (population size ranging from 35 to 9956 women). The overall risk of LBW was 63% higher among women with PAM compared with women without PAM (95% CI = 1.48-1.80) and the risk of PTB was 23% higher among women with PAM compared with women without PAM (95% CI = 1.07-1.41). These results indicate that infection with PAM is associated with PTB and LBW. Further understanding of the pathogenesis of disease and the immunologic changes that occur during pregnancy is essential for reducing the disproportional effects this disease has on this vulnerable population.

El Niño Southern Oscillation (ENSO) and Birthweight in Tuvalu

TPS 742: Adverse birth outcomes 1, Exhibition Hall, Ground floor, August 27, 2019, 3:00 PM - 4:30 PM Climate has been reported to affect birthweight and few studies have been conducted in the Pacific region where influence of climate change can be reflected to health status directly. This study aimed to investigate the association between climate variability including El Niño Southern Oscillation (ENSO) and birthweight in Tuvalu, a Polynesian atoll island country located beneath the tropical Pacific Ocean. Data of all newborns born in Tuvalu between January 1980 and August 2018 were obtained from Ministry of Health (n = 7,528). Oceanic Niño Index (ONI) which is used for operational definitions of ENSO events and sea surface temperature measurement including NINO3, NINO3.4, and NINO4 together with local temperature and precipitation were used as climate variables. The average ONI and sea surface temperatures during full gestational period and each trimester of pregnancy were calculated for each newborn. Generalized additive model (GAM) was used to analyze the relationship between the average ONI and sea surface temperatures during each period of pregnancy and birthweight. Logistic regression model was also used to analyze the relationship between the average ONI and sea surface temperatures and low birthweight (LBW) birth defined as less than 2,500 grams according to the criteria of World Health Organization. Both models were adjusted for sex, birth islands, mother’s age group, marital status, and GDP per capita in the year of birth. GAM analyses demonstrated a negative relationship between birthweight and ONI. However, above a certain temperature, NINO4 and birthweight showed a positive relationship. The odds ratios of LBW birth were 0.93 (95% confidence interval (CI), 0.79-1.11), 1.05 (95% CI, 0.90-1.23), 0.93 (95% CI, 0.80-1.08), and 0.86 (95% CI, 0.73-1.01) for a unit increase of average ONI during full gestational period and each trimester of pregnancy. In conclusion, birthweight of Tuvalu was partly affected by climate variability.

Perinatal Factors Associated with Autism Spectrum Disorder in Jamaican Children.

Mode of delivery, preterm birth, and low birth weight (LBW) are hypothesized to be associated with autism spectrum disorder (ASD) in the offspring. Using data from 343 ASD cases (2-8years) and their age- and sex-matched typically developing controls in Jamaica we investigated these hypotheses. Our statistical analyses revealed that the parish of residence could modify the association between cesarean delivery and ASD, with a difference found in this relationship in Kingston parish [matched odds ratio (MOR) (95% confidence interval (CI)) 2.30 (1.17-4.53)] and other parishes [MOR (95% CI) 0.87 (0.48-1.59)]. Although the associations of LBW and preterm birth with ASD were not significant, we observed a significant interaction between LBW and the household socioeconomic status. These findings require replication.

Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study

BackgroundInfection during pregnancy with Plasmodium falciparum is associated with maternal anaemia and adverse birth outcomes including low birth weight (LBW). Studies using polymerase chain reaction (PCR) techniques indicate that at least half of all infections in maternal venous blood are missed by light microscopy or rapid diagnostic tests. The impact of these subpatent infections on maternal and birth outcomes remains unclear.MethodsIn a cohort of women co-enrolled in a clinical trial of intermittent treatment with sulfadoxine–pyrimethamine (SP) plus azithromycin for the prevention of LBW (< 2500 g) in Papua New Guinea (PNG), P. falciparum infection status at antenatal enrolment and delivery was assessed by routine light microscopy and real-time quantitative PCR. The impact of infection status at enrolment and delivery on adverse birth outcomes and maternal haemoglobin at delivery was assessed using logistic and linear regression models adjusting for potential confounders. Together with insecticide-treated bed nets, women had received up to 3 monthly intermittent preventive treatments with SP plus azithromycin or a single clearance treatment with SP plus chloroquine.ResultsA total of 9.8% (214/2190) of women had P. falciparum (mono-infection or mixed infection with Plasmodium vivax) detected in venous blood at antenatal enrolment at 14–26 weeks’ gestation. 4.7% of women had microscopic, and 5.1% submicroscopic P. falciparum infection. At delivery (n = 1936), 1.5% and 2.0% of women had submicroscopic and microscopic P. falciparum detected in peripheral blood, respectively. Submicroscopic P. falciparum infections at enrolment or at delivery in peripheral or placental blood were not associated with maternal anaemia or adverse birth outcomes such as LBW. Microscopic P. falciparum infection at antenatal enrolment was associated with anaemia at delivery (adjusted odds ratio [aOR] 2.00, 95% confidence interval [CI] 1.09, 3.67; P = 0.025). Peripheral microscopic P. falciparum infection at delivery was associated with LBW (aOR 2.75, 95% CI 1.27; 5.94, P = 0.010) and preterm birth (aOR 6.58, 95% CI 2.46, 17.62; P < 0.001).ConclusionsA substantial proportion of P. falciparum infections in pregnant women in PNG were submicroscopic. Microscopic, but not submicroscopic, infections were associated with adverse outcomes in women receiving malaria preventive treatment and insecticide-treated bed nets. Current malaria prevention policies that combine insecticide-treated bed nets, intermittent preventive treatment and prompt treatment of symptomatic infections appear to be appropriate for the management of malaria in pregnancy in settings like PNG.

#35 Paternal exposure to immunosuppressive drugs: possible influence on pregnancy outcome and infant's health, a systematic review

Introduction: Although there are theoretical concerns about the possible influence on fertility, pregnancy outcome or complications and health of the offspring, preconceptional paternal drug exposure has not been studied significantly. This applies to immunosuppressive drugs like methotrexate and mycophenolic acid. As start of a research project on paternal immunosuppressive drugs and/or autoimmune diseases and their possible influence on fertility, pregnancy outcomes and child health we performed two systematic reviews, one on drugs and one on diseases. Here we give an overview of the pregnancy and infant outcomes of immunosuppressive drugs from the initial search. Methods: The protocol for this systematic review is written according to the PRISMA-P statement and registered in PROSPERO. A systematic literature search was performed in Embase and MEDLINE. Additional sources included Cochrane Central register of Controlled Trials, Web of Science and Google Scholar. The initial search was done in April 2018. For each database a search profile was developed including keywords regarding male fertility, paternal exposure, pregnancy outcomes and complications and infant's health. This was combined with immunosuppressive drugs. The literature search was limited to the English language and human subjects. The following type of studies were included: case control studies, cohort studies, cross-sectional studies, case reports and case series. The methodological quality of the studies was assessed with the Newcastle Ottawa Scale. Results: After deduplication 3720 publications were eligible for title and abstract screening. Full text reading was done for 260 publications, which resulted in inclusion of 41 references on pregnancy and infant related outcomes. Since 2016, 7 population-based cohort studies were published based on the Danish registries, with potential overlap in included pregnancies. The Norwegian registries were used in 2 population-based cohort studies. Other cohort studies used data from Teratology Information Services, the USA National Transplant Pregnancy Registry or hospitals. Case series were mostly based on hospital records. Most studies looked at azathioprine and/or 6-mercaptopurine (n = 8) or methotrexate (n = 5). Other drugs in studies were TNA-alpha blockers, calcineurin inhibitors, mycophenolic acid or colchicine. The most frequently reported outcomes were pregnancy outcome (e.g. miscarriage, live birth), preterm birth (gestational age), low birthweight (birth weight) and congenital abnormalities, in general no major differences between exposed and the comparison group were reported. Conclusions: Paternal use of immunosuppressive drugs preconceptionally has received more attention in the last years. Preliminary data of the systematic review implies that the reported outcomes after immunosuppressive drug use do not differ significantly from the comparison group. The numbers in the different publications, and also the total number of pregnancies included, are still low. The quality of the publications ranges between high and low.

Fasting unmasks differential fat and muscle transcriptional regulation of metabolic gene sets in low versus normal birth weight men.

BackgroundIndividuals born with low birth weight (LBW) have an increased risk of metabolic diseases when exposed to diets rich in calories and fat but may respond to fasting in a metabolically preferential manner. We hypothesized that impaired foetal growth is associated with differential regulation of gene expression and epigenetics in metabolic tissues in response to fasting in young adulthood.MethodsGenome-wide expression and DNA methylation were analysed in subcutaneous adipose tissue (SAT) and skeletal muscle from LBW and normal birth weight (NBW) men after 36 h fasting and after an isocaloric control study using microarrays.FindingsTranscriptome analyses revealed that expression of genes involved in oxidative phosphorylation (OXPHOS) and other key metabolic pathways were lower in SAT from LBW vs NBW men after the control study, but paradoxically higher in LBW vs NBW men after 36 h fasting. Thus, fasting was associated with downregulated OXPHOS and metabolic gene sets in NBW men only. Likewise, in skeletal muscle only NBW men downregulated OXPHOS genes with fasting. Few epigenetic changes were observed in SAT and muscle between the groups.InterpretationOur results provide insights into the molecular mechanisms in muscle and adipose tissue governing a differential metabolic response in subjects with impaired foetal growth when exposed to fasting in adulthood. The results support the concept of developmental programming of metabolic diseases including type 2 diabetes.FundThe Swedish Research Council, the Danish Council for Strategic Research, the Novo Nordisk foundation, the Swedish Foundation for Strategic Research, The European Foundation for the Study of Diabetes, The EU 6th Framework EXGENESIS grant and Rigshospitalet.

Medical and Psychosocial Risk Profiles for Low Birthweight and Preterm Birth.

Low birthweight and preterm birth are risk factors for infant mortality and persistent problems. This study uses representative data to assess whether distinct latent profiles of co-occurring medical and psychosocial factors have implications for preterm birth and low birthweight. Data are from the Pregnancy Risk Assessment Monitoring System, a cross-sectional survey constituting representative data on pregnancies from 2012 to 2013. Latent class analysis derived classes of pregnant women potentially at risk for low birthweight and/or preterm birth. Latent class analysis identified five homogenous profiles of interrelated psychosocial and medical factors. Risk was greatest for the profile marked by high rates of medical factors, followed by a high risk for a profile marked by a combination of very low income and psychosocial factors. Two profiles involving low income and very low income also indicated greater risk for adverse birth outcomes related to socioeconomic status. More attention should be paid to screening for and addressing psychosocial risk in concert with prenatal care. Women who show high-risk profiles can be monitored and supported by an interdisciplinary care team, when warranted.

Adverse neonatal outcomes of adolescent pregnancy in Northwest Ethiopia.

BackgroundAdolescents have physical, social and psychological characteristics that are different from adults. Adolescent pregnancy results in pregnancy and childbirth complications- an area neglected in developing countries like Ethiopia. This study, therefore, was conducted to assess the adverse neonatal outcomes of adolescent pregnancy in Northwest Ethiopia.MethodsInstitutional-based study was conducted in East Gojjam zone, Northwest Ethiopia. A total of 374 adolescent (15–19 years) and 760 adult (20–34 years) women were included in this study. Data were collected among women who came to randomly selected health facilities in East Gojjam zone. Data were collected by trained research assistants using a structured data collection questionnaire. Descriptive statistics, chi-square test, and Student's t-tests were utilized. Bivariate and multivariable logistic regression analysis were employed to adjust for confounding factors of adverse neonatal outcomes. Statistical significance was declared when the p-value was less than 0.05.ResultsHigher proportion of adolescent than adult women were from rural area (57.2% vs 44.7%), were not married (5.1% vs 1.7%), were pregnant for the first time (91.7% vs 34.1%), didn’t attend antenatal care (ANC) follow-up (12% vs 4.5%), and had late initiation of ANC follow-up. After adjusting for known confounding factors, the odds of low birth weight (LBW) was higher among adolescents than adult women (AOR 2.14; 95% CI, 1.36, 3.36, p-value = 0.001). Similarly, the odds of preterm birth was higher among adolescents than adult women (AOR 1.65; 95% CI, 1.09, 2.49, p-value = 0.017). There was no statistically significant difference in the rate of low Apgar score at first and five minutes after birth and neonatal Intensive Care Unit (ICU) admission between babies born from adolescent and adult women.ConclusionsAdolescent women were less likely to receive ANC service. Babies born from adolescent women are at higher odds of adverse neonatal outcomes like LBW and preterm birth than babies born from adult women. Use of community- and health facility-based intervention programs that can prevent adolescent pregnancy and reduce adverse neonatal outcomes among adolescent girls is recommended.

Original low birth weight deteriorates the hindgut epithelial barrier function in pigs at the growing stage.

The deteriorative effect of low birth weight (LBW) on the mucosal permeability of the small intestine in piglets has been widely confirmed. However, whether the hindgut epithelial barrier function in LBW pigs is deteriorated during the growing stage is still unclear. Our study investigated differences in the hindgut epithelial barrier function between LBW and normal birth weight pigs during the growing stage (d 90). Our data demonstrated that the hindgut epithelium of LBW pigs has a high histopathological score, accompanied by decreased antioxidant capacity and increased apoptosis rate, as well as elevated expression and activity of caspase-3. In addition, the number of intestinal goblet cells and gene expression of mucin 2 were significantly down-regulated in LBW pigs. The expression of tight junction proteins (ZO-1 and occludin) was markedly inhibited by the LBW. The mRNA abundance of inflammatory cytokines such as TNF-α, IL-1β, and IL-8 was significantly increased in the hindgut mucosa of LBW pigs. Furthermore, our data revealed that LBW altered the intestinal microbial community in the hindgut mucosa of pigs. Collectively, these finding add to our understanding of the mechanisms responsible for hindgut epithelial barrier dysfunction in LBW pigs during the growing stage and facilitate the development of nutritional intervention strategies.-Tao, S., Bai, Y., Li, T., Li, N., Wang, J. Original low birth weight deteriorates the hindgut epithelial barrier function in pigs at the growing stage.