Low Birth Weight Newborns Research Articles

Analysis of the relationship between the quality of antenatal care examinations and the incidence of preterm birth and low birth weight.

Antenatal care (ANC) plays a crucial role in ensuring maternal and child safety and reducing adverse delivery outcomes. This study aimed to analyze the association between the quality of ANC and the occurrence of preterm birth and low birth weight in a sample of the population from 16 regions in 8 provinces in China. Data from all closed cases of pregnant women and newborns reported in the Maternal and Child Health Monitoring System from January 1, 2018, to December 31, 2018, in 16 monitoring regions across 8 provinces in China were collected and included in the analysis, resulting in a total of 49,084 pregnant women and 49,026 newborns. The mean number of ANC visits was 6.95 ± 3.45. By percentage, 78.79% of the women received ANC examinations at least five times. The percentage of normative ANC examinations and the percentage of qualified ANC examinations was 30.98% and 8.0% respectively. The gestational age(χ2 = 229.305, p<0.001), birth weight (χ2 = 171.990, p<0.001) and the occurrence of neonatal complications (χ2 = 53.112, p<0.001) were all significantly related to the number of ANC visits to mothers. There was a correlation between gestational age (χ2 = 1021.362, p<0.001;χ2 = 194.931, p<0.001) and birth weight (χ2 = 259.009, p<0.001; χ2 = 70.042, p<0.001) with normative ANC and qualified ANC examinations. As the number of ANC examinations increased, the rates of preterm birth and low birth weight decreased. Pregnant women who did not receive normative ANC examinations had a higher risk of preterm birth and neonatal low birth weight compared to those who did; Adjusted Odds Ratio (95%CI) was 23.33(16.97~32.07)and 1.61(1.37~1.90) respectively. Pregnant women who did not receive qualified ANC examinations had a higher risk of preterm birth and neonatal low birth weight compared to those who did; Adjusted Odds Ratio (95%CI) was 15.05(8.45~26.79)and 1.36 (1.02~1.82) respectively. The percentage of women who received normative ANC examination and qualified ANC examination is still low in China, and the quality of antenatal care significantly affects the occurrence of preterm birth and low birth weight in newborns.

The influence of celiac disease on fertility and pregnancy: an Italian survey.

Celiac disease (CD) is an inflammatory enteropathy that has been associated to obstetric and gynecological disorders. However, it is still not adequately tested by gynecologists due to the misconception that it is solely a gastrointestinal disease. This underestimation requires the development of targeted interventions. This study aims to evaluate the association between CD and obstetric/gynecological complications, highlight the importance of informing patients about CD manifestations, and assess the patient satisfaction with the information provided by healthcare professionals on the disease. A digital survey was administered to celiac women via the Italian Celiac Association's website. We analyzed 493 questionnaires. Obstetric and gynecological disorders led to the diagnosis of CD in 11.7% of interviewed. The study revealed that untreated CD patients are more predisposed to miscarriages (41.8% vs 34% before/after diagnosis, respectively, p = 0.111), anemia in pregnancy (71.4% vs 40.4% before/after diagnosis, respectively, p < 0.001) and the risk of low birth weight (newborns weighing < 1500g were 4.0% before and 1.1% after the gluten-free diet, p = 0.028). Women with CD, both before and after gluten-free diet, had higher infertility rates (about 19%) than the general population. Additionally, 73% of interviewees were dissatisfied with the information they received from health professionals about the reproductive implications of CD. Our research contributes to a deeper understanding of the intersection between CD and reproductive outcomes, highlighting the main obstetric and gynecological problems related to it. It emphasizes the importance of patient's perspective and the need for greater awareness about celiac disease from healthcare workers.

Analysis of the relationship between neonatal birth weight and meconium metabolites based on birth cohort metabolomics

Neonatal birth weight is a crucial indicator of intrauterine growth and development with important implications for child development and adult health. The birth weight of a newborn is closely linked to the nutrition and health of the mother during pregnancy as well as genetic factors. Therefore, assessing the metabolic status of the fetus in utero is greatly significant for understanding the mechanisms responsible for abnormal birth weight. While previous studies often analyzed the impact of maternal metabolism on fetal development using umbilical cord blood from pregnant women, such blood may not accurately reflect the actual intrauterine environment owing to the barrier function of the placenta; moreover, obtaining biological samples during the fetal period is challenging. Meconium, the first feces excreted by a newborn, provides ideal biological material for studying maternal and infant health. Metabolomics can reveal metabolic changes in living organisms by analyzing small molecules in biological samples; hence studying meconium samples using metabolomics technology is expected to reveal fetal metabolic changes during pregnancy, thereby providing new insights into fetal nutritional intake, growth, and development, as well as metabolic pathways related to birth weight. To gain a deeper understanding of the metabolic changes associated with birth weight, this study collected metabolomic data from the meconium of 484 newborns in the established Xiaogan birth cohort using an untargeted metabolomics technique based on liquid chromatography-high resolution mass spectrometry (LC-HRMS) and analyzed the association between meconium metabolites and birth weight. This cohort exhibited incidence rates of low birth weight (<2500 g) and macrosomia (>4000 g) of 3.3% and 7.2%, respectively, which were roughly equivalent to the national average. Orthogonal partial least squares discriminant analysis revealed significant differences between the meconium metabolomes of the low birth weight and macrosomic groups when compared to the normal weight group. We discovered significant distinctions between the differential metabolites of newborns of low birth weight and those of normal weight, as well as between macrosomic and normal weight newborns that point to disparate biological pathways. Newborns with low birth weight exhibited significantly lower levels of critical amino acids, such as glutamate and proline, compared to the normal weight group, which may be associated with placental dysfunction and maternal nutritional deficiencies. Conversely, the meconium of macrosomic newborns contained significantly elevated levels of hormone metabolites such as estrone that reflected the pathophysiological state associated with maternal metabolic diseases or excessive placental hormone levels. Our study suggests that the metabolomic profile of the meconium reflects the metabolic pathways and regulatory mechanisms at play during fetal growth and development, and offers potential metabolic biomarkers and directions for future in-depth research into diseases related to fetal development. However, this study was based solely on the Xiaogan birth cohort, which was limited to specific regions and populations. A multicenter, multiethnic, and multiregional study is expected to help validate the universality of our research findings.

Т-РЕЦЕПТОРНЫЕ И КАППА-ДЕЛЕЦИОННЫЕ РЕКОМБИНАЦИОННЫЕ ЭКСЦИЗИОННЫЕ КОЛЬЦА КАК ИНСТРУМЕНТ ОЦЕНКИ ФУНКЦИИ Т- И В-КЛЕТОЧНОГО ЗВЕНА ИММУНИТЕТА У НОВОРОЖДЕННЫХ С ЭКСТРЕМАЛЬНО НИЗКОЙ МАССОЙ ТЕЛА ПРИ РОЖДЕНИИ: ФАКТОРЫ РИСКА

Early detection of newborns with congenital immune errors has become possible as yet thanks to the recent nationwide introduction of expanded neonatal screening into routine practice. The stake of false-positive results is higher in premature infants than in other age groups. This therefore requires further and more thorough investigation of both TREC and KREC dynamics in preterm infants. The purpose of this research was to identify significant factors affecting the levels of TREC and KREC in infants born with extremely low birth weight and to evaluate the dynamics of these parameters depending on the gestational age. Materials and methods used: the study that involved 43 (51,2% (22) girls/48,8% (21) boys) extremely low birth weight newborns with gestational age of 26 [25; 27] weeks who were born at the Perinatal Center with the Voronezh Oblast Regional Clinical Hospital No. 1 (Voronezh, Russia) in 2022-2024 had been carried out. The dynamics of TREC and KREC indicators from the gestational age was evaluated. The influence of significant prenatal and postnatal factors on TREC and KREC indicators was considered. The material for the study was dried blood spots drawn on Guthrie cards and taken as part of neonatal screening. Results: it was revealed that TREC levels increased, KREC values remained relatively stable with increasing gestation period. A decrease in TREC levels is observed in newborns who were born to mothers whose pregnancy was complicated by fetoplacental insufficiency (p=0,012) as well as in those who had required the extended cardiotonic support aiming to stabilize the main hemodynamic parameters (p=0.042). A decrease in KREC levels was observed in newborns from mothers with a history of two and more frozen pregnancies (p&lt;0,001). Conclusion: statistically significant prenatal and postnatal factors affecting TREC and KREC levels in children born with extremely low birth weight have been revealed. The dynamics of TREC/KREC indices depending on the gestational age was noted.

Nomogram Predictive Model for Vaginal Birth after One Prior Cesarean Section: A Retrospective Study

Background: Repeat cesareans pose significant maternal risks, whereas vaginal birth after cesarean (VBAC) offers better outcomes, with a complication rate of 2.4% compared with 3.6% for elective repeat cesareans and 14.1% for failed trial of labor after cesarean (TOLAC). TOLAC rates are low in China, and success rates vary between 60% and 80%. This study aims to develop a nomogram-based predictive model for VBAC in China and improve existing, less rigorous scoring models. Methods: This retrospective cohort study was conducted at Hangzhou Women's Hospital from February 2015 to March 2020, and included 159 parturient attempts at labor after one prior low transverse cesarean section. The participants were divided into two groups based on their mode of delivery for comparison: the VBAC and the TOLAC failure group. Univariate and multivariate logistic regression analyses were conducted to identify independent predictors for VBAC and develop a nomogram predictive model to estimate the success rate of TOLAC. The bootstrap method was used for internal validation of the models. Three different VBAC prediction models were evaluated by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision curves. Results: A total of 127 women had VBAC and 32 women failed TOLAC, with a success rate of 79.9%. Three independent factors affecting the VBAC were identified: gestational age at delivery, Bishop score and newborn birth weight. A predictive nomogram model for the VBAC was constructed that incorporates these three factors. The model showed a good fit (χ2 = 11.94, p = 0.154) with an overall prediction accuracy of 81.1%. The area under the ROC curve was 0.83 (95% CI (confidence interval), 0.76–0.90) (p &lt; 0.001) and the optimal cut-off value was 83.4%. The bootstrap internal validation showed that our predictive model maintained high overall accuracy and specificity, but exhibited low sensitivity and a low Kappa coefficient. Compared to the Grobman model and Jiaming Rao et al. model, our developed prediction model possesses the strongest discriminatory ability and the highest net benefit, followed by the model by Jiaming Rao et al. All three models demonstrate a high degree of fit. Conclusions: Shorter gestational age at delivery, lower newborn birth weight and higher cervical Bishop score are favorable factors for VBAC. The predictive nomogram model for the VBAC after a single cesarean section, constructed with these three factors, has good predictive efficacy. The model is simple to calculate and has practical value in the clinical selection of suitable candidates for TOLAC after a single cesarean section.

Prediction and feature selection of low birth weight using machine learning algorithms

Background and aimsThe birth weight of a newborn is a crucial factor that affects their overall health and future well-being. Low birth weight (LBW) is a widespread global issue, which the World Health Organization defines as weighing less than 2,500 g. LBW can have severe negative consequences on an individual’s health, including neonatal mortality and various health concerns throughout their life. To address this problem, this study has been conducted using BDHS 2017–2018 data to uncover important aspects of LBW using a variety of machine learning (ML) approaches and to determine the best feature selection technique and best predictive ML model.MethodsTo pick out the key features, the Boruta algorithm and wrapper method were used. Logistic Regression (LR) used as traditional method and several machine learning classifiers were then used, including, DT (Decision Tree), SVM (Support Vector Machine), NB (Naïve Bayes), RF (Random Forest), XGBoost (eXtreme Gradient Boosting), and AdaBoost (Adaptive Boosting), to determine the best model for predicting LBW. The model’s performance was evaluated based on the specificity, sensitivity, accuracy, F1 score and AUC value.ResultsResult shows, Boruta algorithm identifies eleven significant features including respondent’s age, highest education level, educational attainment, wealth index, age at first birth, weight, height, BMI, age at first sexual intercourse, birth order number, and whether the child is a twin. Incorporating Boruta algorithm’s significant features, the performance of traditional LR and ML methods including DT, SVM, NB, RF, XGBoost, and AB were evaluated where LR, had a specificity, sensitivity, accuracy and F1 score of 0.85, 0.5, 85.15% and 0.915. While the ML methods DT, SVM, NB, RF, XGBoost, and AB model’s respective accuracy values were 85.35%, 85.15%, 84.54%, 81.18%, and 84.41%. Based on the specificity, sensitivity, accuracy, F1 score and AUC, RF (specificity = 0.99, sensitivity = 0.58, accuracy = 85.86%, F1 score = 0.9243, AUC = 0.549) outperformed the other methods. Both the classical (LR) and machine learning (ML) models’ performance has improved dramatically when important characteristics are extracted using the wrapper method. The LR method identified five significant features with a specificity, sensitivity, accuracy and F1 score of 0.87, 0.33, 87.12% and 0.9309. The region, whether the infant is a twin, and cesarean delivery were the three key features discovered by the DT and RF models, which were implemented using the wrapper technique. All three models had the identical F1 score of 0.9318. However, “child is twin” was recognized as a significant feature by the SVM, NB, and AB models, with an F1 score of 0.9315. Ultimately, with an F1 score of 0.9315, the XGBoost model recognized “child is twin” and “age at first sex” as relevant features. Random Forest again beat the other approaches in this instance.ConclusionsThe study reveals Wrapper method as the optimal feature selection technique. The ML method outperforms traditional methods, with Random Forest (RF) being the most effective predictive model for Low-Birth-Weight prediction. The study suggests that policymakers in Bangladesh can mitigate low birth weight newborns by considering identified risk factors.

Risk factors and prediction model for low-birth-weight infants born to women with gestational diabetes mellitus.

To explore the risk factors for low-birth-weight infants born to pregnant women with GDM to develop a prediction model and to construct a prediction nomogram for the risk of low birth weight infants born to pregnant women with GDM. The clinical data of singleton infants diagnosed with gestational diabetes mellitus in Southeast China in 2019 were retrospectively reviewed. Gestational conditions and neonatal weight were assessed. A total of 386 diabetic mothers and infants were enrolled, including 193 in the low birth weight group and 193 in the normal birth weight group. The statistically significant factors were age over 36 years (OR = 1.916, 95% CI 1.048-3.505), junior high school education (OR = 4.454, 95% CI 1.882-10.543), history of fetal distress (OR = 0.120, 95% CI 0.016-0.925), gestational hypertension (OR = 3.681, 95% CI 1.357-9.986), preeclampsia (OR = 24.652, 95% CI 5.956-102.036), threatened preterm birth (OR = 18.393, 95% CI 8.457-39.999), triglycerides (OR = 0.642, 95% CI 0.485-0.850), and inadequate gestational weight gain (OR = 1.997, 95% CI 1.162-3.432). The area under the receiver operating characteristic curve (AUC) was 0.834 (95% CI: 0.794-0.874, p < 0.001), and the sensitivity and specificity were 82.38 and 87.56%, respectively. The goodness-of-fit test likelihood ratio 2 was 2.089 (p = 0.978). The comprehensive nomogram model showed that the discrimination and mean absolute error were 0.834 and 0.015, respectively. The calibration curves showed acceptable agreement between the predictions of the column line plots and the observations. The DCA curves showed good positive net yields in the prediction model. This study established a prediction model and risk score for low birth weight in pregnant women with GDM. It helps pregnancy clinics to identify the risk of low birth weight in newborns promptly, in addition to glycemic control and weight management for pregnant women with GDM, and should improve the appropriate treatment plan for pregnant women with higher risk, to provide personalized and precise treatment for pregnant women with GDM and improve infant outcomes.

Analysis of zinc and copper levels in very low birth weight infants using human milk additives: phase 1 trial findings

ObjectiveThe aim of this study was to assess whether the micronutrients zinc and copper, provided by human milk additives, are sufficient for very low birth weight preterm infants. MethodA phase 1 randomized double-blind controlled trial was conducted with very low birth weight preterm infants. This is a secondary analysis of copper and zinc. Sixty-six newborns were part of the initial sample, with forty participating and reaching the final stage of the study. Inclusion criteria were: gestational age less than 37 weeks, birth weight greater than or equal to 750 g and less than or equal to 1500 g, small or appropriate for gestational age, exclusively receiving human milk at a volume greater than or equal to 100 mL per kilogram per day, and hemodynamically stable. Participants were randomly assigned to two groups: intervention, Lioneo (received human milk with additive based on lyophilized human milk), n = 20, and control, HMCA (received human milk with commercial additive based on cow's milk protein), n = 20, and their serum levels of zinc and copper were measured on the first and twenty-first days. ResultsThere was a reduction in intragroup zinc serum levels from the first to the twenty-first day of the study (p < 0.01). There was no intergroup difference. No difference was found in serum copper levels. ConclusionHuman milk additives were not sufficient to maintain adequate zinc serum levels in very low birth weight newborns. It was not possible to affirm whether human milk additives were sufficient to maintain adequate serum copper levels in the studied sample. UTN: U1111–1220–0550.

Predictors of effective kangaroo mother care, exclusive breastfeeding, and skin-to-skin contact among low birthweight newborns in Amhara, Ethiopia.

Globally, 20% of all newborns are born with low birth weight (LBW). There is, therefore, an urgent need to expedite the delivery of high-impact, evidenced-based, and low-cost interventions such as kangaroo mother care (KMC (defined as continuous skin-to-skin care) and exclusive breastfeeding for this vulnerable group. A multinational World Health Organization (WHO)-supported consortium created and tested the impact of locally-specific and globally-informed phases of KMC care on KMC uptake/scale-up across multiple sites. Here we report on the study of KMC predictors that is nested within Amhara's KMC implementation trial in Amhara, Ethiopia. We used multivariate logistic regression phases to identify diverse predictors of KMC, skin-to-skin contact, and exclusive breastfeeding at hospital discharge and day 28 of life. We analysed data from 860 LBW newborns. At day 28, implementation period (adjusted odds ratio (aOR) = 3.2-5.0), hospital facility (aOR = 3.0-4.6), and having multiple births (aOR = 0.31) were the strongest predictors of effective KMC. Meanwhile, previous death of a newborn, type of health facility where delivery occurred, and previous LBW delivery were predictors of effective KMC at both time points. No single factor predicted KMC, skin-to-skin contact, and exclusive breastfeeding at all time points and across all implementation periods. Having multiple births was a negative predictor for skin-to-skin contact, while the implementation period and having older fathers (>29 years) were strong positive predictors for exclusive breastfeeding at both discharge and day 28. Mothers with a previous history of neonatal death and current skin-to-skin-care uptake strongly predicted exclusive breastfeeding uptake at both time points. At discharge, however, having a history of preterm birth and neonatal death strongly predicted exclusive breastfeeding uptake, while multiple current births, current very LBW newborns, and the use of standard binders decreased the likelihood of exclusive breastfeeding. To achieve the effective KMC coverage target of ≥80% in Ethiopia, KMC scale-up phases may have to consider the key predictors of KMC, EBF, and SSC to effectively target beneficiaries.

The interaction between PAX9 rs2073244 and passive smoking during pregnancy on low birth weight in newborns: a case–control study

ABSTRACT To explore whether rs2073244 at PAX9 increased susceptibility for full-term low birth weight infants and whether indoors passive smoking exposure has a combined effect with rs2073244 on newborn low birth weight (LBW), a 1:2 paired case–control study of LBW newborns was conducted at Xiamen University Affiliated Women and Children’s Hospital from March 2010 to October 2013. The rate of indoor passive smoking exposure in the LBW group was higher than it in the NBW group (p = 0.019). GG of PAX9 rs2073244 decreased the risk of LBW [OR = 0.38, 95% CI: (0.15-0.98)] and smaller HC [OR = 0.44, 95% CI:(0.20-0.98)]. The relative excess risk for LBW contributed by the additive interaction between the rs2073244 risk genotypes AG/AA and mother pregnancy passive smoking exposure was 10.679 (95%CI 1.728–65.975). Our study suggested that the AG/AA genotype of PAX9 rs2073244 might be a risk factor for LBW of full-term newborns, especially in maternal passive smoking.

The impact of COVID-19 infections on pregnancy outcomes in women

BackgroundGiven that viral infections can increase the risk of adverse pregnancy outcomes, such as spontaneous miscarriage, preterm premature rupture of membranes, and preterm birth, the effects of COVID-19, a novel emerging coronavirus disease rapidly spreading globally, on pregnancy outcomes have garnered significant attention.MethodsWe conducted a review of studies related to pregnant women infected with SARS-CoV-2 over the past five years (December 2019 to April 2023), utilizing search engines such as PubMed, Web of Science, and the China National Knowledge Infrastructure (CNKI). This study was registered with PROSPERO with ID: CRD42024540849.ResultsA total of 218 articles were screened, with 15 studies meeting the inclusion criteria for this research, including 12 cohort studies, one cross-sectional study, one case-control study, and one case series. Six studies found that the preterm birth rate was higher in the infected group compared to the control group; five studies showed that the cesarean section rate was higher in the infected group; three studies found that the APGAR scores of newborns were higher in the control group than in the infected group; three studies indicated that the mortality rate of newborns in the infected group was higher than that in the control group.ConclusionsOur retrospective review suggests that compared to pregnant women not infected with SARS-CoV-2, those diagnosed with COVID-19 are more likely to experience adverse outcomes such as preterm birth, cesarean delivery, and low birth weight in newborns.

Length of Postpartum Hospital Stays During COVID-19: Findings From a Convergent Parallel Mixed-Methods Study

ObjectivesWe examined the length of postpartum hospitalization for live births during the COVID-19 pandemic and explored how pandemic circumstances influenced postpartum hospital experiences. MethodsWe conducted a cross-provincial, convergent parallel mixed-methods study in Ontario (ON) and British Columbia (BC), Canada. We included birthing persons (BPs) with an in-hospital birth in ON from 1 January to 31 March 2019, 2021, and 2022 (quantitative), and BPs (≥18 years) in ON or BC from 1 May 2020 to 1 December 2021 (qualitative). We linked multiple health administrative datasets at ICES and developed multivariable linear regression models to examine the length of hospital stay (quantitative). We conducted semi-structured interviews using qualitative descriptive to understand experiences of postpartum hospitalization (qualitative). Data integration occurred during design and interpretation. ResultsRelative to 2019, postpartum hospital stays decreased significantly by 3.29 hours (95% CI –3.58 to –2.99; 9.2% reduction) in 2021 and 3.89 hours (95% CI –4.17 to –3.60; 9.0% reduction) in 2022. After adjustment, factors associated with shortened stays included: giving birth during COVID-19, social deprivation (more ethnocultural diversity), midwifery care, multiparity, and lower newborn birth weight. Postpartum hospital experiences were impacted by risk perception of COVID-19 infection, clinical care and hospital services/amenities, visitor policies, and duration of stay. ConclusionsLength of postpartum hospital stays decreased during COVID-19, and qualitative findings described unmet needs for postpartum services. The integration of large administrative and interview data expanded our understanding of observed differences. Future research should investigate the impacts of shortened stays on health service outcomes and personal experiences.

Clinical value of prokineticin 2 in the diagnosis of neonatal necrotizing enterocolitis

Background Necrotizing enterocolitis (NEC) is an inflammatory and necrotizing intestinal emergency that occurs in preterm infants and low birth weight newborns; however, no specific serum biomarkers for the diagnosis of NEC has been identified so far. Methods Serum samples were collected from healthy neonatal controls and patients with NEC newly admitted to the Children’s Hospital of Chongqing Medical University. ELISA was used to measure serum PK2 levels, and ROC curve analysis was sued to evaluate the diagnostic efficacy of PK2 and other clinical biomarkers. Results Serum PK2 levels in the NEC group (n = 53) were significantly lower than those in the control group (n = 18), but increased to near-normal levels after the postoperative recovery period. The NLR value of NEC group was higher than that of control group (P < 0.05). There was no significant difference in WBC and PLT count between NEC group and control group (P > 0.05). Serum CRP and PCT levels in NEC group were significantly higher than those in control group (P < 0.001 for CRP and P < 0.05 for PCT, respectively). After surgery, serum CRP, NLR and PCT levels were lower than before surgery, while serum PK2 levels were higher than before surgery (P < 0.05). The areas under the ROC curve (AUC) of PK2, PCT and CRP for the diagnosis of NEC were 0.837, 0.662 and 0.552, respectively. The AUC of PK2 combined with PCT, PK2 combined with CRP, and PK2 combined with PCT and CRP were 0.908, 0.854 and 0.981, respectively. PK2 exhibited the highest diagnostic efficacy for NEC. Conclusion PK2 has higher diagnostic efficacy than PCT and CRP in the diagnosis of NEC; the combination of PK2 and PCT or CRP can significantly improve its diagnostic efficiency, especially when the three are combined at the same time.

Maternal smoking DNA methylation risk score associated with health outcomes in offspring of European and South Asian ancestry

Background:Maternal smoking has been linked to adverse health outcomes in newborns but the extent to which it impacts newborn health has not been quantified through an aggregated cord blood DNA methylation (DNAm) score. Here, we examine the feasibility of using cord blood DNAm scores leveraging large external studies as discovery samples to capture the epigenetic signature of maternal smoking and its influence on newborns in White European and South Asian populations.Methods:We first examined the association between individual CpGs and cigarette smoking during pregnancy, and smoking exposure in two White European birth cohorts (n=744). Leveraging established CpGs for maternal smoking, we constructed a cord blood epigenetic score of maternal smoking that was validated in one of the European-origin cohorts (n=347). This score was then tested for association with smoking status, secondary smoking exposure during pregnancy, and health outcomes in offspring measured after birth in an independent White European (n=397) and a South Asian birth cohort (n=504).Results:Several previously reported genes for maternal smoking were supported, with the strongest and most consistent association signal from the GFI1 gene (6 CpGs with p&lt;5 × 10-5). The epigenetic maternal smoking score was strongly associated with smoking status during pregnancy (OR = 1.09 [1.07, 1.10], p=5.5 × 10-33) and more hours of self-reported smoking exposure per week (1.93 [1.27, 2.58], p=7.8 × 10-9) in White Europeans. However, it was not associated with self-reported exposure (p&gt;0.05) among South Asians, likely due to a lack of smoking in this group. The same score was consistently associated with a smaller birth size (–0.37±0.12 cm, p=0.0023) in the South Asian cohort and a lower birth weight (–0.043±0.013 kg, p=0.0011) in the combined cohorts.Conclusions:This cord blood epigenetic score can help identify babies exposed to maternal smoking and assess its long-term impact on growth. Notably, these results indicate a consistent association between the DNAm signature of maternal smoking and a small body size and low birth weight in newborns, in both White European mothers who exhibited some amount of smoking and in South Asian mothers who themselves were not active smokers.Funding:This study was funded by the Canadian Institutes of Health Research Metabolomics Team Grant: MWG-146332.

Maternal smoking DNA methylation risk score associated with health outcomes in offspring of European and South Asian ancestry.

Maternal smoking has been linked to adverse health outcomes in newborns but the extent to which it impacts newborn health has not been quantified through an aggregated cord blood DNA methylation (DNAm) score. Here, we examine the feasibility of using cord blood DNAm scores leveraging large external studies as discovery samples to capture the epigenetic signature of maternal smoking and its influence on newborns in White European and South Asian populations. We first examined the association between individual CpGs and cigarette smoking during pregnancy, and smoking exposure in two White European birth cohorts (n=744). Leveraging established CpGs for maternal smoking, we constructed a cord blood epigenetic score of maternal smoking that was validated in one of the European-origin cohorts (n=347). This score was then tested for association with smoking status, secondary smoking exposure during pregnancy, and health outcomes in offspring measured after birth in an independent White European (n=397) and a South Asian birth cohort (n=504). Several previously reported genes for maternal smoking were supported, with the strongest and most consistent association signal from the GFI1 gene (6 CpGs with p<5 × 10-5). The epigenetic maternal smoking score was strongly associated with smoking status during pregnancy (OR = 1.09 [1.07, 1.10], p=5.5 × 10-33) and more hours of self-reported smoking exposure per week (1.93 [1.27, 2.58], p=7.8 × 10-9) in White Europeans. However, it was not associated with self-reported exposure (p>0.05) among South Asians, likely due to a lack of smoking in this group. The same score was consistently associated with a smaller birth size (-0.37±0.12 cm, p=0.0023) in the South Asian cohort and a lower birth weight (-0.043±0.013 kg, p=0.0011) in the combined cohorts. This cord blood epigenetic score can help identify babies exposed to maternal smoking and assess its long-term impact on growth. Notably, these results indicate a consistent association between the DNAm signature of maternal smoking and a small body size and low birth weight in newborns, in both White European mothers who exhibited some amount of smoking and in South Asian mothers who themselves were not active smokers. This study was funded by the Canadian Institutes of Health Research Metabolomics Team Grant: MWG-146332.

Kangaroo Baby Massage: An Intervention which Improves the Perceived Maternal Self-Efficacy

Introduction: The Kangaroo Baby Massage (KBM) is a technique designed for preterm and low birth weight newborns that eliminates the need for an incubator, providing a practical and beneficial option for mothers at home. Objective: To test the effect of the KBM on perceived maternal self-efficacy favoring the mother-infant interaction at home. Materials and methods: A pragmatic, double-blind, randomized clinical trial was conducted in three phases: 1) KBM integration with Kathryn Barnard’s theory, 2) study design, and 3) implementation and outcome evaluation. Two groups were defined: The intervention group (KBM) and the control group (which used the kangaroo position without massage), each group consisted of 34 mother-infant pairs. Recruitment took place within an outpatient kangaroo program in Bogota, Colombia. Implementation and follow-up were conducted via teleconsultation, using the KBM video “Diary of My Kangaroo Baby” and simulators. The perceived maternal self-efficacy questionnaire was conducted at three points in time: prior to the study and on the 7th and 14th day after the study. The questionnaire was analyzed with a statistical design of longitudinal data in F1LDF1 factorial experiments. Results: Homogeneous groups were defined based on sociodemographic variables and maternal-perinatal history. Mothers who applied the KBM technique showed higher scores in perceived maternal self-efficacy at both 7 and 14 days compared to the control group mothers [RTE (lower limit; upper limit) - day 7: control = 0.502 (0.437; 0.567) vs. KBM = 0.503 (0.426; 0.581), and day 14: control = 0.564 (0.482; 0.640) vs. KBM = 0.719 (0.650; 0.776)]. Conclusion: The KBM is a nursing intervention that enhances perceived maternal self-efficacy, fostering greater family involvement and strengthening mother-child interaction.

Maternal dietary diversity and its association with infant birth weight: a healthcare centre based cross-sectional study

BackgroundMaternal nutrition during pregnancy is essential to fetal growth and producing a healthy child. This study aims to investigate the relationship between maternal dietary diversity and neonatal weight among pregnant women referred to health centers in Qazvin.MethodsThis was a cross-sectional study of 1076 pregnant women referred to healthcare centers affiliated by Qazvin University of Medical Sciences from April to June 2019. The dietary information of study participants was collected by a food frequency questionnaire. It was used to determine their dietary patterns by applying a factor analysis with a varimax rotation using SPSS software, version 20. Regarding the women's Dietary Diversity Score (DDS), women were categorized into two groups: inadequate (DDS < 4) and adequate (DDS ≥ 4) dietary diversity. The primary outcome was birth weight, and a log-binomial model was run to test the association between DSS and birth outcomes in the study population. The analysis was performed using SPSS Statistics for Windows version 20.0.ResultsStudy findings revealed that mothers with higher dietary diversity scores were those with normal BMI and normal levels of hemoglobin who had 8–10.9 kg maternal weight gain and were headed by an employed husband (P < 0.05). Furthermore, the risk of low birth weight in newborns of mothers with inadequate dietary patterns was 2.6 times higher (ARR = 95% CI 2.6, 1.4, 5.12) compared to the newborns from mothers with adequate diets.ConclusionInsufficient intake of dietary diversity during pregnancy can potentially increase the likelihood of low birth weight in newborns. Thus, we recommend that health system authorities prioritize the planning for healthy nutrition of pregnant mothers in different geographical regions, specifically remote, rural, and deprived areas of the country.

Predictors of Mortality in Late-Onset Sepsis in Very Low Birth Weight Newborns

Abstract Objective Late-onset sepsis (LOS) is a major public health burden globally. Newborns with very low birth weight (VLBW) are at high risk of mortality related to LOS. The protective effect of breast milk feeding against many infections has been studied but data on the effect of breast milk feeding on LOS mortality are limited. In this study, we aimed to evaluate the risk factors for LOS-related mortality. Methods This single-center, case–control study was conducted retrospectively from August 2013 to July 2018. VLBW newborns with ≤32 weeks of gestational age who had culture-proven LOS were included in the study. Demographics, clinical and laboratory data, and parenteral and enteral feeding details within 72 hours before LOS episodes were extracted from electronic and paper medical records. Results A total of 190 LOS episodes were identified in 168 VLBW newborns with a median birth weight of 888 (695–1,143) g. Lower birth weight (adjusted odds ratio [aOR] 0.81, 95% confidence interval [CI] [0.69–0.96], p = 0.01), C-section delivery (aOR 0.38, 95% CI [0.17–0.84], p = 0.02), gram-negative (aOR 4.97, 95% CI [2.01–12.28], p = 0.001) and polymicrobial sepsis (aOR 6.29, 95% CI [1.34–29.47], p = 0.03), and lower breast milk feeding 72 hours before LOS episodes (aOR 0.89, 95% CI [0.80–0.99], p = 0.03) were independently associated with higher odds of LOS related death. Conclusion Gram-negative sepsis was associated with higher odds of LOS mortality and C-section delivery was associated with lower odds of LOS mortality. Additionally, every 10 mL/kg/day increase in breast milk feeding was associated with 11% lower odds of LOS mortality although this finding should be interpreted cautiously as there may be unadjusted confounders due to the study design.

Comparison of pregnancy outcomes between 4th day morula and 5th day blastocyst after embryo transfer: a retrospective cohort study

BackgroundThis study was designed to evaluate pregnancy outcomes between morulae transferred on day 4 (D4) and blastocysts transferred on day 5 (D5).MethodsFrom September 2017 to September 2020, 1963 fresh transfer cycles underwent early follicular phase extra-long protocol for assisted conception in our fertility center were divided into D4 (324 cases) and D5 (1639 cases) groups, and the general situation and other differences of patients in both groups were compared. To compare the differences in pregnancy outcomes, the D4 and D5 groups were further divided into groups A and B based on single and double embryo transfers. Furthermore, the cohort was divided into two groups: those with live births (1116 cases) and those without (847 cases), enabling a deeper evaluation of the effects of D4 or D5 transplantation on assisted reproductive outcomes.ResultsIn single embryo transfer, there was no significant difference between groups D4A and D5A (P > 0.05). In double embryo transfer, group D4B had a lower newborn birthweight and a larger proportion of low birthweight infants (P < 0.05). The preterm delivery rate, twin delivery rate, cesarean delivery rate, and percentage of low birthweight infants were lower in the D5A group than in the D5B group (P < 0.05). Analysis of factors influencing live birth outcomes further confirmed the absence of a significant difference between D4 and D5 transplantation in achieving live birth (P > 0.05).ConclusionWhen factors such as working life and hospital holidays are being considered, D4 morula transfer may be a good alternative to D5 blastocyst transfer. Given the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) success rate and risk of twin pregnancy, D4 morula transfer requires an adapted decision between single and double embryo transfer, although a single blastocyst transfer is recommended for the D5 transfer in order to decrease the twin pregnancy rate. In addition, age, endometrial thickness and other factors need to be taken into account to personalize the IVF program and optimize pregnancy outcomes.

Regional variations in morbidity and mortality among neonates with intraventricular hemorrhage: a national database analysis.

Intraventricular hemorrhage (IVH) often affects newborns of low gestational age and low birth weight, requires critical care for neonates, and is linked to long-term neurodevelopmental outcomes. Assessing regional differences in the U.S. in care for neonatal IVH and subsequent outcomes can shed light on ways to mitigate socioeconomic disparities. Using the 2016-2019 National Inpatient Sample (NIS), patients with a primary diagnosis of IVH were identified using ICD-10-CM codes. A retrospective cohort study was conducted with patients stratified by hospital region. Demographics, comorbidities, presentation, intraoperative variables, and inpatient outcomes were assessed. Multivariate logistic regression analyses were used to identify the impact of insurance status on extended LOS (defined as > 75th percentile of LOS), exorbitant cost (defined as > 75th percentile of cost), and mortality. Included in this study were 1630 newborns with IVH. A larger portion of patients in the South and Midwest were Black, compared to the Northeast and West (Northeast: 12.2% vs Midwest: 30.2% vs South: 22.8% vs West: 5.8%, p < 0.001), while a greater percentage of patients in the West and South were Hispanic (Northeast: 7.3% vs Midwest: 9.5% vs South: 22.8% vs West: 36.2%, p < 0.001). LOS was similar among all regions. Factors associated with prolonged LOS included hydrocephalus and CSF diversions. Median total cost of admission was highest in the West, while the South was associated with decreased odds of exorbitant cost. LOS was associated with exorbitant cost, and large bed-volume hospital, VLBW, and permanent CSF shunt were associated with mortality. Demographic variables, but not presenting or intraoperative variables, differed among regions, pointing to possible geographic health disparities. The West had the highest total cost of admission, while the South was associated with reduced odds of exorbitant admission costs.