Low Maternal Weight Gain Research Articles

Prenatal arsenic exposure, child marriage, and pregnancy weight gain: Associations with preterm birth in Bangladesh

BackgroundPreterm birth is a disease of multifactorial etiologies that has environmental, social, and maternal health components. Individual studies have shown that exposure to arsenic contaminated drinking water, child marriage, and low maternal weight gain during pregnancy contribute to preterm birth. These factors are highly prevalent and often co-exist in Bangladesh, a country in South Asia with one of the world's highest prevalences of preterm birth. ObjectiveTo evaluate the individual and interactive effects of prenatal arsenic exposure, child marriage, and pregnancy weight gain on preterm birth in a prospective birth cohort in Bangladesh. MethodsDuring 2008–2011, we recruited 1613 pregnant women aged ≥18years at ≤16weeks of gestation and followed them until 1-month post-partum. We measured total arsenic in drinking water (n=1184) and in maternal toenails (n=1115) collected at enrollment and ≤1-month post-partum, respectively using inductively coupled plasma mass spectrometry. Child marriage (<18years old) was defined using self-report, and 2nd and 3rd trimester pregnancy weight gain was calculated using monthly records. Gestational age was determined at enrollment by ultrasound. ResultsIn multivariate adjusted Poisson regression models, the risk ratios (RR) for preterm birth were 1.12 (95% CI: 1.07–1.18) for a unit change in natural log water arsenic exposure, 2.28 (95% CI: 1.76–2.95) for child marriage, and 0.64 (95% CI: 0.42–0.97) for a pound per week increase in maternal weight during the 2nd and 3rd trimesters. In stratified analysis by child marriage, pregnancy weight gain was inversely associated with preterm birth among women with a history of child marriage (RR=0.58; 95% CI: 0.37–0.92), but not among women with no history of child marriage (RR=0.86; 95% CI: 0.37–2.01). Mediation analysis revealed that both arsenic exposure and child marriage had small but significant associations with preterm birth via lowering pregnancy weight gain. Similar associations were observed when arsenic exposure was assessed using maternal toenail arsenic concentrations. ConclusionsReducing arsenic exposure and ending child marriage could reduce the risk of preterm birth in Bangladesh. Furthermore, enhancing nutritional support to ensure adequate weight gain during pregnancy may provide additional benefits especially for women with a history of child marriage.

Helicobacter pylori infection: a predictor of vomiting severity in pregnancy and adverse birth outcome

BackgroundNausea and occasional vomiting in early pregnancy is common. Why some women experience severe nausea and occasional vomiting in early pregnancy is unknown. Causes are multifactorial and only symptomatic treatment options are available, although adverse birth outcomes have been described. Helicobacter pylori infection has been implicated in the cause of nausea and occasional vomiting in early pregnancy.ObjectiveThe purpose of this study was to investigate the association of H pylori with vomiting severity in pregnancy and its effect on birth outcome.Study DesignWe assembled a population-based prospective cohort of pregnant women in The Netherlands. Enrolment took place between 2002 and 2006. H pylori serology was determined in mid gestation. Women reported whether they experienced vomiting in early, mid, and late gestation. Maternal weight was measured in the same time periods. Birth outcomes were obtained from medical records. Main outcome measures were vomiting frequency (no, occasional, daily) and duration (early, mid, late gestation), maternal weight gain, birthweight, small for gestational age, and prematurity. Data were analyzed with the use of multivariate regression.ResultsWe included 5549 Women, of whom 1932 (34.8%) reported occasional vomiting and 601 (10.8%) reported daily vomiting. Women who were H pylori-positive (n=2363) were more likely to report daily vomiting (adjusted odds ratio, 1.44; 95% confidence interval, 1.16-1.78). H pylori positivity was associated with a reduction of total weight gain in women with daily vomiting (adjusted difference, -2.1 kg; 95% confidence interval, -2.7 to -1.5); infants born to women with H pylori and daily vomiting had slightly reduced birthweight (adjusted difference -60g; 95% confidence interval, -109 - -12) and an increased risk of being small for gestational age (adjusted odds ratio, 1.49; 95% confidence interval, 1.04-2.14). H pylori and daily vomiting did not significantly affect prematurity rate.ConclusionThis study suggests that H pylori is an independent risk factor for vomiting in pregnancy. In women with daily vomiting, H pylori is also associated with low maternal weight gain, reduced birth weight, and small for gestational age. Because effective treatments for severe nausea and occasional vomiting in early pregnancy are currently lacking, the effect of H pylori eradication therapy on nausea and occasional vomiting in early pregnancy symptom severity should be the target of future studies.

Effect of Anthropometry and Dyslipidaemia on Birth Weight

The period of pregnancy is a very important aspect of fetal growth and development. Maternal weight gain during pregnancy is associated with fetal macrosomia. Generally, delays in low maternal weight gain have been linked to limitations in fetal growth and development, and there is some evidence that low maternal weight gain is associated with an increased risk of pre-term delivery. Objective: To determine the effect of hyperlipidaemia during pregnancy on neonatal growth and birth weight. Methodology: This was a prospective cross sectional study on pregnant who delivered between (1-6) weeks and non pregnant women as a control. Result: There was significant difference between TG of the exposed group (0.87 ± 0.29) mmol/L versus the controls (0.75 ± 0.31) mmol/L p = 0.04. T.CHOL was also significant between the exposed (4.45 ± 0.75) mmol/L and controls (4.03 ± 1.04) mmol/L p = 0.029. Comparing LDL-C of both groups was (2.71 ± 0.79) mmol/L for the cases and (2.26 ± 0.75) mmol/L for the controls a p = 0.005. Also there was a significant difference between HDL-C of the exposed (1.28 ± 0.33) mmol/L and controls (1.45 ± 0.44) mmol/L p = 0.044. There was no correlation between baby’s weight and maternal BMI, p = 0.950. Postnatal lipids did not also show relationship with baby’s weight. Dyslipidaemia during the postpartum period did not reflect a subsequent increase in birth weight. Conclusion: Generally, the study demonstrated strongly that BMI does not affect birth weight especially in women who are overweight and obese. More so, dyslipidaemia during the postpartum period (1-6) weeks did not correlate or reflect a subsequent increase in birth weight and a possible obesity in later life.

Effect of Fine Particulate Matter (PM2.5) on Rat Placenta Pathology and Perinatal Outcomes.

BackgroundFine particulate matter with aerodynamic diameters smaller than 2.5 μm (PM2.5) has been reported to cause adverse effects on human health. Evidence has shown the association between PM2.5 exposure and adverse perinatal outcomes, and the most common method is epidemiological investigation. We wished to investigate the impact of PM2.5 on placenta and prenatal outcomes and its related mechanisms in a rat model.Material/MethodsPregnant rats were exposed to a low PM2.5 dose (15 mg/kg) with intratracheal instillation at pregnant day 10 and day 18, while the controls received an equivalent volume normal saline. All rats received cesarean section 24 h after the last intratracheal instillation and were sacrificed with anesthesia. Blood routine tests (BRT) and interleukin-6 (IL-6) were detected for analyzing inflammation and blood coagulation. Placenta tissue sections underwent pathologic examination, and the levels of homogenate glutathione peroxidase (GSH-Px) and methane dicarboxylic aldehyde (MDA) were determined for oxidative stress estimation.ResultsIncreased absorbed blastocysts, and lower maternal weight gain and fetal weight were found in the PM2.5 exposure group compared to controls (p<0.05). Exposure to PM2.5 caused a significant increase of blood mononuclear cells (PBMC), platelets, and IL-6 levels (P<0.01). There were no differences in GSH-Px and MDA of placenta homogenate between the 2 groups (P>0.05). Placenta pathological examination demonstrated thrombus and chorioamnionitis in the PM2.5 exposure group.ConclusionsPM2.5 exposure can result in placental pathological changes and adverse perinatal outcomes. The placental inflammation and hypercoagulability with vascular thrombosis may play important roles in placental impairment, but oxidative stress appears to be less important.

Born Large for Gestational Age: Bigger Is Not Always Better

Born Large for Gestational Age: Bigger Is Not Always Better

Estimating Effects of Arsenic Exposure During Pregnancy on Perinatal Outcomes in a Bangladeshi Cohort.

The relationship between arsenic and birth weight is not well understood. The objective was to evaluate the causal relationship between prenatal arsenic exposure and birth weight considering the potential mediation effects of gestational age and maternal weight gain during pregnancy using structural equation models. A prospectively enrolled cohort of pregnant women was recruited in Bangladesh from 2008 to 2011. Arsenic was measured in personal drinking water at the time of enrollment (gestational age <16 weeks, N = 1,140) and in toenails collected ≤1 month postpartum (N = 624) using inductively coupled plasma mass spectrometry. Structural equation models estimated the direct and indirect effects of arsenic on birth weight with gestational age and maternal weight gain considered as mediating variables. Every unit increase in natural log water arsenic was indirectly associated with decreased birth weight (β = -19.17 g, 95% confidence interval [CI]: -24.64, -13.69) after adjusting for other risk factors. This association was mediated entirely through gestational age (β = -17.37 g, 95% CI: -22.77, -11.98) and maternal weight gain during pregnancy (β = -1.80 g, 95% CI: -3.72, 0.13). When exposure was modeled using toenail arsenic concentrations, similar results were observed. Every increase in natural log toenail arsenic was indirectly associated with decreased birth weight (β = -15.72 g, 95% CI: -24.52, -6.91) which was mediated through gestational age (β = -13.59 g, 95% CI: -22.10, -5.07) and maternal weight gain during pregnancy (β = -2.13 g, 95% CI: -5.24, 0.96). Arsenic exposure during pregnancy was associated with lower birth weight. The effect of arsenic on birth weight appears to be mediated mainly through decreasing gestational age and to a lesser extent by lower maternal weight gain during pregnancy.

Can Group Exercise Programs Improve Health Outcomes in Pregnant Women? A Systematic Review

Current scientific evidence supports the recommendation to initiate or continue the practice of physical exercise in healthy pregnant women. Group exercise programs have positive effects in improving health and well-being, as well as social support. In order to understand the scientific evidence in this field, and the outcomes in maternal health, it has generated wide interest in exploring the studies carried out with more relevant group exercise programs. The aim of this systematic review was to evaluate the available evidence on the effectiveness of group exercise programs in improving women’s and newborns health outcomes during pregnancy. Three databases were used to conduct literature searches and strict inclusion and exclusion criteria were employed. Seventeen studies were selected for analysis. All studies were randomized control trials conducted with pregnant women that evaluated the effect of group exercise programs on the health outcomes of mother and newborn. Most studies followed a supervised structured exercise program including a main aerobic part, resistance training, pelvic floor training and stretching and relaxation sections. The significant effects of the programs are related with improved maternal perception of health status, lower maternal weight gain, improved levels of maternal glucose tolerance, improved aerobic fitness and muscular strength, lower frequency of urinary incontinence, improved sick leave due to lumbopelvic pain, fewer cesarean and instrumental deliveries, higher newborn Apgar score and faster postpartum recovery. Exercise and health professionals should advise pregnant women that aerobic group exercise during pregnancy improves a wide range of health outcomes for the women and newborns.

Maternal Body Mass Index and Weight Gain in Relation to Low Birth Weight: A Study from Eastern Thailand

Maternal Body Mass Index and Weight Gain in Relation to Low Birth Weight: A Study from Eastern Thailand Introduction: This retrospective study aimed to determine the association of maternal factors and low birth weight newborns at Phrapokklao hospital. Material and Methods: We recruited 1,968 pregnant women delivering babies after 34 weeks of gestation during January 1, 2013 to June 30, 2013. Data collected included fetal weight, maternal age, parity, gestational age, prepregnancy weight, body mass index (BMI), weight gained during pregnancy, hematocrit, place of residence, maternal HIV infection and completion of antenatal care visits. Results: Fifty eight percent of the women had a normal BMI and 65.7% were between 20-34 years old. Pregnancy weight gain categorized by BMI showed that the percent of women in the under, normal, and over-normal ranges were 37.0%, 33.3% and 29.7% respectively. Maternal prepregnancy BMI did not associated with low birth weight newborns (LBWN) or small for gestational (SGA) newborn. Nulliparity and low gestational weight gain was 1.8 and 3.5 times greater risk (adjusted OR 1.814, 95%CI 1.232- 2.671, p-value=0.003 and adjusted OR 3.477, 95%CI 2.132-5.668, p-value=0.001 respectively) of having a LBWN. While low weight gain pregnant women had 6.3 more risks (adjusted OR 6.325, 95%CI 1.437-27.836, p-value = 0.015) of having SGA newborn, it showed protective effect for LGA newborn. The results between using IOM 1990 and 2009 recommendations remained the same irrespective of the different guideline used. Conclusion: Nulliparity and low gestational weight gain were all directly associated with LBWN while low maternal BMI and low gestational weight gain showed protective effect for LGA newborn.

HUBUNGAN PERTAMBAHAN BERAT BADAN SELAMA KEHAMILAN DENGAN BERAT LAHIR BAYI DI KECAMATAN SUKARAJA KABUPATEN BOGOR TAHUN 2001 - 2003

THE RELATIONSHIP BETWEEN WEIGHT GAIN DURING PREGNANCY AND BIRTH WEIGHT IN SUKARAJA SUBDISTRICT, BOGOR IN 2001 - 2003 Maternal body weight gain during pregnancy is important for women suffering from wasting when pregnancy started. Many studies in Indonesia show that low maternal weight gain during pregnancy (less than 10 kg) and high prevalence of pregnant women who had cronic energy deficiency (27.6%) are still problem. The objective of the study is to determine relationship between of maternal weight gain during pregnancy and low birth weight (2500-2999 gram) and its related factors. The study desain was cross-sectional, involving 270 pregnant women, at early stages (12 weeks) who delivered a normal body weight and full term babies (&gt; 37 weeks). Data analysis was done using logistic regression. The result showed that the babies with low birth weight (2500-2999 gram)was 47.8 persen with the average weight of 3015 gram. The average of maternal weight gain during pregnancy was 9.098 kg and those who gained less than 9 kg during pregnancy was 48.9 persen. A significant relationship was found birth weight gain during pregnancy (p=0.000, OR 7.28, 95% CI; 4.25-12.46), and energy intake ((p=0.000, OR 5.15, 95% CI; 2.976-8.913). Multivariate analysis shows that the interaction between energy intake and weight gain during pregnancy is statistically significant (p=0.000, OR 5.8, 95% CI; 1.574-21.536). In conclusion, women who had gain weight at least 9 kg during pregnancy and energy intake more than 70 persen RDA might baby between with birth weight of less than 3000 gram. It is important especially to those who get pregnant suffering from wasting. Keywords : weight gain, pregnancy, birth weight

Risk factors and neonatal/infant mortality risk of small-for-gestational-age and preterm birth in rural Nepal

Objective: Our study seeks to elucidate risk factors for and mortality consequences of small-for-gestational-age (SGA) and preterm birth in rural Nepal. In contrast with previous literature, we distinguish the epidemiology of SGA and preterm birth from each other.Methods: We analyzed data from a maternal micronutrient supplementation trial in rural Nepal (n = 4130). We estimated adjusted risk ratios (aRR) for risk factors of SGA and preterm birth, and aRRs for the associations between SGA/preterm birth and neonatal/infant mortality. We used mutually exclusive categories of term-appropriate-for-gestational-age (AGA), term-SGA, preterm-AGA, and preterm-SGA (with term-AGA as reference) in our analyses.Results: Stunted (<145 cm) and wasted (<18.5 kg/m2) women both had increased risk of having term-SGA (aRR 1.36, 95% CI: 1.14-1.61, aRR 1.22, 95% CI: 1.09–1.36 respectively) and preterm-SGA (aRR 2.48, 95% CI: 1.29–4.74, aRR 1.99, 95% CI: 1.33–2.97 respectively), but not preterm-AGA births. Similar results were found for low maternal weight gain per gestational week. Those born preterm-SGA generally experienced the highest neonatal and infant mortality risk, although term-SGA and preterm-AGA newborns also had statistically significantly high mortality risks compared to term-AGA babies.Conclusions: SGA and preterm birth have distinct risk factors and mortality patterns. Maternal chronic and acute malnutrition appear to be associated with SGA outcomes. Because of high SGA prevalence in South Asia and the increased neonatal and infant mortality risk associated with SGA, there is an urgent need to intervene with effective interventions.

The association between maternal weight gain and spontaneous preterm birth in twin pregnancies

Objective: To estimate the association between maternal weight gain and SPTB in twin pregnancies.Methods: A case-control study of patients with twin pregnancies and a normal prepregnancy BMI (18.5–24.9 kg/m2) in one maternal-fetal medicine practice from 2005 to 2013. We reviewed maternal weight in six time periods: prepregnancy, 12–15 6/7 weeks, 16–19 6/7 weeks, 20–23 6/7 weeks, 24–27 6/7 weeks and 28–31 6/7 weeks. We compared maternal weight gain patterns across pregnancy between patients who did and did not have SPTB <32 weeks. Student’s t-test and chi-square were used for analysis.Results: In total, 382 patients were included, 29 (7.6%) of whom had SPTB <32 weeks. The baseline height, weight and BMI did not differ between the groups, nor did maternal age, IVF status, race or chorionicity. Patients with SPTB <32 weeks had significantly less weight gain as early as 15 6/7 weeks (2.9 ± 4.6 versus 7.3 ± 6.6 lb, p < 0.001), and this continued until 31 6/7 weeks (25.3 ± 8.7 versus 30.8 ± 10.9 lb, p = 0.037).Conclusions: In twin pregnancies with a normal prepregnancy BMI, there is a significant association between SPTB <32 weeks and lower maternal weight gain, particularly prior to 16 weeks. Future studies are needed to test if prepregnancy or early nutritional interventions in twin pregnancies can reduce the risk of preterm birth and improve neonatal outcomes in this high-risk population.

Neonatal outcomes of intrauterine nonylphenol exposure—A longitudinal cohort study in Taiwan

BackgroundNonylphenol (NP) is an environmental hormone with proven estrogenic effects. Although its adverse effects on animals are well documented, the effects of NP exposure on humans remain unclear, and those on the human foetus are completely unknown. This study explores the effects of intrauterine NP exposure on neonates. MethodsA cohort of pregnant women was established in a medical centre in northern Taiwan. Urine samples from the first, second, and third trimesters of gestation were collected. Urinary NP concentration was measured by high-performance liquid chromatography coupled with fluorescent detection. Neonatal outcomes were evaluated immediately after delivery. A mixed-effects model using a generalised estimating equation was applied to assess the association between gestational age, maternal body weight, and maternal NP concentration throughout the three trimesters. A multivariable regression model was used to determine the association between maternal NP level in urine in each trimester and neonatal outcomes. ResultsIn total, 162 singleton pregnant women completed this study through delivery. The geometric mean of creatinine-adjusted urinary NP concentrations were 4.27μg/g, 4.21μg/g, and 4.10μg/g in the first, second, and third trimesters, respectively. Pregnant women whose urinary NP concentrations were above the median in the second trimester had low maternal weight gain (β=−1.55kg, p=0.02) and short neonatal body length (β=−0.47cm, p=0.04). Women with an above-median urinary NP concentration had an odds ratio of having a small for gestational age (SGA) neonate of 7.81 (p<0.05). ConclusionsThis study indicates that maternal high NP exposure in the second trimester is associated with SGA, decreased foetal body length at birth, and low maternal weight gain. The effects of this endocrine-disrupting substance on pregnant women and foetuses should be a concern during gestation.

Low birth weight risk factors survey in neonates in Tehran

Abstract Background and aim Neonatal mortality rate is one of the main health problems which is affected by prenatal status, maternal, fetal and perinatal conditions. Low Birth weight (LBW) is one of the main causes of neonatal and infantile mortality & is one of the important problems in all of communities. The aim of this study is an evaluation of LBW causes in neonates born to mothers in teaching hospitals in Tehran. Materials and methods This case-control study was conducted to estimate LBW causes in born babies in Taleghani , Mahdieh & Hedayat hospitals, Tehran, Iran . Data such as birth weight, sex, maternal age, gestational age, birth interval, history of abortion, prenatal care, maternal occupation, level of education, systemic and underlying diseases, history of infections and smoking were extracted from medical records. Data were statistically analyzed by SPSS ver.15 using Chi-square,t-test and fisher exact test. Findings 7.7% of neonates were LBW newborns. Maternal age, gestational age, maternal weight and height, and the interval between births of LBW neonates were significantly lower compared with normal birth weight neonates. Multiple logistic regressions model was used to estimate the effects of most important predictors on low birth weight. The logistic model showed that the highest risks for low birth weight were related to low interval between 2 birth (OR=0.54, CI=0.32-0.91), Low maternal weight gain during pregnancy (OR=1.4, CI=0.73-2.061), maternal depression or Anxiety (OR=1.62, CI=1.21-2.805) – mother preeclampsia (OR=2.98, CI=2.09-4.32) preterm delivery (OR=3.95, CI=2.38-5.52). Conclusion The Results revealed that Low birth weight rates increases in the presence of short interval between two births, – mother preeclampsia, depression or anxiety, & preterm delivery . Keywords: LBW-LBW Risk factors, regression model

Optic nerve hypoplasia in North America: a re-appraisal of perinatal risk factors.

The purpose of this study is to describe and clarify the birth and prenatal characteristics of a large cohort of children with optic nerve hypoplasia. This is a descriptive report of 204 patients aged </= 36 months and enrolled in a prospective study at the Children's Hospital Los Angeles. Birth characteristics, including complications, were abstracted from study files and medical records. Systematic maternal interviews were conducted to obtain detailed prenatal histories. National birth data were used for comparison with birth findings. Birth characteristics were unremarkable for birthweight and gestation, but significant for increased frequency of caesarean delivery and fetal and neonatal complications. Young maternal age and primaparity were dominating maternal features. Preterm labour, gestational vaginal bleeding, low maternal weight gain and weight loss during pregnancy were prevalent. These findings confirm young maternal age and primaparity as associated risk factors, challenge many other suggested factors such as alcohol and drug abuse, and introduce potentially significant prenatal characteristics such as maternal weight loss and early gestational vaginal bleeding as aetiological correlates.

Risk factors for small for gestational age

The purpose of the paper was to determine the risk factors for small-for-gestational-age (SGA) infants at full term, in Japan. The study was conducted at four hospitals and clinics in the Tokyo metropolitan area. A retrospective review of 2972 mothers and their infants born from singleton pregnancies at any time during the years 2002 and 2003 was conducted. Of these women, 8.4% gave birth to SGA infants. The proportion of SGA infants was significantly higher among heavy smokers (>10 cigarettes/day; 13.7%, P < 0.01). The odds ratio (OR) for SGA decreased significantly in proportion to the pregnancy body mass index (OR, 0.89; 95% confidence interval [CI]: 0.84-0.94, P < 0.001). The OR of SGA for stratified maternal weight gain was 1.79 (95%CI: 1.24-2.58, P </= 0.01) for weight gain < 8.0 kg; 1.16 (95%CI: 0.79-1.71, P = 0.45) for weight gain 8.0-10.0 kg; and 0.49 (95%CI: 0.3-0.78, P < 0.01) for weight gain >12 kg. The present study clearly confirms the detrimental effect of a low prepregnancy body mass index, low maternal weight gain and maternal smoking during pregnancy on the incidence of SGA infants.

Low maternal weight: effects on maternal and infant health during pregnancy

A healthy body weight on conception and adequate weight gain during pregnancy are important to ensure that mother and baby remain well. A low maternal weight and poor pregnancy weight gain can have detrimental implications for the mother and baby. Women need to be provided with clear, consistent information about how much weight they should gain during pregnancy and the adverse effects of a low pre-pregnancy body weight and insufficient weight gain during pregnancy.

Complicated gastroschisis and maternal smoking: a causal association?

The incidence of gastroschisis appears to be rising in developed nations, with epidemiological studies indicating association with young maternal age and smoking. Is there an association between maternal smoking and the development of complicated gastroschisis? A retrospective population-based review of all cases of gastroschisis over 11 years was conducted in three Canadian provinces. Complicated cases were defined as those with an associated intestinal atresia or other vascular compromise of the bowel, those requiring a prolonged time to full enteral feeding (>42 days). Univariate and multivariate regression analyses were conducted. Fifty-four cases of gastroschisis were treated. Seventeen patients had complicated gastroschisis (CG). 47.1% of infants were born to smoking mothers; of those 56.25% were in the CG group. On univariate analysis statistically significant associations with complicated cases were young maternal age (<19 years) (OR = 6.0, CI: 1.3, 28.1), low maternal weight gain (<12 kg) (OR = 4.6, CI: 2.5, 8.5), low birth weight (<2,400 g), (OR = 7.7, CI: 2.0, 28.9), and gestational age under 36 weeks (OR = 11.0, CI: 2.6, 46.2). Seven of 24 cases involving maternal smoking developed atresias or vascular intestinal compromise versus 4 of 27 cases with no maternal smoking, with an odds ratio of 2.1 (CI: 0.60, 7.2). On multivariate analysis, atresias and vascular compromise remained significantly associated with young maternal age, low gestational age and low 1-min Apgar score. Although a positive trend is seen, no statistically significant relationship between maternal smoking and the development of complicated gastroschisis was found. Further clinical and epidemiologic studies are needed to validate our findings.

Safety of leukotriene receptor antagonists in pregnancy

Asthma is a chronic disorder that affects about 8% of pregnant women and may complicate pregnancy. Adequate asthma therapy in pregnancy is crucial but challenging because of safety concerns for the fetus. To evaluate the safety of gestational asthma therapy with leukotriene receptor antagonists (LTRAs) for the mother and fetus/newborn. Subjects were participants of the Organization of Teratology Information Specialists Asthma Medications in Pregnancy Study. Perinatal outcomes among 96 women who took LTRAs (montelukast or zafirlukast) were compared with women who exclusively took short-acting beta(2)-agonists (n = 122) and women without asthma (n = 346). Use of LTRAs was not associated with an increased risk of pregnancy loss, gestational diabetes, preeclampsia, low maternal weight gain, preterm delivery, low Apgar scores, or reduced measures of birth length and head circumference in infants (P > .05). Slightly decreased birth weight in infants born to LTRA users could be attributed to maternal asthma severity/control. The birth prevalence of major structural defects in the LTRA group (5.95%) was significantly higher compared with controls without asthma (P = .007), but not different from the comparison group with asthma (P = .524). Furthermore, the defects observed in the LTRA group did not represent a consistent pattern. Use of LTRAs in pregnancy was not associated with a specific pattern of major structural anomalies in offspring or a large risk of other adverse perinatal outcomes. This study suggests that LTRAs do not appear to be a major human teratogen; however, results should be interpreted with caution because of limited sample size.

Weight Gain and Spontaneous Preterm Birth

To study how the relationship between gestational weight gain and spontaneous preterm birth interacts with maternal race or ethnicity and previous preterm birth status. This was a retrospective cohort study of singleton births to women of normal or low prepregnancy body mass index. Gestational weight gain was measured as total weight gain divided by weeks of gestation at delivery, and weight gain was categorized as low (less than 0.27 kg/wk,), normal (0.27-0.52 kg/wk), or high (more than 0.52 kg/wk). Univariable and multivariable analyses were performed on the relationship between weight gain categories and spontaneous preterm birth, stratified by maternal race or ethnicity and history of previous preterm birth. Overall, low weight gain was associated with spontaneous preterm birth (adjusted odds ratio [AOR] 2.5, 95% confidence interval [CI] 2.0-3.1). Although low gain was consistently associated with increased spontaneous preterm birth, some differences were found in subgroup analysis. Among African Americans with a previous preterm birth, both low and high weight gain were associated with increased odds of spontaneous preterm birth (AOR for low weight gain 4.3, 95% CI 1.2-15.5; AOR for high weight gain 6.1, 95% CI 1.8-20.2). For all other groups, high weight gain was not associated with spontaneous preterm birth. Among Asians with a previous preterm birth, low weight gain was not statistically significantly associated with spontaneous preterm birth (AOR 1.9, 95% CI 0.5-7.7). Among Asians there was also a non-statistically significant inverse relationship between high weight gain and spontaneous preterm birth (AOR 0.5, 95% CI 0.3-1.1). These results confirm an association between low maternal weight gain and spontaneous preterm birth. The effect modification of maternal race or ethnicity and history of previous preterm birth on this association deserves further study. II-2.

Maternal Weight Gain Rate in the Second Trimester Are Associated with Birth Weight and Length of Gestation

Background: Low total weight gain during pregnancy has been widely accepted as a valid risk factor for small-for-gestational-age infants and pre-term births. However, it is not obvious in which trimester the weight gain rate most affects birth weight and length of gestation. Method: Using logistic regression analysis and Pearson’s correlation coefficient test, data from 472 women who had vaginally delivered an infant at term without any complications were analyzed retrospectively. Results: Pre-pregnancy underweight and low total maternal weight gain were significant independent predictors of small-for-gestational-age infants and shortened gestations. Pre-pregnancy weight was significantly related to the birth weight and length of gestation (r = 0.18, p < 0.0001; r = 0.10, p = 0.04, respectively), and total weight gain was also significantly related to those (r = 0.17, p = 0.0003; r = 0.11, p = 0.03, respectively). Significant correlations between maternal weight gain rate in the second trimester and the birth weight and length of gestation were found (r = 0.32, p = 0.005; r = 0.40, p = 0.0003, respectively), while such correlations were not found in the first or third trimester. Conclusion: The most sensitive period of maternal weight gain for the birth weight and length of gestation was the second trimester.