Maternal Height Research Articles

#57 : A Prediction Model of Low Birthweight in Singleton Pregnancies Reduced from Dichorionic Twin Pregnancies

Background and Aims: The incidence of twin pregnancies has risen over the last few decades, mainly attributed to assisted reproduction techniques (ART). Fetal reduction (FR) can significantly reduce low birthweight (LBW) risk in twins. However, the LBW risk is still higher in singletons reduced from twins than for primary singletons. Many factors, such as maternal factors, FR timing and approach may affect LBW risks after FR and no relevant prediction models have been reported to date. The main objective of this study is to develop a nomogram to predict LBW risk in singleton pregnancies reduced from dichorionic (DC) twins. Method: We retrospectively reviewed and analyzed the data on women with (DC) twin pregnancies who underwent FR in Women’s Hospital, Zhejiang university, School of medicine in July 2005 to August 2021. Logistic LASSO regression was used to identify the most relevant variables associated with LBW. The nomogram was constructed and receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and decision clinical analysis were used for model performances assessment and visualization. The model was evaluated by cohorts produced by 500 resampling bootstrap analysis to testify the stability. Results: A total of 471 patients were enrolled in the analysis. At last, seven independent predictive factors for LBW were identified and integrated to construct the nomograms, including maternal height, nulliparous, conception mode, reasons for FR, gestational age at FR, gestational diabetes, pregnancy hypertensive disease. The AUC of our prediction model was 0.793, which was validated by internal (AUC 0.762) confirmation with bootstrap analysis. The nomogram had well-fitted calibration curves. Decision curve analysis demonstrated that the nomogram was clinically useful. Conclusion: We made the first attempt to develop a reliable predictive nomogram for the risk of LBW in DC twin pregnancies reduced to singletons, providing a useful guide for clinicians and patients in making appropriate FR decisions.

Changes in anthropometry in full-term breastfed newborns and associated factors for the first month.

We aim to assess the changes and associated factors in newborn anthropometry in the first month for full-term, healthy, and exclusive-breastfed infants. Neonatal anthropometric measurements were taken on day 5, day 15, and day 30 after delivery. Generalized estimating equations (GEE) analyzed the changes. From 169 mother-newborn pairs, GEE showed that weight gain during the first month was influenced by maternal body mass index (BMI), delivery type, birth weight, and jaundice after adjusting confounding factors (p < .05). The neonatal length was affected by the smoking status of parents, gestational maternal health problems, maternal height, birth weight, and jaundice (p < .05). Neonatal head circumference was influenced by the smoking status of parents, gestational maternal health problems, maternal BMI, delivery type, maternal height, and birth weight. Adverse perinatal factors including mother's smoke exposure, maternal obesity and diabetes, cesarean birth, and neonatal hyperbilirubinemia influence anthropometry in the first months of life.

Higher risk of preterm twin delivery among shorter nulliparous women

ObjectiveTo determine if maternal height in nulliparous women influences pregnancy results in twin pregnancies. Material and methodsRetrospective cohort analysis evaluating twin pregnancies followed at Centro Hospitalar Universitário Lisboa Central, between 1995 and 2020. Of the 2900 pregnancies followed in that period, 886 nulliparous women with dichorionic twin pregnancies were selected. Two groups were considered: A - maternal height <163 cm (<Q2) (n = 436) and B - maternal height ≥167 cm (≥Q3) (n = 234), The following results were compared: Age, body mass index (BMI), premature contractions, premature rupture of membranes (PROM), hypertensive disorders, gestational diabetes, gestational age at birth, delivery <28, <32, <34, < 36, ≥37 weeks (wks), average weight of newborns, very low birth weight, low birth weight, cesarean section rate, stillbirths, five minute Apgar score, neonatal death and perinatal death. Result(s)PTB rates decreased along increasing maternal height. The comparison between group A and group B revealed no statistically significant differences in maternal characteristics (age, mode of conception - spontaneous or ART pregnancies, or BMI). Statistically significant differences were found in mean gestational age at birth (35.1 ± 1.8 vs. 36.0 ± 2.6 wks), PTB rates < 32, 34 and 36 wks, OR: 3.2, 2.3 and 2.4 respectively, p < 0.01. Shorter women had a 1.7× and 2.6× increased risk for significantly low (<2500 g) and very low (<1500 g) newborn birth weight (BW), respectively, and a 40 % increased risk of Cesarian delivery. No significant differences were shown with respect to stillbirths, neonatal and perinatal deaths, which had a low incidence in this study. In ART pregnancies we found the same results regarding PTB rates and newborn birthweight in shorter women. In Logistic Regression analysis, maternal height <Q2 is an independent risk factor for PTB under 32, 34 and 36 wks, adjusted OR: 2.0. 2.2 and 2.4, respectively, 95 % CI 1.1–3.7, p = 0.021. ConclusionIncreased pregnancy risk in nulliparous shorter women should be taken into consideration in double embryo transfers.

Trimester-Specific Urinary Strontium Concentrations during Pregnancy and Longitudinally Assessed Fetal Growth: Findings from a Prospective Cohort

BackgroundStudies have claimed that strontium (Sr) is associated with fetal growth, but the research evidence is insufficient. ObjectivesOur study aimed to evaluate associations of trimester-specific urinary Sr concentrations with fetal growth parameters and birth size indicators. MethodsIn this prospective cohort, 9015 urine samples (first trimester: 3561, 2nd trimester: 2756, 3rd trimester: 2698) from 3810 mothers were measured for urinary Sr levels using inductively coupled plasma mass spectrometry (ICP-MS) and adjusted to urine specific gravity. We calculated standard deviation scores (SD-scores) for ultrasound-measured fetal growth parameters (head circumference, abdominal circumference, femur length, and estimated fetal weight) at 16, 24, 31, and 37 wk of gestation and birth size indicators (birth weight, birth length, and Ponderal index). Generalized linear models and generalized estimating equations models were used. Models were adjusted for potential covariates (gestational age, maternal age, body mass index, parity, passive smoking during pregnancy, education, folic acid supplements use, physical activity, maternal and paternal height, and infant sex). ResultsPositive associations of naturally logarithm-transformed Sr concentrations with fetal growth parameters and birth size indicators were observed. With each doubling increase in the urinary ln-Sr level in all 3 trimesters resulting in a percent change in SD-scores fetal growth parameters at 24, 31, and 37 wk of gestation and birth size indicators, 5.09%–8.23% in femur length, 7.57%–11.53% in estimated fetal weight, 6.56%–10.42% in abdominal circumference, 6.25% in head circumference, 5.15%–7.85% in birth weight, and 5.71%–9.39% in birth length, respectively. Most of the above statistical results could only be observed in male fetuses. ConclusionsOur findings suggest a potential association between Sr concentration and increased fetal growth, but these results and underlying mechanisms need further confirmation and clarification.

The Association Between Maternal Short Stature and Neonatal Intensive Care Unit Admission: A Longitudinal Study in Sabah.

The rising number of newborns requiring neonatal intensive care unit (NICU) care poses immediate threats to their health and places emotional and financial burdens on families and healthcare systems. This study investigates the direct effect of maternal short stature on NICU admission in Sabah, Malaysia. A longitudinal study at Hospital Wanita Dan Kanak-Kanak Sabah (HWKKS) from 2018 to 2022 included 254 Malaysian women with singleton pregnancies and neonates born after the 37th week, excluding significant disorders, smoking/alcohol use, fetal death, and malformations. Birth weight, gestational age, and neonatal condition were recorded. The association between maternal height, low birth weight(LBW), and NICU admission was analyzed. LBW prevalence was 15.35%, with an average participant height of 147.37 cm. Maternal stature was significantly associated with LBW, with the shortest quartile (Q1) having the highest risk. LBW was significantly associated with NICU admission, with LBW newborns at a sixfold higher risk. Maternal height was also significantly associated with NICU admission, with Q1having the highest risk. The receiver operating characteristic (ROC) curve suggested combining Q1 and Q2 for the best prediction of NICU admission, indicating that shorter mothers face a higher risk of neonates requiring NICU care. Maternal short stature could be a valuable predictor of LBW and NICU admission risk. It may be a screening tool to assess these risks in healthcare settings. However, further research is needed to explore this association's underlying mechanisms and potential interventions.

Relationship Between Gestational Weight Gain and Health Service Utilization in Early Childhood: A Retrospective Cohort Study.

Gestational weight gain (GWG) outside recommended ranges can negatively impact both the woman and child. The long-term effects of below-recommended or above-recommended GWG on the child are unclear. This retrospective cohort study used a population-based birth registry of 258,005 live births to evaluate the relationship between maternal GWG and paediatric health service use. The results suggest below recommended GWG in underweight women in particular is associated with an increased rate of hospitalizations and specialist visits for the child in the first 24months. Findings indicate that GWG may impact paediatric outcomes in ways that depend on pre-pregnancy body mass index, as derived from maternal height and weight measures.

Magnitude and Factors Associated with Gestational Weight Gain Adequacy among Pregnant Women in South Gondar Zone, Northwest Ethiopia

BackgroundWeight gain during pregnancy depends on the maternal prepregnancy weight and height. Inappropriate weight gain has negative consequences, including the health care system and society because of its adverse birth outcomes. ObjectiveThis study aimed to assess the magnitude and factors associated with gestational weight gain in Northwest Ethiopia. MethodsFrom September 2018 to June 2019, a community-based prospective follow-up study was conducted in Northwest Ethiopia. A total of 422 pregnant women were followed from conception to delivery and the data were collected using a multistage sampling technique. Stata 14 standard edition (SE) software was used for data analysis. Multinomial logistic regression was used to determine the relationship between dependent and independent variables. P value of ≤0.05 was used to determine statistical significance. ResultsMajority of the participants had normal weight gain [65.12%, 95% confidence interval (CI): 60.08, 69.85]. Besides this, the rate of inadequate and overadequate weight gain was 21.53% (95% CI: 17.60, 26.05) and 13.35% (95% CI: 10.22, 17.25), respectively. Inadequate weight gain was linked to meal frequency [adjusted odd ratio (AOR): 0.52, 95% CI: 0.28, 0.97], targeted supplementary feeding program (TSFP) enrollment (AOR: 2.47; 95% CI: 1.35, 4.50), parity (AOR: 0.18; 95% CI: 0.05, 0.62), and alcohol consumption history (AOR: 0.47; 95% CI: 0.25, 0.88), whereas overadequate weight gain was associated with residency (AOR: 5.22; 95% CI: 2.43, 11.22) and TSFP status (AOR: 2.22; 95% CI: 1.08, 4.57). ConclusionsThis study revealed a notable magnitude of both inadequate and overadequate weight gain. It found that good meal frequency, alcohol consumption, parity, and TSFP enrollment were associated with a reduced risk of inadequate weight gain during pregnancy. In addition, the study identified residence and TSFP enrollment as factors linked to overadequate weight gain during pregnancy.

Association between small-for-gestational age and poor school performance in 2 500 000 children born 1973-2002.

To examine the association between infant weight for gestational age and school performance when leaving school at 16 years of age. Out of 2 525 571 infants born near- or at term, between 1 January 1973 and 31 December 2002, identified from the Swedish Medical Birth Register, 65 912 (2.6%) were born small-for-gestational age (SGA). Outcomes studied were the risk for the need for education in special school, and the final average grades. Modified Poisson regression analyses and weighted linear regression analyses were performed. An association between SGA and the need for a special school was found, irrespective of restrictions or adjustments (RR between 2.47 and 2.25). SGA was associated with final grades below the 10th and 25th percentile (RR 1.49 and 1.18, respectively). A linear relationship between maternal height and the RR for education in special school (p = 0.005), suggested that SGA is a stronger risk factor among children of tall than of shorter women. SGA increased the risk for poor school performance, and for the need for a special school. We found an association between maternal height and school performance in relation to birthweight, suggesting that maternal height should be considered when estimating the impact of SGA on later outcomes.

Correlation Between The Body Height Of Pregnant Mother With The Case Of Cephalopelvic Disproportion (CPD) At The General Hospital In Mandau Subdistrict Bengkalis Regency

Cephalopelvic Disproportion (CPD) is a condition that describes a discrepancy between maternal and fetal pelvic capacity caused by maternal pelvic abnormalities (pelvic bone size and architecture) or abnormalities in the fetal head (size or presentation) or a combination of both. The dominance of sectio caesarea surgery for cephalopelvic disproportion according to the Basic Health Research Survey in Indonesia in 2010 was quite high at 4.40% of all childbirths. Factors affecting cephalopelvic disproportion can be influenced by both mother and baby. Factors of the mother include body height less than 145 cm, and, the size of the outer and inner pelvis is below normal that the baby is unable to pass through whereas factors in the baby is that the large baby size. Previous studies on pregnant women found that the majority of those who experienced cephalopelvic disproportion were mothers with short postures or a body height of less than 145 cm. Objective : To determine the relationship between maternal height and the incidence of cephalopelvic disproportion at the General Hospital in Mandau Subdistrict, Bengkalis Regency period 1 January - 31 December 2017. Method : This type of research is analytic observational with cross sectional design. The sampling technique used is simple random sampling. The sample in this study amounted to 253 respondents. Data for height and incidence of CPD using medical record records of Mandau District Hospital Bengkalis Regency period 1 January - 31 December 2017. The data obtained will then be analyzed using the Spearman correlation test. Results : There was a significant relationship between the height of pregnant women with the incidence of CPD in the District Hospital of Mandau, Bengkalis Regency, period 1 January - 31 December 2017 with a p value of 0.00 (p &lt;0,01) and correlation coefficient (r=-0,737) with strength relationship is very strong and negative direction. Conclusion : There is a significant relationship between the height of pregnant women with the incidence of CPD in the District Hospital of Mandau, Bengkalis Regency, period 1 January - 31 December 2017.

SAT348 Changes In BMI Z-score After Presentation For Early Breast Budding Is Associated With Rapidly Progressive Puberty And Treatment With GnRH Analogues

Abstract Disclosure: H. Jung: None. J. Cho: None. K. Shim: None. Introduction: Childhood overweight and obesity are associated with earlier pubertal timing, especially in girls. We aimed to identify different body mass index (BMI) trajectories in patients presenting for breast budding between 5 and 7 years of age, and investigated whether the change in BMI z-scores during follow up is associated with rapid progression of puberty and eventual treatment with gonadotropin-releasing hormone (GnRH) analogues. Methods: We retrospectively reviewed girls who presented with breast budding at 5 to 7 years of age, between March 2016 and May 2021 at a single center. Those 206 girls, who had more than 3 follow up BMI measurements to more than 9 years of age were included in the study. The girls were grouped according to whether BMI z-scores increased or decreased/remain unchanged overall during follow-up. The BMI z-score changes over time (age) were also assessed for latent class trajectories. The risk of progression to rapid progressive puberty requiring treatment with GnRH analogues was analyzed according to overall changes in BMI z-scores and the different BMI trajectory groups, with adjustment for birthweight, gestational age, maternal menarche, maternal height, as well as the initial age, height, and bone age at presentation. Results: The mean age at presentation for breast budding was 7.1±0.7 years. A greater proportion of girls whose BMI z-scores increased during follow up, required treatment with GnRH analogues (n=53, 64%) compared to those whose BMI z-scores decreased or remained unchanged (n=54, 44%). Girls with increases in BMI z-scores during follow up (n=83) had increased risk (OR 4.68, 95% CI 1.88-11.63, p = 0.001) for rapid progressive puberty and treatment with GnRH analogues compared to those girls with decreases/no changes (n=123) in BMI z-scores, even after adjustment for covariates. Further analysis showed that increases in BMI z-scores even in those of normal weight status, were associated with increased OR (4.88) for treatment. Through latent class mixed modelling analysis, we identified 2 different trajectories (high and increasing BMI z-scores, n=72; and decreasing BMI z-scores, n=134). Risk for rapid progression of puberty and eventual treatment with GnRH analogues did not differ significantly between the different latent class trajectories. Conclusions: Increases in BMI z-scores during the follow up period after presentation for early breast budding may be associated with increased risk for rapid progression of puberty and treatment with GnRH analogues. Analysis of a larger group of patients may allow for better assessment of latent class BMI z-score trajectories. Presentation: Saturday, June 17, 2023

Prenatal exposure to metal mixtures and lung function in children from the New Hampshire birth cohort study

Prenatal exposure to metals/metalloids, even at common US population levels, may pose risks to fetal health, and affect children's lung function. Yet, the combined effects of simultaneous prenatal exposures on children's lung function remain largely unexplored. This study analyzed 11 metals (As speciation, Cd, Co, Cu, Mo, Ni, Pb, Sb, Se, Sn, Zn) in maternal urine during weeks 24–28 of gestation and evaluated lung function, including forced vital capacity (FVC) and forced expiratory volume in the first second of expiration (FEV1), in 316 US mother-child pairs at around age 7. We used Bayesian Kernel Machine Regression (BKMR), weighted quantile sum regression (WQSR), and multiple linear regression to examine the association between metal mixture exposure and children's lung function, adjusting for maternal smoking, child age, sex, and height. In BKMR models assessing combined exposure effects, limited evidence of metal non-linearity or interactions was found. Nevertheless, Co, As species, and Pb showed a negative association, while Mo exhibited a positive association with children's FVC and FEV1, with other metals held constant at their medians. The weighted index, from WQSR analysis assessing the cumulative impact of all metals, highlighted prenatal Mo with the highest positive weight, and Co, As, and Sb with the most substantial negative weights on children's FVC and FEV1. Urinary Co and Pb were negatively associated with FVC (β = −0.09, 95% confidence interval (CI) (−0.18; −0.01) and β = −0.07, 95% CI (−0.13; 0.00), respectively). Co was also negatively associated with FEV1 (β = −0.09, 95% CI (−0.18; 0.00). There was a negative association between As and FVC, and a positive association between Mo and both FVC and FEV1, though with wide confidence intervals. Our findings suggest that prenatal trace element exposures may impact children's lung function, emphasizing the importance of reducing toxic exposures and maintaining adequate nutrient levels.

Glycosylated fibronectin improves first-trimester prediction of pre-eclampsia.

To determine whether maternal serum glycosylated fibronectin (GlyFn) level in the first trimester increases the sensitivity of the Fetal Medicine Foundation (FMF) triple test, which incorporates mean arterial pressure, uterine artery pulsatility index and placental growth factor, when screening for pre-eclampsia (PE) in an Asian population. This was a nested case-control study of Chinese women with a singleton pregnancy who were screened for PE at 11-13 weeks' gestation as part of a non-intervention study between December 2016 and June 2018. GlyFn levels were measured retrospectively in archived serum from 1685 pregnancies, including 101 with PE, using an enzyme-linked immunosorbent assay (ELISA), and from 448 pregnancies, including 101 with PE, using a point-of-care (POC) device. Concordance between ELISA and POC tests was assessed using Lin's correlation coefficient and Passing-Bablok and Bland-Altman analyses. GlyFn was transformed into multiples of the median (MoM) to adjust for maternal and pregnancy characteristics. GlyFn MoM was compared between PE and non-PE pregnancies, and the association between GlyFn MoM and gestational age at delivery with PE was assessed. Risk for developing PE was estimated using the FMF competing-risks model. Screening performance for preterm and any-onset PE using different biomarker combinations was quantified by area under the receiver-operating-characteristics curve (AUC) and detection rate (DR) at a 10% fixed false-positive rate (FPR). Differences in AUC between biomarker combinations were compared using the DeLong test. The concordance correlation coefficient between ELISA and POC measurements was 0.86 (95% CI, 0.83-0.88). Passing-Bablok analysis indicated proportional bias (slope, 1.08 (95% CI, 1.04-1.14)), with POC GlyFn being significantly higher compared with ELISA GlyFn. ELISA GlyFn in non-PE pregnancies was independent of gestational age at screening (P = 0.11), but significantly dependent on maternal age (P < 0.003), weight (P < 0.0002), height (P = 0.001), parity (P < 0.02) and smoking status (P = 0.002). Compared with non-PE pregnancies, median GlyFn MoM using ELISA and POC testing was elevated significantly in those with preterm PE (1.23 vs 1.00; P < 0.0001 and 1.18 vs 1.00; P < 0.0001, respectively) and those with term PE (1.26 vs 1.00; P < 0.0001 and 1.22 vs 1.00; P < 0.0001, respectively). GlyFn MoM was not correlated with gestational age at delivery with PE (P = 0.989). Adding GlyFn to the FMF triple test for preterm PE increased significantly the AUC from 0.859 to 0.896 (P = 0.012) and increased the DR at 10% FPR from 64.9% (95% CI, 48.7-81.1%) to 82.9% (95% CI, 66.4-93.4%). The corresponding DRs at 10% FPR for any-onset PE were 52.5% (95% CI, 42.3-62.5%) and 65.4% (95% CI, 55.2-74.5%), respectively. Adding GlyFn to the FMF triple test increased the screening sensitivity for both preterm and any-onset PE in an Asian population. Prospective non-intervention studies are needed to confirm these initial findings. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Novel Three-Dimensional Body Scan Anthropometry versus MR-Pelvimetry for Vaginal Breech Delivery Assessment.

In this prospective, monocentric study, we investigated the potency of a novel three-dimensional (3D) body scanner for external pelvic assessment in birth planning for intended vaginal breech delivery. Between April 2021 and June 2022, 73 singleton pregnancies with intended vaginal birth from breech presentation (>36.0 weeks of gestation) were measured using a pelvimeter by Martin, a three-dimensional body scanner, and MR-pelvimetry. Measures were related to vaginal birth and intrapartum cesarean section. A total of 26 outer pelvic dimensions and 7 inner pelvic measurements were determined. The rate of successful vaginal breech delivery was 56.9%. The AUC (area under the curve) of the obstetric conjugate (OC) measured by MRI for predicting the primary outcome was 0.62 (OR 0.63; p = 0.22), adjusted for neonatal birth weight 0.66 (OR 0.60; p = 0.19). Of the 22 measured 3D body scanner values, the ratio of waist girth to maternal height showed the best prediction (AUC = 0.71; OR 1.27; p = 0.015). The best predictive pelvimeter value was the distantia spinarum with an AUC of 0.65 (OR = 0.80). The 3D body scanner technique is at least equal to predict successful vaginal breech delivery compared to MRI diagnostics. Further large-scale, prospective studies are needed to verify these results.

Do neonatal birth weight thresholds for labor dystocia outcomes differ between short and normal stature women?

To determine if there is a correlation between maternal short stature and neonatal birth weight among women with adverse outcomes related to labor dystocia. The medical records of singleton deliveries with adverse obstetric outcomes related to labor dystocia during 2014-2020, in a single tertiary center, were reviewed. Outcomes included at least one of the following: cesarean delivery (CD) due to cephalopelvic disproportion (CPD), prolonged second stage, shoulder dystocia, third- or fourth-degree perineal tear. Maternal short stature was defined as height below the 10th centile (short stature group) and normal stature was defined as maternal height between the 10th and 90th centiles (normal stature group). Maternal and neonatal characteristics were compared between the groups. A total of 3295 women were included, among them, 307 in the short stature group (9.3%, height 1.52 ± 0.02 m) and 2988 in the normal stature group (90.7%, height 1.63 ± 0.04 m). Evaluating the entire cohort revealed similar neonatal birth weights comparing the short and normal stature groups. A subgroup analysis of women after CD due to CPD (n = 296) revealed lower neonatal birth weights in the short stature group (n = 31) compared with the normal stature group (n = 265) (3215 ± 411 vs 3484 ± 427 g, P = 0.001, respectively). Multivariable linear regression was performed for women who underwent CD due to CPD. After adjusting for obesity and diabetes mellitus, short stature and nulliparity were found to be independently associated with decreased neonatal birth weight (266 g less for short stature, P = 0.001, and 294 g less for nulliparity, P = 0.001). Among women with short stature, CD due to CPD occurs at lower neonatal birth weights.

Water Sanitation and Hygiene (WASH) and feeding patterns: Linkages with stunting among children aged 6-23 months

Stunting is still a significant public health problem in Indonesia. The interaction between the inadequacy of feeding practices and Water, Sanitation, and Hygiene (WASH) are the direct causes of stunting. The study aimed to assess the relationship between WASH and child feeding patterns with stunting among children aged 6-23 months. The study used a cross-sectional design conducted in July-August 2022 in the working area of Simbang Community Health Center, Maros Regency. Samples of 90 children aged 6-23 months were selected by simple random sampling. Data on sociodemographic, WASH and feeding patterns were collected by interview using a questionnaire. Stunting was measured by a height-for-age z-score. Data were analyzed using the Chi-square test and Logistic Regression. The results showed that the prevalence of stunting was 31,1%. Mother's age &lt;20 years, low maternal height, sex of child, non-exclusive breastfeeding, complementary feeding started, the poor sewage management and availability of latrines related to stunting (p&lt;0,05). Multivariate test results showed low maternal height (p=0,005; OR=21,015), sex of child (p=0,001; OR=22,332), poor sewage management (p=0,008; OR=10,992), and non-exclusive breastfeeding (p=0,002; OR=20,509) has a significant effect on stunting. In conclusion, the WASH and inadequacy of feeding practices contribute to stunting.

Reference ranges for third-trimester maternal cardiovascular function parameters measured in normotensive pregnant women using a non-invasive cardiac output monitor: A study based on data from the prospective PEACH cohort study.

We defined reference ranges for maternal cardiac output, systemic vascular resistance, and stroke volume measured in the third trimester of pregnancy using the Ultrasound Cardiac Output Monitor 1A. Based on data from the prospective PEACH (PreEclampsia, Angiogenesis, Cardiac dysfunction and Hypertension) cohort study. Rigshospitalet and Hvidovre Hospital, Denmark. Normotensive pregnant women aged 18-45 years with singleton pregnancies, enrolled in the PEACH study in 2016-2018. We modelled cardiac output, systemic vascular resistance and stroke volume as a function of gestational age using multilevel linear models with fractional polynomials. Unconditional and conditional reference ranges for cardiovascular parameters measured in gestational weeks 28-40. Our study cohort included 405 healthy pregnant women who contributed 1210 cardiovascular function measurements for analysis. Maximum cardiac output and stroke volume values were measured in gestational weeks 30-32 and decreased over the third trimester, whereas systemic vascular resistance increased during the same period. We created reference ranges for eight combinations of maternal height, age and parity. We also created a simple calculator to allow for implementation of the reference ranges in clinical practice. Our reference ranges allow the use of a bedside ultrasound device to non-invasively assess cardiac function in pregnancy and identify women at risk of complications. The unconditional ranges allow clinicians to evaluate isolated measurements and identify women needing follow-up. The conditional ranges incorporate information from previous measurements and improve monitoring over time.

Screening for pre-eclampsia by maternal serum glycosylated fibronectin at 11-13 weeks' gestation.

To examine the performance of screening for preterm and term pre-eclampsia (PE) at 11-13 weeks' gestation by maternal factors and combinations of maternal serum glycosylated fibronectin (GlyFn), mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF). This was a case-control study in which maternal serum GlyFn was measured using a point-of-care device in stored samples from a non-intervention screening study of singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation. In the same samples, PlGF was measured by time-resolved fluorometry. We used samples from women who delivered with PE at < 37 weeks' gestation (n = 100), PE at ≥ 37 weeks (n = 100), gestational hypertension (GH) at < 37 weeks (n = 100), GH at ≥ 37 weeks (n = 100) and 1000 normotensive controls with no pregnancy complications. In all cases, MAP and UtA-PI had been measured during the routine 11-13-week visit. Levels of GlyFn were transformed to multiples of the expected median (MoM) values after adjusting for maternal demographic characteristics and elements of medical history. Similarly, the measured values of MAP, UtA-PI and PlGF were converted to MoMs. The competing-risks model was used to combine the prior distribution of gestational age at delivery with PE, obtained from maternal characteristics, with various combinations of biomarker MoM values to derive the patient-specific risks of delivery with PE or GH at < 37 and ≥ 37 weeks' gestation. Screening performance was estimated by examining the area under the receiver-operating-characteristics curve (AUC) and detection rate (DR) at 10% fixed false-positive rate (FPR). The maternal characteristics and elements of medical history with a significant effect on the measurement of GlyFn were maternal age, weight, height, race, smoking status and history of PE. In pregnancies that developed PE, GlyFn MoM was increased and the deviation from normal decreased with increasing gestational age at delivery. The DR and AUC of screening for delivery with PE at < 37 weeks' gestation by maternal factors alone were 50% and 0.834, respectively, and these increased to 80% and 0.949, respectively, when maternal risk factors were combined with MAP, UtA-PI and PlGF (triple test). The performance of the triple test was similar to that of screening by a combination of maternal factors, MAP, UtA-PI and GlyFn (DR, 79%; AUC, 0.946) and that of screening by a combination of maternal factors, MAP, PlGF and GlyFn (DR, 81%; AUC, 0.932). The performance of screening for delivery with PE at ≥ 37 weeks' gestation was poor; the DR for screening by maternal factors alone was 35% and increased to only 39% with use of the triple test. Similar results were obtained when GlyFn replaced PlGF or UtA-PI in the triple test. The DR of screening for GH with delivery at < 37 and ≥ 37 weeks' gestation by maternal factors alone was 34% and 25%, respectively, and increased to 54% and 31%, respectively, with use of the triple test. Similar results were obtained when GlyFn replaced PlGF or UtA-PI in the triple test. GlyFn is a potentially useful biomarker in first-trimester screening for preterm PE, but the findings of this case-control study need to be validated by prospective screening studies. The performance of screening for term PE or GH at 11 + 0 to 13 + 6 weeks' gestation by any combination of biomarkers is poor. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Early Puberty Suppression and Gender-Affirming Hormones do not Alter Final Height in Transgender Adolescents.

Early puberty suppression (ePS; Tanner stage 2-3) through Gonadotropin-Releasing Hormone agonists (GnRHa) and gender-affirming hormones (GAH) interferes with growth and may impact final height (FH). To investigate the impact of ePS and GAH on FH in trans boys and trans girls. Retrospective study, including 10 trans boys and 22 trans girls at FH. Bone age (BA) was determined at start of ePS and at start of GAH according to Greulich & Pyle; predicted adult height (PAH) was calculated according to Bayley & Pinneau's tables; target height (TH) was calculated as adjusted mean of maternal and paternal height. TH, PAH and BA were determined according to sex registered at birth (SRAB) and experienced gender (EG). The age at start of PS was 12.37 ± 0.74 years in trans boys and 13.10 ± 1.12 years in trans girls. Total height gain since start of ePS in trans boys was 14.62 ± 4.08 cm, with 70% achieved before start of GAH. In trans girls it was 20.68 ± 7.66 cm, with 61% achieved before GAH. TH for SRAB was the most accurate predictor for FH in both trans boys and girls: the difference with FH was 1.57 cm ± 3.1 (p = 0.168) and -0.98 cm ± 4.17 (p = 0.319) respectively. Also the difference between FH and PAH at the start of PS for SRAB was non-significant in both trans boys and girls (2.62 cm ± 3.79, p = 0.056 and -2.35 cm ± 5.2, p = 0.051, respectively). ePS and GAH do not impact FH, supporting the safety of the treatment; however trans adolescents achieve a FH in line with SRAB, rather than EG.

Risk factors for neonatal mortality: an observational cohort study in Sarlahi district of rural southern Nepal

ObjectivesTo assess the association between maternal characteristics, adverse birth outcomes (small-for-gestational-age (SGA) and/or preterm) and neonatal mortality in rural Nepal.DesignThis is a secondary observational analysis to identify risk factors for...

Comparison of Michaelis Rhombus, Height and Foot Length of Patient in Prediction of Mode of Delivery

Background: The Michaelis rhombus, a diamond-shaped area in the lower back is easy to measure. During labor it is thought to move posteriorly, pushing out the wings of the ileum and increasing the diameter of the pelvis. Comparison of Michaelis Rhombus, height and foot length of patient in has been used as a simple means to identify women at risk of cephalo-pelvic disproportion and help in prediction of a safe mode of delivery. Aim and Objective: The present study was conducted to evaluate the Michaelis rhombus as predictor of contracted pelvis and to compare its efficacy to other measures like maternal height and foot length of labouring and or antenatal mothers. Method: This is a Prospective Observational comparative study conducted on 220 antenatal pregnant women who were admitted at the Department of Obstetrics and Gynaecology, R. D. Gardi Medical college and C.R.G. Hospital, Surasa, Ujjain (M.P.), India. This study was carried out on pregnant women in the age group of 19-35 years, which were coming for delivery in our hospital with gestational age &gt;36 weeks. Result: Out of 220 subjects 190 delivered by normal delivery and 30 subjects by LSCS. Transverse diagonal was significantly lower in LSCS mean 9.53±0.69 cm as compared to normal delivery where transverse diagonal [mean 10.59±0.55 cm] (p = 0.000). Vertical diagonal was lower in LSCS cases (mean 10.73±0.87 cm) as compare to normal delivery where vertical diagonal (mean 11.94±0.73 cm). Foot length was significantly lower in LSCS cases with mean 23.12±1.28 cm as compared to normal delivery with mean 24.48±1.05 cm. Height was significantly lower in LSCS cases with mean 148.23±5.56 cm as compared to normal delivery with mean 153.94±3.31 cm. Conclusion: Anthropometric parameters like Michaelis rhombus, height, foot length can be used as predictor of contracted pelvis. These measurements help to increase ease of patient for clinical assessment of pelvis by decreasing multiple per vaginal examination, thereby decreasing chances of infection.