Maternal Stature Research Articles

Pelvimetry by Three-Dimensional Computed Tomography in Non-Pregnant Multiparous Women Who Delivered Vaginally

SummaryBackgroundWe assessed retrospectively the reference values of pelvic dimensions by 3D CT performed for non-obstetrical indications in non-pregnant multiparous women with a successful vaginal delivery. We further aimed to evaluate the impact of maternal short stature on these parameters.Material/MethodsThe 3D CT pelvimetry was performed retrospectively in 203 non-pregnant women selected consecutively if they had at least one singleton term delivery with head presentation and if there was no history of maternal or fetal birth trauma or cerebral palsy after childbirth. With standard sagittal and reformatted axial-oblique views, anteroposterior including three conjugates of pelvic inlet, transverse, posterior sagittal diameters of pelvic inlet, the plane of greatest diameter, the plane of least diameter, and pelvic outlet were measured. Selected obstetric parameters were collected.ResultsOverall, the pelvises had transverse oval appearance in inlet and size of the female pelvis. The diagonal conjugate was at least 15 mm longer than the obstetric conjugate. Women with short stature had lower maximal birth weight, and this was in accordance with their somewhat lower pelvic diameters.ConclusionsThe findings of this study present the reference values of the main planes of the true pelvis by 3D CT pelvimetry in a relatively large group of multiparous women who passed a trial of labor successfully. Overall, the pelvises had features of female pelvic bony structure although pelvic diameters were somewhat lower in multiparous women with short stature. The 3D pelvimetry with CT applications may be used as an adjunct to clinical and ultrasonographic examinations to rule out cephalopelvic dystocia in selected cases.

Maternal Height and Preterm Birth: A Study on 192,432 Swedish Women.

BackgroundThere is increasing evidence that lower maternal stature is associated with shorter gestational length in the offspring. We examined the association between maternal height and the likelihood of delivering preterm babies in a large and homogeneous cohort of Swedish women.MethodsThis study covers antenatal data from the Swedish Medical Birth Register on 192,432 women (aged 26.0 years on average) born at term, from singleton pregnancies, and of Nordic ethnicity. Continuous associations between women's heights and the likelihood of preterm birth in the offspring were evaluated. Stratified analyses were also carried out, separating women into different height categories.ResultsEvery cm decrease in maternal stature was associated with 0.2 days shortening of gestational age in the offspring (p<0.0001) and increasing odds of having a child born preterm (OR 1.03), very preterm (OR 1.03), or extremely preterm (OR 1.04). Besides, odds of all categories of preterm birth were highest among the shortest women but lowest among the tallest mothers. Specifically, women of short stature (≤155 cm or ≤-2.0 SDS below the population mean) had greater odds of having preterm (OR 1.65) or very preterm (OR 1.47) infants than women of average stature (-0.5 to 0.5 SDS). When compared to women of tall stature (≥179 cm), mothers of short stature had even greater odds of giving birth to preterm (OR 2.07) or very preterm (OR 2.16) infants.ConclusionsAmong Swedish women, decreasing height was associated with a progressive increase in the odds of having an infant born preterm. Maternal short stature is a likely contributing factor to idiopathic preterm births worldwide, possibly due to maternal anatomical constraints.

The association between maternal height and pregnancy outcomes in twin gestations

Objective: We sought to assess the association between maternal height and the risk of preterm birth, fetal growth restriction and mode of delivery in twin gestations.Study design: Cohort study of patients with twin pregnancies delivered from 2005 to 2014. We compared pregnancy outcomes between patients of short stature ≤159 cm to those of normal stature ≥160 cm. Patients with monoamniotic twins and major fetal anomalies were excluded. Pearson’s correlation, Chi-square and Student’s t-test were used as appropriate.Results: Six hundred and sixty-six patients were included, 159 (23.9%) of whom had short stature (mean height 155.8 ± 2.5 cm) and 507 (76.1%) of whom had normal stature (mean height 167.2 ± 5.5 cm). There were no differences in outcomes between the groups in regards to preterm birth, gestational age (GA) at delivery, birth weight of either twin, preeclampsia, gestational diabetes or cesarean section rate. Results were similar when the groups were stratified by parity. As a continuous variable, maternal height did not correlate with GA at delivery (p= 0.388), cesarean delivery (p = 0.522) nor the birth weight of the larger (p = 0.206) or smaller (p = 0.307) twin.Conclusion: In twin pregnancies, maternal short stature is not associated with preterm birth, fetal growth restriction or cesarean section rate. This suggests that although anthropometric measurements have long been used to counsel patients in regards to outcomes, patients of short stature should be reassured that their height does not appear to lead to adverse twin pregnancy outcomes.

Outcome of attempted vaginal delivery after a previous vacuum extraction: a population-based study.

Few studies have investigated long-term effects of a first vaginal instrumental delivery on subsequent mode of delivery. We investigated risks of repeat vacuum extraction and risk factors associated with a repeat vacuum extraction delivery. This is a population-based register study including 391 160 women with two consecutive singleton term (≥37 weeks) live births in cephalic presentation between/within the time period of 1992-2010 in Sweden. Rates and risk ratios of mode of delivery in second pregnancy in relation to primary mode of delivery were calculated using descriptive analyses and generalized linear models. Risk of repeat vacuum extraction was adjusted for maternal age and height, interpregnancy interval, gestational length, birthweight, induction, sex and occiput posterior position. Compared with women with a primary spontaneous vaginal delivery, women with a primary vacuum extraction had an almost five-fold risk of vacuum extraction delivery and nearly a three-fold risk of emergency cesarean section at second delivery. For women with a primary emergency cesarean section, corresponding risks were substantially higher. Risk factors for a repeat vacuum extraction were increasing maternal age and an interpregnancy interval >4 years, decreasing maternal stature, increasing gestation length and birthweight, induction, giving birth to a male infant and occiput posterior position. Nine of ten women who attempted a vaginal birth after a primary vacuum extraction succeeded in having a spontaneous vaginal delivery at second delivery. Compared with women with a primary spontaneous vaginal delivery, women with a primary vacuum extraction were at increased risk of repeat vacuum extraction and emergency cesarean section in subsequent delivery although their risk was not as high as that of women with a primary emergency cesarean section.

Parental Health, Households, Communities and Fetal Health in India

Fetal health is an important determinant of subsequent health or later life outcomes. In this paper, we examine whether parental human capital can substitute for low provision of quality health infrastructure in the areas of India, suffering from adverse disease environment. We use the second and third waves of the National Family Health Survey and restrict sample to first birth and born within last five year from the survey to minimize recall bias. Along with the common measures of fetal health such as birth weight and neonatal mortality, we examine two less frequent measures - likelihood of a male birth as a measure of fetal survival to term, based on the medical evidence of male fragility in utero and birth size which reflects fetal health and nutrition. For the rural areas in high infant mortality states which have low provision of quality health infrastructure and are suffering from adverse disease environment, a 10 centimeter increase in mother height is associated with more than 2% increase in likelihood of having a male child at first birth. Maternal education and stature are positively associated with other fetal health outcomes as well in this area. These associations are weaker in the areas of India where either low provision of health quality or adverse disease environment are less of a concern. Our results suggest gender specific selection in live birth can also occur purely due to biological reasons and gender of the first child may not be random in India. Moreover, intergenerational persistence in poor health status of women can arise due to biological reasons, along with son preference, given the cultural and economic context of the country. Income, access to information and other community characteristics are also associated with various dimensions of fetal health, although the relationships are not always strong or consistent.

Malnutrition and Its Determinants Are Associated with Suboptimal Cognitive, Communication, and Motor Development in Tanzanian Children1–3

Background: A large volume of literature has shown negative associations between stunting and child development; however, there is limited evidence for associations with milder forms of linear growth faltering and determinants of malnutrition in developing countries.Objective: The objective of this study was to assess the association between anthropometric growth indicators across their distribution and determinants of malnutrition with development of Tanzanian children.Methods: We used the Bayley Scales of Infant Development III to assess a cohort of 1036 Tanzanian children between 18 and 36 mo of age who were previously enrolled in a neonatal vitamin A trial. Linear regression models were used to assess standardized mean differences in child development for anthropometry z scores, along with pregnancy, delivery, and early childhood factors.Results: Height-for-age z score (HAZ) was linearly associated with cognitive, communication, and motor development z scores across the observed range in this population (all P values for linear relation < 0.05). Each unit increase in HAZ was associated with +0.09 (95% CI: 0.05, 0.13), +0.10 (95% CI: 0.07, 0.14), and +0.13 (95% CI: 0.09, 0.16) higher cognitive, communication, and motor development z scores, respectively. The relation of weight-for-height z score (WHZ) was nonlinear with only wasted children (WHZ <−2) experiencing deficits (P values for nonlinear relation < 0.05). Wasted children had −0.63 (95% CI: −0.97, −0.29), −0.32 (95% CI: −0.64, 0.01), and −0.54 (95% CI: −0.86, −0.23) z score deficits in cognitive, communication, and motor development z scores, respectively, relative to nonwasted children. Maternal stature and flush toilet use were associated with higher cognitive and motor z scores, whereas being born small for gestational age (SGA) was associated with a −0.16 (95% CI: −0.30, −0.01) z score deficit in cognition.Conclusions: Mild to severe chronic malnutrition was associated with increasing developmental deficits in Tanzanian children, whereas only wasted children exhibited developmental delays during acute malnutrition. Interventions to reduce SGA, improve sanitation, and increase maternal stature may have positive effects on child development. This trial was registered with the Australian New Zealand Clinical Trials Registry as ACTRN12610000636055.

Risk factors for chronic undernutrition among children in India: Estimating relative importance, population attributable risk and fractions

Nearly 40% of the world's stunted children live in India and the prevalence of undernutrition has been persistently high in recent decades. Given numerous available interventions for reducing undernutrition in children, it is not clear of the relative importance of each within a multifactorial framework. We assess the simultaneous contribution of 15 known risk factors for child chronic undernutrition in India. Data are from the 3rd Indian National Family Health Survey (NFHS-3), a nationally representative cross-sectional survey undertaken in 2005–2006. The study population consisted of children aged 6–59 months [n = 26,842 (stunting/low height-for-age), n = 27,483 (underweight/low weight-for-age)]. Risk factors examined for their association with undernutrition were: vitamin A supplementation, vaccination, use of iodized salt, household air quality, improved sanitary facilities, safe disposal of stools, improved drinking water, prevalence of infectious disease, initiation of breastfeeding, dietary diversity, age at marriage, maternal BMI, height, education, and household wealth. Age/sex-adjusted and multivariable adjusted effect sizes (odds ratios) were calculated for risk factors along with Population Attributable Risks (PAR) and Fractions (PAF) using logistic regression. In the mutually adjusted models, the five most important predictors of childhood stunting/underweight were short maternal stature, mother having no education, households in lowest wealth quintile, poor dietary diversity, and maternal underweight. These five factors had a combined PAR of 67.2% (95% CI: 63.3–70.7) and 69.7% (95% CI: 66.3–72.8) for stunting and underweight, respectively. The remaining factors were associated with a combined PAR of 11.7% (95% CI: 6.0–17.4) and 15.1% (95% CI: 8.9–21.3) for stunting and underweight, respectively. Implementing strategies focused on broader progress on social circumstances and infrastructural domains as well as investments in nutrition specific programs to promote dietary adequacy and diversity are required to ensure a long term trajectory of optimal child growth and development in India.

Short Maternal Stature Increases Risk of Small-for-Gestational-Age and Preterm Births in Low- and Middle-Income Countries: Individual Participant Data Meta-Analysis and Population Attributable Fraction1–3

Background: Small-for-gestational-age (SGA) and preterm births are associated with adverse health consequences, including neonatal and infant mortality, childhood undernutrition, and adulthood chronic disease.Objectives: The specific aims of this study were to estimate the association between short maternal stature and outcomes of SGA alone, preterm birth alone, or both, and to calculate the population attributable fraction of SGA and preterm birth associated with short maternal stature.Methods: We conducted an individual participant data meta-analysis with the use of data sets from 12 population-based cohort studies and the WHO Global Survey on Maternal and Perinatal Health (13 of 24 available data sets used) from low- and middle-income countries (LMIC). We included those with weight taken within 72 h of birth, gestational age, and maternal height data (n = 177,000). For each of these studies, we individually calculated RRs between height exposure categories of <145 cm, 145 to <150 cm, and 150 to <155 cm (reference: ≥155 cm) and outcomes of SGA, preterm birth, and their combination categories. SGA was defined with the use of both the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) birth weight standard and the 1991 US birth weight reference. The associations were then meta-analyzed.Results: All short stature categories were statistically significantly associated with term SGA, preterm appropriate-for-gestational-age (AGA), and preterm SGA births (reference: term AGA). When using the INTERGROWTH-21st standard to define SGA, women <145 cm had the highest adjusted risk ratios (aRRs) (term SGA—aRR: 2.03; 95% CI: 1.76, 2.35; preterm AGA—aRR: 1.45; 95% CI: 1.26, 1.66; preterm SGA—aRR: 2.13; 95% CI: 1.42, 3.21). Similar associations were seen for SGA defined by the US reference. Annually, 5.5 million term SGA (18.6% of the global total), 550,800 preterm AGA (5.0% of the global total), and 458,000 preterm SGA (16.5% of the global total) births may be associated with maternal short stature.Conclusions: Approximately 6.5 million SGA and/or preterm births in LMIC may be associated with short maternal stature annually. A reduction in this burden requires primary prevention of SGA, improvement in postnatal growth through early childhood, and possibly further intervention in late childhood and adolescence. It is vital for researchers to broaden the evidence base for addressing chronic malnutrition through multiple life stages, and for program implementers to explore effective, sustainable ways of reaching the most vulnerable populations.

The placenta is the center of the chronic disease universe

Over the past quarter century it has become clear that adult onset chronic diseases like heart disease and type 2 diabetes have their roots in early development. The report by David Barker and colleagues showing an inverse relationship between birthweight and mortality from ischemic heart disease was the first clear-cut demonstration of fetal programming. Because fetal growth depends upon the placental capacity to transport nutrients from maternal blood, it has been a suspected causative agent since the original Barker reports. Epidemiological studies have shown that placental size and shape have powerful associations with offspring disease. More recent studies have shown that maternal phenotypic characteristics, such as body mass index and height, interact with placental size and shape to predict disease with much more precision than does birthweight alone. For example, among people in the Helsinki Birth Cohort, who were born during 1924–1944, the risk for acquiring colorectal cancer increased as the placental surface became longer and more oval. Among people in whom the difference between the length and breadth of the surface exceeded 6 cm, the hazard ratio for the cancer was 2.3 (95% CI 1.2–4.7, p=0.003) compared with those in whom there was no difference. Among Finnish men, the hazard ratio for coronary heart disease was 1.07 (1.02–1.13, P =0.01) per 1% increase in the placental weight/birthweight ratio. Thus, it appears that the ratio of birthweight to placental weight, known as placental efficiency, predicts cardiovascular risk as well. Babies born with placentas at the extremes of efficiency are more vulnerable for adult onset chronic diseases. Recent evidence suggests that placental growth patterns are sex specific. Boys’ placentas are, in general, more efficient than those made by girls. Another recent discovery is that the size, shape and efficiencies of the placenta can change over years of time with very narrow confidence limits. This suggests that the growth of the placenta within a population of women is strongly affected by their nutritional environment. Even though it is known that an individual placenta can expand to improve its nutrient acquisition capacity in the first 2/3rd of gestation, the mechanisms by which placentas grow in response to a specific nutritional environment are not known. Discovering those mechanisms is the task of the current generation of scientists. While it may seem obvious that good nutrition is highly important for women who are pregnant because it supports optimal placentation and fetal development, more research is needed to determine the mechanisms by which maternal nutrition, placenta growth and fetal health are related.

Risk factors for failed vacuum extraction and associated complications in term newborn infants: a population-based cohort study

Objective: The aims of the present study were to investigate risk factors for failed vacuum extraction (VE), and to compare neonatal complications among infants delivered by failed VE with those delivered by successful VE.Methods: Population-based study including all women (and their newborn infants) with singleton pregnancy who gave birth at term by failed VE (n = 4747) or successful VE (n = 83 671) in Sweden between 1999 and 2010. Failed VE was defined as VE followed by an emergency cesarean section (ECS), forceps, or both forceps and ECS. We used logistic regression to examine the association between failed VE in relation to intracranial hemorrhage, subgaleal hemorrhage, Apgar scores <7 at 5 min, and neonatal convulsions.Results: Risk factors for failed VE included occipito posterior position, mid-pelvic fetal station, high birth weight, short maternal stature, epidural analgesia, and induction of labor. Compared with infants born after a successful VE, those delivered by failed VE had a higher risk of subgaleal hemorrhage OR 7.3 CI (5.5–9.7), convulsions OR 1.9 CI (1.4–2.7), and low Apgar OR 2.6 CI (2.3–3.0), but not of ICH.Conclusion: Failed VE is associated with neonatal complications. Fetal head position and station should be carefully assessed prior to the extraction.

Desproporción fetopélvica en un hospital de lima: prevalencia, consecuencias, predicción y prevención

OBJETIVO. Determinar las variables maternas y fetales que predicen la desproporción fetopélvica (DFP). LUGAR. Hospital Nacional Docente Madre-Niño San Bartolomé. DIISEÑO. Estudio clínico retrospectivo. PARTICIPANTES. Gestantes con detención del segundo estadio del parto y nacimiento por cesárea. INTERVENCIONES. Se revisó nuestra base de datos perinatales, del 1 de enero de 1991 al 31 de diciembre, 1999. Se definió DFP como la detención del parto durante 2 horas en nulíparas y 1 hora en multíparas, durante el segundo estadio del parto, y el nacimiento ocurrió por cesárea. Se realizó análisis de regresión logística (ARL) y ROC para predecir la DFP. PRINCIPALES MEDIDAS DE RESULTADOS. Prevalencia de DFP y condiciones asociadas. RESULTADOS. La prevalencia de DFP fue 1,28% (583/45,386). Las mujeres con DFP presentaron mayor probabilidad de talla menor de 160 cm, nuliparidad, peso pregestacional menor de 50 kg, preeclampsia, eclampsia, infección urinaria, internamiento antenatal y muerte materna (p &lt; 0,01) y los recién nacidos con DFP presentaron mayor probabilidad de PC mayor de 34 cm, rotura prematura de membranas fetales, reanimación neonatal, Ápgar menor de 7 a minutos 1 y 5, dificultad respiratoria, asfixia perinatal, sepsis, hiperbilirrubinemia, tamaño grande para la edad de gestación y admisión en UCIN (p &lt; 0,01). El riesgo de DFP en nuestra población puede establecerse como –1,069 + 0,012 PC en mm + 0,001 PRN en gramos -0,498 paridad -0,057 talla materna en cm -0,005 TRN en mm. El PC presenta mayor sensibilidad y especificidad en la identificación de DFP que el peso al nacer y que el índice ponderal neonatal (p &lt; 0,001). CONCLUSIONES. La desproporción fetopélvica ocurrió en 1,28% de los embarazos revisados y comprometió seriamente la salud y la calidad de vida de la mujer y su hijo. Se encuentran en particular riesgo la mujer nulípara con talla menor de 160 cm y el feto con PC mayor de 34 cm.

Do tall women beget larger babies?

Objective: To evaluate the possible relationship between maternal height and fetal size.Patients and methods: We used a population-based cohort of apparently healthy mothers of singletons to evaluate quartiles of the maternal height distribution for parity, being overweight or obese, and for gestational age and birth weight parameters. We also generated birth weight by gestational age curves for each quartile.Results: We analyzed data of 198 745 mothers. Mother from the four quartiles had similar parity, pre-gravid BMI, and gestational age at birth. Short mothers had a significantly higher rate of VLBW and LBW and 2501–4000 g infants, for an OR = 1.38 (95% CI: 1.17–1.62), OR = 2.2 (95% CI: 2.05–2.37) and OR = 1.82 (95% CI: 1.73–1.87) between the shortest and tallest mothers, respectively. By contrast, the opposite trend was noticed for birth weights >4000 g, for an OR = 2.77 (95% CI: 2.65–2.89) between the tallest and shortest mothers. A very similar “growth curve” was apparent until 33 weeks, when a slower growth velocity was observed for shorter compared with taller women.Conclusions: Maternal stature does not appear to be associated with gestational age but significantly influences birth weight. Height-related differences between mothers appears to begin after 33 weeks’ gestation.

Association between maternal nutritional extremes and offspring mortality: A population-based cross-sectional study, Brazil, Demographic Health Survey 2006

Objectiveto estimate the association between maternal nutritional extremes and offspring mortality in the Brazilian population. Methodsthis cross-sectional study used secondary data from Brazilian women of reproductive age obtained from the National Demographic and Health Survey 2006. Maternal anthropometric indices were used: height, body mass index (BMI), and waist circumference. Logistic regression modelling was used to evaluate the relationship between obesity and offspring mortality. The data analysis was appropriate for the complex sample design. Resultschildren of mothers of short stature were at greater risk of death in the postnatal period than children of mothers of normal height, even after adjusting for sociodemographic characteristics [odds ratio (OR) 4.54, 95% confidence interval (CI) 1.31–15.77]. Maternal obesity was associated with mortality, and children whose mothers were abdominally obese were at greater risk of dying in the neonatal period (OR 3.19, 95% CI 1.23–8.27). Children of mothers who were overweight or obese (BMI≥25kg/m2) were at greater risk of dying in the neonatal period (OR 2.41, 95% CI 1.12–5.16), and children of malnourished mothers (BMI<18.5kg/m2) were at greater risk of dying during the postneonatal period (OR 9.47, 95% CI 2.07–43.41). Conclusionmaternal obesity is a risk factor for neonatal death, maternal malnutrition is a risk factor for postneonatal death, and maternal short stature is a risk factor for mortality among Brazilian children.

Shorter mothers have shorter pregnancies

We assessed whether maternal height was associated with gestational age in a cohort of 294 children born at term. Increasing maternal height was associated with longer pregnancy duration (p = 0.002). Stratified analyses showed that the main effect on pregnancy length appears to occur among shorter mothers (<165 cm tall), whose pregnancies were ∼0.6 and ∼0.7 weeks shorter than pregnancies of mothers 165–170 cm (p = 0.0009) and >170 cm (p = 0.0002) tall, respectively. Further, children of shorter mothers were more likely to be born early term than those of average height (p = 0.021) and taller (p = 0.0003) mothers. Maternal stature is likely to be a contributing factor influencing long-term outcomes in the offspring via its effect on pregnancy length.

The intergenerational effects on birth weight and its relations to maternal conditions, São Paulo, Brazil.

Background and Objectives. Parents' birth weight acts as a predictor for the descendant birth weight, with the correlation more strongly transmitted through maternal line. The present research aims to study the correlation between the child's low or increased birth weight, the mother's birth weight, and maternal conditions. Methods. 773 mother-infant binomials were identified with information on both the baby's and the mother's birth weight recorded. Group studies were constituted, dividing the sample according to birth weight (<2,500 grams (g) and ≥3,500 grams (g)). The length at birth was also studied in children ≤47.5 cm (lower quartile). Chi2 test or Fisher's exact test, Spearman's Rho, and odds ratio were performed in order to investigate the relation between the children's weight and length at birth and the mothers' and children's variables. Results. The girls were heavier at birth than their mothers, with an average increase at birth weight between the generations of 79 g. The child's birth weight <2,500 g did not show any correlation with maternal birth weight <2,500 g (Fisher 0.264; Spearman's Rho 0.048; OR 2.1 and OR lower 0.7) or with maternal stature below the lower quartile (<157 cm) (Chi 2 sig 0.323; with Spearman's Rho 0.036; OR 1.5 and OR lower 0.7). The child's low birth weight (<2,500 g) was lightly correlated with drug use by the mother during pregnancy (Fisher 0.083; Spearman's Rho 0.080; OR 4.9 and OR lower 1.0). The child's birth weight <2,500 g showed increased correlation with gestational age lower than 38 weeks and 3 days (Chi 2 sig 0.002; Spearman's Rho 0.113; OR 3.2 and OR lower 1.5). The child's weight at birth ≥3,500 g showed strong correlation with maternal weight at birth ≥3,500 g (Chi 2 sig 0; Spearman's Rho +0.142; OR 0.5 and OR upper 0.7). It was also revealed that the higher the maternal prepregnancy BMI, the stronger the correlation with child's birth weight ≥3,500 g ((maternal prepregnancy BMI > 25.0 with Chi 2 sig 0.013; Spearman's Rho 0.09; OR 1.54 and OR upper 2.17) and (maternal prepregnancy BMI > 30.0 with Chi 2 sig 0 Spearman's Rho 0.137; OR 2.58 and OR upper 4.26)). The child's length at birth in the lower quartile (≤47.5 cm) showed strong correlation with drug use by the mother during pregnancy (Chi 2 sig 0.004; Spearman's Rho 0.105; OR 4.3 and OR lower 1.5). Conclusions. The mother's increased weight at birth and the prenatal overweight or obesity were correlated with increased weight and length at birth of the newborn, coupled with the tendency of increasing birth weight between generations of mothers and daughters. Also, descendants with smaller length at birth are the children of women with the lowest statures.

Nutritional and Reproductive Risk Factors for Small for Gestational Age and Preterm Births.

Approximately 32.4 million small for gestational age (SGA) babies and 13.7 million preterm babies are born annually in low- and middle-income countries (LMICs), of whom 2.8 million are both SGA and preterm. These newborns who are born too small and/or too soon not only experience heightened risk of neonatal and infant mortality, but also of long-term morbidities, like adulthood chronic disease. In order to reduce these burdens worldwide, it is critical to identify and understand the epidemiology of the risk factors that contribute to SGA and preterm births. As part of the Child Health Epidemiology Reference Group, we explored nutritional and reproductive health-related maternal risk factors associated with SGA and preterm outcomes in LMICs, including short maternal stature, young/advanced maternal age, low/high parity, and short birth interval. In this chapter, we highlight our findings and relevant existing literature, and also summarize literature on how low/high BMI and low weight gain during pregnancy, respectively, are associated with SGA and/or preterm outcomes.

Fetal Ci̇nsi̇yeti̇n Ultrasonografi̇k Fetal Bi̇yometri̇k Parametreler Üzeri̇ne Etkisi (The Impact of the Fetal Gender on Ultrasonographic Fetal Biometric Parameters)

Objective: One of the most important parameters to assess the fetal well-being status is fetal weight. It has been known that fetal weight is effected by many characteristics such as maternal weight, stature, smoking habit, parity and ethnicity in addition to fetal gender. In the present study our aim was to assess whether fetal gender had any impact on ultrasonographic BPD, HC, AC, FL and EFW measurements in low-risk singleton pregnancies. Material and Methods: Fetal ultrasonographic measurements were made on the 15-22, 23-26, 27-30, 31-34, 35-38 and 39-40th weeks of gestation seperately and EFWs were calculated. It was evaluated whether any significant difference existed between the two genders on these gestational weeks. Statistical analyses were made using chi-square, student’s t and Mann-Whitney U tests where appropriate.Results: In terms of actual birth weight, male newborns were significantly heavier. Of the sonographic measurements, only HC on 39-40th gestational weeks were significantly greater in male fetuses. In male fetuses there was a good-very good correlation between actual birth weight and AC and EFW. Conclusions: In our study, we determined that fetal gender does not have any impact on antenatal sonographic measurements except for HC was measured greater in male fetuses on the 39-40th gestational weeks. Moreover, it was observed that fetal sonographic parameters were significantly correlated with the actual birth weights and that there was a good correlation between EFW and actual birth weight irrespective of the fetal gender.

Gestational diabetes mellitus among Nordic Caucasian women: Prevalence and risk factors according to WHO and simplified IADPSG criteria

Background. Gestational diabetes mellitus (GDM) is associated with both maternal and offspring adverse effects. The World Health Organization (WHO) has recently adopted novel GDM criteria. The aim of this study was to evaluate the former WHO and a simplified version of the new International Association for Diabetes in Pregnancy Study Group (IADPSG) criteria as to prevalence of and risk factors for GDM in a Nordic Caucasian population. Methods. A 75 g oral glucose tolerance test was performed in 687 women at 18–22 and 32–36 pregnancy weeks. GDM was defined according to the WHO criteria as fasting plasma glucose ≥ 7.0 mmol/L and/or 2-hour plasma glucose ≥ 7.8 mmol/L and by a simplified version of the IADPSG criteria as either fasting glucose ≥ 5.1 mmol/L and/or 2-h plasma glucose ≥ 8.5 mmol/L. One-hour glucose values were not available and were thus not included in the diagnosis of GDM by IADPSG. Prevalence of GDM during pregnancy and risk factors for GDM at 18–22 weeks were studied in retrospect according to each of the two criteria. Results. The total prevalence of GDM during pregnancy was 6.1% (42/687) for the WHO criteria and 7.4% (51/687) for the simplified IADPSG criteria. High maternal age and short stature were independently associated with WHO GDM. Maternal age, fasting insulin and no regular exercise at 18–22 pregnancy weeks associated with simplified IADPSG GDM. Conclusions. Simplified IADPSG criteria moderately increase GDM prevalence compared with the WHO criteria. Risk factors for GDM differ with the diagnostic criteria used.

Risk factors of stunting in preschool children: a case-control study

This article seeks to establish risk factors for mild and moderate stunting among preschool children attending public daycare centers. It involves a case-control study with 67 pairs of children. Cases defined as children with height/age between -1 and -2 Z-scores were paired with controls between -1 Z-score and the median, while cases with height/age < -2 Z-scores were paired with controls with height/age > median to +1 Z-score. The sex and age of the child was used for pairing purposes. The final model of hierarchical multivariate analysis indicated a greater chance of stunting in the following groups of preschoolers: family income < 1/2 Minimum Wage, squatted/courtesy house, number of individuals in the household ≥ 6, maternal age at child's birth < 20 years, low maternal stature, incomplete immunization program, low birth weight. Stunting is determined by adverse socioeconomic conditions and the characteristics of children reflecting health care (maternal height and child variables).

Factors associated with stunting in Ethiopian children under 5: a comparison of DHS 2000, 2005 and 2011 (620.6)

Background: 44% of Ethiopian children are stunted, negatively impacting physical and mental development. A conceptual hierarchical framework that categorizes risk factors into inherent, distal, intermediate and proximal has been used to examine risk factors associated with stunting.Objective: Identify factors associated with stunting using a conceptual hierarchical framework and examine trends in these factors over time among children under 5 in Ethiopia.Methods: Data from DHS (Demographic and Health Survey) 2000, 2005 and 2011 were analyzed. Step‐wise multivariate logistic regression was performed keeping only those factors with a significance of 0.1 or less.Results: In 2011, factors associated with a significantly higher risk of stunting included being a boy, increased age, mother with no or only primary school education, lower SES, short birth interval, small birth size, small maternal stature, low maternal BMI and having a diarrhea episode in the last 2 weeks. Stunting has reduced significantly across the three surveys. There is only slight difference in risk factors over the years. In all three surveys, infants with small birth size are 1.5 times more likely to be stunted (p&lt;0.05), diarrhea is associated with about 1.2‐1.3 times the risk of being stunted and for every cm increase in maternal stature, an infant is about 10% less likely to be stunted. In the 2011 survey, for every unit increase in BMI, the children are 5% less likely to be stunted.Conclusions: Controlling for the effects mediated through education and wealth, birth interval, size at birth, maternal height, maternal BMI and diarrhea are still significant predictors of stunting in Ethiopian children.