Mean Birth Weight Of Neonates Research Articles

Associations of neonatal high birth weight with maternal pre-pregnancy body mass index and gestational weight gain: a case–control study in women from Chongqing, China

ObjectivesTo examine the associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with neonatal high birth weight (HBW) in a sample of Chinese women living in...

Effect of Maternal Nutritional Status on Birth Outcome

The present cross-sectional descriptive study was conducted to assess the nutritional status, maternal haemoglobin concentration, anthropometric details and its association with neonatal anthropometry. 200 pregnant women aged 18-37 years in the gestational age of 27-41 weeks, without any co-morbidity and having a complete medical record were included in the study. Pregnant women who were in labour in the maternity ward and had visited the tertiary centre in Mumbai for antenatal checkups were enrolled for the study. Predesigned, pretested questionnaire was used to obtain socio-demographic and pregnancy details along with 24-hour dietary recall taken prior to delivery. Maternal and neonatal anthropometry was measured by trained personnel using standardized techniques. Haemoglobin concentration prior to delivery and postpartum, birth weight and length was obtained from the hospital record. Analyses were performed using SPSS software (version 16.0) to determine the effect of nutritional status on birth outcome. P-value <0.05 was considered to be statistically significant. The mean maternal anthropometric details were height-153.13±10.39cm, postpartum weight-57.02±11.57kg, postpartum BMI-24.29±3.54kg/m 2 , haemoglobin concentration prior to delivery-11.19±1.78g/dL and post-partum-9.97±1.68g/dL. The mean neonatal birth weight was 2.77±0.50kg though 22.3% neonates had low birth weight (<2.5kg). The mean neonatal anthropometric details were length-45.72±1.14cm, MUAC-10.48±1.14cm, ponderal index-2.88±0.43g/cm 3 and MUAC/Head circumference-0.31±0.03. However, women (≥28 years) were older (+2.46 years), weighed more both pre- and post-partum and also had a higher interpregnancy interval (+1.3 years) and gravida as compared to women (≤27 years) (p<0.05). Birth outcome was influenced by maternal height, weight, postpartum BMI, haemoglobin levels prior to delivery, gestational age and nutrient intake particularly energy, protein, vitamin C and calcium. Maternal diet prior to pregnancy and during pregnancy along with maternal anthropometry, haemoglobin concentrations prior to delivery and gestational age greatly influences birth outcome. Thus, attention has to be given to nutrition of an adolescent girl by proper nutrition education, pre-pregnancy counseling which will help in better pregnancy outcome.

Perinatal outcome according to chorionicity in twins - a Polish multicenter study.

The aim of the study was to analyze the perinatal outcome of twin gestations and estimate the influence of chorionicity on the outcome in a large cohort of twin pregnancies in Poland. A retrospective analysis of 465 twin deliveries in 6 Polish centers in 2012 was conducted. Baseline characteristics, the course of pregnancy and labor, as well as the neonatal outcome were analyzed in the study group and according to chorionicity. A total of 356 twin pregnancies were dichorionic (DC group) (76.6%), and 109 were monochorionic (MC group) (23.4%). There were no differences in the occurrence of pregnancy complications according to chorionicity, except for IUGR of at least one fetus (MC 43.1% vs. DC 34.6%; p = 0.003). 66.5% of the women delivered preterm, significantly more in the MC group (78% vs. 62.9%; p = 0.004). Cesarean delivery was performed in 432 patients (92.9%). Mean neonatal birthweight was statistically lower in the MC group (2074 g vs. 2370 g; p < 0.001). Perinatal mortality of at least one twin was 4.3% (2.8% in the DC group vs. 9.2% in the MC group; p = 0.004). Neonatal complications, including NICU admission, respiratory disorders, and infections requiring antibiotic therapy, were significantly more often observed among the MC twins. The overall perinatal outcome in the presented subpopulation of Polish twins and its dependence on cho-rionicity is similar to the reports in the literature. Nevertheless, the rates of preterm and cesarean deliveries remain higher. It seems that proper counselling of pregnant women and education of obstetricians may result in reduction of these rates.

Maternal Dietary Patterns and Fetal Growth: A Large Prospective Cohort Study in China.

There was limited evidence revealing the association of Chinese maternal dietary patterns with fetal growth. We aimed to examine the relationship of maternal dietary patterns during pregnancy to neonatal birth weight and birth weight for gestational age in a Chinese population. A total of 6954 mother-child pairs were included from the Born in Guangzhou Cohort Study. Maternal diet during pregnancy was assessed using a self-administered food frequency questionnaire. Cluster analysis was used to identify dietary patterns. The following six dietary patterns were identified: “Cereals, eggs, and Cantonese soups” (n 1026, 14.8%), “Dairy” (n 1020, 14.7%), “Fruits, nuts, and Cantonese desserts” (n 799, 11.5%), “Meats” (n 1066, 15.3%), “Vegetables” (n 1383, 19.9%), and “Varied” (n 1224, 17.6%). The mean neonatal birth weight Z scores of women in the above patterns were 0.02, 0.07, 0.20, 0.01, 0.06, and 0.14, respectively. Women in the “Fruits, nuts, and Cantonese desserts” and “Varied” groups had significantly heavier infants compared with those in the “Cereals, eggs, and Cantonese soups” group. Compared with women in the “Cereals, eggs, and Cantonese soups” group, those in the “Varied” group had marginally significantly lower odds of having a small-for-gestational age (SGA) infant after adjustment for other confounders (OR 0.77, 95% CI 0.57, 1.04, p = 0.08). These findings suggest that compared to a traditional Cantonese diet high in cereals, eggs, and Cantonese soups, a diet high in fruits, nuts, and Cantonese desserts might be associated with a higher birth weight, while a varied diet might be associated with a greater birth weight and also a decreased risk of having a SGA baby.

DETERMINATION OF MATERNAL SERUM ZINC, IRON, CALCIUM AND MAGNESIUM DURING PREGNANCY IN PREGNANT WOMEN AND UMBILICAL CORD BLOOD AND THEIR ASSOCIATION WITH OUTCOME OF PREGNANCY.

Background:Trace elements and specially minerals are critical for the development of fetus. Many minerals are transferred to the fetus for fetal stores in the latter part of the pregnancy. It has been shown that various trace elements such as Zinc, Iron, Calcium and Magnesium are metabolically interrelated and there is alteration in their concentration during pregnancy. Beyond pregnancy is associated with increased demand of all the nutrients and deficiency of any of these could affect pregnancy, delivery and outcome of pregnancy.Aim:To study the levels of trace elements namely zinc, iron, magnesium and calcium in maternal and umbilical cord blood and their association with pregnancy outcome.Methods:Sixty pregnant women in Zabol, Iran were selected from those who had registered their names for the prenatal care and who had followed up till the 3rd trimester of pregnancy ending in child birth. Biochemical parameters analyzed with help of the biochemical laboratory. Data were analyzed by SPSS software.Results:The mean biochemical profile such, serum calcium, magnesium, zinc and iron in the pregnant women were as follow: in the 1st trimester 8.3, 1.9, 74.9 and 74.4 µg/dl respectively; in the 2nd trimester 8.5, 1.9, 73.1 and 79.3 µg/dl, respectively; in the 3rd trimester 8.6, 1.9, 68.4, and 82.2 µg/dl, respectively. In the umbilical cord blood, the mean serum calcium, magnesium, zinc and iron were 8.5, 1.9, 84.1, and 89.8 µg/dl, respectively. The mean serum calcium and magnesium during the three trimesters of pregnancy were not significantly different from that in the umbilical cord blood, while the mean serum zinc and iron in the umbilical cord blood were significantly different (p<0.05) in the three trimester of pregnancy. The mean birth weight of neonates was 3.1 kg and 12% of neonates showed low birth weight. Our findings showed that, except magnesium, the profile of other biochemical variables, namely, calcium, zinc and iron in the umbilical cord blood of the neonates with normal birth weight (NBW) were significantly higher than in the umbilical cord blood of neonates with low birth weight (LBW).Conclusion:The results suggest that maternal serum zinc, iron and calcium concentration influenced the birth weight of neonates as outcome of pregnancy, and however, there is need for proper, adequate and balanced micronutrient during pregnancy to affect neonates as healthy outcome.

Prophylactic oral betamimetics for reducing preterm birth in women with a twin pregnancy.

Twin pregnancies are associated with a high risk of neonatal mortality and morbidity due to an increased rate of preterm birth. Betamimetics can decrease contraction frequency or delay preterm birth in singleton pregnancies by 24 to 48 hours. The efficacy of oral betamimetics in women with a twin pregnancy is unproven. To assess the effectiveness of prophylactic oral betamimetics for the prevention of preterm labour and birth for women with twin pregnancies. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (21 September 2015), MEDLINE (January 1966 to 31 July 2015), EMBASE (January 1985 to 31 July 2015) and reference lists of retrieved studies. Randomised controlled trials in twin pregnancies comparing oral betamimetics with placebo or any intervention with the specific aim of preventing preterm birth. Quasi-randomised controlled trials, cluster-randomised trials and cross-over trials were not eligible for inclusion. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two authors assessed the quality of the evidence using the GRADE approach. Overall, the quality of evidence is low for the primary outcomes. All of the included trials had small numbers of participants and few events. Preterm birth, the most important primary outcome, had wide confidence intervals crossing the line of no effect.Six trials (374 twin pregnancies) were included, but only five trials (344 twin pregnancies) contributed data. All trials compared oral betamimetics with placebo.Betamimetics reduced the incidence of preterm labour (two trials, 194 twin pregnancies, risk ratio (RR) 0.37; 95% confidence interval (CI) 0.17 to 0.78; low quality evidence). However, betamimetics did not reduce prelabour rupture of membranes (one trial, 144 twin pregnancies, RR 1.42; 95% CI 0.42 to 4.82; low quality evidence), preterm birth less than 37 weeks' gestation (four trials, 276 twin pregnancies, RR 0.85; 95% CI 0.65 to 1.10; low quality evidence), or less than 34 weeks' gestation (one trial, 144 twin pregnancies, RR 0.47; 95% CI 0.15 to 1.50; low quality evidence). Mean neonatal birthweight in the betamimetic group was significantly higher than in the placebo group (three trials, 478 neonates, mean difference 111.22 g; 95% CI 22.21 to 200.24). Nevertheless, there was no evidence of an effect of betamimetics in reduction of low birthweight (two trials, 366 neonates, average RR 1.19; 95% CI 0.77 to 1.85, random-effects), or small-for-gestational age neonates (two trials, 178 neonates, average RR 0.90; 95% CI 0.41 to 1.99, random-effects). Two trials showed that betamimetics significantly reduced the incidence of respiratory distress syndrome (388 neonates, RR 0.30; 95% CI 0.12 to 0.77), but the difference was not significant when the analysis was adjusted to account for the non-independence of twins (194 twins, RR 0.35; 95% CI 0.11 to 1.16). Three trials showed no evidence of an effect of betamimetics in reducing neonatal mortality, either with the unadjusted analysis, assuming twins are completely independent of each other (452 neonates, average RR 0.90; 95% CI 0.15 to 5.37, random-effects), or in the adjusted analysis, assuming non-independence of twins (226 twins, average RR 0.74; 95% CI 0.23 to 2.38, random-effects). A maternal death was reported in one trial without a significant difference between the groups (144 women, RR 2.84; 95% CI 0.12 to 68.57). There is insufficient evidence to support or refute the use of prophylactic oral betamimetics for preventing preterm birth in women with a twin pregnancy.

Maternal rare inherited bleeding disorders and neonatal complications.

The aim of this study was to examine the association between maternal inherited bleeding disorders and neonatal complications. This was a historical cohort study. The rare inherited bleeding disorders (RIBD) group consisted of a total of 100 women suffering from inherited bleeding disorders, aged 20-45 years who experienced pregnancy. In the healthy control group, 200 age- and body mass index-matched women were selected. Details of demographic and obstetric characteristics of the samples in both groups were collected using their medical records. The mean ages of the women in the RIBD and healthy control groups were 32.6 (7.07) and 32.4 (7.3) years, respectively. No statistically significant differences were found in terms of age and other demographic characteristics of the women between the groups. The mean neonatal birthweight in the RIBD group was statistically lower than that in the healthy control group, 3018.2 (546.9) g vs. 3299.4 (456.8) g, respectively (P = 0.021). The prevalence of low birthweight in the RIBD group was statistically higher in comparison to that in the healthy control group (P = 0.041). After adjustment for potential confounders, it was found that maternal bleeding disorder had significant negative effects on birthweight in newborns (odds ratio, 1.05; 95% confidence interval, 1.01-3.43, P = 0.001). Those infants were statistically more likely to experience head bleeding, early hyperbilirubinemia and hospitalization than the healthy group (P = 0.001). Maternal rare inherited bleeding disorders may have a devastating consequence for neonates.

Relationship Between Time and Day of Birth and Neonatal Mortality in Hospitalized Infants in Neonatal Intensive Care Unit in Fatemieh Hospital, Hamadan, Iran

Background: The neonatal mortality rate is one of the most important indicators of health promotion. However, undoubtedly, the first step to decreasing this indicator is to identify the factors affecting neonatal mortality. Objectives: This study was designed and implemented in order to identify other factors, such as time and day of birth, personnel shift, and work experience, and their relationship with neonatal mortality. Patients and Methods: In this retrospective, cross-sectional study, the medical records of all deceased neonates hospitalized in Fatemieh hospital of Hamadan, during a 5-year period (2006 – 2011) were extracted. A questionnaire including sex, weight, gestational age, time of birth, delivery mode, maternal disease, and leading cause of death was filled out. The information was then analyzed using SPSS 19. Results: In this study, 974 neonatal deaths were registered, among which 57.2% were male. The mean birth weight of neonates was 1.548 g (ranging from 300 – 4.800), and the mean gestational age was 31.2 weeks. The leading causes of death were respiratory distress syndrome (49.6%), septicemia (26.2%), and disseminated intravascular coagulation (4.9%). In terms of the time of death, 63.1% had died during night shifts. The mean length of stay from birth to death was 3.1 and 2.3 days for morning and night shifts, respectively. In terms of the average work experience, the morning shift nursing personnel (seven individuals/shift) had 8.3 years of experience, while the night shift nursing personnel had 4.1 years of experience (five individuals/shift). Conclusions: The mortality rate is higher in neonates born during night shifts and weekends. This is because, in addition to known factors affecting the mortality rate, human factors, such as taking advantage of fewer personnel with less work experience during night shifts, can increase the neonatal mortality rate.

Relationship Between Maternal Bmi And Placental Weight In Relation With Foetal Outcome Amongst Neonates In Federal Teaching Hospital, Abakaliki, Ebonyi State

Foetal outcome, as reported by many researchers across the globe, is affected by many factors of which maternal anthropometric parameters (maternal weight, height and body mass index) are inclusive. The present study was aimed at establishing the significance of the impact of maternal body mass index on neonatal outcome of neonates in Federal Teaching Hospital, Abakaliki, Ebonyi State. A total of 125 subjects were employed in the study. The informations and specific datas of each subject were obtained using a well structured proforma. The datas were tabulated using simple frequency table and presented graphically using bar chart. The degree of significance was determined using Chi-square test of significance. The result obtained showed that the overall mean neonatal birth weight was 3.7±4.15 kg. The mean neonatal birth weight, as recorded in the present study was within the acceptable range while the maternal body mass index was high as compared to the normal range (20-24.9kg/m2). The neonatal birth weight was significantly dependent on the gender of the neonates (p 0.05) contributes to the birth weight of neonates in the current study. Future researchers are encouraged to consider other effective factors besides maternal BMI such as both parental anthropometry and placental ratio in future studies.

1,5-Anhydroglucitol: a new predictor of neonatal birth weight in diabetic pregnancies

ObjectiveTo determine whether 1,5-anhydroglucitol is predictive of neonatal birth weight. Study designA retrospective cohort study including 85 pregnancies complicated by diabetes (Type 1=37, Type 2=24, gestational=24). Women had simultaneous hemoglobin A1c and 1,5-anhydroglucitol measurements every 4–8 weeks throughout pregnancy until delivery. Neonatal birth weight was evaluated by standardized z-scores. Linear regression analysis was performed to determine an association of 1,5-anhydroglucitol with neonatal birth weight z-score. ResultsType 1 diabetic patients had the lowest mean 1,5-anhydroglucitol of 3.5mcg/mL (SD=1.6mcg/mL) and highest mean hemoglobin A1c of 6.5% (SD=0.74%) compared to gestational diabetic patients who had the highest mean 1,5-anhydroglucitol of 6.7mcg/mL (SD=3.8mcg/mL) and lowest mean hemoglobin A1c of 6.0% (SD=0.94%). Mean 1,5-anhydroglucitol values were significantly different between diabetes types (p<0.01). Mean neonatal birth weight was above population averages for all diabetes classifications, although mean birth weight z-scores did not differ significantly between diabetic types (p=0.38). Multivariate linear regression showed a negative association between log-transformed 1,5-anhydroglucitol and birth weight (coefficient −0.82, 95% CI −1.19, −0.46). ConclusionIn pregnancies complicated by diabetes, low 1,5-anhydroglucitol was associated with increased neonatal birth weight. 1,5-Anhydroglucitol may be useful in the assessment of glycemic control in pregnancy in addition to A1c.

Success rate of terbutaline in inhibiting preterm labor for 48 h

Objective: To determine terbutaline success rate in postponing preterm labor for 48 h and to identify factors associated with its efficacy, side effects, maternal and neonatal outcomes.Methods: A retrospective study analyzing data from pregnant women suffering from preterm labor who had received terbutaline for inhibition of labor from January 2007 to December 2013.Results: A total of 385 cases were analyzed; there were 321 cases (83.4%) delivered ≥48 h and 64 cases (16.6%) delivered before 48 h. The factors that affect the success rate of terbutaline administration in singleton pregnancy were cervical dilatation (ORs 0.37; 95% CI 0.18–0.79) and cervical effacement (ORs 0.36; 95% CI 0.17–0.75). The most common side effect of terbutaline was tachycardia (95.1%), but there were no serious cardiovascular events and maternal death. Mean neonatal birth weight was 2.294.3 ± 638.4 g. Neonatal complications included respiratory distress syndrome (RDS) 16.2%, intraventricular hemorrhage (IVH) 1.4%, necrotizing enterocolitis (NEC) 0.7%, sepsis 5.3%, and neonatal death 0.9%.Conclusions: The success rate of terbutaline in treatment of preterm labor was high whereas side effects were tolerable. Neonatal outcome was good. The factors that significantly affect the success rate of terbutaline administration in singleton pregnancy were cervical dilatation and cervical effacement. Thus, terbutaline can be used safely for short-term treatment of preterm labor.

Adjunctive Pessary Therapy after Emergency Cervical Cerclage for Cervical Insufficiency with Protruding Fetal Membranes in the Second Trimester of Pregnancy: A Novel Modification of Treatment.

Aim. To evaluate the effectiveness of adjunctive pessary therapy after emergency cervical cerclage (ECC) in improving perinatal outcome in cervical insufficiency with fetal membranes protruding into the vagina. Material and Methods. A retrospective analysis of patients treated at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between 2008 and 2013. The study group consisted of 15 women treated with ECC and a pessary and the control group consisted of 17 patients treated with cerclage only. Results. The mean gestational age at delivery was significantly higher in the study group (34.7 versus 29.7 weeks, p = 0.03). The period between cerclage insertion and delivery was significantly longer in the study group (82.9 versus 52.1 days, p = 0.045). The mean neonatal birthweight and neonatal “discharge alive” ratio were higher in the study group, although not statistically significant (2550 g versus 1883 g, p = 0.14, and 93.3% versus 70.5%, p = 0.18, resp.). NICU hospitalization rates were comparable (33.3% versus 35.3%, p = 0.9). Conclusions. Adjunctive pessary therapy allows delaying delivery in women treated with ECC due to cervical insufficiency with protruding fetal membranes. It also seems to improve neonatal outcome, although the differences are not statistically significant. Further prospective study is required to prove these findings.

Periodontal Disease as a Risk Factor for Preeclampsia

Background: Preeclampsia is a unique idiopathic syndrome in human pregnancy that can involve almost all organ systems. Objectives: The aim of the present study was to compare the periodontal diseases between the preeclamptic and normal pregnant women in order to find a possible risk factor relationship. Materials and Methods: This case-control study was performed on 200 pregnant women, with maternal age ≤ 35 years and gestational age ˃ 20 weeks with singleton pregnancies. Of these, 100 women were preeclamptic with proteinuria and blood pressure ≥ 140/90 and 100 women with normal blood pressure in the control group. Oral examination was performed on all women by a dentist for detection of periodontal diseases. Gingivitis and periodontitis were diagnosed based on the American Academy of Periodontology (AAP)/American Dental Association (ADA) classification, using the measurement method of Ramfjord. The preeclamptic women were then sub-classified into mild and moderate and comparisons were made between all groups. Results: The mean maternal age, BMI, neonatal birth weights and gestational age at delivery were not significantly different between the preeclamptic and normal groups. There was a significant association between preeclampsia and periodontal diseases (P ˂ 0.01). The mean number of involved teeth (P ˂ 0.001) and the mean pocket depth (P = 0.04) were higher among the preeclamptic group. Gingivitis was more frequent among the cases with mild (56.8%) compared to (31.6%) in the severe preeclamptic group (P = 0.04). Periodontitis was more prevalent among the cases with severe preeclampsia which was not statistically significant. The mean neonatal birth weight was significantly lower in the group with severe preeclampsia (P < 0.01). Conclusions: There was a significant association between preeclampsia and periodontal diseases. The number of involved teeth and pocket depth were higher among the preeclamptic mothers compared to normal pregnant women.

Value of clinical guidelines for vaginal birth after cesarean delivery

Objective To assess the value of clinical guidelines for safe and successful implementation of vaginal birth after cesarean (VBAC).Methods A retrospective study was conducted,which included 2 002 cases with prior cesarean delivery in the First Maternity and Infant Hospital Affiliated to Tongji University,from January 2009 to July 2013.A total of 116 women with singleton live births and one prior cesarean delivery who attempted VBAC were included.The cases were divided into two groups according to the time of implementation of the VBAC guidelines of our hospital:the research group (n=95) and the control group (n=21).Pregnancy outcomes were evaluated according to whether the VBAC guidelines were implemented.Main outcome measures included the rates of attempting VBAC,postpartum hemorrhage,uterine rupture,neonatal Apgar score and admittance to neonatal unit.Chi-square or t-test were used to analyze the data.Results Following implementation of the VBAC guidelines from January 2012,the rate of trial labor increased to 11.1％ (95/855),compared to 1.8％ (21/1 147) before implementation of the VBAC guidelines.In the research group,93 cases (97.9％,93/95) were successful in VBAC and only two cases failed due to fetal distress or a protracted active phase.The mean intrapartum blood loss in the research group was (246± 127) ml,which was lower than that in the control group [(260±35) ml,t=0.50,P＞0.05].Puerperal morbidity occurred in one patient (1.0％) in the research group,which was higher than that in the control group [0 (0.0％)] (P＞0.05).The length of hospitalization in the research group was (2.1 ±0.8) d,which was longer than that in the control group [(2.1-±-0.5) d,t=0.22,P＞0.05].The neonatal 1 min Apgar score was 8-10 in 88 cases (92.6％) and 4-7 in seven cases (7.4％) in the research group; while the 1 min Apgar score in the control group was 8-10 in all 21 cases (100％) (x2=1.64,P＞0.05).None of the above showed significant difference between the two groups.The mean neonatal birth weight in the research group was (3 290± 632) g,which was higher than that in the control group [(2 837±1 057) g,t=-2.59,P＜0.05].Seventeen neonates (17.9％) in the research group were admitted to neonatal units,which was lower than that in the control group [8 (33.1％),x2=4.15,P＜0.05].There were no serious complications such as uterine rupture,hysterectomy or maternal death in the two groups.Conclusions The value of VBAC guidelines for the safe and successful implementation of VBAC is significant.These guidelines help to ensure maternal and fetal safety,and reduce serious complications caused by failed VBAC. Key words: Vaginal birth after cesarean; Postpartim hemorrhage; Uterine rupture; Pregnancy outcome

Maternal and neonatal risk factors associated with vertical transmission of ophthalmia neonatorum in neonates receiving health care in Blantyre, Malawi.

Context:Neonatal conjunctivitis is associated with poor prenatal care worldwide.Purpose:Data on neonatal conjunctivitis is scarce in Malawi. This study describes risk factors associated with conjunctivitis in neonates born in a large tertiary care hospital in Blantyre, Malawi.Materials and Methods:Medical records of a retrospective cohort of 231 neonates diagnosed with conjunctivitis from January 2006 to December 2009 at a large tertiary hospital in Malawi were reviewed. All subjects were clinically diagnosed with ophthalmia neonatorum. Data were collected on patient demographics and clinical features. The frequencies were calculated of various risk factors in neonates with ophthalmia neonatorum and their mothers as well as the treatments administered.Results:Mean age of the mother was 23.45 years (range, 15-40 years), and the mean number of previous deliveries was 2.3 (range, 1-7) children. Nearly, 80% of mothers delivered preterm infants via spontaneous vaginal delivery. The mean birth weight of neonates was 2869.6 grams (1100-5000 grams). Among mothers, premature rupture of membranes was the leading risk factor (24%) followed by sepsis during labor (9%), and history of sexually transmitted infections (STI) (7%). Neonates presented with low Apgar scores (19%), fever (8%), and/or meconium aspiration (5%). Providers treated patients empirically with a varied combination of benzyl penicillin, gentamicin, tetracycline eye ointment, and saline eye wash. Tetracycline with a saline eyewash was used frequently (34%) compared with combinations of benzyl penicillin and gentamicin.Conclusions:Improving prenatal care to reduce sepsis, traumatic deliveries, and early diagnosis of STI with appropriate treatment may potentially reduce vertical transmission of neonatal conjunctivitis in this understudied population.

Study of structural changes in placenta in pregnancy-induced hypertension.

Background:Hypertension is one of the most common complication during pregnancy. It contributes significantly to maternal and perinatal morbidity and mortality. This study was designed to investigate the morphological and histopathological changes in placenta from pregnancies complicated with hypertension.Objectives:To study the morbid changes in placenta in cases of pregnancy-induced hypertension (PIH) and to correlate the findings with birth weight of new born babies in comparison with normotensive mothers.Materials and Methods:The study was done on 100 placentas, out of which 50 were collected from normotensive mothers and the remaining 50 from PIH cases. All the placentas were studied morphologically and histologically. The birth weight of neonates was recorded.Results:In the present study it was observed that weight and dimensions of placenta was less in study group when compared with control group. The mean neonatal birth weight was more in normal pregnancy and feto-placental weight ratio was significantly high in hypertensive group. Histopathological study showed significant number of syncitial knots, areas of fibrinoid necrosis, hyalinization, calcification, and medial coat proliferation of medium sized blood vessels in hypertensive group.Conclusion:PIH significantly affects the placenta by reducing its weight and dimensions. These changes may cause placental insufficiency as a result of compromised utero-placental blood flow. Therefore has an adverse affect on the neonatal birth weight. PIH has definite influence on morphology, histology of placenta, and thus affects the growth of the fetus.

Maternal and foetal outcome of gestational diabetes mellitus in a rural block of Assam, India

AimIndia is known as a diabetic capital of the world and it has been well recognized that women especially pregnant and lactating women form one of the most vulnerable segments of the population from nutritional point of view. ObjectivesTo assess the incidence of gestational diabetes mellitus and measure the maternal and foetal outcome of gestational diabetes mellitus. MethodsA cohort study was conducted in an area served by rural block primary health centre, where all consented pregnant women in first trimester registered between June and August 2011 were followed up in second and third trimester to measure incidence of gestational diabetes mellitus along with maternal and foetal outcome measurement during delivery and postnatal period. ResultsThe incidence of GDM amongst the study population was 3% (28, n = 930). The impaired glucose tolerance was documented amongst 216 (23.2%, n = 930) ladies. Prevalence of underweight was 21.4% (202), while 5.7% (54) were overweight and 0.2% (2) was obese in first trimester. Anaemia prevalence was 72% (670) (Hb < 110 g/l). Serum albumin level was lower in 32.9%. LSCS rate was found significantly higher amongst GDM subjects compared to non-GDM subjects (RR = 4.58; 95% CI, 2.18–9.59, p = 0.000). Mean birth weight of neonate was 2.802 ± 0.479. Birth weight was found significantly higher amongst GDM group compared to non-GDM group (χ2 = 166.8, p = 0.000). Neonatal death was more common amongst GDM group compared to non-GDM group (χ2 = 6.776, p = 0.034). ConclusionThere is increased caesarean section rate, admission to an NICU among women who had gestational diabetes mellitus during pregnancy.

Maternal and Neonatal Outcomes in Pregnancies Complicated by Systemic Lupus Erythematosus: A Population-Based Study

ObjectiveTo determine maternal and neonatal outcomes in pregnancies complicated by systemic lupus erythematosus (SLE). MethodsIn a retrospective cohort study using the Nova Scotia Atlee Perinatal Database, 97 pregnancies in women with SLE, with 99 live births, were compared with 211 355 pregnancies in women without SLE and their 214 115 babies. All were delivered in Nova Scotia between 1988 and 2008. ResultsIn women with SLE, gestational age at birth and mean neonatal birth weight were lower (P < 0.001) than in women without SLE. On bivariate analysis, severe preeclampsia, Caesarean section, newborn resuscitation for > 3minutes, respiratory distress syndrome, assisted ventilation, bronchopulmonary dysplasia, patent ductus arteriosus, mild to moderate intraventricular hemorrhage, retinopathy of prematurity, and congenital heart block in neonates were significantly more frequent in the women with SLE.Logistic regression analysis identified that having SLE increased the risks of Caesarean section (OR 1.8; 95% CI 1.1 to 2.8, P = 0.005), postpartum hemorrhage (OR 2.4; 95% CI 1.3 to 4.3, P = 0.003), need for blood transfusion (OR 6.9; 95% CI 2.7 to 17, P = 0.001), postpartum fever (OR 3.2; 95% CI 1.7 to 6.1, P = 0.032), small for gestational age babies (OR 1.7; 95% CI 1.005 to 2.9, P = 0.047), and gestational age ≤ 37 weeks (OR 2.1; 95% CI 1.3 to 3.4, P = 0.001). Neonatal death was not shown to be more common in women with SLE (RR 3.05; CI 0.43 to 21.44, P = 0.28). ConclusionMothers with SLE have an increased risk of Caesarean section, postpartum hemorrhage, and blood transfusion. They are more likely to deliver premature babies, smaller babies, and babies with congenital heart block.

Reduced apoptosis in term placentas from gestational diabetic pregnancies.

Gestational diabetic mellitus (GDM) pregnancies have an increased risk of macrosomic infants and large placental mass, though the mechanisms explaining each of these is uncertain. We sought to evaluate the contribution of apoptosis to placental size and the expression of glucose transporters (SLC2A) in GDM pregnancies. Maternal age and pre-pregnancy body weight were documented. Newborn weights were recorded after delivery. Placentas 37-40-week gestation from control patients (no pregnancy complication) (n = 5), or with GDM (n = 5) were weighed immediately after delivery. Villous samples (4 mm diameter) were collected and divided into specimens; one was fixed in 4% paraformaldehyde for immunostaining using terminal deoxynucleotidyl transferase dUTP-mediated nick-end labeling (TUNEL) and activated caspase-3. The other specimen was snap frozen in liquid nitrogen and stored at -80°C for active caspase-3, poly(ADP-ribose) polymerase (PARP), SLC2A1 and SLC2A3 gene expression analysis. Our results showed that maternal age and pre-pregnancy body weight were significantly higher in the GDM group when compared with those from the controls (P < 0.05). The mean neonatal birth weight and placenta weight were significantly higher in the GDM group compared with that from the controls (P < 0.05). The apoptotic index of placentas (0.05 ± 0.01 v. 0.17 ± 0.04, P < 0.04), active caspase-3 polypeptide fragments and PARP protein were significantly decreased in GDM placentas as compared with controls. Further, the level of placental SLC2A1 protein expression was ∼3-fold higher in GDM placentas. Our results suggest that reduced apoptosis in GDM placentas may contribute to increased placental tissue, which together with enhanced SLC2A1 expression, could play a role in fetal macrosomia.

Effects of Triggering Oocytes Maturation by rhCG 250 µg vs uhCG 10 000 IU on the Outcomes of IVF-ET Treatment in Chinese Population: A Cohort Study

Objective To compare the effects of recombinant hCG (rhCG) 250 µg and urinary hCG (uhCG) 10 000 IU on triggering oocyte maturation during COH/IVF-ET in Chinese women. Methods A retrospective cohort study which included COH/IVF-ET cases at reproductive medical center of Peking University Third Hospital from March to May 2010 was performed. Analysis of covariance (ANCOVA) was taken for data analysis. Results There were 318 cycles (group A) using rhCG 250 µg and 810 cycles (group B) using uhCG 10 000 IU for triggering. In IVF procedure, there were no significant differences in the number of oocyte retrieval, 2PN fertilization rate, good-quality embryo rate, embryo implantation rate and clinical pregnancy rate between the two groups. The delivery weeks, mean neonatal birth weight and live birth rates were also similar between the two groups. There was no local allergic reaction after injection or neonatal birth defect in group A. Conclusions The rhCG 250 μg and uhCG 10 000 IU have equal effects on triggering oocyte maturation for patients with normal ovarian function in Chinese population. rhCG may have even lower local discomfort occurrence.