Neonatal Anthropometric Parameters Research Articles

Effects of physical activity during pregnancy and gestational weight gain on newborn weight and length at birth in Warmińsko-Mazurskie province.

Epidemiological research has identified a relationship between maternal physical activity, early nutrition and infant birth weight with likelihood of developing future diseases. The aim of the study was to determine a relationship between gestational weight gain and physical activity during pregnancy to the nutritional status of newborns. The presented study was conducted in the period from February 2010 until November 2012 in the gynecological and obstetric clinics in Warmińsko-Mazurskie voivodeship with various levels of reference. The research subjects included 510 women in the puerperal period aged 18-36. The scope of the research included an assessment of the selected anthropometric parameters of both pregnant women (body mass, height, BMI, gestational weight gain) and newborns (infant birth weight, infant length, Ponderal Index), as well as an analysis of the connections between the gestational weight gain, physical activity during pregnancy and anthropometric parameters of newborns. In the study group there was a significant percentage of women characterised by an inactive lifestyle and excessive gestational weight gain. There were significantly higher neonatal birth anthropometric parameters in women with abnormal excessive gestational weight gain than in women with normal and inappropriate - low gestational weight gain. The highest percentage of women with appropriate weight gain was observed in the group of women who are physically active, although this requires confirmation in larger population. Our studies have not shown statistically significant differences between the gestational weight gain and nutritional status of newborns in relation to the level of physical activity of pregnant women.

Early versus late prophylactic iron supplementation in VLBW infants: a randomized controlled trial.

SUMMARY In this single blinded parallel-group randomized controlled trial (RCT), preterm very-low-birth-weight (VLBW) infants received early iron (EI) supplementation (starting at 2 weeks postnatal age), or late iron (LI) supplementation (starting at 6 weeks postnatal age) [1]. The primary outcome was serum ferritin level at 12 weeks, and the secondary outcomes were the incidence of neonatal morbidities, hemoglobin level, anthropometric parameters and blood transfusion requirements. Outcomes were analyzed in 46 and 47 babies in EI and LI groups, respectively. Serum ferritin level was significantly higher (P<0.001) at 12 weeks in the EI group. Hemoglobin and mean corpuscular hemoglobin concentration (MCHC) were also significantly (P<0.001) higher at 12 weeks in the EI group. There were no significant differences in the incidences of neonatal morbidities [necrotizing enterocolitis (NEC), periventricular leukomalacia, retinopathy of prematurity (ROP)], anthropometric parameters and blood transfusion requirements between the two groups. The authors concluded that EI supplementation in preterm VLBW infants improves serum ferritin and hemoglobin levels. COMMENTARIES Evidence - based - medicine Viewpoint This RCT on early versus late enteral iron supplementation in preterm VLBW babies is timely, generalizable and well conceived. The authors concluded that EI supplementation in preterm VLBW infants improves serum ferritin, hemoglobin and MCHC at 12 weeks of postnatal age without any concomitant difference in inflammation to account for the difference in ferritin levels. The study is justified because there is still substantial uncertainty about the optimal age at which enteral iron supplementation should commence in such infants. The method of randomization and allocation concealment in the study is appropriate. Measurement bias was restricted by masking the outcome analyzers. One of the potential dangers of EI supplementation is increase in free radical mediated diseases, such as NEC and ROP. The authors rightly concluded that although their trial was not able to detect a significant difference in these diseases, the study was underpowered to do so. The study confirms the efficacy of early iron supplementation but it is inconclusive regarding the safety of the intervention. Only a large study or a metaanalysis of existing trials may be able to shed light on the equally important issue of safety.

Thymic size correlates with cord blood zinc levels in low-birth-weight newborns

Thymus is essential for immunity as it provides environment for T cell differentiation and maturation. There is limited information on various factors which determine thymic size at birth. We studied the influence of cord blood zinc and copper levels and maternal and neonatal nutritional status on thymic size in term low-birth-weight (LBW) newborns. A prospective observational study on 44 term LBW (<2,500g) newborns (cases) and 71 gestational age-matched newborns weighing ≥2,500g (controls). Sonographically determined thymic index was correlated to cord blood zinc and copper levels and maternal and neonatal nutritional status. Thymic index measured 3.74 ± 1.57cm(3) in LBW newborns compared to 4.90 ± 2.33cm(3) in normal-birth-weight newborns. Thymic index was significantly correlated to cord blood zinc levels but not to cord blood copper levels and had linear relationship to the maternal body mass index and midarm circumference and neonatal anthropometric parameters. Thymic index is linearly related to cord blood zinc levels and maternal and neonatal nutritional status. Compared to thymic size in the Western newborns, the thymus is less than half in size in Indian newborns of normal birth weight. Reduced thymic size in Indian newborns in general and LBW infants in particular may have consequences for their immune competence and the risk of infections. Improving nutrition of pregnant women, particularly zinc nutriture might favorably influence thymic size in their offspring.

Obstetric and Neonatal Outcomes of Maternal Vitamin D Supplementation: Results of an Open-Label, Randomized Controlled Trial of Antenatal Vitamin D Supplementation in Pakistani Women

The objective of the study was to determine whether vitamin D (vitD) supplementation during pregnancy affects obstetric and neonatal outcomes. The study was conducted at a university hospital in Karachi, Pakistan. The study was a single-center, open-label, randomized, controlled trial of routine care (group A, 200 mg ferrous sulfate and 600 mg calcium daily) vs vitD supplementation (group B, 4000 IU vitamin D3 daily), started at 20 weeks and continued till delivery. Maternal serum samples of 25-hydroxyvitamin D (25OHD) were collected at baseline and delivery. Neonatal vitD status was assessed in cord blood or in neonatal serum samples within 48 hours of birth. Obstetric outcomes included gestational hypertension, gestational diabetes, and preterm labor, and neonatal well-being included small for gestational age, birth weight, length, head circumference, and 1- and 5-minute Apgar scores. Of 207 gravidae enrolled, 193 completed the trial. Maternal age, vitD status, and gestational age at enrollment were comparable between the two groups. At delivery, maternal 25OHD was increased in group B (18.3 ± 11 ng/dL vs 8.82 ± 11.84 ng/dL (P = .001) compared with group A (6.9 ± 7.0 ng/dL vs 6.32 ± 3.97 ng/dL, P = .06). The obstetric outcomes were comparable between the two groups (P > .05). Neonatal 25OHD levels were significantly higher in group B compared with group A (19.22 ± 12.19 ng/dL vs 6.27 ± 5.2 ng/dL). There was positive correlation between maternal and neonatal 25OHD levels (r = 0.83, P = .001). One- and 5-minute Apgar scores were significantly higher in group B (7.10 ± 0.66 vs 6.90 ± 0.50, P = .026, and 8.53 ± 0.68 vs 8.33 ± 0.81, P = .051, respectively). Neonatal anthropometric parameters were comparable between the two groups (P > .05). Maternal vitD supplementation improved maternal and neonatal vitD status.

Correlations Among Parental and Neonatal Anthropometric Parameters, Feeding Practices and Infant Obesity.

Background and aimsInfant and adult obesity is becoming a real public health concern in Romania, similar to other countries of the European Union. Maternal obesity and excessive weight gain during pregnancy are proven risk factors for the obesity of the child. The protective role of the breastfeeding against obesity has also been demonstrated. The most important issue is whether the choice of a milk formula with the right protein composition could or not protect the newborn from becoming a future obese infant and child.Our study aims to describe the characteristics of a group of macrosomic newborns, in relation to the mothers’ weight gain during pregnancy, mode of delivery, birth weight, complications at birth, time of first feeding and type of feeding during maternity stay.Patients and methodsWe conducted a retrospective study on 179 newborns with birth weights >4000 grams, born over a period of three months (March–May) in 6 large maternity hospitals in Romania.Resultsthe newborns had a mean gestational age of 39.5 weeks and a mean birth weight of 4195 grams. Male newborns were prevalent (74%). More than half were born by Cesarian section and had Apgar scores with a median of 9. Macrosomes are prone to complications at birth and in our study those were mainly hypoglycemia and birth trauma. Time at first feeding was 95 minutes (mean), with a high percentage of formula/mixed feeding (68%).ConclusionMacrosomia itself attracts the risk of birth by cesarean section (54% of study group), birth trauma and a low rate of exclusive breast milk feeding (32% of study group) at discharge.

Early versus late enteral prophylactic iron supplementation in preterm very low birth weight infants: a randomised controlled trial

ObjectivesTo evaluate whether preterm very low birth weight (VLBW) infants receiving early iron (EI) supplementation (2 mg/kg/day elemental iron) at 2 weeks postnatal age have improved serum ferritin levels compared...

The current pattern of gestational age-related anthropometric parameters of term Nigerian neonates

Background. Weight and length at birth reflect the quality of intra-uterine growth and exert a strong influence on postnatal survival. Objective. To determine the current range of anthropometric measurements of term Nigerian neonates. Methods. Consecutive term singleton mother-baby pairs were surveyed in the first 24 hours after birth. Weight, length, occipitofrontal circumference (OFC) and ponderal index were determined. Results. A total of 825 babies (440 males and 385 females) were studied. The overall mean birth weight (± standard deviation (SD)) of the study subjects was 3 233±539 g, the mean ±SD length 49.0±2.5 cm, the mean ±SD OFC 34.6±1.4 cm, and the mean ±SD ponderal index 2.7±0.4 g/cm 3 . Conclusion. The anthropometric parameters of the Nigerian infants studied were within the range previously reported for Africa and other developing countries, but lower than figures from some developed countries.

Malaria during Pregnancy: Incidence, Manifestations, Therapy, and Prevention

Malaria remains one of the most complex health problems facing humanity and pregnant women are highly vulnerable with substantial risks for the mother, her foetus and the neonate. Plasmodium falciparum is responsible for most of the complications of malaria in pregnancy and maternal anaemia is the most common and potentially lethal consequence of P. falciparum malaria. Central to the pathogenesis of P. falciparum infection in pregnancy is the accumulation of infected erythrocytes in the placenta (placental malaria). Adverse perinatal outcomes associated with placental malaria include congenital malaria, perinatal mortality, preterm delivery, intrauterine growth retardation, low birth weight, reduced neonatal anthropometric parameters, and foetal anaemia. The recommended strategies for controlling malaria in pregnancy include both preventive and curative measures. Sulfadoxine-pyrimethamine (SP) has been extensively used as intermittent preventive chemotherapy in pregnancy, however high rates of resistance to SP reduced its use as therapy for malaria. Artemisin combination therapy (ACT) as well as clindamycin / quinine combinations are important therapeutic schemes used in pregnancy. A major tool currently used for malaria prevention in pregnancy is insecticide-treated net (ITN). Increased international funding and greater political commitment, have led to some level of reduction in malaria burden in pregnancy.

Association of Plasma Leptin Levels With Maternal Body Weight and Body Mass Index in Premature and Term Newborns

Leptin plays an important role in the regulation of body weight and energy metabolism in adults; its role in neonates also needs to be explored. The current study aims to determine the correlation between serum leptin concentrations and anthropometric variables in newborns and their mothers, and to examine the effects of sex, gestational age and antenatal steroid use on neonatal leptin levels. This was a retrospective study. Blood samples were collected from 55 newborns within 24 hours of birth. Plasma leptin levels were measured by immunometric assay. The relationship between neonatal leptin levels and anthropometric parameters was determined using Pearson's correlation and further evaluated by linear regression analysis. Neonatal leptin was significantly correlated with maternal body weight (p < 0.002) and maternal body mass index (BMI) (p < 0.001). However, it was not correlated with gestational age (p = 0.130), birth weight (p = 0.097), or birth BMI (p = 0.336). The leptin levels in premature newborns (gestational age < 37 weeks; 0.69 +/- 1.82ng/mL) were significantly less than those in term newborns (gestational age > or = 37 weeks; 2.09 +/- 2.30 ng/mL, p = 0.031). There were no significant differences between sexes (p = 0.277) or in relation to antenatal steroid use (p = 0.611). Neonatal serum leptin concentrations within 24 hours of birth correlated with maternal body weight and BMI, especially in premature newborns. Premature newborns had significantly lower leptin levels than full-term newborns.

Cord blood resistin and adiponectin in term newborns of diabetic mothers

IntroductionAdipose tissue can release hormones into the blood stream in response to specific extracellular stimuli or changes in metabolic status. Resistin, an adipose-secreted factor, is primarily involved in the modulation of insulin sensitivity and adipocyte differentiation. Adiponectin, an adipocyte-specific hormone with insulin sensitizing, anti-inflammatory and anti-atherogenic effects, is reduced in obesity and type II diabetes. The aim of the study was to assess the influence of maternal pre-existing diabetes on cord blood resistin and adiponectin at birth in relation to neonatal anthropometric parameters and cord blood insulin levels.Material and methodsA total of 60 term newborns were prospectively enrolled and categorized into three groups: 20 were macrosomic infants of pre-gestational diabetic mothers (group I), 20 were non-macrosomic infants of pre-gestational diabetic mothers (group II) and 20 were healthy non-macrosomic infants born to non-diabetic mothers serving as controls (group III). Infants’ anthropometric indices were recorded. Cord blood samples for glucose, insulin, resistin and adiponectin assay, together with maternal glycosylated haemoglobin were obtained.ResultsSerum insulin was increased while resistin and adiponectin were significantly decreased in infants of diabetic mothers (IDMs) compared to the control group. Serum glucose, insulin, resistin and adiponectin were comparable in group I and II. Cord serum resistin correlated positively with cord blood glucose in IDMs in both macrosomic and non-macrosomic groups. Cord serum insulin correlated positively with triceps skinfold thickness in all studied neonates. Cord serum resistin and adiponectin showed no correlation with neonatal anthropometric indices. Multiple regression analysis demonstrated that insulin, resistin and adiponectin together were highly correlated with birth weight, with adiponectin as the one responsible for this positive correlation.ConclusionsInfants of diabetic mothers had elevated levels of cord serum insulin and suppressed levels of cord serum resistin and adiponectin, suggesting that the regulation of these metabolic pathways is probably operational before birth. Levels were comparable in both macrosomic and non-macrosomic neonates.

Estudio transversal español de crecimiento 2008. Parte I: valores de peso y longitud en recién nacidos de 26-42 semanas de edad gestacional

Gestational age and neonatal anthropometric parameters are related to neonatal and postnatal morbidity and mortality.Weight and vertex-heel length were evaluated in 9.362 caucasian newborns (4.884 males and 4.478 females) products of single pregnancies, 26-42 weeks of gestational age, born between 1999 and 2002 in Vall d'Hebron (Barcelona, Spain) and Miguel Servet (Zaragoza, Spain) Children's Hospitals.Mean and standard deviation and percentile distribution values of weight, and length according to sex and gestational age are presented. A progressive increase in these parameters with gestational age and a sexual dimorphism was observed from the 30 week of gestational age onwards, with statistically-significant differences (p<0.01) from 35 weeks of gestational age. At 38 and 42 weeks of gestational ages these differences were 170 g, 160 g, 0.8 cm and 0.9 cm respectively. An increase in weight and length values in relation to previous Spanish studies (1987-1992) was also documented.A sexual dimorphism in intrauterine anthropometric growth parameters was observed. These parameters change with time and may be updated.

The relationship between adiponectin, leptin, insulin, insulin-like growth factor and IGF binding protein-3 in cord blood and neonatal anthropometric parameters

Purpose : This study was designed to examine the effects of adiponectin, leptin, insulin, insulin-like growth factor (IGF)-I and IGF binding protein (BP)-3 levels in cord blood on weight, length, and adiposity at birth in healthy term infants. In addition, we evaluated the mechanism to change the hormone levels in appropriate for gestational age (AGA) during the first month. Methods : We collected cord blood from 200 term neonates (109 males, 91 females) with no perinatal problems, and measured the hormone levels and anthropometric parameters including weight, length, and skin-fold thickness. Term neonates were divided into 3 groups as follows: birth weight appropriate for gestational age (AGA) (n=132), birth weight less for gestational age (SGA) (n=29), and birth weight more for gestational age (LGA) (n=39). Venous blood samples of 15 fullterm healthy neonates were obtained at 3, 7, and 30 d after birth. Results : The adiponectin, insulin, and IGF-I levels were significantly lower in the SGA group than in the AGA and LGA groups. The leptin levels were significantly higher in the LGA group than in the AGA and SGA groups. Cord blood adiponectin, leptin, insulin, IGF-I, and IGFBP-3 levels correlated significantly and positively with birth weight and the sum of the skin-fold thickness. A significant positive correlation was observed between adiponectin, leptin, and IGF-I levels and birth weight. Adiponectin level correlated significantly with that leptin level (r=0.191, P=0.038), but not with insulin, IGF-I and IGFBP-3 levels. IGF-I levels were higher in females than in males. At 7 d after birth, the leptin level decreased along with physiologic weight loss, and then increased. IGF-I, also decreased at 3 d, significantly increased 1 month later. Conclusion : We suggest that adiponectin, leptin, insulin, IGF-I, and IGFBP-3 play an important role in regulating fetal growth. Adiponectin may be involved in regulating fetal growth through mechanisms different from those mediated by insulin or IGF-I. High levels of IGF-I in female neonates indicates a gender difference which serves as evidence for in utero sexual dimorphism. It is likely that IGF-I has a more important role than that of hormones in postnatal growth.

Leptin levels at birth and in early postnatal life in small- and appropriate-for-gestational-age infants

The aim of this study was to evaluate leptin concentration at birth and in early postnatal life in small- and appropriate-for-gestational-age infants and to assess its relationship with infants' anthropometry at birth and some characteristics of maternal pregnancy. A total of 367 infants born after 32-42 weeks of gestation were enrolled in the study. Umbilical cord blood samples were collected from 80 small- and 287 appropriate-for-gestational-age newborns. Altogether, 166 venous blood samples were taken from these neonates on days 2-6 of life. Cord leptin levels were significantly lower in small- compared to appropriate-for-gestational-age infants. We observed a positive correlation between cord leptin and birth weight, all neonatal anthropometric parameters, placental weight, and some maternal nutritional factors. In multivariate analysis, cord leptin concentration explained up to 15% of the variation in sum of newborn's skinfold thickness but only 5% of the variation in birth weight. Postnatally, leptin concentration decreased markedly to the similar low levels in both infant groups and remained so during the first postnatal week. Significantly lower cord leptin concentration in small-for-gestational-age neonates reflects a lower fat mass content compared to appropriate-for-gestational-age infants. However, an abrupt decrease in leptin levels shortly after birth in both groups suggests that placenta could be an important source of leptin in fetal circulation. The impact of low leptin levels at birth in small-for-gestational-age infants on their postnatal appetite and weight gain remains to be elucidated in future studies.

Relation of in utero lead exposure with insulin-like growth factor-I levels and neonatal anthropometric parameters

Our aim was to establish whether independent relationships exist between either anthropometric parameters or insulin-like growth factor-I (IGF-I) and cord blood lead levels in newborns. Umbilical cord blood samples and anthropometric data were obtained at delivery. Cord blood lead levels were analyzed by atomic absorption spectrophotometer. IGF-I levels were measured using RIA. Blood lead levels ⩾100 μg/l were considered elevated in accordance with CDC guidelines. Data on all variables of interest were obtained for 54 term neonates. The mean cord blood lead level was 144±89 μg/l with a range of 51–355 μg/l. Twenty-nine (53.7%) neonates had blood lead levels ⩾100 μg/l. However, only 5 (9.2%) of the neonates had blood lead levels of ⩾250 μg/l. No statistically significant difference was found in case of anthropometric parameters and IGF-I levels between neonates with high lead levels (⩾100 μg/l) and with low lead levels (<100 μg/l) in cord blood ( p>0.05). There was a significant correlation between lead and birth weight in neonates with high lead levels ( r: −0.49, p=0.01) but not other anthropometric data and IGF-I levels. A multivariate regression analysis using the full range of lead values adjusted for the relevant confounders such as gestational age and socioeconomic status was performed. In the model birth weight ( p: 0.01, β: −0.81), birth length ( p: 0.05, β: 0.41) and midarm circumferences ( p: 0.05, β: 0.30) were the best predictors of lead levels, with the total variance explained being 36%. Significant relationship was found between birth weight and lead burden in newborns. Whether serum lead level predicts the development of failure to thrive in these children remains to be determined in follow-up studies.

EFFECT OF ANTIRETROVIRAL DRUGS ON MATERNAL CD4 LYMPHOCYTE COUNTS, HIV-1 RNA LEVELS, AND ANTHROPOMETRIC PARAMETERS OF THEIR NEONATES

To study the effect of antiretroviral drugs administered during pregnancy on CD4 lymphocyte counts and HIV-1 RNA levels of pregnant women and on the anthropometric parameters of their neonates. A prospective study was conducted on 57 pregnant women and their neonates divided into 3 groups: ZDV Group, HIV-infected mothers taking zidovudine (n=20); triple therapy (TT) Group, mothers taking zidovudine+lamivudine+nelfinavir (n=25), and Control Group, normal women (n=12). CD4 lymphocyte counts and HIV-1 RNA levels of pregnant women were analyzed during two periods of pregnancy. The perinatal prognosis took into account preterm rates, birth weight, intrauterine growth restriction, perinatal death, and vertical transmission of HIV-1. Data were analyzed statistically using the nonparametric chi-square, Mann-Whitney, Friedman, Kruskal-Wallis, and Wilcoxon matched pairs tests, with the level of significance set at P<.05. The major maternal demographic and anthropometric data were homogeneous for the various groups. HIV-1 viral burden, which was initially elevated, median of 14,370 copies/mL, was significantly reduced in the TT group, reaching 40 copies/mL. With respect to T-CD4+ lymphocyte counts, there was a significant recovery in Group TT at the end of pregnancy, this value being significantly different from that for the ZDV group (P=0052). There was no difference between groups regarding gestation length, Apgar scores, or neonatal anthropometric classification. There was no case of vertical HIV-1 transmission. The results obtained for the present series demonstrate the efficiency and suggest safety of the use of antiretroviral drugs during pregnancy as revealed by anthropometric parameters of the neonate.

Visual evoked potentials in disproportionately growth-retarded human neonates

To study brain function in the neonatal period, disproportionately growth-retarded (n = 33) and appropriately grown (n = 21) infants were examined using Doppler flow velocities prenatally and visual evoked potentials postnatally. Visual evoked potentials recordings were made at gestation of 40 and 46 weeks. The group of growth-retarded infants had significantly prolonged latencies to both of the two major peaks (designated P and N), most pronounced for the P peak. This result was observed at both ages investigated and corresponds to a developmental delay of 3 weeks. For individuals, the increase in P latency correlated to prenatal flow indices and to neonatal anthropometric parameters indicative of growth retardation. We conclude that in utero growth retardation affects brain development as assessed by visual evoked potentials in the neonatal period. This developmental delay may be produced by intracerebral factors during the process of growth retardation, and these alterations may have a prognostic value.

Patrones antropométricos de los recién nacidos pretérmino y a término (24–42 semanas de edad gestacional) en el Hospital Materno-Infantil Vall d'Hebron (Barcelona) (1997–2002)

Gestational age and neonatal anthropometric parameters are significant predictive factors of neonatal and adult morbidity. Our objective was to evaluate these parameters in a population of preterm and full-term newborns. We retrospectively analyzed neonatal anthropometric parameters (weight, vertex-heel length and head circumference) in 1470 live preterm neonates born at 24-36 weeks' gestation between 1997 and 2002. The same parameters were prospectively analyzed in 1786 live newborns born at 37-42 weeks after uncomplicated pregnancies between 2001 and 2002. All preterm and full-term neonates were the result of single pregnancies and were born at the Hospital Materno-Infantil Vall d'Hebron in Barcelona. Only Caucasian neonates whose parents were born in Spain were included. In the group of full-term neonates all measurements were made by the same researcher. The mean and standard deviation and percentile distribution values of weight, length and head circumference according to sex and gestational age are presented. These parameters progressively increased with gestational age and sexual dimorphism from the 30th week of gestation onwards, with statistically significant differences (p < 0.05) for all parameters at 38-42 weeks' gestational age. The mean gains in male full-term newborns compared with female full-term newborns were: 129.1 g of weight, 0.68 cm of length and 0.45 cm of head circumference (P < 0.05). In our population, 10th percentile values for weight and length were higher than those in other Spanish populations reported in 1988 and 1996. Sexual dimorphism was found in intrauterine anthropometric growth parameters. These parameters change over time and should be updated periodically.

The pathophysiological influence of leptin and the tumor necrosis factor system on maternal insulin resistance: negative correlation with anthropometric parameters of neonates in gestational diabetes

The pathophysiological influence of leptin and the tumor necrosis factor system on maternal insulin resistance: negative correlation with anthropometric parameters of neonates in gestational diabetes

The pathophysiological influence of leptin and the tumor necrosis factor system on maternal insulin resistance: negative correlation with anthropometric parameters of neonates in gestational diabetes

The contribution of the tumor necrosis factor (TNF) system and leptin was studied in insulin resistance and neonatal development during the course of normal pregnancy and gestational diabetes mellitus (GDM).Thirty patients with GDM and their neonates (n = 30), 35 healthy pregnant women (15 in the first, nine in the second and 11 in the third trimester) and their neonates (n = 20), and 25 healthy matched non-pregnantwomen participated in the study. Significantly elevated levels of maternal TNF-α, sTNF receptor (R)-1 and R-2, leptin (detected by enzyme-linked immunosorbent assay) and fasting C-peptide (measuredby radioimmunossay and raised body mass index (BMI) were found in GDM patients and in the third trimester of normal pregnancies. TNF-α, sTNFR-2, C-peptide, leptin concentrations and BMI positivelycorrelated with each other in GDM. An inverse relationship between the body length, head circumference and body weight of the newborns, and maternal TNF-α, leptin and C-peptide concentrations wasshown in GDM. In healthy pregnancies the maternal serum leptin level was in a negative linear correlation with the head circumference of the newborns. In conclusion, increased TNF-α and leptin levelsmay contribute to insulin resistance in GDM and in the third trimester of normal pregnancy and may negatively influence the anthropometric parameters of the newborns.

Implications of a High Placental Ratio in Pregnancies with Appropriate-for-Gestational Age Neonates

Objective: To determine the relationship between the placental weight to birth weight ratio (placental ratio) with maternal pre-pregnancy weight, gestational weight gain, and neonatal outcome in non-diabetic pregnancies resulting in appropriate-for-gestational age (AGA) infants. Methods: A retrospective study was performed on 593 patients with singleton pregnancies, normal results in the 75-gram oral glucose tolerance test and who delivered AGA newborns within a 1-year period. The patients were categorized into high placental ratio (> mean +1 SD based on previous data, n = 113 or 19.1%) and normal ratio groups for the comparison of maternal and neonatal anthropometric parameters. Results: The high placental ratio group had a higher pre-pregnancy weight, body mass index, placental weight, and incidence of low Apgar score, but decreased absolute and percentage gestational weight gain, gestational age, and birth weight. After controlling for pre-pregnancy weight and gestational age, only the correlation between placental weight and percent weight gain remained significant. Conclusion: Our finding suggests that a high placental ratio can identify AGA newborns who are disproportionately small relative to maternal size, and may reflect some form of fetal growth impairment.