Neonatal Anthropometric Research Articles

The influence of gestational hypertension on cord blood adiponectin levels: a case-controlled study

Introduction:Gestational hypertension is one of the most common complications of pregnancy and childbirth worldwide and may be associated with metabolic disorders. Adiponectin is an adipocyte-specific plasma protein with insulin-sensitizing, vascular-protective, anti-inflammatory properties, and its role in metabolic disorders in prenatal and postnatal development in neonates remains unclear. The primary purpose of this study was to determine whether gestational hypertension is a condition lowering cord blood adiponectin level. Next, we have evaluated whether cord blood adiponectin level correlates with selected anthropometric parameters in neonates.Material and methods:The case–control study included 89 newborns divided into two groups: 30 neonates in the study group whose mothers were diagnosed with gestational hypertension and 59 healthy neonates born from normotensive pregnancies. Adiponectin determinations were performed in both groups, and neonatal anthropometric measurements and perinatal data were collected.Results:There was no statistically significant difference (p = 0.27) between adiponectin concentration in cord blood of newborns from the study group [median (Q1–Q3) 9.86 μg/ml (8.16–13.26 μg/ml)] compared with the control group [median (Q1–Q3) 10.65 μg/ml (8.69–14.29 μg/ml)]. No statistically significant correlations were observed between adiponectin level and gestational age, body weight, body length, and chest circumference. A significant correlation was observed between adiponectin level and head circumference among newborns in the control group and among the entire population of newborns included in the study.Conclusion:No significant influence of gestational hypertension on cord blood adiponectin levels or their correlation with neonatal anthropometric measurements was observed.

Estimation of Gestational Age Using Neonatal Anatomical Anthropometric Parameters in Dessie Referral Hospital, Northeast Ethiopia.

IntroductionEstimation of gestational age is a key for the identification of a given low birth weight neonate is either preterm or growth retarded.ObjectiveTo estimate gestational age from neonatal anatomical anthropometric parameters in Dessie Referral Hospital, Ethiopia.MethodsInstitutional-based cross-sectional study design was employed in Dessie Referral Hospital from October 2019 to April 2020, with 424 consecutively live-born of 28–42 weeks of gestation. After considering the inclusion criteria, neonatal anthropometric parameters were measured within 3 days of birth. Foot length, hand length, mid-upper arm circumference, head circumference, crown-heel length, intermammary distance, umbilical nipple distance, and birth weight were measured and summarized using descriptive statistics, and the power of association was evaluated using correlation analysis. Regression equations of gestational age (GA) in completed weeks with anthropometric parameters were formulated using simple and multiple linear regression analysis.ResultsExcept for hand length, all other neonatal anthropometric measurements were positively correlated with GA in completed weeks at p< 0.05. Anthropometric parameters individually, mid-upper arm circumference (MUAC) and BW (birth weight) were correlated well with GA at correlation coefficient (r) of 0.406 and 0.334, respectively. Regression formula was formulated as GA (weeks) = 26.12+ [1.11×MUAC (cm)] and GA (Weeks) = 33.19 + [1.53×BW (kg)]. Multiple regression contributed correlation with GA and used for prediction of GA as GA (weeks) = 28.12 – [0.393×HL (cm)] + [1.07×BW (kg)] + [0.87×MUAC (cm)] (r= 0.458).ConclusionThe overall relative better correlation for prediction of GA, alone and in combination, is found by combined parameters (HL, MUAC, and BW). The relatively better individual anthropometric parameter for GA assessment is MUAC. Hence, using this neonatal parameter as a prediction of gestational age, the death of neonate due to preterm can be minimized.

Vegetarian diets during pregnancy, and maternal and neonatal outcomes.

Vegetarian diets are becoming increasingly popular in the USA. Limited research has examined the health consequences of vegetarian diets during pregnancy. We comprehensively examined associations of vegetarianism during pregnancy with maternal and neonatal outcomes. We used data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Fetal Growth Studies-Singletons, a prospective multi-site cohort of 1948 low-risk pregnant women of four races/ethnicities (White, Black, Hispanic, Asian/Pacific Islander) in the USA (2009-2013). Vegetarianism was self-reported and also defined based on dietary patterns measured using a self-administered first-trimester food-frequency questionnaire (full [lacto-ovo and vegan], pesco-, semi- and non-vegetarians). Neonatal outcomes included birthweight and neonatal anthropometric measures, small for gestational age, small for gestational age with neonatal morbidity and preterm delivery. Maternal outcomes included gestational weight gain, gestational diabetes, hypertensive disorders of pregnancy and gestational anaemia. Ninety-nine (6.2%) women self-reported being vegetarian. The diet-based definition identified 32 (2.0%) full vegetarians, 7 (0.6%) pesco-vegetarians and 301 (17.6%) semi-vegetarians. Neonates of diet-based full vegetarians had higher odds of being small for gestational age [adjusted odds ratio (ORadj) = 2.51, 95% confidence interval: 1.01, 6.21], but not of being small for gestational age with a postnatal morbidity. Full vegetarians had marginally increased the odds of inadequate second-trimester gestational weight gain (ORadj = 2.24, 95% confidence interval: 0.95, 5.27). Vegetarian diets during pregnancy were associated with constitutionally smaller neonatal size, potentially via the mothers' reduced gestational weight gain. Notably, vegetarianism was not associated with small-for-gestational-age-related morbidities or other adverse maternal outcomes.

Sexual dimorphism and the placenta – results from the ROLO kids study

Background/Aims To assess the association between placental morphology and neonatal and infant anthropometry, including analysis by sex. Study Design Data from the ROLO Kids [Randomized COntrol Trial of LOw Glycaemic Index in Pregnancy] study were analyzed including placental weight and morphology. Placental, anthropometric and skinfold measurements were recorded as markers of adiposity in 196 neonates and 215 infants at 6 months of age. Ratios including subscapular-to-triceps skinfold ratio and waist-to-height ratio were used as markers of central adiposity, while the sum of all skinfolds and subscapular plus triceps skinfolds were used as markers of general adiposity. Analysis was performed for total groups and by sex. Results On simple linear regression placental weight was associated with neonatal and infant anthropometric measurements. On multiple regression, the placental weight was associated with birth weight. In the neonatal period placental weight was associated with general adiposity in males only (sum of skinfolds (B 0.007, p < .001) and subscapular + triceps skinfolds a marker of general adiposity (B 0.004 p < .001)). At 6 months of age placental length was positively associated with central adiposity in the total group (B 0.006, p .036) and maximum cord diameter was inversely associated with infant central adiposity (B − 0.309 p .043) in males only. Conclusion The placental phenotype is associated with anthropometry at birth and this association persists to early infancy with a stronger relationship noted in this cohort amongst males. This suggests sexual dimorphism may play a role in the impact of the placenta on infant anthropometry.

Associations of maternal soy product consumption and urinary isoflavone concentrations with neonatal anthropometry: A prospective cohort study.

Isoflavones (ISOs) are naturally occurring endocrine-disrupting compounds. Few human studies have evaluated the effects of ISO exposure on neonatal anthropometry. This study aimed to examine the associations of maternal soy product consumption and urinary ISO concentrations, including genistein, daidzein, glycitein, and equol, with neonatal anthropometry, based on a Chinese cohort study. In Shanghai-Minhang Birth Cohort Study, pregnant women at 12-16 weeks of gestation were recruited, and they completed a structured questionnaire to assess soy product consumption during pregnancy. They also provided a single spot urine sample for the ISO assay. Neonatal anthropometric indices (birth weight; arm, waist, and head circumference; and triceps, back, and abdominal skinfold thickness) were measured at birth. Multivariable linear regression analysis was performed among the 1188 mother-infant pairs to examine the associations between maternal soy product consumption and neonatal anthropometry. The same statistical model was applied to examine the associations between maternal ISO exposure and neonatal anthropometry among 480 mother-infant pairs. Neonate girls born to mothers who "sometimes" and "frequent" consumed soy products had 169.1g (95% confidence interval [CI],-68.9-407.1) and 256.5g (95% CI, 17.1-495.8) higher birth weight, respectively, than those born to mothers who "never" consumed soy products during pregnancy. We observed consistent associations between higher maternal urine ISO concentrations and increased anthropometric indices (birth weight, arm and waist circumference, and triceps and abdominal skinfold thickness) in neonate girls, while no association was observed among boys. The findings suggested that maternal dietary ISO intake during pregnancy is associated with fetal development in a sex-specific pattern. In addition, follow-up studies are required to evaluate whether the observed changes in anthropometric indices at birth are associated with health conditions later in life.

Maternal vitamin D status and association with neonatal anthropometric measures

Pregnant women are at risk of developing vitamin D insufficiency or deficiency. Vitamin D status has a great impact on both pregnancy and the fetus. The aim of the study was to evaluate the maternal serum vitamin D level and its impact on the neonatal anthropometric measures. Material and methods. A prospective study among 71 pregnant women aged 19 to 40 years was carried out. Women with a gestation period of 12-15 weeks between October to April were included in this study. A survey of pregnant women was conducted and the maternal serum total vitamin D [25 (OH) D2 and D3] level was determined by enzyme immunoassay. Neonatal anthropometric parameters (weight, body length, weightlength ratio) were measured. Results and discussion. Vitamin D deficiency was observed in 41 (57.7%) of pregnant women, insufficiency - in 7 (9.9%), and the optimal level - in 23 (32.4%) of examined women. Women with vitamin D deficiency were more likely to have a miscarriage in anamnesis than women with optimal D status (OR - 9.06; 95% CI: 1.11-73.86, р=0.0396). We have not established the influence of other factors (age, social status, body mass index, number of pregnancies) on the maternal D-status. There were no significant differences between indicators of weight by age, body length of a child by age, and Apgar scores depending on the vitamin-D status of pregnant women. Conclusion. The study showed that the optimal vitamin D level is observed only in 32.4%, and its deficiency or insufficiency occurs in 67.6% of pregnant women. The study did not reveal the correlation between maternal vitamin-D status and neonatal anthropometric measures. Taking into account the trend towards lower weight-length ratio to gestational age of the newborns from mothers with vitamin D deficiency/insufficiency, further studies are needed.

Certain prenatal problems and their relationship with neonate's anthropometric indices at birth

Background and Objective: Fetal development is a strong predictor of neonate's survival after birth. Investigation of factors that may affect fetal development is important. The present study aimed to investigate certain prenatal problems and their relationship with neonate's anthropometric indices at birth. Materials and Methods: The present cross-sectional descriptive-analytical study was conducted using records registered in Iran’s Integrated Health System (locally know as SIB), including the records of 616 pregnant mothers who had given birth during 2017-18 in the city of Bushehr (Iran). The registered details of the mothers and infants were reviewed from the first prenatal visit to the first postpartum visit. A checklist was prepared to record the information in their records. The collected data were analyzed in SPSS-19 using appropriate statistical tests at a significance level of p<0.05. Results: The mothers' mean age was 30.84±5.30 years, 3.9% of infants weighed under 2500 g and were therefore in LBW group. The frequency of anemia was 16.25% and 22.5% respectively in the first and second trimesters. Gestational age (β=0.157, P 0.001) and mothers’ body mass Index (BMI) (β=0.241, P>0.001) in the first prenatal visit had a direct and significant relationship with the infant's weight-for-age Z-score. Moreover, GA (β=0.229, P>0.001) and mother's BMI (β=0.242, P>0.001) in the first prenatal visit had a direct and significant relationship with the infant's length-for-age Z-score. The infant's anthropometric indices had no significant relationships with perinatal complications such as anemia, controlled diabetes, and urinary tract infections. Conclusion: Prenatal complications such as anemia were prevalent in the study population, and required particular attention. The mother's BMI can predict fetal development and should be the focus of greater attention in prenatal clinics. Closer monitoring of maternal anthropometry and increasing mother's knowledge in nutrition by the antenatal clinics would be beneficial for both the mother and the neonate.

Predicting postpartum psychiatric admission using a machine learning approach

The accurate identification of mothers at risk of postpartum psychiatric admission would allow for preventive intervention or more timely admission. We developed a prediction model to identify women at risk of postpartum psychiatric admission. Data included administrative health data of all inpatient live births in the Australian state of Queensland between January 2009 and October 2014. Analyses were restricted to mothers with one or more indicator of mental health problems during pregnancy (n=75,054 births). The predictors included all maternal data up to and including the delivery, and neonatal data recorded at delivery. We used multiple machine learning methods to predict hospital admission in the 12 months following delivery in which the primary diagnosis was recorded as an ICD-10 psychotic, bipolar or depressive disorders. The boosted trees algorithm produced the best performing model, predicting postpartum psychiatric admission in the validation data with good discrimination [AUC=0.80; 95% CI = (0.76, 0.83)] and achieving good calibration. This model outperformed benchmark logistic regression model and an elastic net model. In addition to indicators of maternal metal health history, maternal and neonatal anthropometric measures and social/lifestyle factors were strong predictors. Our results indicate the potential of a big data approach when aiming to identify mothers at risk of postpartum psychiatric admission. Mothers at risk could be followed-up and supported after neonatal discharge to either remove the need for admission or facilitate more timely admission.

Head circumference in infants with nonopiate-induced neonatal abstinence syndrome.

No relationship has been reported between nonopiate neonatal abstinence syndrome (NAS) and anthropometric indices, including head circumference (HC). The purpose of this study was to determine the relationship between maternal nonopioid drug use and HC at birth in neonates with NAS. This retrospective observational study included neonates born between January 1, 2010 and March 31, 2019, whose mothers had been taking antipsychotic, antidepressant, sedative, or anticonvulsant medications. The outcome measures were HCs of NAS infants and controls. Of 159 infants, 33 (21%) were diagnosed with NAS. There was no maternal opioid use among mothers during pregnancy. The HCs in the NAS group were significantly smaller than those in the control group. The median z-scores for HC at birth were -0.20 and 0.29 in the NAS group and the control group, respectively (P=.011). The median HCs at birth were 33.0 and 33.5cm in the NAS group and the control group, respectively. Multivariate analysis revealed that maternal antipsychotic drug use and selective serotonin reuptake inhibitors were independently associated with NAS (P<.001 and P=.004, respectively). Notably, benzodiazepine use and smoking were not independent risk factors. The results suggest an association between maternal antipsychotic drug use and NAS, which was further associated with decreased HC. Careful monitoring of maternal drug use should be considered to improve fetal outcomes.

Association of maternal urinary concentration of parabens and neonatal anthropometric indices.

Parabens are used as preservatives in a wide range of products. Although parabens are generally known as safe, but recent evidences indicate that these compounds could lead to potential adverse effects on fetal growth. Thus, this study aimed to investigate the association between maternal parabens level in a sample of Iranian pregnant women with neonatal anthropometric measures. This cross-sectional study was conducted in 2018-2019 in Isfahan city, Iran. Early morning urine samples were collected from 117 pregnant women who were in their first trimester of pregnancy. The urinary concentrations of four parabens including methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), and butylparaben (BuP) were measured by gas chromatography-mass spectrometry. To compensate for variation in urine dilution, the paraben concentrations were adjusted by the creatinine levels. Associations between maternal parabens level and neonatal anthropometric indices were evaluated. The MeP, EtP, PrP, and BuP were detected in %92, %36, %65, and %89 of the urine samples, respectively. No significant association was observed between maternal parabens level and birth length (p-value>0.05). In adjusted model, the BuP concentration in first trimester urine samples showed significantly negative association with head circumference in female neonates [β = -0.013, 95% CI: -0.024, -0.003], while positive significant association with that index in male neonates [β = 0.019, 95% CI: 0.001, 0.038]. In subgroup analysis by sex, in crude and adjusted analyses BuP was found to be only associated with higher birth weight in female neonates. PrP also showed significant positive association with head circumference and birth weight of male neonates in crude analysis. Findings of this study on the association of urinary parabens of pregnant mothers with birth weight and head circumference suggest that maternal exposure to parabens might impact the fetal growth, However, these findings are based on cross-sectional data, thus the results should be interpreted with caution. The current findings underscore the necessity of providing more strict regulations in industries for limiting parabens use in their products, and the importance of public education for women of reproductive age for using paraben-free compounds.

Maternal Altitude-Corrected Hemoglobin and at Term Neonatal Anthropometry at 3400 m of Altitude.

Villamonte-Calanche, Wilfredo, Nelly Lam-Figueroa, Maria Jerí-Palomino, Cleto De-La-Torre, and Alexandra A. Villamonte-Jerí. Maternal altitude-corrected hemoglobin and at term neonatal anthropometry at 3400 m of altitude. High Alt Med Biol. 21:287-291, 2020. Introduction: Fetal growth is prominent in the last trimester of pregnancy. The development of the fetus depends on the nutrient consumption and oxygen delivery of the pregnant woman. Therefore, maternal anemia has an inverse relationship with fetal growth. Consequently, the newborn has lower anthropometric measurements. Residing in places of a high altitude increases the level of hemoglobin (Hb); as a result, the World Health Organization (WHO) recommends adjusting the value of Hb in maternal blood at 3400-m altitude by reducing 2.4 g/dL to obtain the corrected Hb (HbCorr). Objective: To determine if the relationship of maternal HbCorr for high altitude is related to term neonatal anthropometry at 3400-m altitude. Material and Methods: We performed a retrospective cohort study and evaluated the neonatal anthropometric variables (weight, ponderal index, head circumference [HC], and HC for birthweight index) in 308 exposed pregnant women (HbCorr <11 g/dL) and 600 unexposed pregnant women (HbCorr ≥11 g/dL). We obtained absolute relative frequencies and measures of central tendency. Besides, we compared the qualitative and quantitative variables using the chi-square and the Student t or the Mann-Whitney or Kruskal-Wallis U test, if applicable. We also performed linear regression. Results: Of anemic pregnant women, 68.2% were mild, while only 1% were severe. There was no relationship between HbCorr and neonatal anthropometry, and none of the anemic pregnant women showed a statistical difference in the neonatal anthropometric measures evaluated compared to the unexposed women. Conclusion: There is no relationship between HbCorr and neonatal anthropometry at 3400-m altitude.

A study to determine the effect of maternal prepregnancy body mass index on the anthropometric measurements of the newborn

Background: Maternal pre-pregnancy BMI is well established to be a detrimental factor for prenatal development and neonatal anthropometric measures. Objectives of the study was to study the association between maternal pre-pregnancy Body Mass Index (BMI) and the anthropometry of the newborn.Methods: A hospital based cross-sectional, observational study was conducted that included 236 normal newborns and their mothers. A pre-designed questionnaire was used to collect relevant socio-demographic data and obstetric history. Details regarding maternal pre-pregnancy weight was collected from antenatal records at first antenatal visit, maternal height was measured and BMI was calculated. Neonatal anthropometric measurements including birth weight, recumbent length, head circumference, chest circumference and the mid arm circumference was measured.Results: In this study 49.6% of the women were in the age group of 21-25 years, 52.5% of them were multi-gravida and 56.4% had normal vaginal delivery. Among the newborns included in the study 25.8% had low birth weight. We saw a significant positive correlation between BMI and age, BMI and birth weight, BMI and chest circumference that is with increase in BMI there was significant increase in the age, birth weight and chest circumference and vice versa. There was no association between maternal BMI and mid-arm circumference or head circumference of the newborn.Conclusions: Study showed the association between maternal BMI and anthropometry of the newborn especially with respect to the BMI and birth weight, BMI and chest circumference. Thereby, establishing that interventions aimed at improving the nutritional status of the mother have a direct impact on the fetal growth outcomes.

Distinct maternal microbiota clusters are associated with diet during pregnancy: impact on neonatal microbiota and infant growth during the first 18 months of life

ABSTRACT Nutrition during pregnancy plays an important role in maternal–neonatal health. However, the impact of specific dietary components during pregnancy on maternal gut microbiota and the potential effects on neonatal microbiota and infant health outcomes in the short term are still limited. A total of 86 mother–neonate pairs were enrolled in this study. Gut microbiota profiling on maternal–neonatal stool samples at birth was carried out by 16S rRNA gene sequencing using Illumina. Maternal dietary information and maternal–neonatal clinical and anthropometric data were recorded during the first 18 months. Longitudinal Body Mass Index (BMI) and Weight-For-Length (WFL) z-score trajectories using the World Health Organization (WHO) curves were obtained. The maternal microbiota was grouped into two distinct microbial clusters characterized by Prevotella (Cluster I) and by the Ruminococcus genus (Cluster II). Higher intakes of total dietary fiber, omega-3 fatty acids, and polyphenols were observed in Cluster II compared to Cluster I. Higher intakes of plant-derived components were associated with a higher presence of the Christensellaceae family, Dehalobacterium and Eubacterium, and lower amounts of the Dialister and Campylobacter species. Maternal microbial clusters were also linked to neonatal microbiota and infant growth in a birth-dependent manner. C-section neonates from Cluster I showed the highest BMI z-score at age 18 months, along with a higher risk of overweight. Longitudinal BMI and WL z-score trajectories from birth to 18 months were shaped by maternal microbial cluster, diet, and birth mode. Diet was an important perinatal factor in early life that may impact maternal microbiota; in particular, fiber, lipids and proteins, and exert a significant effect on the neonatal microbiome and contribute to infant development during the first months of life. Abbreviations NCDs: Non-Communicable Diseases, C-section: Cesarean Section, BMI: Body Mass Index; WL: Weight for length; EPA: Eicosapentanoic Acid; DHA: Docosahexaenoic Acid; DPA: Docosapentaenoic Acid; SCFA: Short Chain Fatty Acids; MD: Mediterranean Diet; FFQ: Food Frequency Questionnaire; CHI: Calinski Harabasz Index

Abstract 33: Associations of Gestational Cardiovascular Health With Pregnancy Outcomes: The Hyperglycemia and Adverse Pregnancy Outcome Study

Introduction: Combinations of risk factor levels typically contribute more to population burdens of disease than single adverse risk factors. CVH (as defined by the AHA) characterizes a range of health levels, but its significance in pregnancy for obstetric and neonatal outcomes is unknown. Methods: Data from the Hyperglycemia and Adverse Pregnancy Outcome Study were analyzed, including 1,754 mother-child dyads from 9 field centers in 6 countries: US (26%), Barbados (24%), UK (20%), China (15%), Thailand (8%), and Canada (7%). Maternal CVH was scored (0-10 points, with 10 most favorable) at a mean of 28 (range 23-34) weeks’ gestation using 5 metrics ( Table ). Cord blood was collected at delivery, neonatal anthropometrics were measured within 72 hours, and medical records were abstracted for obstetric outcomes. Logistic regression was utilized to test associations of gestational CVH with obstetric and neonatal outcomes, adjusted for center and maternal and infant characteristics ( Table footnote). Results: The mean gestational CVH score was 8.2 (SD 1.5) out of 10; 18% of mothers had all ideal, 37% had 1+ intermediate, 34% had 1 poor, and 9% had 2+ poor metrics. In fully adjusted models ( Table ), odds ratios per 1 point higher (better) CVH score were 0.65 (95% CI, 0.56-0.76) for preeclampsia, 0.89 (0.78-1.00) for unplanned primary cesarean section (among primiparous mothers), 0.84 (0.77-0.93) for large for gestational age infant, 0.87 (0.79-0.97) for infant sum of skinfolds &gt;90 th percentile, and 0.77 (0.69-0.86) for infant insulin sensitivity index (20/[C-peptide*glucose]) &lt;10 th percentile. CVH categories were also associated with outcomes; for example, compared with mothers with all metrics ideal, odds ratios for preeclampsia were 2.00 (0.71-7.14) for mothers with 1+ intermediate, 4.34 (1.63-15.09) for mothers with 1 poor, and 9.40 (3.22-34.52) for mothers with 2+ poor metrics. Conclusion: More favorable levels of gestational CVH were associated with healthier obstetric and neonatal outcomes in this multinational cohort.

Abstract P176: Associations of Gestational Lipids and Apolipoproteins With Pregnancy Outcomes: The Hyperglycemia and Adverse Pregnancy Outcome Study

Introduction: Gestational hyperlipidemia has traditionally been considered physiologic and benign, but the significance of inter-individual variation in lipid levels for maternal-fetal health are poorly understood. We examined associations of gestational lipids and apolipoproteins with adverse obstetric and neonatal outcomes. Methods: Data from the Hyperglycemia and Adverse Pregnancy Outcome Study were analyzed, including 1,813 mother-child dyads from 9 field centers in 6 countries: US (25%), Barbados (24%), UK (20%), China (16%), Thailand (8%), and Canada (7%). Fasting lipids and apolipoproteins were directly measured at a mean of 28 (range 23-34) weeks’ gestation. Cord blood was collected at delivery, neonatal anthropometrics were measured within 72 hours, and medical records were abstracted for obstetric outcomes. Logistic regression was utilized to test associations of lipids and apolipoproteins (per +1 SD; log-transformed if skewed) with pregnancy outcomes, adjusted for center, demographics, and maternal covariates such as BMI, blood pressure, and glycemia. Results: See Table for lipid and apolipoprotein levels in pregnant mothers. In fully adjusted models ( Table ), 1 SD higher log-triglycerides (i.e., ~2.7-fold higher triglyceride level) in late pregnancy was significantly associated with higher odds for preeclampsia (OR 1.53 [95% CI, 1.15-2.05]), large for gestational age infant (1.42 [1.21-1.67]), and infant insulin sensitivity &lt;10 th percentile (1.25 [1.03-1.50]), but not with unplanned primary cesarean section or infant sum of skinfolds &gt;90 th percentile. There were no significant associations of maternal HDL-C, LDL-C, or log-ApoB/A1 ratio with any outcome. Conclusion: Triglyceride levels in the latter half of pregnancy were uniquely associated with both maternal risks (preeclampsia) and neonatal risks (large for gestational age and insulin resistance), even after adjustment for maternal BMI, blood pressure, and glycemia.

Both glycaemic control and insulin dose during pregnancy in women with type 1 diabetes are associated with neonatal anthropometric measures and placental weight.

To investigate longitudinal associations of maternal glucose/HbA1c and insulin dose with birthweight-related outcomes in women with type 1 diabetes. We performed a cohort study including 473 pregnant women with type 1 diabetes with singleton pregnancies. We investigated maternal self-monitored blood glucose (SMBG, mmol/L), HbA1c (%, mmol/mol) and insulin dose (IU/kg/day) in the three trimesters as potential independent variables, while adjusting for potential confounders. Outcomes of interest were birthweight, birthweight SD score, neonatal length, weight/length index, ponderal index and placental weight. Multiple linear regression analysis was performed with separate analyses for SMBG and HbA1c . Maternal glucose and insulin dose were independently associated with birthweight-related outcomes. In the main analysis, in the first trimester most associations were positive for insulin dose, in the second the associations were positive for glucose and inverse for insulin while in the third there were no associations. Most sensitivity analyses produced consistent results. In a sensitivity analysis splitting the first trimester in two periods, positive associations of maternal insulin with birthweight-related outcomes were observed in weeks 0+ to 6+. Early in pregnancy in women with type 1 diabetes, maternal insulin dose is positively associated with birthweight-related outcomes, whereas in the second trimester, a positive association with SMBG emerges and the association with maternal insulin becomes inverse. If confirmed in other cohorts, these results would have implications in the management of women with type 1 diabetes.

Child Head Circumference and Placental MFSD2a Expression Are Associated to the Level of MFSD2a in Maternal Blood During Pregnancy.

Gestational diabetes mellitus (GDM) is a world-wide health challenge, which prevalence is expected to increase in parallel to the epidemic of obesity. Children born from GDM mothers have lower levels of docosahexaenoic acid (DHA) in cord blood, which might influence their neurodevelopment. Recently, the membrane transporter Major Family Super Domain 2a (MFSD2a) was associated with the selective transportation of DHA as lysophospholipids. The expression of the DHA membrane transporter MFSD2a is lower in GDM placentas, which could affect materno-fetal DHA transport. Humans with homozygous inactivating mutations in the MFSD2a gene present severe microcephaly and intellectual impairments. Herein, we intended to identify early blood biomarkers that may be of use during pregnancy to monitor the offspring development and the adequate nutritional interventions, such as nutritional supplementation, that may be selected to improve it. We evaluated MFSD2a expression in maternal blood at the third trimester of pregnancy, and its potential relationship with the expression of placental MFSD2a at delivery and child outcomes. Three groups of pregnant women were recruited: 25 controls, 23 GDM with dietary treatment, and 20 GDM with insulin treatment. Maternal and neonatal anthropometric and biochemical parameters were evaluated. MFSD2a was analyzed in placenta, blood and serum. MFSD2a protein expression in maternal blood was significantly lower in GDM groups and correlated with placental MFSD2a and Z-score neonatal head circumference during the first 6 months of life. The cord/maternal serum ratio of DHA, a solid indicator of materno-fetal DHA transport, was reduced in GDM groups and correlated with MFSD2a in maternal blood at the third trimester and in placenta at delivery. This indicates that altered MFSD2a levels in maternal blood during pregnancy might influence placental nutrient transport and fetal neurodevelopment. Furthermore, MFSD2a levels in maternal blood on the third trimester were inversely correlated to DHA in maternal serum lyso-PL. Thus, the level of MFSD2a in maternal blood could be used as a potential biomarker for the early detection of disturbances of MFSD2a expression during pregnancy and the subsequent consequences for the neurodevelopment of the child, as well as it may help to choose the optimal treatment approach for the affected subjects.

The relationship between maternal and neonatal vitamin B12 and folate levels, anthropometric measurements, and metabolic indicators

Aim: The nutritional imbalances in pregnancy may lead to metabolic problems in newborns, which may cause obesity during childhood and later in life. It is aimed to determine the maternal levels of folate, vitamin B12 at birth and to investigate the correlation between neonatal anthropometric measurements, and metabolic indicators such as serum lipid profile and insulin resistance.Methods: A total of 102 mothers and newborns were enrolled in this prospective cohort study. The demographic, obstetric features, serum levels of vitamin B12, folate, glucose, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, cholesterol, insulin, homocysteine, and homeostatic model assessment (HOMA-IR) were noted. For vitamin B12, levels, ≥191 ng/L were accepted as normal. The correlation between maternal levels of vitamin B12, folate, anthropometric measurements, and metabolic indicators of newborns were evaluated. Results: Body mass index (P=0.004), serum insulin levels (P=0.012), HOMA-IR (P=0.001), and homocysteine (P=0.001) were increased in neonates born from mothers with lower serum levels of vitamin B12. The maternal vitamin B12 levels were positively, strongly correlated with neonatal vitamin B12 levels (r=0.719, P&lt;0.001). There was an inverse, weak correlation between maternal vitamin B12 levels and neonatal serum insulin levels (r=-0.221, P=0.025), HOMA-IR (r=-0.249, P=0.011), and homocysteine (r=-0.394, P&lt;0.001). Maternal folate levels were strongly, positively correlated with neonatal folate (r=0.735, P&lt;0.001); weakly, positively correlated with neonatal vitamin B12 (r=0.327, P=0.001); moderately, inversely correlated with neonatal homocysteine (r=-0.505, P&lt;0.001).Conclusion: Optimizing intake of these vitamins levels during pregnancy is important to reduce the neonatal metabolic abnormalities, which may lead to obesity later in life.

Social and economic factors, maternal behaviours in pregnancy and neonatal adiposity in the PANDORA cohort

BackgroundAustralian Indigenous women experience high rates of social disadvantage and type 2 diabetes (T2D) in pregnancy, but it is not known how social factors and maternal behaviours impact neonatal adiposity in offspring of women with hyperglycaemia in pregnancy. MethodsParticipants were Indigenous (n = 404) and Europid (n = 240) women with gestational diabetes mellitus (GDM) or T2D in pregnancy and their offspring in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study. Social, economic factors, and maternal behaviours were measured in pregnancy and six neonatal anthropometric outcomes were examined after birth. ResultsOn univariate analysis, maternal education < 12 years (p = 0.03), unemployment (p = 0.001), welfare income vs no welfare income (p = 0.001), lower area based socio-economic score (p < 0.001), and fast food intake > 2 times/week (p = 0.002) were associated with increased sum of skinfolds (SSF) in offspring. Smoking was significantly associated with a reduction in anthropometric measures, except SSF. In multivariable models adjusted for ethnicity, BMI and hyperglycaemia, social and economic factors were no longer significant predictors of neonatal outcomes. Smoking was independently associated with a reduction in length, head circumference and fat free mass. Frequent fast food intake remained independently associated with SSF (β-coefficient 1.08 mm, p = 0.02). ConclusionIn women with hyperglycaemia in pregnancy, social factors were associated with neonatal adiposity, particularly skinfold measures. Promoting smoking cessation and limited intake of energy-dense, nutrient-poor foods in pregnancy are important to improve neonatal adiposity and lean mass outcomes. Addressing inequities in social and economic factors are likely to be important, particularly for Indigenous women or women experiencing social disadvantage.

Cord blood metabolic markers are strong mediators of the effect of maternal adiposity on fetal growth in pregnancies across the glucose tolerance spectrum: the PANDORA study.

We aimed to assess associations between cord blood metabolic markers and fetal overgrowth, and whether cord markers mediated the impact of maternal adiposity on neonatal anthropometric outcomes among children born to Indigenous and Non-Indigenous Australian women with normal glucose tolerance (NGT), gestational diabetes mellitus (GDM) and pregestational type 2 diabetes mellitus. From the Pregnancy and Neonatal Outcomes in Remote Australia (PANDORA) study, an observational cohort of 1135 mother-baby pairs, venous cord blood was available for 645 singleton babies (49% Indigenous Australian) of women with NGT (n = 129), GDM (n = 419) and type 2 diabetes (n = 97). Cord glucose, triacylglycerol, HDL-cholesterol, C-reactive protein (CRP) and C-peptide were measured. Multivariable logistic and linear regression were used to assess the associations between cord blood metabolic markers and the outcomes of birthweight z score, sum of skinfold thickness (SSF), being large for gestational age (LGA) and percentage of body fat. Pathway analysis assessed whether cord markers mediated the associations between maternal and neonatal adiposity. Elevated cord C-peptide was significantly associated with increasing birthweight z score (β 0.57 [95% CI 0.42, 0.71]), SSF (β 0.83 [95% CI 0.41, 1.25]), percentage of body fat (β 1.20 [95% CI 0.69, 1.71]) and risk for LGA [OR 3.14 [95% CI 2.11, 4.68]), after adjusting for age, ethnicity and diabetes type. Cord triacylglycerol was negatively associated with birthweight z score for Indigenous Australian women only. No associations between cord glucose, HDL-cholesterol and CRP >0.3mg/l (2.9nmol/l) with neonatal outcomes were observed. C-peptide mediated 18% (95% CI 13, 36) of the association of maternal BMI with LGA and 11% (95% CI 8, 17) of the association with per cent neonatal fat. Cord blood C-peptide is an important mediator of the association between maternal and infant adiposity, across the spectrum of maternal glucose tolerance.