Newborns Of Women Research Articles

Are hypertensive disorders in pregnancy associated with congenital malformations in offspring? Evidence from the WHO Multicountry cross sectional survey on maternal and newborn health.

BackgroundAnnually, around 7.9 million children are born with birth defects and the contribution of congenital malformations to neonatal mortality is generally high. Congenital malformations in children born to mothers with hypertensive disorders during pregnancy has marginally been explored.MethodsCountry incidence of congenital malformations was estimated using data on the 310 401 livebirths of the WHO Multicountry Survey which reported information from 359 facilities across 29 countries. A random-effect logistic regression model was utilized to explore the associations between six broad categories of congenital malformations and the four maternal hypertensive disorders “Chronic Hypertension”, “Preeclampsia” and “Eclampsia” and “Chronic hypertension with superimposed preeclampsia”.ResultsThe occupied territories of Palestine presented the highest rates in all groups of malformation except for the “Lip/Cleft/Palate” category. Newborns of women with chronic maternal hypertension were associated with a 3.7 (95 % CI 1.3–10.7), 3.9 (95 % CI 1.7–9.0) and 4.2 (95 % CI 1.5–11.6) times increase in odds of renal, limb and lip/cleft/palate malformations respectively. Chronic hypertension with superimposed preeclampsia was associated with a 4.3 (95 % CI 1.3–14.4), 8.7 (95 % CI 2.5–30.2), 7.1 (95 % CI 2.1–23.5) and 8.2 (95 % CI 2.0–34.3) times increase in odds of neural tube/central nervous system, renal, limb and Lip/Cleft/Palate malformations.ConclusionsThis study shows that chronic hypertension in the maternal period exposes newborns to a significant risk of developing renal, limb and lip/cleft/palate congenital malformations, and the risk is further exacerbate by superimposing eclampsia. Additional research is needed to identify shared pathways of maternal hypertensive disorders and congenital malformations.

130 Maternal and perinatal outcomes according to gestational age of diagnosis of preeclampsia: A retrospective cohort study

Introduction Preeclampsia represents a multisystemic disorder characterized by hypertension and proteinuria, or dysfunction of target organs, with onset after twenty weeks of pregnancy. It is a frequent condition and its complications are important causes of maternal morbidity and mortality Objective To evaluate the clinical outcomes of women affected by severe pre-eclampsia and perinatal complications, determining its association with gestational age at the moment of diagnosis Methods An analytical and observational study was developed from the secondary analysis of a pre-existing database of 565 patients with severe maternal morbidity, which included 376 pregnant women with severe preeclampsia conducted in a school maternity in Northeast of Brazil. Statistical analysis was performed using Epi Info version 7.1. With the objective to compare the maternal, fetal and neonatal complications in women with early (less than 34 weeks of pregnancy) and late preeclampsia (34 weeks of pregnancy or more) we used the chi-square test of association and Fisher’s exact test, whenever appropriate, calculating the prevalence ratio (PR) and its 95% confidence interval Results Women with early onset of severe preeclampsia had significantly higher risk for developing acute renal failure (PR: 17.60; 95% CI 2.19 to 141.40), abruption placenta (PR: 3.6; 95% CI: 1.40 to 9.19) and prolonged hospitalization (PR: 3.44; 95% CI: 2.42 to 4.90). Comparing the perinatal outcomes among women with early and late preeclampsia, the first had significantly higher prevalence ratio of having children with low birth weight (PR: 2.85; 95% CI: 2, −3.39), stillbirths (PR: 5.75; 95% CI: 2.43 to 13.60) and early neonatal deaths (PR: 6.28; 95% CI: 1.24 to 31.91). In addition, newborns of women with early-onset severe preeclampsia more often required neonatal intensive care (PR: 8.17; 95% CI: 5.48 to 12.20) Conclusion This study confirms the heterogeneity of preeclampsia, showing that the precocity of onset is an important indicator of the severity and possibly of the disease’s the etiology. There is a clear need to increase medical adherence to guidelines of preeclampsia for early diagnosis and prevention of its complications

The Effect of Zinc Supplementation on Expressed Levels of Peroxisome Proliferator-Activated Receptor Gamma and Glucose Transporter Type 1 Genes in Newborns of Women with Gestational Diabetes Mellitus.

The current study was designed to determine the beneficial effects of zinc supplementation on expressed levels of peroxisome proliferator-activated receptor gamma (PPAR-γ) and glucose transporter type 1 (GLUT1) genes in newborns of women with gestational diabetes mellitus (GDM). This randomized, double-blind, placebo-controlled clinical trial was performed among 40 women with GDM. Patients were randomly allocated to intake either 233mg zinc gluconate (containing 30mg zinc) (n = 20) or a placebo (n = 20) for 6weeks. PPAR-γ and GLUT1 mRNA levels were quantified in umbilical cord blood of newborns of women with GDM. After 6weeks of intervention, the change in serum zinc levels was greater in women consuming zinc than in the placebo group (+11.1 ± 13.4 vs. -4.8 ± 17.3mg/dL, P = 0.002). Quantitative results of RT-PCR demonstrated that compared with the placebo, zinc supplementation resulted in a significant increase of expressed levels of PPAR-γ mRNA (P < 0.001) and GLUT1 mRNA (P < 0.001) in umbilical cord blood of newborns of women with GDM. Taken together, the current study demonstrated that zinc supplementation for 6weeks among GDM women increased the mRNA levels of PPAR-γ and GLUT1 in their newborns compared with the placebo group.

Better than nothing? maternal, newborn, and child health services and perinatal mortality, Lubumbashi, democratic republic of the Congo: a cohort study.

BackgroundThe Democratic Republic of Congo (DRC) has a high rate of perinatal mortality (PMR), and health measures that could reduce this high rate of mortality are not accessible to all women. Where they are in place, their quality is not optimal. This study was initiated to assess the relationship between these suboptimal maternal, newborn and child health (MNCH) services and perinatal mortality (PM) in Lubumbashi, DRC’s second-largest city.MethodsWe conducted a prospective cohort study, comparing women who had no, low, moderate, or high numbers of antenatal care (ANC) visits; three different levels of delivery care; and who did or did not attend postnatal care (PNC). Women were followed for 50 days after delivery, with PM as the primary endpoint.ResultsUptake of recommended prenatal interventions was between 11-43 % among ANC attenders, regardless of the frequency of their visits. PM was 26 per 1000. ANC attendance was associated with PM. Newborns of mothers who had the lowest attendance had a mortality two times higher than newborns of women who had not attended ANC (low visits: adjusted odds ratio (aOR) = 2.2; 95 % confidence interval (CI) = 1.4-3.8). However, moderate (aOR = 1.4; 95 % CI =0.7–2.2) and high (aOR = 1.3; 95 % CI 0.7–2.2) attendance were not statistically significantly associated with PM. PNC attendance was not significantly associated with lower PM (relative risk 0.4, 95 % CI 0.1–2.6). Emergency obstetric and newborn care (EmONC) was significantly associated with a reduction in mortality (aOR = 0.2; 95 % CI = 0.2–0.8), with an 84.4 % reduction among newborns at risk, and an overall reduction in mortality of 10 % for all births.ConclusionPerinatal mortality was high among the infants of women in the cohort under study (26 per 1000 live births). Availability of MNCH, specifically EmONC, was associated with lower perinatal mortality, and if this association is causal, might avert 84.4 % of perinatal deaths among newborns at high-risk.

Prevalence of metabolic syndrome in non-diabetic, pregnant Angolan women according to four diagnostic criteria and its effects on adverse perinatal outcomes.

BackgroundMetabolic syndrome (MetS) is a cluster of risk factors for type 2 diabetes (Type2 DM) and cardiovascular diseases (CVD), and its prevalence varies based on region, population, and sex. Newborns of women with MetS have a greater risk of adverse perinatal outcomes. This study explores the prevalence of metabolic syndrome in non-diabetic, pregnant Angolan women and the adverse perinatal outcomes associated with it.MethodsThis cross-sectional study collected the demographic, anthropometric and clinical data of 675 pregnant women in the maternity ward of General Hospital in Huambo, Angola. Metabolic syndrome was defined using four criteria: the third report of the National Cholesterol Education Program Adult Treatment Panel (ATPIII), the Joint Interim Statement (JIS), and definitions by both Bartha et al. and Chatzi et al.ResultsThe crude prevalence of metabolic syndrome was 36.6 % based on the JIS definition, 29.2 % based on NCEP ATPIII, 12.6 % based on Chatzi et al. and 1.8 % based on Bartha et al. In general, the prevalence of adverse perinatal outcomes was 14.1 %.ConclusionsThere was a high prevalence of metabolic syndrome, depending on the criteria used, and thus a great need to harmonize the criteria and cutoff points. Perinatal adverse outcomes were higher in pregnant women with metabolic syndrome.

Maternal lipids associated with large-for-gestational-age birth weight in women with type 1 diabetes: results from a prospective single-center study.

IntroductionDespite improvement in diabetes care over the years, the incidence of macrosomia in type 1 diabetic mothers is still very high and even shows an increasing tendency. It is suggested that other factors that maternal hyperglycemia might be associated with excessive fetal growth in diabetic mothers. The aim of this study was to determine whether maternal lipids might contribute to high rates of large-for-gestational-age (LGA) newborns in women with type 1 diabetes (T1DM).Material and methodsThis prospective, single-center study was performed in a population of women with T1DM admitted to the perinatal center for women with diabetes. Data were collected in the first trimester (< 12th week), in mid-pregnancy (20th–24th weeks), and before delivery (34th–39th weeks).ResultsAmong 114 women included in the analysis, 30 (26.3%) delivered LGA newborns. The remaining 84 (73.7%) newborns were appropriate for gestational age (AGA). Lower high-density lipoprotein (HDL) HDL concentration in the first trimester was significantly associated with LGA (p = 0.01). Similar associations were observed for the HDL concentrations in mid-pregnancy (p = 0.04) and before delivery (p = 0.03). Higher triglyceride concentrations in the first trimester (p = 0.02) and before delivery (p = 0.008) were associated with LGA. Higher glycated haemoglobin (HbA1c) levels in mid-pregnancy and before delivery were associated with LGA. The associations between maternal lipids and LGA were independent of maternal body mass index at onset of the study, gestational weight gain and HbA1c concentrations.ConclusionsDecreased HDL and increased triglycerides during pregnancy might contribute to the development of LGA in women with type 1 diabetes.

Maternal 75-g OGTT glucose levels as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus.

Our goal was to investigate which glucose measurement from the 75-g oral glucose tolerance test (OGTT) has more capability of predicting large for-gestational-age (LGA) newborns of mothers with gestational diabetes mellitus (GDM). The study group consisted of 118 consecutively pregnant women with singleton pregnancy, patients of Outpatients Department of the Endocrinology, Diabetes, and Metabolic Disorders Clinic. All were prospectively screened for GDM between 24th and 28th week of pregnancy and followed to delivery. Outcome measures included: patients' ages, pre-pregnancy BMI, BMI before delivery, FPG, 1 and 2 hour OGTT glucose values, haemoglobin A1c at third trimester, gestational week of delivery, mode of delivery and baby birth weight. From 118 pregnancies, 78 (66.1%) women were with GDM, and 40 (33.9%) without GDM. There were statistically significant differences (30.7 versus 5.0%, p < 0.01) between LGA newborns from GDM and control group, respectively. Gestation week of delivery and fasting glucose levels were independent predictors for LGA (Beta = 0.58 and Beta = 0.37 respectively, p < 0.01). Areas under the receiver operator characteristic curve (AUC) were compared for the prediction of LGA (0.782 (0.685-0.861) for fasting, 0.719 (0.607-0.815) for 1-hour and 0.51 (0.392-0.626) for 2-hour OGTT plasma glucose levels). Fasting and 1-hour plasma glucose levels from OGTT may predict LGA babies in GDM pregnancies.

Акушерские и перинатальные аспекты выбора фолатсодержащих препаратов при невынашивании беременности

Objective - to compare the pregnancy and the condition of full-term newborns of women with gene polymorphisms of folate cycle and a history of miscarriage, receiving metafolin containing complex and mega-doses of folic acid (FA). Materials and methods. A retrospective study of medical records of 114 patients (form number 025/a, 111/a, 113/y). Compare homocysteine levels, coagulation screening indicators, peculiarities of pregnancy, childbirth, newborn status, depending on the version of folate deficiency correction. Results. In the group of patients treated with metafoline containing vitamin and mineral complex (n=60) had significantly lower levels of homocysteine, fibrinogen, thrombinemia markers, the frequency of some obstetric and perinatal complications (in 1.5-3.9 times; p<0.05) compared to women receiving mega-doses of synthetic drugs FC (n=54). Conclusion. Routine administration of excessive doses of synthetic FC in the treatment of miscarriage in women with folate polymorphisms cycle genes is impractical, preference should be given drugs containing the active form of folate - metafolin.

Relation of maternal vitamin D status with gestational diabetes mellitus and perinatal outcome.

To investigate the relationship between maternal vitamin D status and glucose intolerance, and its impact on pregnant women and their newborns. A cohort of pregnant women were divided into three groups: women with gestational diabetes mellitus, ones with normal results both after the 50 gr and 100 gr OGTT (CG-1) and ones having a positive result after the 50 gr OGTT screening but negative results for gestational diabetes mellitus (GDM) after the 100 gr OGTT (CG-2). The newborn length in CG-1 was greater than in GDM and CG-2 (p= 0.002 and p= 0.02). Fasting blood glucose and insulin resistance (IR) were negatively correlated with length of the newborns (r=-0.3, p=0.03 and r=-0.3, p=0.01). The newborns of women with GDM had lower APGAR-1 and 5 scores than those of CG-1 and CG-2 (APGAR-1 p= 0.001 and p= 0.004, APGAR-5 p=0.005 and p=0.007, respectively). APGAR scores were correlated negatively with IR (APGAR-1 r=-0.32, p=0.01, APGAR-5 r=-0.3, p=0.03) and positively with 25OHD levels (APGAR-1 r=0.3, p=0.01, APGAR-5 r=0.3, p=0.02). Vitamin D deficiency, gestational diabetes and insulin resistance are interrelated. Severe vitamin D deficiency during pregnancy is associated with poor pregnancy and neonatal outcome.

Fetal Growth and Body Proportion during Pre-Eclamptic Pregnancy

Purpose: To evaluate the effects of mild and severe PE on fetal growth and body proportion, measurement at serial ultrasound (US) examinations. Five to 7% of all pregnancies are complicated by preeclampsia (PE). Some forms of intrauterine growth restriction (IUGR) have been etiologically linked to PE, based on similar placental disease- abnormal implantation. Materials and Methods: Women (n=400) who had singleton pregnancies and underwent two or more second- and third-trimester obstetric US examinations were included in our study. The women were divided in three groups: 300 normotensive pregnancies (controls), 67 pregnancies with mild PE (MP) and 33 pregnancies with severe PE (SP). Inadequate fetal growth was defined as growth at or below 10 th percentile. We calculated US measurements between fetuses from normotensive and PE pregnancies (MP and SP). Results: In newborns of women with PE, mean birth weight and length were lower than in births without PE. Fetuses in PE pregnancies from 26 week of gestation (wg) with US scan had lower biometric parameters vs. then of normotensive pregnancies, especially values of abdominal circumference and femur length. In PE pregnancies, there could be faster aging of placenta and oligohydramnion. This is time before clinical onset of PE. Conclusion: Our results support the hypothesis that PE is a heterogeneous disorder which involving placental dysfunction and IUGR, often with asymmetric fetal body proportion and reduced fetal length. The results suggest that US measurements of fetal size are important predictors for PE and birth outcomes.

Incidence of Maternal and Neonatal Outcomes in Pregnancies Complicated by Ovarian Masses [297

INTRODUCTION: The purpose of our study is to estimate the incidence of adnexal mass and ovarian cancer during pregnancy and to evaluate their effects on obstetric and fetal outcomes. METHODS: We conducted a population-based cohort study using data from the Healthcare Cost and Utilization Project–Nationwide Inpatient Sample. Cases of ovarian mass during delivery were identified using the International Classification of Diseases, 9th Revision and subsequently categorized into groups of malignant and benign masses. Logistic regression analysis was used to evaluate maternal and fetal outcomes. RESULTS: There were 7,785,583 deliveries between 2003 and 2011 of which 19,591 were diagnosed with ovarian masses during delivery, representing 0.25% of all deliveries. Among these, one in 200 was malignant. The overall malignancy rate was 0.12 per 10,000 deliveries. Apart from the increased rate of cesarean delivery (odds ratio [OR] 5.92, 95% confidence interval [CI] 4.12–8.40) and the risk of thrombosis (OR 5.52, 95% CI 1.96–15.53), there was no significant increase in maternal morbidity or mortality. Prematurity (OR 2.24, 95% CI 1.48–3.40) was the only significant newborn risk in women with malignant ovarian tumors. Newborns of women with an ovarian mass had comparable risks of intrauterine growth restriction, preterm rupture of membranes, and intrauterine death. CONCLUSION: The diagnosis of an ovarian mass is rare during pregnancy and it is associated with an extremely low malignancy rate. Pregnant woman with a confirmed malignant ovarian tumor should be counseled regarding risks of prematurity, thrombosis, and hysterectomy.

Pathogenesis of polycystic ovary syndrome: multifactorial assessment from the foetal stage to menopause.

Polycystic ovary syndrome (PCOS) is a multifactorial disorder that arises from interactions between genetic, environmental and intra-uterine factors. Small-for-gestational-age (SGA) babies and the daughters of mothers with PCOS represent possible postnatal clinical targets for developmental programming by steroid excess. The presence of excess glucocorticoids and/or androgens during foetal organogenesis and growth might promote changes in gene expression, and these changes might be related to an increase in the risk of PCOS-like reproductive and metabolic disorders in postnatal life, such as rapid growth and weight gain during the first 2 years of life (only in SGA babies), hyperinsulinaemia, adipocyte dysfunction and childhood visceral obesity, premature pubarche and adrenarche (only in SGA babies) and PCOS. In the fourth decade of life, women who have PCOS may be at higher risk for type 2 diabetes mellitus, dyslipidaemia and systemic arterial hypertension, which suggests that these women are also at higher risk for cardiovascular disease during menopause. However, PCOS can also occur in women who were born at appropriate weight for GA or in newborns of women without PCOS, which suggests that genetic variation and environmental factors play important roles in the development and maintenance of PCOS in a population. Genome-wide association studies based on adequate population samples have shown a higher frequency of genetic polymorphisms of the LHCGR, THADA and DENND1A genes in women with PCOS. Genetic studies of PCOS have also included analyses of structural changes in the chromosome based on an assessment of telomere length in single, cross-sectional evaluations, and these studies have produced controversial results. The present narrative review assesses the multifactorial origins of PCOS (including environmental, genetic and intra-uterine factors) and the development of conditions associated with this disorder. It is concluded that although PCOS might originate in the intra-uterine environment through developmental programming by steroid excess, the interaction between genetic and environmental factors is crucial for its appearance. Follow-up studies should be conducted to assess the same populations over their entire lifespans while taking into account different aspects of the pathogenesis of PCOS.

Manganese exposure through drinking water during pregnancy and size at birth: A prospective cohort study.

The essential element manganese (Mn) might be toxic at excess exposure. We assessed the impact of elevated Mn exposure through drinking water during pregnancy on birth size in a population-based cohort(n = 1695) in rural Bangladesh. Concentrations of water Mn (median = 236 μg/L, range = 7.1-6336; n = 1177) and erythrocyte Mn (median = 30 μg/kg, range = 6.3-114; n = 758) were measured using ICP-MS. In regression analyses, newborns of women in the highest tertile of water Mn (median = 1495 μg/L) were 0.49 cm (0.20 SD) shorter (B = -0.42; 95% CI: -0.77, -0.08) than those in the lowest tertile (56μg/L). The inverse association was significant in girls and also in boys of mothers with lowest hemoglobin values, likely due to higher absorption of Mn. Manganese concentrations in water and erythrocytes did not correlate, and the associations of the latter with birth size were less obvious. This study suggests that consumption of water with highly elevated Mn levels during pregnancy may impair fetal growth.

Estimation of the parameters of the renin-angiotensin-aldosterone system, water-electrolyte metabolism, and endothelial function in newborns of women with chronic hypertension

The parameters of the renin-angiotensin-aldosterone system (RAAS), natriuretic peptides, and markers of endothelial function in the early neonatal period and at an age of three months were estimated in 83 full-term infants of women with chronic hypertension, including 60 newborns of women with chronic hypertension of mild to moderate severity (the main group) and 23 newborns of women without hypertension (the comparison group). The levels of renin, angiotensin-II, aldosterone, natriuretic peptides, and endothelin-1 in the umbilical cord and peripheral blood were determined by enzyme-linked immunosorbent assay (ELISA); those of stable metabolites of nitrogen, by the Griess method. Newborn of women with chronic hypertension exhibited a significant elevation of the renin, angiotensin II, and brain natriuretic peptide levels at birth. A statistically significant increase in the concentration of atrial natriuretic peptide (ANP1–28) was detected in these infants on the third to fifth day of life. In addition, the infants of this group have significantly higher levels of renin, angiotensin II, and endothelin-1 and decreased levels of endogenous nitrite at the age of three months. The results of our study indicate prenatal activation of the RAAS in the fetus. The elevated RAAS activity persisted in infants of women with chronic hypertension during the first three months of life and endothelial dysfunction in these infants developing by the age of three months.

Hydroxylated PCB Metabolites, Maternal Smoking and Pregnancy Outcomes

Hydroxylated PCB Metabolites, Maternal Smoking and Pregnancy OutcomesAbstract Number:2681 Gu Yiwei, Katrina Kezios, Liu Xinhua, Cirillo Piera, Tarrant Darcy, Myrto Petreas, June-Soo Park, Barbara Cohn, and Pam Factor-Litvak* Gu Yiwei Mailman School of Public Health Columbia University, United States, E-mail Address: [email protected] Search for more papers by this author , Katrina Kezios Mailman School of Public Health Columbia University, United States, E-mail Address: [email protected] Search for more papers by this author , Liu Xinhua Mailman School of Public Health Columbia University, United States, E-mail Address: [email protected] Search for more papers by this author , Cirillo Piera Child Health and Development Studies, United States, E-mail Address: [email protected] Search for more papers by this author , Tarrant Darcy Department of Toxic Substances Control, California Environmental Protection Agency, United States, E-mail Address: [email protected] Search for more papers by this author , Myrto Petreas Department of Toxic Substances Control California Environmental Protection Agency, United States, E-mail Address: [email protected] Search for more papers by this author , June-Soo Park Department of Toxic Substances Control California Environmental Agency, United States, E-mail Address: [email protected] Search for more papers by this author , Barbara Cohn Child Health and Development Studies, United States, E-mail Address: [email protected] Search for more papers by this author , and Pam Factor-Litvak* Mailman School of Public Health Columbia University, United States, E-mail Address: [email protected] Search for more papers by this author AbstractIntroduction Previous research suggests that prenatal exposure to chlorinated compounds, such as polychlorinated biphenyls (PCBs) may be associated with adverse birth outcomes. However, there are no data relating the hydroxylated metabolites (OH-PCBs) to birth outcomes.Methods In a sample of 442 births from the Child Health and Development Studies we measured 11 PCBs and five hydroxylated metabolites: 4-OH-PCB107, 3’-OH-PCB138, 4-OH-PCB146, 3-OH-PCB153, and 4-OH-PCB187 in blood collected from the mother in the immediate post-partum period. Birth weight and length of gestation were taken from the medical records. To examine the associations between maternal exposure to OH-PCBs and length of gestation and birth weight, we used linear models.Results. In adjusted analyses we found inverse associations between 4-OH-PCB107 and birth weight. The association was restricted to newborns of mothers who smoked during pregnancy. Among smokers and after additional control for PCB118, the primary parent compound of 4-OH-PCB107, newborns of women with concentrations of 4-OH-PCB107 >= 75th percentile had birth weights approximately 300 grams (95% confidence interval (CI) -533, -83) lighter than those <= 25th percentile. Each unit increase in PCB118 was associated with an increase in birth weight of 472 grams (95% CI 111, 833). Concentrations of PCB118 were similar in smoking and nonsmoking mothers. However smokers had twice the concentration of 4-OH-PCB107 compared to nonsmokers. No other OH-PCB was associated with birth weight and none were associated with length of gestation.Conclusions . It is likely that maternal prenatal smoking either increases the metabolism of PCB118 to 4-OH-PCB107 and/or decreases the clearance of 4-OH-PCB107 resulting in increased fetal exposure to 4-OH-PCB107. Maternal prenatal 4-OH-PCB 107 levels appear to contribute to lower birth weight among smokers.

Facial responses to basic tastes in the newborns of women with gestational diabetes mellitus

Objective: To compare facial responses to basic tastes among newborns of women with and without gestational diabetes mellitus (GDM).Methods: Two-hundred and one healthy newborns, 100 from GDM women were studied at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Brazil. Basic tastes were evaluated through administration of glucose (25%), sodium chloride (1.4%), citric acid (25%) and quinine hydrochloride (25%); 0.2 ml of solution on the dorsal surface of the tongue. All newborns had their face videotaped and facial responses were coded according to the Baby Facial Action Coding System. The frequency of the facial action units was compared among newborns from mothers with and without GDM.Results: Facial responses to salt was more liking among newborns from GDM mothers as compared to controls; 33 (33%) versus 21 (21%), p = 0.039). Facial responses to sweet, sour and bitter showed no differences among newborns from mothers with and without GDM. Facial expressions to basic tastes showed no differences among newborns from controlled and non- controlled GDM mothers.Conclusion: Newborns from GDM mothers seem to have a little more preference taste to salt. Further studies are needed to confirm this finding and to verify if these newborns responses to basic tastes remain life-long.

Perinatal Outcomes Associated With the Diagnosis of Gestational Diabetes Made by The International Association of the Diabetes and Pregnancy Study Groups Criteria

To assess perinatal outcomes with Carpenter-Coustan criteria for gestational diabetes mellitus (GDM), those with normal glucose testing, and those who would be added to GDM by The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. This was a retrospective cohort study of women who underwent screening and diagnostic testing for GDM. Patients were divided into nonoverlapping groups: GDM by Carpenter-Coustan (Carpenter-Coustan), IADPSG GDM criteria but not Carpenter-Coustan (IADPSG), and normal GDM screening or testing (control). Outcomes included newborn birth weight, birth weight z-score, Ponderal Index, and large for gestational age. Data were analyzed with one-way analysis of variance, t tests, or χ. There were 8,390 women who met inclusion criteria: 338 Carpenter-Coustan; 281 IADPSG; and 7,771 women in the control group. Mean birth weight (3,411 compared with 3,240 g, P<.01), birth weight z-score (0.477 compared with 0.059, P<.01), Ponderal Index (2.79 compared with 2.73 g/cm, P=.014), and large for gestational age (19.9% compared with 8.8%, relative risk 2.25, 95% confidence interval [CI] 1.76-2.88) were higher in IADPSG compared with women in the control group. The IADPSG group had greater birth weight (3,411 compared with 3,288 g, P<.01) than Carpenter-Coustan neonates with no difference in large for gestational age (19.9% compared with 16.0%, relative risk 1.25 95% CI 0.88-1.75), Ponderal Index (2.78 compared with 2.79 g/cm, P=1), or birth weight z-score (0.477 compared with 0.330, P=.30). Newborns of women who would be added to the diagnosis of GDM by IADPSG criteria have greater measures of fetal overgrowth than those in the control group and greater birth weight in comparison with Carpenter-Coustan GDM neonates. II.

Do the first, second and third trimester maternal serum hepcidin concentrations clarify obstetric complications?

Objective: To evaluate whether first, second, and third-trimester maternal serum hepcidin levels are different in pregnancies with and without adverse pregnancy outcomes (APO).Methods: A 165 nullipar pregnant women were included in this prospective cohort study. Serum hepcidin, ferritin, IL-6, C-reactive protein (CRP) and Hb values were measured at 11–14, 24–28, and 30–34 weeks of gestation. The relation between these parameters and APO and neonatal outcomes were investigated. Preterm delivery, intrauterine growth restriction, pre-eclampsia, gestational hypertension and placental abruption were determined as adverse pregnancy outcomes.Results: The risk of APO was three times higher in women with high IL-6 levels in the second trimester. High hepcidin levels in the second trimester were associated with a 1.6 times increased risk of APO. Newborns of women with high IL-6 levels in the third trimester had a 1.6-fold increased risk of neonatal complications. High ferritin levels in the third trimester were associated with minimally increased risk of neonatal complications.Conclusions: Mean serum hepcidin levels were similar in all pregnant women, however, elevated second trimester serum hepcidin and IL-6 levels were associated with a higher risk of APO and high third trimester hepcidin, ferritin and IL-6 levels were associated with higher risk of neonatal complications.

Erythrocyte folate concentrations, CpG methylation at genomically imprinted domains, and birth weight in a multiethnic newborn cohort

Epigenetic mechanisms are proposed to link maternal concentrations of methyl group donor nutrients with the risk of low birth weight. However, empirical data are lacking. We have examined the association between maternal folate and birth weight and assessed the mediating role of DNA methylation at nine differentially methylated regions (DMRs) of genomically imprinted genes in these associations. Compared with newborns of women with folate levels in the lowest quartile, birth weight was higher in newborns of mothers in the second (β = 143.2, se = 63.2, P = 0.02), third (β = 117.3, se = 64.0, P = 0.07), and fourth (β = 133.9, se = 65.2, P = 0.04) quartiles, consistent with a threshold effect. This pattern of association did not vary by race/ethnicity but was more apparent in newborns of non-obese women. DNA methylation at the PLAGL1, SGCE, DLK1/MEG3 and IGF2/H19 DMRs was associated with maternal folate levels and also birth weight, suggestive of threshold effects. MEG3 DMR methylation mediated the association between maternal folate levels and birth weight (P =0.06). While the small sample size and partial scope of examined DMRs limit our conclusions, our data suggest that, with respect to birth weight, no additional benefits may be derived from increased maternal folate concentrations, especially in non-obese women. These data also support epigenetic plasticity as a key mechanistic response to folate availability during early fetal development.

Maternal characteristics and pregnancy outcomes after assisted reproductive technology by infertility diagnosis: ovulatory dysfunction versus tubal obstruction

To examine differences in maternal characteristics and pregnancy outcomes between women with ovulatory dysfunction (OD) and women with tubal obstruction (TO) who underwent assisted reproductive technology (ART). Retrospective cohort study. Centers for Disease Control and Prevention. Exposed and nonexposed groups were selected from the 2000-2006 National ART Surveillance System linked with live-birth certificates from three states: Florida, Massachusetts, and Michigan. None. Maternal characteristics and pregnancy outcomes, including newborn's health status right after delivery (Apgar score, <7 vs. ≥ 7) as the study outcome of interest, were assessed among women with OD/polycystic ovary syndrome (PCOS) and TO who used ART. A significantly higher prevalence of women with OD/PCOS were younger (<35 years of age; 65.7% vs. 48.9%), were white (85.4% vs. 74.4%), had higher education (29.4% vs. 15.6%), and experienced diabetes (8.8% vs. 5.3%) compared with those having TO. The odds of having a lower (<7) Apgar score at 5 minutes were almost twice as high among newborns of women with OD/PCOS compared with those with TO (crude odds ratio, 1.86; 95% confidence interval [CI], 1.31, 2.64; adjusted odds ratio, 1.90; 95% CI, 1.30, 2.77). Women with OD/PCOS who underwent ART have different characteristics and health issues (higher prevalence of diabetes) and infant outcomes (lower Apgar score) compared with women with TO.