Birth Weight Rate Research Articles

Vacuum extraction outcomes in primiparas delivered with an induction of labor

Induction of labor (IOL) has become a common practice in the western world although it might prolong labors and potentially increase interventions. Vacuum extraction (VE) might result in obstetrical complications due to birth trauma. We aimed to evaluate the impact of an IOL on outcomes of primiparas delivered by VE. A retrospective cohort including primiparas with a singleton pregnancy ≥34w delivered by VE. We estimated delivery complications among deliveries that started with an IOL, compared to deliveries with a spontaneous onset of labor (SO). Included 2,975 deliveries, 1,048 (35.2%) with IOL and 1,927 (64.8%) with a SO. Comparing the basic characteristics between the groups: The rates of pre-gestational and gestational DM were higher in the IOL group (13.5% vs 8.2%, p< 0.001). Obesity rates (BMI >30kg/m2) were similar. Gestational age (GA) at delivery did not have a clinically significant difference (39.6 ± 1.4 in the IOL, 39.2± 1.3 in the SO, p< 0.001). Comparing labor characteristics: Epidural analgesia was more common in IOL (97.9% vs 90.7%, p< 0.001). Neonatal birthweight (BW) was higher in IOL (3210.7g ± 438.7 vs 3155.5 ± 417.3, p=0.001) and also the rates of BW ≥3700g (13.5% vs 8.4% p< 0.001). 2nd stage arrest (SSA) as the indication for VE was relatively common in the IOL group (29.8% vs 23%, p< 0.001), and rates of subgaleal hematomas (SGH) were higher (7.6% vs 4.4%, p< 0.001). Other maternal and neonatal complications: 3rd-4th degree perineal lacerations, blood loss, shoulder dystocia, clavicular fractures, Apgar scores, cord pH< 7.1 and NICU admission were comparable. Logistic regression found IOL as a risk factor for both SSA (aOR 1.3, 95%CI 1.1-1.5) and SGH (aOR 1.6, CI 1.2-2.2) when adjusting for the confounders of maternal age and BMI, GA, DM, epidural and neonatal BW. VE performed in deliveries that were induced were more likely to be performed due to SSA and complicated by increased rates of SGH which might be related to the VE indication. These outcomes can be incorporated into clinical decisions regarding IOL and mode of deliveryView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Intra-amniotic inflammation and birth weight in pregnancies with preterm labor with intact membranes: A retrospective cohort study.

To assess the association between newborn birth weight and the presence of intra-amniotic infection, presence of sterile intra-amniotic inflammation, and absence of intra-amniotic inflammation in pregnancies with preterm labor with intact membranes. A total of 69 pregnancies with preterm labor with intact membranes between gestational ages 22 + 0 and 34 + 6 weeks who delivered within seven days of admission were included in this retrospective cohort study. Transabdominal amniocentesis to determine the presence of microorganisms and/or their nucleic acids in amniotic fluid (through culturing and molecular biology methods) and intra-amniotic inflammation (according to amniotic fluid interleukin-6 concentrations) were performed as part of standard clinical management. The participants were further divided into three subgroups: intra-amniotic infection (presence of microorganisms and/or nucleic acids along with intra-amniotic inflammation), sterile intra-amniotic inflammation (intra-amniotic inflammation alone), and without intra-amniotic inflammation. Birth weights of newborns were expressed as percentiles derived from the INTERGROWTH-21st standards for (i) estimated fetal weight and (ii) newborn birth weight. No difference in birth weights, expressed as percentiles derived from the standard for estimated fetal weight, was found among the women with intra-amniotic infection, with sterile intra-amniotic inflammation, and without intra-amniotic inflammation (with infection, median 29; with sterile inflammation, median 54; without inflammation, median 53; p = 0.06). Differences among the subgroups were identified in the birth weight rates, expressed as percentiles derived from the standard for estimated fetal weight, which were less than the 10th percentile (with infection: 20%, with inflammation: 13%, without inflammation: 0%; p = 0.04) and 25th percentile (with infection: 47%, with inflammation: 31%, without inflammation: 9%; p = 0.01). No differences among the subgroups were observed when percentiles of birth weight were derived from the birth weight standard. The presence of intra-amniotic inflammatory complications in pregnancies with preterm labor with intact membranes prior to the gestational age of 35 weeks was associated with a higher rate of newborns with birth weight less than the 10th and 25th percentile, when percentiles of birth weight were derived from the standard for estimated fetal weight.

To weigh or not to weigh in pregnancy: a retrospective study

Introduction A rise in the number of caesarean sections and the rate of birth weight over 4kg prompted an advanced midwife practitioner service to introduce routine weighing for all service users and target weight gain based on Institute of Medicine guidelines. The study's aims were to ascertain if maintaining weight gain reduced pre-eclampsia, caesarean section births, birth weight over 4kg and neonatal intensive care unit admissions. Methods A retrospective study of weight gain and outcomes for 53 pre- and 46 post-routine weighing service users was conducted. Results Over a third (40%) of participants gained excess weight, with a 22% caesarean section rate and 22% of babies weighed over 4kg at birth. There was an overall 6% reduction in caesarean section births and a 22% reduction in babies weighing over 4kg. Conclusions Routine weighing and health promotion techniques have the potential to maximise health and wellbeing and could be a long-term investment in the health and wellbeing of mothers and babies.

Deciphering the Association of Antenatal Care Visits and Pregnancy Outcomes from South Africa

Optimal antenatal care (ANC) opens the windows of opportunities for timely identification and interventions for the prevention of maternal and foetal morbidity and mortality. The objectives were to determine the antenatal care utilisation patterns and its association with adverse pregnancy outcomes. A retrospective cohort study of all women giving childbirths between January 2018 to September 2019 at a midwife obstetric unit was undertaken. All variables were significant on bivariate analysis (p&lt;0.05) were included in the multivariate model and the significant results were expressed with adjusted odds ratios (OR) and p values. Most (94.4%) of the pregnant women received antenatal care, 76% had &gt; 4 and only 24.9% had &gt; 8 ANC visits. Half (52.5%) of them had booking visit at or before 20 weeks gestation. There was no maternal death. Low birthweight (LBW), stillbirth and neonatal death rates were 9%, 17 and 7 per 1000 live births respectively. The number of antenatal visit was a significant predictor for stillbirth, neonatal death and LBW. Women who did not attend ANC were 22 times (OR=21.8, 95% CI: 2.51: 189.24, p=0.005), 17 times (OR=17.31, 95% CI; 1.9:157.1, p=0.001) and 11 times (OR=11.0, 95% CI; 5.4:22.19, p=0.000) more likely to have stillbirths, neonatal deaths and LBW respectively. Increasing the number of ANC visits decreased the likelihood of stillbirth, neonatal death and LBW. Few pregnant women received &gt; 8 ANC visits. Higher numbers of ANC visits were positively associated with decreased occurrences of LBW, still births and neonatal deaths. Strengthening the ANC services should be prioritised in SA.

Perinatal outcomes in children born after fresh or frozen embryo transfer using donated oocytes.

Do children born after vitrified-thawed embryo transfers (ETs) using donated oocytes have worse perinatal outcomes when compared with fresh ET? No significant difference in birthweight and prematurity rates between fresh or frozen embryo transfers (FETs) in newborns after oocyte donation was found. Autologous singletons born after fresh ET have been previously associated with higher rates of preterm birth and low birthweight, while FETs seem to confer a higher risk of hypertensive disorders during pregnancy and macrosomia. However, studies comparing these outcomes using autologous oocytes are unable to adequately disentangle the putative detrimental consequences of embryo vitrification from the possible effects that ovarian stimulation and endometrial preparation may have on endometrial receptivity prior to ET. The oocyte donation model is, for this reason, a more appropriate setting to study these hypotheses; however so far, the information available regarding neonatal outcomes in this patient population is limited to either small and/or heterogeneous studies. We performed a multicentre retrospective cohort study including 5848 singletons born between 2009 and February 2020 following oocyte donation and single blastocyst transfer, subdivided according to whether a fresh ET or FET was performed. We also performed two additional sensitivity analyses, subgrouping the sample according to the type of endometrial preparation (natural versus artificial) and whether the donated oocytes had previously been vitrified or not. Patients with a first singleton livebirth after single blastocyst transfer were compared using multivariable regression analysis to account for potential confounding factors. The primary outcome was birthweight. Secondary outcomes were birthweight z-scores and percentiles, small/large for gestational age, gestational age at delivery, gender, prematurity (<37 weeks and <32 weeks), neonatal morbidity (Apgar scores and need for neonatal intensive care) and maternal morbidity (gestational hypertensive disorders, gestational diabetes and caesarean delivery). There was no significant difference between the fresh ET and FET groups in terms of mean birthweight (3215 g versus 3200 g) and birthweight z-scores (0.03 versus 0.1), in both the unadjusted and confounder-adjusted models. However, artificial endometrial preparation was associated with a higher birthweight (3220 g versus 3105 g) and birthweight z-scores (0.06 versus -0.13) when compared with a transfer in a natural cycle. Although a 1-day statistically significant difference in gestational age at birth (275 versus 274 days) was detected, premature birth rates (<37 weeks) did not vary significantly between groups (9.9% and 11.2% for fresh ET and FET, respectively). No other statistically significant differences were found in the remaining neonatal and maternal outcomes studies between the fresh ET and FET groups. This study is limited by its retrospective design and lack of information regarding congenital malformations. Moreover, the sample selection criteria that were used may limit the generalizability of our results. Perinatal outcomes did not seem to be affected significantly by the embryo vitrification process in an oocyte donation model. Hence, other factors may contribute to the hindered perinatal outcomes described in ART, particularly the potential effect that ovarian stimulation and endometrial preparation may have on endometrial receptivity. No specific funding was obtained for this study. All authors have no conflicts to declare. N/A.

Causal inference with outcomes truncated by death in multiarm studies.

It is challenging to evaluate causal effects when the outcomes of interest suffer from truncation-by-death in many clinical studies; that is, outcomes cannot be observed if patients die before the time of measurement. To address this problem, it is common to consider average treatment effects by principal stratification, for which, the identifiability results and estimation methods with a binary treatment have been established in previous literature. However, in multiarm studies with more than two treatment options, estimation of causal effects becomes more complicated and requires additional techniques. In this article, we consider identification, estimation, and bounds of causal effects with multivalued ordinal treatments and the outcomes subject to truncation-by-death. We define causal parameters of interest in this setting and show that they are identifiable either using some auxiliary variable or based on linear model assumption. We then propose a semiparametric method for estimating the causal parameters and derive their asymptotic results. When the identification conditions are invalid, we derive sharp bounds of the causal effects by use of covariates adjustment. Simulation studies show good performance of the proposed estimator. We use the estimator to analyze the effects of a four-level chronic toxin on fetal developmental outcomes such as birth weight in rats and mice, with data from a developmental toxicity trial conducted by the National Toxicology Program. Data analyses demonstrate that a high dose of the toxin significantly reduces the weights ofpups.

P–579 Pregnancies following preimplantation Genetic Testing have an increased risk for post-partum complications

Abstract Study question Do preimplantation genetic testing (PGT) pregnancies have higher pregnancy and delivery complications compared to naturally conceived (NC) pregnancies? Summary answer PGT pregnancies do not have increase pregnancy complications but do have increased post-partum complications. What is known already There is limited data about the outcome of PGT cycles regarding pregnancy complications. Previous reports show that PGT pregnancies are similar to NC pregnancies regarding birth weight and preterm delivery rate. Patients performing PGT are less likely to have infertility as a background problem, and therefore it is important to evaluate pregnancy complications in this specific population. Study design, size, duration A retrospective cohort study, between 2008–2020 in Shaare Zedek Medical center (SZMC). Demographic, background variables, treatment cycle information, and delivery data were collected from computerized hospital databases and patient files. Participants/materials, setting, methods All patients aged 18–45 that conceived following PGT treatment in the IVF unit and gave birth in SZMC were included in the study. We used two control groups: (1) women with spontaneous pregnancies (SP) who gave birth in SZMC. We used four “neighborhood control” for each PGT patient (two women delivered before and two after the case delivery). (2) pregnancies following ICSI with four neighborhood control for each. Main results and the role of chance 135 deliveries following PGT, 924 ICSI, and 4199 NC. Demographic variables were similar except PGT, and ICSI women were slightly older (30.93 ±4.33 PGT, 31.70±4.98 ICSI, 28.75±5.69 spontaneous, p &amp;lt; 0.01). PGT pregnancies had similar rates of placental complications (hypertensive disorder, preeclampsia (PET), placental abruption) as NC (p = 0.8), while ICSI pregnancies had significantly higher rates of gestational hypertension (p &amp;lt; 0.01) and abruption (p = 0.05). We found a higher rate of preterm delivery &amp;lt;37 weeks in both PGT and ICSI pregnancies (23.7%, 22.7%, 12.1%, p &amp;lt; 0.01 for PGT, ICSI, NC respectively), but only in ICSI was preterm delivery &amp;lt; 34 weeks increased (2.2% vs. 2.1%, p = 0.9, for PGT and NC, 4.3% for ICSI p &amp;lt; 0.01). Post-partum complications were more prevalent in both PGT and ICSI: longer third stage of labor (13.27±12.81, 12.58±10.08, 10.58±8.14, p &amp;lt; 0.05), manual lysis of placenta (6.7%, 2.3%, 1.4% p &amp;lt; 0.05), post-partum hemorrhage (PPH) (5.9%, 4.2%, 2.5% p = 0.02) and need for blood products (3.7%, 4.5%, 1.3% p = 0.02) for PGT, ICSI, NC respectively. The aOR for composite post-partum complications (PPH, hemoglobin drop&amp;gt;3 gram, revision or lysis) was 2.4, 95%CI [1.6–3.7]. We did not find any difference between fresh and frozen cycles in either placental complications, preterm delivery, or post-partum complications in the PGT group. Limitations, reasons for caution A single-center retrospective study. Included only pregnancies both conceived and delivered in SZMC. Wider implications of the findings: Physicians should be aware of PGT pregnancies as risk factors for post-partum placental complications and handle the third stage of the delivery with caution. Trial registration number 0351–18-SZMC

Epidemiology of clinically suspected and laboratory-confirmed bloodstream infections at a South African neonatal unit.

Data from Africa reporting the epidemiology of infection in hospitalised neonates are limited. A prospective study with convenience sampling was conducted to characterise neonates investigated with blood culture/s for suspected infection at a 132-bed neonatal unit in Cape Town, South Africa (1 February-31 October 2018). Enrolled neonates were classified as having proven bloodstream infection (BSI) (blood culture-positive with a pathogen) or presumed infection (clinically suspected but blood culture-negative) or as potentially at risk of infection (maternal risk factors at birth). Of 1299 hospitalised neonates with >1 blood culture sampling episode, 712 (55%) were enrolled: 126 (17.7%) had proven BSI; 299 (42%) had presumed infection and 287 (40.3%) were potentially at risk of infection. Neonates with proven BSI had lower birth weight and higher rates of co-existing surgical conditions versus the presumed/potential infection groups (p < 0.001). Median onset of proven BSI versus presumed infection was at 8 (IQR = 5-13) and 1 (IQR = 0-5) days respectively (p < 0.001). Most proven BSI were healthcare-associated (114/126; 90.5%), with Klebsiella pneumoniae (80.6% extended-spectrum β-lactamase producers) and Staphylococcus aureus (66.7% methicillin-resistant) predominating. Mortality from proven BSI (34/126; 27%) was substantially higher than that observed in presumed (8/299; 2.7%) and potential infections (3/287; 1.0%) (p < 0.001). The odds of death from proven BSI was 3-fold higher for Gram-negatives than for Gram-positive/fungal pathogens (OR = 3.23; 95% CI = 1.17-8.92). Proven BSI episodes were predominantly healthcare-associated and associated with a high case fatality rate. Most neonates with presumed infection or at potential risk of infection had favourable 30-day outcomes.

Influence of Trophectoderm Biopsy Prior to Frozen Blastocyst Transfer on Obstetrical Outcomes.

The purpose of this study is to determine if trophectoderm biopsy prior to autologous frozen blastocyst transfer in programmed cycles is associated with gestational age at delivery, birth weight, or cesarean rate in viable singleton gestations. We conducted a retrospective cohort study of patients at a university-affiliated center that had viable singleton gestations after autologous frozen blastocyst transfer in programmed cycles. Obstetrical outcomes of 67 pregnancies after blastocyst trophectoderm biopsy for preimplantation genetic testing were compared to 78 pregnancies from unbiopsied blastocysts. There were no significant differences between the two cohorts in terms of maternal age, BMI, or ethnicity. There were no differences in the preimplantation genetic testing cohort compared to the reference cohort for median gestational age at delivery (39.4 vs 39.4 weeks, p = 0.80), median birth weight (3420 vs 3430 g, p = 0.97), cesarean rate (51% vs 44%, p = 0.41), preterm delivery rate (12% vs 8%, p = 0.41), rate of low birth weight (12% vs 9%, p = 0.59), or rate of birth weight over 4000 g (13% vs 8%, p = 0.29). There were no differences in the primary outcomes with subgroup analysis based on fetal sex, single embryo transfer, gravidity, history of prior term birth, and maternal age < or ≥ 35 years. Trophectoderm biopsy prior to frozen blastocyst transfer in programmed cycles was not associated with adverse obstetrical outcomes related to gestational age at delivery, birth weight, or cesarean rate.

Birth weight and heart rate autonomic recovery following exercise in healthy term-born adults

The impact of birth weight (BW) on adult health has been studied, related to the autonomic nervous system, and implicated in cardiovascular risk. We investigated cardiorespiratory and heart rate (HR) autonomic recovery after moderate effort in healthy term-born adults with different BWs. We studied 28 healthy physically active women aged between 18 to 30 years split equally into two groups according to BW: G1 (n = 14), BW between 2500 g and 3200 g and G2 (n = 14), BW > 3200 g. The groups remained seated at rest for 15 min, followed by aerobic exercise on a treadmill (five minutes at 50–55% of maximum HR and 25 min 60–65% of maximum HR) and then remained seated for 60 min during recovery from the exercise. Cardiorespiratory parameters and HR variability (HRV) [RMSSD, HF (ms2)] were assessed before and during recovery from exercise. In G1, HR was increased from 0 to 20 min after exercise whilst in G2 HR was higher from 0 to 7 min following exercise. In G1, short-term HRV was increased from 5 to 10 min after exercise but in G2 it recovered prior to 5 min following effort. In conclusion, healthy term-born women with low normal BW present slower HR autonomic recovery after exercise.

Steroids for All

Background: Due to difficulties estimating the risk of preterm labor, many women diagnosed with threatened preterm delivery and given antenatal corticosteroids to improve neonatal outcomes do not deliver until term. Our objective was to compare the short-term outcomes of infants born at term to women who received betamethasone (BMZ) for threatened preterm labor to infants who were not exposed to BMZ in utero. &#x0D; &#x0D; Methods: We performed a retrospective cohort study of infants born at or after 37 weeks’ gestational age (GA) to mothers diagnosed with threatened preterm labor during pregnancy. Controlling for covariates, the primary neonatal outcomes of interest, including transient tachypnea of the newborn (TTN), neonatal intensive care unit (NICU) admission, and birthweight, were evaluated for their association with BMZ exposure. &#x0D; &#x0D; Results: Of 5330 women, 1459 (27.5%) women received BMZ at a mean GA of 32.2±3.3 weeks. The mean age of women was 27±5.9 years-old and the mean GA at delivery was 38.9±1.1 weeks. Women receiving BMZ had higher rates of maternal comorbidities (P&lt;0.001 for diabetes, asthma, and hypertensive disorder) and were more likely to self-identify as white (P=0.022). BMZ-exposed neonates had lower birth weights and increased rates of oxygen usage, TTN, hyperbilirubinemia, hypoglycemia, and NICU admission rates (all P-values &lt;0.05). &#x0D; Controlling for maternal characteristics and GA at delivery, BMZ exposure was not significantly associated with diagnosis of TTN [OR 1.09 (95% CI 0.80-1.50)], though it was associated with more NICU admissions [1.49 (1.19-1.86)] and lower birthweight by 91.5 (-122.3 to -60.6) grams. &#x0D; &#x0D; Conclusions: Compared to women evaluated for preterm labor that did not receive BMZ, women receiving BMZ had infants with higher rates of NICU admission and lower birthweights, though the rate of TTN diagnosis was similar between the two groups. While the benefits of BMZ to infants born preterm are clear, there may be negative impacts for infants delivered at term.

Birth weight and renal markers in children aged 5\u201310\u2009years in Cameroon: a cross-sectional study

BackgroundA relationship exists between birth weight (BW) and glomerular filtration rate (GFR) in postnatal kidney. Willing to fill a gap of knowledge in sub-Saharan Africa, we assessed the effect of BW on blood pressure (BP), proteinuria and GFR among Cameroonians children.MethodsThis was a cross-sectional hospital-based study from January to April 2018 at the Yaounde Gynaeco-Obstetric and Paediatric Hospital (YGOPH). We recruited low BW (LBW) [< 2500 g], normal BW (NBW) [2500-3999 g] and high BW (HBW) [> 4000 g] children, aged 5–10 years, born and followed-up at YGOPH. We collected socio-demographic, clinical (weight, height, BP), laboratory (proteinuria, creatinine), maternal and birth data. The estimated GFR was calculated using the Schwartz equation.ResultsWe included 80 children (61.2% boys) with 21 (26.2%) LBW, 45 (56.2%) NBW and 14 (15.5%) HBW; the median (interquartile range) age was 7.3 (6.3–8.1) years and 17 (21.2%) were overweight/obese. Two (2.5%) children, all with a NBW (4.4%), had an elevated BP whereas 2 (2.5%) other children, all with a LBW (9.5%), had hypertension (p = 0.233). Seven (8.7%) children had proteinuria with 19, 2.2 and 14.3% having LBW, NBW and HBW, respectively (p = 0.051). Equivalent figures were 18 (22.5%), 14.3, 24.2 and 28.6% for decreased GFR, respectively (p = 0.818). There was a trend towards an inverse relationship between BW and BP, proteinuria and GFR (p > 0.05).ConclusionProteinuria is more pronounced in childhood with a history of LBW and HBW while LBW children are more prone to develop hypertension. Regular follow-up is needed to implement early nephroprotective measures among children with abnormal BW.

Tebuconazole exposure disrupts placental function and causes fetal low birth weight in rats

Tebuconazole (TEB) is one of the widely used broad-spectrum triazole fungicides. Its accumulation in mammals leads to various endocrine disruptions. However, it is unclear whether the exposure of TEB during pregnancy affects the growth and development of fetus and placenta. Here, TEB was exposed to pregnant Sprague-Dawley female rats from gestational days 12–21 of 0, 25, 50 or 100 mg/kg for 10 days. TEB reduced placental estradiol levels. TEB disrupted the structure and function of the placenta, leading to hypertrophy, fibrin exudation, edema, calcification, arterial fibroblast proliferation, and trophoblastic infarction. RNA-seq analysis showed that TEB mainly down-regulated the expression of iron transport genes and up-regulated the expression of genes for immune/inflammatory responses. Further qPCR showed that TEB down-regulated Tfrc, Hamp, Eif2ak2 and up-regulated the expression of Cd34, Cd36, Jag1, Pln, Cyp1a1, Esrra, and Aqp1 at 50 and 100 mg/kg. Western blot and semi-quantitative immunohistochemical staining also demonstrated that TEB lowered the levels of TFRC and EIF2AK2 and increased the levels of CD34, CD36, JAG1, CYP1A1, and ESRRA at 50 and 100 mg/kg. In conclusion, TEB severely damages the structure and function of the placenta, leading to hypertrophy of the placenta, low birth weight and feminization of the male fetus possibly via several pathways including iron transport and TNF signaling.

Trends in Retinopathy of Prematurity over 12 Years in a Colorado Cohort

ABSTRACT Purpose To determine trends in retinopathy of prematurity (ROP) in a Colorado cohort between 2006 and 2017 and compare trends in risk factors between our cohort and statewide data. Methods A retrospective cohort study was conducted by the use of records from two registry databases: 1) an academic center’s ROP registry, and 2) vital statistics birth data from the Colorado Department of Public Health and Environment (CDPHE). ROP was categorized as severe (type 1 or type 2), low grade (not type 1 or type 2), or no ROP. Other variables included in the analyses were gestational age and birth weight at delivery, and infant mortality. Trends over time were evaluated for both registry databases using generalized linear models. Results In our ROP registry cohort of 1,267 eligible infants, 134 (10.6%) developed severe ROP and 279 (22%) developed low-grade ROP. We found no overall trend in severe ROP rates (p = .23), and a decreasing trend in rates of low-grade ROP (p < .01) over the study period. Trends in gestational age, birth weight, and mortality rates remained stable during the study period in both the ROP registry and the CDPHE cohorts. Conclusion The rate of severe ROP in our ROP registry cohort did not change over time. There was evidence of a decreasing trend in low grade ROP during the 12-year study period that was not explained by a change in the primary ROP risk factors in either the ROP registry cohort or the Colorado statewide data.

TROPHECTODERM BIOPSY PRIOR TO AUTOLOGOUS FROZEN BLASTOCYST TRANSFER IS NOT ASSOCIATED WITH ADVERSE OBSTETRICAL OUTCOMES

To determine if trophectoderm biopsy prior to autologous frozen blastocyst transfer is associated with gestational age at delivery, birth weight, or cesarean rate in ongoing singleton gestations. retrospective cohort study We identified all patients at a university-affiliated center that had viable singleton gestations after autologous frozen blastocyst transfers from January 2016 through December 2018. Obstetrical outcomes of 67 viable singleton pregnancies after blastocyst trophectoderm biopsy for preimplantation genetic testing (PGT) with next generation sequencing were compared to 78 viable singleton pregnancies from unbiopsied frozen blastocysts. All transfers occurred in programmed frozen transfer cycles. Cycles that utilized a gestational carrier, donor oocytes, or frozen oocytes were excluded. Primary outcomes included gestational age at delivery, birth weight, and cesarean rate. The study had 80% power at a significance level of 0.05 to detect a 4-day difference in median gestational age at delivery, 300-gram difference in median birth weight, and 20% difference in cesarean rate. Secondary outcomes included preterm delivery, low birth weight, and birth weight over 4000 grams. There were no significant differences between the two groups in terms of maternal age, BMI, or ethnicity. There were no differences in the PGT cohort compared to the reference cohort for median gestational age at delivery, median birth weight, cesarean rate, preterm delivery rate, rate of low birth weight, or rate of birth weight over 4000 grams (Table). There were no differences in the primary outcomes for subgroup analysis based on fetal sex, single embryo transfer, nulligravid, and no history of prior term birth. Trophectoderm biopsy prior to frozen blastocyst transfer is not associated with adverse obstetrical outcomes related to gestational age at delivery, birth weight, or cesarean rate.Tabled 1No PGT (ref) n = 78PGT n = 67RR (95% CI)P valueDemographics and baseline characteristicsMaternal age (SD)35.6 (4.3)35.8 (3.7)0.77Maternal BMI kg/m2 (SD)24.5 (5.4)24.0 (5.2)0.59Number of embryos transferred1.6 (0.6)1.2 (0.4)< 0.01Prior preterm birth4 (5%)2 (3%)0.69OutcomesCesarean delivery34 (44%)34 (51%)1.16 (0.82-1.64)0.41Birth weight in grams3430 [3033, 3714]3420 [3050, 3799]0.97Birth weight >4000g6 (8%)9 (13%)1.75 (0.66-4.65)0.29Low birth weight, <2500g7 (9%)8 (12%)1.33 (0.51-3.48)0.59Gestational age in weeks39.4 [39.0, 40.4]39.4 [39.0, 40.3]0.80Delivery prior to 37 weeks6 (8%)8 (12%)1.55 (0.57-4.25)0.41Delivery prior to 34 weeks1 (1%)1 (1%)1.16 (0.07-18.3)1.00Data are reported as mean (SD), median [IQR] or n (%). Open table in a new tab

27 Determinants of referral to developmental resources among neonatal follow-up patients discharged from tertiary neonatal unit from 2005 UNTIL 2014

Abstract Background Lower gestational age or birth weight and higher rate of neurodevelopmental impairment have been commonly linked to higher need for developmental resources in premature infants. Existing evidence on need for developmental support in premature infants is limited in description of the needs, timing and method of assessment. Objectives To identify predictors for the needs for developmental resources among high-risk groups of infants born less than 29 weeks or with a birth weight (BW) less than 1250 grams. Secondarily, to compare the need of referrals to developmental resources and the rate of neurodevelopmental impairment defined as cerebral palsy, global developmental delay, blindness and deafness for this high risk population. Design/Methods We conducted a retrospective chart review of premature infants &amp;lt; 29+0 weeks GA or BW &amp;lt; 1250 grams born between January 2005 and December 31st 2014, who had at least one visit at the neonatal follow up clinic. Univariate and multivariate logistic regression analyses were conducted to examine potential predictors for referral to developmental resources. Results The study included 687 infants. Within this high risk population, 579 (85.0%) of infants were referred, of these 153 (26.4%) had one referral, 132 (22.8%) had 2 and 294 (50.8%) had 3 or more referral/s to developmental resources. Most frequent referrals were for speech therapy (339, 50.0%) physiotherapy (319, 46.8%) occupational therapy (262, 38.3%) and infant development program (232, 34.1%). The rates of referral to developmental resources decrease with increasing gestational age. Multivariate logistic regressions showed that gestational age (OR: 1.19, 95% CI: 1.05 - 1.35), birth weight (OR: 0.87, 95% CI: 0.77 - 0.99), female gender (OR: 0.70, 95% CI: 0.49 - 0.99), intraventricular hemorrhage grades III-IV (OR: 3.02, 95% CI: 1.28 - 7.16), and days on mechanical ventilator (OR:1.03, 95% CI: 1.01 - 1.05) were predictors for 2 or more referrals to developmental resources. Cerebral palsy was present in 4.4 % of the study population, deafness in 4% and blindness in 0.6%. The rate of referral to developmental resources was 54 (98.2%) among infants with neurodevelopmental impairment (NDI) compared to 522 (83.9%) in infants without NDI (p value= 0.01). Conclusion There is substantial need for developmental support among high-risk premature infants. Infants without neurodevelopmental impairments still need significant developmental resources to achieve their outcome.

The impact of excessive gestational weight gain timing on neonatal outcomes in women with class III obesity

Objective This study evaluated the influence of early gestational weight gain (GWG) on neonatal outcomes among women with class III obesity. Study Design Retrospective cohort of women with class III obesity who gained more than the Institute of Medicine (IOM) guidelines (>20lbs). Women gaining ≥75% of total gestational weight prior to 28 weeks (EWG) were compared to women gaining <75% of their total weight prior to 28 weeks (SWG). The primary outcome was a neonatal composite morbidity and mortality. Secondary outcomes included individual components of composite and LGA. Results Of 144 women identified, 42 (29.2%) had EWG and 102 (70.8%) had SWG. Though 11% of the total population had composite neonatal morbidity, this did not differ between groups (p = .4). LGA was nearly twice as common in the SWG group (41% vs 26%, p = .13). EWG was associated with decreased risk of LGA (AOR 0.25 95% CI 0.08, 0.78) and lower median birth weight (AOR −312 g 95% CI −534.7, −90.2). Conclusion Though adverse neonatal outcomes were common in this population, timing of gestational weight gain was not correlated. Increased rates of LGA and higher median birth weight in the SWG group suggests excessive GWG continuing in the third trimester of pregnancy may be of import for neonatal size.

The impact of chorionicity and assisted reproductive therapies in obstetric and neonatal outcomes

Objective Multiple gestations’ incidence have raised worldwide in the last years, much due to assisted reproductive therapies (ART). The goal of this study was to analyze obstetric and neonatal outcomes of twin pregnancies in a level 3 maternity. Methods A retrospective study including all twins born in a period of 12 years in a level 3 maternity was conducted. Analysis comparing spontaneous monochorionic and dichorionic twins and spontaneous and ART dichorionic twins were performed. A p value < .05 was considered statistically significant. Results The sample included 1783 newborns from 875 mothers. Mean maternal age was 31 years, with 616 spontaneous pregnancies and 259 through ART. Prematurity occurred in 77%. Congenital malformations were found in 6%, and the mortality rate was 3%. Monochorionic twins had higher prematurity (79% vs 72%) and very low birthweight (VLBW) rate (19% vs 14%). Congenital anomalies (9% vs 6%), Respiratory Distress Syndrome (23% vs 18%), patent ductus arteriosus (7% vs 4%), anemia (11% vs 5%), periventricular hemorrhage (5% vs 3%), mechanical ventilation (16% vs 10%) and mortality (4% vs 2%) were higher in monochorionic twins. Although congenital malformations were more frequent in the ART group, the difference was not statistically significant. The effect of ART in neonatal and obstetric outcomes was related to maternal age. Conclusion Monochorionic pregnancies were associated with worst obstetric and neonatal outcomes. Although congenital malformations were more frequent in the ART group, the difference was not statistically significant. Most obstetric and neonatal complications were related to advanced maternal age.

Impact of antenatal corticosteroids on head circumference of full-term newborns: A French multicenter cohort study.

Our main objective was to evaluate whether antenatal corticosteroids increase the risk of small head circumference in children born at term. Secondary objectives were to evaluate whether they increase the risk of small birthweight and birth length among those children. A historical cohort included 275 270 live term born children between 2000 and 2013 in 175 French maternity units. The rate of head circumference below the 5th percentile among children born at term and exposed to antenatal corticosteroids was compared with that of two unexposed groups: those children born at term whose mothers had an episode of threatened preterm labor without corticosteroids and those whose mothers had neither threatened preterm labor nor corticosteroids. The association between this treatment and head circumference was evaluated by calculating adjusted risk ratios (aRRs) and their 95% confidence intervals (CIs). The main outcome measure was a head circumference below the 5th percentile at birth, adjusted for sex, and gestational age according to the Pediatric, Obstetrics, and Gynecology Electronic Records Users Association (AUDIPOG) curves. Secondary outcomes were birthweight and birth length below the 5th percentile. The rate of head circumference below the 5th percentile was 5.8% (n = 3388) among children exposed to antenatal corticosteroids and 4.3% (n = 7077) and 4.6% (n = 198 462), respectively, for the two unexposed groups. After adjustment, the risk of having a head circumference below the 5th percentile did not differ between the exposed group and the two control groups (aRR 1.28, 95% confidence interval [CI] 0.97-1.69] and aRR 0.91, 95% CI 0.74-1.13). We did not find an association between antenatal corticosteroids and the rate of birthweight below the 5th percentile. Children exposed to antenatal corticosteroids had a higher risk of a birth length below the 5th percentile when compared with those not exposed to threatened preterm labor or corticosteroids. We found no association between antenatal corticosteroids and increased risk of head circumference below the 5th percentile in children born at term.

Insulin treatment of patients with gestational diabetes: does dosage play a role?

Background and objective In nonpregnant patients high insulin requirements are associated with hypoglycemia and weight gain but not with improvement in glucose control. The effect of insulin requirement on maternal and neonatal outcomes in gestational diabetes mellitus (GDM) is yet unknown. Methods We conducted a retrospective cohort study of maternal and neonatal outcomes of pregnancy according to insulin requirements in women with GDM who were followed and delivered at the Yitzhak Shamir Medical Center between 2006 and 2016. The daily insulin dose in units per body weight was divided into quartiles and analyses were performed to compare the lowest, highest, and two middle quartiles. The primary outcome was a composite of any of the following: cesarean-section (CS), preeclampsia, macrosomia and large for gestational age (LGA) birth weight, neonatal intensive care unit admission, need for phototherapy, and neonatal hypoglycemia. Results Women were divided according to their insulin requirements as follows: 79 (24.8%) women who needed <0.13 IU/kg/day of insulin (insulin-sensitive group), 160 (50%) women who needed 0.14–0.42 IU/kg/day of insulin (comparison-group), and the rest who needed >0.43 IU/kg/day of insulin (insulin resistant group). There were no differences in the composite outcome between the groups (64.6, 61.3, and 69.6% for the insulin sensitive-, comparison- and resistant- groups, respectively, p = .44). Women in the insulin-resistant group had higher fasting glucose levels in the first trimester (91, 98 and 102 mg/dL for women in the insulin sensitive-, comparison- and insulin-resistant groups, respectively; p = .01). Women in the insulin-sensitive group had significantly better glycemic control (fasting glucose levels ≤90 mg/dL and 1-hour and 2-hour postprandial glucose levels ≤140 mg/dL and ≤120 mg/dL for more than 80% of measurements) than those in the insulin-resistant group (70.3 versus 29.9%; p < .001). The rate of CS was significantly higher in the insulin-resistant group (42.3 versus 24.1%; p = .03), but the rate of LGA birth weight was surprisingly higher in the insulin-sensitive group (29.5 versus 16.7%, p = .04). After controlling for confounders, women in the insulin-sensitive group had a decreased risk for CS in relation to the comparison group (OR = 0.46, 95%CI 0.23–0.9, p = .025). Conclusion We found no association between insulin requirements and adverse composite outcome in women with GDM. However, those with higher insulin requirements have poorer glucose control and higher rates of CS than those with lower insulin requirements. Larger studies are needed to inquire short- and long-term outcomes of insulin requirements on fetal and maternal outcomes.