Rate Of SGA Research Articles

A comparison between pregnancy outcome in women in 15 to 19 and 20 to 35 years age group.

Background: Pregnancy is one of the most important periods of a woman’s life and is influenced by many different factors. For years, it was assumed that teenage pregnancy can cause poor pregnancy outcome. The purpose of this study was to compare some pregnancy complications between 2 groups of 15 to 19 and 20 to 35 year- old primigravida pregnant women Methods: This was a cross- sectional study conducted on the data sheets of primigravida women who delivered their babies in a teaching hospital. A total of 3040 eligible women entered the study; of them, 280 (9.3%) were in the 15 to 19 years age group and 2756 in the 20 to 35 years age group. The 2 groups were compared for preeclampsia, PROM, preterm birth, SGA, placental abruption, and placenta previa. A logistic regression model was used for data analysis. Results: The women of the 2 groups significantly differed in BMI and socioeconomic background. The rate of preeclampsia (p=0.008), PROM (p=0.002), and preterm delivery (p=0.001) were less in the 15 to 19 years age group. The rate of placental abruption, placenta previa, IUFD, and SGA was not significantly different between the 2 groups. After multivariate regression analysis, preeclampsia (adjusted odd ratio= 2.157; 95% CI= 1.38- 4.21) and preterm delivery (adjusted odd ratio= 2.443; 95% CI= 1.78- 5.13) were found to be higher in the 20 to 35 years group. Conclusion: The risk of poor pregnancy outcome is not higher in teenage pregnancies compared to pregnancies in the 20 to 35 years age group if confounding factors, including socioeconomic factors, are carefully controlled.

Composite neonatal and maternal morbidities with small- versus appropriate- for gestational age among uncomplicated obese women undergoing repeat cesarean delivery*

Purpose: Our goal was to compare composite neonatal and maternal morbidities (composite neonatal morbidity (CNM), composite maternal morbidity (CMM)) among deliveries with small for age (SGA) versus appropriate for gestational age (AGA; birthweight 10–89%) among obese versus non-obese women undergoing repeat cesarean delivery (CD). Study design: This is a secondary analysis of a prospective observational study. Women who had elective CD ≥37 weeks were studied. We excluded multiple gestations, fetal anomalies, > 1 prior CD, and medical diseases. Patients were divided into BMI ≥30 versus <30 kg/m2. CNM included respiratory distress syndrome, necrotizing enterocolitis, severe intraventricular hemorrhage, seizure, or death; CMM included transfusion, hysterectomy, operative injury, coagulopathy, thromboembolism, pulmonary edema, or death. Multivariate logistic regression was used to control for confounding factors. Results: Of 7561 women, we included 65% were obese and 35% were not. SGA rates differed significantly: 8 versus 12% (p < .001). Overall, CNM was significantly higher in patients with SGA versus AGA (adjusted odds ratio (aOR) 2.04, 95% CI 1.19–3.49). CMM of SGA in obese versus non-obese was statistically different (aOR 0.11, 95% CI 0.02–0.68). Among obese mothers, SGA neonates had significantly higher CNM compared with AGA ones (aOR 2.17, 95% CI 1.03–4.59). Conclusions: SGA occurred in 8% of low-risk obese women with prior CD. CNM of SGA babies in obese versus non-obese women were similar. Paradoxically, CMM was lower in obese cases, possibly reflecting the caution that obese patients receive preoperatively. Our findings may assist in counseling patients and designing trials.

Smoke-Free Legislation in Spain and Prematurity.

Spain implemented a partial smoking ban in 2006 followed by a comprehensive ban in 2011. The objective was to examine the association between these smoke-free policies and different perinatal complications. Cross-sectional study including all live births between 2000 and 2013. Selected adverse birth outcomes were: preterm births (<37 gestational weeks), small for gestational age (SGA; <10th weight percentile according to Spanish reference tables), and low birth weight (<2500 g). We estimated immediate and gradual rate changes after smoking bans by using overdispersed Poisson models with different linear trends for 2000 to 2005 (preban), 2006 to 2010 (partial ban), and 2011 to 2013 (comprehensive ban). Models were adjusted for maternal sociodemographics, health care during the delivery, and smoking prevalence during pregnancy. The comprehensive ban was associated with preterm birth rate reductions of 4.5% (95% confidence interval [CI]: 2.9%-6.1%) and 4.1% (95% CI: 2.5%-5.6%) immediately and 1 year after implementation, respectively. The low birth weight rate also dropped immediately (2.3%; 95% CI: 0.7%-3.8%) and 1 year after the comprehensive ban implementation (3.5%; 95% CI: 2.1%-5.0%). There was an immediate reduction in the SGA rate at the onset of the partial ban (4.9%; 95% CI: 3.5%-6.2%), which was sustained 1 year postimplementation. Although not associated with the comprehensive ban at the onset, the SGA rate declined by 1.7% (95% CI: 0.3%-3.1%) 1 year postimplementation. The implementation of the Spanish smoke-free policies was associated with a risk reduction for preterm births and low birth weight infants, especially with the introduction of the more restrictive ban.

Maternal and Neonatal Morbidity Among Women With Sickle Cell Anemia and Sickle Cell Trait [4R

INTRODUCTION: The objective of this study is to investigate maternal and neonatal morbidities among a contemporary cohort of women with sickle cell anemia (SCA) and sickle cell trait (SCT). METHODS: This is a retrospective cohort study among women with laboratory confirmed SCA and SCT with placental pathology results. We sought to compare maternal and neonatal morbidity among a contemporary cohort of women with SCT and SCA. RESULTS: One hundred thirty-two patients met inclusion criteria: 16 (12%) with SCA and 116 (88%) with SCT. Baseline characteristics including age, gravidity, parity, race, funding source and smoking status were similar between groups. Co-morbidities were similar with the exception of a higher incidence of chronic infectious diseases among patients with SCA (38% vs. 9%, p=0.002). With respect to maternal morbidity, the following were significantly more likely to occur among patients with SCA as compared to SCT: antepartum hospital admission (81% vs. 19%, p &lt; 0.001), antepartum (69% vs. 4%, p &lt; 0.001) and postpartum blood transfusions (38% vs. 5%, p &lt; 0.001), postpartum readmission (19% vs. 3%, p=0.004) and endometritis (6% vs. 0%, p=0.01) (Table 1). With respect to neonatal morbidity, 25% of infants born to mothers with SCA were small for gestational age as compared 6% of infants born to SCT mothers (p=0.02). No other short-term neonatal morbidities were identified among infants born to mothers with SCA as compared to infants born to mothers with SCT. CONCLUSION: Maternal morbidity among patients with SCA is significantly greater as compared to mothers with SCT; infants born to SCA mothers also have higher rates of SGA.

667: Population vs. customized growth curves and composite neonatal morbidity: a secondary analysis of 10 MFMU trials

Publications differ on the improved accuracy of identifying adverse neonatal outcomes based on population nomograms (birthweight [BW] and gestational age [GA]) vs. customized (for maternal height, weight, ethnicity, parity, GA and BW) growth curve. Our objective was to assess the diagnostic accuracy of population vs. customized growth curves (PopGC vs. CusGC) in identifying newborns with composite neonatal morbidity (CNM), including stillbirth and neonatal mortality. Non-anomalous singletons delivered at ≥ 24 wks. in 10 MFMU trials were analyzed. PopGC we based on Alexander’s nomogram while CusGC utilized software from http://www.gestation.net/index.htm, to categorize newborns as SGA (BW < 10% for GA), AGA (BW at 10-89%) or LGA (BW ≥ 90%). Random-effect logistic regression was used to estimate adjusted odds ratio (aOR) with 95% confidence intervals (CI). Receiver operator characteristic (ROC) curves (identifying CNM) with area under the curves (AUC) were constructed. Of 86,809 singleton pregnancies enrolled in 10 trials, 90% (N=77,987) met inclusion criteria. Using the PopGC, 12% were SGA and 10% LGA; with CusGC, rate of SGA and LGA was 15% and 16%, respectively. Compared to PopGC, aOR for SGA based on CusGC was higher for CNM, stillbirth and neonatal death; the same pattern was seen when evaluating aOR for CNM and stillbirth among LGA. Sensitivity for identifying stillbirth among SGA was higher with CusGC than PopGC (54%; 95% CI 47% - 60%) vs. 36%; 30% - 43%), as was for neonatal mortality (48%; 95% CI 44% - 53% vs. 27%; 95% CI 24% - 32%). Comparison AUC for SGA to identify CNM, stillbirth and neonatal mortality is significantly better with customized than population nomogram (P < 0.01; Table). For LGA, customized nomogram was better at identifying cases of stillbirth than population nomogram (P=0.03) but not for CNM (0.64; 95% CI, 0.63 - 0.64) vs. 0.64; 95% CI, 0.63 - 0.65) or neonatal death (p=0.06). Though CusGC was better than PopGC at identifying deliveries with CNM, stillbirth and neonatal mortality, it is not useful to obstetricians for BW is unknown during pregnancy. Thus, a randomized trial comparing customized fetal growth curve with population curve is warranted to determine which method mitigates morbidity and mortality with aberrant fetal growth.

Stillbirths at Term: Case Control Study of Risk Factors, Growth Status and Placental Histology.

ObjectiveTo investigate the proportion of stillbirths at term associated with abnormal growth using customized birth weight percentiles and to compare histological placental findings both in underweight stillborn fetuses and in live births.MethodsA retrospective case-control study of 150 singleton term stillbirths. The livebirth control groups included 586 cases of low-risk pregnancies and 153 late fetal growth restriction fetuses. Stillbirths and livebirths from low-risk pregnancies were classified using customized standards for fetal weight at birth, as adequate for gestational age (AGA; 10-90th percentile), small (SGA; <10th percentile) or large for gestational age (LGA; >90th percentile). Placental characteristics in stillbirth were compared with those from livebirths using four categories: inflammation, disruptive, obstructive and adaptive lesions.ResultsThere was a higher rate of SGA (26% vs 6%, p<0.001) and LGA fetuses (10.6% vs 5.6%, p<0.05) in the stillbirth group. Among stillbirth fetuses, almost half of the SGA were very low birthweight (≤3°percentile) (12% vs 0.3%, p<0.001). The disruptive (7.3% vs 0.17%;p<0.001), obstructive (54.6% vs 7.5%;p<0.001) and adaptive (46.6% vs 35.8%;p<0.001) findings were significantly more common in than in livebirth-low risk. Placental characteristics of AGA and SGA stillbirth were compared with those of AGA and FGR livebirth. In stillbirths-SGA we found a higher number of disruptive (12.8% vs 0%; p<0.001), obstructive (58.9% vs 23.5%;p<0.001) and adaptive lesions (56.4% vs 49%; p 0.47) than in livebirth-FGR.ConclusionThe assessment of fetal weight with customized curves can identify fetuses which have not reached their genetically determined growth potential and are therefore at risk for adverse outcomes. Placental evaluation in stillbirths can reveal chronic histological signs that might be useful to clinical assessment, especially in underweight fetuses.

Pregnancy Outcomes in Women with Preeclampsia Superimposed on Chronic Hypertension with and without Severe Features

Objective The American Congress of Obstetricians and Gynecologists (ACOG) task force on hypertension in pregnancy introduced a new definition of superimposed preeclampsia (SIP) adding severe features (SF) as new criteria to define severe disease. They also recommended that those with SIP be delivered ≥ 37 weeks, whereas those with SF be delivered ≤ 34 weeks. Our aim was to investigate the validity of this new definition by comparing adverse pregnancy outcomes in SIP with (SIP-SF) and without SF (SIP). Study Design Women with chronic hypertension (CHTN) enrolled in a multicenter trial were studied. SIP was reclassified according to the new definition to SIP and SIP-SF (persistent systolic blood pressure [BP] > 160 or diastolic BP > 110, platelets < 100 K, liver function tests > 70, creatinine > 1.1, or persistent central nervous system/abdominal symptoms). Composite adverse outcomes including rates of indicated preterm birth, abruptio placentae, postpartum hemorrhage, and maternal death were compared by chi-square. Adjustment was done with a multivariate logistic-regression analysis and all statistical tests were two-sided. Results A total of 216 women (28%) out of 774 with CHTN developed SIP, 87 (11%) had SIP-SF, and 129 (17%) didn't have SF. Baseline characteristics including maternal age, baseline BP, and assignment to low-dose aspirin were similar between groups. Using univariate analysis, the composite adverse outcome was higher among the SIP-SF group (p = 0.04), as well as indicated preterm birth (p = 0.02), cesarean section (p = 0.02), and SGA (p = 0.02). After adjustment, composite adverse outcomes were not significantly different between groups. The rate of SGA, however, was higher among SIP-SF (adjusted odds ratio: 3.12, p = 0.02). Conclusion The rate of SIP-SF in this study was 11% of all women with CHTN. Surprisingly, pregnancy outcomes were not significantly different in those with and without SF. We suggest a prospective observational study to determine the optimal timing for delivery in those with SIP using new ACOG diagnostic criteria.

Effectiveness of Folic Acid Supplementation in Pregnancy on Reducing the Risk of Small-for-Gestational Age Neonates

conception in 10 036, (25.5%) cases. Preconception commencement of FA supplementation was associated with reduced risk of SGA <10th centile (aOR 0.80, 95% CI 0.71–0.90, P < 0.01) and SGA <5th centile (aOR 0.78, 95% CI 0.66–0.91, P < 0.01). This result was reproduced when the data were pooled with other studies in the systematic review, showing a significant reduction in SGA (<5th centile) births with preconception commencement of FA (aOR 0.75, 95% CI 0.61–0.92, P < 0.006). In contrast, postconception folate had no significant effect on SGA rates.

Birth weight classification in gestational diabetes: is there an ideal chart?

Introduction : Gestational diabetes mellitus (GDM) is associated to increased rates of large for gestational age newborns and macrosomia. Several charts are used to classify birth weight. Is there an ideal chart to classify newborns of GDM mothers? Methods : We evaluated adequacy of birth weight of 332 neonates born to GDM mothers at Hospital de Clinicas de Porto Alegre, Brazil. Newborns were classified according to gestational age as small (SGA), adequate or large (LGA) based on four charts: Alexander, Pedreira, INTERGROWTH 21 st Project and SINASC-2012. The latter was built using data from a large national registry of 2012, the Born Alive National Surveillance System ( Sistema de Informacoes de Nascidos Vivos – SINASC), which included 2.905,789 birth certificates. Frequencies of SGA and LGA and Kappa agreement were calculated. Results : In non-gender adjusted curves, SGA rates (95% confidence interval) varied from 8% (5-11) to 9% (6-13); LGA rates, from 11% (8-15) to 17% (13-21). For males, SGA rates varied from 3% (1-6%) to 6% (3-11%), and LGA rates, from 18% (13-24%) to 31% (24-38%); for female, SGA rates were from 3% (1-7%) to 10% (6-16%) and LGA rates, from 11% (6-16%) to 19% (13-26%). Kappa results were: ALEXANDER vs. SINASC-2012: 0.80 (0.73-0.88); INTERGROWTH 21 st vs. SINASC-2012 (adjusted by sex): 0.62 (0.53-0.71); INTERGROWTH 21 st vs. PEDREIRA: 0.71 (0.62-0.79); SINASC-2012 (by sex) vs. PEDREIRA: 0.86 (0.79-0.93). Conclusions : Misclassification has to be taken into account when evaluating newborns of GDM mothers, as LGA rates can almost double depending on the chart used to classify birth weight.

180-POS

Objectives Women with EH are at high risk of developing PE but it is not clear whether PE in this setting is worse than in the absence of EH. We therefore compared outcomes of women with pre-eclampsia superimposed upon essential hypertension (PE/EH) with those of women with de-novo pre-eclampsia (PE). Methods We have gathered data on pre-eclamptic pregnancies since 1991. We compared maternal outcomes (severe hypertension – BP >170/110 mmHg; cerebral, renal or hepatic dysfunction or thrombocytopenia) and fetal outcomes (SGA Results 1947 women developed PE and 143 women had PE/EH. Women with PE/EH were older than those with PE (33 vs. 30 years, p p p p p p Delivery before 37 weeks was higher in PE/EH (39% vs. 30% p p Conclusions Women with PE/EH had proteinuria less frequently but were more likely to have episodes of severe hypertension. Although they had higher rates of prematurity, SGA rates were lower and PNM unaffected. These data suggest that PE may develop slightly differently in women with underlying essential hypertension. Disclosures F.M. Pettit: None. G.J. Mangos: None. G. Davis: None. A. Henry: None. M.A. Brown: None.

Analysis of Infants Based on Data from the German Perinatal Survey of the Years 1994-2011 in Mecklenburg-Pomerania, Germany. Classification of Infants with regard to their Gestation Duration and Birth Weight.

The demographic change in -Germany describes an ongoing process of population development of which the eastern German states tend to be more affected. These ongoing changes have an influence on the reproductive behavior of the population. After twenty-three years of German reunification, the present study has investigated the question to what extent the somatic classification of newborns in Mecklenburg-Pomerania (M-P), Germany, is affected. Newborn singleton births (n=174,084) were classified from the existing data of the German Perinatal Survey between 1994 and 2011. The rate of premature birth, SGA, and LGA rate as well as the rate of low birth weight ≤2,499 g were determined both gender-dependently and independently. In addition, a combined analysis of the rates has been taken into account. The obtained data material from M-P made it possible for the first time to compare by values. National and international reference studies were considered in this comparison. In M-P, the premature birth rate is 5.2%; the rate of newborns with low birth weight ≤ 2,499 g is 4.4%. Among newborns of ≤2,499 g and SGA newborns, girls compose a higher percentage (4.7%, 12.5%) compared to boys (4.0%, 7.4%). The premature birth rate and LGA newborns appear conversely. For these, the percentage of boys (5.6%, 12.6%) is higher than that of girls (4.8%, 7.0%). 60.6% of the gender non-specific newborns ≤2,499 g are simultaneously premature newborn infants. Only a very small percentage of 0.5% of SGA newborns is at the same time premature infants and newborns with low birth weight. By getting nationwide country-specific figures, a detailed analysis of the newborns in M-P can be performed. The analysis supports the existing national values and is a helpful addition for practice-oriented advice.

The Incidence of Low Birth Weight (LBW) and Small- for- Gestational Age (SGA) and its Related Factors in Neonates, Sabzevar, Iran

Introduction Low birth weight (LBW) is a high risk for children's health and a problem of public health in under developing countries. SGA increases neonatal and infant death, and neonatal and adult morbidity. So the present study aimed to assess the incidence of LBW, SGA and their related factors in Sabzevar in 2011 to 2012. Materials and Methods This prospective descriptive-analytic study was conducted on 481 low birth weight neonates born in Mobini academic hospital of Sabzevar in 2011. Neonates who their BW was Results 480 (6.33%) of participating newborns were LBW (out of 7599). Mean weight of LBW neonates was 2039.1±9.6 g. Among LBW neonates, 62 (12.7%) and 24 (5%) of neonates were VLBW and ELBW, respectively. 162 (34.1%) of neonates were SGA (out of LBW neonates). SGA rate was 2.2% (out of total newborns). Family income (p-value=0.026) and mother's education (p-value=0.004) were significantly lower in SGA neonates rather than LBW neonates. The incidence of mothers' urinary infection in VLBW neonates was significantly higher than non-VLBW neonates (p-value<0.001). Conclusion: Findings showed that LBW and SGA incidence were similar to these statistics in developed countries and also other cities of Iran. But most types of growth retardation were asymmetric, in reverse to the reference books.

Falling insulin requirements are associated with adverse obstetric outcomes in women with preexisting diabetes.

To investigate the clinical significance of falling insulin requirements in women with preexisting or overt diabetes in pregnancy. A retrospective review of 139 pregnancies was conducted in women, with preexisting diabetes, delivering between January 2010 and January 2013. Women with falling insulin requirements of 15% or more from the peak total daily dose in late pregnancy were considered case subjects (n = 35). The primary outcome consisted of a composite of clinical markers of placental dysfunction, including preeclampsia, small for gestational age (SGA, ≤5th percentile for gestational age), stillbirth (>20 weeks), and premature delivery (≤30 weeks). A total of 25.2% of women had >15% fall in insulin requirements with nulliparity as the only predictor at baseline (odds ratio [OR] 2.5 [95% CI 1.1-5.7], P = 0.03). Falling insulin requirements were associated with an increased risk of preeclampsia (OR 3.5 [1.1-10.7], P < 0.05) and the composite of clinical markers of placental dysfunction (4.4 [1.73-11.26], P = 0.002). Although falling insulin requirements were associated with higher rates of SGA (3.4 [1.0-11.3], P = 0.048), they were not associated with other adverse neonatal outcomes. However, there was a higher incidence of neonatal intensive care unit admission (15.5 [3.1-77.6], P = 0.001) and earlier delivery in this group (median 37.7 weeks [IQR 34.3-38.4] vs. 38.3 weeks [37.4-38.9], P = 0.014). Falling insulin requirements, in women with preexisting diabetes, are associated with an increased risk of complications related to placental dysfunction. Further prospective studies are needed to guide clinical management.

The maternal age related patterns of infant low birth weight rates among non-Latino Whites and African-Americans: the effect of maternal birth weight and neighborhood income.

To determine the age related patterns of low birth weight (<2,500g, LBW) and small for gestational age (weight <10th percentile for gestational age, SGA) among former LBW and non-LBW White and African-American mothers. We performed stratified analyses on an Illinois transgenerational dataset of non-Latina White (n=31,616) and African-American (n=38,964) infants born in Chicago or Suburban Cook County (1989-1991) and their mothers (1956-1976) with appended US census income information. In both races, LBW and SGA rates were unrelated to age among former LBW 14-35year old mothers. LBW and SGA rates decreased with advancing age only among former non-LBW White mothers (p<0.0001). Former non-LBW 30-35year old White women (n=11,096) had an infant LBW rate of only 4.3% compared to 6.8% for their teen counterparts (n=1,383), RR (95% CI)=0.6 (0.5, 0.8). In contrast, a weathering pattern of rising LBW and SGA rates with advancing age occurred only among former non-LBW African-American mothers (p<0.0001). Former non-LBW 30-35year old African-American mothers (N=4,807) had a LBW rate of 15.0% compared to 10.8% for their teen counterparts (N=8,627), RR (95% CI)=1.4 (1.3, 1.5). The same trend occurred among the subgroup of African-American mothers with an early-life and adulthood residence in impoverished neighborhoods. Maternal low birth weight does not contribute to the disparate maternal age related patterns of adverse birth outcome between the races. Moreover, it is not associated with a weathering a pattern of rising rates of LBW with advancing age among African-American mothers with a lifelong residence in impoverished neighborhoods.

Smoking among older childbearing women - a marker of risky health behaviour a registry-based study in Finland

BackgroundSmoking during pregnancy is known to negatively affect pregnancy outcomes and it has been associated with numerous complications during pregnancy. Smoking is more common in younger pregnant women, but previous research has shown that adverse pregnancy outcomes related to older maternal age and smoking are even more harmful than with younger smokers. The aim of this study was to compare pregnancy outcomes among smoking and non-smoking pregnant women aged <35 years and ≥35 years.MethodsIn this registry-based study, the data were collected from three national Finnish health registries: Finnish Medical Birth Register, Finnish Hospital Discharge Register, and Register of Congenital Malformations between the years 1997 and 2008. The data included information on 80 260 women who were smoking during pregnancy, of which 11 277 (9%) were ≥35 years and 68 983 (13%) were <35 years old. In multivariate modelling, the main outcome measures were preterm delivery, low Apgar scores at 1 min., low birth weight, small for gestational age, fetal death and preeclampsia.ResultsFewer older women smoked during pregnancy (9%) than younger women did (13%). Smoking increased the risk of adverse pregnancy outcomes, most in the older group. Multivariate logistic regression using non-smoking women aged <35 years as a reference group indicated that smoking women <35 years had higher rates of preterm delivery (OR 1.27 CI 1.20-1.35), SGA (OR 2.18 CI 2.10-2.26) and LBW (OR 1.73 CI 1.62-1.84).Non-smoking women ≥35 had higher rates of preterm delivery (OR 1.15 CI 1.10-1.20), fetal death (OR 1.36 CI 1.12-1.64), preeclampsia (OR 1.14 CI 1.09-1.20) and LBW (OR 1.13 CI 1.07-1.19).Smoking women ≥35 had higher rates of preterm delivery (OR 1.60 CI 1.40-1.82), SGA (OR 2.55 CI 2.34-2.79), fetal death (OR 2.70 CI 1.80-4.05) and LBW (OR 2.50 CI 2.20-2.80).ConclusionsSmoking during pregnancy increased the risk of adverse pregnancy outcomes in all women, but the rates were the highest for women aged ≥35 years. Pregnant women aged ≥35 years smoking during pregnancy was a distinctly high risk group. Maternity care should identify these women and support them in cessation of smoking during the first trimester of pregnancy.

Atypical Antipsychotic Drugs and Pregnancy Outcome

Women of childbearing age are often affected with psychotic disorders, requiring the use of antipsychotic medication during pregnancy. In the present study, we prospectively followed the pregnancies of 561 women exposed to second-generation antipsychotic agents (SGAs; study cohort) and compared these to 284 pregnant women exposed to first-generation antipsychotic agents (FGAs; comparison cohort I) and to 1122 pregnant women using drugs known as not harmful to the unborn (comparison cohort II). Subjects were enrolled through the Institute's consultation service. Major malformation rates of SGA exposed were higher compared to comparison cohort II (adjusted odds ratio, 2.17; 95% confidence interval, 1.20-3.91), possibly reflecting a detection bias concerning atrial and ventricular septal defects. Postnatal disorders occurred significantly more often in infants prenatally exposed to SGAs (15.6%) and FGAs (21.6%) compared to 4.2% of comparison cohort II. Cumulative incidences of elective terminations of pregnancy were significantly higher in both the study cohort (17%) and comparison cohort I (21%) compared to comparison cohort II (3%), whereas the rates of spontaneous abortions did not differ. The numbers of stillbirths and neonatal deaths were within the reference range. Preterm birth and low birth weight were more common in infants exposed to FGAs. To conclude, our findings did not reveal a major teratogenic risk for SGAs, making the better studied drugs of this group a treatment option during pregnancy. Because neonates exposed to SGAs or FGAs in the last gestational week are at higher risk of postnatal disorders, delivery should be planned in clinics with neonatal intensive care units.

Application of A global reference for fetal‐weight and birthweight percentiles in predicting infant mortality

To determine whether the recently published A global reference for fetal-weight and birthweight percentiles (Global Reference) improves small- (SGA), appropriate- (AGA), and large-for-gestational-age (LGA) definitions in predicting infant mortality. Population-based cohort study. The US Linked Livebirth and Infant Death records between 1995 and 2004. Singleton births with birthweight >500 g born at 24-41 weeks of gestation. We compared infant mortality rates of SGA, AGA, and LGA infants classified by three different references: the Global Reference; a commonly used birthweight reference; and Hadlock's ultrasound reference. Infant mortality rates. Among 33 997 719 eligible liveborn singleton births, 25% of preterm and 9% of term infants were classified differently for SGA, AGA, and LGA by the Global Reference and the birthweight reference. The Global Reference indicated higher mortality rates in preterm SGA and preterm LGA infants than the birthweight reference. The mortality rate was considerably higher in infants classified as preterm SGA by the Global Reference but not by the birthweight reference, compared with the corresponding infants classified by the birthweight reference but not by the Global Reference (105.7 versus 12.9 per 1000, RR 8.17, 95% CI 7.38-9.06). Yet, the differences in mortality rates were much smaller in term infants than in preterm infants. Black infants had a particularly higher mortality rate than other races in AGA and LGA preterm and term infants. In respect to the commonly used birthweight reference, the Global Reference increases the identification of infant deaths by improved classification of abnormal newborn size at birth, and these advantages were more obvious in preterm than in term infants.

PP.27 Micro-Vascular Disease at Booking in T1DM and Associated Risk of Developing Pre-Eclampsia

Background and AimsMicro-vascular disease affects the majority of T1DM patients and is directly related to both duration and glycemic control of diabetes. The aim of this study is to identify...

1.2 An Enhanced, Midwifery-Led Ultrasound Service to Monitor Fetal Growth

ObjectiveAntenatal detection of intrauterine growth restriction (IUGR) is a key objective of maternity care. In 2009, 4 in 5 babies in Birmingham born with an SGA birthweight were not recognised...

1339 The Value of Placental Pathological and Microbiological Aspects on Preterm Delivery and Outcome

BackgroundBoth clinical findings and the high incidence of decidual inflammation/infection in placentasare associated with preterm deliveries.ObjectivesTo find out the relation of histopathology and microbiology findings of the placenta and preterm...