Singleton Term Infants Research Articles

Feeding of Dietary Botanical Supplements and Teas to Infants in the United States

To describe the use of dietary botanical supplements and teas among infants, the characteristics of mothers who give them the specific botanical supplements and teas used, reasons for use, and sources of information. We used data from the Infant Feeding Practices Study II, a longitudinal survey of women studied from late pregnancy through their infant's first year of life conducted by the US Food and Drug Administration and the Centers for Disease Control and Prevention between 2005 and 2007. The sample was drawn from a nationally distributed consumer opinion panel and was limited to healthy mothers with healthy term or near-term singleton infants. The final analytical sample included 2653 mothers. Statistical techniques include frequencies, χ² tests, and ordered logit models. Nine percent of infants were given dietary botanical supplements or teas in their first year of life, including infants as young as 1 month. Maternal herbal use (P < .0001), longer breastfeeding (P < .0001), and being Hispanic (P = .016) were significantly associated with giving infants dietary botanical supplements or teas in the multivariate model. Many supplements and teas used were marketed and sold specifically for infants. Commonly mentioned information sources included friends or family, health professionals, and the media. A substantial proportion of infants in this sample was given a wide variety of supplements and teas. Because some supplements given to infants may pose health risks, health care providers need to recognize that infants under their care may be receiving supplements or teas.

Labor epidural analgesia is independent risk factor for neonatal pyrexia

Objective. To explore whether epidural analgesia (EA) in labor is independent risk factor for neonatal pyrexia after controlling for intrapartum pyrexia.Methods. Retrospective observational study of 480 consecutive term singleton infants born to mothers who received EA in labor (EA group) and 480 term infants delivered to mothers who did not receive EA (NEA group).Results. Mothers in the EA group had significantly higher incidence of intrapartum pyrexia [54/480 (11%) vs. 4/480 (0.8%), OR = 15.1, p < 0.0001] and neonatal pyrexia [68/480 (14.2%) vs. 15/480 (3.1%), OR = 5.1, p < 0.0001]. Neonates in the EA group had a median duration of pyrexia of 1 h (maximum 5 h) with a peak temperature within 1 h. Stepwise logistic regression analysis showed that maternal EA was independent risk factor for neonatal pyrexia (>37.5°C) after controlling for intrapartum pyrexia (>37.9°C) and other confounders (OR = 3.44, CI = 1.9–6.3, p < 0.0001). Sepsis work-up was performed significantly more frequently in infants in the EA group [11.7% vs. 2.5%, OR = 5.2, CI = 2.7–9.7, p < 0.0001] with negative blood cultures.Conclusions. EA in labor is an independent risk factor for pyrexia in term neonates. It is unnecessary to investigate febrile offspring of mothers who have had epidurals unless pyrexia persists for longer than 5 h or other signs or risk factors for neonatal sepsis are present.

597: Maternal super-obesity and perinatal outcomes

OBJECTIVE—To determine the effect of maternal super-obesity (BMI ≥50 kg/m 2 ) compared to morbid obesity (BMI 40–49.9 kg/m 2 ) or obesity (BMI 30–39.9 kg/m 2 ) on perinatal outcomes. STUDY DESIGN—Retrospective cohort study of birth records linked to hospital discharge data for all live born singleton term infants born to obese Missouri residents from 2000–2006. We excluded major congenital anomalies and women with diabetes or chronic hypertension. RESULTS—There were 64,272 births meeting study criteria, including 1,185 (1.8%) super-obese mothers. Super-obese women were significantly more likely than obese women to have preeclampsia (aRR 1.7, 95% CI 1.4, 2.1), macrosomia (aRR 1.8, 95% CI 1.3, 2.5), and cesarean delivery (aRR 1.8, 95% CI 1.5, 2.1). Almost half (49.1%) of all super-obese women delivered via cesarean, and 33.8% of super-obese nulliparous women underwent scheduled primary cesarean. CONCLUSION—Women with a BMI ≥50 kg/m 2 are at significantly increased risk for perinatal complications compared to obese women of lower BMI.

Advanced maternal age and the risk of perinatal death due to intrapartum anoxia at term

BackgroundAdvanced maternal age is associated with higher risks of intrapartum complications. However, the effect of maternal age on the risk of perinatal death due to these complications is unclear. The...

Antepartum and Intrapartum Risk Factors for Neonatal Encephalopathy at Term

We investigated antepartum and intrapartum risk factors for neonatal encephalopathy (NE) in term infants. We performed a case-controlled study in which characteristics of singleton term infants who developed NE from 1993 to 2003 were compared with those of randomly selected controls. Antenatal risk factors (including obesity, diabetes, thyroid dysfunction, previous cesarean delivery, preeclampsia, fetal growth restriction, abnormal amniotic fluid volume, and abnormal fetal heart rate [FHR] tracing before labor) and intrapartum risk factors (acute intrapartum sentinel events and other risk factors like suspicious or ominous FHR tracing and clinical chorioamnionitis) were related to occurrence of NE. From the study cohort of 30,580 infants, 27 (0.09%) developed NE and were compared with 100 controls. Neonates with encephalopathy had more frequent antepartum (74% versus 18%, P < 0.001) and intrapartum (67% versus 19%, P < 0.001) risk factors, including acute intrapartum events (33% versus 2%, P < 0.001), than controls. On the whole, 26% of cases of NE had only antepartum risk factors, 22% had only intrapartum risk factors, and 44% had a combination of the two. In 2/27 (7%) cases, no risk factors were recognizable. In conclusion, 44% of cases of NE following term deliveries can be attributed to a combination of antepartum and intrapartum variables.

The prevalence and determinants of breast-feeding initiation and duration in a sample of women in Ireland

To assess breast-feeding initiation and prevalence from birth to 6 months in a sample of mothers in Dublin, and to determine the factors associated with breast-feeding initiation and 'any' breast-feeding at 6 weeks in a sample of Irish-national mothers. This prospective cross-sectional study involved the recruitment of women during the antenatal period, with subsequent follow-up of mothers who delivered healthy, term singleton infants, at 6 weeks and 6 months postpartum. Participants were recruited from antenatal clinics in the Coombe Women and Infants University Hospital, Dublin. In all, 401 Irish-national and forty-nine non-Irish-national mothers met the criteria for inclusion in the present study. Breast-feeding initiation rates of the Irish-national and non-Irish-nationals were 47% and 79.6%, respectively. Factors that were significantly (P = 0.000) associated with both breast-feeding initiation and 'any' breast-feeding at 6 weeks included mothers who were >or=35 years, educated to third level, reported positive postnatal encouragement to breast-feed from their partners and had a positive antenatal intention to breast-feed. The maternal negative perception that breast-feeding is an embarrassing way to feed an infant was demonstrated as a major barrier to initiation. Breast-feeding initiation and prevalence rates of the Irish-national population remain low and lag considerably behind national and international targets. Inclusion of the partner in breast-feeding promotional initiatives during the antenatal period may be crucial to increase breast-feeding rates in Ireland. Public health campaigns that focus on increasing the social acceptability of breast-feeding may prove effective in addressing this cultural barrier.

Low pregnancy weight gain and small for gestational age: a comparison of the association using 3 different measures of small for gestational age

The purpose of this study was to assess associations between pregnancy weight gain (PWG) and small for gestational age (SGA) defined by birthweight < 10th percentile and 2 more restrictive definitions and to assess the proportion of SGA attributed to low PWG. This was a retrospective cohort study of 104,980 singleton, term births from the 2000-2005 Pregnancy Risk Assessment Monitoring System (PRAMS). Compared with women who gained 15-25 lbs during pregnancy, women who gained 1-14 lbs had 1.5 greater odds (95% confidence interval, 1.2-1.8) of SGA for the most restrictive definition and 1.2 greater odds (95% confidence interval, 1.1-1.4) for the least restrictive definition, after adjustments for confounders. Depending upon the definition used, PWG below current Institute of Medicine recommendations contributed to 10-15% of SGA, representing 0.8-1.2% of all singleton term infants. Associations between low PWG and SGA varied little by definition of SGA and contributed to only a small proportion of term SGA infants.

Neonatal respiratory morbidity and mode of delivery in a population‐based study of low‐risk pregnancies

The aim of this study is to evaluate the association between the mode of delivery and the risk of neonatal respiratory complications in a cohort of term newborns in the Lazio region, Italy. Data on 139,379 term singleton infants born in 2003-2005 were retrieved from birth and hospital discharge database. Odds Ratios (ORs) adjusted by age, parity, birth weight, gestational age, and gender were calculated using logistic regression models. The rate of prelabor cesarean section (CS) was 26.2%. The rates of neonatal respiratory morbidity were 29.6/1,000 in infants delivered by prelabor CS and 17.4/1,000 in infants delivered vaginally or by CS in labor. The adjusted risk of neonatal respiratory morbidity associated with prelabor cesarean birth at 37 weeks is four times higher than in intended vaginal birth after 37 weeks. Prelabor cesarean delivery should be performed after at least 38 weeks' of gestation in order to minimize neonatal respiratory morbidity.

Maternal pre-pregnancy body mass index explains infant’s weight and BMI at 14 months: results from a multi-ethnic birth cohort study

Objective:To investigate the association between (self-reported) maternal pre-pregnancy body mass index (pBMI), and child’s weight, height and BMI at age 14 months.Design:Prospective multi-ethnic community-based cohort study.Setting:Amsterdam, The Netherlands.Participants:8266 pregnant women...

The Effect of Tobacco Exposure on Maternal and Fetal Thyroid Function

Smoking has adverse effects on thyroid function in nonpregnant women. For example, a previous study found a small but statistically significant decrease in the concentrations of thyrotropin (TSH) in smokers compared to nonsmokers, and a recent meta-analysis found that the risk of Graves' disease was three-fold greater among smokers than in those who had never smoked; cessation of smoking decreased the risk. However, data on the effects of smoking during pregnancy on maternal and neonatal thyroid function have been conflicting. This prospective cohort study evaluated the effect of smoking on maternal and neonatal thyroid function in 104 healthy women (83 nonsmokers and 21 smokers) undergoing elective cesarean section for term singleton infants during the years 2002-2004. The smoker to nonsmoker ratio (4:1) reflected the general rates of smoking during pregnancy. Mothers who smoked were significantly younger than nonsmokers (median age 29.5 versus 33.0 years, respectively, P ≤.023), and had significantly lighter infants (3250 gm versus 3456 gm, respectively, P ≤.011). Smokers had significantly lower maternal TSH concentrations than nonsmokers (median 1.75 mIU/liter versus 2.15 mIU/liter, respectively, P ≤.007), but there was no difference in free thyroxine (FT4) concentrations (median 9.59 pmol/liter versus 9.56 pmol/liter (P =.755). There was a correlation between the number of cigarettes smoked per day and the maternal TSH concentrations (R = -.427; P ≤.05). Umbilical venous TSH and FT4 concentrations were similar in infants of nonsmokers and smokers (P =.049). This is the first study to show that women who smoke during pregnancy have significantly lower TSH concentrations than nonsmokers.

Time trend in the risk of delivery-related perinatal and neonatal death associated with breech presentation at term

To determine the factors associated with the risk of delivery-related perinatal and neonatal death among term infants presenting by the breech and the effect of changes in the mode of delivery on the overall rates of perinatal and neonatal mortality associated with breech presentation. We studied 32,776 singleton term infants presenting breech excluding anomalous and antepartum losses in Scotland between 1985 and 2004, using linked Scottish national registries of pregnancy outcome data and perinatal death data. The event was delivery-related perinatal and neonatal death (i.e. intrauterine fetal death during labour or death of infant in the first 4 weeks of life), subdivided according to intrapartum anoxia or mechanical cause of death. Analysis was by multivariate logistic regression. During the study period, the risk of delivery-related perinatal and neonatal death decreased by 72% (95% CI -1% to 93%), due to a 90% (95% CI 33-99%) reduction in anoxic or mechanical deaths. Both intrapartum (OR 0.16, 95% CI 0.02-0.75) and planned (OR 0.01, 95% CI 0.00-0.09) caesarean delivery were protective against anoxic or mechanical deaths and increased use of planned caesarean delivery accounted for 16% of the decline in anoxic and mechanical deaths over the study period. Increased use of planned caesarean delivery only partly explains the decline in delivery-related perinatal and neonatal death between 1985 and 2004 in Scotland.

Fetal size in mid‐ and late pregnancy is related to infant alertness: The generation R study

The vulnerability for behavioral problems is partly shaped in fetal life. Numerous studies have related indicators of intrauterine growth, for example, birth weight and body size, to behavioral development. We investigated whether fetal size in mid- and late pregnancy is related to infant irritability and alertness. In a population-based birth cohort of 4,255 singleton full-term infants ultrasound measurements of fetal head and abdominal circumference in mid- and late pregnancy were performed. Infant irritability and alertness scores were obtained by the Mother and Baby Scales at 3 months and z-standardized. Multiple linear regression analyses revealed curvilinear associations (inverted J-shape) of measures of fetal size in both mid- and late pregnancy with infant alertness. Fetal size characteristics were not associated with infant irritability. These results suggest that alterations of intrauterine growth affecting infant alertness are already detectable from mid-pregnancy onwards.

Infant Feeding Practices Study II: Study Methods

Our goal is to describe the methods used in the Infant Feeding Practices Study II (IFPS II), a study of infant feeding and care practices throughout the first year of life. Survey topics included breastfeeding, formula and complementary feeding, infant health, breast-pump use, food allergies, sleeping arrangements, mother's employment, and child care arrangements. In addition, mothers' dietary intake was measured prenatally and postnatally. The IFPS II sample was drawn from a nationally distributed consumer opinion panel of 500,000 households. All questionnaires were administered by mail, 1 prenatally and 10 postpartum. Qualifying criteria were used to achieve the sample goals of mothers of healthy term and late preterm singleton infants. In addition to the questionnaires about the infants, women were sent a diet-assessment questionnaire prenatally and at approximately 4 months after delivery; this questionnaire was also sent to members of a comparison group who were neither pregnant nor postpartum. A sample of 4902 pregnant women began the study, and approximately 2000 continued through their infant's first year. Response rates ranged from 63% to 87% for the different questionnaires. Compared with adult mothers of singletons from the nationally representative sample of the National Survey of Family Growth, IFPS II participants had a higher mean education level; were older; were more likely to be middle income, white, and employed; were less likely to smoke; and had fewer other children. Compared with women who participated in the National Immunization Survey who gave birth in 2004, IFPS II mothers were more likely to breastfeed and to breastfeed longer. The IFPS II provides a valuable database because of its large sample size, the frequency of its questionnaires, and its wide coverage of issues salient to infant feeding.

The effect of tobacco exposure on maternal and fetal thyroid function

Objective To determine the effect of smoking on maternal and fetal thyroid function. Study design This prospective cohort study involved healthy women undergoing elective cesarean section for term singleton infants. Maternal and fetal thyroid indices were compared between smokers ( n = 21) and non-smokers ( n = 83). Results Maternal thyrotropin (TSH) concentrations were significantly lower in smokers than non-smokers (1.75 mIU/L versus 2.15 mIU/L, respectively, p = 0.007), with similar free thyroxine (FT4) concentrations (9.59 pmol/L versus 9.56 pmol/L, p = 0.755). For women who smoked, the correlation between the average number of cigarettes smoked per day and maternal TSH concentrations was −0.427, p = 0.054. Infants of smokers and non-smokers had similar umbilical TSH (5.43 mIU/L versus 5.82 mIU/L, p = 0.124) and FT4 concentrations (13.06 pmol/L versus 13.57 pmol/L, p = 0.049). Conclusion We demonstrated for the first time that women who smoke during pregnancy have significantly lower TSH concentrations than non-smokers.

Review: dietary restriction, with or without aerobic exercise, promotes weight loss in postpartum women

A R Amorim Correspondence to: Dr A R Amorim, Copenhagen University Hospital, Copenhagen, Denmark; AAR@ipm.regionh.dk Are diet and/or exercise effective for weight reduction in postpartum women? ### Data sources: Cochrane...

Maternal plasma cytokines in early- and mid-gestation of normal human pregnancy and their association with maternal factors

Few studies have assessed longitudinal changes in circulating cytokine levels during normal pregnancy. We have examined the natural history of maternal plasma cytokines from early- to mid-pregnancy in a large, longitudinal cohort. Multiplex flow cytometry was used to measure interleukin (IL)-2, IL-6, IL-12, tumor necrosis factor (TNF)-α, interferon (IFN)-γ and granulocyte-macrophage colony-stimulating factor (GM-CSF) in early- (median [IQR]: 8.5 weeks [7.1, 10.0]) and mid-pregnancy (25.0 [24.1, 26.1]) from 1274 Danish women delivering singleton term infants. GM-CSF decreased from early- to mid-pregnancy (median percent change [95% CI]: −51.3% [−59.1%, −41.8%]), while increases were observed in IL-6 (24.3% [4.6%, 43.9%]), IL-12 (21.3% [8.9%, 35.7%]) and IFN-γ (131.7% [100.2%, 171.6%]); IL-2 (−2.8% [−11.5%, 0.0%]) and TNF-α (0% [−5.9%, 25.6%]) remained stable. Positive correlations were found between all cytokines, both in early- and mid-pregnancy (all p < 0.001). Early- and mid-pregnancy levels were rank-correlated for IL-2, IL-12, TNF-α and GM-CSF, but not IL-6 and IFN-γ; these correlations were generally weaker than correlations between different cytokines at a single time point in pregnancy. Women with a pre-pregnancy BMI <18.5 had reduced levels of IFN-γ and GM-CSF compared to women in other BMI categories, while women aged ≥35 years had elevated IL-2, IL-6, TNF-α and IFN-γ. Early-pregnancy levels of TNF-α were higher in women with a prior preterm delivery. Cytokine levels were not associated with gravidity. In conclusion, cytokines were detected in plasma during early- and mid-pregnancy, with IL-6, IL-12, IFN-γ and GM-CSF concentrations varying over pregnancy. Concentrations may depend on BMI, maternal age and prior preterm delivery.

Differences in Mortality between Late-Preterm and Term Singleton Infants in the United States, 1995–2002

To assess differences in mortality between late-preterm (34-36 weeks) and term (37-41 weeks) infants. We used US period-linked birth/infant death files for 1995 to 2002 to compare overall and cause-specific early-neonatal, late-neonatal, postneonatal, and infant mortality rates between singleton late-preterm infants and term infants. Significant declines in mortality rates were observed for late-preterm and term infants at all age-at-death categories, except the late-neonatal period. Despite the decline in rates since 1995, infant mortality rates in 2002 were 3 times higher in late-preterm infants than term infants (7.9 versus 2.4 deaths per 1000 live births); early, late, and postneonatal rates were 6, 3, and 2 times higher, respectively. During infancy, late-preterm infants were approximately 4 times more likely than term infants to die of congenital malformations (leading cause), newborn bacterial sepsis, and complications of placenta, cord, and membranes. Early-neonatal cause-specific mortality rates were most disparate, especially deaths caused by atelectasis, maternal complications of pregnancy, and congenital malformations. Late-preterm infants have higher mortality rates than term infants throughout infancy. Our findings may be used to guide obstetrical and pediatric decision-making.

Health Care Consequences of Cesarean Birth During the First 18 Months of Life

Elective cesarean delivery is increasingly common. The potential effects of surgical delivery in an unselected sample of infants beyond the immediate neonatal period remain poorly defined. We carried out an 18-month follow-up of a population-based cohort of 8327 Hong Kong Chinese infants born in 1997. The main outcome measures were utilization of outpatient visits and hospitalizations, categorized by doctor-diagnosed causes as reported by parents. Among term singleton infants, there was no association of cesarean (compared with vaginal) birth with subsequent hospital admission (adjusted odds ratio = 0.92; 95% confidence interval = 0.79-1.08) or with above versus below the median number of outpatient episodes (1.10; 0.96-1.26) in the first 18 months of life. There were weak positive associations with afebrile gastrointestinal, respiratory, skin and a few other conditions. Cesarean birth is not associated with hospitalization or outpatient care overall during the first 18 months after adjustment for confounders. We cannot rule out isolated associations with minor morbidities.

Predictors of Term Infant Feeding at Week 12 Postpartum

As part of a large nonexperimental, prospective, longitudinal study, 97 breast-feeding mothers of healthy term singleton infants were queried via telephone at weeks 8-12 postpartum about their infant feeding method. At week 12, 71.1% of them provided mother's milk (MM), 16.5% provided artificial milk (AM) and MM, and 12.4% provided AM only. Logistic regression analysis identified the following predictors for risk of supplemental feedings with AM at week 12 postpartum: supplementation with AM at week 6, inadequate milk supply at week 6, frequency of breast stimulation less than 7.8 times daily at week 6. Milk output during weeks 1-6 was predictive of feeding type at week 12. Mothers who reported perceived inadequate milk supply (PIMS) at week 8 were more likely to provide AM at week 12 than mothers who did not report PIMS. Further research is needed to assist mothers of healthy term infants with sustaining their milk supply and assisting them with PIMS.

Is High Consumption of Fatty Fish during Pregnancy a Risk Factor for Fetal Growth Retardation? A Study of 44,824 Danish Pregnant Women

The authors examined the relation between fish consumption during pregnancy and fetal growth among 44,824 women from the Danish National Birth Cohort (1996-2002). They evaluated the associations between consumption of total fish, fatty fish, and lean fish in midpregnancy and birth weight, birth length, and head circumference among singleton full-term infants. Fish consumption was ascertained by food frequency questionnaire. The birth of infants classified below the 10th percentile for gestational age and gender was significantly increased among women who consumed more than 60 g of fish per day, as compared with women who consumed 5 g or less per day. Adjusted odds ratios were 1.24 (95% confidence interval (CI): 1.03, 1.49) for birth weight and 1.21 (95% CI: 1.01, 1.43) for head circumference. The adjusted odds ratio was borderline significant for birth length (odds ratio = 1.20, 95% CI: 1.00, 1.45). These increases in risk were followed by small decreases in average values for these growth measures. Furthermore, the inverse association for total fish consumption could be explained by consumption of fatty fish, while no association was found for lean fish. These results indicate that consumption of fatty fish, a known route of exposure to persistent organic pollutants, could be associated with reduced fetal growth.