Preterm Small For Gestational Age Infants Research Articles

Postnatal Maturation of Amplitude Integrated Electroencephalography (aEEG) in Preterm Small for Gestational Age Neonates

The primary objective was to evaluate the postnatal maturation pattern on aEEG during first two weeks of life in clinically stable and neurologically normal preterm small for gestational age (PSGA) and gestation matched (1 week) preterm appropriate for gestational age (PAGA) neonates born between 300/7 and 346/7 weeks of gestation. Serial aEEG tracings were recorded on 3rd, 7th and 14th day of life. The primary outcome was total aEEG maturation score. Three blinded assessors assigned the scores. We analyzed a total of 117 aEEG recordings in 40 (19 PSGA and 21 PAGA) neonates. The baseline characteristics were comparable except for birthweight [1186 (263) vs 1666(230) g]. There was no difference in the mean (SD) total scores on day 3 (9.0 (1.8) vs. 9.5 (1.1), P=0.32) and day 14 of life, but was lower in PSGA infants on day 7 (8.6 (2.4) vs. 10.1 (1.1), P=0.02). On multivariate analysis, maturation of PSGA neonates was found to be significantly delayed at any point of life from day 3 to day 14 (mean difference, -0.8, 95% CI: -1.6 to -0.02, P=0.04). Lower aEEG maturation score on day 7 possibly indicates delayed maturation in PSGA neonates in the first week of life.

Recent trends, risk factors, and disparities in low birth weight in California, 2005\u20132014: a retrospective study

BackgroundLow birth weight (LBW) is a leading risk factor for infant morbidity and mortality in the United States. There are large disparities in the prevalence of LBW by race and ethnicity, especially between African American and White women. Despite extensive research, the practice of clinical and public health, and policies devoted to reducing the number of LBW infants, the prevalence of LBW has remained unacceptably and consistently high. There have been few detailed studies identifying the factors associated with LBW in California, which is home to a highly diverse population. The aim of this study is to investigate recent trends in the prevalence of LBW infants (measured as a percentage) and to identify risk factors and disparities associated with LBW in California.MethodsA retrospective cohort study included data on 5,267,519 births recorded in the California Birth Statistical Master Files for the period 2005–2014. These data included maternal characteristics, health behaviors, information on health insurance, prenatal care use, and parity. Logistic regression models identified significant risk factors associated with LBW. Using gestational age based on obstetric estimates (OA), small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) infants were identified for the periods 2007–2014.ResultsThe number of LBW infants declined, from 37,603 in 2005 to 33,447 in 2014. However, the prevalence of LBW did not change significantly (6.9% in 2005 to 6.7% in 2014). The mean maternal age at first delivery increased from 25.7 years in 2005 to 27.2 years in 2014. The adjusted odds ratio showed that women aged 40 to 54 years were twice as likely to have an LBW infant as women in the 20 to 24 age group. African American women had a persistent 2.4-fold greater prevalence of having an LBW infant compared with white women. Maternal age was a significant risk factor for LBW regardless of maternal race and ethnicity or education level. During the period 2017–2014, 5.4% of the singleton births at 23–41 weeks based on OE of gestational age were SGA infants (preterm SGA + term SGA). While all the preterm SGA infants were LBW, both preterm AGA and term SGA infants had a higher prevalence of LBW.ConclusionsIn California, during the 10 years from 2005 to 2014, there was no significant decline in the prevalence of LBW. However, maternal age was a significant risk factor for LBW regardless of maternal race and ethnicity or education level. Therefore, there may be opportunities to reduce the prevalence of LBW by reducing disparities and improving birth outcomes for women of advanced maternal age.

Preconceptional Cardiovascular Health and Pregnancy Outcomes in Women with Systemic Lupus Erythematosus.

To estimate the effects of preconceptional cardiovascular (CV) health, measured by American Heart Association (AHA) guidelines, on pregnancy outcomes in women with systemic lupus erythematosus (SLE). The study included patients in the Hopkins Lupus Pregnancy Cohort. Body mass index (BMI), total cholesterol, and blood pressure (BP) in the most recent clinic visit prior to conception or first trimester were used to determine CV health (ideal, intermediate, or poor health) based on AHA definitions. Outcomes included preterm birth, gestational age at birth, and small for gestational age (SGA). Multivariable linear and logistic regression models with generalized estimating equations estimated the association of each CV health factor and outcome. The analysis included 309 live births. There were 95 preterm births (31%), and of the 293 pregnancies with birth weights, 18% were SGA. Ideal BMI, total cholesterol, and BP were reported in 56%, 85%, and 51% of pregnancies, respectively. Intermediate BMI was associated with decreased odds of SGA (OR 0.26, 95% CI 0.11-0.63), adjusted for race and prednisone use. Intermediate/poor total cholesterol was associated with increased odds of preterm birth (OR 2.21, 95% CI 1.06-4.62). Intermediate/poor BP was associated with decreased gestational age at birth (β -0.96, 95% CI -1.62 to -0.29). Poor/intermediate preconception CV health affects pregnancy outcomes of preterm birth and SGA infants among women with SLE. Efforts to maintain BMI, total cholesterol, and BP within the recommended ideal range prior to pregnancy is important to improve pregnancy outcomes in women with SLE.

Increased docosahexaenoic acid and n-3 polyunsaturated fatty acids in milk from mothers of small for gestational age preterm infants

The study aimed to test whether or not milk fatty acid composition in mothers of small for gestational age (SGA) infants is similar to that in mothers of adequate for gestational age (AGA) infants. Thirty three mothers of SGA preterm infants and 66 mothers of AGA preterm infants were included. Milk and plasma fatty acids were analyzed using capillary gas chromatography. Milk DHA (0.68 ± 0.37 vs. 0.44 ± 0.24; p < 0.01) was higher and n-6:n-3 PUFA ratio (12.0 ± 4.64 vs. 16.0 ± 6.32; p < 0.05) was lower in mothers of SGA infants. Plasma ARA and DHA were increased in mothers of SGA infants and decreased in their infants. Milk ARA or DHA was positively related to the correspondent fatty acid in plasma (r = 0.374, p = 0.010 for ARA and r = 0.690, p < 0.001 for DHA). Breast milk in mothers of preterm infants born SGA is enriched in DHA and n-3 PUFA. Breastfeeding SGA preterm infant with own mother's milk is recommended.

Endometriosis and adenomyosis are associated with increased risk of preterm delivery and a small-for-gestational-age child: a systematic review and meta-analysis.

The objective of this systematic review and meta-analysis was to evaluate the risk of preterm delivery and having a small-for-gestational-age (SGA) child in women with endometriosis and adenomyosis compared with women without these two diseases. Studies on endometriosis or adenomyosis and risk of preterm delivery and/or SGA infant were included. The systematic search was conducted for all published articles in PubMed and Embase published from 1950 to 2017 using specific search terms. After duplicates were removed, two authors independently reviewed all studies, initially based on title and subsequently based on abstract. Studies considered relevant were read in full text by both reviewers to identify if studies met the inclusion criteria. The search found 21 studies on a total of 2517516 women meeting the inclusion criteria. Women with endometriosis had an increased odds of preterm delivery [odds ratio (OR) 1.47, 95% CI 1.28-1.69] and SGA infant (OR 1.26, 95% CI 1.04-1.549). Compared with endometriosis, adenomyosis implied an even higher odds of both preterm delivery (OR 3.09, 95% CI 1.88-5.09) and SGA infant (OR 3.23, 95% CI 1.71-6.09) as well. Women with endometriosis or adenomyosis had a higher odds of preterm delivery and having a child that was SGA compared with women without endometriosis or adenomyosis. The odds of both adverse birth outcomes was highest among women with adenomyosis. The results suggest a closer prenatal monitoring among pregnant women with endometriosis or adenomyosis.

Body composition in preterm infants with intrauterine growth restriction: a cohort study.

AbstractAims:The comparison of body composition parameters between the small for gestational age (SGA) and appropriate for gestational age (AGA) at term, 1, 3 and 5 months corrected ages in very preterm infants.Methods:This cohort study included 92 preterm infants at term age, younger than 32 weeks or &lt;1500 g, classified in two groups: SGA and AGA. Anthropometry and body composition, estimated by air displacement plethysmography, were evaluated at the corrected ages: term and 1, 3, and 5 months. We used the lean mass/fat mass index (LM/FM) at each time point and the weight, length and head circumference SDS gain between the time points.Results:At term age, the SGA preterm infants had less lean mass (g), fat mass (g) and percent fat mass but a greater LM/FM index than AGA infants (P&lt;0.001). At 1 month corrected age the LM/FM index and percent fat mass between the groups became similar. Lower lean mass persisted up to 3 months in the SGA group [4004 g (3256–4595) vs. 4432 g (3190–6246), P&lt;0.001]. During the first month corrected age, the weight SDS gain was higher in SGA preterm infants when compared to AGA preterm infants. However, the SGA preterm infants remained lighter, shorter and with smaller head circumferences than the AGA preterm infants until 3 months of corrected age.Conclusions:The greater lean tissue deficits and an earlier “catch-up” in fat in the SGA group can reflect growth patterns variability since the early life.

Maternal Hypertension and Mortality in Small for Gestational Age 22- to 29-Week Infants.

Infants born before 30 weeks gestational age (GA) to mothers with hypertension (HTN) experience lower rates of mortality and serious morbidities when corrected for maternal and infant characteristics. Growth restriction and maternal HTN are often associated. We sought to determine if small for gestational age (SGA) infants have similarly decreased mortality risk when born to mothers with HTN. We identified 6897 singleton SGA, 22 + 0 to 29 + 6 weeks GA infants born between 2008 and 2011, cared for at 578 North American centers in the Vermont Oxford Network. Chromosomal abnormalities and birth defects were excluded. Mortality rates prior to discharge were compared between 4317 HTN and 2580 comparison infants. Logistic regression was used to adjust for birth weight, infant sex, maternal race, inborn/outborn, antenatal steroid exposure, prenatal care, and GA. Small for gestational age HTN infants were older (mean: 26.9 [1.9] vs 26.6 [2.2] weeks; P < .001) and larger (HTN = 584 [159] g vs 562 [156] g; P < .001) than comparison infants. Death prior to discharge occurred in 29% of HTN and 43% of comparison infants. Univariate analyses revealed lower mortality for HTN infants (odds ratio [OR] = 0.54, 95% confidence interval [CI]: 0.48-0.60). After adjustment, mortality remained lower when compared to non-HTN infants (OR = 0.60, 95% CI: 0.52-0.69). Extremely preterm SGA infants face high rates of mortality. Although maternal HTN is associated with SGA, SGA infants born to mothers with HTN have decreased risk of mortality compared to non-HTN SGA infants, prior to and after adjustment for antenatal and maternal characteristics. This may reflect detrimental physiologic effects associated with alternative mechanisms for fetal growth restriction and is important for parental counseling.

238: Twins versus singletons: Outcomes in small for gestational age (

We sought to compare pregnancy outcomes of small for gestational age (SGA) infants with weight less than the 5th percentile in twin versus singletons born late preterm (≥34 and <37 weeks). We used a retrospective cohort of late preterm SGA infants to compare maternal and neonatal outcomes in twin versus singleton gestations. Outcomes examined included neonatal death, intrauterine fetal demise, preeclampsia, placental abruption, postpartum hemorrhage, and endometritis. Out of a population of 1.85 million non-anomalous SGA late preterm deliveries, a total of 4,284 twin and 40,780 singleton gestations were identified. Compared to singleton gestations, twin gestations were less likely to experience neonatal death (OR 0.17; 95% CI 0.04-0.75), intrauterine fetal demise (OR 0.10; 95% CI 0.04-0.27), preeclampsia (OR 0.52; 95% CI 0.44-0.63), and placental abruption (OR 0.32; 95% CI 0.20-0.52). Twin gestations were more likely to experience postpartum hemorrhage (OR 1.82; 95% CI 1.22-2.70) and endometritis (2.23; 1.06-4.67) when compared to singleton gestations. Among non-anomalous SGA (weight <5th percentile) late preterm deliveries, twin gestations experienced fewer intrauterine fetal demises, preeclampsia, placental abruption, and neonatal demise compared to singleton gestations. Twin gestations were more likely to experience postpartum hemorrhage and endometritis compared to singletons.

Antenatal corticosteroids and outcomes of preterm small-for-gestational-age neonates in a single medical center.

ObjectiveThis study investigated the effect of an antenatal corticosteroid (ACS) in preterm small-for-gestational-age (SGA) neonate.MethodsThis study was a retrospective cohort study. We compared women who received ACS with unexposed controls and evaluated neonatal complications among those having a singleton SGA neonate born between 29 and 34 complete gestational weeks. The neonates born after 32 weeks of gestation were divided into subgroups. Multivariable logistic regression analysis was performed.ResultsA total 82 of the preterm infants met inclusion criteria; 57 (69.5%) were born after 32 weeks of gestation. There were no significant differences in terms of mechanical ventilation, seizure, intracranial hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, feeding difficulty, and neonatal mortality between infants whose mothers received ACS ant those whose mothers did not (all P>0.05). However, newborns whose mothers received ACS exhibited a significantly increased risk of developing respiratory distress syndrome (RDS) (adjusted odds ratio [aOR], 3.271; 95% confidence interval [CI], 1.038–10.305; P=0.043). In case of neonates born beyond 32 weeks of gestation, the risk of neonatal hypoglycemia was significantly higher in women receiving ACS after controlling for confounding factors (aOR, 5.832; 95% CI, 1.096–31.031; P=0.039).ConclusionACS did not improve neonatal morbidities, in SGA neonates delivered between 29 and 34 gestational weeks. Rather, ACS could increase the risk of RDS. In cases of SGA neonate delivered between 32 and 34 complete gestational weeks, the risk of hypoglycemia was significantly increased. The use of ACS in women with preterm SGA infants needs to be evaluated further, especially after 32 weeks' gestation.

Urinary β2‐microglobulin and bronchopulmonary dysplasia: Trends in preterm infants

The developmental process of bronchopulmonary dysplasia (BPD) is not identical between very preterm infants born small for gestational age (SGA) and those born appropriate for gestational age (AGA). In this study, we compared the pattern of the inflammatory response in infants of each group, by measuring urinary β2-microglobulin (Uβ2M) as an alternative, concise, and less-invasive biomarker. Uβ2M and clinical details were examined at birth and at 4weeks of age in 146 very preterm infants. Of the 57 infants diagnosed with BPD, 18 were SGA, and 39 were AGA. Uβ2M at birth was significantly lower in SGA BPD infants than in AGA BPD infants, but it increased with time. The prevalence of chorioamnionitis (CAM) was significantly lower in SGA BPD infants than in AGA BPD infants, while that of pregnancy-induced hypertension was the opposite. Exposure to prenatal factors other than CAM may sensitize fetal lungs to become vulnerable to postnatal inflammation in very preterm SGA infants with BPD.

Amplitude-Integrated EEG and Brain Sparing in Preterm Small-for-Gestational-Age Infants.

Preterm small-for-gestational-age (SGA) infants are at risk for a high mortality rate and impaired cognitive development. Only a few studies have focused on amplitude-integrated EEG (aEEG) in preterm SGA infants. They have been shown to have a slower rate of brain maturation, but these findings have not consistently been related to neurodevelopmental outcomes. The aim of our study was to evaluate early aEEG monitoring in SGA compared with adequate-for-gestational-age preterms. This prospective cohort study enrolled infants with very low birth weight who were admitted to the neonatal intensive care unit at Hospital Puerta del Mar, Cádiz, Spain, from June 2009 to September 2012. This study was a subanalysis of SGA from the global cohort previously described by our group. Adverse outcome included severe intraventricular hemorrhage and/or death. Cerebral function was monitored using aEEG recordings during the first 72 hours of life. Preterm SGA infants (18 SGA in the global cohort of 92 patients) had lower 1- and 5-minute Apgar scores, higher score for neonatal acute physiology perinatal extension II scores, and higher proportion of adverse outcomes. When comparing preterm adequate-for-gestational-age infants with SGA infants with good prognosis, those with SGA had more mature and continuous aEEG patterns. Low margin amplitude depression was not as severe in these patients, and a higher proportion of these patients developed sleep-wake cycles. The results of our study suggest that SGA infants with a good prognosis have a more mature aEEG pattern than preterm adequate-for-gestational-age patients with the same outcome. These findings support the brain sparing theory in SGA infants.

Effect of antenatal corticosteroids therapy on the mortality and morbidity of small for gestational age infants born at 24-34 completed weeks: a retrospective multicenter study

Objective: To assess the impact of antenatal corticosteroids (ACS) therapy on mortality and morbidities in small for gestational age (SGA) preterm infants. Method: A retrospective database analysis was performed. Preterm infants born at 24-34 completed weeks who were diagnosed as SGA in 14 hospitals in China between 2013 and 2014 were evaluated for mortality and major morbidities including respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotising enterocolitis (NEC), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and sepsis. These cases were classified into two groups: ACS group and non-ACS group (NACS). Multivariate logistic regression analysis was performed to assess the effect of ACS on neonatal mortality and morbidities. Result: Among the 6 437 infants born at 24-34 completed weeks, 602 were SGA(9.4%), and ACS was administered to 3 432 infants (53.3%). Among SGA infants at gestational age (GA) of 24-31 completed weeks, ACS treatment were associated with decreased mortality (16.9%(13/77) vs. 32.1%(17/53), χ(2)=4.082, P<0.05), incidence of RDS (48.1%(37/77) vs. 79.2%(42/53), χ(2)=12.183, P<0.05) and incidence of severe RDS (33.8%(26/77) vs. 55.6%(30/53), χ(2)=6.677, P<0.05). The incidence of IVH was higher in ACS group than that in NACS group (10.9%(27/248) vs. 5.8%(13/224), χ(2)=3.921, P<0.05) among 32-34 completed weeks infants. There were no significant differences between the ACS group and the NACS group in the incidence of BPD, NEC, ROP, PDA and sepsis (P all >0.05). Multivariate logistic regression analysis demonstrated a decreased mortality (OR=0.375, 95% confidence interval (CI): 0.188-0.749, P=0.005)and incidence of RDS (OR=0.697, 95% CI: 0.462-0.953, P=0.041) in SGA infants exposed to antenatal steroids. There were no significant differences in BPD, IVH, NEC, ROP, PDA and sepsis risks in ACS group compared with NACS group (P all >0.05). Conclusion: ACS administration could reduce the mortality and major morbidities in SGA preterm infants less than 32 weeks GA. This study suggests that ACS should be given to growth restricted fetuses at risk of preterm delivery in order to improve perinatal outcome.

The prevalence and risk factors of preterm small-for-gestational-age infants: a population-based retrospective cohort study in rural Chinese population

BackgroundPreterm birth and small for gestational age (SGA) are strong indicators of neonatal adverse outcomes. With the growing importance of preterm SGA infants, we aim to evaluate the prevalence and risk factors for preterm SGA in China.MethodWe analyzed the data of parents and infants from a population-based cohort research of the free National Pre-pregnancy Checkups Project (NPCP) in rural China. Only singleton live births that occurred between 24 weeks +0 days and 36 weeks +6 days of pregnancy were included in this study. SGA was defined as birth weight less than the 10th percentile of the reference birth-weight-for-gestational-age population. A multiple logistic regression model was built using the statistically significant variables from the 371 variables in the questionnaire.ResultsA total of 11,474 singleton, preterm, live-birth infants were included. Of the total infants, 317 (2.77%) were preterm SGA infants. A higher risk of preterm SGA infants was observed among mothers who were on oral contraceptives (OR: 8.162, 95% CI: 1.622–41.072), mothers who had syphilis (OR: 12.800, 95% CI: 1.250–131.041), and mothers with a high eosinophil percentage (OR: 13.292, 95% CI: 1.282–135.796). Maternal intake of folic acid at least 3 months before pregnancy (OR: 0.284, 95% CI:0.124–0.654) and paternal intake of egg and meat (OR: 0.097,95% CI:0.030–0.315) were protective factors. Compared with North China, the incidence of preterm SGA infants was higher in South China.ConclusionPreterm SGA infants were associated with both maternal and paternal factors.

Fetal Doppler velocimetry and bronchopulmonary dysplasia risk among growth-restricted preterm infants: an observational study

ObjectiveTo investigate whether fetal growth restriction (FGR) diagnosis, based on pathological prenatal fetal Doppler velocimetry, is associated with bronchopulmonary dysplasia (BPD) independently of being small for gestational age (SGA) per...

A preliminary study of renal function in small-for-gestational-age infants at early stage after birth

To investigate the renal function of small-for-gestational-age (SGA) infants at the early stage after birth. A total of 40 preterm SGA infants, 33 full-term SGA infants, 80 preterm appropriate-for-gestational-age (AGA) infants, and 33 full-term AGA infants were included in this study. The following indices were compared between the SGA infants and AGA infants within 48 hours after admission: blood urea nitrogen (BUN), serum creatinine (SCr), estimated glomerular filtration rate (eGFR), blood pressure, urine volume per body weight, and proteinuria. The preterm SGA group had a significantly lower BUN level than the preterm AGA group (P<0.05). However, there were no significant differences in SCr level, eGFR, and blood pressure between the two groups (P>0.05). The full-term SGA group had a significantly higher SCr level and a significantly lower eGFR than the full-term AGA group (P<0.05). However, there were no significant differences in BUN level and blood pressure between the two groups (P>0.05). There was no significant difference in urine volume per body weight between the preterm SGA and preterm AGA groups (P>0.05) and between the full-term SGA and full-term AGA groups (P>0.05). There was no significant difference in the incidence of proteinuria between the preterm SGA and preterm AGA groups (P>0.05). Proteinuria was not present in the SGA full-term and AGA full-term groups. SCr and eGFR can be used as the diagnostic indices for early renal damage of SGA infants. The renal function is worse in full-term SGA infants than in full-term AGA infants.

Multivariate Analysis of Thyrotropin in Preterm Newborns Based on Adequacy of Weight for Gestational Age.

Different and conflicting data have been published concerning thyrotropin (TSH) levels among small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) newborns. The hypothesis of this study was that SGA preterm infants have higher TSH levels than those who are not underweight do. This cross-sectional study analyzed the TSH levels of all preterm newborns with a negative congenital hypothyroidism screening result (TSH <7.5 μIU/mL). Secondary variables were sex, birth weight (SGA, AGA), days of life at blood extraction, maternal origin, gestational age, and being a twin or not. Two multiple linear regression models were constructed comparing TSH levels in SGA and AGA or the z-score for birth weight and the remaining variables. A sample including 5819 preterm infants was obtained: 53.8% male, 23.3% twins, and 3.3% SGA. TSH concentrations were 2.16 ± 2.0 μIU/mL for the SGA infants and 1.80 ± 1.5 μIU/mL for the AGA infants (p = 0.012), with a negative correlation (p < 0.001) between TSH levels and the z-score for the weight of the newborn. The multivariate analysis comparing TSH levels between SGA and AGA gave the following: SGA (B = 0.46, p < 0.001), Latin American mother (B = -0.16, p = 0.029), days of life at blood extraction (B = -0.26, p < 0.001), and gestational age ≤28 weeks (B = -0.56, p < 0.001). Using the z-score for the weight, the associations were: maternal origin North Africa (B = 0.19, p = 0.042), days of life at blood extraction (B = -0.27, p < 0.001), gestational age ≤28 weeks (B = -0.55, p < 0.001), and z-score for weight (B = -0.12, p < 0.001). Our multivariate analysis suggests that TSH concentrations are higher in SGA infants than they are in AGA infants, and this should be taken into account when establishing a reference interval appropriate for this population. The clinical relevance remains unknown, but lines of research are opened that may allow a better understanding of the long-term morbidities in these newborns.

The relationship between 25-hydroxyvitamin D concentration in early pregnancy and pregnancy outcomes in a large, prospective cohort.

Vitamin D insufficiency and deficiency have been associated with an increased risk of adverse pregnancy outcomes. Controversy remains as findings have been inconsistent between disparate populations. The aim of this study was to investigate the relationship between vitamin D status and pregnancy outcomes in a large, prospective pregnancy cohort. 25-Hydroxyvitamin D concentration was analysed in serum samples collected at 15 weeks of gestation from 1710 New Zealand women participating in a large, observational study. Associations between vitamin D status and pre-eclampsia, preterm birth, small for gestational age (SGA) and gestational diabetes were investigated. The mean 25-hydroxyvitamin D concentration was 72·9 nmol/l. In all, 23 % had 25-hydroxyvitamin D concentrations 75 nmol/l (OR 2·3; 95 % CI 1·1, 5·1). However, this effect was not significant when adjustments were made for BMI and ethnicity (OR 1·8; 95 % CI 0·8, 4·2). 25-Hydroxyvitamin D concentration at 15 weeks was not associated with development of pre-eclampsia, spontaneous preterm birth or SGA infants. Pregnancy complications were low in this largely vitamin D-replete population.

Significance of oligohydramnios in preterm small‐for‐gestational‐age infants for outcome at 18 months of age

The aim of this study was to evaluate the association between oligohydramnios and other perinatal factors in preterm small-for-gestational-age (SGA) infants who had cerebral palsy at 18 months of age or who had died before this age. This retrospective study included 320 infants with birthweights<3rd percentile delivered between 22 and 33 complete weeks of gestation. We evaluated the incidence of CP at 18 months of age and of death before this age. The significant risk factors, including oligohydramnios, of CP or death of preterm SGA infants were evaluated by logistic regression analysis. The incidence of CP or death was 47/320 (14.7%), consisting of 24/320 (7.5%) cases of CP and 23/320 (7.2%) cases of death. Oligohydramnios (adjusted odds ratio, 2.18; 95% confidence interval, 1.07-4.45) and gestational age (adjusted odds ratio, 0.76; 95% confidence interval, 0.66-0.87) were independently correlated with outcome. The incidence of adverse outcomes was approximately 15% in preterm SGA infants. SGA infants born with oligohydramnios may be at increased risk for CP or death compared to those with normal amniotic volume.

Effect of Intra- and Extrauterine Growth on Long-Term Neurologic Outcomes of Very Preterm Infants

To determine whether extrauterine growth is associated with neurologic outcomes and if this association varies by prenatal growth profile. For 1493 preterms from the EPIPAGE (Étude Épidémiologique sur les Petits Âges Gestationnels [Epidemiological Study on Small Gestational Ages]) cohort, appropriate for gestational-age (AGA) was defined by birth weight >-2 SD and small for gestational-age (SGA) by birth weight ≤-2 SD. Extra-uterine growth was defined by weight gain or loss between birth and 6months by z-score change. Growth following-the-curve (FTC) was defined as weight change -1 to +1 SD, catch-down-growth (CD) as weight loss ≥1 SD, and catch-up-growth (CU) as weight gain ≥1 SD. At 5years, a complete medical examination (n=1305) and cognitive evaluation with the Kauffman Assessment Battery for Children (n=1130) were performed. Behavioral difficulties at 5years and school performance at 8years were assessed (n=1095). Overall, 42.5% of preterms were AGA-FTC, 20.2% AGA-CD, 17.1% AGA-CU, 5.6% SGA-FTC, and 14.5% SGA-CU. Outcomes did not differ between CU and FTC preterm AGA infants. Risk of cerebral palsy was greater for AGA-CD compared with AGA-FTC (aOR 2.26 [95% CI 1.37-3.72]). As compared with children with SGA-CU, SGA-FTC children showed no significant increased risk of cognitive deficiency (aOR 1.41[0.94-2.12]) or school difficulties (aOR 1.60 [0.84-3.03]). Compared with AGA-FTC, SGA showed increased risk of cognitive deficiency (SGA-FTC aOR 2.19 [1.25-3.84]) and inattention-hyperactivity (SGA-CU aOR 1.65 [1.05-2.60]). Deficient postnatal growth was associated with poor neurologic outcome for AGA and SGA preterm infants. CU growth does not add additional benefits. Regardless of type of postnatal growth, SGA infants showed behavioral problems and cognitive deficiency.

Analysis of correlation factors and pregnancy outcomes of hypertensive disorders of pregnancy – a secondary analysis of a random sampling in Beijing, China

Objective: We aimed to assess the prevalence and risk factors for hypertensive disorders and to study the main pregnancy outcomes in the Beijing area of China.Study design: This study randomly sampled 15 hospitals in Beijing from Jun 2013 to Nov 2013 and evaluated 15 194 deliveries. Logistic regression analysis was used to study the association between risk factors and hypertensive disorders. Pregnancy outcomes included preterm birth, cesarean delivery and small for gestational age (SGA).Results: The prevalence of hypertensive disorders, preeclampsia (PE) and severe PE was 4.4, 2.7 and 1.8%, respectively. The risk factors for hypertensive disorders and severe PE were maternal body mass index before pregnancy, gestational weight gain (GWG), gestational diabetes and pre-gestational diabetes, and third trimester cholesterol (CHOL) levels. First trimester high-density lipoprotein was a protective factor for severe PE. The incidence of hypertensive disorders increased with maternal age. Preterm delivery, cesarean delivery and small infant size for gestational age were more prevalent in the severe PE group compared with the non-hypertensive group.Conclusions: In the Beijing area of China, maternal body mass index before pregnancy, GWG, maternal complications of gestational diabetes and pre-gestational diabetes, and third trimester CHOL levels are risk factors for both hypertensive disorders of pregnancy and severe PE. First trimester high-density lipoprotein is a protective factor for severe PE. Severe preeclampsia leads to a higher incidence of preterm delivery, cesarean delivery and SGA infants.