Small Abdominal Circumference Research Articles

Abdominal Circumference and Hypotension Incidence in Caesarean Section Under Spinal Anaesthesia.

Hypotension is a common side effect during caesarean deliveries under spinal anaesthesia, influenced by factors like obesity, physiological changes and abdominal circumference (AC). This study delves into the intricate relationship between abdominal circumference and hypotension incidence, spinal anaesthesia levels, hemodynamic shifts, and vasopressor requirements in caesarean sections. Method: A prospective observational study with 232 term pregnant women undergoing caesarean sections was categorized into two groups based on their abdominal circumference, group A (AC < 95 cm) and group B (AC > 109 cm). The studycompared hypotension incidence, achieved spinal anaesthesia levels, hemodynamic changesand ephedrine necessity and dosage between the two groups. Results: Group B with a larger abdominal circumference, exhibited a significantly higher rate of hypotension, more pronounced hemodynamic changes,higher level of spinal anaesthesia andrequired more doses of ephedrine to manage hypotension compared to group A with a smaller abdominal circumference. Conclusion: This study highlights the crucial role of abdominal circumference as a predictive factor for hypotension during caesarean sections under spinal anaesthesia. Recognizing this association enables targeted preventive measures, potentially enhancing maternal and fetal outcomes during such procedures. Awareness of this correlation emphasizes the necessity for tailored interventions to mitigate the risk of hypotension, ensuring safer caesarean deliveries under spinal anaesthesia.

Relationship between abdominal fat volume and bone base material pairs from dual-energy spectral computed tomography in young and middle-aged patients with metabolic syndrome.

Metabolic syndrome (MetS) has complex effects on bone health, and dual-energy spectral computed tomography (CT) has become increasingly valuable for bone quantification. However, the relationship between bone base material pairs (BMPs) and abdominal fat volume in patients with MetS remains underexplored. This study thus aimed to analyze the relationship between abdominal fat volume and various bone BMPs using dual-energy spectral CT in young and middle-aged patients with MetS. Patients with MetS who underwent sleeve gastrectomy at the Center of Obesity and Metabolic Diseases, Beijing Shijitan Hospital, Capital Medical University, from June to November 2021 were retrospectively collected. The abdominal fat measurements and BMPs were acquired using dual-energy spectral CT imaging. These included the volumes of total abdominal fat (TAF), abdominal visceral fat (AVF), and abdominal subcutaneous fat (ASF), as well as bone densities based on hydroxyapatite (water), i.e., HAP (water), and calcium (water), i.e., Ca (water), BMPs. After grouping the patients by sex, we analyzed the differences in clinical and imaging features. The correlation between the clinical and imaging parameters of patients with MetS was evaluated with Pearson correlation coefficients. Age- and sex-adjusted partial correlation analysis between fat volume and bone BMPs was conducted for patients of different sexes. Additionally, multiple linear regression analyses were performed with age, sex, and TAF volume as the independent variables and with Ca (water) and HAP (water) as dependent variables. A total of 112 young and middle-aged patients with MetS were included in this study, including 85 females and 27 males. Compared to male patients with MetS, the females with MetS exhibited higher lumbar Ca (water) and HAP (water) BMPs, with lower volumes of TAF and AVF and a smaller abdominal circumference (P<0.01). The volumes of TAF, AVF, and ASF were negatively correlated with the average Ca (water) and HAP (water) BMPs in the first to third lumbar vertebrae (L1-L3) (P<0.05). Ca (water) and HAP (water) BMPs decreased with age and increasing TAF volume (P<0.001). The fitted equations for the relationship between bone BMPs with age, sex, and TAF volume were as follows: (I) bone Ca (water) BMP = 76.469 - 0.500 age + 6.762 sex - 0.002 TAF volume; (II) bone HAP (water) BMP =171.704 - 1.138 age + 11.825 sex - 0.004 TAF volume. In young and middle-aged patients with MetS, the abdominal fat volume was negatively correlated with lumbar bone Ca (water) and HAP (water) BMPs, implying that increased abdominal fat volume may play a crucial role in the pathogenesis of osteopenia among those with MetS. The reduction of bone Ca (water) and HAP (water) with high abdominal fat volume may hold clinical significance for fracture risk in individuals with MetS.

Prenatal counseling of an isolated fetal small head circumference during the second trimester expert ultrasound examination

ObjectiveTo evaluate perinatal and postnatal outcomes of fetuses with an isolated small head circumference (HC) on expert ultrasound examination in the second trimester for further recommendations in prenatal care. Study DesignIn a retrospective cohort we included singleton-pregnancies with a fetal HC > −3.0 SD and ≤ −1.64 SD determined on expert ultrasound examination between 18 and 24 weeks of gestational age. Three subgroups were determined: “isolated small HC (ISHC)”, “small HC plus abdominal circumference (AC) ≤ p10 (SHC+)” and “small HC plus AC ≤ p10 and Doppler abnormalities (SHC + D)”. After ultrasound examination, genetic testing was sometimes offered and postnatally genetic tests were performed on indication. ResultsWe included 252 pregnancies: 109 ISHC, 104 SHC+, and 39 SHC + D. In the ISHC and SHC+ subgroup, 96 % of the fetuses were born alive and did not die neonatal. In the SH + D group this was only 38 %. In the SHC+ subgroup, less fetuses were delivered vaginal (non-instrumental) compared to the ISHC subgroup (61 % vs. 73 %, p < 0.01). In the ISHC and SHC+ subgroup s some fetuses were diagnosed with congenital defects (4 % vs. 10 %, p = 0.08) and with a genetic anomaly (6.4 % vs. 7.7 %, p = 0.13) after 24 weeks or postnatally. In SHC + D subgroups 5 % presented with congenital defects and 2.6 % with a genetic anomaly. ConclusionWe conclude that fetuses with a small HC without structural anomalies on second trimester expert ultrasound require follow-up and special medical attention. We recommend differentiating between ISHC, SHC+, and SHC + D for prenatal counseling. Genetic testing and referral to a clinical geneticist should be considered.

Relationships Between Exposure to Gestational Diabetes Treatment and Neonatal Anthropometry: Evidence from the Born in Bradford (BiB) Cohort

ObjectivesTo examine the relationships between gestational diabetes mellitus (GDM) treatment and neonatal anthropometry.MethodsCovariate-adjusted multivariable linear regression analyses were used in 9907 offspring of the Born in Bradford cohort. GDM treatment type (lifestyle changes advice only, lifestyle changes and insulin or lifestyle changes and metformin) was the exposure, offspring born to mothers without GDM the control, and birth weight, head, mid-arm and abdominal circumference, and subscapular and triceps skinfold thickness the outcomes.ResultsLower birth weight in offspring exposed to insulin (− 117.2 g (95% CI − 173.8, − 60.7)) and metformin (− 200.3 g (− 328.5, − 72.1)) compared to offspring not exposed to GDM was partly attributed to lower gestational age at birth and greater proportion of Pakistani mothers in the treatment groups. Higher subscapular skinfolds in offspring exposed to treatment compared to those not exposed to GDM was partly attributed to higher maternal glucose concentrations at diagnosis. In fully adjusted analyses, offspring exposed to GDM treatment had lower weight, smaller abdominal circumference and skinfolds at birth than those not exposed to GDM. Metformin exposure was associated with smaller offspring mid-arm circumference (− 0.3 cm (− 0.6, − 0.07)) than insulin exposure in fully adjusted models with no other differences found.Conclusions for PracticeOffspring exposed to GDM treatment were lighter and smaller at birth than those not exposed to GDM. Metformin-exposed offspring had largely comparable birth anthropometric characteristics to those exposed to insulin.

Alcohol exposure before and during pregnancy is associated with reduced fetal growth: the Safe Passage Study

BackgroundPrenatal alcohol exposure (PAE) is a worldwide public health concern. While PAE is known to be associated with low birth weight, little is known about timing and quantity of PAE on fetal growth. This study investigated the association between periconceptional and prenatal alcohol exposure and longitudinal fetal growth, focusing on timing and quantity in a high exposure cohort.MethodsThe Safe Passage Study was a prospective cohort study, including 1698 pregnant women. Two-dimensional transabdominal ultrasound examinations were performed to measure fetal femur length, abdominal and head circumference, and biparietal diameter, at three time points during pregnancy. Estimated fetal weight and Z-scores of all parameters were calculated. Trimester-specific alcohol exposure was assessed using the Timeline Followback method. To investigate the associations of specific timing of PAE and fetal growth, two models were built. One with alcohol exposure as accumulative parameter over the course of pregnancy and one trimester specific model, in which PAE was separately analyzed. Linear mixed models adjusted for potential confounders were applied with repeated assessments of both alcohol exposure and fetal growth outcomes.ResultsThis study demonstrated that periconceptional and prenatal alcohol exposure were associated with reduced fetal growth. Effect sizes are displayed as estimated differences (ED) in Z-score and corresponding 95% confidence intervals (95% CIs). When investigated as accumulative parameter, PAE was related to a smaller femur length (ED30; − 0.13 (95% CI; − 0.22; − 0.04), ED36; − 0.14 (95% CI; − 0.25; − 0.04)) and a smaller abdominal circumference (ED36; − 0.09 (95% CI; − 0.18; − 0.01)). Periconceptional alcohol exposure was associated with a smaller abdominal circumference (ED30; − 0.14 (95% CI; − 0.25; − 0.02), ED36; − 0.22 (95% CI; − 0.37; − 0.06)) and a smaller estimated fetal weight (ED36; − 0.22 (95% CI; − 0.38; − 0.05)). Second trimester alcohol exposure was associated with a smaller abdominal circumference (ED30; − 0.49 (95% CI; − 0.86; − 0.12), ED36; − 0.70 (95% CI; − 1.22; − 0.17)) and estimated fetal weight (ED30; − 0.54 (95% CI; − 0.94; − 0.14), ED36; − 0.69 (95% CI; − 1.25; − 0.14)). No additional association of binge drinking was found besides the already observed association of PAE and fetal growth.ConclusionsThis study demonstrated that PAE negatively affects fetal growth, in particular when exposed during the periconception period or in second trimester. Our results indicate that potential negative consequences of PAE are detectable already before birth. Therefore, healthcare providers should actively address and discourage alcohol use during pregnancy.

The Impact of Maternal Obesity on Neonatal Outcomes of Pregnancies Complicated by Fetal Growth Restriction.

This study aimed to characterize the relationship between maternal obesity, fetal abdominal size, and neonatal morbidity in pregnancies complicated by fetal growth restriction (FGR). Pregnancies complicated by FGR, which resulted in delivery of a live, singleton, nonanomalous infant at a single center between 2002 and 2013 were identified in a large, National Institutes of Health-funded database of detailed pregnancy and delivery information extracted by trained research nurses. Pregnancies complicated by diabetes were excluded. Fetal biometry measurements from third trimester ultrasounds performed at the same institution were extracted from another institutional database. Pregnancies were divided into cohorts based on fetal abdominal circumference (AC) gestational age percentile (<10th centile, 10-29th centile, 30-49th centile, and ≥50th centile) at the ultrasound closes to the date of delivery. Obesity was defined by prepregnancy body mass index >30 kg/m2. The primary outcome was a composite of neonatal morbidity (CM) including 5-minute Apgar < 7, arterial cord pH <7.0, sepsis, respiratory support, chest compressions, phototherapy, exchange transfusion, hypoglycemia requiring treatment, or neonatal death. Outcomes were compared between women with versus without prepregnancy obesity overall and then stratified by AC cohort. A total of 379 pregnancies met criteria; CM occurred in 136 (36%). Overall, there was no difference in CM between infants born to women with versus without obesity (risk ratio (RR): 1.11, 95% confidence interval: 0.79-1.56). When stratified according to AC at ultrasound closest to delivery, there was higher prevalence of CM occurring among women with prepregnancy obesity than those without prepregnancy obesity when the fetal AC was >50th or 30 to 49th centile However, these differences did not reach statistical significance. Our study identified no significant difference in risk of CM among growth-restricted infants of obese versus nonobese mothers, including among infants with very small AC. More research is needed to further examine the potential relationships postulated here. · No significant differences in neonatal outcomes of FGR pregnancies in obese versus nonobese patients.. · No significant differences in AC percentile distribution in FGR pregnancies in obese versus nonobese.. · Pregnancies complicated by obesity had a higher need for cardiac support but not chest compressions..

Fetal Gastroschisis: Does Fetal Growth Restriction Correlate With Small for Gestational Age at Birth? [ID: 1375594

INTRODUCTION: Conflicting data exist regarding the optimal formula for calculating estimated fetal weight (EFW) in fetuses with gastroschisis. The widely used Hadlock formula includes abdominal circumference (AC) and may underestimate EFW, as fetuses with gastroschisis tend to have a smaller AC. We evaluated 1) correlation between EFW and birth weight (BW) and 2) agreement between fetal growth restriction (FGR) and small for gestational age (SGA) in fetuses/neonates with gastroschisis. METHODS: This was an IRB-approved single-center retrospective cohort study at a tertiary care center. Data were obtained from 2012 to 2021 and included singleton pregnancies with at least one growth ultrasound (US) performed by our center and neonate born at our center with confirmed gastroschisis. Pearson correlation was used to examine association between EFW and BW. Kappa statistic was used to examine agreement between FGR and SGA. RESULTS: Thirty-five maternal–neonatal pairs were included. There was a strong correlation between EFW on last growth US and BW (r=0.70, 95% CI [0.48, 0.84], P&lt;.001). There was disagreement between FGR on last US and SGA at birth (Kappa coefficient=0.11, 95% CI [0.00, 0.22], P&lt;.001) with 26 (74.3%) FGR fetuses, 5 (14.3%) of which were SGA neonates. CONCLUSION: Although EFW and BW were strongly correlated, less than one-fifth of fetuses diagnosed with FGR became neonates classified as SGA, suggesting that an EFW formula including AC overestimates FGR in fetuses with gastroschisis. Accurate estimation of EFW is necessary for antenatal testing, delivery planning, and avoiding unnecessary interventions. An alternative EFW formula could be considered for fetuses with gastroschisis.

Late-Onset Severe Fetal Growth Restriction and Isolated Severely Small Abdominal Circumference: Do Neonatal Outcomes Differ? [ID: 1377666

INTRODUCTION: Updated guidelines from the Society for Maternal-Fetal Medicine (SMFM) define severe fetal growth restriction (sFGR), or an estimated fetal weight (EFW) less than 3rd percentile, as a distinct entity due to higher perinatal morbidity in this group. Whether an isolated abdominal circumference (AC) less than 3rd percentile similarly portends adverse outcomes remains unclear. METHODS: This is a single-institution, retrospective cohort study of singleton gestations with late-onset FGR and normal Doppler studies from 2012 to 2022. Pregnancies affected by AC less than 3rd percentile (but EFW≥3rd percentile) and EFW less than 3rd percentile were compared using univariable analysis and multivariable logistic regression. The primary outcome was neonatal intensive care unit (NICU) admission. RESULTS: Among eligible participants, 78 (63%) had an isolated AC less than 3rd percentile and 45 (37%) had sFGR. Neonates prenatally diagnosed with sFGR were more likely to be admitted to the NICU than those with isolated AC less than 3rd percentile (68.9% versus 23.1%, P&lt;.001). After adjusting for gestational age, birth weight, race, maternal age, and medical comorbidities, sFGR was still associated with an increased odds of NICU admission (adjusted odds ratio 4.9, 95% CI 1.37–17.48, P=.014). Rates of cesarean delivery (46.7% versus 26.9%; P=.03), small for gestational age (86.7% versus 67.9%, P=.02), and 5-minute Apgar score less than 7 (6.7% versus 0.0%, P=.02) were also higher in the sFGR group. There were no significant differences in NICU length of stay or perinatal death between groups. CONCLUSION: Adverse neonatal outcomes were more prevalent in pregnancies affected by sFGR compared with isolated AC less than 3rd percentile, providing support for the updated SMFM guidelines.

Impaired placental hemodynamics and function in a non-human primate model of gestational protein restriction

Maternal malnutrition increases fetal and neonatal morbidity, partly by affecting placental function and morphology, but its impact on placental hemodynamics are unknown. Our objective was to define the impact of maternal malnutrition on placental oxygen reserve and perfusion in vivo in a rhesus macaque model of protein restriction (PR) using advanced imaging. Animals were fed control (CON, 26% protein), 33% PR diet (17% protein), or a 50% PR diet (13% protein, n = 8/group) preconception and throughout pregnancy. Animals underwent Doppler ultrasound and fetal biometry followed by MRI at gestational days 85 (G85) and 135 (G135; term is G168). Pregnancy loss rates were 0/8 in CON, 1/8 in 33% PR, and 3/8 in 50% PR animals. Fetuses of animals fed a 50% PR diet had a smaller abdominal circumference (G135, p < 0.01). On MRI, placental blood flow was decreased at G135 (p < 0.05) and placental oxygen reserve was reduced (G85, p = 0.05; G135, p = 0.01) in animals fed a 50% PR diet vs. CON. These data demonstrate that a 50% PR diet reduces maternal placental perfusion, decreases fetal oxygen availability, and increases fetal mortality. These alterations in placental hemodynamics may partly explain human growth restriction and stillbirth seen with severe PR diets in the developing world.

Somatometric alterations and lower APGAR score in indigenous newborns

Introduction: the indigenous population is vulnerable and there is limited understanding of their somatometric indicators and APGAR score at birth. Aim: the objective of the study was to explore the association of the condition of indigenous newborn (INB) on somatometric parameters and APGAR score at birth. Methods: this study employed an exploratory cross-sectional design, utilizing the registry of newborns (NB) from a private clinic. The APGAR score at one minute after birth, as well as nutritional indicators derived from measurements of weight, height, and perimeters, were taken into consideration. The statistical analysis involved the use of logistic regressions. Results: the analysis included 7413 NB (1.8 % INB), 52 % were male and 8.1 % were born preterm (gestational age < 37 weeks). In comparison to non-indigenous NB, the INB group showed a higher risk of malnutrition (8 % vs. 6.3 %; p < 0.001), a greater prevalence of excess weight (7.3 % vs. 1.8 %; p < 0.001), smaller head circumference (33.6 cm vs. 34.1 cm; p = 0.017), smaller abdominal circumference (30.9 cm vs. 31.5 cm; p = 0.011), and a higher occurrence of low APGAR scores (< 7) (8.7 % vs. 1.2 %; p < 0.001). Furthermore, the indigenous condition was independently associated with low birth weight (< 2.500 g) (OR, 0.4; 95 % CI, 0.2; 0.9), excess head circumference (OR, 2.7; 95 % CI, 1.5; 4.7), and APGAR score < 7 points (OR, 8.3; 95 % CI, 4.2; 16.5). Conclusions: the indigenous condition was associated with factors that have adverse effects on the health of NB, including reduced head circumference and suboptimal performance on the APGAR scale. These results emphasize the importance of improving access to and quality of prenatal healthcare services for indigenous communities.

Predictors Associated with Adverse Pregnancy Outcomes in a Cohort of Women with Systematic Lupus Erythematosus from Romania-An Observational Study (Stage 2).

Background: Pregnancy in women with systemic lupus erythematosus (SLE) is accompanied by adverse pregnancy outcomes (APOs). We aimed to investigate the association between clinical, sonographic, and laboratory parameters and APOs (preeclampsia, intrauterine growth restriction, premature birth, and maternal mortality). Methods: This observational retrospective study included all pregnancies in women with SLE who attended two tertiary maternity hospitals from Romania between January 2013 and December 2020. Clinical, sonographic, and laboratory variables were examined. Bivariate associations of APO status and each predictor variable were evaluated, and significant predictors were further included in a classification model based on discriminant analysis. Results: Predictors of APOs included BMI > 25 kg/m2, personal history of lupus nephritis or chronic hypertension, proteinuria, low C3, SLE Disease Activity Index 2000 (SLEDAI-2k score ≥ 4 and physician’s global-assessment (PGA) score ≥ 1 throughout pregnancy, increased mean uterine arteries pulsatility index in the first and second trimesters, cerebroplacental ratio < 1 in the second and third trimesters, and small fetal abdominal circumference in the third trimester. Glucocorticoids, methyldopa, and aspirin use appeared to be protective against APOs. Conclusions: This study provides a comprehensive analysis of the most important predictors for APOs in pregnant patients with SLE, which could constitute a basis for further research.

IUGR based on EFW

The definition of IUGR has expanded to include Abdominal Circumference (AC) below the 10th%ile with normal EFW, as well as EFW below 10th%ile. Our objective was to compare characteristics and outcomes of IUGR pregnancies based on diagnostic criteria.

IUGR based on EFW

The definition of IUGR now includes Abdominal Circumference (AC) below the 10th%ile with normal EFW, as well as EFW < 10th%ile. Our objective was to review placental pathology in the two cohorts to compare the frequency of lesions of malperfusion.

Functional and structural evaluation in the lungs of children with repaired congenital diaphragmatic hernia

BackgroundTo evaluate the long-term functional and structural pulmonary development in children with repaired congenital diaphragmatic hernia (CDH) and to identify the associated perinatal-neonatal risk factors.MethodsChildren with repaired CDH through corrective surgery who were born at gestational age ≥ 35 weeks were included in this analysis. Those who were followed for at least 5 years were subjected to spirometry and chest computed tomography for evaluation of their functional and structural growth. Main bronchus diameters and lung volumes (total, left/right) were measured. According to total lung volume (TLV) relative to body surface area, children were grouped into TLV ≥ 50 group and TLV < 50 group and the associations with perinatal-neonatal factors were analyzed.ResultsOf the 28 children (mean age, 6.2 ± 0.2 years) with left-sided CDH, 7 (25%) had abnormal pulmonary function, of whom 6 (87%) showed restrictive patterns. All pulmonary functions except FEF25–75% were worse than those in matched healthy control group. Worse pulmonary function was significantly associated with small head and abdominal circumferences at birth. The mean TLV was 1339.1 ± 363.9 mL and LLV/TLV was 47.9 ± 2.5 mL. Children with abnormal pulmonary function were more likely to have smaller lung volumes. In multivariate analysis, abdominal circumference at birth was significantly associated with abnormal lung volume.ConclusionsA quarter of children with repaired CDH showed abnormal pulmonary function. Small abdominal circumference at birth was associated with abnormal pulmonary function and lower TLV.

408 Use of decelerated abdominal circumference growth velocity (ACGV) in diabetic pregnancies

Fetal growth restriction (FGR) is associated with significant perinatal morbidity and mortality. FGR is a known complication of diabetes in pregnancy. A small fetal abdominal circumference can predict the development of FGR and other adverse outcomes. Our objective was to determine if a slowing of the AC growth velocity over time (decelerated AC growth velocity, dACGV) is associated with adverse pregnancy outcomes in patients with diabetes in pregnancy. A retrospective cohort of 312 patients with pre-gestational diabetes (PGD) or gestational diabetes mellitus (GDM) with ultrasounds between 19w0d – 21w6d and 35w0d – 36w6d from 2013-2019 were collected. ACs at these intervals were used to calculate ACGV. ACGV ≤10th percentile was considered decelerated. Third trimester estimated fetal weight (tEFW)≤10th percentile was used as comparison. Chi square tests or Fisher’s exact tests were used for categorical variables. Of 312 patients included, 26 (8.3%) had dAGCV. A total of 39.4% had PGD and 60.6% had GDM. dACGV was not predictive of small for gestational age (SGA). However, dACGV was associated with increased risk of operative vaginal delivery [odds ratio (OR) 6.5, 95% confidence interval (CI) 2.1, 20.5], while comparable tEFW did not predict this outcome. Patients with dACGV were less likely to be using insulin compared to those with a normal ACGV (OR 0.2, 95% CI 0.1,0.6). Decelerated abdominal circumference growth velocity did not predict SGA in this diabetic cohort. However, dACGV was associated with a higher risk of operative vaginal delivery. This finding may be helpful in counseling patients with diabetes as they approach delivery.

260 Antepartum and delivery outcomes for growth-restricted fetuses based on gastroschisis-specific fetal growth curves

To determine the utility of gastroschisis-specific fetal growth curves by evaluating antepartum and delivery outcomes for fetuses with fetal growth restriction (FGR) based on Hadlock growth curves compared to gastroschisis-specific growth curves. This was a single-institution, retrospective cohort study of pregnancies complicated by isolated gastroschisis delivered between 2011 and 2020. Using ultrasound biometric data, we generated estimated fetal weight growth curves specific to fetuses with gastroschisis, including the 10th, 50th, and 90th percentiles between 15 and 37 weeks. We compared antepartum and delivery outcomes for fetuses diagnosed with FGR by Hadlock growth curves to fetuses diagnosed with FGR by gastroschisis growth curves. 413 ultrasounds from 116 fetuses were included. 67 (58%) of the fetuses met criteria for FGR based on Hadlock growth curves, and 28 (24%) met criteria based on the gastroschisis growth curves. 60% of fetuses diagnosed with FGR by Hadlock were misdiagnosed based on the new growth curves. When comparing fetuses with FGR by Hadlock to those with FGR by the gastroschisis curves, the new curves better predicted 5 out of 16 observed outcomes, including: increased betamethasone administration (52% vs 45%, p=0.001), decreased spontaneous vaginal delivery (43% vs 51%, p<0.001), increased cesarean delivery (54% vs 49%, p=0.001), increased unplanned hospital admission (96% vs 82%, p<0.001), and worsening bowel findings leading to delivery (39% vs 28%, p=0.033). Hadlock growth curves derived from non-anomalous fetuses over-diagnose FGR in fetuses with gastroschisis due to small abdominal circumference measurements caused by abdominal organ herniation. FGR defined by gastroschisis-specific growth curves better predicts many of the common perinatal outcomes seen in pregnancies complicated by this anomaly. Given the known risks of prematurity, using gastroschisis-specific growth curves may assist in improved risk stratification and delivery planning among cases of gastroschisis.

Abdominal circumference discordance for prediction of small for gestational age at birth in twin pregnancies

Objective To evaluate whether single sonographic abdominal circumference (AC) discordancy estimation can predict small for gestational age (SGA) at birth in twin gestations. Methods A retrospective analysis of prospectively collected data. Cohort included all twin gestations delivered at one university-affiliated medical center between 2010 and 2018, with available sonographic evaluation from 22 gestational weeks to term. Pregnancies complicated by fetal chromosomal abnormalities, major anomalies or twin to twin transfusion syndrome were excluded. One sonographic evaluation per pregnancy was selected randomly. AC discordance was calculated as (large twin AC – small twin AC)/large twin AC*100. Prediction of SGA at birth for at least one newborn (<10% percentile for gestational age by gender-specific local curves for multiples) was evaluated using ROC statistics with calculation of Youden index to establish best AC discordance cutoff. AC discordance prediction performance was compared to estimated fetal weight discordance performance. Results were adjusted for confounders using logistic regression analysis. Results After exclusion, 236 twin gestations entered analysis. Of them, 200/236 (84.7%) were dichorionic-diamniotic twins. Mean gestational age at ultrasound evaluation and at delivery were 30.9 ± 4.4 and 35.9 ± 2.4 weeks, respectively. In 28/236 (11.8%) pregnancies, at least one neonate was born SGA. AC discordance predicted SGA at birth as good as sonographic estimated fetal weight (sEFW) discordance: ROC-AUC 0.76, 95% CI 0.67–0.85 vs. 0.77 95% CI 0.66–0.87, p < .001 for all. Best AC discordance cutoff for prediction of SGA at birth was 7.1% (57% sensitivity, 87% specificity), ROC-AUC 0.72 (95% CI 0.61–0.84, p < .001). Results remained significant after adjustment for maternal age, nulliparity, chorionicity and ultrasound to delivery interval (aOR 1.21 95% CI 1.1–1.32, p < .001). Conclusion According to our results, AC discordance at single sonographic evaluation can predict SGA at birth in twin gestations as good as sEFW discordance. Best cutoff for SGA prediction was 7.1%.

Fetal growth and fetoplacental circulation in pregnancies following bariatric surgery: a prospective study.

To investigate the intrauterine fetal growth pattern and fetoplacental circulation in pregnancies following bariatric surgery. Prospective study. Maternity Unit, UK. One hundred and sixty-two pregnant women; 54 with previous bariatric surgery and 108 with no surgery but similar booking body mass index. Participants were seen at 11-14, 20-24, 30-33 and 35-37weeks of gestation and an oral glucose tolerance test (OGTT) was performed at 27-30weeks. Fetal head and abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW) and fetoplacental Dopplers were measured at three time-points in pregnancy. Birthweight (BW) was recorded. Variables were modelled after adjustment for maternal/pregnancy characteristics. Model estimates are reported as posterior means and quantile-based 90% credible intervals (CrI). Fetal biometry, fetoplacental Doppler, BW. Compared with the no surgery group, the post-bariatric surgery group had lower EFW during gestation (up to -120g; [-189g, -51g] lighter) at 35-37weeks, with smaller AC and FL. Similarly, infants of mothers with previous bariatric surgery had lower average BW [-202g [-330g, -72g] lighter). Overall, there was no difference in the fetoplacental Doppler indices between groups but maternal glucose levels at OGTT were positively correlated with third-trimester EFW and BW. Fetuses of women with previous bariatric surgery are smaller during pregnancy and at birth, compared with those of women without such surgery, and this may be related to the lower maternal glucose levels seen in the former population. The fetoplacental circulation appears not to be altered by maternal weight loss surgery. Offspring of post-bariatric women are smaller during pregnancy and at birth but this is not due to placental insufficiency.

A longitudinal analysis of the U.S. Air Force reserve officers\u2019 training corps physical fitness assessment

BackgroundThe U.S. Air Force physical fitness assessment (PFA) is used to determine the overall fitness of their personnel. It is currently unknown to what extent the PFA scores of Reserve Officers’ Training Corps (ROTC) cadets are affected by mandatory physical training. The purpose of this investigation was to longitudinally examine the PFAs of ROTC cadets over a four-year period, evaluate the results across class ranks, and evaluate the sensitivity of the classification of the tests.MethodsAir Force ROTC cadets performed the PFAs (abdominal circumference, 1-min pushups, 1-min sit-ups, and a 1.5-mile run) in both the spring (n = 26) and fall (n = 22) semesters. PFAs were compiled over a four-year period (Spring 2014 – Fall 2017) and were performed in accordance with Air Force Instruction 36–2905. A one-way repeated measures ANOVA was performed separately for the fall and spring groups for each dependent variable across the 4 years. Additionally, a one-way between groups ANOVA was performed for each dependent variable during the time point (fall 2015; N = 46) with the most recorded cadets for each class rank.ResultsLongitudinal assessments revealed a main effect of time (P = 0.010) on abdominal circumference; cadets had a smaller abdominal circumference in their freshman year than in their senior year. A main effect of time (P = 0.006) was also observed on sit-up quantity; cadets performed more sit-ups in their junior year than in their freshman year. Examining between class ranks during the same year (between-subjects ANOVA) revealed a main effect of class rank on sit-up quantity (P = 0.003); the freshmen completed fewer repetitions than the sophomores (P = 0.018) and the juniors did (P = 0.001).ConclusionThe results indicated that only the sit-up component showed differences between class ranks. These findings suggest that the Air Force PFA may not be sensitive enough to detect changes in physical fitness or distinguish between class ranks regarding physical performance, even after years of training. This limitation may be in part due to the limited duration of training incorporated by the ROTC program (2 h per week), which provided a maintenance effect rather than improvement in physical performance. We recommend that more attention be directed to the efficacy of physical training, the sensitivity of measures included in the PFA, or both.

LIPID PROFILE, FUNCTIONAL CAPACITY AND ANKLE-BRACHIAL INDEX IN ACTIVE OLDER ADULTS

ABSTRACT Introduction: Regular physical activity prevents cardiovascular diseases (CVD) and atherosclerosis, in addition to improving lipid levels and functional capacity in older adults. Objective: To evaluate and compare the lipid levels, functional performance and ankle brachial index (ABI) of sedentary and active older adults. Methods: This was a comparative cross-sectional study with 84 elderly (≥60 years) male and female subjects, divided into two groups: sedentary group (SG, n = 50) and active group (AG, n = 34) according to the International Physical Activity Questionnaire (IPAQ). Anthropometric and hemodynamic assessments, ankle brachial index (ABI) calculations, and functionality tests (Short Physical Performance Battery - SPPB and 6-minute walking test - 6MWT) were performed. The Shapiro-Wilk normality test was also used, and we conducted the Student's-t and Mann-Whitney tests for the intergroup comparison. For the categorical data, we used Fisher's exact test (p &lt;0.05). Results: Higher values of high-density lipoprotein cholesterol (HDL-c) (p = 0.001) and lower triglycerides (TG) (p = 0.007) were found in AG compared to SG. In the ABI evaluation, AG presented better right (p = 0.012), left (p = 0.015) and end (p = 0.004) ABI rates when compared to SG. AG had better results in functional performance in the SPPB evaluation (p = 0.0007) and in the 6MWT with a greater distance covered (p = 0.0027). In the anthropometric measurements, AG had lower body mass index (BMI) (0.041) and a smaller abdominal circumference (WC) (0.029). In terms of the incidence of referred diseases, intergroup results were only different for hypertension (0.029), while AG had a lower incidence of hypertension. Conclusion: Active older adults had better lipid levels, higher ABI levels, better functional performance, lower body mass, a smaller abdominal circumference, and lower incidence of hypertension, in comparison to sedentary subjects. Level of evidence I; High quality prospective study.