Neonatal Weight Research Articles

Neonatal Anthropometric Measurements: A Comparison of Neonates With 3-T Fetal MRI Exposure, With 1.5-T Fetal MRI Exposure, and Without In-Utero MRI Exposure.

BACKGROUND. Fetal MRI is increasingly performed at 3 T. Nonetheless, safety concerns persist regarding potential increased risk of intrauterine growth restriction from in-utero 3-T MRI exposure. OBJECTIVE. The purpose of this study was to compare neonatal anthropometric measurements between neonates who underwent 3-T fetal MRI, neonates who underwent 1.5-T fetal MRI, and neonates without in-utero MRI exposure. METHODS. This single-center retrospective study included gravid patients who underwent fetal ultrasound and possible 1.5-T or 3-T fetal MRI within 10 days between January 2017 and January 2022. For each included patient who also underwent 3-T fetal MRI, one matched patient who also underwent 1.5-T MRI and two matched patients without in-utero MRI exposure were randomly selected. Matching was based on gestational age at the time of the fetal ultrasound. Neonatal anthropometric characteristics were compared among groups. RESULTS. The final sample included 416 patients (mean age, 32 ± 5 [SD] years), 104 in the 3-T MRI group, 104 in the 1.5-T MRI group, and 208 in the MRI-unexposed group. The mean gestational age at the time of fetal ultrasound used for matching was 27 weeks 2 days in the 3-T group, 25 weeks 2 days in the 1.5-T group, and 26 weeks 0 days in the MRI-unexposed group (p = .07). The distribution of indications for fetal MRI was not significantly different between the 3-T and 1.5-T groups (p = .56). The mean gestational age at delivery was 37 weeks 5 days in the 3-T group, 38 weeks 0 days in the 1.5-T group, and 38 weeks 2 days in the unexposed group (p = .51). No significant difference was observed among the groups in mean neonatal weight (3 T: 3120 ± 753 [SD] g; 1.5 T: 3104 ± 704 g; unexposed: 2967 ± 614 g; p = .09), mean neonatal weight percentile (3 T: 45 ± 27 [SD]; 1.5 T: 42 ± 26; unexposed: 41 ± 24; p = .56), mean neonatal head circumference (3 T: 34 ± 3 [SD] cm; 1.5 T: 34 ± 3 cm; unexposed: 34 ± 2 cm; p = .05), or mean neonatal head circumference percentile (3 T: 48 ± 29 [SD]; 1.5 T: 42 ± 23; unexposed: 43 ± 30; p = .32). CONCLUSION. There were no significant differences in neonatal anthropometric measurements among neonates who underwent in-utero 3-T MRI, neonates who underwent in-utero 1.5-T MRI, and neonates without in-utero MRI exposure. CLINICAL IMPACT. The results support the safety of 3-T MRI with respect to the growth of the developing fetus.

Causation or Canard: Use of Brain Weight to Body Weight Ratios in Developmental Neurotoxicity

Abstract DNT guideline‐based testing requires the assessment of neurologic, behavioural, and neuropathological endpoints. A review of the impact of DNT studies on regulatory actions revealed that the most common findings at the LOAEL were change in body weight, motor activity, auditory startle response, brain weight and brain morphometrics. An important issue in the interpretation of DNT study findings is that in many of these studies use exposures that impact systemic development as evidenced by decreased body weight and/or body weight gain, especially during the early postnatal period prior to weaning. Currently, there is no international consensus on what degree of growth reduction during early development causes alterations in DNT endpoints. This includes the controversial use of changes body weight adjusted brain weights in concluding that the brain weight changes represent an adverse finding. The current effort compiled brain and body weight changes from 173 publicly available DNT studies designed in line with DNT EPA or OECD test guidelines. This allowed a simple comparison of between a decrease in neonatal body weight and a decrease in brain weight. Results from this project clearly show that developmental exposure induced body weight decreases are not a reliable indicator of whether or not brain weight decreases. From the 173 retrieved studies, 70% showed decreased body weights in pups (122 studies), but only 50 of these studies (41%) reported concomitant decreased brain weights. In addition, there were three studies that reported brain weight decreases when body weight was not changed at any age. This suggests that while changes in body weight may be a confounding factor for some studies, it fails to be a reliable predictor of alteration in brain weight. Thus, use of the ratio of brain weight to body weight is not appropriate as a common approach to dismiss brain weight as a DNT effect. Clearly an international consensus on the interpretation of brain weight changes in DNT studies is needed that takes into account the data presented herein.

Low Prognostic Nutritional Index (PNI) Level is Associated with an Increased Risk of Neonatal Respiratory Distress Syndrome in Preterm Infants with Different Gestational Ages: A Retrospective Study.

Neonatal respiratory distress syndrome (NRDS) is common in preterm infants. Prognostic nutritional index (PNI)((albumin (g/L)+(5×total lymphocyte count (109/L)) is a comprehensive indicator of nutritional and immune levels, and associated with several diseases. The relationship between PNI and the risk of NRDS in newborns of different gestational ages remains unclear. A total of 2722 preterm infants were included in this retrospective study. PNI level and clinical records of these neonates (adverse pregnancy and birth history, amniotic fluid contamination, nuchal cord, placental abnormality, mode of delivery, gender and birth weight of neonates, Apgar scores) were collected. The clinical features of the infants with and without NRDS were compared. Logistic regression analysis was used to evaluate the relationship between PNI and NRDS in newborns with different gestational ages. There were 1226 neonates with NRDS and 1496 without NRDS. The differences in the proportions of placenta abnormality, cesarean section, and small for gestational age (SGA) among infants with 34-37weeks, 28+1-33+6 weeks, and ≤28weeks gestational age were statistically significant. Logistic analysis showed that cesarean section (odds ratio (OR): 1.550, 95% confidence interval (CI): 1.197-2.007, p=0.001), and low PNI (OR: 1.417, 95% CI: 1.110-1.808, p=0.005) were associated with NRDS in infants born at 34-37weeks gestational. Adverse pregnancy and birth history (OR: 1.507, 95% CI: 1.124-2.019, p=0.006), SGA (OR: 1.994, 95% CI: 1.455-2.733, p<0.001), and low PNI (OR: 1.626, 95% CI: 1.230-2.149, p=0.001) were associated with NRDS in infants with 28+1-33+6 weeks gestational age. Low PNI (OR: 5.512, 95% CI: 1.555-19.536, p=0.008) was associated with NRDS in infants with ≤28weeks gestational age. The risk factors for NRDS in preterm infants with different gestational ages were different. But the low PNI level is associated with an increased risk of NRDS in preterm infants with all different gestational ages.

A comparative study on the clinical efficacy and pregnancy outcomes of methimazole and propylthiouracil in managing pregnancy complicated with hyperthyroidism.

The objective of the study was to compare the clinical efficacy and pregnancy outcomes of methimazole and propylthiouracil in managing hyperthyroidism during pregnancy. This retrospective analysis included 100 pregnant women with hyperthyroidism, who were divided into two groups: the methimazole group (Group A) and the propylthiouracil group (Group B). Indicators such as thyroid function, liver function, pregnancy outcomes, and newborn health were closely monitored. The results revealed that both groups experienced a reduction in thyroid function indicators, with Group B showing a more modest decrease. Group B exhibited a higher incidence of liver injury but also achieved more full-term pregnancies. There were no significant differences in adverse reactions, miscarriage rates, or cesarean rates between the two groups. Apgar scores were higher in Group B, while neonatal weights were comparable. We conclude that propylthiouracil improved thyroid function more substantially than methimazole although it was associated with a higher risk of liver injury.

SACROCOCCYGEALTERATOMA

INTRODUCTION Sacrococcygeal teratomas are the most common of all the GCTs in pediatric age group that originate from the totipotent cells from Hansen\\\'s node or primitive germ cells.(1) incidence is approximately 1 in 40,000 live births with a male to female ratio of 1:3–1:4.Huge and highly vascular SCTs,may result in massive hemorrhagic complications. CASE REPORT A 5 day old male baby delivered via LSCS at 36 WOG was admitted to NICU due to large sacrococcygeal teratoma (20X15cms). The neonate had no other congenital abnormality. Total weight of neonate was 2.7kgs of which tumor was approximately 700gm. Ct Abdomen and pelvis Revealed Type 2 Mature sacrococcygeal teratoma with intrapelvic and large extrapelvic component with Spina bifida occulta and surgical removal of tumour was performed DISCUSSION: Sacrococcygeal tumors can be diagnosed antinatally,the cases with antenatal diagnosis are at a high risk of perinatal complications and fetal death from high output cardiac failure. Early surgical Management in above case and Good postoperative care, minimal blood loss during procedure resulted in Good outcome (2) CONCLUSION Mature sacrococcygeal teratoma appear to be benign in nature and complete surgical resection is main stay of treatment REFERENCES 1)Yadav DK, Acharya SK, Bagga D, Jain V, Dhua A, Goel P. Sacrococcygeal Teratoma: Clinical Characteristics, Management, and Long-term Outcomes in a Prospective Study from a Tertiary Care Center. J Indian Assoc Pediatr Surg. 2020 Jan-Feb;25(1):15-21. 2) Shrestha HK, Shrestha RG. Sacrococcygeal Teratoma: A Case Report. JNMA J Nepal Med Assoc. 2020 Jul 31;58(227):508-511

Does antenatal exercise shape labor and delivery outcomes?

Incorporating regular physical activity into the lifestyle of a pregnant woman offers numerous health benefits and prepares her effectively for labor. This study was conducted to determine the impact of antenatal exercise on labor, delivery and perinatal outcome. An interventional study was conducted including 200 women attending the antenatal clinic of Obstetrics and Gynaecology department of PGIMS Rohtak, India. The study subjects were randomly divided into two groups-exercise group and control group. The demographic profile of both the groups was similar. A higher proportion of patients in control group required labor induction compared to exercise group (33% vs 16%, P = 0.002). The rate of vaginal delivery was significantly higher in exercise group than in control group (71% vs 56%, P = 0.027). Additionally, women in exercise group had fewer assisted vaginal deliveries than control group (7% vs 20%, P = 0.007). Rates of cesarean section were comparable between both groups (P = 0.736). The mean duration of labor was significantly shorter in exercise group compared to control group (428.69 ± 131.242min vs 516.91 ± 143.105min, P < 0.0001). Mean Visual Analog Scale (VAS) score for pain was 6.38 ± 1.94 in exercise group compared to 7.89 ± 1.49 in control group (P < 0.0001). No significant difference was observed between the groups in birth weight and APGAR score of neonates. A structured exercise program, practiced regularly during the antenatal period reduced the need for labor induction, shortened labor duration, increased the incidence of vaginal deliveries, and decreased pain perception during labor and delivery.

The effects of fresh embryo transfer and frozen-thawed embryo transfer on the perinatal outcomes of single fetuses from mothers with PCOS.

To investigate the effects of fresh embryo transfer and frozen-thawed embryo transfer on perinatal outcomes among patients with PCOS. Patients who underwent in vitro fertilization and embryo transfer at the reproductive medicine center of the Affiliated Hospital of Guangdong Medical University from February 2013 to March 2021 were retrospectively analyzed. Patients were divided into the fresh embryo transfer group and frozen-thawed embryo transfer group according to whether fresh embryo transfer was performed. According to their conditions, patients were further classified into the ET-PCOS group (group A, n = 104), ET-non-PCOS group (group B, n = 212), FET-PCOS group (group C, n = 102), or FET-non-PCOS group (group D, n = 148); the general data, laboratory indicators and pregnancy outcomes of the patients were statistically analyzed, and the perinatal outcomes and related factors between the groups were compared and analyzed. The level of E2 on the HCG test day in the ET group was lower than that in the FET group. The natural birth rate of group D was lower than that of group A and group B, and the cesarean section rate was higher than that of group A and group B; the clinical pregnancy rate of group A was higher than that of group B and group D, and the difference was statistically significant (P < 0.05). There was no significant difference in the total abortion rate, early abortion rate or late abortion rate between the groups (P > 0.05). There was no significant difference in gestational age, neonatal sex or neonatal weight between the groups (P > 0.05). The incidence of placenta previa in Group B was significantly lower than that in Group D, and the difference was significant (P < 0.05). The incidence of fetal distress in Group B was significantly lower than that in Groups C and D, and the incidence of neonatal jaundice in Group D was significantly higher than that in Groups A and B (P < 0.05). In the multivariate analysis, the number of high-quality embryos was independent factors affecting clinical pregnancy, and the embryo transfer method was an independent factor affecting fetal distress and neonatal jaundice. Young PCOS patients without risk of OHSS have a high clinical pregnancy rate with fresh transplant cycles. PCOS disease itself has no significant effect on the perinatal outcomes of the mother or singleton infant. Frozen-thawed embryo transfer may increase the incidence of low placenta, fetal distress and neonatal jaundice.

The pregnant patient with pulmonary arterial hypertensionand her offspring in the current era. Time to take into account the vasoreactive profile

Abstract Background and aims Pregnancy impose physiological changes that may be difficult to accomplish for women with pulmonary arterial hypertension (PAH). This study evaluates the impact that pregnancy carries in a PAH population managed in a timely manner and whether patients responders to calcium channel blockers (CCB) deserve specific recommendations because of a different prognosis. Methods A retrospective, longitudinal cohort study. All PAH pregnant patients managed at our institution between February 2010 and December 2023 were included. Clinical characteristics at baseline were recorded. Mortality, major complications (maternal death and cardiogenic shock requiring mechanical circulatory support -MCS- or inotropes) and minor complications (hospital admissions for cardiac reason, PAH therapy uptitration and oxygen prescription) were evaluated over the pregnancy course. Long-term follow-up was also assessed. Gestational age, neonatal weight and complications in the new-born (invasive and non-invasive ventilation, inotropic support and neonatal death) were studied. Data were compared between vasoreactive and non-vasoreactive patients. Results 29 patients were studied (median age 31.5, 27-32.7). 8 underwent early termination of pregnancy and 21 decided to proceed. From the latter group, 7 were responders to CCB and none presented complications over the pregnancy course. From the remaining 14 non-respo nders who completed their pregnancy, 13 (92.9%) presented minor complications: 11 (79%) were started on the prostacyclin pathway, 5 (35.7%) required inotropic support, 5 (35.7%) oxygen prescription; and 5 (35.7%) experienced major complications: 2 (14.3%) required MCS, 5 (35.7%) inotropic support, and one patient died (7%). Over a median follow-up period of 5 years (1.2-8.5), 2 patients died from the non-responder cohort (1.4%); while no patient responder to CCB experienced complications; moreover, none lost her vasoreactive response. All the new-borns from non-vasoreactive patients were delivered prematurely; while those from vasoreactive patients reached week 37 in the 85,7% of the cases. One of the new-borns from the non-vasoreactive cohort died, and there was a non-significant trend towards a fewer rate of complications in the vasoreactive offspring (42.9 Vs. 84.6, p = 0.054). Conclusions In spite of the continuous advances in PAH management, pregnancy still associates high maternal and neonatal morbidity. Nevertheless, vasoreactive PAH patients presented a completely different maternal and neonatal prognosis which may prompt specific recommendations for this particular subgroupOutcomes by vasoreactivity profilePregnancy course for the 21 PAH patients

Factors Influencing Instrumental Assisted Births: A Retrospective Study

ABSTRACTObjectiveTo evaluate the rate of instrument‐assisted deliveries among parturient patients hospitalized for live, vaginal births across 5 years and test for factors influencing the use of this procedure.MethodsHospitalizations of pregnant people age 18 years or older presenting for a live vaginal birth between October 2017 and 2022 were included for gestational ages between 35.0 and 42.0 weeks. The outcome measured the presence of neonatal instrument‐assisted birth utilizing forceps or a vacuum. Independent variables tested as influencing the outcome included hospitalization year, maternal age, BMI, parity, gestational age, admission to birth time, labor induction, neonate weight, intrapartum analgesia, gestational diabetes and preeclampsia. Descriptive, bivariate and multivariate statistics were conducted in Excel to compare those with and without instrument‐assisted birth.ResultsThe descriptive analysis demonstrated that cases receiving an instrument‐assisted birth had significantly longer admission to birth time (17.8 h [SD = 11.0] vs. 14.1 h [SD = 14.5], p &lt; 0.001) and received intrapartum analgesics as follows: continuous labor epidural (92.1% vs. 80.6%, p &lt; 0.001), opioids (12.6% vs. 5.9%, p &lt; 0.001) and acetaminophen (20.3% vs. 11.1%, p &lt; 0.001). Multivariate logistic regression model demonstrated that intrapartum analgesics were significantly associated with instrument‐assisted births as follows: continuous labor epidural (OR 2.12, 95% CI 1.63−2.75), opioids (OR 1.37, 95% CI 1.10−1.72) and acetaminophen (OR 1.50, 95% CI 1.24−1.80). Conversely, multiparous status demonstrated decreased odds of having an instrument‐assisted birth (OR 0.32, 95% CI 0.27−0.37).ConclusionAmong pregnant patients, having a longer admission to birth time or receiving an intrapartum analgesic (continuous labor epidural, opioids and/or acetaminophen) was significantly associated with an instrument‐assisted birth, whereas multiparity reduced the odds of the procedure.

Maternal Fasting Plasma Glucose, Age and Body Mass Index as Prediction of Gestational Diabetes Mellitus in Iran.

Gestational diabetes mellitus (GDM) is a common complication of pregnancy that can lead to adverse outcomes. In this retrospective cohort study, maternal fasting blood sugar (FBS) in the second trimester of pregnancy, body mass index (BMI), and age were assessed as potential screening indicators of later GDM. The study population included information on 4007 Iranian pregnant women documented by the Integrated Health Record System (SIB) record system (2019-2020). In the adjusted analysis, FBS maintained a significant relationship with GDM (P ≤0.001). In the simple ROC analysis, the AUC (SE) of FBS for the prediction of GDM was 0.905(0.09), and considering the cut-off point as 85.95, sensitivity (Se) and specificity (Sp) were equal to 0.81 and 0.71, respectively, but by stillbirth, abortion, prematurity, neonatal weight, height, and head circumference not obtained acceptable AUC (≥.60) for detection of FBS cut-off point. The cut-off point of FBS in the presence of maternal age (AUC>0.6) and BMI (AUC>0.6) by GDM was 83.75(Se= 86.4%, Sp= 80.0%). Based on the evidence presented, maternal weight and BMI are important in predicting hyperglycemia leading to GDM. It is necessary to conduct more precise national studies to standardize the FBS cut-off point by controlling age and BMI variables.

Clinical value of transperineal ultrasound in evaluating the effects of different delivery methods on the primipara pelvic floor structure and function

To evaluate the effects of different delivery methods on the pelvic floor structure and function among primiparas by transperineal ultrasound, with a view to providing guidance for early postpartum intervention. Primiparas who underwent postpartum examination with transperineal ultrasound were recruited. Subjects were divided according to mode of delivery (vaginal and cesarean delivery). General information (including age, pre-pregnancy BMI and neonatal weight) were collected, and transperineal ultrasound was performed to measure such indicators as the levator hiatus areas in resting, constrictive anal and maximum Valsalva states, the posterior vesicourethral angles and distances between vesical neck and posterior inferior margin of pubic symphysis in resting and maximum Valsalva states, as well as the vesical neck mobility and urethral rotation angle in maximum Valsalva state. The inter-group differences in ultrasound indicators between the resting and Valsalva states were compared to analyze the postpartum incidences of pelvic floor dysfunctions like stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse in primiparas. The levator hiatus areas in resting, constrictive anal and maximum Valsalva states were all larger in the vaginal delivery group than in the cesarean delivery group (P < 0.05). Compared to the cesarean delivery group, the vaginal delivery group exhibited larger posterior vesicourethral angles in resting and maximum Valsalva states (P < 0.05). The distances between vesical neck and posterior inferior margin of pubic symphysis were greater in the cesarean delivery group than in the vaginal delivery group at both resting and maximum Valsalva, with that at maximum Valsalva showing significant inter-group difference (P < 0.05). The vaginal delivery group exhibited greater vesical neck mobility and urethral rotation angle at maximum Valsalva compared to the cesarean delivery group (P < 0.05). The incidences of stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse were all higher in the vaginal delivery group than in the cesarean delivery group, with the stress urinary incontinence and bladder prolapse incidences showing significant inter-group differences (P < 0.05). With transperineal ultrasound, various pelvic floor indicators of primiparas can be clearly measured and, through these ultrasound indicators, the effects of different delivery methods on the pelvic floor function can be evaluated, which is conducive to early clinical detection and intervention of postpartum pelvic floor dysfunctions, thus facilitating the early postpartum treatment.

Fluctuation trend of inflammatory indexes related to gestational diabetes mellitus from second trimester to third trimester of pregnancy

ObjectiveThis study aims to assess the prognostic and diagnostic value of inflammatory indexes related to gestational diabetes mellitus (GDM) from the second trimester to the third trimester of pregnancy.Materials and methodsIn this study, we randomly selected 65 pregnant women diagnosed with GDM at our hospital from December 2022 to June 2023 to form the GDM group (n = 65). Additionally, 65 pregnant women at the same gestational weeks without GDM were selected as the Normal group (n = 65). We collected gestational information and serum samples at 24 and 36 weeks of gestation from the participants. The levels of NLRP3, IL-1Ra, and TBP-2 were determined using enzyme-linked immunosorbent assay (ELISA) to explore their changes during pregnancy. Further, this study analyzed the changes in the levels of NLRP3, IL-1Ra, and TBP-2 at 24 and 36 weeks of gestation in GDM patients and their correlation with gestational diabetes mellitus.ResultsThe study showed that pre-pregnancy body mass index (BMI), neonatal weight, gestational hypertension, and macrosomia are significantly associated with the occurrence of GDM (P < 0.05). Statistical analysis comparing the normal and GDM groups found no significant changes in the levels of NLRP3, IL-1Ra, and TBP-2 with the progression of gestation in the normal group. In contrast, in the GDM group, the levels of IL-1Ra in serum samples at 24 and 36 weeks were significantly increased (P < 0.05) while the levels of NLRP3 and TBP-2 were significantly reduced (P < 0.05). At 36 weeks, there was a positive correlation between the levels of NLRP3, IL-1Ra, and TBP-2. Compared to the normal group, the overall levels of NLRP3, IL-1Ra, and TBP-2 in the GDM group were lower (P < 0.05) and the weight of the newborns was significantly correlated with these three indicators (P < 0.05), specifically newborn weight increased with the levels of NLRP3 and TBP-2 but decreased with the increase of IL-1Ra (P < 0.05). Multifactorial logistic regression analysis further revealed that NLRP3 is an independent factor influencing GDM (P < 0.05). ROC curve analysis of the NLRP3 level at 24 weeks of gestation found that NLRP3 has a good value in predicting GDM (AUC = 0.720, 95%CI 0.630–0.809, P < 0.001) and the combined prediction of NLRP3, IL-1Ra, and TBP-2 also showed a good predictive value for GDM.ConclusionThe changes in NLRP3, IL-1Ra, and TBP-2 persisted throughout the 24 to 36 weeks of gestation, playing an important role in predicting the occurrence of GDM and the weight of the newborn.

Risk factors and prediction model for low-birth-weight infants born to women with gestational diabetes mellitus.

To explore the risk factors for low-birth-weight infants born to pregnant women with GDM to develop a prediction model and to construct a prediction nomogram for the risk of low birth weight infants born to pregnant women with GDM. The clinical data of singleton infants diagnosed with gestational diabetes mellitus in Southeast China in 2019 were retrospectively reviewed. Gestational conditions and neonatal weight were assessed. A total of 386 diabetic mothers and infants were enrolled, including 193 in the low birth weight group and 193 in the normal birth weight group. The statistically significant factors were age over 36 years (OR = 1.916, 95% CI 1.048-3.505), junior high school education (OR = 4.454, 95% CI 1.882-10.543), history of fetal distress (OR = 0.120, 95% CI 0.016-0.925), gestational hypertension (OR = 3.681, 95% CI 1.357-9.986), preeclampsia (OR = 24.652, 95% CI 5.956-102.036), threatened preterm birth (OR = 18.393, 95% CI 8.457-39.999), triglycerides (OR = 0.642, 95% CI 0.485-0.850), and inadequate gestational weight gain (OR = 1.997, 95% CI 1.162-3.432). The area under the receiver operating characteristic curve (AUC) was 0.834 (95% CI: 0.794-0.874, p < 0.001), and the sensitivity and specificity were 82.38 and 87.56%, respectively. The goodness-of-fit test likelihood ratio 2 was 2.089 (p = 0.978). The comprehensive nomogram model showed that the discrimination and mean absolute error were 0.834 and 0.015, respectively. The calibration curves showed acceptable agreement between the predictions of the column line plots and the observations. The DCA curves showed good positive net yields in the prediction model. This study established a prediction model and risk score for low birth weight in pregnant women with GDM. It helps pregnancy clinics to identify the risk of low birth weight in newborns promptly, in addition to glycemic control and weight management for pregnant women with GDM, and should improve the appropriate treatment plan for pregnant women with higher risk, to provide personalized and precise treatment for pregnant women with GDM and improve infant outcomes.

8548 Breast Development in Infant Girls: Does Endogenous Estrogen Production During Minipuberty Play a Role?

Abstract Disclosure: M. Goldberg: None. S. Zhao: None. A. Kelly: None. V.A. Stallings: None. D.M. Umbach: None. W.J. Rogan: None. N. Shaw: None. D.P. Sandler: None. Background: Breast tissue, present at birth in most term infants, regresses during infancy but persists longer in girls than boys. In girls, this persistence is thought to be due in part to stimulation by estradiol (E2) produced during minipuberty, the postnatal activation of the hypothalamic-pituitary-gonadal axis. Empirical data are sparse, however. Because E2 concentrations in infant girls fluctuate, repeated E2 measures may be necessary to adequately characterize production across minipuberty and to detect effects on estrogen-sensitive breast tissue. Hypothesis: Higher average exposure to E2 during minipuberty is associated with larger breast bud diameter in late infancy in term females. Methods: We leveraged data from 136 girls from the Infant Feeding and Early Development (IFED) Study, a prospective cohort of reproductive development in term infants enrolled during 2010-2013 from the Philadelphia area. We measured E2 in serum samples collected at study visits every 2-4 weeks from age 2-32 weeks. We assessed breast bud diameter via ultrasound at the 32-week visit. For data analysis, we log2-transformed both E2 and breast bud diameter. For E2 concentrations below the limit of detection (2.99 pg/mL, 35% of samples), we applied multiple imputation. We first calculated the intraclass correlation coefficient (ICC) of repeated E2 to understand the relative magnitude of total variation from within subjects. We then calculated subject-specific mean of E2 across time and estimated associations with breast bud diameter at the 32-week visit using both age- and multivariable-adjusted linear regression models. We present results as percent change in breast bud diameter per doubling in average E2 concentration ([2β-1] x 100%). Results: Most infants were Black (71%) and formula-fed (76%). The median number of E2 measures per girl was 9 (range: 5-10). Most of the variation in E2 concentrations was due to within-individual variation (ICC=0.27). The geometric mean E2 concentration from 2-32 weeks of age was 5.1 pg/mL (95% confidence interval [CI]: 4.7-5.4). The median breast bud diameter at the 32-week visit was 13.7mm (range: 4.4-30.5). A doubling in average E2 concentration across minipuberty was associated with a 26% larger breast bud diameter (95% CI 10-43%). This association was similar after adjustment for feeding method, race, gestational age, neonatal weight, and breast bud diameter at the neonatal visit (percent change: 28%, 95% CI: 12-46%). Conclusions: Our results suggest that endogenous estrogen production in females during minipuberty stimulates the infant breast bud. More research is needed to investigate the potential biologic relevance of this hormonal stimulation of infant breast tissue to later breast development and risk of malignant and benign breast disorders. Presentation: 6/1/2024

Association of SARS-CoV-2 infection during late pregnancy with maternal and neonatal outcomes

BackgroundLimited data on the impact of the coronavirus disease 2019 (COVID-19) during pregnancy on newborn outcomes are available. This study aimed to characterize and compare the clinical outcomes of newborns from women with and without the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during late pregnancy.MethodThis was a retrospective cohort study of women who were either infected or not infected with the SARS-CoV-2 virus during late pregnancy. The neonatal complications associated with COVID-19-positive pregnant women were investigated and analyzed.ResultsAmong 2063 pregnant women over 28 weeks of gestation, 1.2%, 3.3%, and 18.7% of patients with multiple pregnancies, abnormal fetal positions, and lack of maternal or neonatal follow-up data, respectively, were excluded. Patients who were COVID-19-negative (60.6%) and -positive (16.2%) remained for further analysis. SARS-CoV-2 infection was significantly associated with higher SARS-CoV-2 infection rates in newborns (0% vs. 1.49%, P < 0.01) and longer duration of hospital stay (6.39 ± 2.2 vs. 4.92 ± 1.6, P < 0.01). However, comparing neonatal complications, including Apgar score, preterm birth, low birth weight, cesarean section rate, newborn hearing, neonatal congenital heart defects, and height and weight compliance rate of 6-month-old children, between non-infected and infected participants did not reach statistical significance.ConclusionSARS-CoV-2 infection in late pregnancy has no significant impact on neonatal outcomes. After six months of follow-up of the neonates, we observed that SARS-CoV-2 infection in the third trimester of pregnancy did not affect their growth and development. Hopefully, these findings will guide management strategies and clinical practice.

Development and external validation of clinical predictive model for stress urinary incontinence in Chinese women : a multicenter retrospective study

BackgroundStress urinary incontinence (SUI), the prevalent form of urinary incontinence, significantly impairs women’s quality of life. This study aims to create a visual nomogram to estimate the risk of SUI within one year postpartum for early intervention in high-risk Chinese women.MethodsWe recruited 1,531 postpartum women who gave birth at two hospitals in Kunshan City from 2021 to 2022. Delivery details were meticulously extracted from the hospitals’ medical records system, while one-year postpartum follow-ups were conducted via phone surveys specifically designed to ascertain SUI status. Utilizing data from one hospital as the training set, logistic regression analysis was performed to pinpoint significant factors and subsequently construct the nomogram. To ensure robustness, an independent dataset sourced from the second hospital served as the external validation cohort. The model’s performance was rigorously evaluated using calibration plots, ROC curves, AUC values, and DCA curves.ResultsThe study population was 1,125 women. The SUI incidence within one year postpartum was 26% (293/1125). According to the regression analysis, height, pre-pregnancy BMI, method of induction, mode of delivery, perineal condition, neonatal weight, SUI during pregnancy, and SUI during the first pregnancy were incorporated into the nomogram. The AUC of the nomogram was 0.829 (95% CI 0.790–0.867), and the external validation set was 0.746 (95% CI 0.689–0.804). Subgroup analysis based on parity showed good discrimination. The calibration curve indicated concordance. The DCA curve showed a significant net benefit.ConclusionDrawing from real-world data, we have successfully developed an SUI predictive model tailored for postpartum Chinese women. Upon successful external validation, this model holds immense potential as an effective screening tool for SUI, enabling timely interventions and ultimately may improve women’s quality of life.

Prepregnancy BMI Modified the Association Between Gestational Weight Gain and Birth Weight in Preterm Neonates

Prepregnancy BMI Modified the Association Between Gestational Weight Gain and Birth Weight in Preterm Neonates

Comparing Perinatal Outcomes of Assisted Reproductive Technology (ART)-Induced vs. Naturally Conceived Twin Pregnancies.

The occurrence of multiple pregnancies is consistently and significantly linked to the growing use of assisted reproductive technology (ART). Even very young women opt for having multiple embryos implanted by medical professionals in order to increase the chances of a successful outcome. Our aim is to review the research on cesarean section rates and perinatal outcomes, like perinatal morbidity, risk of preterm delivery, and low birth weight (LBW) of neonates in multiple pregnancies that resulted from ART in comparison to those that were naturally conceived. We conducted a comprehensive search of the PubMed, Crossref, and Google Scholar electronic databases for related articles up to January 2024 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We found that most studies found no relationship between ART procedures and poor perinatal outcomes in multiple pregnancies compared to naturally conceived ones. A few studies have linked ART services to preterm birth (PTB) and LBW. Careful interpretation of these findings is necessary since confounding factors may invalidate the putative link. Although perinatal death rates are similar, ART increases cesarean section rates. When a statistically significant difference was detected, it was typically attributable to confounding variables such as maternal age, subfertility reasons, or maternal comorbidities like gestational diabetes or hypertension.

Hypoglycaemia in screening oral glucose tolerance test in pregnancy with low birth weight fetus.

Maternal hypoglycemia, a condition characterized by lower than normal blood glucose levels in pregnant women, has been increasingly associated with adverse pregnancy outcomes, including low birth weight (LBW) in neonates. LBW, defined as a birth weight of less than 2500 g, can result from various factors, including maternal nutrition, health status, and metabolic conditions like hypoglycemia. Maternal hypoglycemia may affect fetal growth by altering the supply of essential nutrients and oxygen to the fetus, leading to restricted fetal development and growth. This condition poses significant risks not only during pregnancy but also for the long-term health of the child, increasing the likelihood of developmental delays, health issues, and chronic conditions later in life. Research in this area has focused on understanding the mechanisms through which maternal hypoglycemia influences fetal development, with studies suggesting that alterations in placental blood flow and nutrient transport, as well as direct effects on fetal insulin levels and metabolism, may play a role. Given the potential impact of maternal hypoglycemia on neonatal health outcomes, early detection and management are crucial to minimize risks for LBW and its associated complications. Further investigations are needed to fully elucidate the complex interactions between maternal glucose levels and fetal growth, as well as to develop targeted interventions to support the health of both mother and child. Understanding these relationships is vital for improving prenatal care and outcomes for pregnancies complicated by hypoglycemia.

Influence of perinatal factors on full-term low-birth-weight infants and construction of a predictive model.

Being too light at birth can increase the risk of various diseases during infancy. To explore the effect of perinatal factors on term low-birth-weight (LBW) infants and build a predictive model. This model aims to guide the clinical management of pregnant women's healthcare during pregnancy and support the healthy growth of newborns. A retrospective analysis was conducted on data from 1794 single full-term pregnant women who gave birth. Newborns were grouped based on birth weight: Those with birth weight < 2.5 kg were classified as the low-weight group, and those with birth weight between 2.5 kg and 4 kg were included in the normal group. Multiple logistic regression analysis was used to identify the factors influencing the occurrence of full-term LBW. A risk prediction model was established based on the analysis results. The effectiveness of the model was analyzed using the Hosmer-Leme show test and receiver operating characteristic (ROC) curve to verify the accuracy of the predictions. Among the 1794 pregnant women, there were 62 cases of neonatal weight < 2.5 kg, resulting in an LBW incidence rate of 3.46%. The factors influencing full-term LBW included low maternal education level [odds ratio (OR) = 1.416], fewer prenatal examinations (OR = 2.907), insufficient weight gain during pregnancy (OR = 3.695), irregular calcium supplementation during pregnancy (OR = 1.756), and pregnancy hypertension syndrome (OR = 2.192). The prediction model equation was obtained as follows: Logit (P) = 0.348 × maternal education level + 1.067 × number of prenatal examinations + 1.307 × insufficient weight gain during pregnancy + 0.563 × irregular calcium supplementation during pregnancy + 0.785 × pregnancy hypertension syndrome - 29.164. The area under the ROC curve for this model was 0.853, with a sensitivity of 0.852 and a specificity of 0.821. The Hosmer-Leme show test yielded χ 2 = 2.185, P = 0.449, indicating a good fit. The overall accuracy of the clinical validation model was 81.67%. The occurrence of full-term LBW is related to maternal education, the number of prenatal examinations, weight gain during pregnancy, calcium supplementation during pregnancy, and pregnancy-induced hypertension. The constructed predictive model can effectively predict the risk of full-term LBW.