Pregnancy

About: Pregnancy is a research topic. Over the lifetime, 163969 publications have been published within this topic receiving 4013502 citations. The topic is also known as: pregnancy & gestation.

The Hyperglycemia and Adverse Pregnancy Outcome Study: Associations of GDM and obesity with pregnancy outcomes

Abstract: OBJECTIVE To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. RESEARCH DESIGN AND METHODS Participants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide >90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes. RESULTS Mean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m 2 ), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight >90th percentile for GDM alone was 2.19 (1.93, 2.47), for obesity alone 1.73 (1.50, 2.00), and for both GDM and obesity 3.62 (3.04, 4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat >90th percentiles were similar. Odds for birth weight >90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women). CONCLUSIONS Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.

Maternal hypothyroxinaemia during early pregnancy and subsequent child development: a 3-year follow-up study

Abstract: Summary OBJECTIVE To evaluate the impact of maternal hypothyroxinaemia during early gestation (fT4 below the lowest tenth percentile and TSH within the reference range: 0·15‐2·0 mIU/l) on infant development, together with any subsequent changes in fT4 during gestation. DESIGN A prospective 3-year follow-up study of pregnant women and their children up to the age of 2 years. MEASUREMENTS Child development was assessed by means of the Bayley Scales of Infant Development in children of women with hypothyroxinaemia (fT4 below the tenth percentile at 12 weeks’ gestation) at 12 weeks’ gestation (cases), and in children of women with fT4 between the 50th and 90th percentiles at 12 weeks’ gestation, matched for parity and gravidity (controls). Maternal thyroid function (fT4 and TSH) was assessed at 12, 24 and 32 weeks’ gestation. The mental and motor function of 63 cases and 62 controls was compared at the age of 1 year, and of 57 cases and 58 controls at the age of 2 years. RESULTS Children of women with hypothyroxinaemia at 12 weeks’ gestation had delayed mental and motor function compared to controls: 10 index points on the mental scale (95% CI: 4·5‐15 points, P = 0·003) and eight on the motor scale at the age of 1 year (95% CI: 2·3‐12·8 points, P = 0·02), as well as eight index points on the mental (95% CI: 4‐12 points, P = 0·02), and 10 on the motor scale (95%CI: 6‐16 points, P = 0·005) at the age of 2 years. Children of hypothyroxinaemic women in whom the fT4 concentration was increased at 24 and 32 weeks’ gestation had similar scores to controls, while in the controls, the developmental scores were not influenced by further declines in maternal fT4 at 24 and 32 weeks’ gestation. CONCLUSIONS Maternal hypothyroxinaemia during early gestation is an independent determinant of a delay in infant neurodevelopment. However, when fT4 concentrations increase during pregnancy in women who are hypothyroxinaemic during early gestation, infant development appears not to be adversely affected. In the past decade, interest has been rekindled in the relationship between maternal plasma thyroid hormone concentration during pregnancy and subsequent infant neurodevelopment (Pop et al ., 1995, 1999a; Haddow et al ., 1999; Lazarus, 1999; Smit et al ., 2000). It is well known that both maternal thyroid dysfunction during pregnancy (especially hypothyroidism) and severe iodine deficiency adversely affect the outcome of neurodevelopment in children (Delange, 1994; Glinoer, 1997; Mestman, 1999). Even in areas in which there is sufficient iodine intake in the general population, pregnant women often have fT4 plasma levels in the lower ranges, without elevated TSH. This is defined as hypothyroxinaemia, and is generally regarded as a normal condition. However, there is growing concern that hypothyroxinaemia during early gestation could be harmful to the offspring (Pop et al ., 1999b; Utiger, 1999; Morreale de Escobar et al ., 2000). In fact, little is known about maternal fT4 levels during normal pregnancy, or their relationship to the development of the child. This paper describes the results of a longitudinal prospective study that investigates whether maternal thyroid hormone levels, assessed in women without (sub)clinical thyroid function at three different trimesters during pregnancy, are adversely related to child development at 1 and 2 years of age.

Birth Spacing and Risk of Adverse Perinatal Outcomes

Abstract: BOTH SHORT AND LONG INTERvals between pregnancies have been associated with increased risk of several adverse perinatal outcomes, such as preterm birth, low birth weight (LBW), small for gestational age (SGA), and perinatal death. However, there has been disagreement on whether the relationship is due to confounding by other risk factors. For example, some researchers have argued that short intervals between pregnancies merely designate women already at higher reproductive risk, either because of underlying disorders, socioeconomic status, or lifestyle factors. Furthermore, previous research in this area has several methodological limitations, such as small sample size, lack of control for potential confounding factors, dichotomization of the measure of birth spacing on the basis of an arbitrarily defined cut point, and use of birth interval (time elapsed between the woman’s last delivery and the birth of the index child) instead of interpregnancy interval (time elapsed between the woman’s last delivery and the conception of the next pregnancy) as the measure of birth spacing. The use of birth intervals overestimates the risk of adverse perinatal outcomes for very short intervals between pregnancies. This issue is relevant to public health and clinical practice because if short and/or long interpregnancy intervals are found to be independently associated with increased risk of adverse perinatal outcomes, birth spacing might then be considered an intervention to prevent such adverse outcomes, mainly in the developing world. Therefore, we performed a systematic review, including meta-analysis, of the relationship between birth spacing and the risk of adverse perinatal outcomes that provided an overall summary of the effect