Showing papers on "Small for gestational age published in 2001"

Maternal Periodontitis and Prematurity. Part I: Obstetric Outcome of Prematurity and Growth Restriction

Abstract: Oral Conditions and Pregnancy (OCAP) is a 5-year prospective study of pregnant women designed to determine whether maternal periodontal disease contributes to the risk for prematurity and growth restriction in the presence of traditional obstetric risk factors. Full-mouth periodontal examinations were conducted at enrollment (prior to 26 weeks gestational age) and again within 48 hours postpartum to assess changes in periodontal status during pregnancy. Maternal periodontal disease status at antepartum, using a 3-level disease classification (health, mild, moderate-severe) as well as incident periodontal disease progression during pregnancy were used as measures of exposures for examining associations with the pregnancy outcomes of preterm birth by gestational age (GA) and birth weight (BW) adjusting for race, age, food stamp eligibility, marital status, previous preterm births, first birth, chorioamnionitis, bacterial vaginosis, and smoking. Interim data from the first 814 deliveries demonstrate that maternal periodontal disease at antepartum and incidence/progression of periodontal disease are significantly associated with a higher prevalence rate of preterm births, BW < 2,500 g, and smaller birth weight for gestational age. For example, among periodontally healthy mothers the unadjusted prevalence of births of GA < 28 weeks was 1.1%. This was higher among mothers with mild periodontal disease (3.5%) and highest among mothers with moderate-severe periodontal disease (11.1%). The adjusted prevalence rates among GA outcomes were significantly different for mothers with mild periodontal disease (n = 566) and moderate-severe disease (n = 45) by pair-wise comparisons to the periodontally healthy reference group (n = 201) at P = 0.017 and P < 0.0001, respectively. A similar pattern was seen for increased prevalence of low birth weight deliveries among mothers with antepartum periodontal disease. For example, there were no births of BW < 1000 g among periodontally healthy mothers, but the adjusted rate was 6.1% and 11.4% for mild and moderate-severe periodontal disease (P = 0.0006 and P < 0.0001), respectively. Periodontal disease incidence/progression during pregnancy was associated with significantly smaller births for gestational age adjusting for race, parity, and baby gender. In summary, the present study, although preliminary in nature, provides evidence that maternal periodontal disease and incident progression are significant contributors to obstetric risk for preterm delivery, low birth weight and low weight for gestational age. These studies underscore the need for further consideration of periodontal disease as a potentially new and modifiable risk for preterm birth and growth restriction.

Teenage pregnancy and risk of adverse perinatal outcomes associated with first and second births: population based retrospective cohort study

Abstract: Objective: To determine whether first and second births among teenagers are associated with increased risk of adverse perinatal outcomes after confounding variables have been taken into account. Design: Population based retrospective cohort study using routine discharge data for 1992-8. Setting: Scotland. Main outcome measures: Stillbirth, preterm delivery, emergency caesarean section, and small for gestational age baby among non-smoking mothers aged 15-19 and 20-29. Results: The 110 233 eligible deliveries were stratified into first and second births. Among first births, the only significant difference in adverse outcomes by age group was for emergency caesarean section, which was less likely among younger mothers (odds ratio 0.5, 95% confidence interval 0.5 to 0.6). Second births in women aged 15-19 were associated with an increased risk of moderate (1.6, 1.2 to 2.1) and extreme prematurity (2.5, 1.5 to 4.3) and stillbirth (2.6, 1.3 to 5.3) but a reduced risk of emergency caesarean section (0.7, 0.5 to 1.0). Conclusions: First teenage births are not independently associated with an increased risk of adverse pregnancy outcome and are at decreased risk of delivery by emergency caesarean section. However, second teenage births are associated with an almost threefold risk of preterm delivery and stillbirth. What is already known on this topic Teenage mothers are more likely to deliver prematurely and to have a perinatal death than older women Teenage mothers are also more likely to smoke, be having a first baby, and live in adverse social circumstances What this study adds Non-smoking women aged 15-19 having a first birth were not at increased risk of adverse obstetric outcomes compared with women aged 20-29 after potential confounding variables were adjusted for Non-smoking women aged 15-19 having a second birth were at significantly increased risk of both premature delivery and stillbirth compared with women aged 20-29

Antiplatelet drugs for prevention of pre-eclampsia and its consequences: systematic review

Abstract: Objective: To assess the effectiveness and safety of antiplatelet drugs for prevention of pre-eclampsia and its consequences. Design: Systematic review. Data sources: Register of trials maintained by Cochrane Pregnancy and Childbirth Group, Cochrane Controlled Trials Register, and Embase. Included studies: Randomised trials involving women at risk of pre-eclampsia, and its complications, allocated to antiplatelet drug(s) versus placebo or no antiplatelet drug. Main outcomes measures: Pre-eclampsia, preterm birth, fetal or neonatal death, and small for gestational age baby. Studies were assessed for quality of concealment of allocation and losses to follow up. Results: 39 trials (30 563 women) were included, and 45 trials (>3000 women) excluded. Use of antiplatelet drugs was associated with a 15% reduction in the risk of pre-eclampsia (32 trials, 29 331 women; relative risk 0.85, 95% confidence interval 0.78 to 0.92; number needed to treat 100, 59 to 167). There was also an 8% reduction in the risk of preterm birth (23 trials, 28 268 women; 0.92, 0.88 to 0.97; 72, 44 to 200), and a 14% reduction in the risk of fetal or neonatal death (30 trials, 30 093 women; 0.86, 0.75 to 0.98; 250, 125 to >10 000) for women allocated antiplatelet drugs. Small for gestational age babies were reported in 25 trials (20 349 women), with no overall difference between the groups (relative risk 0.92, 0.84 to 1.01). There were no significant differences in other measures of outcome. Conclusions: Antiplatelet drugs, largely low dose aspirin, have small to moderate benefits when used for prevention of pre-eclampsia.

Intellectual and psychological performance in males born small for gestational age with and without catch-up growth.

Abstract: Infants born small for gestational age (SGA) have an increased risk of neurologic and intellectual dysfunction. Most of these infants catch up in growth and attain normal height, although some do not. Whether catch-up growth influences intellectual function is not known. To analyze whether intellectual and psychological performance of males in early adulthood are associated with body size at birth or by catch-up growth in height among boys, a population-based cohort was studied. This cohort included all male singletons born without congenital malformations in Sweden from 1973 to 1978 and alive at 18 y (n = 276,033). Information from the Swedish Birth Register was individually linked to the Swedish Conscript Register. Of 254,426 conscripted males, information on intellectual and psychological performance was available for 97% and 91%, respectively. Low birth weight, short birth length, small head circumference at birth, and preterm birth increased the risk of subnormal intellectual and psychological performance. Among SGA-born males, the most important predictor was the absence of catch-up growth. Being born SGA is associated with increased risk of subnormal intellectual and psychological performance. The data strongly support the view that, for males born SGA, it is an advantage to have catch-up growth in length.

Short-term benefits of catch-up growth for small-for-gestational-age infants

Abstract: Background Recent studies suggest that small newborns who present rapid postnatal growth may have an increased risk of chronic diseases in adulthood. On the other hand, it is widely assumed that catch-up growth is desirable for low birthweight children, but the literature on this subject is limited. Methods Population-based cohort study in southern Brazil, with 3582 children examined at birth, 20 and 42 months of age. Catch-up growth from 0 to 20 months was related to subsequent risks of hospital admissions and mortality. Results Children who were small-for-gestational-age (SGA) but presented substantial weight gain (>0.66 z-score) up to the age of 20 months had 65% fewer subsequent hospital admissions than other SGA children (5.6% versus 16.0%; P , 0.001). Mortality to age 5 years was 75% lower (3 versus 13 per 1000, a non-significant difference based on a small number of deaths) for rapid-growing SGA children compared to the remaining SGA children. Their admission and mortality rates were similar to those observed for children born with an appropriate birthweight for their gestational age (AGA). Similar positive effects of rapid growth were found for AGA children. Conclusion There appear to be definite benefits associated with catch-up growth. Growth promotion efforts for infants who are born small should take into account their possible short- and long-term consequences.

School Difficulties in 20-Year-Olds Who Were Born Small for Gestational Age at Term in a Regional Cohort Study

Abstract: Objective. To investigate the relation between school difficulties and being born small for ges tational age (SGA) at full term in adolescents and young adults. Methods. A total of 236 full-term singletons who wert born SGA (birth weight and/or length below the third percentile) from 1971 through 1978 and 281 full-term singletons who were born appropriate for gestational age (AGA; between the 25th and 75th percentiles) from the maternity registry of Haguenau, France. Participants were evaluated at a mean age of 20.6 (±2.1) years. The outcomes measured were late entry into secondary school (normal age: 11 years) and failure to take or pass the baccalaureate examination at the end of secondary school (normal age: 18 years). Results. Late entry into secondary school was more frequent for the SGA than the AGA children (odds ratio 2.3) after adjustment for maternal age and educational level, parental socioeconomic status, family size, and gender. A significantly higher proportion of term SGA adolescents failed to take or pass the baccalaureate examination than AGA adolescents (odds ratio: 1.6). SGA participants with a smaller head circumference entered secondary school late more often than SGA participants with a larger head circumference, but the association was not significant after adjustment. Conclusion. Being born SGA at term is associated with poorer school performance at 12 and 18 years. Fetal adaptation to conditions that retard growth during gestation may not be successful in maintaining brain development. Pediatrics 2001;108:111-115; intrauterine growth retardation, small for gestational age, school outcome, development, adolescence.

Zinc supplementation in infants born small for gestational age reduces mortality: a prospective, randomized, controlled trial.

Abstract: Background. Low birth weight infants have been noted to have low zinc concentrations in cord blood, and zinc deficiency in childhood is associated with reduced immunocompetence and increased infectious disease morbidity. This study investigates whether zinc supplementation of infants born full term and small for gestational age affects mortality. Methods. A randomized, double-blind, controlled trial with 2-by-2 factorial design enrolled 1154 full-term small for gestational age infants to receive in syrup 1 of the following: riboflavin; riboflavin and zinc (5 mg as sulfate); riboflavin, calcium, phosphorus, folate, and iron; or riboflavin, zinc, calcium, phosphorus, folate, and iron. A fixed dosage of 5 mL per child was given daily from 30 to 284 days of age. Household visits were made 6 days per week to provide the syrup and conduct surveillance for illness and death. When a child’s death was reported, parental reports and medical records were used to ascertain the cause. The effects of zinc and of the combination of iron, folate, calcium, and phosphorus were analyzed by intent to treat. The mortality analysis was performed using a survival analytic approach that models time until death as the dependent variable; all models had 2 terms as independent variables: 1 for the zinc effect and 1 for the vitamin and mineral (calcium and phosphorus, folate and iron) effect. Results. Zinc supplementation was associated with significantly lower mortality, with a rate ratio of 0.32 (95% confidence interval: 0.12–0.89). Calcium, phosphorus, folate, and iron supplementation was not associated with a mortality reduction, although a statistically nonsignificant trend toward reduction was observed with a rate ratio of 0.88 (95% confidence interval: 0.36–2.15). Conclusion. Zinc supplementation in small for gestational age infants can result in a substantial reduction in infectious disease mortality.

Signs of asphyxia at birth and risk of schizophrenia - Population-based case-control study

Abstract: Background Previous research has found an association between obstetric complications and schizophrenia, but in many studies the sample size was limited, and no assessment of specific exposures was possible. Aims To assess the role of different complications, and in particular to distinguish between disordered foetal development and hypoxia at birth. Method From the Stockholm County In-Patient Register and community registers, we identified 524 cases of schizophrenia and 1043 controls, matched for age, gender, hospital and parish of birth. Data on obstetric complications were obtained from birth records. Results There was a strong association between signs of asphyxia at birth and schizophrenia (OR 4.4; 95% C11.9-10.3) after adjustment for other obstetric complications, maternal history of psychotic illness and social class. Conclusions Signs of asphyxia at birth are associated with an increased risk of schizophrenia in adults.

What's so bad about teenage pregnancy?

Abstract: A systematic literature review identified the most frequently cited medical consequences of teenage pregnancy as anaemia, pregnancy-induced hypertension, low birth weight, prematurity, intra-uterine growth retardation and neonatal mortality. Critical appraisal suggested that increased risks of these outcomes were predominantly caused by the social, economic, and behavioural factors that predispose some young women to pregnancy. Maternal age less than 16 years was associated with a modest (1.2-2.7 fold) increase in prematurity, low birth weight and neonatal death.

Risk factors for small-for-gestational-age babies: The Auckland Birthweight Collaborative Study

Abstract: Objective: This case-control study determined whether internationally recognized risk factors for small-for-gestational-age (SGA) term babies were applicable in New Zealand. Methodology: All babies were born at 37 or more completed weeks of gestation in one of three hospitals in Auckland. Cases weighed less than the sex specific 10th percentile for gestational age at birth, and controls (appropriate-for-gestational-age (AGA)) were a random selection of heavier babies. Information was collected by maternal interview and from obstetric databases. Results: Information from 1714 completed interviews (844 SGA and 870 AGA) was available for analysis. Computerized obstetric records were available for 1691 of the 1701 women who consented to such access. In a multivariate analysis allowing for sex, gestational age at birth, social class and other potential confounders, mothers who smoked had a significantly increased risk of an SGA baby (adjusted OR 2.41; 95% CI 1.78–;3.28), as did primiparous mothers (adjusted OR 1.34; 95% CI 1.03–;1.73), mothers of Indian ethnicity (adjusted OR 3.22; 95% CI 1.95–;5.30), women with pre-eclamptic toxaemia (adjusted OR 2.42; 95% CI 1.08–;5.40) and those with pre-existing hypertension toxaemia (adjusted OR 5.49; 95% CI 1.81–;16.71). Mothers of SGA infants were shorter (P < 0.001) and reported lower prepregnancy body weights (P < 0.001) than mothers of AGA infants. The population attributable fraction for smoking suggests that up to 18% of SGA infants born in the ABC Study could be related to maternal smoking. Conclusions: Risk factors associated with SGA births in other countries are also important in New Zealand. Smoking in pregnancy is an important and potentially modifiable behaviour, and efforts to decrease the number of women who smoke during pregnancy should be encouraged.

Mothers with congenital adrenal hyperplasia and their children: outcome of pregnancy, birth and childhood.

Abstract: OBJECTIVES Fertility rates in women with congenital adrenal hyperplasia (CAH) are reported to be poor, but few data are available. We assessed rates and course of pregnancy, mode of delivery and long-term outcome of offspring from women with CAH. DESIGN A large cohort of women with CAH due to 21-hydroxylase deficiency had initially been diagnosed and followed at one centre. Those women who had given birth were contacted. Information was gathered from hospital records, direct patient contact, structured questionnaire and the Documentation of Pregnancy and Preventive Care Booklets. RESULTS Between 1978 and 1998, 18 women with CAH (one salt wasting, 12 simple virilizing, five nonclassical) had given birth to 31 children (18 females, 13 males). Delivery was by Caesarean section in 16 out of the 31 children. None of the female newborns was masculinized. Twenty-nine children were born at term, five children were small for gestational age (SGA). Postnatal development was basically normal in all children; 18 are now older than 10 years, seven are between 5 and 10 years old, six are less than 5 years old. CONCLUSIONS Fertility is reduced in females with CAH, especially those with the severe or salt wasting phenotype. In those women with CAH who do conceive, course and outcome of pregnancy is mostly uneventful, although the rate of SGA offspring may be increased. Psychomotor and somatic long-term development of the children was within normal limits.

Carbohydrate metabolism during long-term growth hormone treatment in children with short stature born small for gestational age.

Abstract: OBJECTIVE To assess possible side-effects of long-term continuous growth hormone (GH) treatment on carbohydrate (CH) metabolism in children with short stature born small for gestational age. DESIGN In a prospective, randomised double-blind, dose–response multicentre trial, the effect of GH treatment on CH metabolism was evaluated, comparing two GH dosages [3 vs. 6 IU/(m2 body surface·day)]. PATIENTS Seventy-eight children with short stature (height SD-score < − 1·88) born small for gestational age (birth length SD-score < − 1·88) being all prepubertal with a mean (SD) chronological age of 7·3 (2·2) years before start of treatment. MEASUREMENTS Glucose and insulin concentrations during oral glucose tolerance tests (OGTTs) and glycosylated haemoglobin (HbA1c) were measured before and during 6 years of GH treatment. RESULTS Before treatment, the glucose response to oral glucose after 120 min was in six of the 78 children (8%) above 7·8 mmol/l but below 11·1 mmol/l, indicating impaired glucose tolerance (IGT), whereas after 6 years of GH treatment, IGT was found in 4% of the children. None of the children developed diabetes mellitus. Mean fasting glucose levels had increased significantly by 0·5 mmol/l after 1 year of GH treatment, without a further increase thereafter. The 2-h area under the curve adjusted for fasting levels (AUCab) for glucose and the HbA1c levels were lower after 6 years of GH treatment compared to baseline. During GH treatment, all HbA1c levels were in the normal range. In contrast to the effects on glucose levels, GH treatment induced considerably higher fasting insulin levels and glucose-stimulated insulin levels. The increase in AUCab for insulin occurred particularly during the first year of treatment, whereas the fasting insulin levels showed a further increase from one to six years. As a result, the 30- and 120-min ratios of insulin to glucose were higher during GH treatment compared to the start of treatment. The children who remained prepubertal during the entire study period showed similar patterns in glucose and insulin levels compared to the children who entered puberty. None of the observed changes were different between the GH dosage groups. CONCLUSIONS Continuous GH treatment during 6 years in children with short stature born small for gestational age has no adverse effects on glucose levels, even with dosages up to 6 IU/(m2 d). However, as has been reported in other patient groups, GH treatment induces higher fasting insulin levels and glucose-stimulated insulin levels, indicating relative insulin resistance. Since the consequences of long-term hyperinsulinism during childhood are unknown, careful follow-up of these GH-treated children born small for gestational age is required.

Increased incidence of hypospadias in small-for-gestational age infants in a neonatal intensive-care unit.

Abstract: Objective To identify the incidence of hypospadias in children born prematurely and small-for-gestational age (SGA), and to compare this subgroup with infants of similar age and weight without hypospadias. Patients and methods Records from the neonatal intensive-care unit (NICU) of a major metropolitan hospital active in labour and delivery were reviewed over a 3-year period, specifically examining newborns admitted with the diagnosis of SGA, defined as a birth weight of < 10th percentile for gestational age. In all, 154 patients were identified and their charts reviewed, recording the presence and severity of hypospadias, gestational age, birth weight, placental weight, cord length, cord vessels, maternal age, parity, multiple births, drug exposure and associated comorbidity. A control group of age- and weight-matched infants without hypospadias were also identified and compared. Results Of the 154 patients, 17 (11%) had hypospadias; the hypospadias was distal in nine, mid-shaft in four and proximal in four. The severity of hypospadias did not correlate with the degree of prematurity or weight for gestational age. Placental weight, fetal weight, fetal to placental weight ratio and cord length were all lower in the hypospadias group than in the control group, but the differences were not statistically significant. The maternal age was evenly distributed (median 32 years, range 20–43). Most mothers were multiparous and births were multiple in five of 17 (30%). Cryptorchidism (three) and inguinal hernia (three) were present in four of the infants. Conclusions The incidence of hypospadias in SGA infants admitted to the NICU is > 10 times higher than that reported for the general population. There was a trend to lower placental and fetal weight in SGA infants with hypospadias than in the controls. This finding merits further evaluation using a larger population database and suggests that factors resulting in SGA infants occur at a critical point early in development, affecting both somatic and urethral development.

The contribution of maternal smoking to preterm birth, small for gestational age and low birthweight among Aboriginal and non-Aboriginal births in South Australia.

Abstract: OBJECTIVES: To determine the contribution of maternal smoking to preterm birth (< 37 weeks' gestation), small for gestational age (SGA, birthweight < 10th percentile for gestational age) and low birthweight (< 2500 g) among Aboriginal and non-Aboriginal births in South Australia. DESIGN: Retrospective cohort analysis of population-based perinatal data. SETTING: The State of South Australia, population 1.5 million. PARTICIPANTS: 36059 women (of whom 851 were Aboriginal women) who had singleton births in 1998-1999. MAIN OUTCOME MEASURES: Relative risks and population-attributable risks of preterm birth, SGA and low birthweight from smoking in the second half of pregnancy, by age and Aboriginality. RESULTS: Aboriginal women had a higher rate of smoking in pregnancy than non-Aboriginal women (57.8% v 24.0% at the first antenatal visit) and high rates for all age groups, while the rates decreased with age among non-Aboriginal women. Heavy smoking increased with age, and Aboriginal women were heavier smokers. Women who smoked had elevated relative risks of preterm birth (1.64), SGA (2.28) and low birthweight (2.52), and all these showed a dose-response relationship. Among Aboriginal (versus non-Aboriginal) births, population-attributable risks were significantly higher for SGA (48% v 21%, and 59% for births to Aboriginal teenagers), low birthweight (35% v 23%) and preterm birth (20% v 11%). CONCLUSIONS: Health promotion programs, with a focus on smoking cessation and reducing uptake of smoking, need to be implemented in an appropriate cultural context, especially among young Aboriginal women. Such a program is being developed in South Australia.

The Small-for-Gestational Age Infant

Abstract: After completing this article, readers should be able to: 1. Compare and contrast symmetric and asymmetric growth in small-for-gestational age (SGA) infants. 2. Describe common physical characteristics of the SGA infant. 3. Describe common problems encountered in SGA infants and their management. 4. Characterize postnatal growth and neurodevelopmental outcomes of SGA infants. More than 50 years ago, pediatricians and early “neonatologists” observed that newborns who had birthweights that were statistically less than the 10th percentile or 2 standard deviations below the mean weight for their gestational age experienced unique medical problems. These infants, termed small for gestational age (SGA), had more frequent problems with perinatal depression (“asphyxia”), hypothermia, hypoglycemia, polycythemia, long-term deficits in growth, and neurodevelopmental handicaps and higher rates of fetal and neonatal mortality (Fig. 1⇓ ). Despite improvements in perinatal diagnosis and treatment, SGA infants are still born regularly (more frequently in underdeveloped countries, but also in the United States and other developed areas), and their perinatal morbidity and mortality rates continue to exceed those of normal fetuses and infants. Figure 1. Morbidities specific to SGA infants. Adapted from Lubchenco LO. The High Risk Infant . Vol. XIV. In: Schaffer AJ, Markowitz M, eds. Major Problems in Clinical Pediatrics . Philadelphia, Pa: WB Saunders; 1976. As the specific morbidities associated with SGA infants were recognized, relatively standardized approaches to their evaluation and clinical management were established. However, there always have been conflicting data in the literature regarding differences between SGA and appropriate-for-gestational age (AGA) infants in areas such as long-term outcome, nutrient metabolism, and growth potential. Recent literature suggest that adults who experienced severe growth restriction in utero have a significantly increased incidence of hypertension, insulin resistance, and type 2 diabetes. Additionally, new evidence suggests that untoward metabolic events in utero that produce fetal growth restriction also may produce lifelong alterations in growth …