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PubMed1990

Tolerance of fat emulsions in very low birthweight neonates: effect of birthweight on plasma lipid concentrations.

Plasma concentrations of various lipid fractions (total lipids, free glycerol, true triglycerides, free fatty acids, and cholesterol) were studied in 20 normally grown neonates ranging in birthweight from 820 to 1500 gm and in gestational age from 28 to 34 weeks. They were subdivided into three weight categories: 750 to 999, 1000 to 1249, and 1250 to 1500 gm. A lipid emulsion was infused at a constant rate over 24 hours, beginning with an hourly infusion rate of 0.04 gm/kg and increasing each day by 0.04 gm/kg up to a maximum of 0.16 gm/kg. Neonates who weighed less than 1000 gm had higher mean plasma concentrations of total lipids and free glycerol at hourly infusion rates of 0.08 and 0.16 and of triglycerides and free fatty acids at hourly infusion rate of 0.16 gm/kg than their heavier peers. These data suggest that extreme caution be used when administering parenteral fat emulsions to neonates who weigh less than 1000 gm and that we need to monitor plasma closely for signs of hyperlipemia.

Birth Weight↗
PubMed2000

Enteral antibiotics for preventing necrotising enterocolitis in low birthweight or preterm infants.

BACKGROUND: Necrotising enterocolitis continues to be a problem, particularly in preterm neonates. There have been reports published suggesting that the use of enteral antibiotics may be effective as prophylaxis. This systematic review was undertaken to clarify the issue. OBJECTIVES: To evaluate the benefits and harms of enteral antibiotic prophylaxis for necrotising enterocolitis in low birth weight and preterm infants. SEARCH STRATEGY: Searches were made of the Oxford Database of Perinatal trials, MEDLINE (search terms: necrotizing enterocolitis, antibiotics; LIMITS: newborn infant), previous reviews with cross references, abstracts, conference and symposia proceedings, expert informants and journal handsearching in the fields of Neonatal Pediatrics and Microbiology. SELECTION CRITERIA: All randomized or quasi-randomized controlled trials where enteral antibiotics were used as prophylaxis against NEC in LBW (<2500g) and/or preterm (<37 weeks gestation) infants. DATA COLLECTION AND ANALYSIS: The standard method of the Cochrane Collaboration and its Neonatal Review Group was used. The methodological quality of each trial was reviewed by the second author who was blinded to the trial authors and institutions. Each author extracted data separately before comparison and resolution of differences. Relative risk (RR), risk difference (RD), and number needed to treat were used in the analysis. MAIN RESULTS: The administration of prophylactic enteral antibiotics resulted in a statistically significant reduction in NEC [RR 0.47 (0.23, 0.98); RD -0.072 (-0.136, -0.008); NNT 13.9 (7.4, 125)]. There was a reduction in NEC-related deaths which was of borderline statistical significance [RR 0.16 (0.02, 1.26); RD -0.097 (-0.183, -0.010); NNT 10.3 (5.46, 100)]. There were no significant differences in all deaths (one trial only) or in NEC-like enteropathies (one trial only). There was a statistically significant increase in the incidence of colonisation with resistant bacteria [RR 1.73 (1.00, 2. 97); RD 0.123 (0.008, 0.238); NNT 8.1 (4.2, 125)]. REVIEWER'S CONCLUSIONS: There is insufficient evidence to support the use of enteral antibiotic prophylaxis for NEC in clinical practice. To address this question further, a large trial would be required with a sample size sufficient to examine all the important benefits and harms. Adverse outcomes associated with infection, particularly with resistant bacteria, should be evaluated.

Anti-Bacterial Agents↗
PubMed1989

Predictors of low birthweight delivery: a study of factors influencing birthweights.

The average birth weight among the 292 infants was 3,028 (+/- 349 g). The incidence of LWB was 8.9 per cent, being predominantly SGA. There were no significant statistical differences of socioeconomic, obstetric and anthropometric variables between the mothers of the LBW and non LBW groups. Maternal height and mid arm circumference seem to be a promising predictors of LBW delivery. The decision of the cut-off points of these variables depends on the objective and the available resources. These variables should be field-tested in a wider scale before being advocated for use as predictors of LBW delivery.

Adult↗
PubMed2005

The association of ambient outdoor temperature throughout pregnancy and offspring birthweight: findings from the Aberdeen Children of the 1950s cohort.

BACKGROUND: We assessed the effect of mean ambient outdoor temperature during gestation on birthweight. OBJECTIVE: To assess the effect of mean ambient outdoor temperature during gestation on birth weight. DESIGN: Birth cohort study with record linkage to climate databases. SETTING: Aberdeen, Scotland. SAMPLE: A total of 12,150 individuals born in Aberdeen, Scotland between 1950 and 1956. METHODOLOGY/PRINCIPAL FINDINGS: Perinatal data from a cohort of 12,150 individuals born in Aberdeen, Scotland between 1950 and 1956 were linked to daily outdoor temperature data. Birthweight was seasonally patterned, with lowest birthweights among those born in the winter months (December-February) and highest birthweights among those born in the autumn months (September-November); P= 0.01 for joint sine-cosine functions. Mean ambient outdoor temperature during the first trimester of pregnancy was inversely associated with birthweight and mean ambient outdoor temperature during the third trimester of pregnancy was positively associated with birthweight. In fully adjusted (for sex, maternal age, birth year, birth order and social class) models a 1 degrees C increase in mean ambient outdoor temperature in the mid 10-day period of the first trimester was associated with a 5.4-g (95% confidence interval [CI] 2.9, 7.9 g) decrease in birthweight, whereas a 1 degrees C increase in the mid 10-day period of the third trimester was associated with a 1.3-g (95% CI 0.50, 2.1 g) increase in birthweight. Ambient outdoor temperature in the first trimester of pregnancy explained the seasonal patterning of birthweight. MAIN OUTCOME MEASURE: Birthweight. RESULTS: Birthweight was seasonally patterned, with lowest birthweights among those born in the winter months (December-February) and highest birthweights among those born in the autumn months (September-November); P= 0.01 for joint sine-cosine functions. Mean ambient outdoor temperature during the first trimester of pregnancy was inversely associated with birthweight and mean ambient outdoor temperature during the third trimester of pregnancy was positively associated with birthweight. In fully adjusted (for sex, maternal age, birth year, birth order and social class) models a 1 degrees C increase in mean ambient outdoor temperature in the mid 10-day period of the first trimester was associated with a 5.4 g (95% confidence interval 2.9, 7.9 g) decrease in birthweight, whereas a 1 degrees C increase in the mid 10-day period of the third trimester was associated with a 1.3 g (95% confidence interval 0.50, 2.1 g) increase in birthweight. Ambient outdoor temperature in the first trimester of pregnancy explained the seasonal patterning of birthweight. CONCLUSION: Higher ambient outdoor temperature in the first trimester of pregnancy and/or lower ambient outdoor temperature in the third trimester are associated with reduced offspring birthweight. With the increasing occurrence of temperature extremes, in particular, heat waves, these findings, if replicated in other studies, have important public health implications.

Adolescent↗
PubMed1999

Birthweight and the risk for type 2 diabetes mellitus in adult women.

BACKGROUND: Previous reports have suggested an association between birthweight and type 2 diabetes mellitus. OBJECTIVE: To investigate the association between birthweight and type 2 diabetes in a large cohort of adult women, taking into account potential explanatory factors in childhood and adult life. DESIGN: Cohort study. Birthweight was ascertained at the end of follow-up. SETTING: The Nurses' Health Study, a cohort of 121,701 U.S. women born from 1921 to 1946 who have been followed since 1976. PARTICIPANTS: 69,526 women in the Nurses' Health Study who were free of diabetes at baseline and reported their own birthweight on the 1992 questionnaire. MEASUREMENT: 2123 cases of confirmed type 2 diabetes diagnosed from 1976 to 1992. RESULTS: Low birthweight was associated with increased risk for type 2 diabetes. Age-adjusted relative risks suggested a reverse J-shape association between birthweight and risk for type 2 diabetes. However, after adjustment for adult body mass index and maternal history of diabetes, an inverse association across the entire range of birthweight became apparent; compared with the reference group, relative risks by ascending birthweight category were 1.83 (95% CI, 1.55 to 2.16) for birthweight less than 5.0 lb, 1.76 (CI, 1.49 to 2.07) for birthweight 5.0 to 5.5 lb, 1.23 (CI, 1.11 to 1.37) for birthweight 5.6 to 7.0 lb, 0.95 (CI, 0.82 to 1.10) for birthweight 8.6 to 10.0 lb, and 0.83 (CI, 0.63 to 1.07) for birthweight of more than 10 lb (P for trend < 0.001). Adjustment for ethnicity, childhood socioeconomic status, and adult lifestyle factors did not substantially alter this association. The association between birthweight and risk for type 2 diabetes was strongest among women whose mothers had no history of diabetes. CONCLUSIONS: Birthweight is inversely associated with risk for type 2 diabetes during adulthood. Examination of prenatal nutrition and other potential in utero determinants of both birthweight and risk for type 2 diabetes may yield new means to prevent type 2 diabetes.

Adult↗
PubMed1995

The influence of fetal and maternal factors on the distribution of birthweight.

This review of common risk factors for low birthweight emphasizes the usefulness of examining the entire distribution of birthweight. Of the factors we examined, only short gestational age seemed to affect the low end of the birthweight distribution in the form of skewness. Most factors, such as maternal race, infant sex, plurality, altitude, education, and smoking seem to affect the entire birthweight distribution, indicating a generalized effect. With the exceptions of race, infant sex, parity, and altitude, these factors seemed to have similar associations with both low birthweight and infant mortality. However, only the effects of race and sex on mortality have been repeatedly studied in detail for different combinations of gestational age and birthweight. A few of the factors examined, notably infant sex and parity, have opposite associations with birthweight and infant mortality. Female infants and firstborn infants have lower birthweights than their counterparts, but are more likely to survive. For factors that significantly affect the birthweight distribution, but do not affect mortality equally across the birthweight distribution, the development and use of population-based standards may result in less misclassification of IUGR. Separate standards by infant sex, altitude, and perhaps race may lead to more accurate classification of intrauterine growth. Last, the majority of risk factors have differential effects on birthweight depending on the level of the associated factors. For example, low maternal age and low prepregnancy BMI are associated with both increased risk of low birthweight and poor infant survival. Older maternal age and high prepregnancy BMI are associated with reduced risk of low birthweight, but with increased risk of infant mortality. One possible explanation is that young maternal age and low prepregnancy BMI are associated with adverse behavioral risk factors such as cigarette smoking, whereas increased age and high prepregnancy BMI are associated with gestational diabetes, multiparity, and genetic defects. It is possible that the greater variation in birthweight at the high end of the scale is indicative of increased risk of mortality. Thus, higher birthweight does not always equal better birth outcomes.

Birth Weight↗
PubMed1999

Psychosocial predictors of low birthweight: a prospective study.

OBJECTIVE: To examine the role of psychosocial risk factors for low birthweight. DESIGN: A prospective study. SETTING: Obstetric outpatient clinics of the University Hospital Vrije Universiteit, Amsterdam. PARTICIPANTS: Three hundred and ninety-six nulliparous women. METHODS: Questionnaires on background variables, daily stressors, psychological and mental wellbeing, social support and work factors were completed by the women in the first, second and third trimester of pregnancy. Low birthweight for gestational age was defined at different cut off points: 1. < or = 10th customised birthweight centile (n = 69); 2. < or = 5th customised birthweight centile (n = 54); 3. < 3rd customised birthweight centile (n = 35); and 4. < or = the 10th Dutch birthweight centile (n = 40). Multivariate logistic regression was applied and the results were expressed in odds ratios and their 95% confidence intervals. RESULTS: When the cut off level was defined < or = 5th and < 3rd customised centile, the number of daily stressors in the first trimester was a statistically significant risk factor (OR 1.04, 95% CI 1.01-1.07 and OR 1.04, 95% CI 1.01-1.08). No significant psychosocial risk factors could be identified when low birthweight for gestational age was defined < or = the 10th customised birthweight centile. When low birthweight for gestational age was defined < or = the 10th Dutch birthweight centile, number of hours housekeeping per week in the first trimester (OR 1.59, 95% CI 1.03-2.46), low subjective severity rating of daily stressors in the first trimester (OR 0.41, 95% CI 0.17-0.97) and depressive mood in the first trimester (OR 1.12, 95% CI 1.01-1.24) were statistically significant psychosocial risk factors after controlling for maternal weight and height, number of cigarettes smoked per day and educational level. CONCLUSIONS: In the first trimester of pregnancy maternal psychosocial factors are associated with an increased risk of low birthweight. The specific psychosocial risk factors found were different when the definition of low birthweight was changed. Therefore, in this field of research, we suggest use of the most valid outcome measure for low birthweight, being the customised birthweight centiles.

Anxiety↗
PubMed2006

The association between intratwin birthweight discordance and preterm birth in twin pregnancy.

BACKGROUND: Previous studies found that increased birthweight discordance among twins was associated with increased risk of perinatal mortality and morbidity, but there is disagreement regarding the relationship between birthweight discordance and the risk of preterm birth. AIMS: To examine the relationship between intratwin birthweight discordance and preterm birth, and the influence of total birthweight as a confounding factor. METHODS: We conducted a historical cohort study to assess the relationship between intratwin birthweight discordance and preterm birth, using the 1995-1997 twin registry data of the USA. Parallel analyses with and without adjustment for total birthweight were performed. RESULTS: A total of 147,262 eligible twin sets were included in the analysis. In the non-stratified analysis, preterm birth (< 37 weeks) rates were 64.3 and 51.8%, respectively, in subjects with a birthweight discordance > 25% and in those < or = 25%. In the analysis stratified by total birthweight, the rates of preterm birth were higher in subjects with a birthweight discordance > 25% than in those < or = 25% at every total birthweight stratum. Changing the thresholds to define preterm birth or treating gestational age as a continuously distributed variable yielded similar results. Using other methods to adjust for total birthweight also reversed the direction of this relationship. CONCLUSIONS: Increased intratwin birthweight discordance is associated with increased risk of preterm birth, and adjustment for total birthweight biases the relationship to the wrong direction. Clinicians should be aware of the possibility of a preterm birth when there are signs of discordance in birthweight between the two twins.

Birth Weight↗
PubMed2006

The relationship between birthweight discordance and perinatal mortality of one of the twins in a twin pair.

This study aimed to evaluate the prevalence of birthweight discordance among twins, to determine the risk cut-off point for birthweight discordance, and to clarify whether perinatal deaths are aggravated by birthweight discordance or by low birthweight itself. A population-based analysis of all twins born between 1995 and 1999 in Japan was conducted using data collected from national birth, death and stillbirth certificates. Birthweight discordance was determined as: higher birthweight minus lower birthweight divided by higher birthweight multiplied by 100. Among twins with a birthweight discordance of more than 15%, the fetal and perinatal mortality rate was higher than that of twins with a discordance of less than 15%. Ninety per cent of the relative cumulative frequency of twin live-births were within 25% of the birthweight discordance. Logistic regression analysis showed that the stillbirth of at least one of the twins is associated with the birthweight of the larger twin and birthweight discordance. It also showed that the stillbirth of both twins in the twin pair is associated with the birth-weight of larger twins and the gestational weeks. It was clarified that birthweight discordance was associated with the stillbirth of only one twin in the twin pair, and the stillbirth of both twins in the twin pair was associated with low birthweight itself.

Birth Weight↗
PubMed2003

The association between birthweight and current blood pressure: a cross-sectional study in an Australian Aboriginal community.

OBJECTIVES: To study the relationship of blood pressure to birthweight and current body mass index in a population with high rates of low birthweight (< 2.5 kg). DESIGN: A cross-sectional population screening program conducted between 1992 and 1998, with retrospective retrieval of birthweights. SETTING: A remote coastal Australian Aboriginal community with a high prevalence of diabetes, cardiovascular and renal disease. PARTICIPANTS: Eighty-two per cent of the community members (1473/1805) were screened. Birthweights were available for 767 (71%) of the screened participants aged 7-43 years. MAIN OUTCOME MEASURES: The association between birthweight and current blood pressure, accounting for current body mass index. RESULTS: Mean birthweights were low, and 18% of children and 35% of adults had been low-birthweight babies. In children (7-17 years), blood pressure was not correlated with birthweight, but in adults there was an inverse correlation - a 1 kg increase in birthweight was associated with a 2.9 mmHg (95% CI, 0.3-5.5 mmHg) decrease in systolic blood pressure, after adjusting for age, sex and current weight. Overweight adults with low birthweight had the highest blood pressures. CONCLUSIONS: Low birthweight is significantly associated with higher blood pressure in adult life, and the effect is amplified by higher current weight. Given the high rates of low birthweight in Aboriginal people in remote areas, and the detrimental effect of higher blood pressures on chronic diseases (currently present in epidemic proportions), interventions should focus on improving birthweights and on weight control in adolescents and adults. Special attention should be paid to children with low birthweight to avoid their becoming overweight in adult life.

Adolescent↗
PubMed1992

A comparison of risk assessment models for term and preterm low birthweight.

BACKGROUND: Most epidemiological research dealing with the assessment of risk for low birthweight has focused on all low birthweight births. Studies that have attempted to distinguish between term and preterm low birthweights have tended to examine preterm low birthweight, since the risk of perinatal mortality and morbidity is greatest for this group of infants. METHOD: This study uses data from 25,408 singleton births in a 20-county region in North Carolina to identify and compare risk factors for term and preterm low birthweights, and also examines the usefulness of separate multivariate risk assessment systems for term and preterm low birthweights that could be used in the clinical setting. RESULTS: Risk factors that overlap as significant predictors of both types of low birthweight include race, no previous live births, smoking, weight under 100 lb, and previous preterm or low birthweight birth. Age also is a significant predictor of both types of low birthweight, but in opposite directions. Younger age is associated with reduced risk of term low birthweight and increased risk of pattern low birthweight. CONCLUSION: Comparison of all risk factors indicates that different multivariate models are needed to understand the epidemiology of preterm and term low birthweights. In terms of clinical value, a general risk assessment model that combines all low birthweight births is as effective as the separate models.

Adolescent↗
PubMed2004

Relation between birthweight and blood pressure among 7-8 year old rural children in India.

BACKGROUND: Fetal malnutrition has been proposed as a cause of higher blood pressure. However, some studies have shown no or little effect of birthweight on blood pressure. Confounding and selection bias have been a problem in some of the studies. The ideal approach for avoiding selection bias is to conduct a prospective cohort study with minimal loss during follow-up. Therefore, the relationship of birthweight with blood pressure was examined in a cohort born during 1992-1993. METHODS: A cohort of 214 babies, born to usual residents in 10 villages of Haryana state in India on weekdays from September 1992 to November 1993 whose birthweight had been recorded by a trained field worker within 24 hours of delivery, were followed up during 2000-2001. During the 7-8 year period, 17 children had died and 12 had migrated. A trained public health nurse examined the remaining 185 children and measured their weight, height, and blood pressure. RESULTS: Mean birthweight was 2.7 kg and 21.1% had low birthweight (<2500 g). Current weight, height, and body mass index (BMI) were associated with birthweight (P < 0.05). Systolic blood pressure (SBP) increased significantly with rise in current weight and height. Relationship of SBP with birthweight seems to be a U-shaped distribution. Compared with the middle birthweight tertile group, in the lowest and highest birthweight groups boys have higher SBP in the higher BMI category (>or=13.5 kg/m(2)) and girls have higher SBP in both lower and higher BMI categories. ANOVA analysis showed that SBP and diastolic blood pressure (DBP) were not significantly different in birthweight tertile groups among boys, but for SBP the difference was statistically significant among girls (P = 0.03). However, multivariate linear regression analysis that included socioeconomic status and current anthropometeric measures (weight, height, BMI) revealed that birthweight is not associated with SBP or DBP, and the interaction between birthweight and gender was also not significant for SBP and DBP (P = 0.09). CONCLUSION: The findings of this population-representative cohort from rural India with 94% follow-up suggest that birthweight is not associated with blood pressure among 7-8 year old children.

Age Distribution↗