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PubMed2000

Placental lesions associated with cerebral palsy and neurologic impairment following term birth.

OBJECTIVE: The aim of this study was to determine the association of placental findings with cerebral palsy and related forms of neurologic impairment (NI) following birth at > or =37 weeks gestation (term). DESIGN: In a retrospective comparison, placentas from 40 term infants with NI ascertained on the basis of clinicopathologic review for medicolegal consultation were compared with placentas from 176 consecutive meconium-stained term infants at low risk for NI. RESULTS: After stratification for severity, 9 lesions were significantly increased in placentas from infants with NI: 5 lesions generally considered to occur within days of the time of labor and delivery (meconium-associated vascular necrosis, severe fetal chorioamnionitis, chorionic vessel thrombi, increased nucleated red blood cells, and findings consistent with abruptio placenta) and 4 lesions generally believed to have their onset long before labor and delivery (diffuse chronic villitis, extensive avascular villi, diffuse chorioamnionic hemosiderosis, and perivillous fibrin). Findings independently associated with NI by logistic regression in this descriptive study were severe fetal chorioamnionitis (odds ratio [OR], 13.2; 95% confidence interval [CI], 1.2-144); extensive avascular villi (OR, 9.0; 95% CI, 1.6-51); and diffuse chorioamnionic hemosiderosis (OR, 74.8; 95% CI, 6.3-894). The risk of NI increased as a function of the number of lesions present (OR, 10.1; 95% CI, 5.1-20 for each additional lesion), particularly when lesions generally considered to occur near the time of labor and those believed to occur well before labor were found in the same placenta (OR, 94.2; 95% CI, 11.9-747). CONCLUSIONS: These findings suggest that placental pathology can contribute to an understanding of the mechanisms that contribute to NI at term.

Birth Injuries↗
PubMed2003

Ultrasonographic prediction of term birth weight: how accurate is it?

OBJECTIVE: The purpose of this study was to investigate the accuracy of 25 ultrasonic algorithms for the estimation of term fetal weight and to compare these results to an equation that is based on maternal and pregnancy-specific characteristics alone. STUDY DESIGN: Ultrasonography was performed in 82 nondiabetic gravid women at 35 to 41 weeks of gestation. Fetal biparietal diameter, abdominal circumference, head circumference, and femur length were measured. Twenty-five ultrasonic fetal biometric algorithms and an equation that is based only on maternal characteristics were used to predict birth weight. RESULTS: The correlation between predicted and actual birth weight ranged from 0.44 to 0.79 for the ultrasonic algorithms and was 0.60 for the maternal characteristics equation. Ultrasonic algorithms had mean absolute prediction errors that ranged from +/-263 to 646 g (+/-7.5%-18.8%). Accuracy for the maternal characteristics equation was not statistically different from the best performing ultrasonic algorithms (+/-353 g, +/-10.4%). CONCLUSION: Term birth weight estimates that use ultrasonography are generally no more accurate than predictions that are based solely on quantitative assessment of maternal and pregnancy-specific characteristics.

Algorithms↗
PubMed2001

Periodontal infections and pre-term birth: early findings from a cohort of young minority women in New York.

The aim of this report is to provide early data from an ongoing study examining (i) the relationship between periodontal infections and pre-term low birth weight (PLBW) in a cohort of young, minority, pregnant and post-partum women; and (ii) the effect of periodontal interventions on pregnancy outcome. During the first 2 yr of the study, 213 women were enrolled and examined clinically for dental plaque, calculus, bleeding on probing, and probing depth. Birth outcome data were available for 164 women, including one group (n = 74) subjected to oral prophylaxis during pregnancy, and a second group (n=90) who received no prenatal periodontal treatment. Subgingival plaque samples were available from 145 subjects (4 samples/subject) and were analyzed by checkerboard DNA hybridization with respect to 12 bacterial species. The prevalence of PLBW was 16.5% (27 cases) in this cohort. No differences in clinical periodontal status were observed between PLBW cases and women with normal birth outcome. However, PLBW mothers had significantly higher levels of Bacteroides forsythus and Campylobacter rectus, and consistently elevated counts for the other species examined. PLBW occurred in 18.9% of the women who did not receive periodontal intervention (17 cases), and in 13.5% (10 cases) of those who received such therapy.

Adolescent↗
PubMed1989

The relationship between maternal weight for height and term birth weight in teens and adult women.

Many factors may contribute to the high rates of low birth weight observed in most studies of teen pregnancy. This study examined the contribution of low prepregnancy weight and low gestational weight gain, both of which are more common in teens than in adults. Records were obtained for 90 primiparous teens (less than 16 years old at conception) and 90 primiparous adult women (19-30 years old at conception) delivering at St. Luke's Hospital in New York City. Women were matched for year of delivery and clinic payment status. Mean birth weight was 264 g lower in the teen group than in the adult group. In both groups, birth weight increased with increased maternal prepregnancy weight, weight gain, and percent of standard weight for height at term. In adults, birth weight plateaued when maternal weight for height was 120% or more of standard. In teens, however, birth weight was 200-400 g lower than in the adults in all weight-for-height categories except at 140% or more of standard. Both the low birth weight rates and the portion of infants weighing less than 3000 g were much higher in the teen mothers. Thus, even if maternal weight at term is appropriate for height, teen mothers have smaller babies than adult women do.

Adolescent↗
PubMed2006

Evidence for an association between mannose-binding lectin 2 (MBL2) gene polymorphisms and pre-term birth.

PURPOSE: Human mannose-binding lectin, encoded by the MBL2 gene, is an important component of innate immunity and an important regulator of inflammatory processes. MBL2 gene polymorphisms are associated with an increased risk of neonatal infections and some data suggest a relation between the maternal MBL2 genotype and the risk of premature delivery. In this study, we evaluated whether there is an association between the fetal MBL2 genotype and prematurity. METHODS: A microarray-based on-chip PCR method was used to simultaneously detect five common MBL2 polymorphisms (codon 52, 54, 57; promoter -550, -221) in 204 DNA samples isolated from archival blood cards. MBL2 genotypes of infants born before the 36th week of pregnancy (N = 102) were compared to a control group of infants born at term after the 37th week (N = 102). RESULTS: The frequency of the codon 52 polymorphism was significantly higher in the pre-term group compared to the term group (10.8% versus 4.9%, P = 0.04), while the frequency of the codon 54 polymorphism was equal in both groups (11.3% versus 11.8%). Interestingly, carriers of genotypes (O/O) likely conferring deficient MBL plasma levels were more common in the group of premature birth (9.8% versus 2.9%, P = 0.05), while the promoter -550 C/C genotype was underrepresented in the pre-term birth group (24.5% versus 39.2%, P = 0.03). CONCLUSION: Our data add to the knowledge about genetic predisposition to prematurity and suggest that the fetal MBL2 genotype might be an additional genetic factor contributing to the risk of premature delivery.

Austria↗
PubMed1991

A comparison of recurrent and isolated small-for-gestational-age term births.

In this study, based on total Western Australian singleton Caucasian births, women who had repeatedly given birth to small-for-gestational-age (SGA) term infants ('repeater' mothers) were compared with multiparous women who had had only one such infant ('non-repeater' mothers). Women with any preterm births were excluded. The study population comprised 678 repeater and 986 non-repeater mothers. Multiple logistic regression analysis indicated that weight loss or static weight in the third trimester of pregnancy, paternal smoking, low maternal birthweight, short maternal height and unknown family disease history were independent risk factors for repeater status compared with non-repeaters. The risk associated with paternal smoking was confined to mothers who were non-smokers themselves. There may have been a direct association between paternal smoking and recurrent fetal growth retardation or paternal smoking may have acted as a 'marker' for certain behavioural, environmental, social and economic factors which were not measured. Neonatal outcome was worse for the SGA infants of non-repeater mothers than for those of repeater mothers, although the latter were significantly more likely to weight less than 2500 grams.

Female↗
PubMed2003

Risk of sudden infant death syndrome and week of gestation of term birth.

OBJECTIVE: We sought to determine if the risk of sudden infant death syndrome (SIDS) varied according to week of delivery at term among elective and nonelective births. DESIGN: Retrospective cohort study. PARTICIPANTS: All single infants live born between 37 and 42 weeks gestation in Scotland between 1992 and 1995 documented in the Scottish Morbidity Record. OUTCOME: Death in the first year of life where SIDS was in the principal position on the death certificate. RESULTS: There were 202,622 eligible births and 119 deaths attributed to SIDS. Among infants delivered electively, there was no significant association between risk of SIDS and week of delivery. Among those delivered nonelectively, the risk of SIDS declined significantly with each week of gestation (odds ratio .72, 95% confidence interval .60-.86). This trend was only minimally attenuated by adjustment for maternal age, parity, smoking and socioeconomic deprivation category, infant sex, Apgar score, mode of delivery, and birth weight decile (adjusted odds ratio .78, 95% confidence interval .65-.93). CONCLUSIONS: We hypothesize that early spontaneous labor at term and SIDS may be linked because of a common association with suboptimal intrauterine environment.

Adult↗
PubMed2001

Low 5-minute Apgar score: a population-based register study of 1 million term births.

OBJECTIVE: To determine the rate of 5-minute Apgar scores below 7 in term infants (at least 37 weeks) in Sweden during 1988-1997, evaluate the influence of obstetric risk factors on low 5-minute Apgar scores, and to study the infant prognosis regarding infant mortality, neonatal neurologic morbidity, and outcome. METHODS: Data were collected from the Swedish Medical Birth Registry 1988-1997, and the National Hospital Discharge Registry. Odds ratios (OR) and risk ratios were calculated. RESULTS: Among 1,028,705 term newborns, 7787 (0.76%) had 5-minute Apgar scores below 7. The annual rate of low Apgar scores decreased from 0.77% in 1988 to 0.63% in 1992, but thereafter increased to 0.82% in 1998. The highest OR was found for vaginal breech delivery (OR 6.7), birth weights above 5 kg (OR 6.3), and second born twins (OR 4.1). Primiparity, maternal age, smoking, post-date pregnancy, epidural analgesia, male infant gender, and being born at night, were also significant risk factors for Apgar below 7 at 5 minutes. The infant mortality rate was 48 per 1000 (OR 14.4), and the ORs were 31.4 for a diagnosis with cerebral palsy, 7.9 for epilepsy, and 9.5 for mental retardation. CONCLUSION: Several obstetric risk factors are associated with low 5-minute Apgar score in term infants. Mortality and the risk of severe neurologic morbidity are increased in these infants.

Apgar Score↗
PubMed2006

The role of stillbirth prevention and late preterm (near-term) births.

Stillbirth remains an important cause of fetal loss in both the term and late-preterm (near-term) pregnancy. As ongoing research further elucidates the causes of intrauterine fetal demise (IUFD), strategies can be tested to reduce its occurrence. Currently, reduction of IUFD in the term and late preterm infants should focus on reduction or elimination of risk factors (eg, smoking and control of medical conditions) and enhanced fetal surveillance in those pregnancies identified to be at increased risk.

Female↗
PubMed1992

Normal birthweight at Port Moresby General Hospital: a retrospective survey of normal term births to determine birthweight distribution.

A retrospective survey was carried out of term babies born to Papua New Guinean parents at the Port Moresby General Hospital. Only babies of known gestational age from uncomplicated pregnancies who were delivered after 37 and before 42 completed weeks were included in the study. The purpose of the study was to determine the birthweight distribution at term of uncomplicated pregnancies for Papua New Guineans at the Port Moresby General Hospital. The sources of the data were the patients' case records and the labour ward register. The Epi Info V5 (CDC and WHO) statistical software package was used for the analysis. 404 subjects were studied; 116 of these were nulliparae before the index delivery. For the whole study population some of the findings were as follows: mean birthweight 3251g, standard deviation 403.5, mode 3100g, median 3250g, 10th percentile 2713g, 90th percentile 3750g. Birthweight at 41-42 weeks was significantly greater than at 37-38 completed weeks. The height and parity of the mother and sex of the baby also had significant effects on birthweight but the latest birth interval had no significant influence. Babies of highland mothers were significantly heavier than babies of Papuan mothers.

Age Factors↗
PubMedDate not supplied

Serial visual evoked potentials and outcome in term birth asphyxia.

Birth asphyxia is a major cause of neonatal mortality and morbidity. It remains difficult to predict accurately neurologic outcome among survivors, particularly infants with moderate hypoxic-ischemic encephalopathy. Visual evoked potential (VEP) is a reproducible measure of cortical function and reflects acute changes in central nervous system status secondary to asphyxial insult. We performed serial VEPs on 36 term infants with documented birth asphyxia to investigate the relationship between VEPs and neurodevelopmental outcome at 18 months of age. Fourteen infants were neurologically intact at subsequent examination; all had normal VEPs during the first week of life. Twenty-two infants had died or were significantly handicapped at 18 months of age; 20 had abnormal VEPs persisting beyond day 7 of life. Abnormal VEPs accurately predicted abnormal outcome (100%) and were both sensitive (91%) and specific (100%). In 20 infants who were classified as moderately asphyxiated according to the criteria of Sarnat and Sarnat, even greater accuracy, sensitivity, and specificity (all 100%) were observed. VEPs demonstrate good correlation with neurodevelopmental outcome in term infants with birth asphyxia and provide accurate prognostic information useful in the clinical management of these infants.

Apgar Score↗
PubMed1975

[Use of colposcopic examinations in the determination of the birth term].

The authors have determined with the help of colpo-cytological examination the birth's time wich can be expected in 375 pregnancy. Their experiences: 1. With colpo-cytological examination in 76,8% of the cases they could determine the time of the expected delivery. 2. This method can offer precious facts to diagnose overcarrying. 3. This method is simple, quick, cheap, and can be performed everywhere.

Colposcopy↗
PubMed1992

Maternal weight status and term birth weight in first and second adolescent pregnancies.

The relationship of maternal weight status to birth weight was evaluated retrospectively for the first and second pregnancies of 72 younger (age 12-15 years at first conception) and 80 older (age 16-19 years at first conception) low-income adolescents (76% black, 24% white). Mean birth weight increased during the second pregnancies of both groups (277 g and 132 g, respectively). Multiple regression analysis (controlling for potentially confounding variables) indicated a positive relationship between second and third trimester rate of maternal weight gain (kg/week) and birth weight for younger adolescents during their second pregnancy (p = 0.014), and for older adolescents during their first pregnancy (p = 0.047). Mean birth weight increased with each increase in maternal weight-for-height (W/H) category near term from the lowest (< 100% of standard) to the highest (> or = 140% of standard), for both age groups during both pregnancies. Multiple regression analysis indicated that among older adolescents birth weight increased 4.2 +/- 2.0 g (X +/- SE) for each 1% increase in maternal W/H near term in their first pregnancy (p = 0.038) and 7.1 +/- 1.8 g for each 1% increase in maternal W/H near term in their second pregnancy (p = 0.0003). Among younger adolescents these relationships, while in the same direction, were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Plasma leptin status in young calves: effects of pre-term birth, age, glucocorticoid status, suckling, and feeding with an automatic feeder or by bucket.

Plasma leptin concentrations depend on energy intake and fat stores and are modified by hormones, such as glucocorticoids. We have measured plasma leptin concentrations in pre-term calves (born on day 277 of gestation) during the first week of life, in full-term calves (290 days of gestation), fed similar amounts of nutrients with colostrum or a milk-derived formula, combined with or without dexamethasone treatment (to simulate a high glucocorticoid status), during the first five days of life, and in calves fed with an automatic feeder or by bucket or suckling on dams up to day 28. Leptin concentrations increased (P<0.05) from birth to day 7 in pre-term calves. In full-term calves leptin concentrations were stable from day 1 to day 4 in colostrum-fed animals, but decreased (P<0.05) and were lower (P<0.05) if fed a formula with similar amounts of energy and macronutrients as colostrum. Concentrations increased (P<0.05) from day 1 to day 2 in calves suckling on dams and then remained elevated, but did not change and were lower in calves fed with the automatic feeder or by bucket than in suckling calves. Dexamethasone only slightly elevated leptin concentrations. There was no episodic secretion pattern, and there were no consistent associations of leptin with various metabolites and hormones. In conclusion, plasma leptin in young calves with respect to effects of nutrition (low energy intake) and hormones (glucocorticoids) and in association with metabolic changes behaved differently from what is known in mature cattle.

Animals↗