Maternal nutrition and birth weight

Sex Differences at Early Old Stage in Glycolipid Metabolism and Fatty Liver in Offspring Prenatally Exposed to Chinese Great Famine

Background

About 50 years ago, Chinese Great Famine (CGF) affected the entire population in China, and its long-term influence on the offspring has attracted significant attention for research. However, information on possible metabolic differences between sexes is limited. This study explored whether there might be sex differences in the risks of development of glucolipid metabolic dysfunction and fatty liver following prenatal exposure to CGF.

Materials and Methods

There were 11,417 subjects around 55 years of age (6,661 women and 4,756 men). They were divided as the exposed group in which the fetal stage was in CGF, and the unexposed group included those born after CGF. Analysis focused on comparisons between sexes.

Results

Compared to the unexposed group, the BMI and triglyceride (P < 0.05) in men were higher in exposed group, while waist circumference and blood sugar (P < 0.05) in the exposed women were significantly higher. With the ages being properly balanced, the risks of glycolipid metabolic dysfunction were significantly higher in both men and women in the exposed than in the unexposed group (P < 0.001). Prenatal exposure to CGF significantly increased risks of abnormal BMI (P < 0.001, 95% CI: 2.305–2.93), blood sugar (P < 0.05, 95% CI: 1.050–1.401), triglycerides (P < 0.05, 95% CI: 1.006–1.245), and fatty liver (P < 0.001, 95% CI: 1.121–1.390) in men, and increased risks of abnormal blood sugar (P < 0.05, 95% CI: 1.024–1.689) and positive urine sugar (P < 0.05, 95% CI: 1.062–6.211) in women. Height and body weight were either the same or higher in the exposed subjects compared with the unexposed ones, regardless of sexes.

Conclusion

This study is the first to identify sex differences in the long-term effects of CGF on metabolism and fatty liver. Importance of the findings include the benefits of prescribing medicine for the early prevention of certain diseases for each sex before aging based on the differences revealed. This study also shows “catch-up growth” in the offspring prenatally exposed to CGF as possible mechanisms underlying the long-term effects.

Developmental transitions in body color in chacma baboon infants: Implications to estimate age and developmental pace

OBJECTIVES

In many primates, one of the most noticeable morphological developmental traits is the transition from natal fur and skin color to adult coloration. Studying the chronology and average age at such color transitions can be an easy and noninvasive method to (a) estimate the age of infants whose dates of birth were not observed, and (b) detect interindividual differences in the pace of development for infants with known birth dates.

MATERIALS AND METHODS

Using a combination of photographs and field observations from 73 infant chacma baboons (Papio ursinus) of known ages, we (a) scored the skin color of six different body parts from pink to gray, as well as the color of the fur from black to gray; (b) validated our method of age estimation using photographic and field observations on an independent subset of 22 infants with known date of birth; and (c) investigated ecological, social, and individual determinants of age-related variation in skin and fur color.

RESULTS

Our results show that transitions in skin color can be used to age infant chacma baboons less than 7 months old with accuracy (median number of days between actual and estimated age = 10, range = 0-86). We also reveal that food availability during the mother's pregnancy, but not during lactation, affects infant color-for-age and therefore acts as a predictor of developmental pace.

DISCUSSION

This study highlights the potential of monitoring within- and between-infant variation in color to estimate age when age is unknown, and developmental pace when age is known.

Low birth weight, maternal birth-spacing decisions, and future reproduction : A cost-benefit analysis

The aim of this study is an analysis of the possible adaptive consequences of delivery of low birth weight infants. We attempt to reveal the cost and benefit components of bearing small children, estimate the chance of the infants' survival, and calculate the mothers' reproductive success. According to life-history theory, under certain circumstances mothers can enhance their lifetime fitness by lowering the rate of investment in an infant and/or enhancing the rate of subsequent births. We assume that living in a risky environment and giving birth to a small infant may involve a shift from qualitative to quantitative production of offspring. Given high infant mortality rates, parents will have a reproductive interest in producing a relatively large number of children with a smaller amount of prenatal investment. This hypothesis was tested among 650 Gypsy and 717 non-Gypsy Hungarian mothers. Our study has revealed that 23.8% of the Gypsy mothers had low birth weight (<2,500 g) children, whose mortality rate is very high. These mothers also had more spontaneous abortions and stillbirths than those with normal weight children. As a possible response to these reproductive failures, they shortened birth spacing, gaining 2-4 years across their reproductive lifespan for having additional children. Because of the relatively short interbirth intervals, by the end of their fertility period, Gypsy mothers with one or two low birth weight infants have significantly more children than their ethnic Hungarian counterparts. They appear to compensate for handicaps associated with low birth weights by having a larger number of closely spaced children following the birth of one or more infants with a reduced probability of survival. The possible alternative explanations are discussed, and the long-term reproductive benefits are estimated for both ethnic groups.

Sex hormone activity in alcohol addiction: integrating organizational and activational effects

There are well-known sex differences in the epidemiology and etiopathology of alcohol dependence. Male gender is a crucial risk factor for the onset of alcohol addiction. A directly modifying role of testosterone in alcohol addiction-related behavior is well established. Sex hormones exert both permanent (organizational) and transient (activational) effects on the human brain. The sensitive period for these effects lasts throughout life. In this article, we present a novel early sex hormone activity model of alcohol addiction. We propose that early exposure to sex hormones triggers structural (organizational) neuroadaptations. These neuroadaptations affect cellular and behavioral responses to adult sex hormones, sensitize the brain's reward system to the reinforcing properties of alcohol and modulate alcohol addictive behavior later in life. This review outlines clinical findings related to the early sex hormone activity model of alcohol addiction (handedness, the second-to-fourth-finger length ratio, and the androgen receptor and aromatase) and includes clinical and preclinical literature regarding the activational effects of sex hormones in alcohol drinking behavior. Furthermore, we discuss the role of the hypothalamic-pituitary-adrenal and -gonadal axes and the opioid system in mediating the relationship between sex hormone activity and alcohol dependence. We conclude that a combination of exposure to sex hormones in utero and during early development contributes to the risk of alcohol addiction later in life. The early sex hormone activity model of alcohol addiction may prove to be a valuable tool in the development of preventive and therapeutic strategies.

Maternal early second trimester pregnancy weight in relation to birth outcome among Bengalee Hindus of Kolkata, India

OBJECTIVE

The study examined to what degree maternal early second trimester pregnancy weight is useful and efficient in predicting birth outcome of Bengalee women.

SUBJECTS AND METHODS

The cross-sectional retrospective study was conducted in a government general hospital in South Kolkata, India. This hospital serves the needs of people belonging to lower and lower middle class socio-economic groups. Data were collected by one-to-one interview for confirmation of age, history of last menstrual period (LMP) including medical disorders. Mother's weight was recorded at 14-18 weeks of pregnancy from the history of LMP. Birth weight was measured within 24h of delivery and gestational age was assessed by Ballard's method using newborn physical and neurological maturity scoring. Of the 331 Bengalees, 295 mother-baby pairs met the recruitment criteria and were included in this study.

RESULT

Mean +/- SD maternal early second trimester pregnancy weight and birth weight were 45.9+/-7.0kg and 2612+/-371g, respectively. The difference in mean weight (3.74kg) between mothers who delivered low birth weight (LBW) and normal birth weight (NBW) babies was statistically significant (t = 4.497, p < 0.001). Overall, the prevalence of LBW was nearly 34%. A higher incidence of LBW and lower mean birth weight was observed in first quartile or low weight (< or =40 kg) mothers. The rate of LBW decreased (chi2 =14.47, p<0.01) and mean birth weight increased significantly with increasing maternal weight (F=9.218, p<0.001). Risk ratio (RR) for LBW, intrauterine growth retardation (IUGR) and preterm birth in low weight (first quartile or <40.0 kg) mothers were 2.72 (95% confidence interval (CI): 1.45-5.10), 3.54 (95% CI: 1.17-10.74) and 1.97 (95% CI: 0.56-6.90), respectively, compared with heavier (>50.0kg) mothers. Finally, the present data showed that the maternal weight of <46.0 kg is the best cut-off for detecting LBW with 66% sensitivity and 75% negative predictive power.

CONCLUSION

The findings suggest a positive association between maternal early second trimester pregnancy weight and birth outcome. The present study provided an efficient cut-off point for detecting LBW. Antenatal caregivers in health institutions and community health workers in the field can use this cut-off value for screening pregnant women at early second trimester.

Birth weight and stages of CKD: a case-control study in an Australian population

BACKGROUND

In view of recent reports of the relationship of kidney disease to birth weight, we evaluate the relationship between birth weight and chronic kidney disease (CKD), including end-stage kidney disease, in Australian adults.

STUDY DESIGN

A case-control study.

SETTING & PARTICIPANTS

Patients attending the nephrology department at a major metropolitan hospital in Australia were asked to recall their birth weight, excluding those with structural kidney abnormalities. Two controls for each patient, matched for sex and within 5 years of age, were selected from participants from the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study, who had also been asked to report their birth weight.

PREDICTOR

Birth weight in kilograms.

OUTCOMES & MEASUREMENTS

CKD and stages were defined using the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative classification, proteinuria as a marker of kidney damage, and glomerular filtration rate estimates, by using the Modification of Diet in Renal Disease Study equation.

RESULTS

Of 189 patients with CKD who reported their birth weights for whom controls were identified, 106 were men. Mean age was 60.3 +/- 15 (SD) years. Mean birth weight overall was 3.27 +/- 0.6 versus 3.46 +/- 0.6 kg for their controls (P < 0.001), and proportions with birth weights less than 2.5 kg were 12.2% and 4.4% (P < 0.001). In patients with CKD, 22.8%, 21.7%, 18%, and 37.6% were in CKD stages 2 (n = 43), 3 (n = 41), 4 (n = 34), and 5 (n = 71), respectively. Birth weights by CKD stage and their AusDiab controls were as follows: stage 2, 3.38 +/- 0.52 versus 3.49 +/- 0.52 kg; P = 0.2; stage 3, 3.28 +/- 0.54 versus 3.44 +/- 0.54 kg; P = 0.1; stage 4, 3.19 +/- 0.72 versus 3.43 +/- 0.56 kg; P = 0.1; and stage 5, 3.09 +/- 0.65 versus 3.47 +/- 0.67 kg; P < 0.001. Differences in birth weights applied to women and men and people younger than 60 and 60 years and older and were present in the major "causal" categories of renal disease.

LIMITATIONS

Birth weight is by self-recall with a significant nonresponse rate to the questionnaire in both cases and controls.

CONCLUSIONS

Urban Australian patients with CKD had lower birth weights than their matched Australian controls. In addition, the more advanced the CKD stage, the lower the birth weight. Thus, lower birth weights appear to predispose to CKD and to its progression. Among possible explanations is the documented association between birth weight and nephron number.

Prise en charge d'épisodes récidivants de pancréatite aiguë par nutrition parentérale exclusive pendant la grossesse. Cas clinique et revue de la littérature

We report on a 35-year-old woman who underwent at 15 weeks of pregnancy exclusive parenteral nutrition for recurrent episodes of acute pancreatitis. She had a pancreatico-jejunal anastomosis stenosis secondary to cephalic duodenopancreatectomy. Nocturnal exclusive parenteral nutrition was used 79 days during pregnancy and 12 days during post-partum. The fetal growth was normal and the foetal well-being was normal. She presented cholestasis at 30 weeks of pregnancy treated medically. She delivered at 33 weeks of pregnancy by cesarean section a healthy baby girl with normal birth weight.

Examination of a conceptual model of child neglect

This study attempted to provide empirical support for conceptual definitions of child neglect. We identified 12 types of needs, conceptualizing neglect as occurring when children's basic needs are not adequately met. We examined measures administered to 377 children and caregivers at ages 4 and 6 years participating in longitudinal studies on child mal-treatment to identify potential indicators of these needs. Indicators were found for latent constructs, operationalizing three of the basic needs (emotional support and/or affection, protection from family conflict and/or violence, and from community violence). These latent constructs were used in a measurement model; this supported the conceptual definitions of neglect. A structural equation model then assessed whether the latent constructs were associated with child adjustment at age 8 years. Low level of perceived support from mother was associated with internalizing and externalizing behavior problems. Exposure to family conflict was also linked to these problems, and to social difficulties. Finally, children's sense of experiencing little early affection was associated with subsequent externalizing behavior and social problems. The approach of conceptualizing neglect in terms of unmet child needs, developing a measurement model to define latent neglect constructs, and relating these constructs to subsequent adjustment can build our understanding of neglect.

Impact of maternal age and maternal somatic characteristics on newborn size

Pregnancies during early adolescence were commonly thought to represent special risks, such as preterm delivery or low-weight newborns, resulting in increased mortality and morbidity of mother and child. An important biopsychosocial interaction can be assumed. In the present study the impact of maternal age and maternal somatic characteristics such as prepregnancy weight, stature, or pregnancy weight gain on newborn somatometric features (birth weight, birth length, head circumference, and arcomial circumference) using a dataset of 8,011 single term births were analyzed. The offspring of 215 extremely young mothers ages 12-16 years were significantly (P < 0.0001) lighter and smaller in all body dimensions than the offspring of older adolescent mothers, ages 17-19 years, and the offspring of adult gravida, ages 20-29 years, although no increased incidence of low-weight newborns (<2,500 g) could be observed. As expected, the youngest mothers were also significantly smaller and lighter than their older, biologically more mature counterparts, although the relative weight gain during pregnancy was highest in the youngest age group (23.4% vs. 22.9 and 22.1%, respectively). In general, age but also pregnancy weight gain and prepregnancy weight status were significantly associated with pregnancy outcome. Within term births taking place under sufficient psychosocial support, maternal somatic features had an important impact on newborn size.

Growth and development of adolescent girls from the Segou Region of Mali (West Africa)

In Mali, adolescent girls face many physical stresses which, with a history of poor nutrition, can result in delayed growth and development. Despite the fact that adolescent girls encounter nutritional demands, most research in Mali has focused only on young children. This study examines anthropometric and reproductive data on 1,056 adolescent girls (aged 10-17 years) from the Segou Region of Mali. When compared to the reference population, the Malian girls exhibited poorer indicators of growth and development. Z-scores for height-for-age and weight-for-age were below 0 at all ages. Urban girls had better indicators of growth than rural girls. The body composition data show that the Malian girls have lower body fat than reference girls. Menarche was delayed by about 1.5 years compared to girls from the United States and Europe. Delayed growth and development may be due to many factors, including a history of undernutrition, poor socioeconomic status, and increased energy demands.

Association between maternal age at menarche and newborn size

The impact of maternal age at menarche on newborn size was tested using data from 4,996 single births taking place at Vienna, Austria, between 1985 and 1995--so-called teenager pregnancies were excluded from the present analyses. All women experienced pregnancies between the ages of 19 to 42 years. Maturational time was related significantly to infant weight and length independent of maternal age and behavioral variables such as smoking. Early maturation, i.e., age at menarche before the 12th birthday, was significantly associated with decreased newborn weight and size. The incidence of low-weight newborns was significantly higher in early-maturing mothers. The more favorable nutritional status of women whose menarche occurred relatively early was not able to compensate for the negative effects of early maturation on intrauterine growth. Higher circulating estrogen levels in early maturers preserved into adulthood are discussed as possible reasons for intrauterine growth retardation of the offspring of early-maturing mothers.

Do big females have big pelves?

Previous studies have shown that maternal stature is a correlate of both pelvic size and reproductive efficiency. This study addresses the issue of body size and obstetric advantage. The relationship between pelvic size and three nonpelvic measures of body size is determined for females and males. The skeletal sample consists of blacks, whites, and Native Americans. The variables include 28 measures of the pelvis, length and head diameter of the femur, and clavicular length. The coefficient of multiple determination (CMD) is computed for each pelvic measure using multiple regression, with the three nonpelvic measures serving as the independent variables. Partial correlation coefficients are also calculated between each pelvic and nonpelvic variable, while controlling for the other two nonpelvic variables. The results show that all CMDs in females and all but one CMD in males are "low," i.e., below 33%. The sexes are nonsignificantly different in their CMDs for 22 of the 28 pelvic variables; of the six variables that are significantly different, five are of the midplane. The sexes are also broadly comparable in their partial correlations. The results are explained as follows. First, the concordance between the sexes in the relationship between pelvic size and nonpelvic measures of body size is due to their genetic similarity for homologous structures. Second, as pelvic size is at the minimum at the midplane, the sexual differences in CMDs are the result of selection with respect to obstetrics. Third, four explanations for the low CMDs are discussed: 1) lack of populationally or racially specific analysis; 2) nonlinear relationship between pelvic size and nonpelvic measures of body size; 3) combination of negative allometric selection between newborn body weight and maternal stature and weight with positive selection for maternal pelvic size; and 4) hormonally induced increase in pelvic capacity during parturition.

Interacting effects of nutrition and social class differentials on fertility and infant mortality in the pre-industrial population

Inadequate nutrition of both the mother and her offspring at each stage of its development - before pregnancy, in the womb, in infancy and during early childhod - played an important role in the patterns of subfertility and infant mortality in a saturated, marginal, preindustrial community. It is suggested that the three social classes had different diets but all were deficient in some essential constituents. Differences in nursing practices in the social groups contributed to differential exogenous mortality and to malnourishment and maternal depletion in the subsistence and (paradoxically) in the elite classes, producing an interacting web of effects and generating a vicious circle from which they could not escape for 150 years. Although the population apparently preferred daughters, the persistent generation effect of low birthweight girls bearing low birthweight daughters probably contributed to the steady-state conditions in this compromised community.

Age, reproductive history, seasonality, and maternal body composition during pregnancy for nomadic Turkana of Kenya

To evaluate the potential differences in maternal nutritional investment in pregnancy, data collected from nomadic Ngisonyoka Turkana women during a July 1993-July 1994 field season were utilized. The roles maternal age, parity, duration of the previous nonpregnant interval, overlap between pregnancy and lactation on trimester changes in weight and summed skinfolds during pregnancy were examined. Because seasonality is an important aspect of the Turkana environment, the effects of seasonality were also assessed. First trimester weight gain is positively associated with overlap in pregnancy and lactation. Second trimester maternal weight gain is negatively influenced by higher parity and by overlap between lactation and early pregnancy. Third trimester weight gain is influenced only by seasonally induced morbidity. First trimester changes in maternal skinfolds are negatively influenced by older maternal age and parity, and positively influenced by a longer nonpregnant interval, and overlap between pregnancy and lactation. Second and third trimester skinfolds are significantly associated only with overlap between lactation and pregnancy (negatively in the second, positively in the third). Seasonality does not influence maternal skinfolds. Differences in age- and parity-related patterns of maternal nutritional investment in pregnancy are not supported by the data. The possibility that Turkana cultural beliefs may influence nutritional status during pregnancy is discussed. Am. J. Hum. Biol. 11:658-672, 1999. Copyright 1999 Wiley-Liss, Inc.

Birthweight and blood pressure among children in Harare, Zimbabwe

AIM

To determine whether poor uterine growth may be associated with increased blood pressure and subsequent hypertension in adulthood.

METHODS

A retrospective cohort study of 756 schoolchildren (mean age 6.5 years) was carried out in six low income areas in Harare city, Zimbabwe. Indices of intrauterine growth and blood pressure were assessed.

RESULTS

Adjusted for current weight, the children's systolic blood pressure was inversely related to their birthweight; for each decreasing kg of birthweight, systolic blood pressure rose by 1.73 mm Hg (95% CI; 0.181 to 3.28). After adjustment for current weight, systolic blood pressure was also inversely associated with occipito-frontal circumference, but not with birth length or gestational age. Diastolic blood pressure was not associated with any of the intrauterine indices.

CONCLUSION

Fetal size may be inversely related to systolic blood pressure in childhood in an African population.

Maternal prepregnancy weight status and pregnancy weight gain as major determinants for newborn weight and size

The impact of maternal anthropometric characteristics, above all prepregnancy weight status and pregnancy weight gain, on newborn size was tested using 10,240 single births in the University Hospital of Vienna, Austria. Highly significant relations between maternal prepregnancy weight status and newborn size were observed. With higher maternal prepregnancy body mass index, higher birthweight, length, head circumference, acromial circumference and fronto occipitalis diameter occurred. Furthermore the incidence of low weight newborns (< 2500 g) was significantly higher in underweight women than in normal weight, overweight and obese women. Although the pregnancy weight gain was significantly higher in underweight women than in normal weight, this higher pregnancy weight gain was not able to compensate for the negative impact of poor weight status before pregnancy. These results indicate that even in a highly developed country such as Austria, where starvation is a nearly unknown problem and the medical and social system are well developed, a poor maternal weight status is a risk factor for growth retarded and low weight births.

Longitudinal weight growth patterns in the highland fringes of West Sepik Province, Papua New Guinea: a comparison of three groups

Longitudinal weight growth data from three groups in West Sepik Province, Papua New Guinea, are compared. A form of analysis based on the four-parameter Jenss curve is adopted, to allow intelligible comparisons of parameter means despite irregular weighing schedules for individual children. Although many weighing records include notes of a child's ill-health (e.g. malaria), omission of these weighings does not have a large effect on the results. Some significant sex differences were found, but do not appear to be importantly confounded with group differences. Of the three groups compared, the East Mianmin live at moderate altitude, the Imnai live at low altitude, and the West Mianmin are a migrant group from moderate to low altitude. In principle the analysis could have shown the groups to be differentiated by altitude of current residence (suggesting the influence of environmental factors), by altitude of ancestral residence (suggesting the influence of genetic and/or cultural factors) or by some interaction of causal factors. Findings on most parameters suggest interaction. Neither moderate nor low-altitude conditions appear consistently more favourable to rapid growth; it is suggested that the advantage of a more favourable disease environment at moderate altitude may be at least partially offset by a nutritional disadvantage. The effect of environmental conditions may also be non-uniform, especially for young infants, since infants of the migrant group, the West Mianmin, are born heaviest but grow more slowly in the early months than infants of either non-migrant group.

Growth and threshold weaning weights among captive rhesus macaques

Interspecific analyses of infant growth and the time to maternal reconception (or weaning) demonstrate a consistent threshold for weaning weight at close to four times neonate weight, irrespective of the duration of lactation (Lee et al., [1991] J. Zool. Lond. 225:99-114). Intraspecific variation in the attainment of a threshold weaning weight was determined in a sample of 31 captive infant rhesus macaques, where growth between birth and subsequent parturition was measured along with information on maternal size, weight, and social characteristics. A threshold weaning weight was found, with infants attaining approximately 1,335 g at the time of reconception. Birth weights of the infants were influenced by maternal physical and social variables in that larger mothers, and alpha ranking mothers, produced larger neonates. Postnatal growth rate, which determined the attainment of the threshold weight, was independent of maternal size or condition, but was influenced by offspring sex and the probability of reconception. Future reproductive status of mothers was specifically related to differences in patterns of growth among the infants. Mothers who conceived again at 30 weeks had infants who grew more slowly after the first 12 weeks of life, especially if these infants were sons. Mothers in this colony appeared to make decisions about the need to sustain their infants' growth in relation to their ability to invest in current offspring, which may compromise their subsequent reproduction.

Growth of nomadic and settled Turkana infants of northwest Kenya

Turkana tribespeople reside in a semi-arid savanna ecosystem in northwest Kenya. For over a decade, Ngisonyoka Turkana nomads have been studied within a multidisciplinary framework that embraces ecology, anthropology, and human population biology. Original research objectives of the South Turkana Ecosystem Project were to study nomads longitudinally and within the context of the dry savanna ecosystem. These objectives have been expanded to incorporate settled Turkana who were nomads in the recent past, but who, for a variety of reasons, have taken up a life of sedentary cultivation. The research described here focused on comparisons of growth patterns of nomadic and settled infants from birth to 24 months of age. Infants were measured (recumbent length, weight, head circumference, arm and calf circumference, and selected skinfolds) in 1989 and 1990. Settled infants were slightly longer, but nomadic infants were heavier and fatter. Head circumferences were the same. Some variation was observed by season and year of measurement (from comparative surveys). Both groups showed pronounced weight faltering after 6 months of age when compared with U.S. NCHS reference values. Head circumference faltering was moderate and recumbent length faltering was only slight after 12 months of age. Comparisons of Turkana infant growth in the two populations can contribute indirectly to a better understanding of infant nutritional status, probable morbidity, and other factors, some of which may be linked to female reproduction.