Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data

Attendance patterns in well-child visits across diverse pediatric populations, Midwestern United States

Objective

Routine well-child visits (WCVs) are essential for monitoring child health; however, substantial differences exist in attendance, particularly among non-Hispanic Black families. We quantified these disparities within a single healthcare system, comparing two distinct pediatric practice groups: one serving primarily non-Hispanic Black and one serving primarily non-Hispanic white children.

Method

This retrospective analysis included patients born in 2022 with at least one WCV in their first 15 months of life using electronic medical records from a healthcare system in the Chicago area. We assessed WCVs against American Academy of Pediatrics guidelines, using Pearson's chi-squared tests to compare attendance rates and logistic regression to calculate adjusted odds ratios (aOR) and 95 % confidence intervals (CI) for factors associated with attending 6 or more WCVs.

Results

Among 2567 eligible patients, 51.7 % were from Site 1 (predominantly non-Hispanic Black) and 48.3 % were from Site 2 (predominantly non-Hispanic white). Among Site 1 patients, 83.3 % attended six or more WCVs compared to 91.6 % from Site 2 (p < 0.001), with lower attendance at Site 1 observed starting at 2 months (aOR 0.55, 95 % CI 0.38, 0.80). Across all patients, patients with Medicaid insurance had 61 % lower odds of attending 6+ WCVs compared to commercially insured patients (aOR 0.39, 95 % CI 0.26, 0.58).

Conclusion

These findings highlight critical differences in WCV attendance among children within the same healthcare system. Lower at the site serving primarily non-Hispanic Black children may be attributable to barriers to healthcare access, including socioeconomic challenges and implicit bias in healthcare delivery.

Epidemiological profile of perinatal health among indigenous pregnant people in the Wayamu territory, Brazil

OBJECTIVE

To describe the epidemiological profile of prenatal care, childbirth, and live births among Indigenous women in the Wayamu Territory, located in the municipality of Oriximiná, Pará, Brazil, from 2013 to 2022.

METHODS

This is a descriptive, retrospective, and quantitative study based on secondary data from the Live Birth Information System (SINASC), accessed via DATASUS. A total of 713 live births were analyzed. The study included the following variables: maternal age, type of delivery, number of prenatal consultations, place of birth, birth weight, Apgar score at 1 and 5 min, and newborn sex. Low birth weight was defined as < 2,500 g. Statistical analyses included descriptive statistics, Chi-square tests, Pearson correlation, and t-tests, with a significance level of p < 0.05.

RESULTS

Most births were vaginal (81.35%), and the majority of mothers were aged 20-29 years (46.84%), followed by adolescents aged 10-19 years (24.96%). A total of 96.77% of Indigenous women attended at least one prenatal consultation, and 39.55% completed seven or more. Low birth weight was observed in 8.84% of newborns. A significant positive correlation was found between the number of prenatal consultations and birth weight (r = 0.789, p = 0.006). A Chi-square test showed that adolescent mothers were proportionally more represented than adult women aged 20-29 years (p < 0.001).

CONCLUSION

The maternal and neonatal outcomes observed among Indigenous women in the Wayamu Territory are similar to national patterns but reveal persistent challenges, including adolescent pregnancy, low prenatal consultation rates, and increasing medicalization of childbirth. These findings highlight the need for expanded public policies focused on culturally sensitive and equitable maternal and child healthcare for Indigenous populations in Brazil.

Sex-specific effects of prenatal exposure to phthalates and bisphenol A on adverse birth outcomes: Results from The Korean CHildren's ENvironmental health Study (Ko-CHENS)

OBJECTIVES

Although previous epidemiological studies have reported the effects of fetal exposure to phthalates and phenols on birth outcomes, evidence is still limited. The objective of this study was to investigate whether prenatal exposure to endocrine-disrupting chemicals [EDCs; phthalates and bisphenol A (BPA)] is associated with birth outcomes and whether there are sex-specific effects.

METHODS

We used data from the Korean CHildren's ENvironmental health Study (Ko-CHENS) cohort. Exposure to phthalates and BPA was measured by urine tests, and the information on outcomes and confounders was obtained from delivery records, biomarker assessment, and a self-reported questionnaire. We performed multivariate logistic regression to estimate the association between exposure to individual phthalates and bisphenol A and birth outcomes. Additionally, to evaluate the effects of EDC mixture exposure, we performed weighted quantile sum regression analysis. Subgroup analysis stratified by maternal age and sex at birth was performed to examine potential differences in associations.

RESULTS

This study included 2,176 mother-child pairs from the Ko-CHENS. We observed a significant association between the risk of PTB and exposure to BPA during early pregnancy and mono-carboxyoctyl phthalate (MCOP) during late pregnancy, with odds ratios of 1.23 (95% CI: 1.01, 1.49) and 1.29 (95% CI: 1.03, 1.62), respectively. Additionally, there was a significant association between exposure to MCOP during early pregnancy and the risk of LBW (OR: 1.39, 95% CI: 1.03, 1.89). For male infants in particular, exposure to MCOP during early pregnancy was associated with the risk of LBW (OR: 2.44, 95% CI: 1.43, 4.15), and exposure to MCOP during late pregnancy was associated with the risk of PTB (OR 1.45, 95% CI: 1.05, 2.02).

CONCLUSIONS

This study suggests a potential association between exposure to BPA during early pregnancy and PTB, while exposure to MCOP during late pregnancy was associated with increased PTB risk in male infants.

Impact of health literacy and subjective happiness in pregnancy on neonatal anthropometry: a cohort study

BACKGROUND

Maternal health literacy (MHL) and happiness can significantly impact pregnancy outcomes (POs) and neonatal health. This study primarily aimed to assess the level of maternal health literacy. Additionally, we sought to determine how maternal health literacy, happiness, socio-demographics, and pregnancy outcomes influence neonatal anthropometrics, thereby providing a more comprehensive understanding of the determinants of maternal and neonatal health.

METHODS

In a 2-year cohort study on 591 pregnant women with normal pregnancies, we recorded the maternal socio-demographic and obstetric factors. Moreover, the Maternal Health Literacy and Pregnancy Outcomes Questionnaire (MHLAPQ) and Happiness Questionnaire were used to gather health-related information. After delivery, the neonatal anthropometric measurements, including body weight (BW), supine length (SL), and head circumference (HC), were recorded at birth.

RESULTS

Among the 591 participants, 338 (57.2%) were in the 20-29-year age group. The mean maternal health literacy (MHL) score was 57.34 ± 8.67. MHL scores were associated with maternal and paternal education and occupation, as well as a history of miscarriage. Pregnancy outcomes were linked to maternal and paternal education and employment status, while higher happiness scores were found among housewives. BW showed significant differences based on maternal occupation and a history of stillbirth, while SL varied significantly with maternal occupation. Positive correlations were identified between BW and MHL, as well as between PO, MHL, and maternal happiness scores.

CONCLUSION

In summary, our results revealed that MHL and happiness are important factors in improving the POs and neonatal health. In addition, maternal and paternal education and occupation were found to affect the MHL scores.

Prevalence and determinants of mother and newborn skin-to-skin contact: an assessment from the 2017-18 BDHS data

BACKGROUND

Evidence shows that skin-to-skin contact (SSC) enhances children's well-being. More information is needed on the prevalence and determinants of SSC in Bangladesh. This study aimed to estimate the prevalence and associated factors of mothers and their newborns' skin-to-skin contact in Bangladesh.

METHODS

Data extracted from a cross-sectional survey, (Bangladesh Demographic and Health Survey (BDHS) 2017-18), where 5304 (unweighted) women who gave birth in the last 3 years preceding the survey were included in the final analysis. Multivariable logistic regression analysis was used to identify the determinants of SSC practice. Adjusted odds ratios (aORs) with their corresponding 95% confidence intervals (CIs) were reported.

RESULTS

The prevalence of SSC practice in Bangladesh was 15.6% (95% CI [14.3, 17.0]). The adjusted regression model showed that the SSC practice was significantly associated with the geographic region, place of delivery, mode of delivery, and number of antenatal care visits. The SSC practice was 50% lower (aOR = 0.5, 95% CI [0.3, 0.8]) in the Rajshahi Division compared to the Dhaka Division. Women who had an institutional delivery had 2 times higher odds (aOR = 2.0, 95% CI [1.6, 2.5]) of SSC practice than women who had experienced a non-institutional delivery. Compared to women who delivered by cesarean section, the odds of SSC practice were 2.1 times higher (aOR = 2.1, 95% CI [1.6, 2.6]) for women who had a normal delivery. Women who completed at least four antenatal visits had 20% higher odds (aOR = 1.2, 95% CI [1.0, 1.4]) of SSC practice than women who completed fewer than four antenatal visits.

CONCLUSION

Given that only approximately one-sixth of the surveyed women are engaged in SSC practice, informal instructional and awareness programs are necessary in Bangladesh to promote the importance and extent of SSC practice.

EGF and IgA in maternal milk, donor milk, and milk fortifiers in the neonatal intensive care unit setting

Human milk contains a variety of factors that positively contribute to neonatal health, including epidermal growth factor (EGF) and immunoglobulin A (IgA). When maternal milk cannot be the primary diet, maternal milk alternatives like donor human milk or formula can be provided. Donor human milk is increasingly provided to infants born preterm or low birth weight with the aim to supply immunological factors at similar concentrations to maternal milk. We sought to assess the concentrations of human EGF and IgA in the diet and stool of neonates between exclusive maternal milk, donor human milk, or formula-based diets. Using a prospective cohort study, we collected samples of diet and stool weekly from premature and low birth weight neonates starting at 10 days postnatal through five weeks of life while admitted to a neonatal intensive care unit (NICU). Compared to formula, there was significantly more EGF in both the milk and the stool of the infants fed human milk. Donor milk pooled from multiple donors contained similar concentrations of EGF and IgA to maternal milk, which was also significantly more than formula diets. Maternal milk supplemented with a fortifier derived from human milk contained significantly more EGF and IgA compared to unfortified maternal milk or maternal milk supplemented with fortifier derived from bovine milk. Further analysis of human milk-derived fortifiers confirmed these fortifiers contained significant concentrations of EGF and IgA, contributing to an increased concentration of those factors that bovine milk-derived fortifiers do not confer. These findings illustrate how the choice of diet for a newborn, and even how that diet is modified through fortifiers or pasteurization before ingestion, impacts the beneficial biomolecules the infant receives from feeding.

A cluster randomized trial of xylitol chewing gum for prevention of preterm birth: The PPaX trial

BACKGROUND

Maternal periodontal disease is associated with preterm and low-birthweight deliveries, but randomized trials of likely efficacious treatments (e.g., dental scaling and root planing) during pregnancy have not reduced these adverse outcomes. As an alternative, we hypothesized that periconception initiation of xylitol chewing gum would reduce the occurrence of preterm or low-birthweight deliveries among a historical high-prevalence population in Malawi.

METHODS

We conducted an open-label, parallel-enrollment, matched-pair, cluster-randomized, controlled clinical trial across eight health centers (sites) in and around Lilongwe, Malawi. Sites were paired by anticipated delivery volume and randomized to prenatal and oral health education alone (active control) or with twice-daily xylitol chewing gum (intervention) throughout the periconception and antenatal periods. For the primary prevention of preterm (<37 weeks) and low-birthweight (<2,500 g) deliveries (co-primary outcomes), comparison by allocation group was performed using generalized linear mixed models for each outcome as a fixed factor and the site(s) as a random factor.

FINDINGS

10,069 participants were enrolled (n = 4,549 at intervention sites, n = 5,520 at active control sites), with >95% available for analyses. Initiation of xylitol chewing gum resulted in significant reductions in the co-primary outcomes: preterm birth (12.6% [549/4,349] vs. 16.5% [878/5,321]; relative risk [RR] 0.76, 95% confidence interval [CI] 0.57-0.99) and <2,500-g neonates (8.9% [385/4,305] vs. 12.9% [679/5,260]; RR 0.70, 95% CI 0.49-0.99). Xylitol chewing gum use also led to fewer neonatal demises (0.2% [8/4,305] vs. 0.4% [22/5,260]; RR 0.41, 95% CI 0.19-0.89).

CONCLUSIONS

Periconception initiation and ongoing use of xylitol chewing gum significantly reduced the occurrence of preterm and low-birthweight deliveries in Malawi.

FUNDING

E.W. Al Thrasher Foundation (to K.A.) and USAID Saving Lives at Birth Grand Challenges Grant AID-OAA-G-11-00062 (to K.A.). Additional financial and in-kind support was graciously provided by Texas Children's Hospital and Baylor Foundation Malawi.

Time-Trend Analysis of Low Birthweight in Greece: Mapping a Heavy Public Health Burden

INTRODUCTION

Low birthweight is a critical determinant of neonatal and infant mortality and is further associated with several long-term adverse health outcomes. This study aims to comprehensively analyze low birthweight rate (LBWR) trends in Greece from 1980 to 2023.

MATERIALS AND METHODS

National official data on live births in Greece from 1980 to 2023 were obtained from the Hellenic Statistical Authority, based on birth certificate records. A total of 4,593,229 live births were analyzed and categorized by birthweight. The annual LBWR (birthweight < 2,500 g) and very low birthweight rate (VLBWR) (birthweight < 1,500 g) were calculated per 100 total live births. Additionally, the annual moderately low birthweight rate (MLBWR) was computed separately for two subgroups: 1,500-1,999 g and 2,000-2,499 g. Time trends for these rates were evaluated using joinpoint regression analysis, and the annual percent change (APC) was calculated with 95% confidence intervals (95% CI).

RESULTS

After a decade of stability from 1980 to 1990, the LBWR in Greece entered a 20-year period of consistent increase (1990-2010), with an APC of 2.3 (95% CI: 1.9 to 4.9). In the most recent period (2010-2023), the LBWR has plateaued at high levels. The LBWR reached its lowest point in 1982 at 5.58% and increased by 80%, reaching historically high levels in 2022 and 2023 at 10.07% and 10.02%, respectively. Since 2008, it has consistently remained above 9%. The VLBWR exhibited a steady upward trend throughout the entire 1980-2023 period with an APC of 0.9 (95% CI: 0.7 to 1.1) and increased from a low of 0.70% in 1980 to a peak of 1.20% in 2010. For the 2,000-2,499 g category, the MLBWR rose steadily over three decades (1980-2010: APC = 2.0, 95% CI: 1.8 to 2.3) and remained essentially unchanged from 2010 to 2023. In contrast, the MLBWR for the 1,500-1,999 g group showed a non-significant trend during 1980-1990, followed by a rapid increase between 1990 and 2001 (APC = 3.9, 95% CI: 2.9 to 7.9), which continued at a slower pace from 2001 to 2023 (APC = 1.0, 95% CI: 0.5 to 1.3).

CONCLUSIONS

During 1980-2023, the LBWR increased by 80%, with significant rising trends in the 1990s and 2000s, resulting in Greece having the highest rates among high-income countries. Whereas the overall LBWR has stabilized since 2010, there has been a continued rise in the proportion of neonates with birthweight < 2,000 g, who face the highest risk of adverse outcomes. Continued monitoring of LBWR is essential, alongside investments in the implementation of effective, targeted interventions.

Perinatal outcomes of women with recurrent pregnancy loss undergoing frozen embryo transfer from the Society of Assisted Reproductive Technology database

OBJECTIVE

To assess whether infants born to women with a history of recurrent pregnancy loss (RPL) have an increased risk of adverse perinatal outcomes after frozen embryo transfer (FET) compared with women without a history of infertility or RPL.

DESIGN

Retrospective cohort study utilizing the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System database between 2014 and 2020.

SUBJECTS

Patients in the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System database who underwent their first FET resulting in live birth either with a diagnosis of RPL (cases n = 3,299) or without a history of RPL or infertility, the comparison population being tubal ligation (TL) only (n = 1,408).

EXPOSURE

Recurrent pregnancy loss.

MAIN OUTCOME MEASURES

Low birthweight (<2,500 g), additional outcomes included gestational age (continuous), birthweight (continuous), preterm delivery (<37 weeks), mode of delivery, and neonatal death, defined as death before the completion of the 28th day of life.

RESULTS

We observed no statistically significant difference in low birthweight, birthweight overall, mode of delivery, or risk of neonatal death between patients with RPL compared with women with TL who underwent their first FET, resulting in live birth. Patients with history of RPL compared with TL utilizing FET were more likely to have a later gestational age at delivery. Patients with RPL were also less likely to have a preterm delivery (imputed adjusted odds ratio, 0.75; 0.64-0.89) than the patients with TL. Furthermore, performing preimplantation genetic testing for aneuploidy (PGT-A) in both patients with RPL or TL did not impact perinatal outcomes compared with patients who did not undergo PGT-A.

CONCLUSION

Patients with history of recurrent pregnancy loss do not have an increased risk of adverse perinatal outcomes when they undergo FET compared with patients without infertility or RPL. In addition, performing in vitro fertilization/PGT-A in patients with RPL does not adversely impact birth outcomes of their infants.

Heart Diseases in Pregnancy: A Comprehensive Analysis of Maternal and Neonatal Outcomes

Objective This study aims to evaluate the prevalence, maternal and neonatal outcomes, and clinical implications of heart diseases in pregnancy. Methods A prospective observational study was conducted on pregnant women diagnosed with heart disease. Maternal and neonatal outcomes, including mortality, preterm birth, and mode of delivery, were assessed. Statistical comparisons were made based on ejection fraction (EF < 30% vs. EF ≥ 30%). Results Peripartum cardiomyopathy (n = 10, 27.78%) and rheumatic heart disease (n = 10, 27.78%) were the most prevalent cardiac conditions, followed by prosthetic valve disease and acyanotic congenital heart disease, each contributing to 11.11% (n = 4) of cases. A significant proportion of patients (n = 20, 55.56%) presented between 32 and 37 weeks of gestation. The study observed a maternal mortality rate of 13.89% (n = 5), with a stark contrast between women with an EF of <30% (n = 4, 33.33% mortality) and those with an EF of ≥30% (n = 1, 4.17% mortality). ICU admissions were required in 22.22% (n = 8) of cases, predominantly in women with an EF of <30% (n = 6, 50% vs. n = 2, 8.33%). Vaginal delivery was achieved in 66.67% (n = 24) of cases, while 27.78% (n = 10) underwent cesarean section. Among neonatal outcomes, 77.78% (n = 28) of infants were preterm, 52.78% (n = 19) had low birth weight (LBW), and 30.56% (n = 11) were small for gestational age (SGA). NICU admissions were recorded in 19.44% (n = 7) of cases, with a neonatal mortality rate of 5.56% (n = 2). Conclusion Heart diseases in pregnancy significantly impact both maternal and neonatal outcomes. Early detection and multidisciplinary management are crucial for improving prognosis and reducing complications.

Long-term maternal outcomes of pregnancy after orthotopic liver transplantation in the Netherlands: A retrospective multicenter cohort study

Pregnancy after orthotopic liver transplantation (OLT) puts the mother, child, and transplanted organ at risk. Little is known about long-term outcomes. We performed a nationwide retrospective cohort study to evaluate short-term and long-term outcomes of post-OLT pregnancies. The secondary aim was to assess predictors for adverse pregnancy outcomes. A composite outcome of preeclampsia, preterm birth, low birth weight, and neonatal intensive care unit admission was made. Survival of women who received a transplant at <50 years of age with and without pregnancy after OLT were compared (Dutch Organ Transplantation Registry data). Descriptive statistics, regression analysis, Kaplan-Meier and log-rank analysis, and generalized estimating equation analysis were used. Among the included 70 women with 113 pregnancies >20 weeks of gestation, hypertension occurred in 20% and preeclampsia in 12%. The live birth rate was 87%; 33% were preterm, and 23% had low birth weight. Long-term follow-up (median 10 y [IQR: = 4-14]) showed small changes in serum creatinine and bilirubin ( p < 0.001). Sixteen mothers (23%) died during follow-up (median 8 y [IQR: = 4-12]), with all their children aged <18 years. No difference in survival was found when comparing women with and without pregnancy after OLT. The composite outcome occurred in 43/98 of pregnancies. Higher body mass index (BMI) and maternal age at conception increased the composite outcome risk (OR: 1.24, p < 0.01, and OR: 1.25, p = 0.01, respectively). To conclude, pregnancy after OLT does not seem to influence long-term outcomes of graft, kidney function, or patient survival in most cases. However, although pregnancy does not seem to impact survival after OLT, we do show that a substantial number of children will lose their mothers early in life. We believe this is important for pregnancy couseling of patients with an OLT and their partners.

Do Maternal Factors Modify the Associations Between Iron Supplementation and Low Birth Weight in Sub-Saharan Africa?

Iron supplementation is recommended to reduce low birth weight (LBW) but its impact in Africa is underexplored. This study examines factors that may modify the effects of maternal iron supplementation on LBW in sub-Saharan Africa. Health Survey data from 26 sub-Saharan countries, including 149,346 woman-infant pairs, were analyzed. LBW (< 2500 g) was the outcome, and iron supplementation (yes/no) and its duration (none, < 90 days, or ≥ 90 days) were exposures. A regression modeling framework was used to assess associations, adjusting for potential confounders and stratification by country income level. Family income, mother's education, maternal age, and partner's education were assessed as potential effect modifiers. The prevalence of LBW was 10.36%. Maternal iron supplementation adherence was 37.34%, but lower among poor and young women (31.43%). Not taking iron supplements during pregnancy increased the odds of LBW (aOR 1.19; 95%CI: 1.09, 1.30). Longer duration (more than 90 days) reduced the odds of LBW (aOR 0.84; 95%CI: 0.76, 0.93). These impacts were greater among poor women (aOR 0.74; 95%CI: 0.64, 0.84), women/partner with no education (aOR 0.79; 95%CI: 0.67, 0.92), and younger age (aOR 0.72; 95%CI: 0.54, 0.97). Taking iron supplements longer during pregnancy contributes to lowering LBW in sub-Saharan countries. Younger mothers from poor areas with no education, along with those whose partners lack education, appear more vulnerable and may benefit from access to supplements. Enhancing adherence and addressing these disparities are key to addressing LBW in these settings.

A Post-Authorisation Safety Study of a Respiratory Syncytial Virus Vaccine in Pregnant Women and Their Offspring in a Real-World Setting: Generic Protocol for a Target Trial Emulation

Background: Assessing the real-world safety of preventive products against respiratory syncytial virus (RSV) in pregnant women holds significant public health implications, especially as vaccination programs become more widespread. This generic protocol describes a post-authorisation safety study (PASS) to evaluate the safety of RSV vaccination in pregnant women using a target trial emulation framework. Methods: This generic protocol, adapted from an ongoing PASS, is designed using the target trial emulation framework to evaluate the safety of an RSV vaccine in pregnant women. Emulating target trial conditions have the ability to minimise confounding and bias. In this pragmatic real-world observational study, RSV-vaccinated pregnant women are matched (1:N) with unexposed women based on gestational age, calendar time, maternal age, immunocompromised status, and high-risk pregnancy. Key adverse outcomes include preterm birth, stillbirth, hypertensive disorders of pregnancy, Guillain-Barré Syndrome (GBS), low birth weight (LBW), and small for gestational age (SGA). Future studies may add additional outcomes per vaccine risk profile and Global Alignment of Immunization safety Assessment (GAIA) recommendations. Distinguishing outcomes measured during pregnancy from those assessed at or after birth is crucial for analysis and interpretation. Conclusions: This protocol offers a structured approach to evaluating the safety of RSV vaccines in pregnant women. It aims to guide researchers in designing studies and should be adapted to specific settings and data availability.

Differential associations between birthweight and cardiometabolic characteristics among persons with and without type 2 diabetes in the UK Biobank

Low birthweight is a risk factor for type 2 diabetes. We hypothesised that differential associations between birthweight and clinical characteristics in persons with and without type 2 diabetes may provide novel insights into the role of birthweight in type 2 diabetes and its progression. We analysed UK Biobank data from 9,442 persons with and 254,446 without type 2 diabetes. Associations between birthweight, clinical traits, and genetic predisposition were assessed using adjusted linear and logistic regression, comparing the lowest and highest 25% of birthweight to the middle 50%. Each kg increase in birthweight was associated with higher BMI, waist, and hip circumference, with stronger effects in persons with versus without type 2 diabetes (BMI: 0.74 [0.58, 0.90] vs. 0.21 [0.18, 0.24] kg/m2; waist: 2.15 [1.78, 2.52] vs. 1.04 [0.98, 1.09] cm; hip: 1.65 [1.33, 1.97] vs. 1.04 [1.04, 1.09] cm). Family history of diabetes was associated with higher birthweight regardless of diabetes status, albeit with a twofold higher effect estimate in type 2 diabetes. Low birthweight was further associated with prior myocardial infarction regardless of type 2 diabetes status (OR 1.33 [95% CI 1.11, 1.60] for type 2 diabetes; 1.23 [95% CI 1.13, 1.33] without), and hypertension (OR 1.25 [1.23, 1.28] and stroke 1.24 [1.14, 1.34]) only among persons without type 2 diabetes. Differential associations between birthweight and cardiometabolic traits in persons with and without type 2 diabetes illuminate potential causal inferences reflecting the roles of pre- and postnatal environmental versus genetic aetiologies and disease mechanisms.

The Relationship Between Food Insecurity and Low Birthweight Across US Counties and Related Racial Disparities

OBJECTIVE

To explore the relationship between low birthweight (LBW) and food insecurity across US counties and determine whether this relationship differs between Black and White women.

METHODS

LBW data was derived from the 2013-2019 National Center for Health Statistics and National Vital Statistics System Birth Files. Food insecurity data was derived from Feeding America's 2013-2019 Map the Meal Gap project. Analyses included descriptive statistics and regression models.

RESULTS

Data were available for 3037 US counties. Food insecurity significantly predicted county-level LBW (t(3035) = 44.48, P < .001) and explained 39.46% of the variance in LBW (F(13,035) = 1978.03, P < .001, R = .63). Food insecurity predicted LBW for both Black (t(1418) = 17.39, P < .001) and White women (t(1918) = 18.26, P < .001) and had a slightly larger effect size for Black women with fitted line plots also supporting a stronger relationship for Black women.

CONCLUSIONS

Food insecurity predicts LBW in US counties, and the relationship may be stronger for Black women. Increasing access to healthy food should be considered when planning county-level efforts for improving LBW.

High-Risk Outcomes in In Vitro Fertilization Pregnancies for Women of a Very Advanced Maternal Age: Insights from a Multi-Hospital Study in Greece

Background: In vitro fertilization (IVF) has transformed infertility treatment, yet it is associated with increased risks of adverse perinatal outcomes, particularly in women of advanced maternal age. This study aimed to investigate the prevalence of complications such as preeclampsia (PE), gestational diabetes mellitus (GDM), preterm labor (PTL), low birth weight (LBW), and placental abnormalities (PA) among women over 50 undergoing assisted reproductive technology (ART) in Greece, where the eligibility age limit has been recently raised to 54 years. Methods: We conducted a retrospective analysis of pregnancy outcomes in women over 50 compared to those under 50, utilizing medical records mainly from University Hospital of Ioannina but also from other public hospitals and private clinics in Greece. Results: Our findings indicate that women over 50 face an increased risk of developing preeclampsia (PE) by 4.61 times, GDM by 1.69 times, PTL by 1.82 times, LBW by 1.67 times, and PA by 3.92 times. Conclusions: These results underscore the need for heightened awareness and the monitoring of pregnancy complications in this demographic, informing clinical strategies to improve maternal and neonatal outcomes.

Patterns of postnatal weight gain and its predictors among preterm very low birth weight neonates born in Bahir-Dar city public hospitals, 2022: A cross sectional study

INTRODUCTION

Postnatal weight gain in very low birth weight infants remains a challenge during the neonatal period in low and middle-income countries like Ethiopia, where no feeding alternatives and follow-up charts are available. Although extrauterine growth retardation is a common problem in preterm very low birth weight infants, there is a lack of evidence in resource-limited countries regarding patterns of postnatal weight gain. Therefore, this study aimed to assess the patterns of postnatal weight gain and its predictors among preterm very low birth weight infants in Ethiopia.

METHODS

A cross-sectional study was conducted on a randomly selected sample of 412 neonates in Ethiopia. Data were collected using structured questionnaires and analyzed with Stata version 14.0 software. Bivariable and multivariable logistic regression analyses were performed to identify significant predictors. Model fitness and assumptions were assessed. Associations were reported using adjusted odds ratios (AOR) with 95% confidence intervals.

RESULTS

In the current study, 14.6% (95% CI: 10.4-20.1) of neonates had adequate postnatal weight gain at discharge. Spontaneous vaginal delivery [AOR: 2.54; 95% CI (1.17, 5.54)], birth Z-score > -1.29 [AOR: 4.51; 95% CI (1.43, 14.16)], early feeding initiation time [AOR: 3.36; 95% CI (1.63, 6.92)], and respiratory distress syndrome [AOR: 0.31; 95% CI (0.12, 0.78)] were significant predictors for postnatal weight gain among very low birth weight neonates in Ethiopia.

CONCLUSION

The postnatal weight gain reported in this study was low as compared to the national figure. Mode of delivery, birth z-score, initiation time of the first feeding, and respiratory distress syndrome were associated with postnatal weight gain. The Federal Ministry of Health, stakeholders, national neonatal associations, and non-governmental organizations should work collaboratively to promote vaginal delivery and early initiation of feeding and develop guidelines specifically tailored for this special population. Furthermore, healthcare providers should prioritize and focus on neonates who have respiratory distress and low Z-scores.

A five-year review of the morbidity and mortality pattern in the special care baby unit of a private-owned tertiary hospital in Nigeria

Introduction

neonatal mortality in Nigeria is still high and the primary causes are largely preventable. The study was carried out to assess the pattern of morbidity and mortality among hospitalized Nigerian neonates.

Methods

a retrospective study was carried out on neonates admitted into the Special Care Baby Unit of the Babcock University Teaching Hospital, Ilishan-Remo, over five years between January 2014 and December 2018. The patients´ case files were retrieved from the health records unit and relevant information on their morbidities and outcomes were extracted. Bivariate analyses and logistic regression analyses were done to determine factors associated with mortality.

Results

a total of 490 babies were studied, of which 276 (56.3%) were males. Nearly two-thirds of the babies were inborn (309; 63.1%), 344 (70.2%) were delivered at term, and 136 (27.8%) were low birth weight babies. The median gestational age at birth was 37 weeks. Perinatal asphyxia was the most common diagnosis necessitating admission (104; 21.2%), closely followed by neonatal jaundice. Sepsis and prematurity were also common diagnoses. Mortality occurred in 39 (8.0%) babies; the highest case fatality rates were recorded among preterm babies (13/70; 18.6%) and those who had perinatal asphyxia (16/104; 15.4%). On logistic regression analysis, outborn status (aOR= 2.51, 95% CI= 1.26 - 5.01, p= 0.009) and preterm delivery (aOR= 4.10, 95% CI= 2.06 - 8.16, p<0.001) had significant independent association with mortality.

Conclusion

perinatal asphyxia and prematurity were the leading causes of death among the neonates studied. Efforts to reduce neonatal mortality by preventing these morbidities and promptly initiating appropriate treatment, when present, should be heightened to reduce neonatal mortality.

Causal machine learning models for predicting low birth weight in midwife-led continuity care intervention in North Shoa Zone, Ethiopia

BACKGROUND

Low birth weight (LBW) is a critical global health issue that affects infants disproportionately, particularly in developing countries. This study adopted causal machine learning (CML) algorithms for predicting LBW in newborns, drawing from midwife-led continuity care (MLCC).

METHODS

A quasi-experimental study was carried out in the North Shoa Zone of Ethiopia from August 2019 to September 2020. A total of 1166 women were allocated into two groups. The first group, the MLCC group, received all their antenatal, labor, birth, and immediate post-natal care from a single midwife. The second group received care from various staff members at different times throughout their pregnancy and childbirth. In this study, CML was implemented to predict LBW. Data preprocessing, including data cleaning, was conducted. CML was then employed to identify the most suitable classifier for predicting LBW. Gradient boosting algorithms were used to estimate the causal effect of MLCC on LBW. Moreover, meta-learner algorithms were utilized to estimate the individual treatment effect (ITE), the average treatment effect (ATE), and performance. Moreover, meta-learner algorithms were utilized to estimate the individual treatment effect (ITE), the average treatment effect (ATE), and performance.

RESULTS

The study results revealed that Causal K-Nearest Neighbors (CKNN) was the most effective classifier based on accuracy and estimated LBW using a 94.52% accuracy, 90.25% precision, 92.57% recall, and an F1 score of 88.2%. Meconium aspiration, perinatal mortality, pregnancy-induced hypertension, vacuum babies in need of resuscitation, and previous surgeries on their reproductive organs were identified as the top five features affecting LBW. The estimated impact of MLCC versus other professional groups on LBW was analyzed using gradient boosting algorithms and was found to be 0.237. The estimated ATE for the S-learner was 0.284, which is lower than the true ATE of 0.216. Additionally, the estimated ITE for both the T-learner and X-learner was less than -0.5, indicating that mothers would not choose to participate in the MLCC program.

CONCLUSIONS

Based on these findings, the CKNN classifier demonstrated a higher accuracy and effectiveness. The S-learner and R-learner models, utilizing the XGBoost Regressor and BaseSRegressor, provided accurate estimations of ITE for assessing the impact of the MLCC program. Promoting the MLCC program could help stabilize LBW outcomes.

Meconium-Related Obstruction and Clinical Outcomes in Term and Preterm Infants

Importance

Textbooks attribute 80% of meconium-related small bowel obstructions to cystic fibrosis and 15% of colonic obstructions to Hirschsprung disease. It is unknown whether these estimates are accurate, particularly among preterm infants, whose immature bowel predisposes them to meconium-related obstruction (MRO).

Objective

To estimate the incidence of MRO by type and to assess its association with clinical outcomes.

Design, Setting, and Participants

This retrospective cohort study of live-born infants included in the National Inpatient Sample from January 1, 2016, to December 31, 2020, used survey weighting methods to estimate the national incidence of MRO by etiology. Data were analyzed from November 27, 2023, to November 12, 2024.

Exposure

MRO.

Main Outcomes and Measures

The primary outcome was diagnosis with MRO. Secondary outcomes included mortality, need for abdominal surgery, hospitalization duration, and cost. Multivariable regression models were developed to evaluate characteristics associated with MRO and to assess the association of MRO of prematurity with clinical outcomes after adjusting for demographic and clinical covariates.

Results

Of 3 550 796 infants, 51.2% were male and 46.7% were privately insured. Overall, 9.1% (n = 322 499) were born preterm. Of 1844 (0.1%) infants treated for MRO, 41 (2.2%) had cystic fibrosis, 60 (3.3%) had Hirschsprung disease, and 1743 (94.5%) had neither predisposing condition. Preterm infants were at highest risk for MRO, with 4.7 MRO cases per 100 000 births associated with cystic fibrosis, 4.7 MRO cases per 100 000 births associated with Hirschsprung disease, and 187.3 MRO cases per 100 000 births associated with neither predisposing condition. Among infants with neither cystic fibrosis nor Hirschsprung disease, those with gestational ages from 28 weeks to 31 weeks 6 days were most likely to develop MRO compared with term infants (adjusted odds ratio, 6.08 [95% CI, 4.27-8.67]). Among preterm infants, having an MRO was associated with a 4.2 percentage point increase in the probability of abdominal surgery (95% CI, 3.1-5.4 percentage points), a 7.3-day increase in length of stay (95% CI, 5.8-8.8 days), and a $23 215 increase in hospitalization costs (95% CI, $17 739-$28 690) compared with infants who did not have an obstruction, with no change in mortality rate (0.1 percentage point change [95% CI, -0.6 to 0.8 percentage points]).

Conclusions and Relevance

In this cohort study of over 3.5 million infants, MRO was most likely to occur among preterm infants without cystic fibrosis or Hirschsprung disease. These infants more frequently required surgery and had longer and more costly hospitalizations, indicating a need for dedicated prevention and treatment pathways for this understudied disease.

Single-dose intravenous iron vs oral iron for treatment of maternal iron deficiency anemia: a randomized clinical trial

BACKGROUND

Maternal iron deficiency anemia is a persistent global health challenge with increased risk of adverse perinatal outcomes. Obstetric guidelines advocate for first-line treatment of moderate iron deficiency anemia with twice-daily oral iron; however, rates of iron deficiency anemia in pregnancy remain above global targets and are rising.

OBJECTIVE

Determine whether single-dose intravenous iron for primary treatment of maternal iron deficiency anemia in the second trimester is superior to twice daily oral iron in reducing incidence of low birth weight infants and maternal anemia at delivery.

STUDY DESIGN

This is a parallel, 3-arm, semiblind superiority randomized controlled multicenter trial across 4 sites in India from March 15, 2021-May 12, 2023. Participants were singleton pregnancies at 14 to 17 weeks with moderate iron deficiency anemia (hemoglobin 7.0-9.9 g/dL) who were randomized 1:1:1 to (1) 60 mg oral ferrous sulfate twice daily; or single-dose infusion of (2) intravenous ferric derisomaltose or (3) intravenous ferric carboxymaltose. Two intravenous arms were selected as these are the only 2 intravenous iron formulations publicly available in India. All participants received folic acid supplementation throughout pregnancy and antihelminthic therapy, as recommended by national guidelines. The dual primary outcomes were: (1) low birth weight (<2500 grams) and (2) attainment of a maternal nonanemic state (hemoglobin ≥11.0 g/dL at 30-34 weeks or delivery) for each intravenous iron arm vs oral iron; intravenous iron arms were not compared to each other. Secondary outcomes included safety measures, and other maternal and infant outcomes. Participants with hemoglobin <7 g/dL or <1 g/dL improvement on therapy received rescue treatment with intravenous iron or blood transfusion as determined by their provider. Sensitivity analyses included defining nonanemic state as achieving hemoglobin ≥11.0 without need for additional IV iron or transfusion. Comparison of each intravenous iron arm to oral iron was conducted with a 2-sided alpha set at 0.0005 for achieving nonanemic state and 0.0245 for low birth weight for each intravenous iron arm using a Cochran-Mantel-Haenszel chi-square test stratified by enrollment site.

RESULTS

The oral iron, ferric derisomaltose, and ferric carboxymaltose arms included 1450, 1456, and 1462 participants respectively. There was a reduced rate of low birth weight with intravenous ferric carboxymaltose (25·2%, relative risk 0·87 [97·55% confidence interval 0.75, 0.99], P=.017), but not intravenous ferric derisomaltose (29.1%, relative risk 0.98 [97.55% confidence interval 0.86, 1.12], P=.71) vs oral iron (29.3%). Achievement of nonanemic state was not improved: intravenous ferric carboxymaltose (relative risk 1.05 [99.95% confidence interval 0.97-1.15]) and intravenous ferric derisomaltose (relative risk 1.06 [99.95% confidence interval 0.98, 1.16]) vs oral (69.7%). In sensitivity analysis, there was increased rate of achieving nonanemic state without use of additional IV iron or transfusion in both intravenous ferric derisomaltose (relative risk 1.25 (1.13-1.396), P<.0001) and intravenous ferric carboxymaltose (relative risk 1.24 (1.12-1.38), P<.0001) vs oral iron.

CONCLUSION

First-line treatment of moderate maternal iron deficiency anemia with single-dose infusion of intravenous iron results in a reduced incidence of low birth weight infants (intravenous ferric carboxymaltose vs oral) and a higher incidence of attaining maternal nonanemic state without use of additional iron or blood transfusion (intravenous ferric carboxymaltose and ferric derisomaltose vs oral). Clinical guidelines should address the potential benefit of single-dose intravenous iron as the primary treatment of moderate iron deficiency anemia in pregnancy.

Association between maternal serum zinc and birth weight is modified by neonatal SOD2 polymorphism and promoter methylation

BACKGROUND

Conflicting findings exist regarding the association between maternal serum zinc and neonatal birth weight. This study aimed to explore the association between maternal serum zinc and birth weight, and whether this association was modified by neonatal SOD2 polymorphism and promoter methylation.

METHODS

We recruited 464 mother-newborn pairs at Houzhai Center Hospital from January 2010 to January 2012. Maternal serum zinc concentration was determined using atomic absorption spectrophotometry. Neonatal SOD2 polymorphism and promoter methylation were measured by TaqMan probe assay and real-time quantitative methylation-specific PCR (QMSP), respectively. Relationships among maternal serum zinc, neonatal SOD2 promoter methylation, and birth weight were analyzed by generalized linear model (GLM). Stratified and interaction analyses were conducted to explore the modification of neonatal SOD2 polymorphism and promoter methylation on the association between maternal serum zinc and birth weight.

RESULTS

Our findings revealed that higher maternal zinc concentrations were associated with decreased birth weight (P-trend < 0.05). Each 1 μmol/L increment in maternal zinc level was associated with a 9.553 g (95 % CI: -16.370, -2.735) decrease in birth weight. A significant interaction between SOD2 promoter methylation and maternal serum zinc in relation to birth weight was observed in the AG+GG group (P-interaction < 0.05). Newborns carrying AA genotype were more sensitive to maternal serum zinc in the lower SOD2 group (P-interaction < 0.05).

CONCLUSIONS

Maternal serum zinc was inversely associated with birth weight, and this association was modified by neonatal SOD2 polymorphism and promoter methylation. These findings suggest that SOD2 polymorphism and promoter methylation may influence the relationship between maternal zinc status and fetal growth.

An efficient interpretable framework for unsupervised low, very low and extreme birth weight detection

Detecting low birth weight is crucial for early identification of at-risk pregnancies which are associated with significant neonatal and maternal morbidity and mortality risks. This study presents an efficient and interpretable framework for unsupervised detection of low, very low, and extreme birth weights. While traditional approaches to managing class imbalance require labeled data, our study explores the use of unsupervised learning to detect anomalies indicative of low birth weight scenarios. This method is particularly valuable in contexts where labeled data are scarce or labels for the anomaly class are not available, allowing for preliminary insights and detection that can inform further data labeling and more focused supervised learning efforts. We employed fourteen different anomaly detection algorithms and evaluated their performance using Area Under the Receiver Operating Characteristics (AUCROC) and Area Under the Precision-Recall Curve (AUCPR) metrics. Our experiments demonstrated that One Class Support Vector Machine (OCSVM) and Empirical-Cumulative-distribution-based Outlier Detection (ECOD) effectively identified anomalies across different birth weight categories. The OCSVM attained an AUCROC of 0.72 and an AUCPR of 0.0253 for extreme LBW detection, while the ECOD model showed competitive performance with an AUCPR of 0.045 for very low LBW cases. Additionally, a novel feature perturbation technique was introduced to enhance the interpretability of the anomaly detection models by providing insights into the relative importance of various prenatal features. The proposed interpretation methodology is validated by the clinician experts and reveals promise for early intervention strategies and improved neonatal care.

Scaling Up Kangaroo Mother Care Through a Facility Delivery Model in Rural Districts of Pakistan: Protocol for a Mixed Methods Study

BACKGROUND

The neonatal mortality rate in Pakistan is the third highest in Asia, with 8.6 million preterm babies. These newborns require warmth, nutrition, and infection protection, typically provided by incubators. However, the high maintenance and repair costs of incubators pose a barrier to accessibility for many premature and low birth weight neonates in low- and middle-income countries. This study aims to implement a context-specific kangaroo mother care (KMC) model in Sanghar within secondary health care facilities and catchment communities.

OBJECTIVE

This study aims to achieve at least 80% KMC coverage for premature and low birth weight neonates.

METHODS

This research uses a mixed methods design grounded in implementation science principles, with the goal of developing adaptive strategies tailored to district and facility managers, as well as health care workers, leveraging previous evidence on the benefits of KMC. The research is conducted in the district of Sanghar, Sindh with an emphasis on promoting KMC for infants weighing between 1200 and 2500 g in three facilities. It includes preimplementation data collection, training of health care providers and lady health workers, and intervention involving mother-baby skin-to-skin contact, breastfeeding initiation, and postdischarge follow-ups. Ethical considerations and data management are prioritized, to improve KMC coverage and neonatal health outcomes.

RESULTS

This research will be implemented over a period of 18 months. The primary objective of this research is to achieve an 80% improvement in KMC coverage, with the secondary objective to promote optimal breastfeeding practices among postpartum mothers. Key indicators include the proportion of eligible infants enrolled in KMC, the percentage of mother-baby pairs receiving skin-to-skin care postdischarge, and the duration of KMC during the neonatal period. Additionally, the study will assess exclusive breastfeeding rates, neonatal weight gain, and neonatal deaths within the cohort. The data management team will evaluate the effectiveness of the model in achieving the targeted KMC coverage.

CONCLUSIONS

The integration of KMC into the health care system will provide valuable insights for policy makers regarding effective implementation and scaling strategies. The study's findings will highlight facilitators and barriers to KMC adoption, benefiting regions across Pakistan and globally. Additionally, these findings will offer valuable insights for the development of future newborn care programs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56142.

Neonatal outcomes in offspring of mothers with pregestational diabetes: a hospital-based multicentre prospective cohort study protocol

INTRODUCTION

Pregestational diabetes mellitus (PGDM) occurs when a woman becomes pregnant after having diabetes mellitus. The presence of diabetes during the entire pregnancy can have an adverse impact on fetal and neonatal outcomes. The objective of this study is to examine the association between PGDM and neonatal outcomes at birth.

METHODS AND ANALYSIS

This prospective hospital-based cohort study is ongoing at three tertiary-level hospitals in Kerala, India. The study targets to recruit 1260 pregnant women. All pregnant women above the age of eighteen who had confirmed pregnancy in an early pregnancy scan and in the first trimester of pregnancy visiting the three study sites for antenatal care will be included in the study. Those who will have a miscarriage, an abortion or twin pregnancies will be excluded from the study. All pregnant women will be evaluated for diabetic state via RBS, HbA1c and FBS based on the International Association of Diabetes and Pregnancy Study Groups criteria during their initial visit to the study sites. PGDM will be diagnosed by the following criteria-FBS ≥126 mg% OR HbA1c ≥6.5 mg% OR Random blood glucose ≥200 mg% on the initial visit or documented prior to the index pregnancy. Neonatal outcomes among the newborn babies will be assessed on the day of birth. We will report adjusted ORs with 95% CI for significant associations derived from multivariable logistic regression analysis.

ETHICS AND DISSEMINATION

The present study received ethical approval from the three study sites. Informed consent will be obtained from the study participants before data collection.

TRIAL REGISTRATION NUMBER

CTRI/2024/06/068978.

CONCLUSION

Early identification and management of PGDM among mothers will probably help to prevent adverse neonatal outcomes at birth.

The feasibility of implementing a digital pregnancy and postpartum support program in the Midwestern United States and the association with maternal and infant health

Objective

The benefits of mobile applications in the prenatal period remain understudied. This study assessed associations between the Pregnancy Postpartum Support Program (PPSP), a digital wraparound service, and maternal and infant outcomes in a Medicaid population.

Methods

A retrospective analysis was conducted on pregnant patients with Medicaid insurance who received care and delivered in a Midwestern United States healthcare system between 8/1/2022-8/15/2023, comparing outcomes among those who did versus did not opt for PPSP enrollment. Enrolled patients were offered a mobile device app providing weekly education, "twenty-four seven" support from a clinical team, and telehealth provider visits. Adjusted multiple covariate analyses were completed using linear and logistic regressions. Patient engagement, vendor-based interaction and perception of care data were also examined.

Results

1912 patients were evaluated: 397 in the PPSP and 1515 in the control group. PPSP cohort inclusion was associated with 4 % lower maternal length of stay (LOS) (p = 0.05), 14 % lower infant LOS (p < 0.01), higher mean infant birthweight (p < 0.01), lower odds of birthweight <2500 g (p = 0.05) and lower odds of preterm birth (p = 0.04). Nearly 85 % of all enrolled reported being "very satisfied" with the program.

Conclusions

Overall, the program was positively received by PPSP participants. Favorable outcomes associated with enrollment may be due to the program, unmeasured variables, or both. Our study shows the feasibility of offering digital support to pregnant women who voluntarily enrolled in the PPSP and adds to the evidence evaluating virtual care strategies.

The association between mercury exposure during pregnancy and adverse birth outcomes: A systematic review and meta-analysis

Studies have shown that mercury (Hg) exposure during pregnancy is associated with adverse birth outcomes (ABO) in infants, but the association between the two has not been systematically summarized. Therefore, we conducted a systematic review and meta-analysis of existing observational studies on the association between maternal Hg exposure (MHE) during pregnancy and ABO in infants to evaluate the association between them. We comprehensively searched all relevant literature published in three electronic databases (Web of Science, PubMed, Embase) from 2004 to June 2024. According to the heterogeneity, fixed effect model (I2 ≤ 50 %) or random effect model (I2 > 50 %) was used to pool the associated effect values. The results showed a positive association between MHE and low birth weight (LBW) (OR = 1.079, 95 % CI: 1.032-1.128) and no statistically significant association between and preterm birth (PTB) (OR = 1.044, 95 % CI: 0.956-1.140) and small-for-gestational-age (SGA) (OR = 1.006, 95 % CI: 0.983-1.030). In addition, each 10-fold increase in MHE during pregnancy was associated with abnormal Birth Anthropometrics. These findings suggest that MHE is a risk factor for LBW and is associated with abnormal anthropometric measurements at birth. However, there is insufficient evidence for Hg exposure and SGA, PTB. Further population-based studies are warranted to investigate these associations.

Challenges and trends in Gram-negative bacterial infections in critically neonates: A seven-and-a-half-year observational study

BACKGROUND

Analyze the incidence, risk factors, and fatality rates of bloodstream infections by Gram-negative bacteria (GNB-BSIs) in a Neonatal Intensive Care Unit.

METHODS

This study employs a retrospective cohort design utilizing records of neonates admitted to the Neonatal Intensive Care Unit between January 2015 and June 2022.

RESULTS

Among 1,495 neonates, 5.2% developed GNB-BSIs. The average incidence of infection per 1,000 patient-days was 2.9. Primary risk factors for infection that included preceeding carbapenem use were significant risk factors (odds ratio=514.4; P < .01) and fourth-generation cephalosporins (odds ratio=66; P < .01). Among the 85 GNB, 75.3% were fermenters, and 24.7% were non-fermenters. Of the isolates, 14.1% produced extended-spectrum beta-lactamase, and 2.3% carbapenem-resistant. Infection correlated with prolonged hospital stays (10-39days) and increased mortality (10%-29.9%).

CONCLUSIONS

The high incidence of GNB-BSIs was exacerbated by the preceeding use of broad-spectrum antimicrobials, increasing the presence of multidrug-resistant isolates and fatality rates. These findings emphasize the importance of active surveillance.

Postnatal foot length measurement as a proxy to identify low birth weight for frontline health workers in rural Sindh Province, Pakistan: a diagnostic accuracy study

OBJECTIVE

To assess the diagnostic accuracy of postnatal foot length (FL) measurements as a proxy to identify low birth weight (LBW) for frontline healthcare workers in rural Sindh Province, Pakistan.

DESIGN

A community-based cross-sectional study.

SETTING

This study was conducted in the catchment area of Global Network's Maternal and Newborn Health Registry, Thatta, Sindh Province, Pakistan, from January to June 2023.

PARTICIPANTS

Singleton live births irrespective of gestational age at birth.

REFERENCE STANDARD

Birth weight was measured using calibrated digital weighing scales in grams based on the average of three readings with minimal clothing.

INDEX TEST

FL was measured within 48 hours of birth using a rigid transparent plastic ruler in centimetres based on the average of three measurements.

PRIMARY OUTCOME

Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristics curve and area under the curve with 95% CI were calculated. Euclidean distance was used to identify the cutoff of FL to identify LBW. A simple linear equation was created to predict the birth weight.

RESULTS

Out of 336 analysed newborns, 179 (53.3%) were male and 157 (46.7%) were female. The median birth weight was 2801 g (IQR: 2465-3057), of whom 88 (26.2%) were LBW. The median foot length was 7.9 cm (IQR: 7.6-8.1). For identifying LBW, the foot length cutoff was ≤7.6 cm with 90.3% sensitivity, 81.8% specificity, 63.8% PPV and 96.0% NPV. A FL of 7.6 cm predicted birth weight of 2459.4 g.

CONCLUSION

Postnatal FL cutoff of ≤7.6 cm has adequate predictive value served as a simple, low-cost and reliable method to identify LBW for frontline healthcare providers in the rural settings of Thatta without calibrated weighing scales to triage LBW newborns in need of higher-level care.

TRIAL REGISTRATION NUMBER

NCT05515211.

Prediction of gestational diabetes mellitus using early-pregnancy data: a secondary analysis from a prospective cohort study in Iran

BACKGROUND

Early identification of gestational diabetes mellitus is essential for improving maternal and neonatal outcomes. While risk factors such as advanced maternal age, elevated pre-pregnancy body mass index, multiparity, and a history of gestational diabetes have been recognized, the role of serum biomarkers remains uncertain. This study explores the predictive value of early-pregnancy laboratory findings in conjunction with maternal demographic and clinical characteristics for gestational diabetes mellitus.

METHODS

Early-pregnancy data from the first pregnancy visits at 6-12 weeks of gestation from women in the Mothers and Children's Health cohort were collected. Comprehensive maternal demographic data (e.g., age and body mass index) and obstetrics history (e.g., gravidity, parity, miscarriage, intrauterine growth retardation, gestational diabetes mellitus, and preeclampsia) were recorded. Maternal blood samples were analyzed for complete blood count and biochemistry parameters. Gestational diabetes mellitus was diagnosed based on 75-g oral glucose tolerance test results between 24 and 28 weeks of gestation, following the International Association of Diabetes and Pregnancy Study Groups criteria. Multivariate logistic regression analysis assessed the predictive capacity of various variables. Receiver operating curve analysis was conducted to identify optimal predictive cut-offs for continuous variables.

RESULTS

1,565 pregnant women with a mean age of 32.6 ± 5.7 years, mean body mass index of 25.5 ± 4.9 kg/m², mean gravidity of 1.1 ± 1.1, and mean parity of 0.8 ± 0.8 were included. 297 pregnancies (19.0%) were complicated by gestational diabetes mellitus. In the multivariate analysis, higher maternal age (p < 0.001, odds ratio = 1.076 [1.035-1.118]), a history of gestational diabetes mellitus (p < 0.001, odds ratio = 3.007 [1.787-5.060]) and preeclampsia (p = 0.007, odds ratio = 2.710 [1.310-5.604]), and elevated early-pregnancy fasting blood sugar (p < 0.001, odds ratio = 1.062 [1.042-1.083]) emerged as independent predictors of gestational diabetes mellitus. Moreover, the receiver operating curve yielded an optimal cut-off of 89.5 mg/dL for early-pregnancy fasting blood sugar in predicting gestational diabetes mellitus.

CONCLUSIONS

Our findings demonstrated that, in addition to established risk factors, a history of preeclampsia and elevated early-pregnancy fasting blood glucose are independent predictors of gestational diabetes mellitus. Therefore, close monitoring of pregnant women with these risk factors in early pregnancy is warranted to facilitate timely diagnostic and therapeutic interventions, reducing the burden of gestational diabetes.

TRIAL REGISTRATION

Not applicable.

Adverse birth outcome research case definitions associated with maternal HIV and antiretroviral drug use in pregnancy: a scoping review

BACKGROUND

Adverse birth outcomes (preterm birth, low birth weight, small for gestational age, and stillbirth) seem to persist in infants born to people with HIV, even in the context of maternal antiretroviral therapy. However, findings have been disparate, inconclusive, and difficult to compare directly across settings, partly owing to variable outcome definitions. We aimed to collate, compare, and map existing adverse birth outcome definitions to inform a harmonized approach to universally measure these outcomes in studies including pregnant people with HIV.

METHODS

We conducted a scoping review of studies that reported adverse birth outcomes associated with maternal HIV and antiretroviral use in pregnancy, specifically those that included definitions of 'preterm birth', 'low birth weight', 'small for gestational age', and 'stillbirth'. Five databases were searched from 01 January 2011 to 15 August 2022. Title, abstract and full-text screening was conducted independently in duplicate. A comparative quantitative analysis was conducted to compare study characteristics by period of study (< 2013; 2013-2015; > 2016) and country income group. A qualitative content analysis was conducted to compare and map deviations from the WHO definitions as a reference.

RESULTS

Of the 294 articles that included at least one adverse birth outcome, 214 (73%) studies started before 2013, 268 (91%) were published as primary research articles, and 137 (47%) were conducted in Eastern and Southern Africa. Among the 283 studies included in the country income group analysis, 178 (63%) were conducted in low- and middle-income countries. Studies reporting low birth weight, preterm birth, small for gestational age and stillbirth deviated from the WHO definitions in n = 11/169 (7%), n = 93/246 (39%), n = 40/112 (36%) and n = 85/108 (79%) instances, respectively. The variations included the use of different thresholds and the addition of new terminology.

CONCLUSION

The current WHO definitions are valuable tools for population-level monitoring; however, through consensus, these definitions need to be optimized for research data collection, analysis, and presentation. In conjunction with good reporting, variation in adverse birth outcome definitions can be decreased to facilitate comparability of studies as well as pooling of data for enhanced evidence synthesis.

Redlining in New York City: impacts on particulate matter exposure during pregnancy and birth outcomes

BACKGROUND

Evidence suggests historical redlining shaped the built environment and health outcomes in urban areas. Only a handful of studies have examined redlining's association with air pollution and adverse birth outcomes in New York City (NYC). Additionally, no NYC-specific studies have examined the impact of redlining on birth weight.

METHODS

This longitudinal cohort study analysed data from the National Institute of Health Environmental Influences on Child Health Outcomes Programme to investigate the extent to which maternal residence in a historically redlined neighbourhood is associated with fine particulate matter (PM2.5) exposure during pregnancy using multivariable regression models. Additionally, we examined how maternal residence in a historically redlined neighbourhood during pregnancy influenced birth weight z-score, preterm birth and low birth weight.

RESULTS

Our air pollution model showed that living in a historically redlined census tract or an ungraded census tract was associated with increased PM2.5 exposure during pregnancy. We also found living in a historically redlined census tract or an ungraded census tract was associated with a lower birth weight z-score. This finding remained significant when controlling for individual and census tract-level race, ethnicity and income. When we controlled PM2.5 in our models assessing the relationship between redlining grade and birth outcome, our results did not change.

DISCUSSION

Our study supports the literature linking redlining to contemporary outcomes. However, our research in ungraded tracts suggests redlining alone is insufficient to fully explain inequality in birth outcomes and PM2.5 levels today.

Factors associated with low birth weight in low-income populations in the Western Balkans: insights from the multiple indicator cluster survey

Introduction

Low birth weight, defined as a birth weight below 2,500 g, represents a significant public health concern with a multifactorial risk dimension. Socio-demographic factors and individual characteristics of women and their social environment could influence low birth weight. This study aimed to analyze the association between the socio-demographic and reproductive characteristics of women living in low-income households and low birth weight in Serbia, Kosovo, and Montenegro.

Methods

This study was conducted as secondary data analysis during the Multiple Indicator Cluster Survey - Round 6 in Serbia, Kosovo, and Montenegro. The household questionnaire and the individual questionnaire for women aged 15-49 were used as standard research instruments. We analyzed 1,019 women whose households belonged to the first (poorest) or second (poor) wealth index quintiles and who had given birth to a live child within the 2 years preceding the study. A multivariate logistic regression was applied with low birth weight in newborns as the outcome variable.

Results

The univariate regression analysis showed that women with low birth weight newborns were significantly more likely to live in settlements mainly inhabited by Roma, reside in urban areas, marry or enter a union before age 18, have lower education levels, experience higher illiteracy rates, and receive antenatal care not provided by a medical doctor compared to women whose newborns weighed 2.5 kg or more. A multivariate logistic regression model with a low birth weight of newborns as an outcome variable showed the association between women's illiteracy (OR: 1.741; 95% CI: 1.060-2.859) and antenatal care not provided by a medical doctor (OR: 2.735; 95% CI: 1.229-6.087).

Discussion

Illiteracy and limited access to medical doctor services during pregnancy were factors that increased the likelihood of low birth weight in newborns born to women living in low-income households in the selected Western Balkans populations. The cross-sectional design of this study does not allow the establishment of causal relationships among variables, but it can provide important evidence for future prevention strategies. Interventions are needed to enhance the education of women and to improve access to antenatal care across Serbia, Kosovo, and Montenegro.

Association between neonatal mortality and births not weighed among 400 thousand institutional deliveries in 32 low- and middle-income countries

BACKGROUND

Low birthweight (LBW) children have a higher risk of neonatal mortality. All institutional deliveries, therefore, should be weighed to determine appropriate care. Mortality risk for newborns who are not weighed at birth (NWB) is unknown.

METHODS

This paper used logit regression models to compare the odds of death for NWB neonates to that of other neonates using data on 401 712 institutional births collected in Demographic and Health Surveys from 32 low- and middle-income countries.

RESULTS

In the pooled sample, 2.3% died in the neonatal period and 12% were NWB. NWB neonates had a high risk of mortality compared to normal birthweight children (Adjusted odds ratio [AOR] 5.8, 95% CI: 5.3, 6.5). The mortality risk associated with NWB was higher than for LBW. The neonatal mortality risk associated with NWB varied across countries from AOR of 2.1 (95% CI: 1.22, 3.8) in Afghanistan to 94 (95% CI: 22, 215) in Gabon. In the pooled sample, the 12% of children who were NWB accounted for 37% of all neonatal deaths.

CONCLUSIONS

The association between NWB and neonatal mortality may suggest a need to focus on the quality of institutions related to newborn care. However, further studies are needed to determine causality. A health emergency or death may also cause NWB.

Trophectoderm biopsy is associated with lower risks of moderate to extreme prematurity and low birthweights: a national registry cohort study of singleton livebirths from frozen-thawed blastocyst transfers

BACKGROUND

Trophectoderm biopsy has become the mainstay assisted reproductive technique performed for preimplantation genetic testing, accounting for 43.8% of embryo transfer cycles in the United States in 2019 alone. Despite its prevalence, data on the obstetric and perinatal outcomes post-trophectoderm biopsy remains sparse and mixed.

OBJECTIVE

This study aimed to examine the risks of adverse perinatal outcomes in birthweights and prematurity after transfers of the vitrified-thawed blastocyst with trophectoderm biopsy for preimplantation genetic testing.

STUDY DESIGN

This was a retrospective observational cohort study of 45,712 singleton livebirths resulting from autologous vitrified-thawed blastocyst transfer cycles with or without trophectoderm biopsy for preimplantation genetic testing, reported by participating member clinics to the Society for Assisted Reproductive Technology national registry between 2014 and 2017. Adverse perinatal outcomes of preterm births and low birthweights were analyzed. Multivariable regression analyses were performed to control for covariates. Comparing the trophectoderm biopsy (n=21,584) and no trophectoderm biopsy (n=24,128) groups, adjusted odds ratios were calculated for the outcomes of small-for-gestational-age, large-for-gestational-age, low birthweight <2500 g, very low birthweight <1500 g, extremely low birthweight <1000 g, late preterm births <37 weeks, moderate preterm births <34 weeks, and extremely preterm births <28 weeks.

RESULTS

Women in the trophectoderm biopsy group were older and more likely to have prior pregnancies, deliveries, and a history of spontaneous abortions. Tobacco use, diminished ovarian reserve, and recurrent pregnancy loss were also more prevalent in the trophectoderm biopsy group. Trophectoderm biopsy was not associated with small-for-gestational-age (adjusted odds ratio, 0.97; 95% confidence interval, 0.85-1.12; P=.72) or large-for-gestational-age newborns (adjusted odds ratio, 1.10; 95% confidence interval, 0.99-1.22; P=.09). Risks of preterm births <37 weeks gestation were similar between the biopsy and nonbiopsy groups (adjusted odds ratio, 0.93; 95% confidence interval, 0.85-1.02; P=.11). Trophectoderm biopsy was associated with a significantly lower risk of low birthweight <2500 g (adjusted odds ratio, 0.80; 95% confidence interval, 0.70-0.92; P<.001), very low birthweight <1500 g (adjusted odds ratio, 0.62; 95% confidence interval, 0.46-0.83; P<.001), extremely low birthweight <1000 g (adjusted odds ratio, 0.48; 95% confidence interval, 0.31-0.74; P<.001), moderate preterm birth <34 weeks (adjusted odds ratio, 0.76; 95% confidence interval, 0.64-0.91; P=.003), and extreme preterm birth <28 weeks (adjusted odds ratio, 0.63; 95% confidence interval, 0.43-0.92; P=.02).

CONCLUSION

Trophectoderm biopsy is not associated with increased risks of small-for-gestational-age, large-for-gestational-age, or late preterm birth. Risks of low birthweight, very low birthweight, and extremely low birthweight from moderate and extreme preterm births are lower after trophectoderm biopsy, possibly by selecting against confined placental mosaicism or inducing placental epigenetic changes, the mechanisms of which warrant further investigation.

The effect of low birthweight on physical activity engagement and markers of chronic disease in the Framingham cohort

While physical activity reduces the risk for chronic disease development, evidence suggests those experiencing early life growth-restriction do not express positive adaptations in response to physical activity. The purpose of this study was to examine the effects of low birthweight (LBW) on markers of chronic disease, adult physical activity, and the response to physical activity engagement in a longitudinal human cohort study. Data from the Framingham Offspring Cohort were organized to include participants with birthweight, physical activity, and chronic disease biomarker/treatment data available at two timepoints (exam 5 and exam 9, 19-year difference). A two-way ANCOVA was performed to determine the association of LBW and sex on physical activity engagement (63.0% female, 10.4% LBW). A multinomial logistic regression was performed to examine the associations of low birthweight and sex on chronic disease development while adjusting for physical activity. LBW was associated with elevated blood glucose and triglycerides (Exam 9). Though not statistically significant (p = 0.08), LBW females potentially spent more time in sedentary activity at exam 5 than LBW males and normal birthweight (NBW) females. LBW males spent significantly more time (p = 0.03) sedentary at exam 9 compared to NBW males and LBW females. There were no differences in the likelihood of chronic disease treatment between groups. Chronic disease biomarkers remained elevated when adjusted for total physical activity. In conclusion, LBW participants in the Framingham Offspring Cohort were not more likely to be treated for chronic diseases when controlling for physical activity engagement, though biomarkers of chronic disease remained elevated.

Nutritional Management of Low Birth Weight and Preterm Infants in Low- and Low Middle-Income Countries

INTRODUCTION

Preterm and low birth weight (LBW) infants are at an increased risk of morbidity and mortality compared with their term counterparts, with more than 20 million LBW infants born each year, the majority in lower middle-income countries (LMICs). Given the increased vulnerability and higher nutritional needs of these infants, optimizing feeding strategies may play a crucial role in improving their health outcomes.

METHODS

We updated evidence of Every Newborn Series published in The Lancet 2014 by identifying relevant systematic reviews, extracting low-income country (LIC) and LMIC data, and conducting revised meta-analysis for these contexts.

RESULTS

We found 15 reviews; the evidence showed that early initiation of enteral feeding reduced neonatal mortality overall, but not in LIC/LMIC settings. Breastfeeding promotion interventions increased the prevalence of early initiation of breastfeeding and exclusive breastfeeding at 3 and 6 months of age in LMIC settings. There was an increased risk of neonatal mortality with formula milk in LIC/LMIC settings. Despite contributing to greater weight gain, there was a higher risk of necrotizing enterocolitis with formula milk overall. Breast milk fortification and nutrient-enriched formula improved growth outcomes. Iron and vitamin A supplementation reduced anemia and mortality rates (LMIC), respectively. The evidence also suggested that benefits of various different micronutrient supplementation interventions such as zinc, calcium/phosphorous, and vitamin D, outweigh the risks since our review demonstrates little to no adverse effects deriving from their supplementation, particularly for a breastfed preterm and/or LBW infant.

CONCLUSION

Early adequate nutritional support of preterm or LBW infant is paramount to averse adverse health outcomes, contribute to normal growth, resistance to infection, and optimal development. Breast milk feeding and micronutrient supplementation are crucial to reduce diarrhea incidence and mortality respectively while feed fortification or nutrient-enriched formula, when breast milk is not available, to enhance better growth especially in LMICs where there is higher population of growth restriction and stunting. This review also highlights need for randomized trials in LMICs at large scale to further strengthen the evidence.

INTRODUCTION

Preterm and low birth weight (LBW) infants are at an increased risk of morbidity and mortality compared with their term counterparts, with more than 20 million LBW infants born each year, the majority in lower middle-income countries (LMICs). Given the increased vulnerability and higher nutritional needs of these infants, optimizing feeding strategies may play a crucial role in improving their health outcomes.

METHODS

We updated evidence of Every Newborn Series published in The Lancet 2014 by identifying relevant systematic reviews, extracting low-income country (LIC) and LMIC data, and conducting revised meta-analysis for these contexts.

RESULTS

We found 15 reviews; the evidence showed that early initiation of enteral feeding reduced neonatal mortality overall, but not in LIC/LMIC settings. Breastfeeding promotion interventions increased the prevalence of early initiation of breastfeeding and exclusive breastfeeding at 3 and 6 months of age in LMIC settings. There was an increased risk of neonatal mortality with formula milk in LIC/LMIC settings. Despite contributing to greater weight gain, there was a higher risk of necrotizing enterocolitis with formula milk overall. Breast milk fortification and nutrient-enriched formula improved growth outcomes. Iron and vitamin A supplementation reduced anemia and mortality rates (LMIC), respectively. The evidence also suggested that benefits of various different micronutrient supplementation interventions such as zinc, calcium/phosphorous, and vitamin D, outweigh the risks since our review demonstrates little to no adverse effects deriving from their supplementation, particularly for a breastfed preterm and/or LBW infant.

CONCLUSION

Early adequate nutritional support of preterm or LBW infant is paramount to averse adverse health outcomes, contribute to normal growth, resistance to infection, and optimal development. Breast milk feeding and micronutrient supplementation are crucial to reduce diarrhea incidence and mortality respectively while feed fortification or nutrient-enriched formula, when breast milk is not available, to enhance better growth especially in LMICs where there is higher population of growth restriction and stunting. This review also highlights need for randomized trials in LMICs at large scale to further strengthen the evidence.

Face Processing in Prematurely Born Individuals-A Systematic Review

BACKGROUND/OBJECTIVES

Prematurely born individuals are at risk for developing socio-emotional difficulties and psychopathologies such as autism spectrum disorder. Particular difficulties processing social information conveyed by the face may underlie these vulnerabilities.

METHODS

This comprehensive review provides an overview of 27 studies published between 2000 and mid-2022 concerning face processing in individuals born preterm and/or born with low birth weight across different age ranges, paradigms, and outcome measures. The results were interpreted across different developmental stages.

RESULTS

Behavioural studies indicated that prematurity is associated with poorer facial identity and expression processing compared to term-born controls, especially for negative emotions. Structural alterations and delayed maturation in key neural face processing structures could explain these findings. Neuroimaging also revealed functional atypicalities, which may either be rooted in the structural alterations or may partly compensate for the delayed maturation.

CONCLUSIONS

The results suggest that altered face processing may be associated with an increased risk of developing psychopathologies in individuals born prematurely. Future studies should investigate the preterm behavioural phenotype and the potential need for face processing rehabilitation programs.

Association between maternal exposure to polycyclic aromatic hydrocarbons and birth anthropometric outcomes: A systematic review and meta-analysis

BACKGROUND

Previous research has proposed that exposure to polycyclic aromatic hydrocarbons (PAHs) during pregnancy could potentially lead to a higher risk of adverse birth anthropometric outcomes. However, the current evidence on this connection remains inconclusive, as various studies have presented conflicting results.

OBJECTIVE

This systematic review and meta-analysis seeks to synthesize the available research on the potential link between maternal PAHs exposure and birth anthropometric outcomes.

METHODS

A comprehensive search of Scopus, PubMed/MEDLINE, Web of Science, and the Cochrane Library up to July 1, 2024, was conducted to identify studies investigating the impact of maternal PAHs exposure during pregnancy on birth anthropometric measures, including small gestational age (SGA), low birth weight (LBW), birth weight (BW), birth length (BL), birth head circumference (BHC), and birth chest circumference (BCC). Quality assessment was performed using the Newcastle-Ottawa Scale (NOS) and the GRADE framework, and a random-effects meta-analysis was conducted to consolidate association estimates.

RESULTS

Out of 5499 articles initially screened, 27 studies were included in the review. The meta-analysis revealed no significant association between maternal PAHs exposure and LBW (OR: 1.02, 95 % CI: 0.96-1.08), with moderate heterogeneity (I²: 25.8 %, P=0.37). Notably, PAHs exposure was significantly associated with BW (β: -9.79 g, 95 % CI: -16.71 to -2.87), along with high heterogeneity (I²: 99.9 %, P<0.001), and shorter BL (β: -0.04 cm, 95 % CI: -0.07 to -0.01), also with high heterogeneity (I²: 84.3 %, P<0.001). Additionally, a borderline significant decrease in BHC was observed (β: -0.01 cm, 95 % CI: -0.02 to -0.00) with no significant heterogeneity among studies. The results SGA were inconsistent across the studies.

CONCLUSION

Maternal exposure to PAHs was associated with adverse birth anthropometric outcomes, particularly lower BW and BL. The borderline significant reduction in BHC suggests a potential impact worth further investigation, although this finding remains inconclusive and not yet actionable. Results for SGA varied significantly among studies, underscoring the complexity of these associations. Collectively, these findings highlight the necessity for additional research to elucidate the effects of specific PAH metabolites on birth anthropometric outcomes and to explore potential interventions aimed at mitigating the identified risks.

The impact of impaired intrauterine growth on male fertility: A systematic review and meta-analysis

BACKGROUND

Adverse intrauterine environment was believed to have deleterious effects on the gonadal function. However, the association between impaired intrauterine growth and fertility in adult males has not been established.

OBJECTIVES

To compare the reproductive rates of males born small for gestational age (SGA), with low birth weight (LBW) or very low birth weight (VLBW) with control groups.

METHODS

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was followed to search PubMed, Web of Science, Cochrane Library, and Embase databases from inception to June 16, 2023. Cohort studies investigating the reproductive rates of males born SGA, with LBW or VLBW were included. A random or fixed effects model was used for different exposures.

RESULTS

A total of 10 studies out of 3,801 records were included. Males born SGA showed a higher risk of infertility than the control group (odds ratio, OR = 0.91, 95% confidence interval, 95% CI 0.89-0.93, p = 0.000). The reproductive rates of individuals born with LBW or VLBW were lower than the control group (OR = 0.86, 95% CI 0.78-0.94, p = 0.001; OR = 0.57, 95% CI 0.40-0.81, p = 0.002, respectively). Participants were further divided into two age groups of 18-35 and 35-45 years. In both subgroups, the reproductive rates were lower in males born SGA, with LBW or VLBW compared with controls. Sensitivity analysis showed the robustness of the pooled estimates among LBW and VLBW.

CONCLUSION

In summary, SGA, LBW, and VLBW were associated with a higher risk of male infertility in both early and middle adulthood. Achieving optimal intrauterine growth would be helpful to prevent male infertility.

Fetomaternal Outcomes of Severe Anemia in Pregnancy: A Prospective Observational Study

Introduction Anemia during pregnancy can lead to poor pregnancy outcomes, increasing maternal, fetal, and neonatal morbidity and mortality. Timely detection and management can lead to improved pregnancy outcomes. Objective To study various fetomaternal outcomes in severe anemia during pregnancy. Methods It is a prospective observational study conducted on 102 pregnant females, who presented with severe anemia (hemoglobin (Hb) < 7 gm/dL) between February 2020 and March 2021. Results In this study, 50% of patients presented before term (<37 weeks of gestation). Patients predominantly belonged to the rural population (n = 71, or 69.61%), the majority were multigravidas (81.37%), and 56.86% belonged to the upper-lower socioeconomic class. The mean age at presentation was 26.55 ± 4.99 years. Among maternal outcomes, abruption was seen in 7.84% of patients, post-partum hemorrhage (PPH) in 14.71%, sepsis in 3.92%, prolonged hospitalization in 48.04%, intensive care unit (ICU) admission in 4.90%, and maternal mortality in one patient. Additionally, 82.35% of patients went into spontaneous labor, and 76.47% of patients delivered vaginally. Among fetal and neonatal outcomes, 50% of neonates were premature, 62.75% were low birth weight (LBW), 42.16% were small for gestational age (SGA), and 22.55% of neonates were admitted to the neonatal ICU, of which two neonates expired. Stillbirth was noted in six (5.88%) babies. When the studied population was divided on the basis of the severity of anemia into two groups (Group A: very severe anemia with Hb < 4 gm/dL and Group B: severe anemia with Hb ≥ 4 gm/dL but <7 gm/dL), most of the outcomes were much worse for group A, with a statistically significant difference.  Conclusion Not only can very severe anemia (Hb < 4 gm/dL), but also severe anemia (Hb ≥ 4 gm/dL but <7 gm/dL), adversely affect both maternal and fetal outcomes if not diagnosed and optimized on time.

Intrapartum Electronic Cigarette Use and Birth Outcomes: Evidence from a Population-Based Study

The harms of combustible cigarette (CC) use in pregnancy for fetal development are well studied. Less understood are the potential impacts of newer non-combustible cigarette alternatives, including electronic cigarettes (ECs). Our goal was to examine whether EC use during pregnancy predicts increased risk of adverse birth outcomes. This retrospective cohort study used data from the Obstetrics Initiative (OBI), a statewide collaborative of 70 maternity hospitals. OBI's clinical registry of data on nulliparous, term, singleton, and vertex fetal presentation pregnancies were from medical records. Three groups of pregnancy cigarette users (Controls (n = 26,394), CC (n = 2216), and EC (n = 493)) were compared on birth outcomes, controlling for background differences. Controls were defined as nonsmokers of ECs or CCs. Compared to the controls, the EC group had significantly lower birth weight, while the CC group had reduced birthweight and greater rates of arterial cord pH < 7.1. Compared to EC users, CC users had higher rates of neonates requiring antibiotics and NICU admission. Growing evidence suggests ECs are not safer alternatives to CCs and use during pregnancy should be discouraged. Additional research is needed, as non-significant trends for increased risk of several adverse neonatal outcomes following EC use were found, potentially significant in larger studies with average risk for adverse pregnancy outcomes and when frequency and timing of EC exposure are considered.

Morphometric analysis of the intergenerational effects of protein restriction on nephron endowment in mice

Background

Parental nutritional status is crucial in shaping offspring's kidney development. However, the association between a protein-restrictive diet and its intergenerational impact on kidney development remains unclear.

Methods

We conducted multigenerational morphometric measurements to investigate the effects of parental protein deprivation on offspring kidney development across four generations. F0 mice were divided into two groups and fed a normal protein diet (NPD) or a low-protein diet (LPD) for three weeks before mating and continued these diets throughout gestation and lactation. Body weight (BW), kidney weight (KW), KW/BW ratio, nephron counts, and blood pressure were assessed in F1 pups. To examine paternal effects, we bred CD1 females on an NPD with males on an LPD. BW, KW, KW/BW, and nephron counts were measured at P20. To measure the transgenerational effect of parental LPD on kidney development, F1 offspring (from parents on LPD) were fed NPD upon weaning. These F1 offspring were bred at 6 weeks of age to produce F2, F3 and F4 generations. Kidney metrics were evaluated across generations.

Results

The average body weight of P0 pups from parents on NPD was 1.61g, while pups from parental LPD weighed an average of 0.869g, a decrease of 54 % (p = 6.9e-11, Wilcoxon test). F1 from parental LPD have significantly smaller kidneys than the control, with an average combined kidney weight of 0.0082g versus 0.0129g, a 37 % decrease (p = 3.2e-02, Wilcoxon test). P20 BW and KW remained low in LPD offspring. These effects persisted for 4 generations (F1 to F4) with an average glomerular count reduction of roughly 20 %. F3 and F4 showed wider variability in glomerular counts but were not statistically significant compared to controls.

Conclusions

Both maternal and paternal LPD significantly affected offspring nephron endowment. Our study underscores the complex nature of nutritional transgenerational effects on kidney development, emphasizing the importance of both maternal and paternal dietary impacts on kidney development and the developmental origin of adult disease.

Associations between maternal microbiome, metabolome and incidence of low-birth weight in Guatemalan participants from the Women First Trial

Background

Low birth weight (LBW; <2,500 g) affects approximately 15 to 20 percent of global births annually and is associated with suboptimal child development. Recent studies suggest a link between the maternal gut microbiome and poor obstetric and perinatal outcomes. The goal of this study was to examine relationships between maternal microbial taxa, fecal metabolites, and maternal anthropometry on incidence of LBW in resource-limited settings.

Methods

This was a secondary analysis of the Women First trial conducted in a semi-rural region of Guatemala. Maternal weight was measured at 12 and 34 weeks (wk) of gestation. Infant anthropometry measures were collected within 48 h of delivery. Maternal fecal samples at 12 and 34 weeks were used for microbiome (16S rRNA gene amplicon sequencing) and metabolomics analysis (34 wk). Linear mixed models using the MaAslin2 package were utilized to assess changes in microbiome associated with LBW. Predictive models using gradient boosted machines (XGBoost) were developed using the H2o.ai engine.

Results

No differences in β-diversity were observed at either time point between mothers with LBW infants relative to normal weight (NW) infants. Simpson diversity at 12 and 34 weeks was lower in mothers with LBW infants. Notable differences in genus-level abundance between LBW and NW mothers (p < 0.05) were observed at 12 weeks with increasing abundances of Barnesiella, Faecalibacterium, Sutterella, and Bacterioides. At 34 weeks, there were lower abundances of Magasphaera, Phascolarctobacterium, and Turicibacter and higher abundances of Bacteriodes, and Fusobacterium in mothers with LBW infants. Fecal metabolites related to bile acids, tryptophan metabolism and fatty acid related metabolites changed in mothers with LBW infants. Classification models to predict LBW based on maternal anthropometry and predicted microbial functions showed moderate performance.

Conclusion

Collectively, the findings indicate that alterations in the maternal microbiome and metabolome were associated with LBW. Future research should target functional and predictive roles of the maternal gut microbiome in infant birth outcomes including birthweight.

A novel scale for assessing the risk of low birthweight: Birthweight questionnaire

BACKGROUND

The birthweight of a newborn is critical to their health, development, and well-being. Previous studies that used maternal characteristics to predict birthweight did not employ a harmonised scale to assess the risk of low birthweight (LBW).

OBJECTIVE

The goal of this study was to develop a new instrument that uses items on a uniform scale to assess the risk of an LBW in a pregnant woman.

METHODS

Item response theory was employed to evaluate a similar existing scale, and some weaknesses were identified.

RESULTS

Based on the observed weaknesses of the existing scale, a new uniform scale was developed, which is a 3-point Likert scale consisting of seven items.

CONCLUSION

The scale, termed birthweight questionnaire, is a valuable tool for collecting data that could assist in assessing the risk of an LBW at every stage of pregnancy.

Associations between Historical Redlining and the Risk of Pregnancy Complications and Adverse Birth Outcomes in Massachusetts, 1995-2015

Objective: To assess the impact of historical redlining on the risk of pregnancy complications and adverse birth outcomes in Massachusetts (MA) from 1995 to 2015. Methods: In total, 288,787 pregnant people from the MA Birth Registry had information on parental characteristics, pregnancy factors, and redlining data at parental residences at the time of delivery. Historic redlining data were based on MA Home Owners' Loan Corporation (HOLC) security maps, with grades assigned (A "best," B "still desirable," C "definitely declining," and D "hazardous"). We used covariate-adjusted binomial regression models to examine associations between HOLC grade and each chronic condition and pregnancy/birth outcome. Results: Living in HOLC grades B through D compared with A was associated with an increased risk of entering pregnancy with chronic conditions and adverse pregnancy/birth outcomes. The strongest associations were seen with pregestational diabetes (adjusted risk ratio [RR] Grade D: 1.7, 95% confidence interval [CI]: 1.3, 2.4) and chronic hypertension (adjusted RR Grade D: 1.5, 95% CI: 1.1, 1.9). Conclusions: Historical redlining policies from the 1930s were associated with adverse pregnancy outcomes and chronic conditions; associations were strongest for chronic conditions in pregnancy.

Feasibility and diagnostic accuracy of neonatal anthropometric measurements in identifying low birthweight and preterm infants in Africa: a systematic review and meta-analysis

BACKGROUND

Complications of prematurity are the leading cause of under-5 mortality globally and 80% of newborn deaths are of low birth weight (LBW) babies. Early identification of LBW and preterm infants is crucial to initiate timely interventions.

OBJECTIVE

To evaluate the feasibility and diagnostic accuracy of alternative neonatal anthropometric measurements in identifying LBW and preterm infants in Africa.

METHODS

In this systematic review and meta-analysis, we evaluated the diagnostic performance of infant foot length, mid-upper arm circumference (MUAC), head and chest circumferences against birth weight and gestational age. Pooled correlation between the index and the reference methods was estimated. Multiple anthropometric thresholds were considered in estimating the pooled sensitivity, specificity and area under receiver operating characteristic curve (AUC).

RESULTS

21 studies from 8 African countries met the inclusion criteria. Correlation coefficients with birth weight were 0.79 (95% CI 0.70 to 0.85) for chest circumference, 0.71 (95% CI 0.62 to 0.78) for MUAC and 0.66 (95% CI 0.59 to 0.73) for foot length. Foot length measured by rigid ruler showed a higher correlation than tape measurement. Chest circumference with 28.8 cm cut-off detects LBW babies with AUC value of 0.92 (95% CI 0.71 to 0.97). Foot length identified preterm infants, with 82% sensitivity, 89% specificity and AUC of 0.91 (95% CI 0.69 to 0.98) at a 7.2 cm optimal cut-off point. MUAC had an AUC of 0.83 (95% CI 0.47 to 0.95) for preterm detection. In identifying LBW babies, foot length and MUAC have AUC values of 0.89 (95% CI 0.70 to 0.96) and 0.91 (95% CI 0.73 to 0.97) at 7.3 cm and 9.8 cm optimal cut-off points, respectively. Foot length and MUAC are relatively simple and minimise the risk of exposing infants to cold.

CONCLUSION

Newborn foot length, MUAC, head and chest circumferences have comparable diagnostic accuracy in identifying LBW and preterm babies. Using foot length and MUAC in low-resource settings are the most feasible proxy measures for screening where weighing scales are not available.

PROSPERO REGISTRATION NUMBER

CRD42023454497.

Ambient air pollution and low birth weight in Brazil: A nationwide study of more than 10 million births between 2001 and 2018

Low birth weight (LBW) is a global health concern. While it is commonly associated with maternal health and behavior, exposure to ambient air pollution, can also play a role in contributing to LBW. In Brazil, where diverse environmental conditions and regional disparities exist, assessing the impact of ambient air pollution on LBW becomes particularly pertinent. To our knowledge, there is a gap in the existing literature, as no previous study has specifically investigated the relationship between ambient air pollution and LBW nationwide in Brazil. This study aims to fill this gap by examining the association between ambient air pollution and LBW in each trimester of pregnancy across the Brazilian states. In this work, birth data from January 1, 2001, to December 31, 2018 has been used. We utilized logistic regression models to estimate the odds ratio (OR) for low birth weight (LBW) associated with ambient air pollution (PM2.5, NO2, and O3) during each trimester of pregnancy (1st to 3rd trimester) across all 27 Brazilian states in our nationwide case-control study. We adjusted our model for several variables, including ambient temperature, relative humidity, and socioeconomic status (SES) variables at the individual level. We also conducted effect modification analyses by infant sex, mother's age, and the number of prenatal visits. Our study comprises over 10,213,144 birth records nationwide. Of these, 479,204 (4.92%) infants were included as cases of LBW. Our results indicate positive associations between PM2.5 and LBW, mainly in the Southern region. For example, in the state of Santa Catarina (South region), ORs were 1.003 (95% CI: 1.002, 1.004), 1.003 (95% CI: 1.002, 1.004), and 1.005 (95% CI: 1.003, 1.007) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. NO2 had a robust association with LBW in the Northern and Northeastern states, including the state of Amapá (North region, where the Amazon Forest is located) with ORs of 1.377 (95% CI: 1.010, 1.878), 1.390 (95% CI: 1.020, 1.894), and 1.747 (95% CI: 1.297, 2.352) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. Similarly, O3 had a robust association in the North and Midwest states, as observed in the state of Amapá with ORs of 1.033 (95% CI: 1.012, 1.054), and 1.033 (95% CI: 1.013, 1.053) for the 2nd, and 3rd trimesters, respectively. In the stratified analysis, boys were more vulnerable than girls, and the lower number of prenatal visits was associated with higher OR. Our findings are essential to the development of guidelines to prevent maternal exposure and protection of newborns in Brazil. This study provides valuable insights for region-specific strategies to improve maternal and neonatal health.

Managing Newborn Screening Repeat Collections for Sick and Preterm Neonates

Some preterm and sick neonates have altered biochemical profiles and follow-up newborn screening (NBS) collections are recommended. The Victorian NBS program historically recommended repeat collections for babies with birth weight < 1500 g (managed by the maternity service provider) and 3 weeks post-transfusion (managed by the laboratory). We aimed to determine adherence to current guidelines and review the guidelines to improve NBS performance. To do this, we audited data from 348,584 babies between January 2018 and June 2022. Babies with a recorded birth weight of <1500 g were filtered for inclusion. For the overall review and visualization of the protocol, we sourced information from the literature, our professional society and tertiary hospital services. A total of 2647 babies had a birth weight recorded between 200 and 1499 g. Of these, 2036 (77%) had a second sample collected, indicating that >1 in 5 babies were not receiving a follow-up collection. Our timing of repeat collections for transfused babies, requiring a 3-week follow-up collection, was longer than in other Australasian jurisdictions. A new combined "sick-prem protocol" was launched to support repeat collections and after a 1-year review achieved 95% compliance. We recommend NBS laboratories audit preterm and sick neonate repeat collections to ensure appropriate follow-up. This should be supported with a visual process map to aid education and compliance.