Antenatal screening and risk factors for intrauterine growth retardation

Earlier pregnancies in nulliparous women with current father and lower risks for preeclampsia and low-birth weight newborns

New paternity has been related to placenta-associated complications in pregnancy. We evaluated whether a lack of earlier pregnancies or deliveries with a current father are associated with the pregnancy, prenatal, and early neonatal outcomes after controlling for the most common maternal confounders in prospective birth cohort study. An online questionnaire was used to survey 4459 pregnant women from the Kuopio Birth Cohort in their third trimester. The topics included their history of paternity in current and earlier pregnancies. Data were combined with prenatal, perinatal, and early neonatal information. A multivariable logistic regression analysis was performed to compare the possible associations between selected pregnancy and early neonatal outcomes with respect to paternal change. Pregnant women with changed partners had higher rates of smoking during pregnancy and hypertension before pregnancy. In the adjusted analysis, primigravidas and nulliparous multigravidas with different father had the highest risks for preeclampsia (adjusted odds ratios (aORs) 4.46 and 2.69, respectively), low birth weight (aORs 3.15 and 2.25), and smallness for gestational age (aORs 2.23 and 2.16) compared to the parous controls. Nulliparous women who had earlier pregnancies with the current father had less preeclampsia or gestational hypertension, as well as low birth weight (aOR 0.42, 95 % confidence interval (CI) 0.21-0.82 and aOR 0.26, 95 % CI 0.08-0.87, respectively) compared to other nulliparas. Among parous women, most of the pregnancy, obstetric, and early neonatal outcomes were similar in the adjusted analysis, regardless of new changes in paternity.

A discrepancy between gestational age estimated by last menstrual period and biparietal diameter may indicate an increased risk of fetal death and adverse pregnancy outcome

OBJECTIVE

To determine if the discrepancy between gestational age estimated by last menstrual period and by biparietal diameter (GALMP - GABPD) is associated with adverse pregnancy outcome.

DESIGN

Population-based follow up study.

POPULATION

Singleton pregnancies were studied when a reliable date of last menstrual period and biparietal diameter measured between 12 and 22 weeks of gestation was available (n = 16,469).

METHODS

Logistic regression analysis and Kaplan-Meier survival analysis were used to analyse the association between GALMP - GABPD and adverse pregnancy outcome.

MAIN OUTCOME MEASURES

Adverse outcome was defined as abortion after 12 weeks of gestation, still-birth or postnatal death within one year of birth, delivery < 37 weeks of gestation, a birthweight < 2,500 g or a sex-specific birthweight lower than 22% below the expected.

RESULTS

The risk of death was more than doubled if GALMP - GABPD of > or = 8 days was compared with GALMP - GABPD of < 8 days (OR 2.2; 95% CI 1.6-3.1). The risk of death was a factor of 6.1 higher if GALMP - GABPD of > or = 8 days was combined with increased (> 2 x multiple of median) maternal alpha-fetoprotein measured in the 2nd trimester.

CONCLUSIONS

A discrepancy between GALMP and GABPD generally reflects the precision of the two methods used to predict term pregnancy. However, a positive discrepancy of more than seven days, particularly with high maternal alpha-fetoprotein, might indicate intrauterine growth retardation and an increased risk of adverse perinatal outcome.

Antenatal brain injury: aetiology and possibilities of prevention

Although the aetiology of antenatal brain injury is often unclear, procedures can be employed to prevent or reduce the risk of injury. Defective neuropore closure can be prevented by periconceptional administration of folic acid, and the incidence of other severe malformations and genetic disorders can be reduced by early identification and termination of pregnancy. Antenatal identification of IUGR, administration of corticosteroids to cases with pending preterm birth, and treatment of maternal/fetal infections would also reduce the incidence of injury. Mothers can decrease the risk of injury by maintaining a good diet, avoiding smoking, alcohol intake and exposure to TORCH infections during pregnancy.

Differences in late fetal death rates in association with determinants of small for gestational age fetuses: population based cohort study

OBJECTIVE

To examine differences in late fetal death rates in association with determinants of small for gestational age fetuses.

DESIGN

Population based cohort study.

SUBJECTS

1 026 249 pregnancies without congenital malformations.

SETTING

Sweden 1983-92.

MAIN OUTCOME MEASURE

Late fetal death rate.

RESULTS

Depending on underlying determinants late fetal death rates were greatly increased in extremely small for gestational age fetuses (range 16 to 45 per 1000) compared with non-small for gestational age fetuses (1.4 to 4.6). In extremely small for gestational age fetuses late fetal death rates were increased from 31 per 1000 in mothers aged less than 35 years to 45 per 1000 in older mothers, and from 22 per 1000 in women <155 cm in height to 33 per 1000 in women >=175 cm tall. Late fetal death rates were also higher in extremely small for gestational age fetuses in singleton compared with twin pregnancies and in non-hypertensive pregnancies compared with pregnancies complicated by severe pre-eclampsia or other hypertensive disorders. Slightly higher late fetal death rates were observed in nulliparous compared with parous women and in non-smokers compared with smokers.

CONCLUSIONS

Although the risk of late fetal death is greatly increased in fetuses that are extremely small for gestational age the risk is strongly modified by underlying determinants-for example, there is a lower risk of late fetal death in a small for gestational age fetus if the mother is of short stature, has a twin pregnancy, or has hypertension.

The relation between serum markers in the second trimester and placental pathology. A study on extremely small for gestational age fetuses

OBJECTIVES

To examine whether in women who are delivered of an extremely small for gestational age infant, raised levels of second trimester maternal serum alpha-fetoprotein (MSAFP) or human chorionic gonadotrophin (MShCG) levels are related to the presence of placental pathology detected at birth.

DESIGN

Retrospective cross-sectional study.

SETTING

Department of Obstetrics and Gynaecology, Antenatal Diagnosis Unit, Groningen University Hospital, The Netherlands.

PARTICIPANTS

Eighty-four women who were delivered of an extremely SGA infant (< 2.3rd centile) in whom the MSAFP and the MShCG levels were known and placental pathology reports were available (study group), and 8692 women in whom the MSAFP and MShCG levels were known and the pregnancy outcome was normal (control group). Pregnancies with congenital anomalies were excluded. Analyte levels were expressed in multiples of the median (MoM) for gestational age. Statistical analysis between groups was performed by ANOVA, after logarithmic transformation of the MoMs, to normalise their distribution.

MAIN OUTCOME MEASURES

1. The means of the MSAFP and MShCG concentrations in the study group with and without placental lesions were compared with those in the control population. 2. The means of the MSAFP and MShCG levels in the study group with placental lesions were compared with those in the study group without placental lesions.

RESULTS

1. Comparison of study groups with controls: in the study group without placental lesions, the mean log MSAFP MoM (0.062), as well as the mean log MShCG MoM (-0.033), was not significantly different (P = 0.11 and P = 0.68, respectively) from the mean analyte levels in the control population (0.002 and 0.006, respectively). The mean logs of these analytes in the study group with placental lesions (0.162 and 0.129, respectively) were significantly higher compared with the MSAFP and MShCG levels in the control population (P < 0.001 for both analytes). 2. Comparison of study groups with each other: the mean log of the MSAFP level of 0.162 in the group with placental lesions was significantly different from the mean of 0.062 of the study group without placental lesions (P < 0.025). The higher mean log MShCG MoM of 0.129 in the group with placental lesions was significantly different from the mean log MShCG MoM of -0.033 in the study group without placental lesions (P < 0.025).

CONCLUSIONS

Raised levels of second trimester MSAFP and MShCG in women who are subsequently delivered of an extremely small for gestational age infant are related to the presence of pathological changes in the placenta, detectable at birth. It is speculated that these placental pathological changes, which frequently accompany small for gestational age pregnancies, have their origin in the second trimester, when the normal physiological changes of the placenta occur.