Length and ponderal index at birth: associations with mortality, hospitalizations, development and post-natal growth in Brazilian infants

Exercise FITT-V during pregnancy: Association with birth outcomes

BACKGROUND

Prenatal exercise improves birth outcomes, but research into exercise dose-response effects is limited.

METHODS

This study is a retrospective, secondary analysis of pooled data from three blinded, prospective, randomized controlled trials. Prenatal exercise frequency, intensity, type, time, and volume (FITT-V) were assessed in supervised sessions throughout pregnancy. Gestational age (GA), neonatal resting heart rate (rHR), morphometrics (body circumferences, weight-to-length and ponderal index) Apgar and reflex scores, and placental measures were obtained at birth. Stepwise regressions and Pearson correlations determined associations between FITT-V and birth outcomes.

RESULTS

Prenatal exercise frequency reduces ponderal index (R2 = 0.15, F = 2.76, p = .05) and increased total number of reflexes present at birth (R2 = 0.24, F = 7.89, p < .001), while exercise intensity was related to greater gestational age and birth length (R2 = 0.08, F = 3.14; R2 = 0.12, F = 3.86, respectively; both p = .04); exercise weekly volume was associated with shorter hospital stay (R2 = 0.24, F = 4.73, p = .01). Furthermore, exercise type was associated with placenta size (R2 = 0.47, F = 3.51, p = .01).

CONCLUSIONS

Prenatal exercise is positively related to birth and placental outcomes in a dose-dependent manner.

Prenatal exposure to multiple environmental chemicals and birth size

BACKGROUND

Epidemiological studies addressing the combined effects of exposure to chemical mixtures at different stages of pregnancy on birth size are scarce.

OBJECTIVE

To evaluate the association between prenatal exposure to chemical mixtures and birth size.

METHODS

Our previous study repeatedly measured the urinary concentrations of 34 chemical substances among 743 pregnant women and identified three distinct clusters of exposed population and six dominant principal components of exposed chemicals in each trimester. In this study, we assessed the associations of these exposure profiles with birth weight, birth length, and ponderal index using multivariable linear regression.

RESULTS

We found that compared with women in cluster 1 (lower urinary chemical concentrations), women in cluster 2 (higher urinary concentrations of metals, benzothiazole, benzotriazole, and some phenols), and women in cluster 3 (higher urinary concentrations of phthalates) were more likely to give birth to children with higher birth length [0.23 cm (95% CI: -0.03, 0.49); 0.29 cm (95%CI: 0.03, 0.54), respectively]. This association was observed only in 1st trimester. In addition, prenatal exposure to PC3 (higher benzophenones loading) was associated with reduced birth length across pregnancy [-0.07 cm (95% CI: -0.18, 0.03) in 1st and 2nd trimester; -0.13 cm (95% CI: -0.24, -0.03) in 3rd trimester]. Exposure to PC6 (higher thallium and BPA loading in 2nd trimester) was associated with increased birth length [0.15 cm (95% CI: 0.05, 0.26)]. Compared with other outcomes, associations of both clusters and PCs with birth length were stronger, and these associations were more pronounced in boys.

IMPACT STATEMENT

Exposure to multiple chemicals simultaneously, the actual exposure situation of pregnant women, was associated with birth size, indicating that chemical mixtures should be taken more seriously when studying the health effects of pollutants.

Birth anthropometry predicts neonatal and infant mortality in rural Bangladesh: a focus on circumferential measurements

BACKGROUND

Low birth weight predicts risk of infant death. However, several birth measurements may be equally predictive, for which cutoffs and associated risks are less explored.

OBJECTIVES

We assessed and optimized population cutoffs of birth length, weight, and midupper arm circumference (MUAC), head circumference (HC), and chest circumference (CC) for predicting neonatal (≤28 d) and infant (≤365 d) mortality in northwest Bangladesh.

METHODS

Among 28,026 singletons born in an antenatal micronutrient supplement trial, 21,174 received anthropometry ≤72 h after birth, among whom 583 died in infancy. Optimization for predicting mortality for each measurement was guided by the Youden Index (sensitivity + specificity - 1). Relative risk ratios (RRRs) and positive predictive values (PPVs) were calculated across cutoff ranges for individual and any pair of measurements.

RESULTS

Optimal cutoffs, harmonized to 100-g or 0.5-cm readings, for neonatal and infant mortality were 44.5 cm for length, 2200 g for weight, 9.0 cm for MUAC, 31.0 cm for HC, and 28.5 cm for CC, below which all predicted mortality. However, a CC <28.5 cm, alone and combined with HC <31.0 cm, yielded the highest RRR [9.68 (95% CI: 7.84, 11.94) and 15.74 (95% CI: 12.54, 19.75), respectively] and PPV (11.3% and 10.7%) for neonatal mortality and highest RRR [6.02 (95% CI: 5.15, 7.02) and 9.19 (95% CI: 7.72, 10.95)] and PPV (16.3% and 14.5%) for infant mortality. Pairs of measurements revealed a higher RRR for neonatal and infant mortality than individual measurements of any one pair, although the ranges of PPV remained comparable.

CONCLUSIONS

In Bangladesh, multiple birth measurements alone or in combination, particularly chest circumference, predict neonatal and infant mortality.

Chronic maternal hepatitis B virus infection and pregnancy outcome- a single center study in Kunming, China

Background

Chinese population has a high prevalence of chronic hepatitis B virus (HBV) infection, the impact of which on pregnancy outcome remains controversial. A single-center retrospective cohort study was performed in Kunming, a multi-ethnic city in south-western China to examine this issue.

Methods

The singleton pregnancies delivering at ≥28 weeks gestation under our care in 2005–2017 constituted the study cohort. Maternal characteristics and pregnancy outcome were compared between mothers with and without seropositivity for hepatitis B surface antigen (HBsAg) determined at routine antenatal screening.

Results

Among the 49,479 gravidae in the cohort, the 1624 (3.3%) HBsAg seropositive gravidae had a lower incidence of nulliparity (RR 0.963, 95% CI 0.935–0.992) and having received tertiary education (RR 0.829, 95% CI 0.784–0.827). There was no significant difference in the medical history, pregnancy complications, or labor or perinatal outcome, except that HBV carriers had significantly lower incidence of labor induction (RR 0.827, 95% CI 0.714–0.958) and of small-for-gestational age (SGA) infants (RR 0.854, 95% CI 0.734–0.994). On regression analysis, maternal HBV carriage was independently associated with spontaneous labor (aRR 1.231, 95% CI 1.044–1.451) and reduced SGA infants (aRR 0.842, 95% CI 0.712–0.997).

Conclusions

Our 3.3% prevalence of maternal HBV infection was around the lower range determined in the Chinese population. The association with spontaneous labor and reduced SGA infants could have helped to promote the perpetuation of the infection through enhanced survival of the offspring infected at birth, thus explaining the high prevalence in the Chinese population.

Higher maternal parathyroid hormone concentration at delivery is not associated with smaller newborn size

Intrauterine growth restriction (IUGR) reflects inadequate growth in-utero and is prevalent in low resource settings. This study aimed to assess the association of maternal delivery parathyroid hormone (PTH) - a regulator of bone turnover and calcium homeostasis - with newborn anthropometry, to identify regulators of PTH, and to delineate pathways by which maternal PTH regulates birth size using path analysis. This was a cross-sectional analysis of data from participants (n = 537) enrolled in the Maternal Vitamin D for Infant Growth trial in Dhaka, Bangladesh. Primary exposures were maternal delivery intact PTH (iPTH) or whole PTH (wPTH) and outcomes were gestational age- and sex-standardized z-scores for birth length (LAZ), weight (WAZ), and head circumference (HCAZ). Hypothesized regulators of PTH included calcium and protein intake, vitamin D, magnesium, fibroblast-like growth factor-23 (FGF23), and C-reactive protein. Maternal iPTH was not associated with birth size in linear regression analyses; however, in path analysis models, every SD increase in log(iPTH) was associated with 0.08SD (95% CI: 0.002, 0.162) higher LAZ. In linear regression and path analysis models, wPTH was positively associated with WAZ. Vitamin D suppressed PTH, while FGF23 was positively associated with PTH. In path analysis models, higher magnesium was negatively associated with LAZ; FGF23 was positively associated and protein intake was negatively associated with LAZ, WAZ, and HCAZ. Higher maternal PTH in late pregnancy is unlikely to contribute to IUGR. Future studies should investigate maternal FGF23, magnesium and protein intake as regulators of fetal growth, particularly in settings where food insecurity and IUGR are public health problems.

The association of sex of co-twin and birth size in twins born in Yucatan, Mexico between 2008 and 2017

Background: Birth measures of twins are potentially influenced by sex of co-twin.Aim: To analyse the association between sex of co-twin and birth weight, length and ponderal index in twin infants from Yucatan, Mexico.Subjects and methods: A total of 2057 twin pairs born during 2008-2017 were analysed. Female-female (F-F), male-male (M-M) and male-female (M-F) twin pair types were defined. Multiple linear regression models were used to analyse the association of (1) being female from M-F pairs and birth measures among overall female infants (M-F and F-F), and (2) being male from M-F pairs and birth measures among overall male infants (M-F and M-M). The length of gestation and mothers' age and level of education were used as covariates.Results: Models showed that being male from M-F pairs was associated with increases of 81 g in birth weight and 0.61 cm in length, compared to males from M-M pairs, and being female from opposite-sex pairs was associated with increases of 0.36 cm in length, compared to females from same-sex pairs.Conclusions: Males from M-F pairs show greater birth size than males from same-sex pairs, which supports the hypothesis that birth measures of twins are influenced by sex of the co-twin.

Are all piglets born lightweight alike? Morphological measurements as predictors of postnatal performance

Birth weight (BiW) of pigs is a commonly used predictor of postnatal performance; however, it has been suggested that morphological measurements may be more reflective of the intrauterine environment and thus better predictors of postnatal growth. The aim of this study was to determine 1) whether morphological measurements, including ponderal index (PI), body mass index (BMI), and abdominal circumference (AC), could be used as predictors of postnatal performance and 2) if so, would they be better predictors than BiW and 3) would the same predictors apply to pigs of different BiW at different stages of their growth? Morphological measurements, BiW, and BW at d 28 and 70 were available for 731 pigs from experiments conducted over a 2-yr period. A series of linear models was used to determine predictors that affected growth performance from birth to d 28 and from d 28 to 70. For both light (LBiW; ≤1.25 kg) and normal BiW pigs (NBiW; 1.60 to 2.00 kg), BiW was not the best predictor of performance ( > 0.05); different variables for the growth periods considered applied to pigs with different BiW. For LBiW pigs BMI ( < 0.001) and AC ( = 0.0202) were the best predictors for d 1 to 28, and AC ( = 0.0317) and PI ( = 0.0450) were the best predictors from d 28 to 70, with pigs with a larger AC and higher PI/BMI more likely to have higher ADG pre- or postweaning. In contrast, the best predictor variables for NBiW pigs were AC ( = 0.0482) for d 1 to 28 and crown-rump length (CRL; = 0.0138) for d 28 to 70. Focusing on LBiW pigs with low ADG, BMI was the best predictor ( < 0.05) of growth for pre and postweaning, whereas for LBiW pigs with high ADG the best predictors were AC ( = 0.00132) from d 1 to 28 and BiW ( = 0.00601) from d 28 to 70, with increasing BMI, AC, and BiW associated with greater ADG. For NBiW pigs with high preweaning ADG, the best predictor consisted solely of AC ( 0.0210), but no morphological predictor variables were significant for NBiW pigs with low preweaning ADG. For d 28 to 70, the best predictor for NBiW pigs with low ADG was CRL ( = 0.0171), but for high ADG no predictor variables were significant. The present study showed that the morphology of piglets is more important than BiW when predicting the postnatal growth of pigs; however, which measurement is the most important depends on both the BiW and stage of growth. For small-sized pigs, these morphological measures may be considered as a decision-making tool by farmers when trying to identify potential poor performers.

Characterization of the motor performance of newborns in a neonatal unit of tertiary level

Objective:

To characterize the motor performance of newborns in a neonatal unit of tertiary level and compare the results to the values recommended by the Test of Infant Motor Performance (TIMP).

Method:

Newborns between 34 and 416/7 weeks of corrected gestational age, breathing spontaneously and presenting state of consciousness 4 or 5, according to Brazelton, were included. TIMP was used to evaluate the motor performance.

Results:

The age groups of 34-35 and 36-37 weeks showed on average TIMP scores similar to the reference values (p>0.05), while in the age groups of 38-39 weeks and 40-41 weeks TIMP scores were statistically lower than the reference values (p<0.001 and p=0.018, respectively). The 34-35 and 36-37 week groups were rated as average, while the 38-39 and 40-41 week groups were defined as low average. Classifications below average and very below average were not observed.

Conclusion:

The newborns showed average scores compared to the TIMP reference values; however, there were two groups whose performances were within the low average. There was no significant difference in motor performance of newborns in the age groups of 38-39 and 40-41 weeks. This behavior suggests that the sample studied has special features that possibly negatively influenced their motor performance. The results showed that the TIMP is a very useful tool and can be used safely in tertiary neonatal units.

Reference curves of birth weight, length, and head circumference for gestational ages in Yogyakarta, Indonesia

Background

The birth weight reference curve to estimate the newborns at risk in need of assessment and monitoring has been established. The previous reference curves from Indonesia, approximately 8 years ago, were based on the data collected from teaching hospitals only with limited gestational ages. The aims of the study were to update the reference curves for birth weight, supine length and head circumference for Indonesia, and to compare birth weight curves of boys and girls, first child and later children, and the ones in the previous studies.

Methods

Data were extracted from the Maternal-Perinatal database between 1998–2007. Only live singletons with recorded gestational ages of 26 to 42 weeks and the exact time of admission to the neonatal facilities delivered or referred within 24 h of age to Sardjito Hospital, five district hospitals and five health centers in Yogyakarta Special Territory were included. Newborns with severely ill conditions, congenital anomaly and chromosomal abnormality were excluded. Smoothening of the curves was accomplished using a third-order polynomial equation.

Results

Our study included 54,599 singleton live births. Growth curves were constructed for boys (53.3%) and girls (46.7%) for birth weight, supine length, and head circumference. At term, mean birth weight for each gestational age of boys was significantly higher than that of girls. While mean birth weight for each gestational age of first-born-children, on the other hand was significantly lower than that of later-born-children. The mean birth weight was lower than that of Lubchenco’s study. Compared with the previous Indonesian study by Alisyahbana, no differences were observed for the aterm infants, but lower mean birth weight was observed in preterm infants.

Conclusions

Updated neonatal reference curves for birth weight, supine length and head circumference are important to classify high risk newborns in specific area and to identify newborns requiring attention.

The Growth Pattern of Tibetan Infants at High Altitudes: a Cohort Study in Rural Tibet region

Studies on growth pattern of Tibetan infants and the difference from other child groups were limited due to its special living environment and unique customs. In this study, 253 Tibetan infants were followed-up from their birth to 12^th month in rural Tibet. Five visits were conducted and weight and length were measured at each visit. Mixed model was employed to analyze the growth pattern of Tibetan infants and its comparison to the Han infants. Propensity Scores (PS) technique was adopted to control for the potential confounding factors. The mixed model found that the birth weight/length had a negative impact on the increment of Tibetan infants after birth (weight: β = -0.6819, P < 0.0001, length: β = -0.9571, P < 0.0001). The weight increment of Tibetan infants was greater than Han infant with age (β_age*ethnic = 0.0345, P < 0.001), after using PS as a covariant. And another mixed model in which PS was used as a matching factor found similar trend. Compared with Chinese Han infants, Tibetan infants were lower weight and shorter length within one year after birth but they had greater increment of weight, suggesting that Tibetan infants might have a significant catch-up growth within the first year of life.

Serum copeptin and pregnancy outcome in preeclampsia

Background:

A number of biochemical predictors of preeclampsia have been reported, but little is known about their possible relationship with maternal and fetal outcomes. This study determined serum copeptin in pregnant women with preeclampsia and assessed its relationship with pregnancy outcomes.

Materials and Methods:

Thirty women with severe preeclampsia (SP), 30 with mild preeclampsia (MP), and 30 with uncomplicated pregnancy were enrolled into this study. Serum copeptin, creatinine, and liver function were determined using enzyme-linked immunosorbent assay and colorimetry as appropriate. Pregnancy outcomes, both maternal and fetal, were taken using standard methods.

Results:

Copeptin was significantly elevated in preeclampsia subjects compared with controls and in SP compared with MP. Assessing the diagnostic property of copeptin for preeclampsia, the area under the curve for copeptin was 0.99. Nine (30%) and 3 (10%) of SP and MP, respectively had abruptio placenta while 6 (20%), 2 (6.7%), and 1 (3.3%) still births were recorded in SP, MP, and controls, respectively. Neonates of mothers with preeclampsia had significantly lower birth weight, infant length, ponderal index, and head circumference compared with neonates of the controls. Copeptin had a significant inverse relationship with birth weight, ponderal index, head circumference, Apgar score, and infant length in neonates of mothers with preeclampsia.

Conclusion:

Serum copeptin level in the third trimester could predict preeclampsia and its elevation is associated with adverse perinatal outcome.

Perfluoroalkyl acids (PFAAs) and anthropometric measures in the first year of life: Results from the Duisburg Birth Cohort

In the context of the Duisburg Birth Cohort, this retrospective cohort study provides results of internal exposure to perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), and perfluorohexanesulfonic acid (PFHxS) in 156 mother-child pairs, and investigates whether and to what extent in utero exposure of these chemicals at German background levels exerts an effect on newborn and infant weight and length, and weight in relation to length expressed by ponderal index, in order to examine whether any reduction in weight is disproportionate to length. The levels of PFOA, PFOS, and PFHxS were determined in 81 maternal and 83 umbilical cord stored frozen plasma samples and 105 umbilical cord blood samples. Calculated factors were used to convert umbilical cord values to maternal levels. Weights and lengths were retrieved at birth and at 1, 4, 6, and 12 mo from examination booklets and ponderal index (kg/m³) was calculated. Subsequently, correlations were assessed using multiple linear regressions and generalized estimation equations with each of the measures as a continuous outcome variable and with PFOA, PFOS, and PFHxS concentration quartiles as categorized predictor variables, while adjusting for relevant covariates. PFOA, PFOS, and PFHxS were generally within German background exposure levels. There was a significant association between PFOA, PFOS, and PFHxS concentration quartiles and decrease in ponderal index at birth but not weight or height. A nonsignificant negative association between exposure to all three compounds and birth weight was noted. Follow-up showed no sustained effect of the PFAA on anthropometric measures during the first year.

Metal-based particles in human amniotic fluids of fetuses with normal karyotype and congenital malformation--a pilot study

This study explores the inorganic composition of amniotic fluid in healthy human fetuses and fetuses with congenital malformation with a special attention to presence of metal-based solid particles. Amniotic fluid originates from maternal blood and provides fetus mechanical protection and nutrients. In spite of this crucial role, the environmental impact on the composition of amniotic fluid remains poorly studied. The samples of human amniotic fluids were obtained by amniocentesis, including both healthy pregnancies and those with congenital malformations. The samples were analysed using several techniques, including Raman microspectroscopy, scanning electron microscopy with energy-dispersed spectrometry (SEM-EDS), Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD) analysis. Several metal-based particles containing barium, titanium, iron, and other elements were detected by SEM-EDS and Raman microspectroscopy. XRD analysis detected only sodium chloride as the main component of all amniotic fluid samples. Infrared spectroscopy detected protein-like organic components. Majority of particles were in form of agglomerates up to tens of micrometres in size, consisting of mainly submicron particles. By statistical analysis (multiple correspondence analysis), it was observed that groups of healthy and diagnosed fetuses form two separate groups and therefore, qualitative differences in chemical composition may have distinct biological impact. Overall, our results suggest that metal-based nanosized pollutants penetrate into the amniotic fluid and may affect human fetuses.

Prescription Opioids in Pregnancy and Birth Outcomes: A Review of the Literature

Prescription opioids are used prenatally for the management of pain, as well as for opiate dependency. Opioids are known to cross the placenta and despite the evidence of possible adverse effects on fetal development, studies have consistently shown prescription opioids are among the most commonly prescribed medications and the prevalence of use is increasing among pregnant women. This article summarizes the available literature documenting potential harms associated with prescription opioid use during pregnancy, including poor fetal growth, preterm birth, birth defects, and neonatal abstinence syndrome.

Survival, morbidity, growth and developmental delay for babies born preterm in low and middle income countries - a systematic review of outcomes measured

BACKGROUND

Premature birth is the leading cause of neonatal death and second leading in children under 5. Information on outcomes of preterm babies surviving the early neonatal period is sparse although it is considered a major determinant of immediate and long-term morbidity.

METHODS

Systematic review of studies reporting outcomes for preterm babies in low and middle income settings was conducted using electronic databases, citation tracking, expert recommendations and "grey literature". Reviewers screened titles, abstracts and articles. Data was extracted using inclusion and exclusion criteria, study site and facilities, assessment methods and outcomes of mortality, morbidity, growth and development. The Child Health Epidemiology Reference Group criteria (CHERG) were used to assess quality.

FINDINGS

Of 197 eligible publications, few (10.7%) were high quality (CHERG). The majority (83.3%) report on the outcome of a sample of preterm babies at time of birth or admission. Only 16.0% studies report population-based data using standardised mortality definitions. In 50.5% of studies, gestational age assessment method was unclear. Only 15.8% followed-up infants for 2 years or more. Growth was reported using standardised definitions but recommended morbidity definitions were rarely used. The criteria for assessment of neurodevelopmental outcomes was variable with few standardised tools - Bayley II was used in approximately 33% of studies, few studies undertook sensory assessments.

CONCLUSIONS

To determine the relative contribution of preterm birth to the burden of disease in children and to inform the planning of healthcare interventions to address this burden, a renewed understanding of the assessment and documentation of outcomes for babies born preterm is needed. More studies assessing outcomes for preterm babies who survive the immediate newborn period are needed. More consistent use of data is vital with clear and aligned definitions of health outcomes in newborn (preterm or term) and intervention packages aimed to save lives and improve health.

Decreased heart rate variability in children born with low birth weight

BACKGROUND

Low birth weight (LBW) is associated with cardiovascular morbidity in adulthood. Imbalance in the autonomic nervous system (ANS) has been implicated as a mechanism behind the developmental programming of cardiovascular function. We hypothesized that deviations in the ANS function are seen in children born with LBW.

METHODS

Eighty-six children were included: 31 born preterm (<32 wk gestational age), 27 born at term but small for gestational age (SGA), and 28 born at term with normal birth weight (control). Twenty-four-hour Holter-electrocardiogram monitoring was performed at an average age of 9 y. Heart rate variability results were analyzed using frequency and time domain methods.

RESULTS

All frequency components and both time domain parameters tested were significantly lower in the preterm and SGA children compared with controls. The low frequency/high frequency ratio was not significantly different between children born with LBW and controls.

CONCLUSION

The autonomic control appears to be affected in children born with LBW despite gestational age at birth. Decreased total power, as an estimation of the ANS's global activity, rather than the balance between parasympathetic and sympathetic modulation might be an early marker of cardiovascular disease later on in life for LBW born children.

Association of birth length and risk of hospitalisation among full-term babies in Japan

BACKGROUND

Barker's fetal programming hypothesis suggests that disproportionate size at birth may have a lifelong impact on one's health. However, the literature on birth length is considerably more sparse compared with birthweight. We, therefore, examined the relationship between birth length and hospitalisation early in life among Japanese children.

METHODS

We used the nationwide Longitudinal Survey of Babies in 21st Century and restricted the study subjects to full-term singleton babies (n = 44,057). We estimated the effects of birth length and birthweight on the risk of hospitalisation using log linear regression models. We controlled for a set of neonatal and maternal factors.

RESULTS

Birth length was associated with the chance of hospitalisation due to all causes between 6 and 18 months of age. In addition, the association was stronger than that with birthweight. Adjusted risk ratios showed that the relationship between birth length and hospitalisation was U-shaped: 1.16 [95% confidence intervals, 1.08, 1.25] at 30-48 cm, 1 [Reference] at 49 cm, 1.13 [1.04, 1.22] at 50 cm, and 1.11 [1.02, 1.20] at 51-60 cm. Short babies with low or high weight, as well as long babies with low weight, seem to be at increased risk of hospitalisation.

CONCLUSIONS

We found a U-shaped relationship between birth length and risk of hospitalisation due to all causes during the period from 6 to 18 months.

Fish consumption during pregnancy, mercury transfer, and birth weight along the Madeira River Basin in Amazonia

Birth weight can be a predictor of maternal health issues related to nutrition and environmental contaminants. Total hair mercury (HHg) concentration was studied as an indicator of both fish consumption and methylmercury exposure in mothers (and newborns) living in selected low income areas of the Madeira River basin, Amazonia, Brazil. This cohort study (n = 1,433) consisted of traditional riverines (n = 396), riverines who had moved to urban (n = 676) and rural (n = 67) settings, and tin miner settlers (n = 294). Median maternal HHg was significantly different (p = 0.00001) between riverine (12.1 µg·g⁻¹), rural (7.82 µg·g⁻¹), urban (5.4 µg·g⁻¹), and tin miner (4.5 µg·g⁻¹) groups studied. The same trend (of medians) was observed for newborns’ HHg which also showed significant differences between riverine (3.0 µg·g⁻¹), rural (2.0 µg·g⁻¹), urban (1.5 µg·g⁻¹), and tin miner (0.8 µg·g⁻¹) groups. The correlation between maternal and newborn HHg was statistically significant in the riverine (r = 0.8952; p = 0.0001), urban (r = 0.6744; p = 0.0001), and rural (r = 0.8416; p = 0.0001) groups but not in the mother-infant pairs in the tin miner group (r = 0.0638; p = 0.2752). Birth weight was significantly different among groups but did not show a pattern consistent with that of fish consumption (and HHg). A multiple regression analysis showed that only family income and gestational age had a significant impact on birth weight. Conclusions: Maternal HHg is an important biomarker of maternal fish consumption and of methylmercury exposure during pregnancy. However, in these Amazonian groups, only maternal education and gestational age seemed to affect birth weight positively.

Motor development of Japanese twins in childhood as reported by mothers

OBJECTIVE

Twins tend to lag behind singletons in their motor development, though the causes of this appear to be complicated and are not yet fully understood. The present study was performed to clarify the factors associated with the motor development of twins.

METHODS

The twins in the first group consisted of school applicants, including 1131 twin pairs, and the second group consisted of children of members of several maternal associations, and included 951 pairs. All data were gathered by questionnaire survey, and six gross-motor development milestones were analyzed in individuals or pairs.

RESULTS

Relative to general population norms in Japan, twins tended to be delayed in reaching several motor development milestones. Stepwise regression analysis showed that of all the variables measured, gestational age was the most influential on all six milestones. Birthweight was also influential on most milestones. Other factors affecting motor development milestones were parity for 'sitting without support,' 'pulling up to a standing position,' and 'walking without support,' and zygosity for 'walking without support.' In these cases, longer gestational age, heavier birthweighf, primiparity, and dizygosity showed a tendency toward earlier attainment of development. Motor development within pairs was more similar in monozygotic pairs compared with dizygotic pairs regarding each item, suggesting genetic contributions.

CONCLUSION

The results of the present study showed specific and nonspecific factors that affect motor development of twins. These findings should prove useful in understanding the motor development of twin children and help clinicians to refine maternal and child health care for multiple-birth children.

Pregnancy risk in female kidney and liver recipients: a retrospective comparative study

OBJECTIVE

To determine and compare maternal, neonatal and graft outcomes in pregnant women after kidney or liver transplantation, who had delivered from 1 January 2005 to 1 February 2010.

METHODS

A retrospective, single-center study provided in Warsaw, Poland.

RESULTS

Complete data were collected in 38 deliveries in 37 women. Preexisting hypertension was present in 15 of 19 (79%) pregnant kidney recipients and in 2 of 19 (10.5%) women after liver transplantation (p < 0.000). The incidence of preeclampsia was also more often in pregnant kidney recipients (p = 0.04). Mean gestational age at labor was lower in the kidney group (34.9 ± 3.56 vs. 37.5 ± 1.62, p = 0.000). A similar relation was observed in the frequency of preterm deliveries before 37 weeks of gestation (42% vs. 11%, respectively, p = 0.02) and neonates small for gestational age (47% vs. 11%, respectively, p = 0.008). Cesarean sections were performed in approximately 79% (15/19) and 95% (18/19) liver and kidney posttransplant pregnancies, respectively. Four of 38 infants presented structural malformations.

CONCLUSIONS

Pregnancies after kidney transplantation are complicated with a higher prevalence of prematurity and worse neonatal prognosis, which depends mainly on the underlying condition.

Nutritionally mediated programming of the developing immune system

A growing body of evidence highlights the importance of a mother's nutrition from preconception through lactation in programming the emerging organ systems and homeostatic pathways of her offspring. The developing immune system may be particularly vulnerable. Indeed, examples of nutrition-mediated immune programming can be found in the literature on intra-uterine growth retardation, maternal micronutrient deficiencies, and infant feeding. Current models of immune ontogeny depict a "layered" expansion of increasingly complex defenses, which may be permanently altered by maternal malnutrition. One programming mechanism involves activation of the maternal hypothalamic-pituitary-adrenal axis in response to nutritional stress. Fetal or neonatal exposure to elevated stress hormones is linked in animal studies to permanent changes in neuroendocrine-immune interactions, with diverse manifestations such as an attenuated inflammatory response or reduced resistance to tumor colonization. Maternal malnutrition may also have a direct influence, as evidenced by nutrient-driven epigenetic changes to developing T regulatory cells and subsequent risk of allergy or asthma. A 3rd programming pathway involves placental or breast milk transfer of maternal immune factors with immunomodulatory functions (e.g. cytokines). Maternal malnutrition can directly affect transfer mechanisms or influence the quality or quantity of transferred factors. The public health implications of nutrition-mediated immune programming are of particular importance in the developing world, where prevalent maternal undernutrition is coupled with persistent infectious challenges. However, early alterations to the immune system, resulting from either nutritional deficiencies or excesses, have broad relevance for immune-mediated diseases, such as asthma, and chronic inflammatory conditions like cardiovascular disease.

Association between calcium in cord blood and newborn size in Bangladesh

Ca status in the uterus during pregnancy has been suggested to affect fetal growth and size at birth. In Bangladesh, low Ca levels in pregnant women and low birth weight in infants are common. The present study explored the association between Ca levels in cord blood and newborn size at birth (birth weight and birth length) in Bangladesh. Samples and data included 223 women with live-born singleton deliveries in rural Bangladesh. Newborn weight and length were measured at birth. From cord blood obtained at delivery, Ca, 25-hydroxy vitamin D, bone-specific alkaline phosphatase and intact parathyroid hormone levels were determined. An association between size at birth and Ca levels in cord blood was found (birth weight, P = 0.022; birth length, P = 0.001). Associations between Ca and newborn size were further analysed using multivariate regression analyses. After adjusting for several covariates of characteristics in mothers and newborns (gestational weeks at birth, sex of newborn, socio-economic status, maternal height, BMI, age and season at birth), birth length still exhibited a significant relationship with Ca levels in cord blood (birth length, P = 0.030). The present study indicates that Ca status in cord blood might be associated with the birth length of newborns. Ca levels during gestation may affect fetal growth.

Deviant intrauterine growth and risk of schizophrenia: a 34-year follow-up of the Northern Finland 1966 Birth Cohort

BACKGROUND

Low birth weight conveys a modest risk for schizophrenia. The effects of high birth weight and deviant birth length are less clear.

METHODS

We linked perinatal data from 10,934 subjects from the Northern Finland 1966 Birth Cohort (n = 12 058) to the Finnish Hospital Discharge Register where we identified 111 cases of DSM-III-R schizophrenia up to age 35 years. Adjusted odds ratios between the risk of schizophrenia and birth weight, birth length and ponderal index and the risk of schizophrenia were analyzed.

RESULTS

Both low (OR 2.5; 95% CI 1.2-5.1) and high birth weight (OR 2.4; 95% CI 1.1-4.9) increased the risk of later schizophrenia. In addition, short (OR 2.6; 95% CI 1.1-5.9) and long babies had an elevated risk of schizophrenia as adults (OR 1.8; 95% CI 1.0-3.5). A reverse J-shape curve described the associations between birth weight, length and schizophrenia.

CONCLUSIONS

Deviant intrauterine growth of the fetus in either direction was associated with increased risk of schizophrenia.

The origins and evolution of genetic disease risk in modern humans

Patterns and risks of human disease have evolved. In this article, I review evidence regarding the importance of recent adaptive evolution, positive selection, and genomic conflicts in shaping the genetic and phenotypic architectures of polygenic human diseases. Strong recent selection in human populations can create and maintain genetically based disease risk primarily through three processes: increased scope for dysregulation from recent human adaptations, divergent optima generated by intraspecific genomic conflicts, and transient or stable deleterious by-products of positive selection caused by antagonistic pleiotropy, ultimately due to trade-offs at the levels of molecular genetics, development, and physiology. Human disease due to these processes appears to be concentrated in three sets of phenotypes: cognition and emotion, reproductive traits, and life-history traits related to long life-span. Diverse, convergent lines of evidence suggest that a small set of tissues whose pleiotropic patterns of gene function and expression are under especially strong selection-brain, placenta, testis, prostate, breast, and ovary-has mediated a considerable proportion of disease risk in modern humans.

Fish consumption during pregnancy, prenatal mercury exposure, and anthropometric measures at birth in a prospective mother-infant cohort study in Spain

BACKGROUND

Birth size has been shown to be related to maternal fish intake, although the results are inconsistent.

OBJECTIVE

The objective was to assess the association of consumption of different types of fish and prenatal mercury exposure with birth weight, birth length, and classification as small for gestational age (SGA) in newborns.

DESIGN

Cord blood total mercury was measured in 554 newborns in a population-based cohort born from 2004 to 2006. Fish consumption was classified in 4 frequency categories (<1 portion/mo, 1-3 portions/mo, 1 portion/wk, and > or =2 portions/wk).

RESULTS

When multivariate models were adjusted, newborns in the higher quartile of total mercury weighed 143.7 g less (95% CI: -251.8, -35.6; P for trend = 0.02) and had higher odds of being SGA for length (odds ratio: 5.3; 95% CI: 1.2, 23.9; P from likelihood ratio test = 0.03) without a linear relation (P for trend = 0.13) compared with those in the lowest quartile. Mothers consuming >/=2 portions/wk of canned tuna had newborns who weighed more than those who consumed <1 portion/mo (P for trend = 0.03) and a lower risk of having infants who were SGA for weight (P for trend = 0.01). Consumption of > or =2 portions/wk of large oily fish was associated with a higher risk of being SGA for weight and consumption of lean fish with a lower risk of being SGA for length compared with the consumption of <1 portion/mo, but in neither case was there a linear relation (P for trend >0.05).

CONCLUSIONS

The role of fish in fetal growth depends on the amount and type of fish consumed. The findings for mercury warrant further investigation in other settings.

Vegetable but not fruit intake during pregnancy is associated with newborn anthropometric measures

We examined the relationship between consumption of fruit and vegetables during pregnancy and anthropometric measures at birth in a general population mother-infant cohort in Valencia, Spain. A total of 787 infants born between May 2004 and February 2006 were included. Fruit and vegetable consumption during pregnancy was assessed by a FFQ administered using an in-person interview. We used multiple linear regression to assess associations between fruit and vegetable intake (in quintiles) and birth weight and length adjusted for sex and gestational age, and logistic regression to assess being small for gestational age (SGA) in weight and SGA in length, defined as adjusted birth weight or length below the 10th percentile. A linear relationship was found between vegetable consumption and having a SGA (weight) and SGA (length) baby. Women in the lowest quintile of vegetable intake during the first trimester had a higher odds of having a SGA (weight) baby than women in the highest quintile [odds ratio (OR), 3.7; 95% CI: 1.5-8.9; P-trend < 0.001] and had a higher odds of having an SGA (length) baby in the third trimester (OR, 5.5; 95% CI: 1.7-17.7; P-trend = 0.04) in multivariate analysis. We found a nonmonotonic relationship between adjusted birth weight and length and vegetable consumption during the first trimester; newborns in the 2 lowest quintiles of intake had a significantly lower weight and length than those in the 4th quintile. There was no association between fruit consumption and birth outcomes. Our findings indicate that vegetable consumption throughout pregnancy may have a beneficial effect on fetal growth.

Prenatal smoking exposure and asymmetric fetal growth restriction

BACKGROUND

Prenatal smoking exposure causes intrauterine fetal growth restriction (IUGR), although its effects on fetal proportionality are less clearly defined.

AIM

The present study assessed fetal proportionality in babies with IUGR using maternal salivary cotinine to indicate maternal smoking exposure.

SUBJECTS AND METHODS

A case-control study at the Liverpool Women's Hospital, UK of babies with asymmetric and symmetric IUGR and non-growth restricted babies was carried out.

RESULTS

270 white women including 90 IUGR cases and 180 controls were enrolled. Asymmetry presented in 52.2% of IUGR cases. Geometric mean maternal cotinine concentration was higher with asymmetric (p=0.002) than symmetric IUGR (p=0.07), when compared to controls. Maternal smoking exposure was independently associated with asymmetric IUGR (OR 2.4, 95% CI, 1.5-4.4, p</=0.001). Maternal anaemia was more frequent in babies with symmetric IUGR (OR 1.9, 1.3-3.4, p=0.002), but not in asymmetric babies. Rohrer's index ranged between 1.64 and 2.25 for asymmetric infants and significantly decreased with increasing maternal cotinine concentration in IUGR babies. Increased cotinine was not associated with shortened gestational age in IUGR babies.

CONCLUSIONS

Asymmetric IUGR occurred more frequently in heavy smokers. Stopping smoking even late in pregnancy may be beneficial for improved fetal outcomes. Symmetric IUGR was associated with maternal anaemia, highlighting the importance of prenatal nutritional status.

Renal volume and function in school-age children born preterm or small for gestational age

Impaired renal development during foetal life is a proposed mechanism for adult hypertension in people born small. Whether preterm birth contributes to such adverse development is still unclear. We investigated the selective contributions from foetal growth restriction or preterm birth to renal function and volume in children with low birth weight. Three groups of 9 to 12-year-old children were studied: those born at < 32 gestational weeks (preterm, n = 39), those born at term but small for gestational age (SGA, n = 29) and those born at the term appropriate for gestational age (controls, n = 37). We estimated renal function by calculating glomerular filtration rate (GFR) and by measuring urinary proteins. Volumetric ultrasound of the kidneys was performed in 86 children (preterm, n = 33; SGA, n = 25; controls, n = 29). Estimated glomerular filtration rate (eGFR) and urinary protein patterns were similar between the groups. Kidney volume (preterm 162 ml (31); SGA 163 ml (26) and controls 182 ml (47)) was smaller in the preterm group than in the controls, but the difference was not significant when adjusted for body surface area, gender and age (P = 0.25). Total renal volume correlated to birth weight (r = 0.23, P = 0.03). No significant differences were found in renal function or volume between the three groups at school age.

Validity of maternal report on birth weight 11 years after delivery: the 1993 Pelotas Birth Cohort Study, Rio Grande do Sul State, Brazil

Birth weight has short and long-term effects on health. Some studies have used retrospective data on birth weight, reported by the subject or by the parents. This paper compares data on birth weight measured by the research team in 1993 with birth weight reported by the mother in 2004-2005, using data from the 1993 Pelotas Birth Cohort Study, Rio Grande do Sul State, Brazil. We also evaluate the role of misclassification when exploring the effect of birth weight on a given outcome. Mean difference between the two variables was 20g (SD = 288.3). Agreement for detecting low birth weight was 95.2% in the sample as a whole (kappa = 0.73), but was lower among low-schooling mothers. Mothers of children weighing less than 3,500g at birth tended to overestimate the child's birth weight. Inversely, mothers of heavier children tended to underestimate the values. One out of four mothers reported a difference of at least 200g in birth weight as compared to that measured in 1993. Use of reported birth weight diluted the magnitude of the association with body mass index at 11 years in comparison with measured birth weight. Reported birth weight should be used with great caution, if at all.

Early childhood growth and development in rural Guatemala

BACKGROUND

Small size at birth and in early childhood has been associated with impaired neurodevelopment in studies from developing countries, but few have examined associations with growth.

AIMS

The objective of this study was to assess the relationship between growth and neurodevelopment during early childhood (birth-36 months).

DESIGN

Multivariate regression models were used to analyze the data collected in the course of a study of pregnancy outcomes and early childhood growth and development carried out in rural Guatemala in 1991-1999. Motor and mental development scores were based on the Psychomotor and Mental Development Indices, respectively, derived from the administration of an adapted version of the Bayley Scales of Infant Development (Second Edition, 1993) at 6, 24 and 36 months. Z-scores for height-for-age (HAZ), weight-for-age (WAZ), and head circumference-for-age (HCZ) were used as indicators of attained size; changes in these Z-scores over time represent growth.

RESULTS

Birth size was significantly associated with child development at 6 and 24 months. Gains in length and weight during the first 24 months were positively associated with child development, whereas growth from 24 to 36 months age was not associated with child development at 36 months. Motor development was more strongly and consistently related to child growth than was mental development. Head circumference gain after 6 months was not a significant predictor of child development at 24 and 36 months.

CONCLUSIONS

Small size at birth and poor physical growth during the first 24 months are related to neurodevelopmental delays. More evidence from developing countries will help explain the underlying mechanisms and identify appropriate interventions to prevent neurodevelopmental delay in early childhood.

Is there an association between low birth weight and caries in the primary dentition?

OBJECTIVES

An association between low birth weight and caries in the primary dentition has been suggested but not demonstrated. This study analyzed this association using data from a probability sample of US children 2-6 years of age.

METHODS

Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used. Variables included decayed and filled primary surfaces (dfs), birth weight, gestational age, and Apgar score (a surrogate measure of fetal well-being); maternal age, education, income; number of previous births, marital status, the existence of pregnancy complications, and cigarette smoking during the pregnancy. Data were analyzed using SUDAAN 8.0.2.

RESULTS

Bivariate Poisson regression showed that children of mothers who were unmarried (incidence density ratio, IDR = 3.28), with less education (IDR = 1.43), who were 17 years of age or younger at birth (IDR = 1.51), and had 2 or fewer prenatal visits (IDR = 1.65) had a significantly ( p <0.05) greater risk of caries than the reference groups. Children of mothers with pregnancy-related hypertension (IDR = 0.14) had less than 20% the risk of caries than the reference group. Blacks (IDR = 1.37) and Mexican-Americans (IDR = 2.38) had greater risk of caries than whites, and children of low (IDR = 2.57) and middle income (IDR = 2.00) level families had higher caries risks than those of upper income families. Multivariate Poisson regression found only race-ethnicity, age, and income level to be statistically significant.

CONCLUSIONS

This study did not support the association between low birth weight and caries of the primary dentition.

The ponderal index in triplets: III. Association with birth weight discordance

Our objective was to determine the association of the ponderal index with birth weight discordance in triplets. We analyzed data from triplets delivered at 28-37 weeks for birth weight discordance (>25% difference between the heaviest and lightest triplet). Three categories of discordance (low skew, symmetrical, and high skew) were classified according to the relative position of the middle triplet. Birth weights and the ponderal index (birth weight/[length]3) of all concordant and discordant triplet groups were compared. Of 752 triplet sets included, 184 (24.5%) were discordant. Total triplet birth weight was higher in the concordant compared to all discordant categories. As opposed to birth weight, where only the middle triplet differed according to discordance pattern, the ponderal index for the largest triplet was significantly higher in the low skew discordant group compared to the concordant and other discordant triplet groups. In contrast, the ponderal index for the smallest and middle triplets were similar among the discordant groups. We concluded that discordance in triplet pregnancies exhibits different patterns of mass (birth weight) versus size (ponderal index). Our findings suggest that it may be the size of largest triplet that determines the presence or absence or discordance in triplet gestations.

The ponderal index in triplets: I. Relationship to small for gestational age neonates

The aim of the study was to examine the ponderal index in small for gestational age (SGA) triplets. Prospectively collected data from a cohort of triplets born at 28 to 37 weeks were analyzed. A low neonatal ponderal index (birth weight/[length]3) was defined as less than 1 SD below the mean (2.0), and SGA was considered as birth weight below the 10th percentile by triplet standards. We studied 2181 sets of triplets. Triplets delivered at < or = 33 weeks have a lower mean ponderal index compared with those delivered at > 33 weeks. About 70% of SGA triplets do not have a low ponderal index, whereas 79.2% of infants with a low ponderal index are not SGA by triplet standards. Both the frequency of a low ponderal index and the frequency of infants with a low ponderal index who are not SGA decrease with increasing gestational age. We conclude that the majority of triplets with a low ponderal index might not be considered growth restricted, supporting the concept that reduced fetal weight of triplets is more likely a physiological rather than a pathological phenomenon.

Ponderal index is a poor predictor of in utero growth retardation

OBJECTIVE

To evaluate the usefulness of ponderal index (PI) and related indices of weight and length in identifying asymmetric growth, body thinness and organ asymmetry associated with IUGR.

DESIGN

Cross sectional study.

SETTING

Aberdeen Maternity Hospital.

POPULATION

The population includes term (>/=37 weeks) singleton live births (n= 53,934) between 1986 and 1996, ultrasound measurements in 2522 pregnancies, 712 unselected term pregnancies in 1979/1980 and stillbirths (24-36 weeks) between 1986 and 1995 where the fetus was diagnosed as suffering from acute (n= 73) or chronic (n= 30) anoxic death.

METHODS

The strength of association between direct measures of IUGR and various indices of weight and length was determined by linear and multiple stepwise linear regression.

MAIN OUTCOME MEASURES

Weight, length, PI and skinfold thicknesses (triceps, biceps, flank thighs, back) were measured at birth. Abdominal circumference, biparietal diameter and femur length were measured by ultrasound at >/=37 weeks. Ratio of liver, heart and kidney to brain were measured in stillbirths.

RESULTS

Weight alone was a better predictor of skinfold thickness, abdominal circumference and the ratio of abdominal circumference to biparietal diameter than weight divided by length raised to the power 1, 2, 3 (PI), 4 or 5. The inclusion of gestational age made little difference to the predictive ability of weight for these full term births. Weight, but not PI, was significantly different between the two groups of stillborn fetuses (chronic and acute), which had significantly different (P < 0.001) organ ratios.

CONCLUSION

Body weight alone was a better predictor of anthropometric ratios, organ asymmetry and measures of thinness at birth thought to be associated with IUGR than the PI. The inclusion of a length term generally reduced the predictive ability with the highest powers resulting in the poorest prediction.

Early origins and adult correlates of psychosomatic distress

Previous studies have demonstrated associations between fetal insults and psychological and developmental outcomes in children and adolescents. It is not clear whether psychosomatic problems in adults also have early origins. This study involved full-term live-born singletons free of congenital anomaly in the 1970 British Birth Cohort Study. Birthweight, gestational age, maternal smoking, parental social class and birth order were recorded around the time of birth. Psychological and somatic distresses were measured by the Malaise Inventory at age 26. A number of socio-behavioural covariates were also measured at this time. Multiple (least square) regression analysis showed that birthweight standardised for gestational age had a "reverse J" relation with psychological distress (p < 0.05); gestational age was inversely related to psychological distress (each p < 0.05); levels of maternal smoking were positively related to both psychological distress and somatic distress (each p < 0.01). Logistic regression analyses of high levels of psychological distress and somatic distress gave similar results. The findings were not strongly affected by adjustment for various adult correlates. In supplementary analyses multiple imputation was used to handle loss to follow-up and missing values at age 26. Approximately, the same patterns of associations were found. The results support the hypothesis of a biological link between perinatal factors and psychological distress in adults. The strengths of the associations were compared with those between the outcome and adult correlates.

Association of hexachlorobenzene and other organochlorine compounds with anthropometric measures at birth

The aim of the present study was to assess the association of prenatal exposure to hexachlorobenzene (HCB) and other organochlorine compounds with anthropometric measures at birth. A total of 98 mother-infant pairs (83% of all children born in a specific area polluted with HCB in the period 1997-1999) were recruited after giving written consent. Levels of organochlorine compounds were measured in 72 maternal serum samples at delivery and in 70 cord serum samples. Of the organochlorines measured in cord serum, median levels of HCB were higher than for the other compounds (median of HCB = 1.13 ng/mL, median of dichlorodiphenyl dichloroethylene = 0.85 ng/mL, and median of total polychlorinated biphenyls = 0.27 ng/mL). Premature newborns had higher concentrations of HCB [1.94 ng/mL among prematures versus 1.10 among nonprematures (p < 0.10)], dichlorodiphenyl dichloroethylene [2.40 versus 0.80 (p < 0.05)], and polychlorinated biphenyls in cord serum [0.70 versus 0.14 (p < 0.10)]. Those infants born with a small length for gestational age had higher levels of HCB in cord serum than those with an adequate length for gestational age [1.64 ng/mL versus 1.00 ng/mL (p < 0.05)]. In addition, HCB cord serum levels were negatively associated in a dose-response way with crown-heel length [for each doubling of the dose there was a decrease of 0.46 (SE = 0.22) cm] after adjusting for smoking, gestational age, and other organochlorine compounds. The associations of dichlorodiphenyl dichloroethylene and polychlorinated biphenyls with length were not significant. The results did not vary when stratified for prematurity. These data suggest that HCB reduces intrauterine physical linear growth.

Vitamin and mineral nutrition for the health and development of the children of Europe

Most European countries are now affected by demographic transition and changing epidemiology of disease; the nutrition of children is increasingly recognised as crucial for present and future health. Adequate dietary intake and nutritional status among children are important for their own growth, development and function but there is now increasing evidence that childhood nutrition also influences adult health. Intrauterine nutrition influences adult morbidity and mortality, but the childhood diet and nutritional status modify the increased risk of being born small. Thus, childhood diet needs to be taken more seriously in order to improve a nation's health as well as producing bright, active children. A key factor is the recognition that nutritional interventions at different stages of the life cycle are necessary if childhood nutrition is to improve. The mosaic pattern of the geography and social structure of communities in Europe produces ‘poverty’ and ‘consumer’ related nutrition patterns - often side by side. At one extreme, there is an urgent need to prevent obesity; while at the other extreme serious attention is required towards the prevention of deficiency disorders, mostly related to poverty and social exclusion. Few European governments take childhood nutrition at all seriously. This paper reviews a number of micronutrient issues and makes the case for the development of evidence-based policies and programmes for improving the nutrition of children in Europe.

Pregnancy outcome for nomadic Turkana pastoralists of Kenya

The outcome of an individual pregnancy is a key component of overall reproductive success and is strongly influenced by environmental, behavioral, and biological variation within populations. This prospective study examined the outcomes of 68 pregnancies among nomadic Turkana of Kenya from July 1993 to July 1994. A total of 12 women experienced pregnancy losses, and 3 women experienced live births with a subsequent perinatal death. The following characteristics are associated with increased risk for experiencing a fetal or perinatal death: severe morbidity episodes, shorter nonpregnant intervals, lower third-trimester weight, higher third-trimester summed skinfolds but limited third-trimester reduction in summed skinfolds, and higher activity levels late in gestation. Turkana newborns measured within 48 hr of birth (n = 19) weighed an average of 2,860 +/- 640 g and had a mean ponderal index of 2.72 +/- 0.46. Variation in birth weight was predicted by preterm delivery, delivery during the wet season, and maternal morbidity levels. Birth length averaged 50.8 +/- 6.8 cm and was positively influenced by full term delivery, better maternal health, and birth during the dry season. These results suggest complicated pathways linking the physical environment, subsistence requirements, heterogeneity in maternal fitness, behavior, and pregnancy outcome. The results augment the larger picture of reproductive success for Turkana nomads who live in a highly variable savanna environment.

Maternal leisure-time physical activities are not determinant risk factors of low birthweight babies: A cross-sectional study of 1,714 pregnant women

There is a general recognition of the role of low birthweight (LBW) as a major determinant of infant mortality rates. Since the rate of LBW has been increasing over the past fifteen years in Japan, we decided to ascertain the risk factors related to it, and also to verify whether or not maternal leisure-time physical activities including sports activities, before pregnancy and during gestation, affected the rate of LBW babies. In our study of the 2,682 questionnaires delivered within a year to the Municipal Health Centers of the three cities chosen for this study, 1,714 questionnaires were analyzed. The results in a univariate analysis showed that maternal height, pre-pregnancy weight, length of gestation, smoking, hospitalization before the 37th week of gestation, a history of LBW, and occupational activities were significantly associated with LBW. In logistic regression analyses, mothers of smaller stature, less pre-pregnancy weight, less length of gestation and mothers who were, furthermore, hospitalized before the 37th week of gestation, smoked, had previously delivered a LBW baby or had experienced stressful events during pregnancy were more likely to have LBW babies. The results showed that maternal leisure-time physical activities before and/or during pregnancy had no bearing on the delivery of a LBW baby.

Natural selection and sex differences in morbidity and mortality in early life

Both morbidity and mortality are consistently reported to be higher in males than in females in early life, but no explanation for these findings has been offered. This paper argues that the sex difference in early vulnerability can be attributed to the natural selection of optimal maternal strategies for maximizing lifetime reproductive success, as modelled previously by Trivers and Willard. These authors theorized that males and females offer different returns on parental investment depending on the state of the environment. Natural selection has therefore favoured maternal ability to manipulate offspring sex in response to environmental conditions in early life, as shown in variation in the sex ratio at birth. This argument can be extended to the whole period of parental investment until weaning. Male vulnerability in response to environmental stress in early life is predicted to have been favoured by natural selection. This vulnerability is most evident in the harsh conditions resulting from pre-term birth, but can also be seen in term infants, and manifests as greater morbidity and mortality persisting into early childhood. Malnutrition, interacting with infection after birth, is suggested as the fundamental trigger mechanism. The model suggests that whatever improvements are made in medical care, any environmental stress will always affect males more severely than females in early life.