Antenatal risk factors associated with neonatal morbidity in large-for-gestational-age infants: an international prospective cohort study

Maternal Metabolic Health and Mother and Baby Health Outcomes (MAMBO): Protocol of a Prospective Observational Study

BACKGROUND

Metabolic disease is increasingly impacting women of reproductive age. In pregnancy, uncontrolled metabolic disease can result in offspring with major congenital anomalies, preterm birth, and abnormal fetal growth. Pregnancy also accelerates the complications of metabolic diseases in mothers resulting in an increased risk of premature cardiovascular events. Despite the convincing evidence that preconception care can largely mitigate the risks of metabolic disease in pregnancy, there are few data about how to identify the highest-risk women so that they can be connected with appropriate preconception care services.

OBJECTIVE

The aim of the study is to determine the maternal phenotype that represents the highest risk of having adverse neonatal and maternal pregnancy outcomes.

METHODS

This will be a prospective cohort study of 500 women recruited in early pregnancy. The primary outcome is a composite of offspring born small for gestational age (SGA) or large for gestational age (LGA) (customized birthweight ≤10th and ≥90th centile for gestational age). Secondary outcomes are (1) composite of adverse neonatal birth outcomes (SGA, LGA, major congenital abnormalities, preterm birth [<37 weeks' gestation]) and (2) composite of new maternal metabolic outcomes (gestational diabetes, diabetes in pregnancy, type 2 diabetes [T2D] or prediabetes; gestational hypertension, preeclampsia, eclampsia or new essential hypertension after pregnancy; and gestational weight gain ≥20kg or new overweight/obesity at the 12-18 months postpartum visit). A multivariable logistic regression analysis will be conducted to identify candidate predictors of poor pregnancy outcomes due to metabolic disease. From this model, model coefficients and the associated 95% CIs will be extracted to derive the risk score for predicting the delivery of LGA/SGA offspring (primary outcome) and composites of adverse neonatal outcomes and maternal outcomes (secondary outcomes).

RESULTS

Seed funding for the project was acquired in November 2022 and subsequent funding was acquired in May 2024. The first participant was recruited on March 23, 2023. At the time of manuscript submission, 402 participants have been recruited. Data analysis has not yet been performed. Results are expected to be published in the first half of 2027.

CONCLUSIONS

This is a prospective observational cohort study that intends to identify the metabolic disease risk factors, or combination of factors, that are most likely to cause adverse maternal and fetal health outcomes. These characteristics will be used to develop a risk calculator which will assist in identifying the highest risk women and in triaging them to appropriate services. The study has been approved by the institutional Human Research Ethics Committee (HREC/90080/MH-2022).

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12623000037606; https://tinyurl.com/yeytsxtp.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/72542.

Relationship between large and small for gestational age and hospital readmission after postpartum discharge: a population-based, data-linkage study

This study aims to determine the association of small for gestational age (SGA) and large for gestational age (LGA) at birth with hospital readmission after postpartum discharge for up to 28 days of delivery. This is a population-based, data-linkage study using the French National Uniform Hospital Discharge Database. "Healthy" singleton term infants born between January 1st, 2017, and November 30th, 2018, in the French South region were included. SGA and LGA were defined as birth weight < 10th and > 90th percentiles, respectively, according to sex and gestational age. A multivariable regression analysis was performed. Among 67,359 included infants, 2441 (3.6%) were readmitted, and 61% of them were hospitalized within 14 days postpartum. Hospitalized infants were more likely to be LGA at birth (10.3% vs. 8.6% in non-hospitalized infants, p < 0.01); the proportion of SGA infants did not differ between both groups. Compared to appropriate birth weight for GA (AGA) infants, LGA infants were more often hospitalized for infectious diseases (57.7% vs. 51.3%, p = 0.05). After regression analysis, LGA infants had a 20% higher odds of being hospitalized than those born AGA (aOR (95%CI) = 1.21 (1.06-1.39)), while aOR (95%CI) for SGA was 1.11 (0.96-1.28).

CONCLUSION

 In contrast to SGA, LGA was associated with hospital readmission during the first month of life. Follow-up protocols that include LGA should be evaluated.

WHAT IS KNOWN

• Newborns are at high risk of hospital readmission during the postpartum period. • However, the influence of appropriateness for gestational age at birth, i.e. being born small for gestational age (SGA) or large for gestational age (LGA), has been little evaluated.

WHAT IS NEW

• In contrast to SGA born infants, we found that infants born LGA were at high risk of hospital admission and the main cause was infectious diseases. • This population should be considered at risk of early adverse outcomes and should require attentive medical follow-up after postpartum discharge.

Maternal weight and gestational diabetes impacts on child health

PURPOSE OF REVIEW

To review recent evidence linking maternal body mass index and gestational diabetes mellitus (GDM) with offspring health outcomes.

RECENT FINDINGS

It is now established that the rising prevalences of maternal obesity and GDM are both making substantial contributions to the growing burden of childhood obesity and associated disorders. Strengthening evidence also links maternal obesity with increased offspring risks of cardiovascular disease, nonalcoholic fatty liver disease, lower respiratory tract infections during infancy, wheezing illnesses, asthma and attention deficit hyperactivity disorder during childhood, and with higher risks of psychiatric disorders and colorectal cancer in adulthood. GDM has been associated with increased offspring risks of cardiovascular disease, childhood wheeze/asthma (but not allergic sensitization), and with high refractive error, attention deficit hyperactivity and psychiatric disorders from childhood onwards.

SUMMARY

The long-term consequences of maternal obesity and GDM for the offspring in childhood and later adult life present major challenges for public health across the life course and for future generations. Tackling these challenges requires a systems-based approach to support achieving a healthy weight in young people prior to conception, alongside new insights into population based preventive measures against gestational diabetes.

Diagnostic accuracy of modified Hadlock formula for fetal macrosomia in women with gestational diabetes and pregnancy weight gain above recommended

OBJECTIVES

Women with gestational diabetes (GDM) and weight gain during pregnancy above recommended more often give birth to macrosomic children. The goal of this study was to evaluate the diagnostic accuracy of the modified formula for ultrasound assessment of fetal weight created in a pilot study using a similar specimen in comparison to the Hadlock-2 formula.

METHODS

This is a prospective, cohort, applicative, observational, quantitative, and analytical study, which included 213 pregnant women with a singleton pregnancy, GDM, and pregnancy weight gain above recommended. Participants were consecutively followed in the time period between July 1st, 2016, and August 31st, 2020. Ultrasound estimations were made within three days before the delivery. Fetal weights estimated using both formulas were compared to the newborns' weights.

RESULTS

A total of 133 fetal weight estimations were made. In comparison to the newborns' weight modified formula had significantly smaller deviation in weight estimation compared to the Hadlock-2 formula, higher frequency of deviation within 5% of newborns weights (78.2% [95% CI=0.74-0.83] vs. 60.2%), smaller frequency of deviations from 5 to 10% (19.5 vs. 33.8%) and above 10%, which was even more significant among macrosomic children. There were 36/50 (72%) correctly diagnosed cases of macrosomia by modified and 33/50 (66%) by Hadlock-2 formula. Area under the curve (AUC) for the modified formula was 0.854 (95% CI=0.776-0.932), and for the Hadlock-2 formula 0.824 (95% CI=0.740-0.908). The positive predictive value of the modified formula was 81.81%, the negative 97.91%.

CONCLUSIONS

In cases of greater fetal weights, the modified formula showed greater precision.

Risk recognition and identification of sports activities in colleges and universities

Recently, Intense training in specialized sport among colleges and universities has steadily improved. Although most sportspeople accept that some degree of expertise in sport is required to achieve the elite stage, there is controversy over risk recognition and identification of sports activities in colleges and universities to optimize future performance. There is concern that a young athlete can suffer from sports specialization before adolescence due to various risk factors such as injuries, social tension, and hypertension etc..,. Furthermore, PubMed and OVID are looking to discuss sports specialization and athlete experience-based consensus opinions and position statements based on Universities and Colleges. Risk recognition and identification tools are developed to identify the locations of athletes within the specialization spectrum using Linear Structural Modeling (LSM). Here, a degree of sports expertise is needed to create elite skill levels to overcome risk factors that have been suggested in the linear model. In most sports, though, such accelerated preparation should be deferred until late adolescence to reduce risk factors. The psychological burden has been analyzed for recognition, and classification based on the case study has been firmly researched in this paper.

Association between false positive glucose challenge test results and large-for-gestational-age infants: a retrospective cohort study

OBJECTIVES

There is no consensus regarding a possible relation between false positive glucose challenge test (GCT) results and large-for-gestational-age (LGA) infants. This study aimed to clarify the association between false positive GCT results and LGA, after adjusting for potential confounding factors, using a large clinical dataset.

DESIGN

Retrospective cohort study.

SETTING

National Hospital Organisation Kofu National Hospital, which is a community hospital, between January 2012 and August 2019.

PARTICIPANTS

Japanese women who underwent GCT between 24 and 28 weeks of gestation at the hospital were included. After excluding those with gestational diabetes mellitus, diabetes in pregnancy and multiple pregnancies, subjects were divided into a false positive GCT group (≥140 mg/dL) and a GCT negative group (<140 mg/dL).

METHODS

Obstetric records of patients were examined. The χ²-test and multivariable logistic regression analysis were used to investigate the association between false positive GCT results and LGA.

PRIMARY AND SECONDARY OUTCOME MEASURES

Incidence of LGA and the association between false positive GCT results and LGA.

RESULTS

The mean subject age was 31.4±5.5 years, with 43.3% nulliparity (n=974) and 2160 (96.1%) term deliveries. The incidence of LGA was 9.4% (211/2248) and 11.4% (257/2248) of the women had false positive GCT results. False positive GCT results were significantly associated with an increased risk of LGA (OR, 1.51; 95% CI, 1.02 to 2.23), after controlling for maternal age, prepregnancy maternal weight, maternal weight gain during pregnancy and parity.

CONCLUSIONS

It appears that there is a significant association between false positive GCT results and LGA. Additional research is required to confirm these results and to investigate appropriate interventions for women with abnormal screens for gestational diabetes mellitus.