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Impact of Neonatal Body (Dis)Proportionality Determined by the Cephalization Index (CI) on Gross Motor Development in Children with Down Syndrome: A Prospective Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010013. [PMID: 36670564 PMCID: PMC9856915 DOI: 10.3390/children10010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Background: Children with Down syndrome (DS) lag behind typical children in the acquisition of developmental milestones, which could differ depending on body proportionality. We aimed to determine the difference in the acquisition of developmental milestones in children with DS with a disproportionate cephalization index (CI) compared to a proportionate CI. We created a motor development model that predicted milestone acquisition times. Methods: In this 20-year prospective cohort study, 47 children with DS aged 3 months to 5 years, followed up to 2020, were grouped according to the ratio of head circumference to birth weight (HC/BW) or CI into proportionate (CI < 1.1) and disproportionate (CI ≥ 1.1). We used a modified Munich Functional Developmental Diagnostic Scale that was assessed for reliability and content validity (Levene’s test and discriminant analysis) to determine 28 motor milestones. Linear regression was used to predict time to milestone acquisition, controlling for sex, maternal age, and birth weight. Results: Compared to proportionate CI, children with disproportionate CI were delayed in the milestone acquisition of a prone position by 2.81 months, standing before walking by 1.29 months, and a supine position by 1.61 months. Both groups required more time to reach standing after the acquisition of independent walking, but children with disproportionate CI reached those milestones later (4.50 vs. 4.09 months, p < 0.001). Conclusion: Children with disproportionate CI acquired milestones in a predictable order but slower than those with a proportionate CI. Our findings support the need to classify the degree of motor developmental delay in children with DS into unique functional groups rather than rely on clinicians’ arbitrary descriptions of the timing of developmental delays in children with DS.
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Monteith C, Flood K, Pinnamaneni R, Levine TA, Alderdice FA, Unterscheider J, McAuliffe FM, Dicker P, Tully EC, Malone FD, Foran A. An abnormal cerebroplacental ratio (CPR) is predictive of early childhood delayed neurodevelopment in the setting of fetal growth restriction. Am J Obstet Gynecol 2019; 221:273.e1-273.e9. [PMID: 31226291 DOI: 10.1016/j.ajog.2019.06.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/05/2019] [Accepted: 06/12/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fetal growth restriction accounts for a significant proportion of perinatal morbidity and death. The cerebroplacental ratio is gaining much interest as a useful tool in differentiating the "at-risk" fetus in both fetal growth restriction and appropriate-for-gestational-age pregnancies. The Prospective Observational Trial to Optimize Pediatric Health in Fetal Growth Restriction group has demonstrated previously that the presence of this "brain-sparing" effect is associated significantly with adverse perinatal outcomes in the fetal growth restriction cohort. However, data about neurodevelopment in children from pregnancies that are complicated by fetal growth restriction are sparse and conflicting. OBJECTIVE The aim of the Prospective Observational Trial to Optimize Pediatric Health in Fetal Growth Restriction NeuroDevelopmental Assessment Study was to determine whether children born after fetal growth-restricted pregnancies are at additional risk of adverse early childhood developmental outcomes compared with children born small for gestational age. The objective of this secondary analysis was to describe the role of cerebroplacental ratio in the prediction of adverse early childhood neurodevelopmental outcome. STUDY DESIGN Participants were recruited prospectively from the Perinatal Ireland multicenter observational Prospective Observational Trial to Optimize Pediatric Health in Fetal Growth Restriction study cohort. Fetal growth restriction was defined as birthweight <10th percentile with abnormal antenatal umbilical artery Doppler indices. Small for gestational age was defined similarly in the absence of abnormal Doppler indices. Cerebroplacental ratio was calculated with the pulsatility indices of the middle cerebral artery and divided by umbilical artery with an abnormal value <1. Children (n=375) were assessed at 3 years with the use of the Ages and Stages Questionnaire and the Bayley Scales of Infant and Toddler Development, 3rd edition. Small-for-gestational-age pregnancies with normal Doppler indices were compared with (1) fetal growth-restricted cases with abnormal umbilical artery Doppler and normal cerebroplacental ratio or (2) fetal growth restriction cases with both abnormal umbilical artery and cerebroplacental ratio. Statistical analysis was performed with statistical software via 2-sample t-test with Bonferroni adjustment, and a probability value of .00625 was considered significant. RESULTS Assessments were performed on 198 small-for-gestational-age children, 136 fetal growth-restricted children with abnormal umbilical artery Doppler images and normal cerebroplacental ratio, and 41 fetal growth-restricted children with both abnormal umbilical artery Doppler and cerebroplacental ratio. At 3 years of age, although there were no differences in head circumference, children who also had an abnormal cerebroplacental ratio had persistently shorter stature (P=.005) and lower weight (P=.18). Children from fetal growth restriction-affected pregnancies demonstrated poorer neurodevelopmental outcome than their small-for-gestational-age counterparts. Fetal growth-restricted pregnancies with an abnormal cerebroplacental ratio had significantly poorer neurologic outcome at 3 years of age across all measured variables. CONCLUSION We have demonstrated that growth-restricted pregnancies with a cerebroplacental ratio <1 have a significantly increased risk of delayed neurodevelopment at 3 years of age when compared with pregnancies with abnormal umbilical artery Doppler evidence alone. This study further substantiates the benefit of routine assessment of cerebroplacental ratio in fetal growth-restricted pregnancies and for counseling parents regarding the long-term outcome of affected infants.
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Affiliation(s)
- Cathy Monteith
- Department of Obstetrics & Gynecology, Royal College of Surgeons, Ireland, Dublin Ireland.
| | - Karen Flood
- Department of Obstetrics & Gynecology, Royal College of Surgeons, Ireland, Dublin Ireland
| | | | - Terri A Levine
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Fiona A Alderdice
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland; National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Julia Unterscheider
- Department of Obstetrics & Gynecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia
| | - Fionnuala M McAuliffe
- Obstetrics & Gynecology, UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Patrick Dicker
- Department of Epidemiology & Public Health, Royal College of Surgeons, Ireland, Dublin Ireland
| | - Elizabeth C Tully
- Department of Obstetrics & Gynecology, Royal College of Surgeons, Ireland, Dublin Ireland
| | - Fergal D Malone
- Department of Obstetrics & Gynecology, Royal College of Surgeons, Ireland, Dublin Ireland
| | - Adrienne Foran
- Department of Neonatology, Royal College of Surgeons, Ireland, Dublin Ireland
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Celeste M. Impact of Twin-to-Twin Transfusion Syndrome, Preterm Birth, and Vision Loss on Development. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2019. [DOI: 10.1177/0145482x0509900905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study compared the developmental outcomes of twin boys (one who is blind and one who is sighted) who were born prematurely and diagnosed with twin-to-twin transfusion syndrome (TTTS) at age 24 months. The results indicate a disparity in the developmental outcomes of the twins. Although the medical risk factors that are associated with TTTS and preterm births, as well as vision loss, appear to have a negative impact on developmental outcomes, it is impossible to determine the degree to which any factor is responsible for this result.
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Affiliation(s)
- Marie Celeste
- Department of Education, Loyola College in Maryland, 109 Beatty Hall, 4501 North Charles Street, Baltimore, MD 21210
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4
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Intrauterine growth restriction and development of the hippocampus: implications for learning and memory in children and adolescents. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:755-764. [PMID: 30236384 DOI: 10.1016/s2352-4642(18)30245-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/13/2018] [Accepted: 07/20/2018] [Indexed: 12/15/2022]
Abstract
Intrauterine growth restriction (IUGR) is often the result of compromised placental function and suboptimal uteroplacental blood flow. Children born with IUGR have impaired cognitive functioning and specific memory deficits, indicating long-lasting impairments in hippocampal functioning; indeed, hippocampal volume is reduced in infants with IUGR. Animal studies have provided valuable insight into the nature of deficits in hippocampal-dependent functions observed in children born with IUGR; outcomes of experimental IUGR reveal reduced neuron numbers and morphological alterations in the cornu ammonis fields 1 and 3 and dentate gyrus subregions of the hippocampus. However, whether such early and ongoing structural changes in the hippocampus could account for deficits in spatial memory reported in adolescent rats with IUGR is yet to be established. Understanding the association between hippocampal structural and functional alterations in IUGR will aid in the development of interventions to minimise the effect of IUGR on the hippocampus and long-term cognitive outcomes.
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Liu Y, Chen H, Jing C, Li F. The Association Between Maternal Subclinical Hypothyroidism and Growth, Development, and Childhood Intelligence: A Meta-analysis. J Clin Res Pediatr Endocrinol 2018; 10:153-161. [PMID: 28958983 PMCID: PMC5985385 DOI: 10.4274/jcrpe.4931] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To explore the association between maternal subclinical hypothyroidism (SCH) in pregnancy and the somatic and intellectual development of their offspring. METHODS Using RevMan 5.3 software, a meta-analysis of cohort studies published from inception to May 2017, focusing on the association between maternal SCH in pregnancy and childhood growth, development and intelligence, was performed. Sources included the Cochrane Library, Pub-Med, Web of Science, China National Knowledge Infrastructure and Wan Fang Data. RESULTS Analysis of a total of 15 cohort studies involving 1.896 pregnant women with SCH revealed that SCH in pregnancy was significantly associated with the intelligence (p=0.0007) and motor development (p<0.00001) of the offspring. SCH was also significantly associated with the child’s weight in four studies involving 222 women (p=0.02). Maternal SCH in pregnancy was identified as a risk factor for fetal growth restriction with a combined relative risk (RR) value of 2.4 [95% confidence interval (CI): 1.56, 3.7]. Meta-analysis of 10 studies that provided numbers of preterm infants revealed a significant association between maternal SCH in pregnancy and premature delivery, with a combined RR of 1.96 (95% CI: 1.34, 2.88). There was a significant effect of maternal SCH in pregnancy on fetal distress in utero (p=0.003). CONCLUSION Maternal SCH in pregnancy is associated with increased risk of adverse neonatal outcomes, including delayed intellectual and motor development, low birth weight, premature delivery, fetal distress and fetal growth restriction.
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Affiliation(s)
- Yahong Liu
- The Second Hospital of Lanzhou University, Department of Pediatrics, Lanzhou, Gansu, China
| | - Hui Chen
- The Second Hospital of Lanzhou University, Department of Endocrinology, Lanzhou, Gansu, China,* Address for Correspondence: The Second Hospital of Lanzhou University, Department of Endocrinology, Lanzhou, Gansu, China GSM: +86-0931-13909313366 E-mail:
| | - Chen Jing
- Nanfang College of Sun Yat-sen University Faculty of Health and Nursing, Guangzhou, Guangdong, China
| | - FuPin Li
- Gansu Provincial Maternity and Childcare Hospital, Lanzhou, Gansu, China
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Hunter DS, Hazel SJ, Kind KL, Owens JA, Pitcher JB, Gatford KL. Programming the brain: Common outcomes and gaps in knowledge from animal studies of IUGR. Physiol Behav 2016; 164:233-48. [DOI: 10.1016/j.physbeh.2016.06.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 12/18/2022]
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Garcia-Simon R, Figueras F, Savchev S, Fabre E, Gratacos E, Oros D. Cervical condition and fetal cerebral Doppler as determinants of adverse perinatal outcome after labor induction for late-onset small-for-gestational-age fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:713-717. [PMID: 25670681 DOI: 10.1002/uog.14807] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/25/2015] [Accepted: 01/27/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To estimate the combined value of fetal cerebral Doppler examination and Bishop score for predicting perinatal outcome after labor induction for small-for-gestational-age (SGA) fetuses in the presence of normal umbilical artery Doppler recordings. METHODS We conducted a cohort study in two tertiary centers, including 164 women with normal umbilical artery Doppler recordings who underwent induction of labor because of an estimated fetal weight < 10(th) percentile. The fetal middle cerebral artery pulsatility index and cerebroplacental ratio (CPR) were obtained in all cases within 24 h before induction. Cervical condition was assessed at admission using the Bishop score. A predictive model for perinatal outcomes was constructed using a decision-tree analysis algorithm. RESULTS Both a very unfavorable cervix, defined as a Bishop score < 2, (odds ratio (OR), 3.18; 95% CI, 1.28-7.86) and an abnormal CPR (OR, 2.54; 95% CI, 1.18-5.61) were associated with an increased likelihood of emergency Cesarean section for fetal distress, but only the latter was significantly associated with the need for neonatal admission (OR, 2.43; 95% CI, 1.28-4.59). In the decision-tree analysis, both criteria significantly predicted the likelihood of Cesarean section for fetal distress. CONCLUSION Combined use of the Bishop score and CPR improves the ability to predict overall Cesarean section (for any indication), emergency Cesarean section for fetal distress, and neonatal admission after labor induction for late-onset SGA in the presence of normal umbilical artery Doppler recordings.
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Affiliation(s)
- R Garcia-Simon
- Obstetrics Department, Hospital Clinico Lozano Blesa, University of Zaragoza and Instituto de Investigación Sanitaria de Aragón (IISA), Zaragoza, Spain
| | - F Figueras
- Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - S Savchev
- Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Fabre
- Obstetrics Department, Hospital Clinico Lozano Blesa, University of Zaragoza and Instituto de Investigación Sanitaria de Aragón (IISA), Zaragoza, Spain
| | - E Gratacos
- Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - D Oros
- Obstetrics Department, Hospital Clinico Lozano Blesa, University of Zaragoza and Instituto de Investigación Sanitaria de Aragón (IISA), Zaragoza, Spain
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Konijnenberg C. Methodological Issues in Assessing the Impact of Prenatal Drug Exposure. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2015; 9:39-44. [PMID: 26604776 PMCID: PMC4640424 DOI: 10.4137/sart.s23544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/29/2015] [Accepted: 10/02/2015] [Indexed: 01/30/2023]
Abstract
Prenatal drug exposure is a common public health concern that can result in perinatal complications, birth defects, and developmental disorders. The growing literature regarding the effects of prenatal exposure to specific drugs such as tobacco, alcohol, cocaine, and heroin is often conflicting and constantly changing. This review discusses several reasons why the effects of prenatal drug exposure are so difficult to determine, including variations in dose, timing, duration of exposure, polydrug use, unreliable measures of drug exposure, latent or “sleeper” effects, genetic factors, and socioenvironmental influences. In addition to providing research guidelines, this review also aims to help clinicians and policy makers to identify the strengths and weaknesses in studies investigating the effects of prenatal drug exposure. This knowledge may be used to make better informed decisions regarding the appropriate treatment for pregnant, drug-dependent women and their children.
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Streja E, Miller JE, Wu C, Bech BH, Pedersen LH, Schendel DE, Uldall P, Olsen J. Disproportionate fetal growth and the risk for congenital cerebral palsy in singleton births. PLoS One 2015; 10:e0126743. [PMID: 25974407 PMCID: PMC4431832 DOI: 10.1371/journal.pone.0126743] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 04/07/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the association between proportionality of fetal and placental growth measured at birth and the risk for congenital cerebral palsy (CP). STUDY DESIGN We identified all live-born singletons born in Denmark between 1995 and 2003 and followed them from 1 year of age until December 31st, 2008. Information on four indices of fetal growth: ponderal index, head circumference/ abdominal circumference ratio, cephalization index and birth weight/ placenta weight ratio was collected. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). All measurements were evaluated as gestational age and sex specific z-scores and in z-score percentile groups, adjusted for potential confounders, and stratified on gestational age groups (<32, 32-36, 37-38, 39, 40, ≥ 41 weeks). RESULTS We identified 503,784 singleton births, of which 983 were confirmed cases of CP. Head/ abdominal circumference ratio (aHR:1.12; 95%CI:1.07-1.16) and cephalization index (aHR:1.14; 95%CI:1.11-1.16) were associated with the risk of CP irrespective of gestational age. Birth weight-placental weight ratio was also associated with CP in the entire cohort (aHR:0.90; 95%CI:0.83-0.97). Ponderal index had a u-shaped association with CP, where both children with low and high ponderal index were at higher risk of CP. CONCLUSIONS CP is associated with disproportions between birth weight, birth length, placental weight and head circumference suggesting pre and perinatal conditions contribute to fetal growth restriction in children with CP.
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Affiliation(s)
- Elani Streja
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Jessica E. Miller
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Chunsen Wu
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bodil H. Bech
- Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lars Henning Pedersen
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Diana E. Schendel
- Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- National Centre for Register-based Research, Department of Economics and Business, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Peter Uldall
- The Danish Cerebral Palsy Registry, National Institute of Public Health, Southern University, Copenhagen, Denmark
- Pediatric Department, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jørn Olsen
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Davis MA, Higgins J, Li Z, Gilbert-Diamond D, Baker ER, Das A, Karagas MR. Preliminary analysis of in utero low-level arsenic exposure and fetal growth using biometric measurements extracted from fetal ultrasound reports. Environ Health 2015; 14:12. [PMID: 25971349 PMCID: PMC4429981 DOI: 10.1186/1476-069x-14-12] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 01/04/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND Early life exposure to arsenic is associated with decreased birth weight in highly exposed populations but little is known about effects of low-level arsenic exposure on growth in utero. METHODS Using a sample of 272 pregnancies from New Hampshire we obtained biometric measurements directly from fetal ultrasound reports commonly found in electronic medical records. We used information extraction methods to develop and validate an automated approach for mining biometric measurements from the text of clinical reports. As a preliminary analysis, we examined associations between in utero low-level arsenic exposure (as measured by maternal urinary arsenic concentration) and fetal growth measures (converted to Z-scores based on reference populations for estimated fetal weight, head, and other body measures) at approximately 18 weeks of gestation. RESULTS In a preliminary cross-sectional analysis of 223 out of 272 pregnancies, maternal urinary arsenic concentration (excluding arsenobetaine) was associated with a reduction in head circumference Z-score (Spearman correlation coefficient, rs = -0.08, p-value = 0.21) and a stronger association was observed among female fetuses at approximately 18 weeks of gestation (rs = - 0.21, p-value < 0.05). Although, associations were attenuated in adjusted analyses - among female fetuses a 1 μg/L increase in maternal urinary arsenic concentration was associated with a decrease of 0.047 (95% CI: -0.115, 0.021) in head circumference and 0.072 (95% CI: -0.151, 0.007) decrease in biparietal head diameter Z-score. CONCLUSIONS Our study demonstrates that useful data can be extracted directly from electronic medical records for epidemiologic research. We also found evidence that exposure to low-level arsenic may be associated with reduced head circumference in a sex dependent manner that warrants further investigation.
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Affiliation(s)
- Matthew A Davis
- />Children’s Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH USA
- />Institute for Quantitative Biomedical Sciences Graduate Program, Dartmouth College, Hanover, NH USA
- />University of Michigan School of Nursing, Ann Arbor, MI USA
- />Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH USA
| | - John Higgins
- />Collaboratory for Healthcare and Biomedical Informatics, Geisel School of Medicine at Dartmouth, Hanover, NH USA
| | - Zhigang Li
- />Children’s Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH USA
- />Department of Biostatistics, Geisel School of Medicine at Dartmouth, Hanover, NH USA
| | - Diane Gilbert-Diamond
- />Children’s Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH USA
- />Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH USA
| | - Emily R Baker
- />Children’s Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH USA
- />Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Amar Das
- />Children’s Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH USA
- />Collaboratory for Healthcare and Biomedical Informatics, Geisel School of Medicine at Dartmouth, Hanover, NH USA
| | - Margaret R Karagas
- />Children’s Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, NH USA
- />Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH USA
- />Department of Epidemiology, Geisel School of Medicine at Dartmouth, One Medical Center Drive, 7927 Rubin Building, 03756 Lebanon, NH USA
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Andescavage NN, DuPlessis A, Limperopoulos C. Advanced MR imaging of the placenta: Exploring the in utero placenta-brain connection. Semin Perinatol 2015; 39:113-23. [PMID: 25765905 PMCID: PMC4409865 DOI: 10.1053/j.semperi.2015.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The placenta is a vital organ necessary for the healthy neurodevelopment of the fetus. Despite the known associations between placental dysfunction and neurologic impairment, there is a paucity of tools available to reliably assess in vivo placental health and function. Existing clinical tools for placental assessment remain insensitive in predicting and evaluating placental well-being. Advanced MRI techniques hold significant promise for the dynamic, non-invasive, real-time assessment of placental health and identification of early placental-based disorders. In this review, we summarize the available clinical tools for placental assessment, including ultrasound, Doppler, and conventional MRI. We then explore the emerging role of advanced placental MR imaging techniques for supporting the developing fetus and appraise the strengths and limitations of quantitative MRI in identifying early markers of placental dysfunction for improved pregnancy monitoring and fetal outcomes.
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Affiliation(s)
- Nickie Niforatos Andescavage
- Division of Neonatology, Children’s National Health System, 111
Michigan Ave. NW, Washington, DC 20010,Fetal & Transitional Medicine, Children’s National Health
System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine,
2300 Eye St. NW, Washington, DC 20037
| | - Adre DuPlessis
- Fetal & Transitional Medicine, Children’s National Health
System, 111 Michigan Ave. NW, Washington, DC 20010,Diagnostic Imaging & Radiology, Children’s National Health
System, 111 Michigan Ave. NW, Washington, DC 20010,Department of Pediatrics, George Washington University School of Medicine,
2300 Eye St. NW, Washington, DC 20037
| | - Catherine Limperopoulos
- Division of Neonatology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010; Division of Fetal and Transitional Medicine, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037; Division of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010; Division of Radiology, George Washington University School of Medicine, 2300 Eye St. NW, Washington, DC 20037.
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12
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Levine TA, Grunau RE, McAuliffe FM, Pinnamaneni R, Foran A, Alderdice FA. Early childhood neurodevelopment after intrauterine growth restriction: a systematic review. Pediatrics 2015; 135:126-41. [PMID: 25548332 DOI: 10.1542/peds.2014-1143] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Children who experienced intrauterine growth restriction (IUGR) may be at increased risk for adverse developmental outcomes in early childhood. The objective of this study was to carry out a systematic review of neurodevelopmental outcomes from 6 months to 3 years after IUGR. METHODS PubMed, Embase, PsycINFO, Maternity and Infant Care, and CINAHL databases were searched by using the search terms intrauterine, fetal, growth restriction, child development, neurodevelopment, early childhood, cognitive, motor, speech, language. Studies were eligible for inclusion if participants met specified criteria for growth restriction, follow-up was conducted within 6 months to 3 years, methods were adequately described, non-IUGR comparison groups were included, and full English text of the article was available. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-documented quality-appraisal guidelines. RESULTS Of 731 studies reviewed, 16 were included. Poorer neurodevelopmental outcomes after IUGR were described in 11. Ten found motor, 8 cognitive, and 7 language delays. Other delays included social development, attention, and adaptive behavior. Only 8 included abnormal Doppler parameters in their definitions of IUGR. CONCLUSIONS Evidence suggests that children are at risk for poorer neurodevelopmental outcomes following IUGR from 6 months to 3 years of age. The heterogeneity of primary outcomes, assessment measures, adjustment for confounding variables, and definitions of IUGR limits synthesis and interpretation. Sample sizes in most studies were small, and some examined preterm IUGR children without including term IUGR or AGA comparison groups, limiting the value of extant studies.
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Affiliation(s)
- Terri A Levine
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland;
| | - Ruth E Grunau
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, Canada
| | - Fionnuala M McAuliffe
- Department of Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - RagaMallika Pinnamaneni
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland; and Children's University Hospital, Temple Street, Dublin, Ireland
| | - Adrienne Foran
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland; and Children's University Hospital, Temple Street, Dublin, Ireland
| | - Fiona A Alderdice
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
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Chen LM, Du WJ, Dai J, Zhang Q, Si GX, Yang H, Ye EL, Chen QS, Yu LC, Zhang C, Lu XM. Effects of subclinical hypothyroidism on maternal and perinatal outcomes during pregnancy: a single-center cohort study of a Chinese population. PLoS One 2014; 9:e109364. [PMID: 25353960 PMCID: PMC4212915 DOI: 10.1371/journal.pone.0109364] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/29/2014] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Adverse maternal outcomes and perinatal complications are closely associated with overt maternal hypothyroidism, but whether these complications occur in women with subclinical hypothyroidism (SCH) during pregnancy remains controversial. The aim of this study was to evaluate the effects of SCH on maternal and perinatal outcomes during pregnancy. METHODS A prospective study of data from 8012 pregnant women (371 women with SCH, 7641 euthyroid women) was performed. Maternal serum samples were collected in different trimesters to examine thyroid hormone concentrations. SCH was defined as a thyroid stimulating hormone concentration exceeding the trimester-specific reference value with a normal free thyroxine concentration. The occurrence of maternal outcomes, including gestational hypertension (GH), gestational diabetes mellitus, placenta previa, placental abruption, prelabor rupture of membranes (PROM), and premature delivery; and perinatal outcomes, including intrauterine growth restriction (IUGR), fetal distress, low birth weight (LBW; live birth weight ≤ 2500 g), stillbirth, and malformation, was recorded. Logistic regression with adjustment for confounding demographic and medical factors was used to determine the risks of adverse outcomes in patients with SCH. RESULTS Compared with euthyroid status, SCH was associated with higher rates of GH (1.819% vs. 3.504%, P = 0.020; χ2 = 7.345; odds ratio (OR), 2.243; 95% confidence interval (CI), 1.251-4.024), PROM (4.973% vs. 8.625%, P = 0.002; χ2 = 72.102; adjusted OR, 6.014; 95% CI, 3.975-9.099), IUGR (1.008% vs. 2.965%, <0.001; χ2 = 13.272; adjusted OR, 3.336; 95% CI, 1.745-6.377), and LBW (1.885% vs. 4.582%, P<0.001; χ2 = 13.558; adjusted OR, 2.919; 95% CI, 1.650-5.163). CONCLUSIONS The results of this study indicate that pregnant women with SCH had increased risks of GH and PROM, and their fetuses and infants had increased risks of IUGR and LBW. Thus, routine maternal thyroid function testing is necessary to improve maternal and perinatal outcomes.
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Affiliation(s)
- Liang-Miao Chen
- Department of Endocrinology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, Zhejiang, China
| | - Wen-Jun Du
- Department of Endocrinology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, Zhejiang, China
| | - Jie Dai
- Department of Endocrinology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, Zhejiang, China
| | - Qian Zhang
- Department of Endocrinology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, Zhejiang, China
| | - Guang-Xin Si
- Department of Endocrinology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, Zhejiang, China
| | - Hong Yang
- Department of Endocrinology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, Zhejiang, China
| | - En-Ling Ye
- Department of Endocrinology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, Zhejiang, China
| | - Qing-Shou Chen
- Department of Endocrinology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, Zhejiang, China
| | - Le-Chu Yu
- Department of Endocrinology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, Zhejiang, China
| | - Chi Zhang
- Chinese-American Research Institute for Diabetic Complications, Wenzhou Medical University, Wenzhou, China
- Ruian Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- * E-mail: (CZ); (XL)
| | - Xue-Mian Lu
- Department of Endocrinology, Third Affiliated Hospital, Wenzhou Medical University, Ruian, Zhejiang, China
- Chinese-American Research Institute for Diabetic Complications, Wenzhou Medical University, Wenzhou, China
- Ruian Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- * E-mail: (CZ); (XL)
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Growth restriction alters adult spatial memory and sensorimotor gating in a sex-specific manner. J Dev Orig Health Dis 2014; 3:59-68. [PMID: 25101812 DOI: 10.1017/s2040174411000729] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In Western society, impaired uteroplacental blood flow is the major cause of human intrauterine growth restriction. Infants born small and who experience late childhood accelerated growth have an increased risk of developing adult diseases. Recent studies also suggest a link between birth weight and altered adult behavior, particularly relating to motor function, learning and memory, depression and schizophrenia. The aim of this study was to determine the relative influence of prenatal and postnatal growth restriction on adult behavioral outcomes in male and female rats. Uteroplacental insufficiency was induced in Wistar Kyoto rats by bilateral uterine vessel ligation on day 18 of gestation producing growth-restricted offspring (Restricted group). The Control group had sham surgery. Another group underwent sham surgery, with a reduction in litter size to five at birth equivalent to the Restricted litter size (Reduced Litter group). At 6 months of age, a series of behavioral tests were conducted in male and female offspring. Growth restriction did not impair motor function. In fact, Restricted and Reduced Litter males showed enhanced motor performance compared with Controls (P < 0.05). Spatial memory was greater in Restricted females only (P < 0.05). The Porsolts test was unremarkable, however, males exhibited more depressive-like behavior than females (P < 0.05). A reduction in sensorimotor gating function was identified in Reduced Litter males and females (P < 0.05). We have demonstrated that growth restriction and/or a poor lactational environment can affect adult rat behavior, particularly balance and coordination, memory and learning, and sensorimotor gating function, in a sex-specific manner.
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Affiliation(s)
- Elizabeth L Prado
- Department of Nutrition; University of California at Davis; Davis CA USA
- SUMMIT Institute of Development; Mataram Nusa Tenggara Barat Indonesia
| | - Kathryn G Dewey
- Department of Nutrition; University of California at Davis; Davis CA USA
- SUMMIT Institute of Development; Mataram Nusa Tenggara Barat Indonesia
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Klaric AS, Galić S, Kolundzić Z, Bosnjak VM. Neuropsychological development in preschool children born with asymmetrical intrauterine growth restriction and impact of postnatal head growth. J Child Neurol 2013; 28:867-73. [PMID: 22914378 DOI: 10.1177/0883073812452790] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neuropsychological development and the impact of postnatal head growth were studied in preschool children with asymmetrical intrauterine growth restriction. Examinees born at term with a birth weight below the 10th percentile were matched to the control group according to chronological and gestational age, gender, and maternal education. Fifty children were in each group, with a mean age of 6 years, 4 months. The Touwen neurological examination, the Čuturić developmental test, an imitative hand positions test, and a visual attention test were performed. There were significant differences (P< .03) in motor variables, the developmental quotient, and the imitative hand positions test. Fine motor skills had the most discriminative power. Relative growth of the head in relation to weight gain was positively correlated to neurocognitive outcome. Intrauterine growth-restricted children with a current head circumference ≤10th percentile had poorer outcomes. Conclusively, intrauterine growth restriction has a negative impact on neurocognitive development. Slow postnatal head growth is correlated with a poorer neuropsychological outcome.
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Affiliation(s)
- Andrea Simić Klaric
- General County Hospital, Medical School, University of Osijek, Osijek, Croatia.
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Kippler M, Wagatsuma Y, Rahman A, Nermell B, Persson LÅ, Raqib R, Vahter M. Environmental exposure to arsenic and cadmium during pregnancy and fetal size: A longitudinal study in rural Bangladesh. Reprod Toxicol 2012; 34:504-11. [DOI: 10.1016/j.reprotox.2012.08.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 08/07/2012] [Accepted: 08/21/2012] [Indexed: 10/28/2022]
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Acute appendicitis and adverse pregnancy outcomes: a nationwide population-based study. J Gastrointest Surg 2012; 16:1204-11. [PMID: 22402956 DOI: 10.1007/s11605-012-1858-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 02/26/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND/OBJECTIVE Acute appendicitis is the most common non-obstetric surgical procedure in pregnant women. Using two large-scale nationwide population-based datasets, this study aimed to assess the risk of adverse pregnancy outcomes between mothers with and without appendicitis in Taiwan. METHODS This study used two nationwide population-based datasets: the Taiwan National Health Insurance Research Dataset and the Taiwan national birth certificate registry. This study included 908 women who had live singleton births and who had been hospitalized with a diagnosis of acute appendicitis, and another randomly selected 4,540 women as a comparison group. Conditional logistic regression analyses were performed to calculate the risk of adverse pregnancy outcomes including low birth weight (LBW), preterm birth, small for gestational age (SGA), cesarean section (CS), congenital anomalies, Apgar scores at 5 min (<7), and pre-eclampsia/eclampsia. RESULTS The adjusted odds ratios for LBW, preterm birth, SGA, CS, and congenital anomalies in women with acute appendicitis were 1.82 (95 % CI = 1.43-2.30), 1.59 (95 % CI = 1.25-2.02), 1.33 (95 % CI = 1.12-1.60), 1.24 (95 % CI = 1.07-1.44), and 2.07 (95 % CI = 1.07-4.03), respectively, compared with women without acute appendicitis after adjusting for highest maternal educational level, marital status, geographic region, gestational diabetes, gestational hypertension, coronary heart disease, anemia, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome, infant sex and parity, and paternal age. CONCLUSIONS There were increased risks for having LBW, preterm infants, SGA, congenital anomalies, and for experiencing CS among women with acute appendicitis than comparison women.
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Leitner Y, Harel S, Geva R, Eshel R, Yaffo A, Many A. The neurocognitive outcome of IUGR children born to mothers with and without preeclampsia. J Matern Fetal Neonatal Med 2012; 25:2206-8. [DOI: 10.3109/14767058.2012.684164] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van Wyk L, Boers KE, van der Post JAM, van Pampus MG, van Wassenaer AG, van Baar AL, Spaanderdam MEA, Becker JH, Kwee A, Duvekot JJ, Bremer HA, Delemarre FMC, Bloemenkamp KWM, de Groot CJM, Willekes C, Roumen FJME, van Lith JMM, Mol BWJ, le Cessie S, Scherjon SA. Effects on (neuro)developmental and behavioral outcome at 2 years of age of induced labor compared with expectant management in intrauterine growth-restricted infants: long-term outcomes of the DIGITAT trial. Am J Obstet Gynecol 2012; 206:406.e1-7. [PMID: 22444791 DOI: 10.1016/j.ajog.2012.02.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/22/2012] [Accepted: 02/03/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We sought to study long-term (neuro)developmental and behavioral outcome of pregnancies complicated by intrauterine growth restriction at term in relation to induction of labor or an expectant management. STUDY DESIGN Parents of 2-year-old children included in the Disproportionate Intrauterine Growth Intervention Trial at Term (DIGITAT) answered the Ages and Stages Questionnaire (ASQ) and Child Behavior Checklist (CBCL). RESULTS We approached 582 (89.5%) of 650 parents. The response rate was 50%. Of these children, 27% had an abnormal score on the ASQ and 13% on the CBCL. Results of the ASQ and the CBCL for the 2 policies were comparable. Low birthweight, positive Morbidity Assessment Index score, and admission to intermediate care increased the risk of an abnormal outcome of the ASQ. This effect was not seen for the CBCL. CONCLUSION In women with intrauterine growth restriction at term, neither a policy of induction of labor nor expectant management affect developmental and behavioral outcome when compared to expectant management.
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Affiliation(s)
- Linda van Wyk
- Leiden University Medical Center, Leiden, The Netherlands.
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Grewal J, Wernicke M, Zhang J. Early childhood development when second-trimester ultrasound dating disagrees with last menstrual period: a prospective cohort study. BMC Pregnancy Childbirth 2012; 12:32. [PMID: 22545943 PMCID: PMC3495038 DOI: 10.1186/1471-2393-12-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 02/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When an ultrasound-based estimate of gestational age (GA) is less (greater) than an estimate based on a definite last menstrual period, the fetus may grow slower (faster) than average. While the association between these discrepancies in GA estimates and adverse perinatal outcomes has been examined extensively, there is scant evidence about long-term effects, such as child neurodevelopment. METHODS Using data from a prospective cohort study titled, NICHD Study of Successive Small-for-Gestational Age Births, we examined if GA discrepancies in early second trimester of pregnancy (17 weeks' gestation) are associated with: (1) impaired motor and mental function at 13 months (measured using Bayley Scales of Infant Development (Bayley)), and (2) impaired cognitive development at five years (assessed by Wechsler Preschool and Primary Scale of Intelligence - Revised Intelligence Quotient (WPPSI-R)) in the infant. The study population consisted of 572 (30% of the overall sample of 1,945) women who presented for prenatal care in Norway and Sweden between 1986 and 1988. RESULTS Our results showed that GA discrepancies in early second trimester are significantly associated with birthweight. We found no significant relationship, however, with the Bayley development scores at 13 months and with the WPPSI-R IQ measures at five years. CONCLUSIONS GA discrepancies at 17 weeks' gestation are not associated child neurodevelopment. These discrepancies do, however, relate to birthweights, providing a basis for detecting fetal growth patterns early in the second trimester of pregnancy. Our study, however, was unable to evaluate the impact of first-trimester discrepancies on impaired neurodevelopment in the infant.
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Affiliation(s)
- Jagteshwar Grewal
- Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, 6100 Executive Boulevard, Room 7B03G, Rockville, MD 20852, USA.
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Smaldone GMM, Krohn MA, McGee EA. Cervical cancer and risk for delivery of small-for-gestational age neonates. J Womens Health (Larchmt) 2012; 19:969-74. [PMID: 20392155 DOI: 10.1089/jwh.2009.1574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine if cervical intraepithelial neoplasia grade 3 (CIN-3) and cervical cancer are associated with adverse obstetrical outcomes. METHODS Women with diagnoses of CIN-3 and cervical cancer were first identified from the University of Pittsburgh Medical Center (UPMC) Network Cancer Registry by using respective ICD-3 codes. Identified records were then linked to the Magee Obstetrical Maternal and Infant (MOMI) database to identify women who subsequently delivered pregnancies at Magee-Womens Hospital. Women with cervical disease were compared with women without known disease to determine the impact of cervical disease on various maternal and neonatal outcomes. The latter group consisted of those women who delivered singleton pregnancies at our institution, as determined by the MOMI database, but who did not have any matching records in the UPMC Cancer Registry. Statistical significance was defined by a p value <0.05. RESULTS We identified CIN-3 (n = 52) and cervical cancer patients (n = 83) who later had documented pregnancies delivered at Magee-Womens Hospital between 1989 and 2006. Women with cervical cancer and CIN-3 were at greater risk to deliver small-for-gestational age (SGA) neonates compared with women without known cervical disease (RR 1.54, 95% confidence interval [CI] 1.0-2.46). A secondary analysis of risk factors for SGA neonates demonstrated a significant association with cervical cancer (p = 0.04). After accounting for variables known to be risk factors for SGA, cervical cancer was associated with a 1.9-fold increased risk of a SGA delivery (OR 1.9, 95% CI 1.1-3.4). CONCLUSIONS Cervical cancer is a risk factor for delivery of an SGA neonate in a subsequent pregnancy.
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Affiliation(s)
- Gina M Mantia Smaldone
- Department of Obstetrics, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Language development in preschool children born after asymmetrical intrauterine growth retardation. Eur J Paediatr Neurol 2012; 16:132-7. [PMID: 21764612 DOI: 10.1016/j.ejpn.2011.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 06/04/2011] [Accepted: 06/19/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND After intrauterine growth retardation, many minor neurodevelopmental disorders may occur, especially in the motor skills domain, language and speech development, and cognitive functions. AIM The assessment of language development and impact of postnatal head growth in preschool children born with asymmetrical intrauterine growth retardation. METHODS Examinees were born at term with birth weight below the 10th percentile for gestational age, parity and gender. Mean age at the time of study was six years and four months. The control group was matched according to chronological and gestational age, gender and maternal education with mean age six years and five months. There were 50 children with intrauterine growth retardation and 50 controls, 28 girls and 22 boys in each group. For the assessment of language development Reynell Developmental Language Scale, the Naming test and Mottier test were performed. RESULTS There were statistically significant differences (p < 0.05) in language comprehension, total expressive language (vocabulary, structure, content), naming skills and non-words repetition. Statistically significant positive correlations were found between relative growth of the head [(Actual head circumference - head circumference at birth)/(Body weight - birth weight)] and language outcome. Children with neonatal complications had lower results (p < 0.05) in language comprehension and total expressive language. CONCLUSION Intrauterine growth retardation has a negative impact on language development which is evident in preschool years. Slow postnatal head growth is correlated with poorer language outcome. Neonatal complications were negatively correlated with language comprehension and total expressive language.
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Tofail F, Hamadani JD, Ahmed AZT, Mehrin F, Hakim M, Huda SN. The mental development and behavior of low-birth-weight Bangladeshi infants from an urban low-income community. Eur J Clin Nutr 2011; 66:237-43. [DOI: 10.1038/ejcn.2011.165] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Konijnenberg C, Melinder A. Prenatal exposure to methadone and buprenorphine: a review of the potential effects on cognitive development. Child Neuropsychol 2011; 17:495-519. [PMID: 21480011 DOI: 10.1080/09297049.2011.553591] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The amount of opioid users receiving opioid maintenance therapy has increased significantly over the last few years. As a result, an increasing number of children are prenatally exposed to long-lasting opioids such as methadone and buprenorphine. This article reviews the literature on the cognitive development of children born to mothers in opioid maintenance therapy. Topics discussed are the effects of prenatal exposure on prematurity, somatic growth, brain volume, myelination, and the endocrine and neurotransmitter system. Social-environmental factors, including parental functioning, as well as genetic factors are also described. Areas requiring further research are identified.
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Affiliation(s)
- Carolien Konijnenberg
- Norwegian Centre for Addiction Research, Institute of Psychiatry, University of Oslo, Oslo, Norway.
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Bassan H, Stolar O, Geva R, Eshel R, Fattal-Valevski A, Leitner Y, Waron M, Jaffa A, Harel S. Intrauterine growth-restricted neonates born at term or preterm: how different? Pediatr Neurol 2011; 44:122-30. [PMID: 21215912 DOI: 10.1016/j.pediatrneurol.2010.09.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 08/05/2010] [Accepted: 09/27/2010] [Indexed: 10/18/2022]
Abstract
Late onset intrauterine growth restriction is a common form of growth restriction, mainly caused by placenta-vascular insufficiency. Whether the intrauterine or extrauterine environment offers a better long-term outcome for the growth-restricted fetus remains unclear. We compared the risk factors and long-term outcomes of late onset growth-restricted neonates delivered between 31-36 weeks of gestation vs those delivered at term. This prospective cohort study included 114 preterm and 193 term born growth-restricted neonates. They underwent a neurobehavioral examination (neonatal period), a neurodevelopmental assessment and the Bayley Scales of Infant Development (age 2 years), and neuromotor assessment and the Wechsler Preschool and Primary Scale of Intelligence (age 6 years). Growth-restricted neonates born prematurely exhibited a significantly higher incidence of maternal hypertension, a maternal history of abortions and stillbirths, increased intrapartum and postnatal complication rates, and abnormal neonatal neurobehavioral scores than expected. Both preterm and term born growth-restricted groups, however, exhibited comparable long-term neurodevelopmental and cognitive outcomes at ages 2 and 6 years. Although prematurely born neonates undergo an earlier growth restriction process and exhibit a higher perinatal risk factor profile, their long-term outcomes are comparable to those of growth-restricted neonates born at term.
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Affiliation(s)
- Haim Bassan
- Child Neurology and Development Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. ARCHIVES OF GENERAL PSYCHIATRY 2010; 67:1012-24. [PMID: 20921117 PMCID: PMC3025772 DOI: 10.1001/archgenpsychiatry.2010.111] [Citation(s) in RCA: 1182] [Impact Index Per Article: 84.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT Maternal depressive symptoms during pregnancy have been reported in some, but not all, studies to be associated with an increased risk of preterm birth (PTB), low birth weight (LBW), and intrauterine growth restriction (IUGR). OBJECTIVE To estimate the risk of PTB, LBW, and IUGR associated with antenatal depression. DATA SOURCES AND STUDY SELECTION We searched for English-language and non-English-language articles via the MEDLINE, PsycINFO, CINAHL, Social Work Abstracts, Social Services Abstracts, and Dissertation Abstracts International databases (January 1980 through December 2009). We aimed to include prospective studies reporting data on antenatal depression and at least 1 adverse birth outcome: PTB (<37 weeks' gestation), LBW (<2500 g), or IUGR (<10th percentile for gestational age). Of 862 reviewed studies, 29 US-published and non-US-published studies met the selection criteria. DATA EXTRACTION Information was extracted on study characteristics, antenatal depression measurement, and other biopsychosocial risk factors and was reviewed twice to minimize error. DATA SYNTHESIS Pooled relative risks (RRs) for the effect of antenatal depression on each birth outcome were calculated using random-effects methods. In studies of PTB, LBW, and IUGR that used a categorical depression measure, pooled effect sizes were significantly larger (pooled RR [95% confidence interval] = 1.39 [1.19-1.61], 1.49 [1.25-1.77], and 1.45 [1.05-2.02], respectively) compared with studies that used a continuous depression measure (1.03 [1.00-1.06], 1.04 [0.99-1.09], and 1.02 [1.00-1.04], respectively). The estimates of risk for categorically defined antenatal depression and PTB and LBW remained significant when the trim-and-fill procedure was used to correct for publication bias. The risk of LBW associated with antenatal depression was significantly larger in developing countries (RR = 2.05; 95% confidence interval, 1.43-2.93) compared with the United States (RR = 1.10; 95% confidence interval, 1.01-1.21) or European social democracies (RR = 1.16; 95% confidence interval, 0.92-1.47). Categorically defined antenatal depression tended to be associated with an increased risk of PTB among women of lower socioeconomic status in the United States. CONCLUSIONS Women with depression during pregnancy are at increased risk for PTB and LBW, although the magnitude of the effect varies as a function of depression measurement, country location, and US socioeconomic status. An important implication of these findings is that antenatal depression should be identified through universal screening and treated.
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Bassan H, Kidron D, Bassan M, Rotstein M, Kariv N, Giladi E, Davidson A, Gozes I, Harel S. The effects of vascular intrauterine growth retardation on cortical astrocytes. J Matern Fetal Neonatal Med 2010. [DOI: 10.3109/14767050903197068] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Expression of thyroid hormone transporters in the human placenta and changes associated with intrauterine growth restriction. Placenta 2010; 31:295-304. [DOI: 10.1016/j.placenta.2010.01.013] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 01/21/2010] [Accepted: 01/22/2010] [Indexed: 11/24/2022]
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Lodha A, Asztalos E, Moore AM. Cytokine levels in neonatal necrotizing enterocolitis and long-term growth and neurodevelopment. Acta Paediatr 2010; 99:338-43. [PMID: 19922507 DOI: 10.1111/j.1651-2227.2009.01600.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate if circulating cytokines are related to growth and neurodevelopmental outcome following necrotizing enterocolitis (NEC). STUDY DESIGN Pro-inflammatory cytokine levels were measured prospectively in 40 neonates and compared with neurodevelopmental outcome. Cytokine levels were measured at the onset of feeding intolerance (Group II, n = 17) or NEC (Group III, n = 10) and at weeks 2-3 in control infants (Group I, n = 13). Neurodevelopmental outcome was assessed at the age of 24-28 months. Data were analysed using descriptive statistics, non-parametric tests and Student t-test. RESULTS Median birth weights (range) in groups I, II and III were 1120 (525-1564) g, 1068 (650-1937) g and 1145 (670-2833) g, and median gestational ages (range) were 28 (24-35) weeks 28 (24-35) weeks and 28 (25-37) weeks respectively. NEC occurred in 10 infants. Serum IL-6 (interleukin-6) was elevated in group III, (p = 0.03). Significant developmental delay was found in 12% of the infants in Group II and 20% of the infants in Group III, but no infant in group I. Five infants in group III with NEC (50%), had head ultrasound abnormalities. At 1 year of age, growth, weight and head circumference were significantly different in Group III, however, at two years of age, only height was significantly different, p < 0.02. Although there was wide variation, neonatal cytokine levels tended to be greater in the infants later found to have abnormal cognitive and psychomotor outcomes. CONCLUSION This study suggests that increased serum levels of pro-inflammatory cytokines may play a role in the poor growth and neurodevelopment associated with this high-risk population.
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MESH Headings
- Cerebral Palsy/etiology
- Child Development
- Child, Preschool
- Cytokines/blood
- Enterocolitis, Necrotizing/blood
- Enterocolitis, Necrotizing/complications
- Enterocolitis, Necrotizing/physiopathology
- Female
- Growth Disorders/etiology
- Humans
- Infant, Newborn
- Infant, Premature/blood
- Infant, Premature/growth & development
- Infant, Premature, Diseases
- Infant, Very Low Birth Weight/blood
- Infant, Very Low Birth Weight/growth & development
- Male
- Nervous System/growth & development
- Nervous System/physiopathology
- Prospective Studies
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Affiliation(s)
- A Lodha
- Division of Neonatology, Department of Pediatrics, University of Calgary, Alberta Children Hospital, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada.
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Indices of body and brain size at birth and at the age of 2 years: relations to cognitive outcome at the age of 16 years in low birth weight infants. J Dev Behav Pediatr 2009; 30:535-43. [PMID: 19901846 DOI: 10.1097/dbp.0b013e3181c35ee4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine in low birth weight infants the relations of being small for gestational age at birth, microcephalic at birth, low weight for age at 2 years, and microcephalic at 2 years to full scale intelligence quotient (FSIQ) at the age of 16 years. METHODS A prospective observational study of 422 of 837 eligible nondisabled low birth weight (<2000 g) adolescents from the newborn brain hemorrhage cohort with weight and head circumference at birth and at the age of 2 years in whom FSIQ was assessed with the Wechsler Abbreviated Scales of Intelligence at the age of 16 years. RESULTS In a multiple regression analysis, being small for gestational age (beta = -0.14, p = .02) and microcephalic at 2 years (beta = -0.18, p < .001), but not low weight for age at 2 years or microcephaly at birth, had significant independent effects on 16-year FSIQ. After adjusting for pre-, peri-, and postnatal risk factors for poor cognitive performance, the independent effects of being small for gestational age (beta = -0.13, p = .004) and microcephalic at 2 years (beta = -0.13, p = .01) persisted. In this analysis, birth social risk had the largest significant independent effect on 16-year FSIQ (beta = -0.28, p < .001). CONCLUSIONS Being small for gestational age at birth, but not low weight for age at 2 years, and microcephaly at 2 years, but not at birth, were independently related to FSIQ of nondisabled low birth weight adolescents, both with and without control for pre-, peri-, and postnatal risk factors.
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Theodore RF, Thompson JMD, Waldie KE, Becroft DMO, Robinson E, Wild CJ, Clark PM, Mitchell EA. Determinants of cognitive ability at 7 years: a longitudinal case-control study of children born small-for-gestational age at term. Eur J Pediatr 2009; 168:1217-24. [PMID: 19165501 DOI: 10.1007/s00431-008-0913-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 12/10/2008] [Indexed: 10/21/2022]
Abstract
The aim of this study was to identify the determinants of children's intelligence at 7 years, including pregnancy, postnatal, demographic factors, and small-for-gestational age (SGA) birth at term. Information was collected at birth (n = 871), 1 year (n = 744), 3.5 years (n = 550), and 7 years (n = 591). Approximately half of the children in this study were born SGA (birthweight <or=10th percentile). There was no significant difference found between IQ scores for SGA children compared to AGA children, after adjustment for potential confounders (p = 0.45). Paternal education, developmental delay, and birth order were associated with intelligence scores at 7 years in the multiple regression analysis. This study found no long-term effect of SGA birth at term on intelligence in middle childhood. Potentially modifiable postnatal and demographic factors were found to be strong predictors of intelligence at 7 years.
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Affiliation(s)
- Reremoana F Theodore
- Department of Paediatrics, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, New Zealand.
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Abstract
The inaccessibility of the human fetal brain to studies of perfusion and metabolism has impeded progress in the understanding of the normal and abnormal systems of oxygen substrate supply and demand. Consequently, current understanding is based on studies in fetal animals or in the premature infant (ex utero fetus), neither of which is ideal. Despite promising developments in fetal magnetic resonance imaging (MRI) and Doppler ultrasound, major advances in fetal neurodiagnostics will be required before rational and truly informed brainoriented care of the fetus becomes feasible.
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Fattal-Valevski A, Toledano-Alhadef H, Leitner Y, Geva R, Eshel R, Harel S. Growth patterns in children with intrauterine growth retardation and their correlation to neurocognitive development. J Child Neurol 2009; 24:846-51. [PMID: 19617460 DOI: 10.1177/0883073808331082] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The relationship between somatic growth and neurocognitive outcome was studied in a cohort of 136 children with intrauterine growth retardation. The children were followed up from birth to 9 to 10 years of age by annual measurements of growth parameters, neurodevelopmental evaluations, and IQ. The rate of catch-up for height between 1 and 2 years of age was significantly higher than the catch-up for weight (P < .001). The cognitive outcome at 9 to 10 years correlated with head circumference at all ages. The neurodevelopmental outcome at 9 to 10 years correlated with weight at all ages. Correlation with head circumference was more significant with IQ, while with weight it was stronger with the neurodevelopmental score. Height at 1 year was a significant predictor for IQ and neurodevelopmental outcome at 9 to 10 years. These findings are of distinct importance for prediction of subsequent neurodevelopmental outcome in children with intrauterine growth retardation.
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Affiliation(s)
- Aviva Fattal-Valevski
- Institute for Child Development and Pediatric Neurology Unit, Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Geva R, Eshel R, Leitner Y, Fattal-Valevski A, Harel S. Verbal short-term memory span in children: long-term modality dependent effects of intrauterine growth restriction. J Child Psychol Psychiatry 2008; 49:1321-30. [PMID: 19120711 DOI: 10.1111/j.1469-7610.2008.01917.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Recent reports showed that children born with intrauterine growth restriction (IUGR) are at greater risk of experiencing verbal short-term memory span (STM) deficits that may impede their learning capacities at school. It is still unknown whether these deficits are modality dependent. METHODS This long-term, prospective design study examined modality-dependent verbal STM functions in children who were diagnosed at birth with IUGR (n = 138) and a control group (n = 64). Their STM skills were evaluated individually at 9 years of age with four conditions of the Visual-Aural Digit Span Test (VADS; Koppitz, 1981): auditory-oral, auditory-written, visuospatial-oral and visuospatial-written. Cognitive competence was evaluated with the short form of the Wechsler Intelligence Scales for Children--revised (WISC-R95; Wechsler, 1998). RESULTS We found IUGR-related specific auditory-oral STM deficits (p < .036) in conjunction with two double dissociations: an auditory-visuospatial (p < .014) and an input-output processing distinction (p < .014). Cognitive competence had a significant effect on all four conditions; however, the effect of IUGR on the auditory-oral condition was not overridden by the effect of intelligence quotient (IQ). CONCLUSIONS Intrauterine growth restriction affects global competence and inter-modality processing, as well as distinct auditory input processing related to verbal STM functions. The findings support a long-term relationship between prenatal aberrant head growth and auditory verbal STM deficits by the end of the first decade of life. Empirical, clinical and educational implications are presented.
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Affiliation(s)
- R Geva
- Department of Psychology, The Developmental Neuropsychology Lab, The Gonda (Goldschmied) Brain Research Center, Bar-Ilan University, Ramat Gan, Israel.
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Zuk L, Harel S, Leitner Y, Jaffa A, Fattal-Valevski A. Upper limb movements and outcome in intrauterine-growth-retarded infants at 2 years. Brain Dev 2008; 30:636-42. [PMID: 18490124 DOI: 10.1016/j.braindev.2008.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 02/18/2008] [Accepted: 03/13/2008] [Indexed: 11/25/2022]
Abstract
This study aims to examine the usefulness of spontaneous upper limb movements (ULM) as an early marker for predicting neurodevelopmental outcome in infants with intrauterine-growth retardation (IUGR). The assessment of general movements (GMs) during the first 20 weeks is an accepted method for early detection of brain dysfunction. During this period, spontaneous upper limb movements were examined in 32 infants with IUGR and 32 appropriate-for-gestational-age-matched controls. ULM (arms, forearms and hands) were scored as optimal or suboptimal by sequential videotape recordings in the writhing (term-2 weeks: score 0-5); early fidgety (9-11 weeks: score 0-6); and late fidgety (14-16 weeks: score 0-6) periods, and correlated with neurodevelopmental score at 2 years of age. The mean ULM score was lower in the IUGR infants than the controls (p<0.05) and in the IUGR group was lower in the infants with abnormal outcome (p<0.05). Significant correlations were found between ULM and 2-year neurodevelopmental scores in the IUGR group. The ULM during late-fidgety period was most predictive for 2-year neurodevelopmental score. No difference was found in the mean ULM score between the pre-term and term IUGR infants. We conclude that ULM score can serve as an early predictor for neurodevelopmental outcome at 2 years of age in infants with IUGR.
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Affiliation(s)
- Luba Zuk
- Physical Therapy Department, Spayer School for Allied Sciences, Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Ochiai M, Nakayama H, Sato K, Iida K, Hikino S, Ohga S, Tsukimori K, Wake N, Masumoto K, Taguchi T, Hara T. Head circumference and long-term outcome in small-for-gestational age infants. J Perinat Med 2008; 36:341-7. [PMID: 18598125 DOI: 10.1515/jpm.2008.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess risk factors for the growth and development of small-for-gestational age (SGA) infants whose birth weight was less than the 10(th) percentile. PATIENTS AND METHODS SGA infants who were admitted to the neonatal intensive care unit from 1995 to 1998 were enrolled in the study. Fifty-six SGA infants, having no chromosomal abnormalities, inherited diseases, TORCH infections, major anomaly and/or multiple birth, were divided into 34 asymmetrical and 22 symmetrical SGA infants by >or= or <10(th) percentile head circumference (HC) at birth. The physical growth including HC, and the developmental quotient (DQ) and intelligent quotient (IQ) scores were evaluated up to 6 years of age. RESULTS Symmetrical SGA infants had lower levels of weight, height and HC, but not of total DQ at 3 years or IQ scores at 6 years of age than asymmetrical SGA infants. The 21 SGA infants who had a HC less than the 10(th) percentile at 1 year of age (non-catch-up group) showed lower total DQ (mean 96 vs. 105) and IQ (82 vs. 102) scores than 34 SGA infants who had not (catch-up group). CONCLUSIONS These results suggested that psychomotor development of SGA infants depended on the HC at 1 year of age rather than that at birth.
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Affiliation(s)
- Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
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Pallotto EK, Kilbride HW. Perinatal outcome and later implications of intrauterine growth restriction. Clin Obstet Gynecol 2008; 49:257-69. [PMID: 16721105 DOI: 10.1097/00003081-200606000-00008] [Citation(s) in RCA: 273] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This chapter reviews outcomes for children who have intrauterine growth retardation (IUGR) or small-for-gestation-age (SGA) status at birth. Such infants are at risk for increased perinatal mortality, birth adaptation complications, including perinatal acidosis, hypoglycemia, hypothermia, coagulation abnormalities, and selected immunologic deficiencies. IUGR infants also appear to be at great risk for complications of prematurity, including chronic lung disease and necrotizing enterocolitis. Childhood implications for IUGR include an increased risk for short stature, cognitive delays with decreased academic achievement, and a small but significant increased risk of neurologic disorders, including cerebral palsy. Low socioeconomic status is correlated with the occurrence of IUGR and is significantly related to long-term disabilities. Morbidities associated with preterm delivery appear to be additive to those associated with fetal growth restriction so IUGR, preterm infants may be at great risk for poor neurodevelopmental outcome.
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Affiliation(s)
- Eugenia K Pallotto
- Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64108, USA
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Tatli M, Guzel A, Kizil G, Kavak V, Yavuz M, Kizil M. Comparison of the effects of maternal protein malnutrition and intrauterine growth restriction on redox state of central nervous system in offspring rats. Brain Res 2007; 1156:21-30. [PMID: 17512503 DOI: 10.1016/j.brainres.2007.04.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 04/05/2007] [Accepted: 04/13/2007] [Indexed: 01/07/2023]
Abstract
Both maternal protein malnutrition and intrauterine growth restriction (IUGR) have deleterious effects on brain development, but a comparison of these effects has not been previously reported. The objectives of this study were to investigate and compare the effects of both factors on the oxidative status of the central nervous system (CNS), including the spinal cord, in offspring rats. We evaluated various parameters of oxidative status and antioxidant enzyme activities of superoxide dismutase and catalase (CAT) in different regions of the CNS from 60-day-old rats subjected to prenatal and postnatal protein restrictions [middle protein restriction 12%, severe protein restriction (SPR) 4%] or IUGR produced by uterine artery ligation. Furthermore, we compared these study groups to each other and to control rats fed an isocaloric 24% protein diet. Results were analyzed using one-way ANOVA followed by Tukey's post hoc test. Both protein restrictions and IUGR altered various parameters of oxidative status. In all evaluated structures, protein restrictions resulted in increases in thiobarbituric acid-reactive substances level and index of lipid peroxidation (P<0.001), and in decreases in antioxidant enzyme activities (P<0.005). IUGR also increased lipid peroxidation levels in the blood samples (P<0.04) and protein oxidative damage in the cerebellum and cerebral cortex (P<0.005); however, no effects were detected on the spinal cord. The greatest decrease in CAT activity was in the cerebellum of rats fed with SPR diet (P<0.001). This study suggests that not only severe but also middle protein malnutrition have deleterious effects on CNS structures, including the spinal cord. Protein restriction has a greater effect on the redox state of the CNS than IUGR.
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Affiliation(s)
- Mehmet Tatli
- Department of Neurosurgery, Faculty of Medicine, University of Dicle, 21280 Diyarbakir, Turkey.
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Leitner Y, Fattal-Valevski A, Geva R, Eshel R, Toledano-Alhadef H, Rotstein M, Bassan H, Radianu B, Bitchonsky O, Jaffa AJ, Harel S. Neurodevelopmental outcome of children with intrauterine growth retardation: a longitudinal, 10-year prospective study. J Child Neurol 2007; 22:580-7. [PMID: 17690065 DOI: 10.1177/0883073807302605] [Citation(s) in RCA: 209] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One hundred twenty-three children with intrauterine growth retardation were prospectively followed from birth to 9 to 10 years of age in order to characterize their specific neurodevelopmental and cognitive difficulties and to identify clinical predictors of such difficulties. Perinatal biometric data and risk factors were collected. Outcome was evaluated at age 9 to 10 by neurodevelopmental, cognitive, and school achievement assessments. Sixty-three children served as controls who were appropriate for gestational age. Significant differences in growth (P < .001), neurodevelopmental scores (P < .001), intelligence quotient (IQ) (P < .0001), and school achievements measured by the Kaufmann Assessment Battery for Children (P < .001) were found between the children with intrauterine growth retardation and controls. Children with intrauterine growth retardation demonstrated a specific profile of neurocognitive difficulties at school age, accounting for lower school achievements. The best perinatal parameter predictive of neurodevelopment and IQ was the Cephalization Index (P < .001). Somatic catch-up growth at age 2 and at age 9 to 10 correlated with favorable outcome at 9 to 10 years of age.
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Affiliation(s)
- Yael Leitner
- Institute for Child Development and Pediatric Neurology Unit, Division of Pediatrics, Tel Aviv University, Israel
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Shah PS, Wong KY, Merko S, Bishara R, Dunn M, Asztalos E, Darling PB. Postnatal growth failure in preterm infants: ascertainment and relation to long-term outcome. J Perinat Med 2007; 34:484-9. [PMID: 17140299 DOI: 10.1515/jpm.2006.094] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Traditional measure of postnatal growth failure assessment has poor discriminatory power for long-term outcomes. Our objective was to identify measure of postnatal growth failure associated with long-term outcome in preterm infants born at < 28 weeks' gestation. PATIENTS AND METHODS Four measures of defining postnatal growth failure at 36 weeks corrected gestational age: (1) weight < 10(th) centile, (2) weight < 3(rd) centile, (3) z score difference from birth > 1 and, (4) z score difference from birth > 2; were compared for their predictive values and strength of association with adverse neurodevelopmental outcomes at 18-24 months. RESULTS Postnatal growth failure defined as a decrease in z score of > 2 between birth and 36 weeks corrected gestational age had the best predictive values compared to other postnatal growth failure measures, however, it was significantly associated with psychomotor developmental (P=0.006) but not with mental developmental indices (P=0.379). CONCLUSION Postnatal growth failure defined by z score change influenced psychomotor but not mental tasks in this cohort. This method of ascertainment could be useful to identify infants who might benefit from nutritional interventions.
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Affiliation(s)
- Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Leitner Y, Yifat R, Mesterman R, Gilutz G, Levi-Hakeini O, Bitchonsky O, Harel S. A Long-term, epidemiological survey of outcome and adjustment of children with developmental disabilities. J Child Neurol 2007; 22:143-50. [PMID: 17621474 DOI: 10.1177/0883073807300297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The medical, educational, and psychosocial outcomes of 3224 subjects (age range, 7-33 years; mean age, 20.06 years; SD, 5.74) diagnosed and treated in the Institute for Child Development in Tel Aviv between the years 1975 and 1994 were assessed by a telephone interview. Results indicate that only 9% of the subjects are seriously disabled, and 8% are mentally retarded. Over the years, subjects were referred to the Child Development Center at an increasingly younger age, probably reflecting greater professional and parental awareness of the importance of early intervention. The nature of interventions changed, so that physiotherapy, occupational therapy, and psychological guidance were more often provided. While more children were referred to special education at kindergarten, the percentage of those graduating from regular schools has increased. Most completed 12 years of schooling and successfully acquired full or partial matriculation certificates. As adults, most function independently; fulfill civic obligations, such as their army service; are fully employed; and express satisfaction with their life. These results suggest that children with developmental disabilities who receive early intervention are likely to be functionally independent and to be satisfied with their lives, although they continue to need medical services and require some government support. Further studies are essential to examine the correlation of specific risk factors and early interventions with outcome.
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Affiliation(s)
- Yael Leitner
- Institute for Child Development and Pediatric Neurology Unit, Division of Pediatrics, Tel Aviv Sourasky Medical Center, Israel.
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Emond AM, Lira PIC, Lima MC, Grantham-McGregor SM, Ashworth A. Development and behaviour of low-birthweight term infants at 8 years in northeast Brazil: a longitudinal study. Acta Paediatr 2006; 95:1249-57. [PMID: 16982498 DOI: 10.1080/08035250600615127] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM To investigate the development and behaviour of low-birthweight (LBW) term infants compared with matched term infants of appropriate birthweight (ABW). METHODS Two parallel cohorts of LBW infants (1500-2499 g) and ABW controls (3000-3499 g) were enrolled at birth in northeast Brazil. At 8 y, 164 children were assessed using clinical and psychological tests. RESULTS The LBW group had lower IQ scores than ABW children on the Weschler Intelligence Scale for Children; differences were larger on the performance (5 points, p = 0.04) than the verbal scale (3 points, p = 0.11). LBW children had poorer dynamic balance (p = 0.03) and eye-hand coordination (p = 0.02), but better selective attention (p = 0.02). Hyperactivity and conduct problems were common in both groups, but fewer LBW children had peer problems (p = 0.04). After controlling for social background, IQ was not significantly associated with birthweight (p = 0.10). Significant determinants were maternal education, home stimulation and type of school attended. The effect of birthweight on coordination and selective attention remained significant. Birth head circumference and growth in head size in the first 6 mo had independent effects on IQ. CONCLUSION After controlling for social background, LBW term infants did not differ from ABW infants in cognition at school age. Head circumference at birth and 6 mo was a better predictor than birthweight of IQ.
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Affiliation(s)
- Alan M Emond
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK.
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Geva R, Eshel R, Leitner Y, Fattal-Valevski A, Harel S. Memory functions of children born with asymmetric intrauterine growth restriction. Brain Res 2006; 1117:186-94. [PMID: 16962082 DOI: 10.1016/j.brainres.2006.08.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Revised: 06/09/2006] [Accepted: 08/03/2006] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Learning difficulties are frequently diagnosed in children born with intrauterine growth restriction (IUGR). Models of various animal species with IUGR were studied and demonstrated specific susceptibility and alterations of the hippocampal formation and its related neural structures. The main purpose was to study memory functions of children born with asymmetric IUGR in a large-scale cohort using a long-term prospective paradigm. METHODS One hundred and ten infants diagnosed with IUGR were followed-up from birth to 9 years of age. Their performance was compared with a group of 63 children with comparable gestational age and multiple socioeconomic factors. Memory functions (short-term, super- and long-term spans) for different stimuli types (verbal and visual) were evaluated using Visual Auditory Digit Span tasks (VADS), Rey Auditory Verbal Learning Test (Rey-AVLT), and Rey Osterrieth Complex Figure Test (ROCF). RESULTS Children with IUGR had short-term memory difficulties that hindered both serial verbal processing system and simultaneous processing of high-load visuo-spatial stimuli. The difficulties were not related to prematurity, neonatal complications or growth catch-up, but were augmented by lower maternal education. Recognition skills and benefits from reiteration, typically affected by hippocampal dysfunction, were preserved in both groups. CONCLUSIONS Memory profile of children born with IUGR is characterized primarily by a short-term memory deficit that does not necessarily comply with a typical hippocampal deficit, but rather may reflect an executive short-term memory deficit characteristic of anterior hippocampal-prefrontal network. Implications for cognitive intervention are discussed.
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Affiliation(s)
- Ronny Geva
- The Institute for Child Development and Pediatric Neurology Unit, Division of Pediatrics, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel.
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Geva R, Eshel R, Leitner Y, Valevski AF, Harel S. Neuropsychological outcome of children with intrauterine growth restriction: a 9-year prospective study. Pediatrics 2006; 118:91-100. [PMID: 16818553 DOI: 10.1542/peds.2005-2343] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim was to evaluate the effect of late-onset intrauterine growth restriction on the neuropsychological profile and on academic achievements at 9 years of age using a large-scale prospective paradigm. STUDY DESIGN We followed up 123 infants diagnosed with late-onset intrauterine growth restriction yearly for 9 years. They were matched with 63 children for gestation age and multiple socioeconomic factors and evaluated by an extensive neuropsychological battery to assess intelligence quotient, academic achievements, learning and memory, visuomotor skills, visuospatial integration, attention, language, executive functions, and creativity. RESULTS Children with intrauterine growth restriction had lower intelligence quotient and more frequent neuropsychological difficulties. Difficulties in executive functioning, inflexibility-creativity, and language, indicative of frontal lobe dysfunction, were typically affected by intrauterine growth restriction and were rarely identified in the control group. Learning difficulties accompanied by lower academic achievements were more prevalent in the intrauterine growth restriction group, particularly when anthropometric catch-up was incomplete. CONCLUSIONS The longitudinal findings reaffirm that functional coherence depends on preestablished structural growth and reorganization of the central nervous system. The neuropsychological profile at 9 years of age indicates that late-onset intrauterine growth restriction compromises frontal network functioning.
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Affiliation(s)
- Ronny Geva
- Institute for Child Neurology and Neurology Unit, Dana Children's Hospital, Souraski Medical Center, University of Tel Aviv, Tel Aviv, Israel.
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Bassan H, Bassan M, Pinhasov A, Kariv N, Giladi E, Gozes I, Harel S. The pregnant spontaneously hypertensive rat as a model of asymmetric intrauterine growth retardation and neurodevelopmental delay. Hypertens Pregnancy 2006; 24:201-11. [PMID: 16263593 DOI: 10.1080/10641950500281142] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Hypertension in pregnancy and vascular placental insufficiency are considered common pathogenic factors in human intrauterine growth retardation (IUGR). IUGR neonates experience higher mortality, and the surviving infants have a higher incidence of neurological and intellectual impairment. METHODS To mimic this condition, we used pregnant spontaneously hypertensive rats (SHR) and performed biometric measurements on Embryonic Day 20, postnatal developmental reflexes, and locomotor activity evaluations. RESULTS SHR fetuses had significant decreased body weight compared to the Wistar-Kyoto control fetuses (1.51+/-0.02 g vs. 2.05+/-0.01 g, respectively; p<0.0001), and were relatively microcephalic (2.86+/-0.04 cm vs. 3.3+/-0.03 cm, respectively; p<0.0001). Their cephalization index (head circumference/body weight) was increased (1.88+/-0.03 vs. 1.62+/-0.02, respectively; p<0.0001), indicating a "brain-sparing" process. The disproportional ratio indicated that the IUGR type in this model is asymmetric. The SHR pups exhibited a significant (p<0.04) neurodevelopmental delay in the acquisition of neonatal reflexes (righting, negative geotaxis, placing), but they spontaneously caught up with the control pups after approximately 10 days. On Day 30, the SHR pups exhibited significantly increased walking speed and distance and spent less time in quadrant than the controls (p<0.002). CONCLUSION We speculate that the model of pregnant SHR closely simulate human IUGR caused by hypertension in pregnancy and should enable investigation of mechanisms of hypertension-mediated placenta-vascular injury as well as provide a system for preclinical evaluations of future preventive neuroprotective treatments.
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Affiliation(s)
- Haim Bassan
- The Institute for Child Development and Pediatric Neurology, Division of Pediatrics, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
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Min J, Park EA, Kong K, Park B, Hong J, Kim YJ, Lee H, Ha E, Park H. The influence of some intrauterine growth variables on neonatal blood pressure. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.9.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jungwon Min
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Eun Ae Park
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyoungae Kong
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Bohyun Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Juhee Hong
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Young Ju Kim
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hwayoung Lee
- Department of Anatomy, College of Medicine, Ewha Womans University, Seoul, Korea
| | - EunHee Ha
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyesook Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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Idris I, Srinivasan R, Simm A, Page RC. Maternal hypothyroidism in early and late gestation: effects on neonatal and obstetric outcome. Clin Endocrinol (Oxf) 2005; 63:560-5. [PMID: 16268809 DOI: 10.1111/j.1365-2265.2005.02382.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maternal hypothyroidism may be associated with a variety of adverse neonatal and obstetric outcomes. Whether these outcomes are affected by maternal thyroid status at initial presentation or in late gestation specifically within a dedicated antenatal endocrine clinic remains unclear. The effects of thyroxine dose requirement during pregnancy and serum concentrations of TSH within such clinic settings are still not known. OBJECTIVES We investigated these outcomes in patients with hypothyroidism during early and late gestation. TSH levels and thyroxine dose requirement during early and late gestation were also evaluated. METHODS We performed a retrospective study of data from 167 pregnancies managed in the antenatal endocrine clinic. Analysis of outcomes was linked to TSH at first presentation and in the third trimester. Outcome variables included: rate of caesarean section, pre-eclampsia, neonatal unit admission, neonatal weight and gestational age. Controlled TSH was defined as mothers with TSH between 0.1 and 2 with normal free thyroid hormone levels. RESULTS The caesarean section (CS) rates were higher in the study cohort (H) compared with the local (C) rate (H = 28.7%, C = 18%). The higher rate in our patient cohort was not due to a higher rate of emergency section nor to a lower threshold for performing elective caesarean section. The infant birthweight (IBW) from mothers with TSH > 5.5 (H1) and mothers with TSH between 0.1 and 5.5 at presentation (H2) was [median (range)] 3.38 (1.73-4.70) vs. 3.45 (1.36-4.76); P = ns. The prevalence of low-birthweight (LBW) infants (< 2.5 g) in groups H1 and H2 was 15% and 4.8%, respectively [odds ratio (OR) = 3.55, 95% confidence interval (95% CI) = 0.96-10.31]. IBW from mothers with TSH > 2 (H3) and mothers with controlled TSH in the third trimester (H4) were similar [3.38 (1.78-4.4) vs. 3.46 (1.36-4.76); P = ns]. The prevalence of LBW in groups H3 and H4 was 9% and 4.9%, respectively (OR = 1.95, 95% CI = 0.52-7.26). The median thyroxine dose (microg) increased significantly during pregnancy (first trimester: 100; second trimester: 125, P < 0.001; and third trimester: 150, P < 0.001) associated with appropriate suppression of TSH levels in the second and third trimesters. Rates of pre-eclampsia or admissions to neonatal units were negligible. CONCLUSION Thyroxine dose requirement increases during pregnancy and thus close monitoring of thyroid function with appropriate adjustment of thyroxine dose to maintain a normal serum TSH level is necessary throughout gestation. Within a joint endocrine-obstetric clinic, maternal hypothyroidism at presentation and in the third trimester may increase the risk of low birthweight and the likelihood for caesarean section. The latter observation was not due to a higher rate of emergency caesarean section nor to a lower threshold for performing elective caesarean section. A larger study with adjustments made for the various confounders is required to confirm this observation.
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Affiliation(s)
- Iskandar Idris
- Department of Diabetes and Endocrinology, Nottingham City Hospital, UK.
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Leitner Y, Heldman D, Harel S, Pick CG. Deficits in spatial orientation of children with intrauterine growth retardation. Brain Res Bull 2005; 67:13-8. [PMID: 16140157 DOI: 10.1016/j.brainresbull.2005.04.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Revised: 04/15/2005] [Accepted: 04/19/2005] [Indexed: 11/21/2022]
Abstract
The spatial orientation of intrauterine growth retarded (IUGR) children versus age-matched controls was examined using two spatial tests. The first test was the radial arm maze (RAM), a navigational test frequently used in animal models. The second test was a subtest from the Kaufman assessment battery for children (K-ABC). The IUGR group comprised 28 children aged 6 years. The control group comprised 29 appropriate-for-gestational age children. The performance of the IUGR children was significantly inferior to controls in both tests. In the RAM test, the ratio between the correct entrances to the total entrances was significantly lower in the IUGR group than in the control group (P<0.001). In the K-ABC, the IUGR group could not perform as well as control children (P<0.001). These results suggest that spatial orientation in IUGR children is inferior to their age-matched controls, possibly contributing to their potential learning difficulties. The present results also suggest that the RAM can be potentially used to test spatial orientation of children at-risk.
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Affiliation(s)
- Y Leitner
- Pediatric Neurology Unit and Child Development Center, Sourasky Medical Center, Tel Aviv and Sackler School of Medicine, Tel Aviv University, Israel
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Fattal-Valevski A, Toledano-Alhadef H, Golander A, Leitner Y, Harel S. Endocrine profile of children with intrauterine growth retardation. J Pediatr Endocrinol Metab 2005; 18:671-6. [PMID: 16128244 DOI: 10.1515/jpem.2005.18.7.671] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intrauterine growth retardation (IUGR) is a major cause of short stature in childhood. Most but not all children experience catch-up growth by 2 years of age. METHODS We investigated the endocrine profile (thyroid function, prolactin, cortisol, C-peptide and insulin-like growth factor-I [IGF-IJ levels) of 57 children with IUGR, aged 2-10 years, and compared it with 30 controls whose birth weight was appropriate-for-gestational-age. RESULTS The hormonal profile for both groups was similar for thyroid hormones, prolactin, C-peptide and IGF-I. Cortisol levels were significantly lower in the IUGR group compared to controls (p <0,05). When the IUGR group was divided into 'catch-up' growth and 'non-catch-up' subgroups, the latter had significantly lower IGF-I levels (p <0.001). CONCLUSIONS Lower cortisol levels in children born with IUGR may reflect impaired function of the hypothalamic-pituitary-adrenal axis associated with this condition. The significantly lower IGF-I levels of the 'non-catch-up' subgroup may be involved in their failure to grow.
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Affiliation(s)
- Aviva Fattal-Valevski
- The Institute for Child Development and Pediatric Neurology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
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