Influence of preconception carbohydrate intake on hypertensive disorders of pregnancy: The Japan Environment and Children's Study

AIM

Hypertensive disorders of pregnancy (HDP) are a crucial cause of morbidity and mortality. We aimed to examine whether preconception carbohydrate intake is associated with new-onset HDP and small for gestational age (SGA) births.

METHODS

We identified 93 265 normotensive (primiparous, 37 387; multiparous, 55 878) participants from the Japan Environmental Children's Study database who delivered between 2011 and 2014. After excluding participants with multiple gestations, preconception hypertension, and insufficient data, primiparous and multiparous participants were categorized into five groups according to their preconception carbohydrate-intake quintiles (Q1 and Q5 were the lowest and highest groups, respectively). Multiple logistic regression analysis was performed to identify the effect of preconception carbohydrate intake on early (<34 weeks) and late-onset (≥34 weeks) HDP and the incidence of SGA births.

RESULTS

With the middle carbohydrate intake group (Q3) as a reference, the risk for late-onset HDP among multiparous women was higher in the Q5 group (adjusted odds ratio [aOR] 1.31, 95% confidence interval [CI] 1.02-1.69). The incidence of SGA births was higher in the Q1 group among both primiparous (aOR 1.16, 95% CI 1.01-1.33) and multiparous women (aOR 1.16, 95% CI 1.02-1.32).

CONCLUSIONS

Excessive carbohydrate intake increases the incidence of HDP in multiparous women, while low-carbohydrate intake increases the incidence of SGA births. New recommendations for preconception carbohydrate intake are required to prevent major HDP-related complications.

Joint Exposure to Ambient Air Pollutants Might Elevate the Risk of Small for Gestational Age (SGA) Infants in Wuhan: Evidence From a Cross-Sectional Study

Objective: To investigate the effect of exposure to multiple ambient air pollutants during pregnancy on the risk of children being born small for gestational age (SGA). Methods: An Air Pollution Score (APS) was constructed to assess the effects of being exposed to six air pollutants simultaneously, PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃ (referred to as joint exposure). A logistic regression model was applied to estimate the associations of APS and SGA. Results: The adjusted odds ratios (ORs) of SGA per 10 ug/m³ increased in APS during the first and second trimesters and the entire pregnancy were 1.003 [95% confidence intervals (CIs): 1.000, 1.007], 1.018 (1.012, 1.025), and 1.020 (1.009, 1.031), respectively. The ORs of SGA for each 10 μg/m³ elevated in APS during the whole pregnancy were 1.025 (1.005, 1.046) for mothers aged over 35 years old vs. 1.018 (1.005, 1.031) for mothers aged under 35 years old. Women who were pregnant for the first time were more vulnerable to joint ambient air pollution. Conclusion: In summary, the results of the present study suggested that joint exposure to ambient air pollutants was associated with the increment in the risks of SGA.

He Tamariki Kokoti Tau: Tackling preterm incidence and outcomes of preterm births by ethnicity in Aotearoa New Zealand 2010-2014

OBJECTIVE

To explore preterm birth among Māori indigenous peoples through Kaupapa Māori research of preterm birth in Aotearoa New Zealand.

METHODS

Linked maternity, mortality, and hospital data were analyzed for women and their infants born between January 1, 2010 and December 31, 2014. Relative risks (RR) were calculated for each ethnic group for preterm birth, small for gestational age (SGA), and mortality.

RESULTS

Adjusted rates showed that compared with Māori women, European women were at significantly less risk of having extremely and very preterm infants (RR 0.86, 95% confidence interval [CI] 0.76-0.95). Preterm infants of European women had a significantly lower adjusted RR of early neonatal death (RR 0.65, 95% CI 0.45-0.93) or post-neonatal death (RR 0.41, 95% CI 0.26-0.64). In addition to ethnicity, preterm rates were influenced by maternal age, body mass index, smoking status, and SGA status.

CONCLUSION

This study demonstrates that the Aotearoa New Zealand maternity system privileges whiteness, suggesting that clinical pathways for evidence-based medical care are not delivered systemically and equitably for all. Health pathways that focus on equity as a fundamental right will enhance health outcomes for Māori women and their infants.

Sphingolipids and Kidney Disease: Possible Role of Preeclampsia and Intrauterine Growth Restriction (IUGR)

Sphingolipids are now considered not only as constitutional components of the cellular membrane but also as essential bioactive factors regulating development and physiologic functions. Ceramide is a vital intermediate of sphingolipid metabolism, synthesized by de novo and salvage pathways, producing multiple types of sphingolipids and their metabolites. Although mutations in gene-encoding enzymes regulating sphingolipid synthesis and metabolism cause distinct diseases, an abnormal sphingolipid metabolism contributes to various pathologic conditions, including kidney diseases. Excessive accumulation of glycosphingolipids and promotion of the ceramide salvage and sphingosine-1-phosphate (S1P) pathways are found in the damaged kidney. Acceleration of the sphingosine kinase/S1P/S1P receptor (SphK/S1P/S1PR) axis plays a central role in deteriorating kidney functions. The SphK/S1P/S1PR signaling impairment is also found during pregnancy complications, such as preeclampsia and intrauterine growth restriction (IUGR). This mini-review discusses the current state of knowledge regarding the role of sphingolipid metabolism on kidney diseases, and the possible involvement of preeclampsia and IUGR conditions.

Risk of Ischemic Placental Disease in Relation to Family History of Preeclampsia

OBJECTIVE

To assess the risk of ischemic placental disease (IPD) including preeclampsia, small for gestational age (SGA), and abruption, in relation to preeclampsia in maternal grandmother, mother, and sister(s).

STUDY DESIGN

We performed a secondary analysis of data from a randomized trial of vitamins C and E for preeclampsia prevention. Data on family history of preeclampsia were based on recall by the proband. The associations between family history of preeclampsia and the odds of IPD were evaluated from alternating logistic regressions.

RESULTS

Of the 9,686 women who delivered nonmalformed, singleton live births, 17.1% had IPD. Probands provided data on preeclampsia in 55.5% (n = 5,374) on all three family members, 26.5% (n = 2,562) in mother and sister(s) only, and 11.6% (n = 1,125) in sister(s) only. The pairwise odds ratio (pOR) of IPD was 1.16 (95% confidence interval [CI]: 1.00-1.36) if one or more of the female relatives had preeclampsia. The pORs of preeclampsia were 1.54 (95% CI: 1.12-2.13) and 1.35 (95% CI: 1.03-1.77) if the proband's mother or sister(s) had a preeclamptic pregnancy, respectively, but no associations were seen for SGA infant or abruption.

CONCLUSION

This study suggests that IPD may share a predisposition with preeclampsia, suggesting a familial inheritance.

[A clinical study of growth and metabolism of small for gestational age infants]

OBJECTIVE

To study the differences in growth and metabolism between small for gestational age (SGA) infants and appropriate for gestational age (AGA) infants.

METHODS

A total of 1 370 preterm infants were enrolled in this study. According to the association between gestational age and birth weight, they were divided into SGA group with 675 infants and AGA group with 695 infants. The two groups were compared in terms of general conditions, physical growth and blood biochemical parameters.

RESULTS

The SGA group had a significantly longer length of hospital stay than the AGA group (P<0.05). Compared with the AGA group, the SGA group had significantly lower body weight, body weight Z score, and body length at discharge and significantly higher incidence rate of extrauterine growth retardation and growth rate of head circumference (P<0.05). Compared with the AGA group, the SGA group had significantly longer time to full enteral nutrition and duration of parenteral nutrition (P<0.05). Compared with the AGA group, the SGA group had significantly higher levels of albumin, prealbumin, and serum phosphorus on admission and total bile acid before discharge, as well as a significantly lower albumin level before discharge (P<0.05). The incidence rates of asphyxia, neonatal respiratory distress syndrome, myocardial damage, feeding intolerance, pneumonia, sepsis, hypoglycemia and hypothyroxinemia in the SGA group were significantly higher than in the AGA group (P<0.05).

CONCLUSIONS

Compared with AGA infants, SGA infants have significantly delayed physical development during hospitalization and significantly higher incidence rates of extrauterine growth retardation and related complications.

Metabolomics for predicting fetal growth restriction: protocol for a systematic review and meta-analysis

INTRODUCTION

Fetal growth restriction (FGR) is a relevant research and clinical concern since it is related to higher risks of adverse outcomes at any period of life. Current predictive tools in pregnancy (clinical factors, ultrasound scan, placenta-related biomarkers) fail to identify the true growth-restricted fetus. However, technologies based on metabolomics have generated interesting findings and seem promising. In this systematic review, we will address diagnostic accuracy of metabolomics analyses in predicting FGR.

METHODS AND ANALYSIS

Our primary outcome is small for gestational age infant, as a surrogate for FGR, defined as birth weight below the 10th centile by customised or population-based curves for gestational age. A detailed systematic literature search will be carried in electronic databases and conference abstracts, using the keywords 'fetal growth retardation', 'metabolomics', 'pregnancy' and 'screening' (and their variations). We will include original peer-reviewed articles published from 1998 to 2018, involving pregnancies of fetuses without congenital malformations; sample collection must have been performed before clinical recognition of growth impairment. If additional information is required, authors will be contacted. Reviews, case reports, cross-sectional studies, non-human research and commentaries papers will be excluded. Sample characteristics and the diagnostic accuracy data will be retrieved and analysed. If data allows, we will perform a meta-analysis.

ETHICS AND DISSEMINATION

As this is a systematic review, no ethical approval is necessary. This protocol will be publicised in our institutional websites and results will be submitted for publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42018089985.

Amplitude-integrated electroencephalographic activity and middle cerebral artery Doppler flow measurements in preterm small for gestational age infants

Amplitude-integrated encephalography (EEG) is frequently used in neonatal intensive care units to monitor brain functions. Its bedside application and easy interpretation are the most important features. Brain development of small for gestational age infants can be affected by intrauterine chronic hypoxia. The current study aimed to evaluate cerebral functions of small for gestational age infants by means of amplitude-integrated EEG. Thirty- to 34-week-old 22 small for gestational age and 27 appropriate for gestational age preterm infants were included in the study. The mode of delivery, gender, birth weight, and Apgar scores of the patients were recorded. Following middle cerebral artery mean velocity measurement with cranial Doppler at the 24th hour of birth, an amplitude-integrated EEG recording was performed on all infants, for a period of 4 to 24 hours. Small for gestational age infants had significantly higher middle cerebral artery mean velocity than appropriate for gestational age infants (21.09 ± 4.25 vs 17.8 ± 4.07; P = .029). The amplitude-integrated EEG recordings showed lower "lower border of quiet sleep" and total Burdjalov score in small for gestational age infants when compared with appropriate for gestational age infants (2.5 [1-3.25] µV vs 3 [2.75-4] µV; P = .04, 8 [6-10], 9 [9-11]; P = .04, respectively). Increased middle cerebral artery blood flow observed in small for gestational age infants might be a marker of chronic intrauterine hypoxia to which these infants were exposed. These infants demonstrated a more immature pattern of amplitude-integrated EEG.

Examination of the percentage of immature platelet fraction in term and preterm infants at birth

Background:

Reticulated platelets (RPs) are newly synthesized platelets. Recently, an automatic method was established to detect RPs as a percentage of the immature platelet fraction (IPF%). Although, neonates often develop thrombocytopenia at some time during their hospitalization, the details of IPF% in neonates remain unclear. We, therefore, studied the relations between IPF% and other factors to gain a more detailed understanding of IPF% in neonates.

Methods:

The following clinical data were obtained from the medical records of 105 neonates who met our inclusion criteria: Gestational age, birth weight, IPF% and platelet count of neonatal peripheral blood at birth, and perinatal data. The subjects were divided into three groups: Group A, birth weight standard deviation score (SDS) ≥ −2 standard deviation (SD) and ≤ +2 SD; Group S, < −2 SD; and Group L, > +2 SD.

Results:

IPF% correlated negatively with platelet count at birth in the whole study population. IPF% was 2.8 ± 1.3% in term neonates, and IPF correlated negatively with gestational age and birth weight. Platelet count correlated positively with birth weight SDS in the whole study population and in Group S. IPF% correlated negatively with birth weight SDS in the whole study population and in Group S. In neonates with a platelet count below 25 × 10⁴/μl, IPF% correlated negatively with platelet count. Among other neonates, however, IPF% remained almost constant.

Conclusion:

Monitoring of IPF% is useful for estimating the function of thrombocytopoiesis in neonates and preterm infants.