Minerva Thame

Fetal growth is directly related to maternal anthropometry and placental volume

Objective: To describe the influence of maternal weight and weight gain, placental volume and the rate of placental growth in early pregnancy on fetal dimensions measured sonographically.Design: In a prospective study, 712 women were recruited from the antenatal clinic of the University Hospital of the West Indies. Data analysis was confined to 374 women on whom measurements of the placental volume at 14, 17 and 20 weeks gestation were complete. Measurements of maternal anthropometry and fetal size (by ultrasound) were performed. Weight gain in pregnancy between the first antenatal visit (8–10 weeks) and 20 weeks gestation, and the rate of growth of the placenta between 14–17 and 17–20 weeks gestation were calculated.Main outcome measures: Fetal anthropometry (abdominal and head circumferences, femoral length, and biparietal diameter) at 35 weeks gestation.Results: Lower maternal weight at the first antenatal visit was associated with a significantly smaller placental volume at 17 and 20 weeks gestation (P<0.002 and <0.0001 respectively). In all women, maternal weight gain was directly related to fetal anthropometry. Placental volume at 14 weeks gestation and the rate of growth of the placenta between 17 and 20 weeks gestation were significantly related to all four fetal measurements.Conclusion: This study has provided evidence that both placental volume, and the rate of placental growth may influence fetal size. These effects are evident in the first half of pregnancy, and appear to be mediated through maternal weight and weight gain.Sponsorship: This study was supported by a grant from the Wellcome Trust, 183 Euston Road, London, England.

Outcome of pregnancy in homozygous sickle cell disease.

OBJECTIVE: Previous reports on pregnancy in homozygous sickle cell (SS) disease are biased by hospital-based, more severely affected subjects and may have underestimated recurrent early pregnancy losses. We report pregnancy outcome in a representative sample of SS subjects subsequently referred to as “subjects” or “sickle cell subjects,” and matched normal controls followed from birth. METHODS: The outcomes of 94 pregnancies in 52 subjects and 157 pregnancies in 68 controls followed in a cohort study from birth are presented. Outcome measures included the age at menarche, interval to first pregnancy, outcome of pregnancy, and maternal complications. Possible predictors of low birth weight are assessed. Outcomes were compared by the Kaplan-Meier analysis for interval to first pregnancy and by Student t test, χ2 test, or Fisher exact test, as appropriate. Correction was made for multiple testing, and multiple linear regression was used for analysis of birth weight. RESULTS: Compared with controls, SS subjects had later menarche (median age 15.4 versus 13.0 years) and first pregnancy (median age 23.7 versus 20.1 years), and more spontaneous abortions (36% versus 10%). Babies of SS subjects had a lower gestational age (P < .001) and lower birth weight (P < .001), the latter being significantly affected by sickle-related events in pregnancy. There was no difference in pregnancy-induced hypertension, preeclampsia, or antepartum or postpartum hemorrhage, but a retained placenta was marginally more common in SS subjects (Fisher exact test, P = .007 after adjustment for multiple testing). Two SS subjects died, a mortality rate of 2.1%. CONCLUSION: The increased fetal loss and maternal morbidity in mothers with homozygous sickle cell disease is confirmed. LEVEL OF EVIDENCE: II-2

Blood Pressure Is Related to Placental Volume and Birth Weight

The objective of this study was to determine whether maternal nutrition and fetal and placental size program blood pressure. A longitudinal study linking the maternal anthropometric measurements of the first antenatal visit, ultrasound data of placental and fetal size, anthropometry at birth, and childhood growth and blood pressure was performed. The subjects were 428 women who attended the antenatal clinic at the University Hospital of the West Indies, Kingston, Jamaica, and their children, who were subsequently followed up. Systolic blood pressure at ages 1, 2, 2.5, 3, and 3.5 years was the main outcome measure. Pooling the data across ages, systolic blood pressure fell by 1.4 mm Hg for every 1-kg increase in birth weight (95% CI 0.2 to 2.7, P=0.02) and by 1.2 mm Hg for every 100-mL increase in placental volume at 20 weeks of gestation (95% CI 0.4 to 2.0, P=0.004). Blood pressure was also negatively associated with placental volume at 17 weeks and fetal abdominal circumference at 20 weeks. Measures of maternal nutritional status were strongly related to birth weight and placental volume but not directly to childhood blood pressure at these young ages. In conclusion, blood pressure is associated with fetal size in this population, as previously described among Europeans. We found associations between placental volume and abdominal circumference in the second trimester and childhood blood pressure, suggesting that the initiating events of blood pressure programming occur early in pregnancy. Measures of maternal nutritional status were not directly related to childhood blood pressure at these young ages but were strong predictors of both birth weight and placental volume, suggesting an indirect relation.

Second-trimester placental volume and infant size at birth ☆

OBJECTIVE To investigate the ability of second‐trimester placental volume measured sonographically to predict birth size. METHODS A total of 712 women were recruited from the antenatal clinic of the University Hospital of the West Indies; 561 fulfilled the study criteria and progressed to delivery. Placental volume and fetal anthropometry (biparietal diameter, head and abdominal circumferences, and femoral length) were measured sonographically at 14, 17, and 20 weeks. The main outcome measures were infant birth and placental weights, length, head, chest, and abdominal circumferences at birth. RESULTS Placental volume in the second trimester was positively associated with all birth measurements. Of the fetal measurements at 14 and at 17 weeks, head circumference was the strongest predictor of birth weight (B [slope of the regression line] = .095, P = .014 at 14 weeks; B = .118, P = .012 at 17 weeks), but at 20 weeks, abdominal circumference was the strongest. However, at each age, placental volume was the strongest determinant of birth weight, and improved the prediction based only on fetal measurements. The odds ratio for low birth weight (under 2500 g) increased by 1.68 (95% confidence interval 1.05, 2.69, P = 0.03) for every standard deviation decrease in placental volume at 14 weeks gestation. CONCLUSION The present study suggests that low birth weight was often preceded by small placental volume in the second trimester. Placental volume may be a more reliable predictor of size at birth than fetal measurements, and may be useful in early identification of the fetus at risk in the perinatal period.

Growth, body composition, and the onset of puberty: longitudinal observations in Afro-Caribbean children

CONTEXTnChildhood growth and body composition may influence the onset of puberty.nnnOBJECTIVEnWe examined the effects of birth size, growth rates throughout childhood, and body composition on the onset of puberty in Afro-Caribbean children.nnnDESIGN AND SETTINGnThis was a longitudinal birth cohort study (the Vulnerable Windows Cohort Study) in Jamaica.nnnSUBJECTS AND MEASUREMENTSnThe anthropometry (weight, height, skinfold measurements, and waist circumference) of 259 children was measured at birth, at 6 wk, every 3 months to 2 yr, and then every 6 months. Tanner staging for puberty and orchidometry were performed every 6 months starting at approximately age 8 yr. Bioelectrical impedance was done at age 11 yr.nnnRESULTSnIn the girls, thelarche, pubarche, and menarche occurred at median ages of 8.8, 9.9, and 12.0 yr, respectively. Pubarche in boys occurred at a median age of 11.3 yr when the median testicular volume was 2.8 ml. Faster weight gain during infancy (age 0-6 months) and childhood, but not birth size, was associated with more advanced puberty (P values <0.05). Fat mass at age 8 yr was associated with more advanced puberty (P values <0.001) in both sexes. At age 11 yr, lean mass, but not fat mass, was associated with more advanced puberty (P values <0.001).nnnCONCLUSIONnThese data support the hypothesis that faster growth throughout childhood, especially with fat mass accretion, is associated with more advanced puberty apart from menarche. With the onset of puberty, lean mass accretion significantly increases.

Fecundity and pregnancy outcome in a cohort with sickle cell‐haemoglobin C disease followed from birth

Objectiveu2003 To compare pregnancy outcome in sickle cell‐haemoglobin C (SC) disease with that in homozygous sickle cell (SS) disease and age‐matched controls with a normal haemoglobin (AA) genotype.

The Mechanisms of Low Birth Weight in Infants of Mothers With Homozygous Sickle Cell Disease

OBJECTIVE. A low mean birth weight is a constant finding in pregnancies of women with homozygous sickle cell disease. The factors responsible are largely unknown and have now been investigated in an 11-year retrospective analysis. METHODS. Records for 126 pregnancies of mothers with homozygous sickle cell disease and 126 pregnancies of control women with an AA phenotype, matched according to age and date of delivery, were examined. Events during pregnancy and outcomes of pregnancy were recorded. RESULTS. Pregnancy outcomes for mothers with homozygous sickle cell disease confirmed the lower birth weight, gestational age, and placental weight. A low birth weight in infants of mothers with homozygous sickle cell disease was strongly related to gestational age and placental weight and weakly related to reticulocyte counts and a history of preeclampsia in univariate analyses, but only gestational age and placental weight remained significant in multivariate analyses. No relationships were seen with maternal age, parity, anthropometric features, other hematologic features (hemoglobin levels, fetal hemoglobin levels, mean cell volume, and α-thalassemia), pregnancy-induced hypertension, or prepartum hospital admissions (expressed as number or total days). Compared with Jamaican standards, birth weight was affected more than head circumference or length in infants of mothers with homozygous sickle cell disease, indicating asymmetric growth retardation, which occurred for 27% of boys and 38% of girls (compared with 4% and 9%, respectively, among infants of control mothers). CONCLUSIONS. A chronic condition such as homozygous sickle cell disease might have been expected to cause symmetric growth retardation throughout pregnancy. The finding of asymmetric retardation might indicate adverse factors emerging late in pregnancy and might have relevance for the poor pregnancy outcomes in such mothers.

Body composition in pregnancies of adolescents and mature women and the relationship to birth anthropometry

Objective:To investigate differences in body composition between adolescent girls and mature women during pregnancy and the relationship to newborn anthropometry.Design:A prospective study.Setting:The antenatal clinic at the University Hospital of the West Indies, Kingston, Jamaica.Subjects:Four hundred and twenty-five women were invited to join the study. Three hundred and sixty-one women (84.9%) completed the study.Interventions:Study participants were divided into two groups: adolescents and mature women, who were all less than 15 weeks pregnant and had no systemic illness at the time of entry into the study. A questionnaire was administered which retrieved information on demographics, age, marital status, menstrual history, parity, socio-economic status, medical history and smoking/drinking habits. Anthropometric measurements including weight, height, triceps, biceps, subscapular and suprailiac skinfolds, as well as blood pressure measurements and urine analysis were performed at the first antenatal visit and repeated at 15, 25 and 35 weeks gestation. Anthropometric measurements of the newborn were performed at birth.Results:There were significant differences between anthropometry and skinfold thickness at the first antenatal visit between the adolescents and the mature women where the adolescents had lower measurements compared to the mature women. In the newborn anthropometry, the only significant difference seen was in the triceps skinfold thickness and the mid-upper arm circumference where the newborn of the adolescents had significantly smaller values (P=0.04; P=0.02, respectively). The percentage fat, fat mass and lean body mass were significantly lower in the adolescent compared to the mature women (P<0.0001), both at the first antenatal visit and at 35 weeks gestation. A greater gain was seen in these measurements throughout the pregnancy in the adolescents (P<0.0001). Linear regression analyses showed that the gain in lean body mass was the most important predictor of birth anthropometry.Conclusion:Body composition differs in pregnancy between adolescents and mature woman, and if adequate weight and lean body mass are attained, it impacts positively on birth size irrespective of age.Sponsorship:This study was supported by a grant from the Caribbean Health Research Council, 25A Warner Street, St Augustine, Trinidad, West Indies.

Neonatal sepsis in Jamaican neonates.

Abstract Aim: To determine the incidence and causative organisms of bacterial sepsis in neonates at The University Hospital of the West Indies. Methods: A retrospective review of all neonates with culture-proven sepsis admitted to the hospital between January 1995 and December 2000 was conducted. Incidence rates and antimicrobial susceptibility patterns were determined. Results: There were 4702 admissions to the neonatal unit during the study period. Of these, 135 had culture-proven sepsis and 115 were inborn, giving an incidence of 6.7/1000 live births. There were 89 positive blood cultures, 51 positive urine cultures and two positive CSF cultures. The single most common organism was Klebsiella spp (28%). Other organisms included Escherichia coli (16%), group B Streptococcus (11%) and Enterobacter spp (10%). The aminoglycoside resistance rate of Klebsiella spp was 46% and seven isolates had multiple resistance to antibiotics. There was a case fatality rate of 6.7%. Conclusion: Physicians involved in newborn care at The University Hospital of the West Indies need to recognise the important role Klebsiella now plays in neonatal sepsis and its contribution to neonatal mortality. Empirical antibiotic regimens for gram-negative sepsis must take into consideration the high rates of aminoglycoside resistance that are now prevalent.

Weight retention within the puerperium in adolescents: a risk factor for obesity?

OBJECTIVEnThe present study aimed to investigate weight retention and body composition in the postpartum period between adolescent girls and older women.nnnDESIGNnA prospective cohort study. Anthropometry and skinfold thickness measurements were performed at the first antenatal visit and at 6 weeks postpartum. An FFQ was administered at 6 weeks postpartum to explore the relationship between diet and postpartum weight retention.nnnSETTINGnClinics at the University of the West Indies, Kingston, Jamaica.nnnSUBJECTSnRecruitment included women aged 19 years and younger (adolescent girls) and 20 years and older (older women).nnnRESULTSnThree hundred and forty women were studied. Adolescent girls had significantly lower measurements compared with the older women at the first antenatal visit and at 6 weeks postpartum. Dietary intakes of energy and macronutrients were similar in both groups. Postnatal assessments showed that adolescent girls retained more weight (P = 0.003) and a greater percentage of body fat (P < 0.002) than older women. In multiple regression analyses, 0.982 kg more fat mass was retained postpartum in the adolescent group compared with the older women, while there was no significant difference in lean body mass retained between the two groups.nnnCONCLUSIONSnAdolescent girls retained more weight postpartum and this was predominantly fat mass as opposed to lean body mass.