Rena Gale

BIRTH WEIGHT, CURRENT BODY WEIGHT, AND BLOOD PRESSURE IN LATE ADOLESCENCE

Objective--To study the effect of birth weight and body weight on blood pressure in late adolescence. Design--Analysis of data on weight, height, and blood pressure at age 17 of subjects from the Jerusalem perinatal study, according to their birth weight. Data for men and women were analysed separately. Setting--Jerusalem, Israel. Subjects--32,580 subjects (19,734 men and 12,846 women) born in the three major hospitals in Jerusalem during 1964-71 and subsequently drafted in to the army. MAIN OUTCOME MEASURES--Correlations between birth weight and blood pressure at age 17 and weight and height at age 17 and blood pressure. Results--Diastolic and systolic blood pressures were associated with birth weight in both young men and young women, but the correlation coefficients were low. A high body weight at age 17 (greater than 66 kg for women, greater than 75 kg for men) rather than a low birth weight (less than 2500 g) was linked with higher systolic and diastolic blood pressures in both men and women (p less than 0.01). Conclusions--Intrauterine environment, as reflected by birth weight, has little effect on blood pressure in young men and women. Modification of factors which lead to excess weight during adolescence may have a major role in preventing hypertension in adults.

The cognitive outcome of full-term small for gestational age infants at late adolescence

Objective To assess the cognitive and academic performance of adolescents who were born small for gestational age (SGA) at term. Methods A 17-year historical prospective study was done by matching neonatal data of 1758 infants to the results of the medical and intelligence assessment performed at age 17 years at the army draft board medical examination in Israel. The results of children born SGA (weight at term birth below the third percentile) were compared to those of children who were born appropriate for gestational age (AGA). Results After adjustment by a multiple linear regression analysis, the mean (± standard error of the mean) intelligence test scores were 103.1 ± 2.9 versus 105.8 ± 1.5 (P = 0.3) for the males and 100.3 ± 2.5 versus 104.7 ± 1.6 (P < .03) for the females. Males born SGA at term were found to have lower educational achievements (having less than 12 years of schooling or attending a vocational school) compared with the AGA group. The odds ratio for this finding after adjustment by a logistic regression analysis was 2.40 (95% confidence interval 1.07–5.39; P < .03). Intranatal events were not found to have an effect on the measured neurodevelopmental outcome. Conclusion Infants born SGA at term have an increased risk for lower cognitive performance and schooling achievements than those born AGA; this result seems to be unrelated to their intranatal course.

Is low birth weight a risk factor for asthma during adolescence

The effect of low birth weight on the incidence of asthma by 17 years of age was investigated by studying medical draft examination records of 20,312 male subjects born in Jerusalem between January 1967 and December 1971. Additional information on birth weight and other demographic factors was abstracted from the Jerusalem Perinatal Study computerised database. A stepwise multiple logistic regression was used to estimate the odds ratios for developing asthma by 17 years of age in 500 g birthweight categories from less than 2000 g to 4500 g. The odds ratios were adjusted for the confounding effects of ethnic origin, social class (determined by area of residence), paternal education, maternal age, and birth order. The group with low birth weights (less than 2500 g, n = 1004) had a significantly increased risk of developing asthma by 17 years of age, with an adjusted odds ratio of 1.44 (95% confidence interval (CI) 0.79 to 2.66) for birthweight group less than 2000 g and 1.49 (95% CI 1.05 to 2.12) for birthweight group 2000-2499 g compared with the reference group of 3000-3499 g. We conclude that infants with birth weights of less than 2500 g may have a higher risk of asthma during childhood and adolescence than infants who were heavier at birth.

Size at birth, maternal nutritional status in pregnancy, and blood pressure at age 17: population based analysis

Abstract Objective: To assess the effect of size at birth, maternal nutrition, and body mass index on blood pressure in late adolescence. Design: Population based analysis of birth weight corrected for gestational age, mothers weight before pregnancy and weight gain in pregnancy, obtained from the Jerusalem perinatal study, and blood pressure and body mass index at age 17, available from military draft records. Setting: Jerusalem, Israel. Subjects: 10 883 subjects (6684 men and 4199 women) born in Jerusalem during 1974-6 and subsequently drafted to the army. Main outcome measures: Systolic and diastolic blood pressures measured at age 17 and their correlation with birth weight, size at birth, mothers body mass index and weight gain during pregnancy, and height and weight at age 17. Results: Systolic and diastolic blood pressures were significantly and positively correlated with body weight, height, body mass index at age 17, and with mothers body weight and body mass index before pregnancy, but not with birth weight or mothers weight gain in pregnancy. Conclusion: Variables reflecting poor intrauterine nutrition, including low maternal body mass index before pregnancy, poor maternal weight gain in pregnancy, and being born small for gestational age, were not associated with a higher blood pressure in late adolescence. Key messages Several studies have shown a significant inverse relation between blood pressure and birth weight, though the finding is not consistent In 10 883 Israelis blood pressure measured at age 17 was related to their birth weight adjusted for gestational age, their current body mass index, and their mothers weight before pregnancy and weight gain during pregnancy Blood pressure was significantly and positively correlated with body mass index at age 17 and with mothers weight before pregnancy but not with birth weight or mothers weight gain during pregnancy Variables reflecting poor intrauterine nutrition were therefore not associated with higher blood pressures in late adolescence

Pre‐eclampsia and offspring's blood pressure, cognitive ability and physical development at 17‐years‐of‐age

Objective— To investigate the influence of maternal pre‐eclampsia on the blood pressure, physique and intelligence of the offspring at the age of 17 years.

Light-Emitting Diodes: A Novel Light Source for Phototherapy

High intensity light-emitting diodes (LEDs) are being studied as possible light sources for the phototherapy of hyperbilirubinemic neonates. These power-efficient, low heat-producing light sources have the potential to deliver high intensity light of narrow wavelength band in the blue-green portion of the visible light spectrum, which overlaps the absorption spectrum of bilirubin (BR). We compared the efficacy between single LEDs of different color and then constructed a prototype phototherapy device using 300 blue LEDs. The efficacy of this device was compared with that of conventional phototherapy devices by measuring the in vitro photodegradation of BR in human serum albumin. When blue, blue-green, green, and white LEDs were compared, the blue light was the most effective in degrading BR by 28% of dark control, followed by blue-green (18% of control), and then white light (14% of control). Green light was the least effective (11% of control). The prototype device with three focused arrays, each with 100 blue LEDs, generated greater irradiance (>200 µW·cm-2·nm-1) than any of the conventional devices tested. It also supported the greatest rate of BR photodegradation. We conclude that light from LEDs should be considered a more effective treatment for hyperbilirubinemia than light from presently used phototherapy devices. Furthermore, the unique characteristics of this light source may make it especially suitable for use in safe and lightweight home phototherapy devices.

Grand multiparity: An obstetric or neonatal risk factor?

Grand multiparity has been considered to be a factor in maternal and neonatal morbidity. In addition, families with seven or more children have been associated with low socioeconomic status. To minimize the confounding effect of the socioeconomic status, the outcome of grand multiparity has been investigated in a mostly homogeneous, ultraorthodox Jewish community in Jerusalem, Israel. A total of 5916 deliveries in one community hospital (Bikur Cholim) were studied, of which 893 (13%) occurred in mothers who had given birth to seven or more infants. There was a significant decrease in the incidence of small for gestational age infants among the grand multiparous women (3.6% as opposed to 5.8% in the control population). This difference was independent of maternal age. Moreover, grand multiparous women gave birth to significantly more large for gestational age infants. No increase in obstetric complications or neonatal morbidity and mortality was found among the offspring of the grand multiparous mothers. Having taken socioeconomic status into account, we conclude that grand multiparity does not carry an increased risk of perinatal morbidity or mortality.

Long-term effects of vacuum and forceps deliveries

The long-term effects of vacuum and forceps deliveries are largely unknown. We determined the long-term outcome of instrumental deliveries in 52,282 infants born in Jerusalem between 1964 and 1972. For each individual, events at birth were related to results of an intelligence test and medical examination done at 17 years of age by the Israeli Defence Forces draft board. 1747 individuals were delivered by vacuum, 937 by forceps, 47,500 by spontaneous delivery, and 2098 by caesarean section. Crude data showed that mean intelligence scores at 17 were significantly higher (p less than 0.0001) in the vacuum and forceps deliveries groups than in the spontaneous-delivery group; however, after adjustment for confounding factors by stepwise multiple regression, these differences were no longer seen. Although the forceps-delivery group had functional impairment of feet, vision, and retina compared with the spontaneous-delivery group, and the vacuum-extraction group had impairment of the legs, differences were small. Our findings suggest that infants delivered by vacuum or forceps are not at risk of physical and cognitive impairment at 17 years of age.

Epidemiology of neonatal jaundice in the Jerusalem population.

Of 10,122 singleton babies born from January 1, 1984 to March 31, 1988, we compared 1,154 term infants with high serum bilirubin levels (>12.9 mg/dl) to 1,154 infants with low serum bilirubin levels (<12.9 mg/dl) randomly selected from the remaining 8,968 subjects. We found that a high bilirubin level was significantly associated with male sex; maternal diabetes (chronic and gestational); pregnancy-induced hypertension; previous sibling with neonatal jaundice; delivery by cesarean section, vacuum, or forceps; epidural anesthesia; mother with blood type O; first delivery; cephalohematoma; short gestation; lower birth weight; and lower birth order (p < 0.01); and older maternal age, low percentile for birth weight, and the percentage of weight loss during hospitalization (p < 0.05). Variables with significantly different frequencies in control and study groups were used in a multivariate analysis, thus further refining the data by the use of logistic regression. Teenage mothers (<19 years old) had the lowest risk, whereas older mothers (>35 years old) had the highest risk of all age groups for having an infant with neonatal jaundice. First delivery and previous sibling with neonatal jaundice were also risk factors. Male sex, short gestation, and delivery by vacuum extraction were other notable risk factors. Our results suggest that, even among industrialized Western societies, risk factors may interact differently to produce higher neonatal serum bilirubin levels. The importance of a risk factor may also be dependent upon its relative prevalence in a parturient population.

The effect of abortion on the incidence of pre-eclampsia

The incidence of pre-eclampsia was studied in 9771 women that were pregnant for the first or second time. The protection offered by a previous pregnancy which ended in abortion was compared to that provided by a first pregnancy that proceeded to term. The rate of pre-eclampsia was 2.9% for primigravid women and was significantly lower (1.5%, p less than 0.001) for women giving birth for the second time. Adjusting by multiple regression for confounding factors (e.g., maternal age, social class, ethnic origin and smoking), the incidence of pre-eclampsia was also significantly lower (p = 0.038) following an induced abortion, but not following a spontaneous abortion.