Ulrik Schiøler Kesmodel

Pre-pregnancy weight and the risk of stillbirth and neonatal death.

Objective  To evaluate the association between maternal pre‐pregnancy body mass index (BMI) and the risk of stillbirth and neonatal death and to study the causes of death among the children.

Effect of Prepregnancy Maternal Overweight and Obesity on Pregnancy Outcome

OBJECTIVE: To estimate the association between maternal overweight and obesity on complications during pregnancy and delivery in Denmark. METHODS: A population-based study on a cohort consisting of all Danish women giving birth to a singleton from 2004 through June 30, 2010 (N=403,092) was undertaken. Women were identified from the Danish Medical Birth Registry, which contains data on 99.8% of all deliveries in Denmark. Maternal complications during pregnancy and delivery and fetal complications were classified according to the International Classification of Diseases, 10th Revision. RESULTS: The final study population consisted of 369,347 women, 20.9% being overweight (body mass index [BMI] 25–29.9), 7.7% obese (BMI 30–35), and 4% severely obese (BMI higher than 35). Overweight, obese, and severely obese women had more complications than did normal weight women. Adjusted odds ratios (ORs) were significantly increased as follows: for gestational diabetes mellitus, 3.5, 7.7, and 11.0 for each BMI category; for preeclampsia 1.9, 3, and 4.4. Planned and especially emergency cesarean delivery was significantly increased with increasing BMI (OR ranging from 1.2 to 2.1). The risk of giving birth to a macrosomic neonate (greater than 4,500 g) increased significantly with increasing BMI (1.6, 2.2, and 2.7), as did the risks of having a neonate with a low Apgar score (1.3, 1.4, and 1.9) and having a stillborn fetus (1.4, 1.6, and 1.9). For shoulder dystocia the risk was significantly increased in the unadjusted analysis, but the significance disappeared in the adjusted analysis. No statistically significance was seen for hemorrhage and thrombosis. CONCLUSION: This study shows a significant increased risk of a wide variety of pregnancy, birth, and neonatal complications in overweight, obese, and severely obese women. LEVEL OF EVIDENCE: II

Systematic review of the fetal effects of prenatal binge-drinking

Objective: The effects of binge-drinking during pregnancy on the fetus and child have been an increasing concern for clinicians and policy-makers. This study reviews the available evidence from human observational studies. Design: Systematic review of observational studies. Population: Pregnant women or women who are trying to become pregnant. Methods: A computerised search strategy was run in Medline, Embase, Cinahl and PsychInfo for the years 1970–2005. Titles and abstracts were read by two researchers for eligibility. Eligible papers were then obtained and read in full by two researchers to decide on inclusion. The papers were assessed for quality using the Newcastle–Ottawa Quality Assessment Scales and data were extracted. Main outcome measures: Adverse outcomes considered in this study included miscarriage; stillbirth; intrauterine growth restriction; prematurity; birth-weight; small for gestational age at birth; and birth defects, including fetal alcohol syndrome and neurodevelopmental effects. Results: The search resulted in 3630 titles and abstracts, which were narrowed down to 14 relevant papers. There were no consistently significant effects of alcohol on any of the outcomes considered. There was a possible effect on neurodevelopment. Many of the reported studies had methodological weaknesses despite being assessed as having reasonable quality. Conclusions: This systematic review found no convincing evidence of adverse effects of prenatal binge-drinking, except possibly on neurodevelopmental outcomes.

The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis.

BACKGROUND The objective of this review is to evaluate the literature on the association between mild, moderate, and binge prenatal alcohol exposure and child neurodevelopment. METHODS Meta-analysis with systematic searches of MEDLINE (1970 through August 2012), EMBASE (1988 through August 2012), and PsycINFO(®) (1970 through August 2012) and examination of selected references. RESULTS From 1,593 articles, we identified 34 presenting data from cohort studies that met our inclusion criteria. Information on study population, outcomes, measurement instruments, timing and quantification of alcohol exposure, covariates, and results was abstracted. Outcomes included academic performance, attention, behavior, cognition, language skills, memory, and visual and motor development. The quality of each article was assessed by 2 researchers using the Newcastle-Ottawa Scale. Based on 8 studies of 10,000 children aged 6 months through 14 years, we observed a significant detrimental association between any binge prenatal alcohol exposure and child cognition (Cohens d [a standardized mean difference score] -0.13; 95% confidence interval [CI], -0.21, -0.05). Based on 3 high-quality studies of 11,900 children aged 9 months to 5 years, we observed a statistically significant detrimental association between moderate prenatal alcohol exposure and child behavior (Cohens d -0.15; 95% CI, -0.28, -0.03). We observed a significant, albeit small, positive association between mild-to-moderate prenatal alcohol exposure and child cognition (Cohens d 0.04; 95% CI, 0.00, 0.08), but the association was not significant after post hoc exclusion of 1 large study that assessed mild consumption nor was it significant when including only studies that assessed moderate alcohol consumption. None of the other completed meta-analyses resulted in statistically significant associations between mild, moderate, or binge prenatal alcohol exposure and child neuropsychological outcomes. CONCLUSIONS Our findings support previous findings suggesting the detrimental effects of prenatal binge drinking on child cognition. Prenatal alcohol exposure at levels less than daily drinking might be detrimentally associated with child behavior. The results of this review highlight the importance of abstaining from binge drinking during pregnancy and provide evidence that there is no known safe amount of alcohol to consume while pregnant.

Time-lapse parameters as predictors of blastocyst development and pregnancy outcome in embryos from good prognosis patients: a prospective cohort study

STUDY QUESTION Do early time-lapse parameters predict which embryos will develop to high-quality blastocysts and does timing of development differ between embryos that implant and those that do not. SUMMARY ANSWER Development to high-quality blastocysts could be predicted within the first 48 h of culture, whereas time-lapse parameters could not predict pregnancy. WHAT IS KNOWN ALREADY Historical cohort studies on embryos from unselected groups of patients have suggested several putative kinetic markers of viability. Before well-designed randomized studies can be conducted, relevant selection models based on solid data must be developed. So far conclusions from the previous studies are ambiguous. STUDY DESIGN, SIZE, DURATION A prospective cohort study conducted from February 2011 to June 2012. A total of 571 ICSI embryos from 92 patients were included in the blastocyst development analysis and 84 single embryo transfers were included in the pregnancy outcome analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Embryos from women aged <38 years, with no endometriosis and ≥ 8 oocytes retrieved. University affiliated clinic. Embryos were cultured in a time-lapse incubator till Day 6. Logistic regression analysis was performed with variables selected based on indication. MAIN RESULTS AND THE ROLE OF CHANCE Duration of the first cytokinesis, duration of the 3-cell stage and direct cleavage to 3-cells predicted development to high-quality blastocyst. We found no difference in timing between implanted and non-implanted embryos. LIMITATIONS, REASONS FOR CAUTION A larger study might detect differences in timing between implanted and non-implanted embryos. The cohort consisted of good prognosis patients only and may not be representative of the entire IVF population. WIDER IMPLICATIONS OF THE FINDINGS Our results in context with the lack of consistency in previous studies and the presumed influences of different external factors indicate that a universal algorithm for optimal timing of development might not be feasible. The apparent negative significance of division patterns that differ from the expected may imply that time-lapse will facilitate de-selection of embryos. STUDY FUNDING/COMPETING INTEREST(S) Funding for the present study was provided by Aarhus University, the Lippert Foundation, the Toyota Foundation, the Aase og Einar Danielsen foundation and by an unrestricted grant from MSD and Ferring. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER The study was registered at ClinicalTrial.gov with accession number NCT01139268.

An increasing proportion of infants weigh more than 4000 grams at birth

Background. To investigate how mean birthweight has changed in the past decade, and to describe changes in the proportion of infants with a birthweight above 4000 grams (g).

A prospective study of smoking during pregnancy and SIDS

AIMS To study the association between smoking during pregnancy and sudden infant death syndrome (SIDS) using prospectively collected data, making it possible to account for a number of potential confounders. DESIGN Prospective follow up study (n = 24 986). RESULTS The overall rate of SIDS was 0.80 per 1000 live births (n = 20). Children of smokers had more than three times the risk of SIDS compared with children of non-smokers (OR = 3.5; 95% CI 1.4–8.7), and the risk of SIDS increased with the number of cigarettes smoked per day (p < 0.05). Adjustment for parity, alcohol, and caffeine intake during pregnancy, maternal height and weight before pregnancy, years of school, occupational status, marital status, and number of antenatal care visits did not change the results. Adjustment for mothers age marginally reduced the risk of SIDS associated with smoking (OR = 3.0; 95% CI 1.2–7.3). CONCLUSIONS Given the prospective nature of the study, the number of deaths is small; however, if our results reflect a true association between smoking during pregnancy and SIDS, approximately 30–40% of all cases of SIDS could be avoided if all pregnant women stopped smoking in a population with 30% pregnant smokers. Our study adds to earlier evidence for an association between smoking during pregnancy and SIDS. The strengths of the study are the possibility to adjust for a number of potential confounders and the fact that information about smoking habits during pregnancy was prospectively collected.

Maternal characteristics and lifestyle factors and the risk of delivering high birth weight infants

OBJECTIVE To identify factors associated with an increased risk of giving birth to infants weighing more than 4000 g and to study whether changes in these factors over time can explain the increasing proportion of high birth weight infants over the last decade. METHODS Our analyses included 24,093 pregnancies of nondiabetic women with information on potential risk factors for high birth weight: maternal prepregnancy weight, height, age, parity, smoking habits, alcohol and caffeine intake, marital status, educational level, gestational age, and infant gender. Information was obtained from questionnaires completed during pregnancy and birth registration forms at the Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark, from 1990 to 1999. RESULTS We found a statistically significantly increased risk of giving birth to infants weighing more than 4000 g for women with high prepregnancy weight and height, parity greater than 2, gestational age greater than 42 weeks, and male infant gender and for nonsmokers. Women with a low caffeine intake or 10 or more years of education were also at statistically significantly higher risk. The variation found in birth weight over the past 10-year period was explained by changes in maternal prepregnancy weight, height, smoking habits, educational level, and caffeine intake over the same period. CONCLUSION Risk factors associated with a higher proportion of high birth weight infants may be clinically significant and have an impact on public health. High birth weight increases the risk of adverse outcomes of delivery as well as the risk of childhood morbidity.

The effect of different alcohol drinking patterns in early to mid pregnancy on the child’s intelligence, attention, and executive function

Please cite this paper as: Kesmodel U, Bertrand J, Støvring H, Skarpness B, Denny C, Mortensen E, the Lifestyle During Pregnancy Study Group. The effect of different alcohol drinking patterns in early to mid pregnancy on the child’s intelligence, attention, and executive function. BJOG 2012;119:1180–1190.

Self reported alcohol intake in pregnancy: comparison between four methods

STUDY OBJECTIVE To assess the agreement between four different measures of alcohol intake in pregnancy. DESIGN AND SETTING Danish speaking pregnant women referred to the Midwife Centre in Aarhus, Denmark, for routine antenatal care were contacted at their first visit at approximately 15–16 weeks gestation from October to December 1998. The women were interviewed about current average alcohol intake and intake within the previous week, and subsequently filled in a two week diary on alcohol intake. When booking for delivery at the end of the first trimester the women were also asked to complete a questionnaire including a one item question on current average alcohol intake. PARTICIPANTS Participants were 441 pregnant women. MAIN RESULTS Per cent agreement ± 1 category ranged between 73 and 82. Mean (SD) intake ranged between 1.09 (1.35) drinks/week for diaries, and 0.69 (0.85) for questionnaires. Mean differences between methods were all close to zero. Three of the four measures yielded comparable distributions of average alcohol intake, but reports of intake within the past seven days seemed to be an inappropriate measure of average intake, yielding three times as many abstainers as expected when combining the methods. CONCLUSIONS When assessing the distribution of alcohol intake in pregnancy or when studying adverse pregnancy outcomes that are probably caused mainly by sustained exposure it seems that for pregnant women with low to moderate alcohol intake diaries or an average measure from interviews or a simple one item questionnaire may be applied. A measure of intake for the previous week seems to be a relevant measure only when studying adverse pregnancy outcomes that are most probably caused by binge-like exposure.