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Introduction: Antiretroviral therapy‐naïve pregnant women living with HIV are at an increased risk for adverse pregnancy outcomes. It remains controversial whether this risk persists with antiretroviral therapy. We conducted a systematic review and meta‐analysis to evaluate whether pregnant women living with HIV and receiving antiretroviral therapy antenatally, are at an increased risk of adverse outcomes compared with HIV‐negative controls. Material and methods: We searched MEDLINE, Embase, International Pharmaceutical Abstracts, EBM Reviews, PubMed (non‐MEDLINE records), EBSCO CINAHL Complete, Clarivate Web of Science, African Index Medicus, LILACS and Google Scholar for all observational studies comparing pregnant women living with HIV on antiretroviral therapy with HIV‐negative controls from 1 January 1994 to 10 August 2021 with no language or geographic restrictions. Perinatal outcomes included preterm birth (PTB), low birthweight, small‐for‐gestational age and preeclampsia. Using a random‐effects model we pooled raw data to generate odds ratio (OR) with 95% confidence intervals (CI) for each outcome. Sub‐analyses for high and low resource countries and time of antiretroviral therapy initiation were performed. This systematic review and meta‐analysis is registered with PROSPERO, number CRD42020182722. Results: Of the 7900 citations identified, 27 were eligible for analysis (12 636 pregnant women living with HIV on antiretroviral therapy and 7 812 115 HIV‐negative controls). ORs (95% CI) of PTB (1.88 [1.63–2.17]), small‐for‐gestational age (1.60 [1.18–2.17]) and low birthweight (2.15 [1.58–2.92]) were significantly higher in pregnant women living with HIV than in HIV‐negative women, while the risk of preeclampsia (0.86 [0.57–1.30]) was comparable. The risk of PTB and low birthweight was higher in both high resource and low resource countries, while the risk of small‐for‐gestational age was higher only in the former. Preconceptional antiretroviral therapy was associated with a higher risk of PTB compared with antenatal initiation. Conclusions: Pregnant women living with HIV on antiretroviral therapy have an increased risk of PTB, low birthweight and small‐for‐gestational age in high resource countries, as well as PTB and low birthweight in low income countries compared with HIV‐negative controls. [ABSTRACT FROM AUTHOR]

Introduction: Fetal growth restriction is a major risk factor for adverse perinatal outcome. As most of the growth‐restricted fetuses are small for gestational age (SGA), an efficient antenatal screening method for SGA fetuses would have a major impact on perinatal health. The aim of this study was to compare the SGA prediction rate achieved with third‐trimester routine ultrasound estimation of fetal weight (EFW) with that obtained using ultrasound examination on indication. The secondary aim was to evaluate the clinical outcome in relation to the SGA screening method. Material and Methods: During 1995–2009, two perinatal centers in southern Sweden offered routine ultrasound examination at 32–34 gestational weeks to 99 265 women with singleton pregnancies. Of these, 59 452 (60%) underwent the ultrasound examination. The other population, comprising 24 868 pregnancies, was cared for in another three centers that used a risk‐based method with ultrasound examinations on indication only. Of them, 5792 (23%) underwent ultrasound examination at 32–36 gestational weeks. The deviation in the EFW from the expected one was expressed as the EFW z‐score, SGA EFW being defined as the EFW z‐score less than −2. SGA prediction ability was assessed by receiver operating characteristic (ROC) curves. Crude and adjusted risk ratios were calculated for selected variables of perinatal outcome when comparing the populations. Results: The SGA prediction ability for routine ultrasound was high, area under the ROC curve was 0.90 (95% CI 0.89–0.91). For an EFW z‐score of −1, the sensitivity was 67.3% and specificity was 90.5% among routinely screened pregnancies; corresponding numbers in the ultrasound on indication population were 34.3% and 96.6%. The screened population had a lower risk of preterm birth, birthweight z‐score less than −3, and Apgar score less than 7 at 5 min with adjusted risk ratios 0.87 (95% CI 0.82–0.92), 0.75 (95% CI 0.61–0.92), and 0.77 (95% CI 0.68–0.87), respectively. No difference in perinatal mortality was detected. There were no differences in perinatal outcome between the two subcohorts of infants born SGA. Conclusions: Third‐trimester routine ultrasound improves the detection of SGA antenatally compared with ultrasound performed on indication, but no convincing improvement in perinatal outcome was identified. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to establish whether heparin improves the neonatal outcome of fetuses with suspected placental insufficiency.Material and Methods: Before data extraction, the project was registered in the PROSPERO International Prospective Register of Systematic Reviews (registration number: CRD42019117627). A systematic search was performed to identify relevant studies, using PubMed, SCOPUS, ISI Web of Knowledge, and PROSPERO database for meta-analysis. Suspected placental insufficiency was defined as either an estimated fetal weight or abdominal circumference below the 10th centile or when at least 2 of the following criteria were met: (1) abnormal biochemical markers, (2) sonographic evidence of abnormal placental morphology, or (3) abnormal uterine artery Doppler. Heparin in any commercial presentation was defined as the intervention. Mean difference (MD) by random effects model was used. Heterogeneity between studies was assessed using Cochran's Q, H, and I2 statistics.Results: From 1159 assessed studies, two were retained for analysis. The results showed a significantly higher birthweight (MD 365; 95% CI 236 to 494; P < 0.001) and a significant increase of gestational age at birth by 1 week in those women treated with heparin (MD 0.806; 95% CI 0.354 to 1.258; P < 0.001). However, there were no significant differences in Apgar scores, neonatal admission, neonatal mortality, or composite neonatal morbidity.Conclusions: In women with very high suspicion of placental insufficiency, heparin may increase fetal growth and prolong pregnancy. There is no evidence for a beneficial effect of heparin in reducing neonatal adverse outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Although early and late fetal growth restriction have been suggested to be distinct entities, the optimal gestational age cut-off that differentiates the two conditions is currently unclear and has been arbitrarily set in previous studies between 32 and 37 weeks. We aimed to use placental pathology findings to determine that optimal gestational age cut-off between early and late fetal growth restriction.Material and Methods: A retrospective cohort study of all women with singleton gestation who gave birth to a neonate diagnosed as small-for-gestational age (small-for-gestational age, defined as birthweight <10th percentile for gestational age) at a tertiary referral center between January 2001 and December 2015, and for whom placental pathology was available. Placental abnormalities were classified into lesions associated with maternal vascular malperfusion (MVM), fetal vascular malperfusion, placental hemorrhage and chronic villitis. Placental findings were analyzed as a function of gestational age at birth. The analysis was repeated in the subgroups of women without hypertensive complications of pregnancy (to reflect changes associated with isolated small-for-gestational age) and of neonates with severe small-for-gestational age (defined as birthweight <5th percentile), which are more likely to represent true fetal growth restriction.Results: A total of 895 women met the inclusion criteria. The only histological finding that changed with gestational age was MVM pathology, which decreased in frequency with increasing gestational age. We identified a considerable drop in the rate of MVM lesions at 33 weeks of gestation. The rate of MVM pathology in placentas of infants born before 330/7  weeks was significantly higher than that observed in placentas of infants born at 330/7  weeks or longer: 71.6% vs 27.4%, P < 0.001 for ≥2 MVM lesions, and 35.5% vs 3.5%, P < 0.001 for ≥3 MVM lesions. These findings persisted in the subgroups of women without hypertensive complications of pregnancy (n = 662) and of neonates with severe small-for-gestational age (n = 464).Conclusions: Using placental pathology as a direct measure of the mechanisms underlying fetal growth restriction, the optimal gestational age at birth cut-off which differentiates early from late fetal growth restriction appears to be 330/7  weeks. [ABSTRACT FROM AUTHOR]

Introduction: The INTERGROWTH-21st project (IG-21) was recently performed aiming to provide a universal benchmark for comparing fetal growth across different ethnicities. Our aim was to compare the IG-21 with a customized standard for predicting pregnancies at risk for neonatal small-for-gestational age (SGA) and adverse outcomes.Material and Methods: This was a prospective cohort study including singleton pregnancies presenting for fetal growth assessment between 26 and 36 weeks of gestation. Fetal growth restriction was defined as estimated fetal weight <10th centile for gestational age using IG-21 and a customized standard. Neonatal SGA was defined as birthweight <10th centile for gestational age by the Alexander chart. Primary outcome was the prediction of neonatal SGA. Secondary outcomes included a composite of adverse neonatal outcomes. The discriminatory ability of each growth standard was compared using area under receiver operating characteristic curves (AUC).Results: Of 1054 pregnancies meeting the inclusion criteria, the incidence of neonatal SGA was 139 (13.2%), and a composite adverse neonatal outcome occurred in 300 (28.4%). The sensitivity of the customized standard (38.8%) was higher than that of IG-21 (24.5%) for predicting neonatal SGA, with AUC (95% CI) of 0.67 (0.63-0.71) for customized vs 0.62 (0.58-0.65) for IG-21; P = .003. Both standards were comparable in predicting the composite adverse neonatal outcomes: AUC (95% CI) 0.52 (0.50-0.55) for customized vs 0.51 (0.50-0.53) for IG-21; P = 0.25.Conclusions: Both growth standards had modest performance in detecting neonatal SGA and were poor at predicting short-term adverse neonatal outcome. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the role of mid-trimester fetal biometry, uterine artery Doppler indices and maternal demographics in prediction of small-for-gestational-age (SGA) birth.Materials and Methods: We conducted a retrospective cohort study in a single referral center. The study included 23 894 singleton pregnancies scanned between 19 and 24 weeks of gestation. Maternal demographics included age, body mass index and ethnicity. Fetal biometry, birthweight and uterine artery pulsatility index values were converted into centiles. Multivariable logistic regression analysis was performed and the predictive accuracy was assessed using receiver operating characteristic curve analysis. The main outcome measure was prediction of delivery of preterm and term SGA neonates defined as a birthweight in the lowest centile groups (<10th, <5th and <3rd centiles).Results: Maternal ethnicity, fetal biometry and uterine artery Doppler indices were significantly associated with the risk of SGA <5th centile (p < 0.01). Maternal factors or fetal biometry alone showed poor to moderate performance in prediction of term and preterm SGA <5th centile at a 10% false-positive rate. Uterine artery pulsatility index alone was able to predict 25, 60 and 77% of SGA <5th centile delivering at >37, <37 and <32 weeks of gestation respectively at a 10% false-positive rate; maternal factors, fetal biometry and uterine artery Doppler combined detected 40, 66 and 89% of term, preterm and very preterm SGA <5th centile at a 10% false-positive rate.Conclusions: Second-trimester screening can identify the majority of pregnancies at high risk of SGA birth and showed a higher performance for earlier gestational ages at birth and lower birthweight centiles. [ABSTRACT FROM AUTHOR]

Objectives This study aims to summarize evidence on the relation between neighborhood deprivation and the risks for preterm birth, small-for-gestational age, and stillbirth. Design The design was a systematic review and meta-analysis. Main outcome measures The main outcome measures included studies that directly compared the risk of living in the most deprived neighborhood quintile with least deprived quintile for at least one perinatal outcome of interest (preterm delivery, small-for-gestational age and stillbirth). Methods Study selection was based on a search of Medline, Embase and Web of Science for articles published up to April 2012, reference list screening, and email contact with authors. Data on study characteristics, outcome measures, and quality were extracted by two independent investigators. Random-effects meta-analysis was performed to estimate unadjusted and adjusted summary odds ratios with the associated 95% confidence intervals. Results We identified 2863 articles, of which 24 were included in a systematic review. A meta-analysis ( n = 7 studies, including 2 579 032 pregnancies) assessed the risk of adverse perinatal outcomes by comparing the most deprived neighborhood quintile with the least deprived quintile. Compared with the least deprived quintile, odds ratios for adverse perinatal outcomes in the most deprived neighborhood quintile were significantly increased for preterm delivery (odds ratio 1.23, 95% confidence interval 1.18-1.28), small-for-gestational age (odds ratio 1.31, 95% confidence interval 1.28-1.34), and stillbirth (odds ratio 1.33, 95% confidence interval 1.21-1.45). Conclusions Living in a deprived neighborhood is associated with preterm birth, small-for-gestational age and stillbirth. [ABSTRACT FROM AUTHOR]

Objective To test if serum YKL-40 is increased in women developing preeclampsia or small-for-gestational age fetuses. We also assessed the association between uterine artery pulsatility index, notching and serum YKL-40 levels. Design Prospective cohort study. Setting A primary referral unit for obstetric ultrasound. Population A total of 1214 unselected pregnant women enrolled at nuchal translucency examination between 11+3 and 13+6 weeks of gestation. Methods All women had ultrasound and blood sample collection at the nuchal translucency scan, a 20-week malformation scan and 25-week and 32-week fetal growth examinations. Uterine artery Doppler was assessed and outcome was registered from medical records. Main outcome measures Preeclampsia, hypertension, small-for-gestational age. Results Serum YKL-40 was associated with increasing maternal age ( p < 0.0001), body mass index ( p = 0.0002), primiparity ( p = 0.0003), and hypertension ( p = 0.015). Serum YKL-40 increased from 12 to 20 weeks and decreased from 20-25 and 25-32 weeks of gestation. No association was found between preeclampsia and serum YKL-40. Small-for-gestational-age at birth was significantly associated with a 5.4% increase in serum YKL-40 at 32 weeks of gestation (95% CI 1.5-9.3, p = 0.005). An association was found between uterine artery pulsatility index at 32 weeks and small-for-gestational age ( p = 0.0015) but not between YKL-40 and uterine artery notching ( p = 0.83). Conclusions Serum YKL-40 was not associated with preeclampsia. Increasing serum YKL-40 was related to maternal age, body mass index and small-for-gestational age and may reflect an exaggerated inflammatory response. [ABSTRACT FROM AUTHOR]

Objective. To compare perinatal outcomes of late small-for-gestational age (SGA, birthweight <10th percentile) infants, according to antenatal recognition. Design. Retrospective study. Setting. Tertiary referral center. Population. All singleton pregnancies with SGA (birthweight <10th percentile) infants born ≥36 weeks' gestation from January 2007 to April 2009. Methods: Chart review of 771 pregnancies. SGA infants identified prior to delivery (group A) were compared with those not identified (group B). Main outcome measures. Mode of delivery, perinatal complications, admission to neonatal intensive care unit (NICU). In group A, receiver operating characteristic (ROC) analysis and area under the curve (AUC) of antenatal tests to predict NICU admission were calculated. Results. In 17% of infants, SGA was recognized before birth (group A), whereas in 83% it was recognized only at birth (group B). Infants with the most severe degree of SGA (birthweight <3rd percentile) were more frequently diagnosed antenatally (30%). Admission to NICU (14 vs. 3%, p < 0.001) and cesarean delivery (42 vs. 26%; p < 0.001) were more likely in group A. Adverse outcomes related to hypoxia were all observed in group B, but the difference was not significant. In antenatally detected fetuses a combination of fetal abdominal circumference, umbilical artery pulsatility index and middle cerebral artery pulsatility index z-scores was useful for prediction of NICU admission (AUC = 0.94). Conclusion. Antenatal recognition of late SGA may improve perinatal outcomes. However, admission to neonatal intensive care and cesarean delivery were more frequent among SGA infants recognized antenatally. [ABSTRACT FROM AUTHOR]

Previous narrative reviews in this area have concluded that there are few interventions that are likely to be beneficial and that further high-quality research is required. Our objective was to perform a review of systematic reviews of the effectiveness of interventions for the prevention of small-for-gestational age (SGA) fetuses and perinatal mortality, to summarize the most up-to-date evidence and assess quality. Searches were carried out by using Medline, Embase, Cochrane Library and DARE (inception to September 2011), by hand searching of journal and reference lists and by contact with experts. Systematic reviews of randomized controlled trials were selected. Two reviewers independently selected articles and assessed the methodological and reporting quality. Data were extracted on study characteristics, quality and results. Summary data were presented as relative risks (RRs) and 95% confidence intervals (CIs). There were 834 randomized controlled trials (>668 672 participants), reporting on 45 different interventions. The most effective interventions to prevent the SGA fetus were antiplatelets at <16 weeks in women at risk of pre-eclampsia (RR 0.47; CI 0.30-0.74) and progesterone therapy for prevention of preterm birth (RR 0.64; CI 0.49-0.83). For the prevention of perinatal mortality in high-risk women, antiplatelets (RR 0.69; CI 0.53-0.90) and antenatal corticosteroids (RR 0.77; CI 0.67-0.89) were effective interventions. It is concluded that effective interventions are available for reducing the occurrence of SGA fetuses and preventing related perinatal mortality. Some are effective in all women, while others target specific co-morbidities. There is a need to consider a comprehensive approach to primary prevention that targets SGA along with pre-eclampsia and preterm birth. [ABSTRACT FROM AUTHOR]

Background. Differences in birth outcomes such as low birthweight (LBW), preterm births (PTB), stillbirth, differences in birthweight in Black vs. White race are well known. Infants born to biracial parents (mother and father from either Black or White races) also experience higher adverse birth outcomes. Objective. To systematically review and meta-analyze birth outcomes among parents of mixed racial background compared to parents of same race. Search strategy. Medline, Embase, CINAHL and bibliographies of identified articles were searched for English language studies. Selection criteria. Studies reporting association between parental mixed racial status and LBW, PTB, or small-for-gestational age (SGA) outcomes were included. Data collection and analyses. After exclusion of duplicate cohorts in different publications, data from White mother-Black father (WMBF), Black mother-White father (BMWF) and Black mother-Black father (BMBF) groups were compared with the White mother-White father (WMWF) group. Results. Eight English language studies from of 26 335 596 singleton births were included and reviewed. Compared to the WMWF group, the adjusted odds ratio (95% confidence intervals) were: (a) low birthweight; 1.21 (1.10-1.33) for WMBF, 1.75(1.64-1.87) for BMWF, and 2.08 (1.81-2.38) for BMBF; (b) preterm births; 1.17 (1.05-1.31) for WMBF, 1.37 (1.18-1.59) for BMWF, and 1.78 (1.59-2.00) for BMBF; and (c) stillbirths; 1.43 (0.92-2.21) for WMBF, 1.51 (1.09-2.08) for BMWF, and 1.85 (1.47-2.32) for BMBF. Conclusion. Biracial status of parents was associated with higher risk for adverse pregnancy outcomes than both White parents but lower than both Black parents, with maternal race having a greater influence than paternal race on pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Objective. To identify factors associated with perinatal mortality in northeastern Tanzania. Design. Prospective cohort study. Setting. Northeastern Tanzania. Population. 872 mothers and their newborns. Methods. Pregnant women were screened for factors possibly associated with perinatal mortality, including preeclampsia, small-for-gestational age, preterm delivery, anemia, and health-seeking behavior. Fetal growth was monitored using ultrasound. Finally, the specific causes of the perinatal deaths were evaluated. Main outcome measure. Perinatal mortality. Results. Forty-six deaths occurred. Key factors associated with perinatal mortality were preterm delivery (adjusted odds ratio (OR) 14.47, 95% confidence interval (CI) 3.23-64.86, p < 0.001), small-for-gestational age (adjusted OR 3.54, 95%CI 1.18-10.61, p = 0.02), and maternal anemia (adjusted OR 10.34, 95%CI 1.89-56.52, p = 0.007). Adherence to the antenatal care program (adjusted OR 0.027, 95%CI 0.003-0.26, p = 0.002) protected against perinatal mortality. The cause of death in 43% of cases was attributed to complications related to labor and specifically to intrapartum asphyxia (30%) and neonatal infection (13%). Among the remaining deaths, 27% (7/26) were attributed to preeclampsia and 23% (6/26) to small-for-gestational age. Of these, 54% (14/26) were preterm. Conclusions. Preeclampsia, small-for-gestational age and preterm delivery were key risk factors and causes of perinatal mortality in this area of Tanzania. Maternal anemia was also strongly associated with perinatal mortality. Furthermore, asphyxia accounted for a large proportion of the perinatal deaths. Interventions should target the prevention and handling of these conditions in order to reduce perinatal mortality. [ABSTRACT FROM AUTHOR]

Objective. To describe the incidence of placenta previa and to assess neonatal morbidity and mortality in pregnancies with placenta previa after adjustment for previous cesarean section, smoking, multiparity, maternal age and in vitro fertilization. Design. National cohort study. Setting. Danish national IVF-, birth- and patient registers. Population. All pregnancies in Denmark from 1978-2006 and a subpopulation of all singleton pregnancies during the years 2001-2006 with placenta previa ( n=1721) compared to pregnancies without this diagnosis. Methods. Incidence rates and multivariate analysis. Main outcome measures. Gestational age, birthweight, Apgar score after five minutes, stillbirth, neonatal mortality and admittance to neonatal intensive care unit. Results. The incidence of placenta previa in Denmark was 0.54% in 2006. Neonates born after pregnancies with placenta previa had a higher risk of being born at a gestational age below 37 weeks (OR 8.6; 95%CI 7.5-9.9), having an Apgar score of ≤7 at five minutes (OR 2.7; 95%CI 2.0-3.7), being transferred to a neonatal intensive care unit (OR 4.3; 95%CI 3.8-4.9) and for stillbirth and neonatal mortality combined (OR 1.8; 95%CI 1.1-3.0), compared with neonates born in pregnancies without placenta previa. No increased risk of being small-for-gestational age was found (OR 1.0; 95%CI 1.0-1.2). Conclusion. When adjusting for confounders, neonates born after pregnancies with placenta previa had a significantly higher risk of being born preterm, having a low Apgar score, being transferred to neonatal intensive care, and death. [ABSTRACT FROM AUTHOR]

Objective: To determine if pregnancy complications are increased in super-obese (a body mass index (BMI) of 50 or more) compared to other, less obese parturients.Design: Cross-sectional study.Setting and Population: All 19,700 eligible women, including 425 (2.2%) super-obese women with singleton births between 1996 and 2007 delivering at a tertiary referral center, identified using a perinatal research database.Methods: Bivariate and trend analyses were used to assess the relation between super-obesity and various pregnancy complications compared to other well-established BMI categories. Adjusted odds ratios (ORs) were calculated using multivariable logistic regression techniques.Main Outcome Measures: Outcomes for adjusted and unadjusted analyses were small-for-gestational age (SGA) birth, large-for-gestational age (LGA) birth, preeclampsia, gestational diabetes mellitus (GDM), fetal death, preterm birth, placental abruption, cesarean delivery, and Apgar scores < 7.Results: Compared to all other obese and non-obese women, super-obese women had the highest rates of preeclampsia, GDM, LGA, and cesarean delivery (all p < 0.05 for trend test). Super-obesity was also associated with a 44% reduction in SGA compared to all other women (OR 0.55, 95% confidence interval (CI) 0.40-0.76) and a 25% reduction compared to other, less obese women (OR 0.75, 95% CI 0.54-1.03). Super-obesity was positively associated with LGA, GDM, preeclampsia, cesarean delivery, and a 5-minute Apgar score < 7 compared to all other women after controlling for important confounders.Conclusion: Super-obesity is associated with higher rates of pregnancy complications compared to women of all other BMI classes, including other obese women. [ABSTRACT FROM AUTHOR]

Objective. To examine the risk of adverse pregnancy outcomes (low birthweight (LBW), preterm birth, and small-for-gestational age (SGA)) in pregnant women with urinary tract infections (UTIs) using a 3-year nationwide population-based database, simultaneously taking characteristics of infant and mother into consideration. Design. Retrospective cross-sectional study. Setting. Taiwan. Sample. In total, 42,742 mothers with UTIs and 42,742 randomly selected mothers were included. Methods. Conditional logistic regression analyses to investigate the risk of LBW, preterm birth, and SGA, comparing these two cohorts. Main outcome measures. LBW, preterm birth, and SGA. Results. Pearson χ2 tests show that there were significant differences in the prevalence of preterm births (<37 weeks) (7.2%, 7.7 vs. 8.3%, p = 0.006) and SGA infants (<10th percentile) (16.1%, 16.5 vs. 18.9%, p = 0.003) among pregnant women who were not exposed to UTIs, those exposed to antepartum non-pyelonephritic UTIs and those exposed to pyelonephritis. However, after adjusting for potential confounding factors, the odd ratios (ORs) for LBW were not statistically significant for mothers exposed to antepartum non-pyelonephritic UTIs, compared to women who were not diagnosed with UTIs; neither for <34 or <37 weeks nor SGA <10th percentile and <2 SDs. Similarly, compared to women who were not exposed to UTIs, the adjusted ORs for LBW, <34 weeks, <37 weeks, SGA <10th centile, and <2 SD did not reach a significant level for mothers exposed to pyelonephritis. Conclusions. Women exposed to antepartum pyelonephritis or non-pyelonephritic UTIs were not at increased risk of having LBW, preterm, and SGA babies, compared to mothers who did not experience UTIs. [ABSTRACT FROM AUTHOR]

Background. Maternal low birth weight (LBW), preterm birth (PTB) and small-for-gestational age (SGA) birth status have been suggested as precursors for an infant being born LBW, PTB or SGA. Objective. To systematically review the risks of infant LBW/PTB/SGA among mothers who were LBW/PTB/SGA. Search strategy. Medline, Embase, CINAHL and bibliographies of identified articles were searched for English language studies. Selection criteria. Studies reporting association between maternal birth status and LBW, PTB or SGA outcomes were included. Study quality was assessed for biases in selection, exposure assessment, confounder adjustment, analyses, outcomes assessment and attrition. Data collection and analysis. Unadjusted data from included studies were extracted by two reviewers. Summary odds ratio (OR) and confidence intervals (CI) were calculated using random effect model. Main results. Twenty-two studies of low to moderate risk of biases were included. Maternal LBW was associated with infant LBW (12 studies, 525,706 participants, OR 2.23, 95% CI 2.11–2.35), PTB (six studies, 331,121 participants, OR 1.57, 95% CI 1.43–1.71) and SGA (three studies, 324,357 participants, OR 1.83, 95% CI 1.43–2.33). Maternal PTB was associated with infant PTB (seven studies, 282,616 participants, OR 1.41, 95% CI 1.26–1.59) and SGA (three studies, 41,590 participants, OR 1.33, 95% CI 1.08–1.64). Maternal SGA was associated with infant PTB (OR 1.58, 95% CI 1.06–2.37) and SGA (OR 2.64, 95% CI 2.28–3.05). Conclusions. Maternal LBW, PTB or SGA status was associated with their children's LBW/PTB/SGA status. Maternal birth status should be included in risk assessment when planning pregnancy care for individual women. [ABSTRACT FROM AUTHOR]

Objective: To investigate if placental Doppler velocimetry can predict the recurrence of a small-for-gestational age (SGA) fetus in subsequent pregnancies. Design: Retrospective study. Setting: City cohort over 15 years attending a university hospital. Methods: A total of 196 pregnancies suspected of a SGA fetus (<3rd percentile) evaluated by uterine and umbilical artery Doppler velocimetry. Blood velocity waveform was analyzed for pulsatility index (PI) as well as the uterine artery waveform for notching in early diastole. Main Outcome Measure: The occurrence of a SGA newborn during the succeeding pregnancy by Doppler results from the previous pregnancy. Results: In the group of 196 pregnancies suspected for SGA, 27 (13.8%) delivered a SGA newborn in the following pregnancy. Thirty-seven (18.9%) of the 196 had an abnormally high PI in the uterine arteries in their first pregnancy, 12 (32.4%) of these delivered a SGA child in the next pregnancy (relative risk 3.44, p<0.001). The corresponding figure for those with normal uterine artery PI was 15 (9.4%). Abnormal umbilical artery Doppler was a worse predictor of recurrence of SGA (p=0.051). Uterine artery notching was not related to a SGA newborn during next pregnancy. Conclusion: The results suggest that abnormal uterine artery Doppler is related to increased risk of recurrence of SGA during the next pregnancy. This knowledge might provide the clinician with an opportunity to initiate preventive treatment and increase surveillance to women at risk during succeeding pregnancy. [ABSTRACT FROM AUTHOR]

Objective. To study the neuroendocrine release of cortisol in response to perceived stress among pregnant women exposed to partner violence and how this affects the duration of pregnancy and the intrauterine growth of the infant. Design. Cross-sectional community-based study. Setting. Health and Demographic Surveillance System of Leon, Nicaragua. Population. One-hundred and forty-seven pregnant women. Methods. Standardized scales to measure intimate partner violence, social resources, perceived stress, and socio-economic conditions were applied. Two salivary samples for cortisol were collected in the morning and afternoon on the same day. Linear regression and path analysis were used. Main outcome measures. Cortisol levels, gestational age, and weight at delivery. Results. Partner violence during the pregnancy, low social resources, and perceived maternal stress were associated with high level of salivary cortisol. Pregnant women with high cortisol levels were significantly more likely to give birth to small-for-gestational age babies, but not to deliver preterm. A substantial decrease of birthweight, 121-186 g, was associated with an increase in cortisol in association with violence exposure. Conclusion. Partner violence during pregnancy is a stressor that provokes high levels of cortisol, which is associated with reduction of birthweight. [ABSTRACT FROM AUTHOR]

Objective. To better characterize the relation between socioeconomic disadvantage and small-for-gestational age births (SGA). Design. Analysis of data from a mandatory population-based surveillance system. Setting. Public or private hospitals and at home. Population. All 877,951 singleton births occurring in New South Wales, Australia, between 1994 and 2004. Methods. Multilevel models were developed to determine the factors associated with babies weighing less than the 3rd percentile for gestation and gender. Main outcome measures. Odds of SGA. Results. The risk of SGA increased with increasing socioeconomic disadvantage. Smoking accounted for approximately 40% of the increased risk associated with socioeconomic disadvantage, and delayed antenatal care approximately 5%. While the absolute rate of SGA remained stable over the study period, the odds of SGA in mothers living in the most disadvantaged areas compared to those in the least disadvantaged areas increased from approximately 1.7 to 2.2. This trend persisted after accounting for maternal smoking. The risk of SGA over this period also increased in mothers commencing antenatal care after the first trimester. After accounting for smoking, socioeconomic disadvantage and clinical conditions, mothers under 21 years of age were at reduced risk of SGA, but mothers over 35 were at increased risk. Conclusions. Socioeconomic disadvantage remains one of the dominant determinants of SGA, even in a developed country with universal insurance. This relation appears to be strengthening. Smoking patterns, inadequate antenatal care and clinical conditions partially account for this association and trend, however, most is mediated by other factors. [ABSTRACT FROM AUTHOR]