Search

This paper develops a performativist metaphysical grounding of NPM‐based performance measurement as a radical alternative to a representationalist grounding, an alternative that turns performance measurement on its head. Performance measurement turns from an act of representation characterized by a metaphor of reflection into an ethical practice of mattering characterized by a metaphor of diffraction. In performativism, performance measurement does not (imperfectly) represent performance as a base for knowing and intervention from afar (both in terms of space and time) but is somehow performative of who and what come to count in the world. Its exclusionary character makes it an inherently ethical practice. We contrast a performativist grounding of performance measurement with a representationalist grounding and rework concepts of responsibility and accountability. We illustrate a performativist grounding of performance measurement with examples from academia and healthcare and provide a direction for future research. [ABSTRACT FROM AUTHOR]

This review aims to determine how head shape is measured and describes the use of orthoses in the management of deformational plagiocephaly. A systematic review was conducted and papers published in English up to and including 2006 were sourced from nine databases. After initial screening, 20 papers were included; three literature reviews and 17 original papers. Of the original papers, eight concerned the method of head shape measurement. Measurements are important in determining clinical classification and treatment modality of deformational plagiocephaly. All studies were appraised and assigned a level of evidence according to the Scottish Intercollegiate Guidelines Network. Methodological quality was inadequate. Publications involving the use of cranial orthoses used convenience samples, were not blinded, and used different measurement techniques. No comparison groups were included and participants were not randomized. Evidence suggests that conservative treatments might reduce skull deformity although the quality is poor. Clinical studies investigating the use of cranial orthoses reported beneficial effects. Further research is required to identify the efficacy of cranial orthoses in the treatment of deformational plagiocephaly based on a standardized measurement technique to facilitate classification of this condition. [ABSTRACT FROM AUTHOR]

Monitoring fetal growth in utero is crucial to anomaly diagnosis. However, current computer‐vision models struggle to accurately assess the key metrics (i.e., head circumference and occipitofrontal and biparietal diameters) from ultrasound images, largely owing to a lack of training data. Mitigation usually entails image augmentation (e.g., flipping, rotating, scaling, and translating). Nevertheless, the accuracy of our task remains insufficient. Hence, we offer a U‐Net fetal head measurement tool that leverages a hybrid Dice and binary cross‐entropy loss to compute the similarity between actual and predicted segmented regions. Ellipse‐fitted two‐dimensional ultrasound images acquired from the HC18 dataset are input, and their lower feature layers are reused for efficiency. During regression, a novel region of interest pooling layer extracts elliptical feature maps, and during segmentation, feature pyramids fuse field‐layer data with a new scale attention method to reduce noise. Performance is measured by Dice similarity, mean pixel accuracy, and mean intersection‐over‐union, giving 97.90%, 99.18%, and 97.81% scores, respectively, which match or outperform the best U‐Net models. [ABSTRACT FROM AUTHOR]

Many children in low‐ and middle‐income countries are not attaining their developmental potential. Stunting is associated with poor child development, but it is not known which correlates of stunting are impairing child development. We explored potential socioeconomic, nutritional, clinical, and household correlates of early child development among 12–59‐month‐old children with stunting in a cross‐sectional study in Uganda. Development was assessed using the Malawi Development Assessment Tool (MDAT) across four domains of gross and fine motor, language, and social skills. Linear regression analysis was used to assess correlates of development in the four domains and total MDAT score. Of 750 children included, the median [interquartile range] age was 30 [23−41] months, 55% of the children resided in rural settings with 21% from female‐headed households and 47% of mothers had no schooling. The mean ± standard deviation height‐for‐age z‐score (HAZ) was −3.02 ± 0.74, 40% of the children had a positive malaria test and 65% were anaemic (haemoglobin < 110 g/L). One‐third had children's books at home, majority (96%) used household objects to play with and most of them (70%) used toys as pretence items like those to mimic cooking. After age, sex, and site adjustments, HAZ (0.24, 95% confidence interval [CI]: 0.14−0.33) and head circumference (0.07, 95% CI: 0.02−0.12) were positive correlates of total MDAT score, whereas weight‐for‐height z‐score (WHZ) was not. Current breastfeeding was associated with 0.41 (95% CI: 0.17−0.65) lower total MDAT score. Children from households with a single income earner had 0.22 (95% CI: 0.06−0.37) lower total MDAT score. Furthermore, severe food insecurity, inflammation and positive malaria test were associated with lower scores for motor development. All family care indicator subscales (FCIs) positively correlated with the total MDAT score and this association was independent of household's socioeconomic status. In conclusion, stunting degree, head circumference, number of household income earners and stimulation by improved FCIs correlate with early child development among stunted children. The negative association with prolonged breastfeeding is likely due to reverse causality. Identified correlates may inform initiatives to support children with stunting attain their development potential. Key messages: Our findings reinforce the association between stunting and early child development.The negative association with prolonged breastfeeding is likely due to reverse causality as a result of mothers nursing their smaller, thinner, and more sickly children longer.The strong correlation between all family care indicators with development may express the benefit of improved home stimulation such as provision of reading materials and varied play materials on early child development even among already stunted children in poor settings. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of stomach position on postnatal outcome in cases of left congenital diaphragmatic hernia (CDH) without liver herniation, diagnosed and characterized on prenatal ultrasound (US), by comparing those with ('stomach-up' CDH) to those without ('stomach-down' CDH) intrathoracic stomach herniation.Methods: Infants with left CDH who underwent prenatal US and postnatal repair at our institution between January 2008 and March 2017 were eligible for inclusion in this retrospective study. Detailed prenatal US examinations, fetal magnetic resonance imaging (MRI) studies, operative reports and medical records of infants enrolled in the pulmonary hypoplasia program at our institution were reviewed. Cases with liver herniation and those with an additional anomaly were excluded. Cases in which bowel loops were identified within the fetal chest on US while the stomach was intra-abdominal were categorized as having stomach-down CDH. Cases in which bowel loops and the stomach were visualized within the fetal chest on US were categorized as having stomach-up CDH. Prenatal imaging findings and postnatal outcomes were compared between the two groups.Results: In total, 152 patients with left CDH were initially eligible for inclusion. Seventy-eight patients had surgically confirmed liver herniation and were excluded. Of the 74 included CDH cases without liver herniation, 28 (37.8%) had stomach-down CDH and 46 (62.2%) had stomach-up CDH. Of the 28 stomach-down CDH cases, 10 (35.7%) were referred for a suspected lung lesion. Sixty-eight (91.9%) cases had postnatal outcome data available for analysis. There was no significant difference in median observed-to-expected (o/e) lung-area-to-head-circumference ratio (LHR) between cases with stomach-down CDH and those with stomach-up CDH (41.5% vs 38.4%; P = 0.41). Furthermore, there was no difference in median MRI o/e total lung volume (TLV) between the two groups (49.5% vs 44.0%; P = 0.22). Compared with stomach-up CDH patients, stomach-down CDH patients demonstrated lower median duration of intubation (18 days vs 9.5 days; P < 0.01), median duration of extracorporeal membrane oxygenation (495 h vs 223.5 h; P < 0.05), rate of supplemental oxygen requirement at 30 days of age (20/42 (47.6%) vs 3/26 (11.5%); P < 0.01) and rate of pulmonary hypertension at initial postnatal echocardiography (28/42 (66.7%) vs 9/26 (34.6%); P = 0.01). No neonatal death occurred in stomach-down CDH patients and one neonatal death was seen in a patient with intrathoracic stomach herniation.Conclusions: In infants with left CDH without liver herniation, despite similar o/e-LHR and o/e-TLV, those with stomach-down CDH have decreased neonatal morbidity compared to those with stomach herniation. Progressive or variable physiological distension of the stomach over the course of gestation may explain these findings. Stomach-down left CDH is mistaken for a lung mass in a substantial proportion of cases. Accurate prenatal US characterization of CDH is crucial for appropriate prenatal counseling and patient management. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Maternal iodine (I) status is critical in embryonic and foetal development. We examined the effect of preconception iodine supplementation on maternal iodine status and on birth outcomes. Non‐pregnant women in Guatemala, India and Pakistan (n ~ 100 per arm per site) were randomized ≥ 3 months prior to conception to one of three intervention arms: a multimicronutrient‐fortified lipid‐based nutrient supplement containing 250‐μg I per day started immediately after randomization (Arm 1), the same supplement started at ~12 weeks gestation (Arm 2) and no intervention supplement (Arm 3). Urinary I (μg/L) to creatinine (mg/dl) ratios (I/Cr) were determined at 12 weeks for Arm 1 versus Arm 2 (before supplement started) and 34 weeks for all arms. Generalized linear models were used to assess the relationship of I/Cr with arm and with newborn anthropometry. At 12 weeks gestation, adjusted mean I/Cr (μg/g) for all sites combined was significantly higher for Arm 1 versus Arm 2: (203 [95% CI: 189, 217] vs. 163 [95% CI: 152, 175], p < 0.0001). Overall adjusted prevalence of I/Cr < 150 μg/g was also lower in Arm 1 versus Arm 2: 32% (95% CI: 26%, 38%) versus 43% (95% CI: 37%, 49%) (p = 0.0052). At 34 weeks, adjusted mean I/Cr for Arm 1 (235, 95% CI: 220, 252) and Arm 2 (254, 95% CI: 238, 272) did not differ significantly but were significantly higher than Arm 3 (200, 95% CI: 184, 218) (p < 0.0001). Nominally significant positive associations were observed between I/Cr at 12 weeks and birth length and head circumference z‐scores (p = 0.028 and p = 0.005, respectively). These findings support the importance of first trimester iodine status and suggest need for preconception supplementation beyond salt iodization alone. [ABSTRACT FROM AUTHOR]

A response by N. Melamed and I. Meizner to a letter to the editor about their article "Sonographic estimation of fetal head circumference: how accurate are we?" in the January 2011 issue is presented.

Objective: Neurodevelopmental delay is frequently encountered in children with a congenital heart defect (CHD). Fetuses with major CHD have a smaller head circumference (HC), irrespective of altered cerebral flow or brain oxygenation. This cohort study compared head growth in cases with isolated vs those with non-isolated CHD to evaluate the effect of additional pathology on head size in these fetuses.Method: All CHD cases diagnosed prenatally in the period January 2002-July 2014 were selected from our regional registry, PRECOR. Cases of multiple pregnancy, and those affected by maternal diabetes, severe fetal structural brain anomalies or functional CHD were excluded. Subjects were divided into groups according to whether the CHD was isolated, and the non-isolated group was subdivided into three groups: cases with genetic anomaly, extracardiac malformation or placental pathology. In both isolated and non-isolated CHD groups, CHDs were also grouped according to their potential effect on aortic flow and oxygen saturation. Mean HC Z-scores at 20 weeks and increase or decrease (Δ) of HC Z-scores over the course of pregnancy were compared between isolated and non-isolated groups, using mixed linear regression models.Results: Included were 916 cases of CHD diagnosed prenatally, of which 378 (41.3%) were non-isolated (37 with placental pathology, 217 with genetic anomaly and 124 with extracardiac malformation). At 20 weeks, non-isolated cases had significantly lower HC Z-scores than did isolated cases (Z-score = -0.70 vs -0.03; P < 0.001) and head growth over the course of pregnancy showed a larger decrease in this group (Δ HC Z-score = -0.03 vs -0.01 per week; P = 0.01). Cases with placental pathology had the lowest HC Z-score at 20 weeks (Z-score = -1.29) and the largest decrease in head growth (Δ HC Z-score = -0.06 per week). In CHD subjects with a genetic diagnosis (Z-score = -0.73; Δ HC Z-score = -0.04 per week) and in those with an extracardiac malformation (Z-score = -0.49; Δ HC Z-score = -0.02 per week), HC Z-scores were also lower compared with those in subjects with isolated CHD. CHDs that result in low oxygenation or flow to the brain were present more frequently in isolated than in non-isolated cases.Conclusions: Smaller HC in fetuses with CHD appears to be associated strongly with additional pathology. Placental pathology and genetic anomaly in particular seem to be important contributors to restricted head growth. This effect appears to be irrespective of altered hemodynamics caused by the CHD. Previously reported smaller HC in CHD should, in our opinion, be attributed to additional pathology. Neurodevelopment studies in infants with CHD should, therefore, always differentiate between isolated and non-isolated cases. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To assess potential differences in fetal size between the French population and the international population from the INTERGROWTH-21st (IG-21st ) Project and to measure the impact of switching to the IG-21st reference standards for fetal size.Methods: This was a nationwide cross-sectional study of fetal ultrasound biometry. Low-risk singleton pregnancies were recruited prospectively within the network of the national French College of Fetal Ultrasound, CFEF, over a 6-week period. Further selection was performed based on the criteria of the IG-21st Project in order to obtain a comparable population. Head circumference (HC) was used as the main fat-free skeletal measure of growth for comparison of French fetal size with that of the IG-21st population. The impact of switching to the IG-21st fetal growth standards was quantified by comparing Z-scores calculated using the IG-21st standards with those calculated using locally derived reference ranges for HC, abdominal circumference (AC) and femur length (FL).Results: Following selection, 4858 cases were analyzed. The distribution of HC demonstrated clear similarity between our French population and the IG-21st population: our observed centile curves closely matched those of IG-21st and the Z-scores were close to 0 across gestational age. The IG-21st standards performed as well as did locally derived charts in terms of screening for small-for-gestational age by AC, while they identified significantly fewer small FL values than were expected and than did the locally derived charts.Conclusions: Under strict selection criteria, fetal size in France is similar to that of the international population used in the IG-21st Project. The discrepancies in FL are unlikely to impact on prenatal management. Therefore, switching from locally derived reference ranges to the IG-21st standards appears to be a safe option. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Prenatal supplementation with protein-energy (PE) and/or multiple-micronutrients (MMNs) may improve fetal growth, but trials of lipid-based nutritional supplements (LNSs) have reported inconsistent results. We conducted a post-hoc analysis of non-primary outcomes in a trial in Gambia, with the aim to test the associations of LNS with fetal growth and explore how efficacy varies depending on nutritional status. The sample comprised 620 pregnant women in an individually randomized, partially blinded trial with four arms: (a) iron and folic acid (FeFol) tablet (usual care, referent group), (b) MMN tablet, (c) PE LNS, and (d) PE + MMN LNS. Analysis of variance examined unadjusted differences in fetal biometry z-scores at 20 and 30 weeks and neonatal anthropometry z-scores, while regression tested for modification of intervention-outcome associations by season and maternal height, body mass index, and weight gain. Despite evidence of between-arm differences in some fetal biometry, z-scores at birth were not greater in the intervention arms than the FeFol arm (e.g., birth weight z-scores: FeFol −0.71, MMN −0.63, PE −0.64, PE + MMN −0.62; group-wise p = .796). In regression analyses, intervention associations with birth weight and head circumference were modified by maternal weight gain between booking and 30 weeks gestation (e.g., PE + MMN associations with birth weight were +0.462 z-scores (95% CI [0.097, 0.826]) in the highest quartile of weight gain but -0.099 z-scores (−0.459, 0.260) in the lowest). In conclusion, we found no strong evidence that a prenatal LNS intervention was associated with better fetal growth in the whole sample. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "New Charts for Ultrasound Dating of Pregnancy," by D. G. Altman and L. S. Chitty in a 1997 issue.

Objectives: Congenital heart defects (CHDs) are reported to be associated with a smaller fetal head circumference (HC) and neurodevelopmental delay. Recent studies suggest that altered intrauterine brain hemodynamics may explain these findings. Our objectives were to evaluate the pattern of head growth in a large cohort of fetuses with various types of CHD, analyze these patterns according to the type of CHD and estimate the effect of cerebral hemodynamics with advancing gestation in the second and third trimesters.Methods: Singleton fetuses with an isolated CHD were selected from three fetal medicine units (n = 436). Cases with placental insufficiency or genetic syndromes were excluded. CHD types were clustered according to the flow and oxygen saturation in the aorta. Z-scores of biometric data were constructed using growth charts of a normal population. HC at different gestational ages was evaluated and univariate and multivariate mixed regression analyses were performed to examine the patterns of prenatal HC growth.Results: Fetuses with severe and less severe types of CHD demonstrated statistically significant HC growth restriction with increasing gestational age (slope of -0.017/day); however, there was no statistically significant effect of fetal hemodynamics on HC growth. Fetuses with CHD but normal brain oxygenation and normal aortic flow showed a significant decrease in HC growth (slope of -0.024/day). Only fetuses with isolated tetralogy of Fallot demonstrated a smaller HC z-score at 20 weeks of gestation (-0.67 (95% CI, -1.16 to -0.18)).Conclusions: Despite the decline in head growth in fetuses with a prenatally detected isolated CHD, HC values were within the normal range, raising the question of its clinical significance. Furthermore, in contrast to other studies, this large cohort did not establish a significant correlation between aortic flow or oxygen saturation and HC growth. Factors other than altered fetal cerebral hemodynamics may contribute to HC growth restriction with increasing gestational age, such as (epi)genetic or placental factors. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To compare the standard methods for ultrasound measurement of fetal head circumference (HC) and biparietal diameter (BPD) (outer-to-outer (BPDoo) vs outer-to-inner (BPDoi) caliper placement), and compare acquisition of these measurements in transthalamic (TT) vs transventricular (TV) planes.Methods: This study utilized ultrasound images acquired from women participating in the Oxford arm of the INTERGROWTH-21(st) Project. In the first phase of the study, BPDoo and BPDoi were measured on stored images. In the second phase, real-time measurements of BPD, occipitofrontal diameter (OFD) and HC in TT and TV planes were obtained by pairs of sonographers. Reproducibility of measurements made by the same (intraobserver) and by different (interobserver) sonographers, as well as the reproducibility of caliper placement and measurements obtained in different planes, was assessed using Bland-Altman plots.Results: In Phase I, we analyzed ultrasound images of 108 singleton fetuses. The mean intraobserver and interobserver differences were < 2% (1.34 mm) and the 95% limits of agreement were < 5% (3 mm) for both BPDoo and BPDoi. Neither method for measuring BPD showed consistently better reproducibility. In Phase II, we analyzed ultrasound images of 100 different singleton fetuses. The mean intraobserver and interobserver differences were < 1% (2.26 mm) and the 95% limits of agreement were < 8% (14.45 mm) for all fetal head measurements obtained in TV and TT planes. Neither plane for measuring fetal head showed consistently better reproducibility. Measurement of HC using the ellipse facility was as reproducible as HC calculated from BPD and OFD. OFD by itself was the least reproducible of all fetal head measurements.Conclusions: Measurements of BPDoi and BPDoo are equally reproducible; however, we believe BPDoo should be used in clinical practice as it allows fetal HC to be measured and compared with neonatal HC. For all head measurements, TV and TT planes provide equally reproducible values at any gestational age, and HC values are similar in both planes. Fetal head measurement in the TT plane is preferable as international standards in this plane are available; however, measurements in the TV plane can be plotted on the same standards. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives: Fetuses with congenital heart disease (CHD) show evidence of abnormal brain development before birth, which is thought to contribute to adverse neurodevelopment during childhood. Our aim was to evaluate whether brain development in late pregnancy can be predicted by fetal brain Doppler, head biometry and the clinical form of CHD at the time of diagnosis.Methods: This was a prospective cohort study including 58 fetuses with CHD, diagnosed at 20-24 weeks' gestation, and 58 normal control fetuses. At the time of diagnosis, we recorded fetal head circumference (HC), biparietal diameter, middle cerebral artery pulsatility index (MCA-PI), cerebroplacental ratio (CPR) and brain perfusion by fractional moving blood volume. We classified cases into one of two clinical types defined by the expected levels (high or low) of placental (well-oxygenated) blood perfusion, according to the anatomical defect. All fetuses underwent subsequent 3T-magnetic resonance imaging (MRI) at 36-38 weeks' gestation.Results: Abnormal prenatal brain development was defined by a composite score including any of the following findings on MRI: total brain volume <  10(th) centile, parietoccipital or cingulate fissure depth <  10(th) centile or abnormal metabolic profile in the frontal lobe. Logistic regression analysis demonstrated that MCA-PI (odds ratio (OR), 12.7; P = 0.01), CPR (OR, 8.7; P = 0.02) and HC (OR, 6.2; P = 0.02) were independent predictors of abnormal neurodevelopment; however, the clinical type of CHD was not.Conclusions: Fetal brain Doppler and head biometry at the time of CHD diagnosis are independent predictors of abnormal brain development at birth, and could be used in future algorithms to improve counseling and targeted interventions. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Breastfeeding during infancy is associated with a range of short- and long-term health benefits. We examine whether breastfeeding in the first 2 months of life is associated with structural markers of brain development in infants from the general population. This study was embedded within the Generation R study. Cranial ultrasounds were obtained at approximately 7 weeks post-natal age. The diameter of the gangliothalamic ovoid, corpus callosum length, ventricular volume and head circumference were measured. Maternal reports of breastfeeding were obtained at 2 months of age. We examined associations in relation to current breastfeeding practices (exclusively breastfed, n = 318, breast- and bottle-fed, n = 119, and bottle-fed, n = 243). Analyses were adjusted for head size and relevant covariates. Secondary analyses were conducted for breastfeeding history (exclusively breastfed, n = 318, breast- and bottle-fed, n = 281, and never breastfed, n = 81). Exclusive breastfeeding was associated with more optimal brain development compared with babies who were bottle-fed or never breastfed. Results were most consistent for gangliothalamic ovoid diameter. Larger gangliothalamic ovoid diameters were evident in babies who were exclusively breastfed compared with bottle-fed babies [difference between means (95% confidence interval) = 0.21(0.02, 0.39), P = 0.02]. Smaller ventricular volume and larger head circumference were also found for exclusively breastfed babies. Breastfeeding was not significantly associated with corpus callosum length. Maternal reports of breastfeeding are associated with more mature brain development within the first 2 months of life. Results are most consistent for gangliothalamic ovoid diameter, a subcortical structure rich in docosahexaenoic acid. Findings also pointed to non-specific neural developmental advantage for exclusively breastfed babies. [ABSTRACT FROM AUTHOR]

An abstract of the conference paper "GA-adjusted ventricle measurement in relation to fetal gender and cephalometry," by L. J. Salomon and colleagues, is presented.

The aim of this retrospective study was to determine the effectiveness of maxillary, mandibular and chin advancement (MMCA) surgery as a treatment for obstructive sleep apnoea and to determine the cephalometric parameters of this surgery. Twenty consecutive adult patients with obstructive sleep apnoea for whom other treatments (constant positive airway pressure, mandibular advancement splint and soft tissue surgery) had failed underwent MMCA surgery. Pre- and post-surgical polysomnography studies measuring the Respiratory Disturbance Index (RDI), minimum blood oxygen saturation (MinSaO2) and Epworth Sleepiness Scale (ESS) were compared. Lateral cephalometric radiographs measuring the pre- and post-surgical posterior airway space (PAS) were also analysed. Regression analysis indicated that the change in PAS at the level of B point largely accounted for the change in the RDI, although it was not significantly related with the postoperative oxygen saturation. MMCA surgery was found to be effective as a treatment for obstructive sleep apnoea, and improved all postoperative measures in this study. There was a significant relationship between B point, the PAS and a reduction in RDI. [ABSTRACT FROM AUTHOR]

The article presents a study which compares the accuracy, reproducibility, and time required for fetal biometric measurements by an inexperienced operator using three-dimensional (3D) and two-dimensional (2D) ultrasonography. The study measured 50 fetuses at a gestational age of 17-34 weeks, including biparietal diameter (BPD), abdominal circumference (AC), and head circumference (HC). The study concludes that the inexperienced operator obtained reproducible fetal biometric measurements.

Aim Fetal androgens influence fetal growth as well as postnatal neurocognitive ability. However, to our knowledge, no published study has prospectively examined the impact of early-life androgens on infant brain growth. We report the association between circulating fetal androgen levels, measured from umbilical-cord blood at birth, and a proxy measure of brain growth: head circumference. Method Participants were 82 unselected female infants from a large representative birth cohort (mean gestational age 39.4wks, SD 1.7). Umbilical-cord blood was obtained at birth and analysed for androgen concentrations (total testosterone, androstenedione, dehyrdroepiandrosterone, and its sulphated metabolite). Head circumference and two other measures of growth – weight (mean 3311.4g, SD 461.3) and length – were measured within 3 days of birth and again at approximately 1 year of age (mean age 13.1mo, SD 1.1). Results Multivariate linear regressions found an inverse association between levels of free testosterone and growth in head circumference (correlatio n=−.24), even when adjusting for sociodemographic/obstetric covariates and head size at birth. Growth in weight and length could not be predicted by free testosterone concentration. Interpretation This is the first report of an association between prenatal androgen levels and postnatal growth in head circumference. These findings suggest that early-life androgens may impact brain development during infancy. [ABSTRACT FROM AUTHOR]

Objectives: The need for training programs and certification processes in fetal ultrasound has become obvious. The purpose of this study was to evaluate the feasibility of a score-based quality control system for fetal biometry in the second trimester.Methods: Standard measurements of biparietal diameter and head circumference, abdominal circumference, and femur length at 20-24 weeks had been made by four operators using the same ultrasound machine. Twenty-five of each of the cephalic, abdominal and femoral images with the calipers in place were selected arbitrarily from each operator's ultrasound database and anonymized. These 300 images were analyzed by three experienced reviewers blinded to the operator's identity. Each image was first evaluated subjectively and then scored according to six criteria for abdominal and cephalic measurements and four criteria for femur length making a six-point score for abdominal and cephalic biometry and a four-point score for femur length. For subjective evaluation, inter-reviewer differences were analyzed using percentage agreement and adjusted kappa. For objective evaluation, a difference in scoring of one point or less among reviewers was considered good agreement. Intrareviewer variability was assessed using 40 images of each type of examination selected arbitrarily.Results: The distribution of scores was similar between reviewers. One operator obtained significantly lower scores whereas the other three had good and comparable results. There was no statistical difference in the mean score attributed by each reviewer and agreement was good in 84-90% of the cases. Intrareviewer agreement was good in 90-100% of the cases, with similar scores for each reviewer.Conclusion: A quality control policy based on image scoring is feasible and allows for fair to good inter- and intrareviewer reproducibility. The potential contribution of this approach to assess the quality of routine ultrasound examinations should be tested on a larger scale. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to de the role of the nasal septum in embryonic facial development.Methods: Nasal septal growth and facial development were examined in sagittally-sectioned 6-9 week human foetuses and compared to previously published data for later prenatal periods. To complement this data a cephalometric study of a child with untreated warfarin embryopathy was undertaken since a previous study in rats had shown warfarin exposure interferes with septal growth.Results: The results showed that prenatal septal growth was maximal during the 6-9 week period and resulted in the establishment of a facial profile that was maintained until birth. This critical of growth corresponds to the period of warfarin exposure of the human foetus that results warfarin embryopathy. The cephalometric examination of a child with untreated warfarin embryopathy showed a combination of short anterior cranial base and a short maxilla had contributed to a significant retrusion of the maxilla suggestive of failure of the midface to devel the 6-9 week period.Conclusion: These findings would support the hypothesis that the nasal septum plays an active role in embryonic midfacial development. [ABSTRACT FROM AUTHOR]

We use the United Kingdom's Born in Bradford study to investigate whether women in lower quality environments are less likely to breastfeed. We use measures of physical environmental quality (water disinfectant by‐products [DBPs], air pollution, passive cigarette smoke, and household condition) alongside socio‐economic indicators, to explore in detail how different exposures influence breastfeeding. Drawing on evolutionary life history theory, we predict that lower environmental quality will be associated with lower odds of initiating, and higher hazards of stopping, breastfeeding. As low physical environmental quality may increase the risk of adverse birth outcomes, which may in turn affect breastfeeding chances, we also test for mediation by gestational age, birthweight, head circumference, and abdominal circumference. Our sample is composed of mothers who gave birth at the Bradford Royal Infirmary in West Yorkshire between March 2007 and December 2010 for whom breastfeeding initiation data was available. Analyses were stratified by the two largest ethnic groups: White British (n = 3,951) and Pakistani‐origin (n = 4,411) mothers. After controlling for socio‐economic position, Pakistani‐origin mothers had lower chances of initiating and higher chances of stopping breastfeeding with increased water DBP exposure (e.g., OR for 0.03–0.61 vs. <0.02 μg/day dibromochloromethane exposure 0.70 [0.58–0.83], HR 1.16 [0.99–1.36]), greater air pollution exposure predicted lower chances of initiation for both ethnic groups (e.g., OR for 10 μg/m3 increase in nitrogen dioxide 0.81 [0.66–0.99] for White British mothers and 0.79 [0.67–0.94] for Pakistani‐origin mothers) but also a reduced hazard of stopping breastfeeding for White British mothers (HR 0.65 [0.52–0.80]), and exposure to household damp/mould predicted higher chances of breastfeeding initiation amongst White British mothers (OR 1.66 [1.11–2.47]). We found no evidence that physical environmental quality effects on breastfeeding were mediated through birth outcomes amongst Pakistani‐origin mothers and only weak evidence (p < 0.10) amongst White British mothers (exposure to passive cigarette smoke was associated with having lower birthweight infants who were in turn less likely to be breastfed whereas greater air pollution exposure was associated with longer gestations and in turn reduced hazards of stopping breastfeeding). Overall, our findings suggest that there is differential susceptibility to environmental exposures according to ethnicity. Although the water DBP results for Pakistani‐origin mothers and air pollution‐initiation results for both ethnic groups support our hypothesis that mothers exhibit reduced breastfeeding in poorer quality environments, several physical environmental quality indicators showed null or positive associations with breastfeeding outcomes. We consider physiological explanations for our findings and their implications for life history theory and public health policy. [ABSTRACT FROM AUTHOR]

Infant growth faltering occurs in breastfed infants <6 months of age. The possibility that maternal health status contributes to this growth faltering is underexplored. We investigated whether (a) subclinical mastitis (SCM), an asymptomatic inflammation of the breast, (b) maternal intestinal nematode and protozoan infections, indicators of faecal–oral contamination, or (c) poor breastfeeding practices increased the odds of stunting (length‐for‐age z‐score < −2SD), underweight (weight‐for‐age z‐score < −2SD), or low head circumference (head circumference‐for‐age z‐score < −2SD) in breastfed infants in rural indigenous communities in Guatemala. Mother–infant dyads (n = 105) were subdivided into those with and without SCM (milk Na:K ratio > 0.6). Maternal and infant anthropometry were measured at the time of breast milk collection. Maternal stool samples were examined for the presence of intestinal nematodes and protozoa. Questionnaires were used to characterize breastfeeding practices (exclusivity and frequency) and support, hygiene (latrine use and household faucet), and infant diarrhoea. SCM occurred in 14% of women and was associated with increased odds of infant stunting (odds ratio [OR] = 4.3; confidence interval [CI] [1.1, 15.8]), underweight (OR = 9.2; CI [1.8, 48.0]), and low head circumference (OR = 15.9; CI [2.6, 96.9]). Maternal pathogenic protozoa and nematodes were uncommon (<4%), but nonpathogenic protozoa were common (e.g., Entamoeba coli [39%]). Entamoeba coli increased the likelihood (OR = 3.3; CI [1.02, 10.6]) of low head circumference, whereas higher breastfeeding frequency lowered its odds (OR = 0.74, CI [0.56, 0.97]). Prevention of SCM may improve early infant growth, but public health measures that increase breastfeeding frequency and reduce faecal–oral contamination may be required to minimize low head circumference. [ABSTRACT FROM AUTHOR]

Aflatoxins are toxic metabolites of Aspergillus moulds and are widespread in the food supply, particularly in low‐ and middle‐income countries. Both in utero and infant exposure to aflatoxin B1 (AFB1) have been linked to poor child growth and development. The objective of this prospective cohort study was to investigate the association between maternal aflatoxin exposure during pregnancy and adverse birth outcomes, primarily lower birth weight, in a sample of 220 mother–infant pairs in Mukono district, Uganda. Maternal aflatoxin exposure was assessed by measuring the serum concentration of AFB1‐lysine (AFB‐Lys) adduct at 17.8 ± 3.5 (mean ± SD)‐week gestation using high‐performance liquid chromatography. Anthropometry and birth outcome characteristics were obtained within 48 hr of delivery. Associations between maternal aflatoxin exposure and birth outcomes were assessed using multivariable linear regression models adjusted for confounding factors. Median maternal AFB‐Lys level was 5.83 pg/mg albumin (range: 0.71–95.60 pg/mg albumin, interquartile range: 3.53–9.62 pg/mg albumin). In adjusted linear regression models, elevations in maternal AFB‐Lys levels were significantly associated with lower weight (adj‐β: 0.07; 95% CI: −0.13, −0.003; p = 0.040), lower weight‐for‐age z‐score (adj‐β: −0.16; 95% CI: −0.30, −0.01; p = 0.037), smaller head circumference (adj‐β: −0.26; 95% CI: −0.49, −0.02; p = 0.035), and lower head circumference‐for‐age z‐score (adj‐β: −0.23; 95% CI: −0.43, −0.03; p = 0.023) in infants at birth. Overall, our data suggest an association between maternal aflatoxin exposure during pregnancy and adverse birth outcomes, particularly lower birth weight and smaller head circumference, but further research is warranted. [ABSTRACT FROM AUTHOR]

Prenatal maternal stress can adversely affect birth outcomes, likely reflecting effects of maternal stress hormones on fetal development. Maternal stress might also induce behavioural changes, such as dietary change, that might influence fetal development. Few studies have documented relationships between stress and dietary change in pregnancy. We analysed stress and dietary change among 222 pregnant women exposed to the 2011 Queensland Floods. We assessed women's objective hardship, subjective distress and cognitive appraisal of the disaster; changes in their diets and their associations with infants' gestational age, weight, length and head circumference at birth, head circumference to birth length ratio (HC/BL) and ponderal index. Greater objective hardship was correlated with more negative dietary change, skipped meals and skipped multivitamins. There were no direct effects of stress or dietary change on birth outcomes. However, we observed an interactive effect of dietary change and exposure timing on head circumference for gestational age (HC for GA) ( p = 0.010) and a similar trend for HC/BL ( p = 0.064). HC for GA and HC/BL were larger among children whose mothers experienced negative changes to their diet in early pregnancy compared with later pregnancy, consistent with a 'head-sparing' response with early gestation exposure. Further analyses indicated that dietary change mediates the relationship between objective hardship because of the floods and these outcomes. This is the first report of relationships among an independent stressor, dietary change and birth outcomes. It highlights another possible mechanism in the relationship between prenatal maternal stress and child development that could guide future research and interventions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Suppressed prolactin but normal neurophysin levels in cigarette smoking breastfeeding women," in the October 1982 issue, which discusses cigarrette smoking in breastfeeding women.