Maternal anemia in various trimesters of singleton pregnancies and its correlation with birth weight: An observational study

Background: Anemia is a very important preventable nutritional disorder affecting pregnant ladies which may have some adverse effects on the neonatal survival and development. Birth weight was correlated with changes in maternal hemoglobin concentration in various trimesters as it is important for determining child survival and development. Aims and Objectives: The aim of the study was to assess the correlation between maternal hemoglobin levels in various trimesters and neonatal birth weight. Materials and Methods: The study enrolled all pregnant women within age group 15–35 years who gave birth at Agartala Government Medical College and GBP Hospital from June 15, 2017 to August 15, 2017. Pregnant women were included into the study following delivery by simple random sampling into cases (Pregnant women who delivered low birth weight babies <2500 g) and control group (Pregnant women who delivered normal birth weight babies ?2500 g). Antenatal data were collected from hospital case sheet and labor room register. Data were analyzed using descriptive statistics and presented as Mean + SD. P < 0.05 (P < 0.05) was considered statistically significant. Results: Mean hemoglobin concentration was normal (?11 g/dl) in all three trimesters among the controls but it is found to be <11 g/dl in second and third trimesters of the case group. The mean birth weight of the babies was 2.151(± 0.2386) kg in case group and 3.047(± 0.3666) kg in control group. Conclusions: It was found that maternal hemoglobin concentration has a positive correlation (r > 0) with neonatal birth weight in all three trimesters in both cases and controls which is statistically significant (P < 0.05).

Study of fetomaternal outcome in twin pregnancy

Background: Twin pregnancy being one of the causes of high-risk pregnancy is associated with both maternal and fetal complications. This study aims at analysing the fetal and maternal outcome in such cases. All cases were studied according to their parity, maternal age, fetal presentation, mode of delivery and gestational age.Methods: This prospective study was conducted at one of the tertiary care teaching institutes over a period of one year from January 2018 to December 2018. Out of a total number of 7295 deliveries, 130 were twin pregnancy. It included all women admitted in labour room with clinical or ultrasound diagnosis of twin pregnancy after 20 weeks of gestation.Results: In the present study incidence of twin pregnancy was 1.78%. We observed the highest incidence of twins in the age group of 20-29 years. The least incidence was below the age of 20 years. Incidence of twin pregnancy in our study in primipara was 47.7% and in multipara was 52.3%. Most of the patients (43%) delivered at 32-36 weeks of gestation. Maternal complications were noticed as anemia in 29.2% patients, pregnancy induced hypertension in 55.4% patients, post-partum hemorrhage in 4.6% patients, polyhydramnios in 3.1% patients, premature rupture of membranes in 8.5% patients, gestational diabetes in 0.8% patients and urinary tract infection in 2.3% patients. Majority of the patients delivered vaginally (60.8%), others by lower segment cesarean section (LSCS). In this study 95.8% babies were low birth weight. There were 34 neonatal deaths (13%).Conclusions: Twin pregnancy is a high-risk pregnancy associated with significantly increased maternal morbidity, neonatal morbidity and mortality. Such pregnancies require good antenatal care, early detection of maternal and fetal complications and timely referral to a centre well equipped for management of such cases.

Not only pregnancy but also the number of fetuses in the uterus affects intraocular pressure.

Aim: To investigate whether, intraocular pressure (IOP) is affected when there is a second fetus in the uterus during pregnancy. Materials and Methods: Eighty eyes of 40 twin pregnancies (TwPs), 80 eyes of 40 singleton pregnancies (SiPs) and 80 eyes of 40 non‑pregnant females (NoPs) were included in the study. Statistical Analysis: Repeated measurements analysis of variance with two factors, one‑way analysis of variance (ANOVA) and theTukey’s multiple comparison test were used. Results: The mean IOP (MIOP) values in TwPs were 14.29 ± 1.28, 11.48 ± 1.20, and 9.81 ± 1.36 mmHg and the MIOP values in SiPs were 14.42 ± 0.95, 13.12 ± 0.75, and 10.97 ± 0.89 mmHg in subsequent trimesters. The MIOP values in NoPs were 14.77 ± 1.18, 14.92 ± 1.33, and 15.08 ± 0.89 mmHg in subsequent 3‑month measurements. The results show that the MIOP values for the TwPs group were significantly lower than the SiPs in all trimesters. Conclusions: During pregnancy, the number of fetuses in the uterus is an indirectly important factor that influences the decrease in IOP. We hypothesize that the increased ocular hypotensive effect of TwPs is most likely related to the presence of higher levels of hormones, particularly estrogen, progesterone and relaxin compared with SiPs.

Comparison of Maternal Fatty Acid Intake and Fatty Acid Composition of Serum Phospholipids Between Singleton and Twin Pregnancies / 대한지역사회영양학회지

Essential fatty acids are important essential nutrients during pregnancy. The objective of this study was to compare fatty acid composition of serum phospholipids and essential fatty acid intakes between Korean pregnant women with a single baby and Korean pregnant women with twins. A total of 116 pregnant women who had maintained their health without any symptoms of pregnancy complications participated in the study. The subjects consisted of 57 women of singleton pregnancy and 58 women of twin pregnancy at the 1st, 2nd, or 3rd trimester of pregnancy. A 24-hour dietary recall was administered to each subject to obtain dietary information. The mean ages of the singleton pregnancy group and the twin pregnancy group were 31.44 years and 32.27 years, respectively, and the mean height values were 161.86 cm and 160.64 cm, respectively. The mean daily energy intakes in the singleton pregnancy group were 1639.95 kcal, 1904.71 kcal, and 1882.82 kcal for the 1st, 2nd, and 3rd trimester group, respectively. The mean daily energy intakes in the twin pregnancy group were 1745.99 kcal, 2203.46 kcal, and 2092.26 kcal for the 1st, 2nd, and 3rd trimester group, respectively. There were no significant differences in the mean fatty acid intakes by the type of pregnancy (i.e., singleton vs. twins and the stage of pregnancy (i.e., 1st vs. 2nd vs. 3rd trimester). However, the mean total fatty acid intake of those at the 1st trimester among the singleton pregnancy group tended to be higher than that of those at the 1st trimester among the twin pregnancy group. Such a trend seemed to be retro-versed. That is, the mean total fatty acid intakes of the twin pregnancy group were higher compared to the singleton pregnancy group for the 2nd and 3rd trimester group. The LA and total n6 concentrations of serum phospholipids of the singleton pregnancy group were significantly higher as the gestational age increased (p < 0.05). The alpha-LNA(p < 0.05), EPA (p < 0.05), and total n3 (p < 0.001) concentrations of serum phospholipids of the twin pregnancy group were significantly lower as the gestational age increased. The alpha-LNAconcentrations of serum phospholipids in the singleton pregnancy group at the 3rd trimester were significantly higher than that in the twin pregnancy group at the same trimester (p < 0.05). The serum phospholipids levels of AA and DHA of the twin pregnancy group were generally higher compared to those of the singleton pregnancy group. Particularly the differences reached at the level of statistical significance for those at the 1st trimester (p < 0.01). It is concluded that the study findings imply that fatty acid metabolism may meaningfully differ by the type and stage of pregnancy. Future research needs to be conducted to more elucidate grounding etiology and possible roles of dietary fatty acid intake levels in relation to the study findings.

Comparison of Maternal Fatty Acid Intake and Fatty Acid Composition of Serum Phospholipids Between Singleton and Twin Pregnancies / 대한지역사회영양학회지

Essential fatty acids are important essential nutrients during pregnancy. The objective of this study was to compare fatty acid composition of serum phospholipids and essential fatty acid intakes between Korean pregnant women with a single baby and Korean pregnant women with twins. A total of 116 pregnant women who had maintained their health without any symptoms of pregnancy complications participated in the study. The subjects consisted of 57 women of singleton pregnancy and 58 women of twin pregnancy at the 1st, 2nd, or 3rd trimester of pregnancy. A 24-hour dietary recall was administered to each subject to obtain dietary information. The mean ages of the singleton pregnancy group and the twin pregnancy group were 31.44 years and 32.27 years, respectively, and the mean height values were 161.86 cm and 160.64 cm, respectively. The mean daily energy intakes in the singleton pregnancy group were 1639.95 kcal, 1904.71 kcal, and 1882.82 kcal for the 1st, 2nd, and 3rd trimester group, respectively. The mean daily energy intakes in the twin pregnancy group were 1745.99 kcal, 2203.46 kcal, and 2092.26 kcal for the 1st, 2nd, and 3rd trimester group, respectively. There were no significant differences in the mean fatty acid intakes by the type of pregnancy (i.e., singleton vs. twins and the stage of pregnancy (i.e., 1st vs. 2nd vs. 3rd trimester). However, the mean total fatty acid intake of those at the 1st trimester among the singleton pregnancy group tended to be higher than that of those at the 1st trimester among the twin pregnancy group. Such a trend seemed to be retro-versed. That is, the mean total fatty acid intakes of the twin pregnancy group were higher compared to the singleton pregnancy group for the 2nd and 3rd trimester group. The LA and total n6 concentrations of serum phospholipids of the singleton pregnancy group were significantly higher as the gestational age increased (p < 0.05). The alpha-LNA(p < 0.05), EPA (p < 0.05), and total n3 (p < 0.001) concentrations of serum phospholipids of the twin pregnancy group were significantly lower as the gestational age increased. The alpha-LNAconcentrations of serum phospholipids in the singleton pregnancy group at the 3rd trimester were significantly higher than that in the twin pregnancy group at the same trimester (p < 0.05). The serum phospholipids levels of AA and DHA of the twin pregnancy group were generally higher compared to those of the singleton pregnancy group. Particularly the differences reached at the level of statistical significance for those at the 1st trimester (p < 0.01). It is concluded that the study findings imply that fatty acid metabolism may meaningfully differ by the type and stage of pregnancy. Future research needs to be conducted to more elucidate grounding etiology and possible roles of dietary fatty acid intake levels in relation to the study findings.

The normal range of amniotic fluid alpha-fetoprotein in singleton midtrimester pregnancy of Korean women / 대한산부인과학회지

OBJECTIVE: To determine normal range of amniotic fluid alpha-fetoprotein (AFAFP) in midtrimester singleton Korean pregnant women whose pregnancy and neonatal outcomes were uneventful. METHODS: AFAFP levels were measured in midtrimester pregnancy during amniocentesis from May 1995 to September 2006 at tertiary referral center. Normal ranges were obtained from 954 singleton pregnancies in which pregnancy and neonatal outcomes were normal. RESULTS: Median values of AFAFP in midtrimester pregnancy were 15,800 ng/mL, 13,903.9 ng/mL, 11,408.7 ng/mL, 9,690.1 ng/mL, 6,923.4 ng/mL, 6,330.0 ng/mL, 5,295.3 ng/mL, 4,421.2 ng/mL, 3,162.5 ng/mL at 16 week, 17 week, 18 week, 19 week, 20 week, 21 week, 22 week, 23 week, and 24 week. CONCLUSION: The normal range of AFAFP level in each gestational week in Korean women could be a good reference for prenatal diagnosis of various disorders.

Nutrición materna, crecimiento fetal en gestaciones con dos productos y resultado perinatal / Maternal nutritional status, fetal growth in twin pregnancies and perinatal outcome

Objetivo: Determinar el efecto de la nutrición materna sobre el crecimiento fetal en gestaciones múltiples con resultado perinatal adecuado. Material y métodos: Se realizó un estudio de cohorte con gestantes de 20 semanas de embarazo, sin patología agregada. Mensualmente se evaluó peso, fondo uterino (FU) y gasto energético en reposo (GER). Para el análisis de los cambios en peso, FU y GER se utilizó la prueba de ANOVA para datos repetidos, las diferencias intrasujetos fueron con base en la edad gestacional y las diferencias intersujetos en función al tipo de embarazo e IMC pregestacional (IMCp). Resultados: La muestra estuvo constituida por 39 gestantes (19 EM y 20 EU). Se tomaron los eventos exitosos (10 EM como casos y 11 EU como controles). El peso corporal incrementó significativamente entre la semana 0-32 y existió una interacción tiempo de gestación e IMCp (p < 0.05). El FU mostró un incremento significativo a lo largo de la gestación (p < 0.001), que fue dependiente del tipo de embarazo (p < 0.001) y no se vio afectado por el IMCp (p > 0.05). El GER mostró un incremento lineal significativo (p < 0.05), que fue independiente del tipo de gestación (p > 0.05), pero dependiente del IMCp (p < 0.05). Cuando se analizó el GER/kg de peso, se encontró un menor gasto/kg en las mujeres con sobrepeso (p < 0.05). Conclusiones: Los determinantes de la nutrición materna de la semana 20 y hasta la semana 32 de gestación, dependen del IMCp y no del tipo de embarazo; a diferencia del de crecimiento fetal que depende del tipo de embarazo.

Objetive: To determine the effect of maternal nutritional status on fetal growth in twin pregnancies with good perinatal outcome. Material y methods: A cohort conformed by 39 healthy pregnant women with 20 weeks of gestation or less(19 with twin pregnancy (TP)and 20 with singleton pregnancy (SP)). Every four weeks height, weight, uterine fundus height (UFH)and resting energy expenditure (REE) were measured. General Lineal Models for repeated measures were used to evaluate longitudinal changes in body weight, REE, and UFH at 20, 24, 28, and 32 weeks of pregnancy (within subjects) The group was divided by pregnancy type or BMI (< 25, and > 25) (between subjects) in order to evaluate their effect on weight, uterine fundus height and REE changes. Results: The successful deliveries were uses for the analysis (10TP as cases and 11 SP as controls). Weight gain increased significantly between 0 and 32 weeks of gestation with an interaction between gestational age and prepregnancy body mass index (pBMI) (p < 0.05). The UFH also increased significantly during gestation (p < 0.001); this increase was dependant on pregnancy type (p < 0.001) and it was not affected by the pBMI (p > 0.05). REE showed a linear increase (p < 0.05) that depended on the pBMI (p < 0.05) but not on pregnancy type (p > 0.05). When the REE/kg was analyzed, the weight showed a lower energy expenditure per kg in overweight women (p < 0.05). Conclusions: Maternal nutritional determining factors from 20 to 32 weeks of gestation depends on the pBMI and did not depend on pregnancy type, while fetal growth did.