Smoking influence on early and late fetal growth.

OBJECTIVES: Smoking during pregnancy is a leading and modifiable risk factor for fetal growth restriction (FGR) and low birthweight (<10th centile). We studied the effects of smoking in the development of early and late FGR or low birthweight, as well as in uteroplacental and fetoplacental hemodynamics of growth-restricted fetuses. METHODS: Retrospective cohort study of 5,537 consecutive singleton pregnancies delivered at ≤34 + 0 ("early delivery" group, n=95) and >34 + 0 ("late delivery" group, n=5,442) weeks of gestation. Each group was divided into smokers and non-smokers. Prenatal diagnosis of FGR was based on customized fetal growth standards and fetal Doppler, and postnatal birthweight was assessed using the Olsen newborn chart. RESULTS: There were 15/95 (15.8%) and 602/5,442 (11.1%) smokers in the early and late delivery groups, respectively. In early deliveries, FGR was diagnosed in 3/15 (20%) of smokers and in 20/80 (25%) of non-smokers (p=0.68). We also found no differences in birthweights and hemodynamics. In late deliveres, FGR was detected in 30/602 (5%) smokers and 64/4,840 (1.3%) non-smokers (p<0.001). Birthweights <3rd centile and <10th centile were more common in smokers vs. non-smokers: 38/602 (6.3%) vs. 87/4,840 (1.8%) and 89/602 (14.8%) vs. 288/4,840 (6%), respectively (all p<0.01). Fetal Doppler of late FGR showed slightly higher umbilical artery resistances in smokers. CONCLUSIONS: Smoking in pregnancy is associated with FGR, low birthweight and higher umbilical artery Doppler resistances after 34 weeks of gestation, but we could not confirm this association in earlier deliveries.

Obstetric and pediatric growth charts for the detection of fetal growth restriction and neonatal adverse outcomes in preterm newborns before 34 weeks of gestation.

INTRODUCTION: Identification of fetal growth-restricted (FGR) infants depends on the fetal or newborn charts used to identify them. We aimed to compare the prenatal and postnatal diagnosis of FGR and their ability to predict adverse perinatal outcomes. METHODS: Observational retrospective cohort study of 95 consecutive mother-infant pairs with preterm birth between 24 and 34 weeks (study period: January 2014 to December 2015). Prenatal sonographic diagnosis of FGR, based on customized fetal growth standards and fetal Doppler, was compared with the postnatal diagnosis of FGR based on a birthweight < 3rd percentile according to newborn charts (International Newborn size references for the Intergrowth twenty-first century program, and Olsen's charts). Neonatal mortality and adverse neonatal outcomes were compared among groups. RESULTS: In 23/95 (24%) cases a prenatal diagnosis of early FGR was made. Postnatal FGR was confirmed in 11/23 (48%) cases using Olsen's charts and 8/23 (35%) using Intergrowth 21st charts. One postnatal FGR case was missed by prenatal ultrasound. Bronchopulmonary dysplasia, sepsis and hypoglycemia were more frequent in pre- and postnatal FGR versus non-FGR. After adjusting for gestational age and sex, only an increased relative risk of hypoglycemia (2.0, 95%CI 1.0-2.8) was observed in infants with pre- and postnatal FGR diagnosis. Nonsignificant differences on neonatal outcomes were identified between prenatal FGR cases with normal birthweight and the non-FGR group. CONCLUSION: Only prenatal FGR cases in which a birthweight below the third percentile is confirmed by means of postnatal charts (Olsen or Intergrowth standard) are at higher risk of adverse postnatal outcome.

Obstetric and pediatric growth charts for the detection of late-onset fetal growth restriction and neonatal adverse outcomes.

OBJECTIVES: Late-onset fetal growth restriction (FGR) has heterogeneous prenatal and postnatal diagnostic criteria. We compared the prenatal and postnatal diagnosis of late-onset FGR and their ability to predict adverse perinatal outcomes. METHODS: Retrospective cohort study of 5442 consecutive singleton pregnancies that delivered beyond 34 + 0 weeks. Prenatal diagnosis of FGR was based on customized fetal growth standards and fetal Doppler while postnatal diagnosis was based on a birthweight <3rd percentile according to newborn charts (Olsen's charts and Intergrowth 21st century programme). Perinatal outcomes were analyzed depending on whether the diagnosis was prenatal, postnatal or both. RESULTS: A total of 94 out of 5442 (1.7%) were diagnosed as late-onset FGR prenatally. Olsen's chart and Intergrowth 21st chart detected that 125/5442 (2.3%) and 106/5442 (2.0%) of infants had a birthweight <3rd percentile, respectively. These charts identified 35/94 (37.2%) and 40/94 (42.6%) of the newborns with a prenatal diagnosis of late-onset FGR. Prenatally diagnosed late-onset FGR infants were at a higher risk for hypoglycemia, jaundice and polycythemia. Both prenatally and postnatally diagnosed as late-onset FGR had a higher risk for respiratory distress syndrome when compared to non-FGR. The higher risks for intensive care admission and composite adverse outcomes were observed in those with a prenatal diagnosis of late-onset FGR that was confirmed after birth. CONCLUSIONS: Current definitions of pre- and postnatal late-onset FGR do not match in more than half of cases. Infants with a prenatal or postnatal diagnosis of this condition have an increased risk of neonatal morbidity even if these diagnoses are not coincident.

[Motivations and Perceived Barriers to Initiate or Sustain Breastfeeding among Spanish Women]. / Motivaciones y barreras percibidas por las mujeres españolas en relación a la lactancia materna.

OBJECTIVE: Breastfeeding for its multiple benefits is the best cost-effective health intervention and should be a public health priority. The aim of this study was to determine motivations and barriers perceived by mothers to initiate or to maintain breastfeeding. METHODS: A cross-sectional, observational study was carried in 2013 out among 569 mothers resident in Spain, with children under the age of 2, who completed a structured questionnaire. A two-stage sampling, stratified by Autonomous Communities and non-probabilistic within each community was used. RESULTS: 88% of the mothers were breastfeeding their children or had breastfed. At the time of the survey 66.6% had stopped breastfeeding, and the average age for weaning was 6.4 (SD 3.8) months. The main reason for stopping breastfeeding was maternal perceptions of insufficient milk supply (29%). The second reason was going back to work (18%). 67% of the mothers said that they made the decision to breastfeed on their own. The main disadvantages reported were: the difficulty to reconcile breastfeeding and work (43%), breastfeeding in public places (39%), more frequent nighttime awakenings (62%) and the reduced weight gain of the baby (29%). Going back to work was the main reason for choosing formula feeding (34%) and also for initiating partial breastfeeding (39%). CONCLUSIONS: The main disadvantages reported were: the difficulty to reconcile breastfeeding and work, breastfeeding in public places, more frequent nighttime awakenings and the reduced weight gain of the baby. Going back to work was the main reason for choosing formula feeding and also for initiating partial breastfeeding.

OBJETIVO: La lactancia materna (LM) por sus múltiples beneficios es la mejor intervención coste-efectiva en salud y debería constituir un objetivo prioritario de salud pública. El objetivo de este estudio fue conocer las motivaciones y barreras percibidas por las madres para iniciar o mantener la LM. METODOS: Estudio observacional transversal con 569 madres residentes en España en 2013, con hijos menores de 2 años que cumplimentaron un cuestionario estructurado. Muestreo bietápico, estratificado por comunidades autónomas y no probabilístico en cada comunidad. RESULTADOS: El 88% de las madres daban LM o lo habían hecho. La edad media del destete fue 6.4 (DE 3.8) meses. El principal motivo para suspender la lactancia fue la sensación de baja producción de leche (29%) seguido de la incorporación al trabajo (18%). El 67% de las madres indicaron que la decisión de amamantar la habían tomado ellas mismas. La dificultad para combinar la LM con la actividad laboral (43%), dar el pecho en lugares públicos (39%), los despertares nocturnos (62%) y el menor aumento de peso del lactante (29%) fueron los inconvenientes más referidos. La incorporación laboral fue el principal motivo para elegir la lactancia artificial (34%) y para iniciar la lactancia parcial (39%). CONCLUSIONES: La dificultad para combinar la LM con la actividad laboral, dar el pecho en lugares públicos, los despertares nocturnos y la menor ganancia de peso del lactante fueron los inconvenientes más referidos. La incorporación laboral fue el principal motivo para elegir la lactancia artificial y para iniciar la lactancia parcial.

Vertically transmitted cytomegalovirus infection in newborn preterm infants.

OBJECTIVE: To determine the epidemiology of congenital and acquired cytomegalovirus (CMV) infections in preterm infants and to analyze the efficacy of breast milk freezing in decreasing the vertical transmission rate of CMV. STUDY DESIGN: During 2013 and 2014, preterm newborns who weighed ≤1500 g and were admitted to 22 Spanish neonatal units were included and screened for CMV infection according to the Spanish Neonatology Society recommendations. Each hospital treated the breast milk according to its own protocols. RESULTS: Among the 1236 preterm neonates included, 10 had a congenital infection (0.8%) and 49 had an acquired infection (4.0%) (82% demonstrated positive PCR-CMV in breast milk). The neonates who received only frozen milk presented less frequently with acquired infection (1.2%) than those fed fresh milk (5.5%) (RR=0.22; 95% CI 0.05-0.90; P=0.017). The newborns who received bank milk followed by frozen or fresh breast milk more frequently had an acquired infection (2.1% or 2.2%, respectively) than those fed only frozen breast milk. CONCLUSIONS: The incidence of congenital CMV infection in our sample is low, as described in the literature. To reduce acquired CMV infection, freezing breast milk might be an advisable procedure for preterm neonates born from seropositive mothers, either from the beginning of lactation or after a period of bank milk administration.

[Motivations and perceived barriers to initiate or sustain breast- feeding among Spanish women]. / Motivaciones y barreras percibidas por las mujeres Españolas en relación a la lactancia materna.

OBJECTIVE: Breastfeeding for its multiple benefits is the best cost-effective health intervention and should be a public health priority. The aim of this study was to determine motivations and barriers perceived by mothers to initiate or to maintain breastfeeding. METHODS: A cross-sectional, observational study was carried in 2013 out among 569 mothers resident in Spain, with children under the age of 2, who completed a structured questionnaire. A two-stage sampling, stratified by Autonomous Communities and non-probabilistic within each community was used. RESULTS: 88% of the mothers were breastfeeding their children or had breastfed. At the time of the survey 66.6% had stopped breastfeeding, and the average age for weaning was 6.4 (SD 3.8) months. The main reason for stopping breastfeeding was maternal perceptions of insufficient milk supply (29%). The second reason was going back to work (18%). 67% of the mothers said that they made the decision to breastfeed on their own. The main disadvantages reported were: the difficulty to reconcile breastfeeding and work (43%), breastfeeding in public places (39%), more frequent nighttime awakenings (62%) and the reduced weight gain of the baby (29%). Going back to work was the main reason for choosing formula feeding (34%) and also for initiating partial breastfeeding (39%). CONCLUSIONS: The main disadvantages reported were: the difficulty to reconcile breastfeeding and work, breastfeeding in public places, more frequent nighttime awakenings and the reduced weight gain of the baby. Going back to work was the main reason for choosing formula feeding and also for initiating partial breastfeeding.

OBJETIVO: La lactancia materna (LM) por sus múltiples beneficios es la mejor intervención coste-efectiva en salud y debería constituir un objetivo prioritario de salud pública. El objetivo de este estudio fue conocer las motivaciones y barreras percibidas por las madres para iniciar o mantener la LM. METODOS: Estudio observacional transversal con 569 madres residentes en España en 2013, con hijos menores de 2 años que cumplimentaron un cuestionario estructurado. Muestreo bietápico, estratificado por comunidades autónomas y no probabilístico en cada comunidad. RESULTADOS: El 88% de las madres daban LM o lo habían hecho. La edad media del destete fue 6.4 (DE 3.8) meses. El principal motivo para suspender la lactancia fue la sensación de baja producción de leche (29%) seguido de la incorporación al trabajo (18%). El 67% de las madres indicaron que la decisión de amamantar la habían tomado ellas mismas. La dificultad para combinar la LM con la actividad laboral (43%), dar el pecho en lugares públicos (39%), los despertares nocturnos (62%) y el menor aumento de peso del lactante (29%) fueron los inconvenientes más referidos. La incorporación laboral fue el principal motivo para elegir la lactancia artificial (34%) y para iniciar la lactancia parcial (39%). CONCLUSIONES: La dificultad para combinar la LM con la actividad laboral, dar el pecho en lugares públicos, los despertares nocturnos y la menor ganancia de peso del lactante fueron los inconvenientes más referidos. La incorporación laboral fue el principal motivo para elegir la lactancia artificial y para iniciar la lactancia parcial.