Goiter, iodine bioavailability and intrauterine growth restriction in Indigenous and Afro-descendant pregnant women from six non-metropolitan areas of Colombia (2019-2020).

INTRODUCTION: Iodine is an essential mineral for fetal growth and brain development. The aim of this research was to evaluate goiter, iodine deficiency and intrauterine growth restriction in pregnant women of minority ethnic groups in Colombia. METHODS: A cross-sectional study was performed in six non-metropolitan areas of Colombia. RESULTS: A total of 318 Indigenous and Afro-descendant pregnant women were invited to participate: 248 (83.2%) Indigenous and 50 (16.8%) Afro-descendants were studied. The mean age was 24 years (range 13-44 years). Of the women, 130 (43.5%) were from the department of Cauca, 72 (24.1%) were from Córdoba, 28 (9.4%) were from Guajira, 26 (8.8%) were from Sierra Nevada de Santa Marta, 22 (7.4%) were from Amazonas, 16 (5.4%) were from Meta and 4 (1.3%) were from the department of Cesar. A total of 244 (81.8%) were illiterate and 291 (97.7%) were of very low socioeconomic level. Goiter was observed in 69 (23.3%) pregnant women (38 (41.7%) from the department of Cauca, 10 (35.7%) from Guajira, 5 (31.2%) from Meta, 6 (27.2%) from Amazonas and 10 (13.8%) from Córdoba). Iodine deficiency (<100 µg/L) was observed in 42 (14.9%) pregnant women (16 (11.6%) mild (50-99 µg/L), 19 (13.8%) moderate (20-49 µg/L) and 7 (5.1%) severe (<20 µg/L)). Being literate was a protective factor for iodine deficiency (odds ratio (OR)=0.19, 95% confidence interval (CI) 0.04-0.84, p=0.016). Being illiterate and iodine deficient was only a risk factor for goiter (OR=6.72, 95%CI 3.9-9.5, p=0.038) in the department of Cauca. CONCLUSION: A high prevalence of goiter, iodine deficiency and intrauterine growth restriction was observed in minority ethnic groups of Colombia. The highest prevalence and risk was observed in the department of Cauca.

Socioeconomic inequities during COVID 19 pandemic increase preterm birth and low birth weight in the most underprivileged.

BACKGROUND: The mitigation measures implemented to face the healthcare emergency brought by COVID 19 pandemic generated an increase in socioeconomic inequities in the most underprivileged population which is also the most threatened in their human rights. In Uruguay, this population is assisted in the public health care system. To analyze how these measures impacted on these mothers and their neonates we selected outcomes that most contributed to neonatal mortality. OBJECTIVE: To analyze the incidence of Preterm Birth (PB), Intrauterine Growth Restriction (IUGR) and Low Birth Weight (LBW) in the public health care system in Uruguay, during the period of time in which the strictest measures were adopted to mitigate the COVID 19 pandemic in 2020 (para-pandemic period) compared to the same period in 2019 (pre-pandemic). METHODS: A retrospective, cross sectional, descriptive study was performed to compare PB, IUGR and LBW from 15 March to 30 September 2019 (before COVID 19 pandemic) to the same period of 2020 (when COVID 19 pandemic bloomed), in the public health care subsystem. The analysis was performed with data from the national perinatal database system (SIP). RESULTS: In 2020, a significative increase in PB, RR: 1.14 (CI 95%: 1.03-1.25), and in LBW, RR: 1.16 (CI 95% 1.02-1.33), was registered compared to 2019 (pre-pandemic period). IUGR also showed an increase, but without statistical significance (4.6% in 2019 vs 5.2% in 2020, RR 1.13 CI 95% 0.98-1.31). The compared groups showed no differences in the distribution of biological confounding variables that could explain the increase in incidence of the main outcomes. CONCLUSIONS: In the absence of other factors that could explain the results we consider that social crisis associated to the restrictive measures implemented in the country to dwindle the effect of the pandemic exacerbated the adverse conditions that affect the reproductive process for those underprivileged women assisted in the public sector, increasing PB and LBW. It is important to consider the future impact of these results on neonatal and infant mortality and to implement social measures to reduce the damage as soon as possible.

Preeclampsia in pregnant women with COVID-19: a prospective cohort study from two tertiary hospitals in Southern Brazil.

Background: COVID-19 is an infectious pathology that shows vascular changes during pregnancy, as well as in the placentas. The main objectives of this study were to estimate the prevalence and the risk factors for preeclampsia in hospitalized pregnant women with COVID-19. As well as comparing maternal and perinatal outcomes in hospitalized pregnant women with COVID-19 and preeclampsia with those without preeclampsia. Methods: Prospective cohort study of 100 hospitalized pregnant women from two tertiary hospitals, diagnosed with COVID-19, and divided into two groups: PE+ group (pregnant women with COVID-19 and preeclampsia) and PE- group (pregnant women with COVID-19 without preeclampsia). These pregnant women had prevalence, risk factors, maternal and perinatal data analyzed. Results: The prevalence of preeclampsia was 11%. Severe COVID-19 was the main risk factor for preeclampsia (OR = 8.18 [CI 1.53-43.52]), as well as fetal growth restriction was the main perinatal outcome (OR = 8.90 [CI 1.52-38.4]). Comorbidities were more frequent in the PE+ group (63.6% vs 31.5%, p = 0.03), as well as prematurity (81.8% vs 41.6%, p = 0.02), low birth weight (63.6% vs 24.7%, p = 0.01), and the need for neonatal intensive care admission of the newborn (63.6% vs 27.0%, p = 0.03). Pregnant women with PE had twice as long a length of stay in the intensive care unit (RR = 2.35 [CI 1.34-4.14]). Although maternal mortality was more frequent among pregnant women with PE, it was not statistically significant. Conclusions: Prevalence of preeclampsia in hospitalized pregnant women with COVID-19 was 11%. Severe COVID-19 was the main risk factor for preeclampsia and associated comorbidities increased the risk for developing preeclampsia. Long length of stay in the intensive care unit was the main maternal outcome and fetal growth restriction was the main perinatal outcome of preeclampsia.

Trypanosoma cruzi Infection in Pregnancies without Congenital Transmission Is Associated with Reduced Fetal Growth: A Cross-Sectional Study in Argentina, Honduras, and Mexico.

We aimed to measure the association between Trypanosoma cruzi infection in pregnancy and reduced fetal growth in the absence of T. cruzi congenital transmission. We conducted a cross-sectional study of secondary data of all singleton live births between 2011 and 2013 in five hospitals from Argentina, Honduras, and Mexico. We excluded newborns with T. cruzi infection. Noninfected pregnant people were those without any positive rapid tests. The main study outcomes were birth weight, head circumference, and length for gestational age and sex. Logistic regression models were adjusted for country, age, education level, and obstetric history. Of the 26,544 deliveries, 459 (1.7%) pregnant people were found by rapid tests to be positive for T. cruzi. Of these, 320 were positive by enzyme-linked immunosorbent assay and 231 had a positive polymerase chain reaction (PCR) test. Uninfected newborns from T. cruzi-infected pregnant people were more likely to have birth weights below the 5th and 10th percentiles and head circumferences below the 3rd and 10th percentiles. Among T. cruzi-infected pregnant people diagnosed by PCR, the odds ratios were 1.58 for birth weight below the 10th percentile (95% CI, 1.12-2.23) and 1.57 for birth weight below the 5th percentile (95% CI, 1.02-2.42). Higher T. cruzi parasitic loads in pregnancy had a stronger association with reduced fetal growth (both in birth weight and head circumference), with an odds ratio of 2.31 (95% CI, 1.36-3.91) for a birth weight below the 5th percentile. The association shows, irrespective of causality, that newborns of pregnancies with T. cruzi have an increased risk of reduced fetal growth. We recommend further studies to assess other potential confounders and the causality of these associations.

SARS-CoV-2 infection by trimester of pregnancy and adverse perinatal outcomes: a Mexican retrospective cohort study.

OBJECTIVE: Conflicting evidence for the association between COVID-19 and adverse perinatal outcomes exists. This study examined the associations between maternal COVID-19 during pregnancy and adverse perinatal outcomes including preterm birth (PTB), low birth weight (LBW), small-for-gestational age (SGA), large-for-gestational age (LGA) and fetal death; as well as whether the associations differ by trimester of infection. DESIGN AND SETTING: The study used a retrospective Mexican birth cohort from the Instituto Mexicano del Seguro Social (IMSS), Mexico, between January 2020 and November 2021. PARTICIPANTS: We used the social security administrative dataset from IMSS that had COVID-19 information and linked it with the IMSS routine hospitalisation dataset, to identify deliveries in the study period with a test for SARS-CoV-2 during pregnancy. OUTCOME MEASURES: PTB, LBW, SGA, LGA and fetal death. We used targeted maximum likelihood estimators, to quantify associations (risk ratio, RR) and CIs. We fit models for the overall COVID-19 sample, and separately for those with mild or severe disease, and by trimester of infection. Additionally, we investigated potential bias induced by missing non-tested pregnancies. RESULTS: The overall sample comprised 17 340 singleton pregnancies, of which 30% tested positive. We found that those with mild COVID-19 had an RR of 0.89 (95% CI 0.80 to 0.99) for PTB and those with severe COVID-19 had an RR of 1.53 (95% CI 1.07 to 2.19) for LGA. COVID-19 in the first trimester was associated with fetal death, RR=2.36 (95% CI 1.04, 5.36). Results also demonstrate that missing non-tested pregnancies might induce bias in the associations. CONCLUSIONS: In the overall sample, there was no evidence of an association between COVID-19 and adverse perinatal outcomes. However, the findings suggest that severe COVID-19 may increase the risk of some perinatal outcomes, with the first trimester potentially being a high-risk period.

The impact of gestational weight gain on fetal and neonatal outcomes: the Araraquara Cohort Study.

BACKGROUND: Gestational weight gain (GWG) is an important indicator for monitoring maternal and fetal health. OBJECTIVE: To evaluate the effect of GWG outside the recommendations of the Institute of Medicine (IOM) on fetal and neonatal outcomes. STUDY DESIGN: A prospective cohort study with 1642 pregnant women selected from 2017 to 2023, with gestational age ≤ 18 weeks and followed until delivery in the city of Araraquara, Southeast Brazil. The relationship between IOM-recommended GWG and fetal outcomes (abdominal subcutaneous tissue thickness, arm and thigh subcutaneous tissue area and intrauterine growth restriction) and neonatal outcomes (percentage of fat mass, fat-free mass, birth weight and length, ponderal index, weight adequateness for gestational age by the Intergrowth curve, prematurity, and Apgar score) were investigated. Generalized Estimating Equations were used. RESULTS: GWG below the IOM recommendations was associated with increased risks of intrauterine growth restriction (IUGR) (aOR 1.61; 95% CI: 1.14-2.27), low birth weight (aOR 2.44; 95% CI: 1.85-3.21), and prematurity (aOR 2.35; 95% CI: 1.81-3.05), and lower chance of being Large for Gestational Age (LGA) (aOR 0.38; 95% CI: 0.28-0.54), with smaller arm subcutaneous tissue area (AST) (-7.99 g; 95% CI: -8.97 to -7.02), birth length (-0.76 cm; 95% CI: -1.03 to -0.49), and neonatal fat mass percentage (-0.85%; 95% CI: -1.12 to -0.58). Conversely, exceeding GWG guidelines increased the likelihood of LGA (aOR 1.53; 95% CI: 1.20-1.96), with lower 5th-minute Apgar score (aOR 0.42; 95% CI: 0.20-0.87), and increased birth weight (90.14 g; 95% CI: 53.30 to 126.99). CONCLUSION: Adherence to GWG recommendations is crucial, with deviations negatively impacting fetal health. Effective weight control strategies are imperative.

Causal Pathways Between the Acute Experience of Violence During Pregnancy and Fetal Intrauterine Growth Restriction: A Cohort Study.

Introduction: Violence during pregnancy (VDP) is a prevalent global issue with dire consequences for the mother and the developing fetus. These consequences include prematurity, low birthweight, and intrauterine growth restriction (IUGR), but its pathways remain elusive. This study investigated the causal pathways between VDP and IUGR using mediation analysis. Methods: A prospective population-based birth cohort was followed from the beginning of the third gestational trimester to the second year of life. IUGR was defined by the Kramer index, and information on VDP was collected using the WHO-Violence Against Women (WHO VAW) questionnaire. Cases were considered positive only when no other life episodes were reported. Ten different mediators were analyzed as possible pathways based on previous research. Path analysis was conducted to evaluate these relationships. Results: The path analysis model included 755 dyads and presented an adequate fit. Violence during pregnancy showed a direct effect (ß = -0.195, p = 0.041) and a total effect (ß = -0.276, p = 0.003) on IUGR. Violence was associated with gestational depression or anxiety, tobacco and alcohol consumption, changes in blood pressure, and the need for emergency care, but these did not constitute mediators of its effect on IUGR. The sum of the indirect effects, however, showed a significant association with IUGR (ß = -0.081, p = 0.011). Conclusion: The acute experience of violence during pregnancy was associated with IUGR, primarily via a direct pathway. An indirect effect was also present but not mediated through the variables analyzed in this study. The robust strength of these associations underscores the negative health consequences of violence against women for the succeeding generation.

Impact of chronic toxoplasmosis in pregnancy: association between maternal seropositivity for Toxoplasma gondii IgG antibodies and fetal growth restriction.

Insults caused by acute infections during the gestational period on fetal development are known; however, new evidence suggests that chronic infectious diseases can also impact the maternal immune status and lead to negative consequences for the neonate. This study investigated the association between the prevalence of specific antibodies in pregnant women and alterations in fetal development at birth. A follow-up study evaluated women during the gestational period and their respective newborns at delivery time. The pregnant women were tested for the presence of antibodies to infectious agents: Toxoplasma gondii (T. gondii), cytomegalovirus (CMV), syphilis, human immunodeficiency virus (HIV), hepatitis B and C. Semi-structured questionnaires were administered to the pregnant women at the time of recruitment after obtaining informed consent. Detailed information about the newborns was extracted from medical records. The seroprevalence of chronic T. gondii infection, as determined by the presence of IgG antibodies against the protozoan, was found to be 56.2%, while the overall prevalence of CMV IgG antibodies was 96.3%. Non-primiparous pregnant women from socio-economic classes, less affluent groups, and skilled working-class individuals had higher chances of testing positive for specific T. gondii IgG antibodies. Newborns classified as small for gestational age represented 12.9% of the total. Those born to mothers seropositive for anti-T. gondii IgG antibodies were 9.4 times more likely to be born small for gestational age (p = 0.035). The results suggest that chronic T. gondii infection may contribute to higher rates of newborns with growth restriction. These findings add to a growing body of evidence regarding the impact of chronic infectious diseases on intrauterine fetal development.

Obstetric and Perinatal Outcomes in Pregnant Women with Lupus: Retrospective Study in a Portuguese Tertiary Center.

OBJECTIVE: Pregnancy in women with lupus poses a higher risk of complications compared with the general population. The present study aimed to determine and describe the obstetric and neonatal outcomes of pregnant women with lupus. MATERIALS AND METHODS: We conducted an observational retrospective study of pregnant women with the diagnosis of lupus, who were selected and followed at the Maternal-Fetal Medicine Clinic of our institution between January 2013 and July 2018. We analyzed 59 pregnancies and 52 newborns, and collected data regarding sociodemographic features, the preconception period, pregnancy, childbirth, postpartum and the newborn. A descriptive analysis of the variables was performed. RESULTS: In 58% of the cases, the pregnancy was uneventful. We registered flares in 25% of the cases, preeclampsia in 3%, fetal growth restriction in 12%, gestational loss in 10%, preterm labor in 10%, postpartum complications in 20%, and small for gestational age newborns in 17% of the cases. CONCLUSIONS: Most pregnancies in women with lupus have favorable obstetric and neonatal outcomes. Prenatal counseling, adequate multidisciplinary surveillance, and optimized treatment of the disease are fundamental pillars for these good results.

OBJETIVO: A gravidez em mulheres com lúpus representa um risco maior de complicações em comparação com a população em geral. O presente estudo teve como objetivo determinar e descrever os resultados obstétricos e neonatais de gestantes com lúpus. MATERIAIS E MéTODOS: Realizamos um estudo retrospectivo observacional de gestantes com diagnóstico de lúpus, selecionadas e acompanhadas no Ambulatório de Medicina Materno-Fetal de nossa instituição entre janeiro de 2013 e julho de 2018. Analisamos 59 gestações e 52 recém-nascidos e coletamos dados referentes às características sociodemográficas, período pré-concepcional, gravidez, parto, pós-parto e nascimento. Foi realizada uma análise descritiva das variáveis. RESULTADOS: Em 58% dos casos, a gravidez transcorreu sem intercorrências. Registramos surtos em 25% dos casos, pré-eclâmpsia em 3%, restrição do crescimento fetal em 12%, perda gestacional em 10%, trabalho de parto prematuro em 10%, complicações pós-parto em 20% e recém-nascidos pequenos para a idade gestacional em 17% dos casos. CONCLUSõES: A maioria das gestações em mulheres com lúpus tem resultados obstétricos e neonatais favoráveis. Aconselhamento pré-natal, vigilância multidisciplinar adequada e tratamento otimizado da doença são pilares fundamentais para esses bons resultados.

Intended delivery mode and neonatal outcomes in pregnancies with fetal growth restriction.

Objective: To compare neonatal outcomes in pregnancies with fetal growth restriction (FGR) by intended delivery mode.Methods: This is a retrospective cohort study of singleton pregnancies with FGR that were delivered ≥34.0 weeks gestation. Neonatal outcomes were compared according to the intended delivery mode, which the attending obstetrician determined. Of note, none of the subjects had a contraindication to labor. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated via logistic regression models to assess the potential association between intended delivery mode and neonatal morbidity defined as a composite outcome (i.e. umbilical artery pH ≤7.1, 5-min Apgar score ≤7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). A sensitivity analysis excluded intrapartum fetal distress requiring emergency cesarean delivery from the composite outcome since only patients with spontaneous labor or labor induction could meet this criterion. Potential confounders in the adjusted effects models included maternal age, body mass index, hypertensive disorders, diabetes, FGR type (i.e. early or late), and oligohydramnios.Results: Seventy-two (34%) patients had an elective cesarean delivery, 73 (34%) had spontaneous labor and were expected to deliver vaginally, and 67 (32%) underwent labor induction. The composite outcome was observed in 65.3%, 89%, and 88.1% of the groups mentioned above, respectively (p < 0.001). Among patients with spontaneous labor and those scheduled for labor induction, 63% and 47.8% required an emergency cesarean delivery for intrapartum fetal distress. Compared to elective cesarean delivery, spontaneous labor (OR 4.32 [95% CI 1.79, 10.42], p = 0.001; aOR 4.85 [95% CI 1.85, 12.66], p = 0.001), and labor induction (OR 3.92 [95% CI 1.62, 9.49] p = 0.002; aOR 5.29 [95% CI 2.01, 13.87], p = 0.001) had higher odds of adverse neonatal outcomes.Conclusion: In this cohort of FGR, delivering at ≥34 weeks of gestation, pregnancies with spontaneous labor, and those that underwent labor induction had higher odds of neonatal morbidity than elective cesarean delivery.

Longitudinal Child Growth Patterns in Twins and Singletons in the Upstate KIDS Cohort.

OBJECTIVES: To investigate childhood growth patterns in twins and to determine whether they show the same signs of excess growth as singletons born small-for-gestational age (SGA), which may confer future cardiometabolic risk. STUDY DESIGN: In the Upstate KIDS cohort of infants delivered from 2008 through 2010, we compared height, weight, and body mass index (BMI) z-scores at 0-3 and 7-9 years of age, as well as risk of rapid weight gain (RWG) in infancy and overweight/obesity beginning at 2 years, among appropriate-for-gestational age (AGA) twins (n = 1121), AGA singletons (n = 2684), and two groups of SGA twins: uncertain SGA twins (<10th percentile for birthweight by a singleton reference but >10th% by a population-based twin birthweight reference; n = 319) and true SGA twins (<10th% by a population-based twin reference; n = 144). RESULTS: Compared with AGA twins, both SGA twin groups had lower weight and BMI z-scores at both time points. By 7-9 years, both groups caught up in height with AGA twins. Compared with AGA singletons, z-score differences decreased between 0-3 and 7-9 years for uncertain SGA and true SGA twins, though true SGA twins had the lowest z-scores for all measures. During infancy, twins were more likely to display RWG compared with AGA singletons (RR = 2.06 to 2.67), which may reflect normal catch-up growth, as no twin group had higher prevalence of overweight/obesity at either time point. CONCLUSIONS: Though twins had lower height, weight, and BMI z-scores at birth and into toddlerhood, differences were reduced by 7-9 years, with no evidence of pathological growth and no group of twins showing elevated risk of overweight/obesity.

Intrauterine growth restriction, prematurity, and low birth weight: risk phenotypes of neonatal death, Rio de Janeiro State, Brazil. / Restrição do crescimento intrauterino, prematuridade e baixo peso ao nascer: fenótipos de risco de morte neonatal, Estado do Rio de Janeiro, Brasil.

Intrauterine growth restriction and prematurity determine low birth weight. The combination of the three conditions results in different neonatal phenotypes that interfere with child survival. Neonatal prevalence, survival and mortality were estimated according to neonatal phenotypes in the cohort of live births in 2021 in the state of Rio de Janeiro, Brazil. In this study, live births of multiple pregnancies, with congenital anomalies and inconsistencies in the information of weight and gestational age were excluded. The Intergrowth curve was used to classify weight adequacy. Mortality (< 24 hours, 1-6 and 7-27 days) and survival (Kaplan-Meier) were estimated. In total, 6.8%, 5.5%, and 9.5% of the 174,399 live births were low birth weight, small for gestational age (SGA), and premature, respectively. Considering low birth weight live births, 39.7% were SGA and 70% were premature. The neonatal phenotypes were heterogeneous according to maternal, delivery, pregnancy, and newborn characteristics. The mortality rate per 1,000 live births was high for low birth weight premature newborns, both SGA (78.1) and AGA (adequate for gestational age: 61.1), at all specific ages. Reductions in the survival rate were observed when comparing non-low birth weight and AGA term live births. The estimated prevalence values were lower than those of other studies, partly due to the exclusion criteria adopted. The neonatal phenotypes identified children who were more vulnerable and at higher risk of death. Prematurity contributed more to mortality than SGA, and its prevention is necessary to reduce neonatal mortality in the state of Rio de Janeiro.

A restrição do crescimento intrauterino e a prematuridade determinam o baixo peso ao nascer, e a combinação das três condições resulta em diferentes fenótipos neonatais que interferem na sobrevivência infantil. Foram estimadas a prevalência, a sobrevivência e a mortalidade neonatal, segundo os fenótipos neonatais, na coorte de nascidos vivos de 2021 no Rio de Janeiro, Brasil. Foram excluídos nascidos vivos de gravidez múltipla, com anomalia congênita, e com inconsistências nas informações de peso e idade gestacional. Foi utilizada a curva Intergrowth para classificar adequação do peso, e estimadas a mortalidade (< 24 horas, 1-6 e 7-27 dias) e sobrevida (Kaplan-Meier). Dos 174.399 nascidos vivos, 6,8%, 5,5% e 9,5% eram, respectivamente, baixo peso ao nascer, pequeno para idade gestacional (PIG) e prematuros. Entre nascidos vivos com baixo peso ao nascer, 39,7% eram PIG e 70%, prematuros. Os fenótipos neonatais foram heterogêneos segundo características maternas, do parto, da gestação e do recém-nascido. A taxa de mortalidade por 1.000 nascidos vivos foi elevada para neonatos de baixo peso ao nascer prematuros, tanto PIG (78,1) quanto AIG (adequado para idade gestacional: 61,1), em todas as idades específicas. Houve reduções significantes da sobrevida quando comparados aos nascidos vivos não baixo peso ao nascer, AIG termo. As prevalências estimadas mostraram menores valores que as de outros estudos, em parte pelos critérios de exclusão adotados. Os fenótipos neonatais identificaram crianças mais vulneráveis e com maior risco de morte. A prematuridade contribuiu mais para a mortalidade que a condição de PIG; sua prevenção é necessária para reduzir a mortalidade neonatal no Estado do Rio de Janeiro.

La restricción del crecimiento intrauterino y la prematuridad determinan el bajo peso al nacer, y la combinación de las tres condiciones da como resultado diferentes fenotipos neonatales que interfieren en la supervivencia infantil. Se estimó la prevalencia, supervivencia y mortalidad neonatal según los fenotipos neonatales, en la cohorte de nacidos vivos en 2021 en el Estado de Río de Janeiro, Brasil. Se excluyeron nacidos vivos de embarazo múltiple, con anomalía congénita y con inconsistencias en la información sobre el peso y edad gestacional. Se utilizó la curva Intergrowth para clasificar la adecuación de peso, y se estimó la mortalidad (< 24 horas, 1-6 y 7-27 días) y supervivencia (Kaplan-Meier). De los 174.399 nacidos vivos, 6,8%, 5,5% y 9,5% fueron, respectivamente, bajo peso al nacer, pequeños para la edad gestacional (PIG) y prematuros. Entre los bacidos vivos com bajo peso al nacer, el 39,7% eran PIG y el 70% prematuros. Los fenotipos neonatales fueron heterogéneos según las características maternas, del parto, del embarazo y del recién nacido. La tasa de mortalidad por 1.000 nacidos vivos fue alta para los neonatos bajo peso al nacer prematuros, tanto PIG (78,1) como AIG (apropiado para la edad gestacional: 61,1), en todas las edades específicas. Hubo reducciones significativas en la supervivencia en comparación con el término AIG bajo peso al nacer nos nacidos vivos. Las prevalencias estimadas mostraron valores inferiores a los de otros estudios, en parte debido a los criterios de exclusión adoptados. Los fenotipos neonatales identificó a los niños más vulnerables y con mayor riesgo de muerte. La prematuridad contribuyó más a la mortalidad que la condición PIG, y su prevención es necesaria para reducir la mortalidad neonatal en el Estado de Río de Janeiro.

Different intrauterine environments and children motor development in the first 6 months of life: a prospective longitudinal cohort.

This prospective cohort longitudinal study examines the risk factors associated with different intrauterine environments and the influence of different intrauterine environments on children's motor development at 3- and 6-months of life. Participants were 346 mother/newborn dyads enrolled in the first 24 to 48 h after delivery in public hospitals. Four groups with no concurrent condition composed the sample: mothers with a clinical diagnosis of diabetes, mothers with newborns small for gestational age due to idiopathic intrauterine growth restriction (IUGR), mothers who smoked tobacco during gestation, and a control group composed of mothers without clinical condition. Children were assessed at three- and six-months regarding motor development, weight, length, head circumference, and parents completed a socioeconomic questionnaire. The IUGR children had lower supine, sitting, and overall gross motor scores at 6 months than the other children's groups. Anthropometric and sociodemographic characteristics negatively influenced gross motor development. IUGR and anthropometric and sociodemographic characteristics negatively impact motor development. Intrauterine environment impact child neurodevelopment.

The prevalence and perinatal repercussions of preeclampsia after the implementation of a prophylaxis protocol with aspirin.

OBJECTIVES: To evaluate the prevalence and perinatal repercussions of preeclampsia (PE) after the implementation of a prophylaxis protocol with aspirin in singleton pregnancy at Maternity School of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (2015-2106). METHODOLOGY: PE prevalence according to gestational age (GA) and the prevalence ratio (PR) between PE and prematurity, small for gestational age (SGA), and fetal death were calculated in patients assisted during 2015 and 2016. RESULTS: PE occurred in 373(10.75%) of 3468 investigated cases, where PE < 37 weeks was of 2.79% and PE greater than 37 weeks was of 7.95%. A total of 413 (11.9%) prematurity cases, 320 SGA (9.22%), and 50 fetal deaths (1.44%) occurred. In the PE group, 97 premature newborns (PR 0.90) and 51 SGA (PR 1.16) were born, and two fetal deaths occurred (PR 7.46). Concerning PE < 37 weeks, 27 SGA cases (PR 1.42) and two fetal deaths (PR 2.62) were observed. Regarding PE greater than 37 weeks, 24 SGA (PR 1.09) were born, and no fetal deaths were observed. Our findings were compared to previously published results. CONCLUSIONS: PE was significantly associated with SGA newborns, especially premature PE. Prescribing aspirin for PE prophylaxis based only on clinical risk factors in a real-life scenario does not appear to be effective but resulted in a PE screening and prophylaxis protocol review and update at ME/UFRJ.

Silicone breast implants may contribute to early-onset fetal growth restriction.

INTRODUCTION: There are many studies showing that silicone breast implants may affect lactation, but few analyzed whether these implants affect placentation. We observed that many mothers with growth-restricted pregnancies had inflammatory conditions, such as silicone breast implants or giardiasis. METHODS: This single-center cohort study assessed the prevalence of inflammatory conditions in normotensive growth-restricted singleton pregnancies. Next, we stratified the patients according to the presence or absence of silicone breast implants, to determine whether these implants influence fetal growth restriction onset or severity. RESULTS: Twelve (32%) of the 38 participants underwent cosmetic breast augmentation 4-18 years before pregnancy. Half of the patients with and 38% without silicone breast implants had giardiasis. Half of the mothers with and 35% without silicone breast implants had autoantibodies. Silicone breast implants were associated with a 70% increased risk of fetal growth restriction before 32 weeks' gestation (95% confidence interval [CI], 1.2-2.5). Fetal growth restriction was diagnosed significantly earlier in mothers with than in those without silicone breast implants, respectively at 27 (95% CI, 25-30) and 30 weeks' gestation (95% CI, 29-32). Silicone breast implants also tripled the risk of fetuses being below the third percentile, but the difference was not significant. CONCLUSION: Our results suggest that the association of inflammatory conditions, such as silicone breast implants, giardiasis, and autoantibodies may contribute to placental insufficiency. Silicone breast implants older than four years increased the risk of early-onset fetal growth restriction. Studies with large samples are needed to validate our findings and define whether silicone-related fetal growth restriction should be included in autoimmune/inflammatory syndrome induced by adjuvants (ASIA) criteria. Key Points • Fetal growth restriction (FGR), responsible for 30% of stillbirths, is the most common cause of prematurity and intrapartum asphyxia. • In this study, including 38 mothers with normotensive FGR, all participants had 2-4 inflammatory conditions, such as giardiasis, sinusitis, candidiasis, dysbiosis, extreme fear or autoantibodies. • Silicone breast implants were associated with a 70% increased risk of fetal growth restriction before 32 weeks' gestation. • FGR was diagnosed at 27 weeks' gestation (95% CI, 25-30) in mothers with and at 30 weeks' gestation (95% CI, 29-32) in mothers without silicone breast implants.

Perinatal outcomes of two consecutive strategies for the management of fetal growth restriction: a before-after study.

PURPOSE: We aim to compare the perinatal outcomes of two consecutive management strategies for fetal growth restriction (FGR), with or without the inclusion of additional Doppler parameters. METHODS: A quasi-experimental before/after study was conducted in which we compared a composite perinatal outcome, prematurity rate, and neonatal complications between two management strategies in small fetuses. In the strategy 1 (S1), the management was based on fetal biometry and umbilical artery Doppler. The second strategy (S2) added the assessment of uterine and middle cerebral artery Doppler. We also compared outcomes between strategies according to early (≤ 32 weeks) and late (> 32 weeks) diagnosis subgroups. RESULTS: We included 396 patients, 163 in S1 and 233 in S2. There were no significant differences in the perinatal composite outcome (p 0.98), prematurity (p 0.19), or in the subgroup analysis. We found a significant reduction in respiratory distress syndrome (RDS) rate with S2 both globally (OR 0.50, p 0.02), and in the early diagnosis subgroup (OR 0.45, p 0.01). In addition, we observed a significant reduction in the incidence of sepsis with S2 both globally (OR 0.30, p 0.04) and in the early diagnosis subgroup (OR 0.25, p 0.02). We did not observe significant differences in necrotizing enterocolitis (p 0.41) and intraventricular hemorrhage (p 1.00). CONCLUSION: The expanded strategy for the management of FGR did not show significant differences in the primary composite outcome or prematurity. However, it was associated with a lower incidence of RDS and neonatal sepsis.

Neurological morbidity in monochorionic twins with selective fetal growth restriction.

The increased risks of various obstetric, maternal and fetal comorbidities of monochorionic twin pregnancies are widely known. However, despite its high prevalence and significance, the assessment of neurological morbidity as more commonly in selective fetal growth restriction (sFGR) is concerned with more health care. This literature review aims to provide more information about such an assessment. To this end, retrospective cases of sFGR were studied in monochorionic twins, already diagnosed, classified and who had the recommended management, published between 2001 and 2018 in 17 scientific articles. In the assessment of fetal mortality, the highest risk of death of the restricted fetus was found in type 3 of sFGR, while type 2 sFGR was responsible for the highest death rates of both fetuses and also the lowest mean gestational age at delivery, 30.9 weeks. Regarding neurological morbidity, however, studies have shown a higher risk of brain damage in the habitually growing twin compared to the restricted one in the case of sFGR. This may be due to prematurity or intermittent diastolic flow on Doppler in type 2 and 3 of sFGR, however, statements about its pathophysiology still lack further studies.

Performances of birthweight charts to predict adverse perinatal outcomes related to SGA in a cohort of nulliparas.

BACKGROUND: Small-for-gestational-age neonates (SGA) are at increased risk of neonatal morbidity. Nulliparity represents a risk factor for SGA; birthweight charts may perform differently for the detection of SGA among nulliparas. This study aimed at describing the prevalence of SGA in nulliparas according to different birthweight charts and evaluating the diagnostic performance of these charts to maternal and perinatal outcomes. METHODS: This is a secondary analysis of a Brazilian cohort of nulliparas named Preterm SAMBA study. Birthweight centiles were calculated using the Intergrowth-21st, WHO-Fetal Growth Charts, Birth in Brazil population chart and GROW-customised chart. The risks of outcomes among SGA neonates and their mothers in comparison to neonates with birthweights between the 40th-60th centiles were calculated, according to each chart. ROC curves were used to detect neonatal morbidity in neonates with birth weights below different cutoff centiles for each chart. RESULTS: A sample of 997 nulliparas was assessed. The rate of SGA infants varied between 7.0-11.6%. All charts showed a significantly lower risk of caesarean sections in women delivering SGA neonates compared to those delivering adequate-for-gestational-age neonates (OR 0.55-0.64, p < .05). The charts had poor performance (AUC 0.492 - 0.522) for the detection of neonatal morbidity related to SGA born at term. CONCLUSION: The populational and customised birthweight charts detected different prevalence of small-for-gestational-age neonates and showed similar and poor performance to identify related neonatal adverse outcomes in this population.

Differential fetal growth rates mediated by sociodemographic factors in Yucatan, Mexico: an epidemiological study.

BACKGROUND: Fetal growth restriction (FGR) may be related to ethnicity. Additionally, ethnic groups experience adverse socioeconomic circumstances that increase FGR risk. However, the dearth of evidence of the interaction between socioeconomic factors and FGR highlights the need for additional research. OBJECTIVE: To analyze the association between socioeconomic factors and FGR in Maya and non-Maya populations in Yucatan, Mexico. METHODS: A total of 21,320 singleton births in 2017 in Yucatan were analyzed. The student's t-test and the chi-square test were used to compare the means and proportions of maternal and perinatal variables between the FGR group and the birthweight appropriate for gestational age (AGA) group. Path analysis was performed to identify the direct and indirect effects of socioeconomic factors on FGR and mediators between predictors and FGR. RESULTS: The prevalence of FGR at birth was 9.06%; this rate was higher in the Maya population (12.4, 95% CI 11.3-13.5), without differences between socioeconomic levels. Path analysis revealed sociostructural variables (ethnicity and poverty) are reliable predictors of FGR at birth mediated by maternal education (ß = -.152, p < .001) and teenage pregnancy (ß = .065, p = .037). The proposal path model had a good fit index CFI = .968, TLI = .920, RMSEA = .046. CONCLUSION: The prevalence of FGR was higher among Maya women than non-Maya women The socioeconomic conditions associated with FGR at birth were ethnicity, poverty, maternal education, and teenage pregnancy. Maternal education and teenage pregnancy act as mediators between sociostructural variables and FGR at birth.

Diagnosis of congenital infections in premature, low-birthweight newborns with intrauterine growth restriction caused by cytomegalovirus (CMV), herpes simplex virus (HSV), Parvo-B 19, and Zika virus: a systematic review.

OBJECTIVES: To identify the prevalence of viral congenital infections in newborns classified as premature, low-birthweight, small for gestational age or intrauterine growth restriction. METHODS: The definition considered for selecting papers were: P as newborns younger than 28 days; V as low-birthweight, prematurity and intrauterine growth restriction; O as frequency of congenital infections with Cytomegalovirus, Parvovirus B19, Herpes Simplex, and Zika virus. The research was performed using EMBASE, LILACS, SCOPUS and MEDLINE databases, with no limitations on date and language. RESULTS: Eight studies were included. Manuscripts including Herpes Simplex, Zika virus or Parvovirus B19 did not fulfill the defined criteria. A wide variation in the frequency of CMV congenital infection (0-4.8%) was found, which might be attributed to regional and methodological differences between investigations. CONCLUSIONS: Newborn characteristics associated with CMV congenital infections may direct investigations towards these patients with a higher probability of infection. However, as data are controversial, studies concerning screening of infection are important to define recommendations of diagnosis.