Does emigration by itself improve birth weight? Study in European newborns of Indo-Pakistan origin.

Objective: Our aim was to evaluate the effect of emigration on fetal birth weight (BW) in a group of pregnant women coming from the Indian subcontinent. Methods: This was a retrospective study in a mixed population of pregnant women from the Indian subcontinent that either moved to Europe or stayed in their original countries. The influence of emigration along with several pregnancy characteristics: GA at delivery, fetal gender, maternal age, height, weight, body mass index (BMI) and parity on BW was evaluated by means of multivariable linear regression analysis. Results: According to European standards, babies born to Indo-Pakistan emigrants and babies born to women staying in the Indian subcontinent were similarly small (BW centile 30± 29 and 30.1 ± 28, p<0.68). Multivariable regression demonstrated that emigration by itself did not exert a direct influence on BW (p  = 0.27), being BMI and gestational age at delivery the true determinants of BW (p<0.0001). Conclusions: Maternal BMI is the most relevant parameter affecting fetal growth regardless of the place of residence.

Anaemia among females in child-bearing age: Relative contributions, effects and interactions of α- and ß-thalassaemia.

INTRODUCTION: Anaemia in women during pregnancy and child bearing age is one of the most common global health problems. Reasons are numerous, but in many cases only minimal attempts are made to elucidate the underlying causes. In this study we aim to identify aetiology of anaemia in women of child bearing age and to determine the relative contributions, effects and interactions of α- and ß-thalassaemia in a region of the world where thalassaemia is endemic. METHODS: A cross sectional study was conducted at the Colombo North Teaching Hospital of Sri Lanka. The patient database of deliveries between January 2015 and September 2016 at University Obstetrics Unit was screened to identify women with anaemia during pregnancy and 253 anaemic females were randomly re-called for the study. Data were collected using an interviewer-administered questionnaire and haematological investigations were done to identify aetiologies. RESULTS: Out of the 253 females who were anaemic during pregnancy and were re-called, 8 were excluded due to being currently pregnant. Of the remaining 245 females, 117(47.8%) remained anaemic and another 22(9.0%) had non-anaemic microcytosis. Of anaemic females, 28(24.8%) were iron deficient, 40(35.4%) had low-normal serum ferritin without fulfilling the criteria for iron deficiency,18(15.3%) had ß-haemoglobinopathy trait and 20(17.0%) had α-thalassaemia trait. Of females who had non-anaemic microcytosis, 14(66.0%) had α-thalassaemia trait. In 4 females, both α- and ß-thalassaemia trait coexist. These females had higher levels of haemoglobin (p = 0.06), MCV (p<0.05) and MCH (p<0.01) compared to individuals with only ß-thalassaemia trait. A significantly higher proportion of premature births (p<0.01) and lower mean birth weights (p<0.05) were observed in patients with α-thalassaemia trait. CONCLUSIONS: Nearly one third of anaemic females in child bearing age had thalassaemia trait of which α-thalassemia contributes to a majority. Both α- and ß-thalassaemia trait can co-exist and have ameliorating effects on red cell indices in heterozygous states. α-Thalassaemia trait was significantly associated with premature births and low birth weight. It is of paramount importance to investigate the causes of anaemia in women of child bearing age and during pregnancy in addition to providing universal iron supplementation.

Comparison of ultrasound fetal biometry of singleton fetuses with a reference chart in pregnant women with normal nutritional and health status

Objetives: The aim of this study was to compare fetal biometry of singleton fetuses in pregnant women with normal nutritional and health status in the Ampara district, with a commonly used reference chart. Methods: A cross sectional study was carried out in the Ampara District. Women with normal nutritional and health status and minimal environmental constraints on fetal growth (n=714) were enrolled during the first trimester and gestational age was confirmed by fetal crown-rump length measurement between 11 weeks + 0 days and 13 weeks + 6 days. For this study, each mother was considered only once for measurement of fetal biometry, at gestations between 11 and 41 weeks. Fetal bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) were measured using standard techniques, and separate regression models were fitted to estimate the means and standard deviations and derive gestation specific centiles for each parameter, assuming that the measurements have a normal distribution at each gestational age. The fetal biometry results obtained from the current study were compared with a commonly used reference chart. Results: The fitted 10th, 50th and 90th centiles at 40 weeks of gestation were, 87.9 mm, 93.2 mm and 98.5 mm for BPD, 313.8 mm, 328.9 mm and 344.0 mm for HC; 298.2 mm, 322.5 mm and 346.9 mm for AC and 69.7 mm, 75.0 mm and 80.2 mm for FL. When compared with the reference chart, significant differences of fetal biometry were seen in the third trimester but not in the second trimester. Conclusions: Ultrasound fetal biometry of singleton fetuses in pregnant women with normal nutritional and health status in the Ampara District were significantly different in the third trimester, from a routinely used reference chart.

Ultrasound diagnosis of fetal renal abnormalities.

Development of the urogenital system in humans is a complex process; consequently, renal anomalies are among the most common congenital anomalies. The fetal urinary tract can be visualised ultrasonically from 11 weeks onwards, allowing recognition of megacystis at 11-14 weeks, which warrants comprehensive risk assessment of possible underlying chromosomal aneuploidy or obstructive uropathy. A mid-trimester anomaly scan enables detection of most renal anomalies with higher sensitivity. Bilateral renal agenesis can be confirmed ultrasonically, with empty renal fossae and absent bladder filling, along with severe oligohydramnios or anhydramnios. Dysplastic kidneys are recognised as they appear large, hyperechoic, and with or without cystic spaces, which occurs within the renal cortex. Presence of dilated ureters without obvious dilatation of the collecting system needs careful examination of the upper urinary tract to exclude duplex kidney system. Sonographically, it is also possible to differentiate between infantile type and adult type of polycystic kidney diseases, which are usually single gene disorders. Upper urinary tract dilatation is one of the most common abnormalities diagnosed prenatally. It is usually caused by transient urine flow impairment at the level of the pelvi-ureteric junction and vesico-ureteric junction, which improves with time in most cases. Fetal lower urinary tract obstruction is mainly caused by posterior urethral valves and urethral atresia. Thick bladder walls and a dilated posterior urethra (keyhole sign) are suggestive of posterior urethral valves. Prenatal ultrasounds cannot be used confidently to assess renal function. Liquor volume and echogenicity of renal parenchyma, however, can be used as a guide to indirectly assess the underlying renal reserve. Renal tract anomalies may be isolated but can also be associated with other congenital anomalies. Therefore, a thorough examination of the other systems is mandatory to exclude possible genetic disorders.

Timing of birth in multiple pregnancy.

Timing of delivery of twins should be decided when the benefit of prolonging the pregnancy outweighs the risk of stillbirth. Perinatal mortality of singletons is increased significantly after 42 weeks, whereas perinatal mortality in twins starts to increase significantly after 37 weeks. Recent, large cohort studies have showed significantly higher stillbirth rates near term even in apparently low-risk monochorionic twin pregnancies. Stillbirth risk in monochorionic twins is three-fold higher than in dichorionic twins, and this risk remains high throughout the pregnancy. In uncomplicated monochorionic twins between 32 and 37 weeks, no statistically significant increase of stillbirth occurs between 32 and 37 weeks; these pregnancies are usually monitored until delivery at 37 weeks. The risk of stillbirth in dichorionic twins does not seem to be different between 28 and 38 weeks, justifying a differential policy for the timing of delivery in monochorionic compared with dichorionic twin pregnancies. Therefore, uncomplicated dichorionic twins should be managed expectantly, and delivery can be arranged from 38 weeks. In cases of discordant fetal wellbeing at preterm gestations, timing of delivery should be based mainly on parameters and outlook for the healthy twin balanced against the condition of the compromised fetus. The threshold for early delivery may be lower in monochorionic twins because of the high mortality and morbidity in surviving twins with co-twin death.

Screening for pre-eclampsia by using changes in uterine artery Doppler indices with advancing gestation.

OBJECTIVE: The aim of the study was to assess the relationship of changes in uterine artery (UtA) Doppler pulsatility indices (PI) between first and second trimesters and the subsequent development of pre-eclampsia. METHODS: A retrospective study of singleton pregnancies undergoing both first and second trimesters UtA Doppler screening between 2002 and 2009 was conducted. Multiples of median of UtA Doppler PI were used for developing indices describing UtA changes between the two trimesters. Receiver-operating characteristics curves (ROC) were calculated for multiple comparisons. RESULTS: Three thousand five hundred sixty women had UtA Doppler screening in the first and second trimesters. Eleven women were excluded because of termination of pregnancy before 24 weeks. Out of the 3549 women recruited, 126 developed Pre-eclampsia (PE; 22 early PE delivered <34 weeks and 41 preterm PE delivered <37 weeks). The best index for predicting pre-eclampsia was the difference between the mean second trimester and mean first trimester UtA PI (areas under the ROC for early PE and preterm PE of 0.851 and 0.786, respectively). CONCLUSION: Changes of UtA resistance between the first and second trimesters can be calculated as the difference between UtA PI at these gestations. The data of this study demonstrate that the difference in mean PI is the best index in predicting early PE and preterm PE.