Fetal Growth

Nutrition is the major intrauterine environ- mental factor that alters expression of the fetal genome and may have lifelong consequences. This phenomenon, termed "fetal programming," has led to the recent theory of "fetal origins of adult disease." Namely, alterations in fetal nutrition and endocrine status may result in developmental adaptations that permanently change the structure, physi- ology, and metabolism of

Analizar el impacto sobre el crecimiento fetal del tratamiento con glucocorticoides para acelerar la maduración del pulmón fetal, según el número de ciclos administrados.Se ha utilizado la base de datos del Estudio Colaborativo Español de Malformaciones Congénitas (ECEMC) en una muestra de 29.557 recién nacidos vivos no gemelos sin defectos congénitos. Se compararon, mediante un análisis estratificado por edad gestacional al nacimiento, el peso, la talla y el perímetro cefálico de los expuestos prenatalmente a betametasona o dexametasona con los no expuestos. Para el control de factores de confusión o interacción (año de nacimiento, edad materna, edad gestacional, paridad, consumo de tabaco y/o bebidas alcohólicas, diabetes crónica, diabetes gestacional y otras enfermedades crónicas) se utilizó un modelo lineal general con efectos aleatorios, en el que la variable aleatoria fue el lugar de nacimiento.La exposición prenatal a 2 o más ciclos de glucocorticoides comporta una disminución del peso, la talla y el perímetro cefálico en prematuros. Concretamente, en la muestra analizada supone una pérdida del 22% del peso (p < 0,0001), del 5% de la talla (p = 0,002) y del 6% del perímetro cefálico al nacimiento (p = 0,0005). La exposición a un solo ciclo también comporta una pérdida significativa del peso y la talla, aunque no del perímetro cefálico. Asimismo, se ha observado una interacción significativa entre el tratamiento y la edad gestacional, lo cual indica que el impacto de la medicación es más acusado en los más prematuros.En este análisis retrospectivo la exposición prenatal a glucocorticoides para acelerar la maduración pulmonar fetal se asoció, en los recién nacidos prematuros, a un efecto negative sobre el peso, la talla y el perímetro cefálico. Este efecto fue más acusado en los prematuros expuestos a más de un ciclo de glucocorticoides.To study the effects of antenatal corticosteroids treatment to promote fetal lung maturation, on fetal growth, depending on the number of the courses administered.The study was based on data from the Spanish Collaborative Study of Congenital Malformations (ECEMC), analysing a sample of 29,557 singleton liveborn infants without congenital defects. An stratified analysis by gestational age was performed to compare the weight, length and head circumference at birth, in the exposed and unexposed infants to dexamethasone/ betamethasone. To control confounding factors (year of birth, maternal age, gestational age, parity, maternal smoking and/or alcohol consumption, gestational diabetes, non-gestational diabetes and other maternal chronic diseases) we used a general linear model with random effects, being the randomised variable the place of birth.The exposure to more than one course of antenatal corticosteroids resulted in a significant reduction of birth weight, length and head circumference in singleton preterm infants. The birth weight decreased by 22% (p < 0.0001), the length 5% (p = 0.002) and the head circumference 6% (p = 0.0005). The treatment with only one course reduced also significantly the weight and length but not the head circumference. In addition, we observed a significant interaction between the treatment and gestational age at birth indicating that the effect of corticosteroids is stronger in the most premature babies.In this retrospective analysis, the antenatal exposure to corticosteroids to promote fetal maturation is associated with diminished weight, length and head circumference in the premature newborn infant. This negative effect was greater in those premature babies exposed to multiple courses.

One third of the Indian babies are of low birth weight (,2.5 kg), and this is attributed to maternal undernutrition. We therefore examined the relationship between maternal nutrition and birth size in a prospective study of 797 rural Indian women, focusing on macronutrient intakes, dietary quality and micronutrient status. Maternal intakes (24-h recall and food frequency questionnaire) and erythrocyte folate,

Objective The present study aims to establish a more sensitive nomogram of fetal sacral length measurements, as well as to specify the accuracy of fetal sacral length for the ultrasonographic assessment of gestational age. Methods The present study investigated a total of 2,184 pregnant women who were referred for routine pregnancy follow-up. All of the reviewed women had uncomplicated singleton pregnancies without known structural and chromosomal fetal anomalies. Results A statistically significant linear relationship was established between sacrum length and gestational age [gestational age = 4.49 + 0.92 × sacrum length (r = 0.98, R 2 = 0.96)]. The rate of increase in sacrum length of fetuses with a gestational age of <28 weeks was formulated as [gestational age = −0.05 + 1.01 × sacrum length (r = 0.96, R 2 = 0.98)], while the same formula was [gestational age = −0.09 + 1.32 × sacrum length (r = 0.94, R 2 = 0.96)] for fetuses with a gestational age of ≥28 weeks. On the other hand, a statistically significant correlation was found to exist between biparietal diameter (r = 0.68, P = 0.001), head circumference (r = 0.590, P = 0.001), femur length (r = 0.719, P = 0.001) and sacrum length (r = 0.696, P = 0.001). However, the same statistically significant correlation exists between abdominal circumference and the other sonographic measurements (r = 0.223, P = 0.375). Conclusions The fetal sacral length appears as an easily acquired and valuable parameter, which directly and strongly correlates with gestational age and other biometrical measurements. Therefore, fetal sacral length may be utilized as a complementary tool in both the evaluation of fetal growth and prediction of gestational age. Further research is required to determine the significance of fetal sacral length in prenatal follow-up.

Eating disorders in pregnancy can have profound effects upon both fetus and mother. Critical periods of fetal development may be altered in the presence of maternal undernutrition, and the psychological impact of pregnancy may be severe for the mother. This essay explores how midwives can best support women with eating disorders throughout the antenatal period.

This review summarizes the level of epidemiologic evidence for relationships between prenatal and/or early life exposure to environmental chemical contaminants and fetal, child, and adult health. Discussion focuses on fetal loss, intrauterine growth restriction, preterm birth, birth defects, respiratory and other childhood diseases, neuropsychological deficits, premature or delayed sexual maturation, and certain adult cancers linked to fetal or childhood exposures. Environmental exposures considered here include chemical toxicants in air, water, soil/house dust and foods (including human breast milk), and consumer products. Reports reviewed here included original epidemiologic studies (with at least basic descriptions of methods and results), literature reviews, expert group reports, meta-analyses, and pooled analyses. Levels of evidence for causal relationships were categorized as sufficient, limited, or inadequate according to predefined criteria. There was sufficient epidemiological evidence for causal relationships between several adverse pregnancy or child health outcomes and prenatal or childhood exposure to environmental chemical contaminants. These included prenatal high-level methylmercury (CH(3)Hg) exposure (delayed developmental milestones and cognitive, motor, auditory, and visual deficits), high-level prenatal exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs), and related toxicants (neonatal tooth abnormalities, cognitive and motor deficits), maternal active smoking (delayed conception, preterm birth, fetal growth deficit [FGD] and sudden infant death syndrome [SIDS]) and prenatal environmental tobacco smoke (ETS) exposure (preterm birth), low-level childhood lead exposure (cognitive deficits and renal tubular damage), high-level childhood CH(3)Hg exposure (visual deficits), high-level childhood exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) (chloracne), childhood ETS exposure (SIDS, new-onset asthma, increased asthma severity, lung and middle ear infections, and adult breast and lung cancer), childhood exposure to biomass smoke (lung infections), and childhood exposure to outdoor air pollutants (increased asthma severity). Evidence for some proven relationships came from investigation of relatively small numbers of children with high-dose prenatal or early childhood exposures, e.g., CH(3)Hg poisoning episodes in Japan and Iraq. In contrast, consensus on a causal relationship between incident asthma and ETS exposure came only recently after many studies and prolonged debate. There were many relationships supported by limited epidemiologic evidence, ranging from several studies with fairly consistent findings and evidence of dose-response relationships to those where 20 or more studies provided inconsistent or otherwise less than convincing evidence of an association. The latter included childhood cancer and parental or childhood exposures to pesticides. In most cases, relationships supported by inadequate epidemiologic evidence reflect scarcity of evidence as opposed to strong evidence of no effect. This summary points to three main needs: (1) Where relationships between child health and environmental exposures are supported by sufficient evidence of causal relationships, there is a need for (a) policies and programs to minimize population exposures and (b) population-based biomonitoring to track exposure levels, i.e., through ongoing or periodic surveys with measurements of contaminant levels in blood, urine and other samples. (2) For relationships supported by limited evidence, there is a need for targeted research and policy options ranging from ongoing evaluation of evidence to proactive actions. (3) There is a great need for population-based, multidisciplinary and collaborative research on the many relationships supported by inadequate evidence, as these represent major knowledge gaps. Expert groups faced with evaluating epidemiologic evidence of potential causal relationships repeatedly encounter problems in summarizing the available data. A major driver for undertaking such summaries is the need to compensate for the limited sample sizes of individual epidemiologic studies. Sample size limitations are major obstacles to exploration of prenatal, paternal, and childhood exposures during specific time windows, exposure intensity, exposure-exposure or exposure-gene interactions, and relatively rare health outcomes such as childhood cancer. Such research needs call for investments in research infrastructure, including human resources and methods development (standardized protocols, biomarker research, validated exposure metrics, reference analytic laboratories). These are needed to generate research findings that can be compared and subjected to pooled analyses aimed at knowledge synthesis.

Objective: To address the maternal and neonatal risks of both depression and antidepressant exposure and develop algorithms for periconceptional and antenatal management. Method: Representatives from the American Psychiatric Association, the American College of Obstetricians and Gynecologists and a consulting developmental pediatrician collaborated to review English language articles on fetal and neonatal outcomes associated with depression and antidepressant treatment during childbearing.

ll rispetto del binomio “stile di vita & nutrizione” si inserisce universalmente come la nuova fron- tiera preventiva e terapeutica in ambito sociale,  finanziario, sanitario ed epigenetico.

Il rispetto di tale sodalizio nella fase perinatale ne esprime ancor più i benefici nell’immediato e a lungo termine sia per la salute dell’uomo di “per sé” ma anche per le stesse nicchie ecologiche.

Ancel e Maria Keys nel 1961 diedero avvio al primo e più noto studio epidemiologico comparativo tra sette differenti paesi da cui emergeva la dieta mediterranea come la più salutare. Questo studio contribuirà alla definizione e individuazione topografica della DM, con Creta, la Grecia e l’Italia meridionale come il “core” di una dieta che non si limita agli aspetti nutrizionali ma comprende atteggiamenti di frugalità, convivialità, stili di vita attivi e moderazione nei consumi.
La dieta mediterranea non va intesa soltanto per gli specifici riferimenti
agli aspetti nutrizionali, ma comprende anche atteggiamenti di frugalità,
convivialità, stili di vita attivi e moderazione nei consumi.
Il rispetto di tale sodalizio nella fase perinatale ne esprime ancor più i bene ci nell’immediato e a lungo termine sia per la salute dell’uomo di “per sé” ma anche per le stesse nicchie ecologiche.
Dalle ricerche epidemiologiche pioneristiche di Barker sull’effetto perinatale della restrizione dietetica materna in gravidanza e dall’a- nalisi comparata di Ancel Keys nei confronti di abitudini alimentari emerge incontrovertibil- mente che il consumo di una dieta bilanciata e varia prima del concepimento, in gravidanza e puerperio è essenziale per esprimere il potenziale di salute della diade mamma-bambino.

To examine pregnancy outcomes in women age 40 or older. We used data from the California Health Information for Policy Project, which consists of linked records from the birth certificate and the hospital discharge record of both mother and newborn of all births that occurred in acute care civilian hospitals in California between January 1, 1992, and December 31, 1993. The study population consisted of all women who delivered at age 40 or over. The control population was women who delivered between age 20 and 29 years during this 2-year period. We reviewed gestational age at delivery, birth weight, mode and type of delivery, discharge summary and birth certificate demographics, birth outcome, pregnancy, and delivery data. Approximately 1,160,000 women delivered during the study period, and 24,032 (2%) of these women were age 40 or older. Of this latter group, 4777 (20%) were nulliparous. The cesarean delivery rate for nulliparous women in the study population was 47.0%, and the rate...

Normal fetal growth depends on the genetically predetermined growth potential and its modulation by the health of the fetus, placenta and the mother. Fetuses that are small because of intrauterine growth restriction (IUGR) are at higher risk for poor perinatal and long-term outcome than those who are appropriately grown. Of the many potential underlying processes that may result in IUGR,