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Fetal programming
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Katherine E. Pelch, Jana L. Allison, Susan C. Nagel
While the increase risk of adult disease in association to low birth weight continues to be a major concern in both developing and developed countries, an equally important association with the effects of being born large for gestational age must also be studied, especially in light of the growing obesity epidemic. Large for gestational age is typically defined as birth weight greater than the 90th percentile for gestational age and is often associated with maternal obesity and/or diabetes (24). When excess maternal glucose crosses the placenta, the fetus becomes hyperglycemic and then experiences hyperinsulinemia. As insulin is an important growth factor for the developing fetus, aberrant circulating levels negatively affect adipose, muscle, and cardiac tissues resulting in a large or macrosomic baby (24). Large babies and those born to diabetic mothers are more likely to experience complications during delivery and, as adolescents, are more likely to be obese and to develop type II diabetes (8,9,24–27).
Personalized Nutrition in Chronic Kidney Disease
Published in Nilanjana Maulik, Personalized Nutrition as Medical Therapy for High-Risk Diseases, 2020
The literature on vegan, vegetarian or plant-based diets in pregnancy is limited, and heterogeneous. A systematic review based on seven papers supports the position of the American Dietetic Association: ‘well-planned vegetarian diets are appropriate for individuals during all stages of the lifecycle, including pregnancy, lactation, infancy, childhood’ (Craig and Mangels 2009). A second review, targeting plant-based diets outside the context of limited resources, analyzed 29 papers. None of the studies suggested a higher risk for severe adverse pregnancy-related events in vegan/vegetarian mothers (Piccoli, Clari et al. 2015). A slightly shorter duration of gestation, and lower infant weight, both in the normal and ‘atterm’ range, were reported in some studies. However, it is not clear if this reflects protection against large for gestational age babies, or a higher prevalence of small for gestational age babies (Piccoli, Clari et al. 2015). The only relevant note of caution was the finding in one large study of a higher incidence of hypospadias in the children of vegan mothers, which has remained unexplained and unconfirmed (North and Golding 2000). It is crucial to prevent nutritional deficits, in particular of vitamin B12, vitamin D, iron and zinc, and their levels need to be regularly monitored in our on-diet patients (Foster, Herulah et al. 2015; Piccoli, Clari et al. 2015).
Sleep and pregnancy complications
Published in Moshe Hod, Vincenzo Berghella, Mary E. D'Alton, Gian Carlo Di Renzo, Eduard Gratacós, Vassilios Fanos, New Technologies and Perinatal Medicine, 2019
Fetal growth: The effect of maternal SDB on fetal growth has been studied in recent years, but most of the studies used subjective assessment of sleep; the latter suggested that there is no clear association between birth weight and SDB. A small number of studies have thus far used objective assessment of sleep during pregnancy, and most of them were retrospective, using large epidemiological databases, and revealed inconsistent findings. Recently, we published a prospective study on the anthropometric outcomes of infants born to nonobese otherwise healthy pregnant women with SDB. We demonstrated that maternal SDB in pregnancy—even in a mild form—was associated with accelerated fetal growth, increased birth weight, birth length, and greater adiposity. The proportion of large for gestational age babies was significantly higher among those nonobese healthy women (25).
Correlation of Maternal Neck/Waist Circumferences and Fetal Macrosomia in Low-Risk Turkish Pregnant Women, a Preliminary Study
Published in Fetal and Pediatric Pathology, 2021
Necati Hancerliogullari, Hatice Kansu-Celik, Z. Asli Oskovi Kaplan, Aysegul Oksuzoglu, A. Seval Ozgu-Erdinc, Yaprak Engin-Ustun
In a term fetus, birthweight of 2500–4000 is considered “normal”. Fetal macrosomia is defined as birth weight higher than 4000 or 4500 grams, varying in different reports, regardless of gestational age [1, 2]. Large for gestational age is defined as fetal weight >90th percentile of gestational age [1]. Fetal macrosomia affects 3%–15% of pregnancies. Increased fetal weight is associated with multiparity, history of macrosomic infant, fetal gender, maternal factors such as obesity and pre-pregnancy body mass index (BMI), diabetes, excessive weight gain in pregnancy, and also increased complications such as birth trauma, shoulder dystocia and brachial plexus injury [3, 4]. Fetal macrosomia is also a risk factor for prolonged labor, need of augmentation with oxytocin, cesarean delivery, prolonged hospitalization and maternal morbidity [1, 5].
Incidence of large for gestational age and predictive values of third-trimester ultrasound among pregnant women with false-positive glucose challenge test
Published in Journal of Obstetrics and Gynaecology, 2021
Pornpimol Ruangvutilert, Thanthip Uthaipat, Chutima Yaiyiam, Dittakarn Boriboonhirunsarn
Gestational diabetes mellitus (GDM), is defined as glucose intolerance with onset or first recognition during pregnancy (Hod et al. 2015; American College of Obstetricians and Gynaecologists. Committee on Practice Bulletins-Obstetrics 2018; American Diabetes Association 2018). GDM is associated with increased perinatal and maternal morbidity. Foetal risks include large for gestational age (LGA), macrosomia, shoulder dystocia, birth injuries, hypoglycaemia, and potential long-term sequelae such as obesity. Maternal risks include preeclampsia, caesarean delivery, birth passage injuries, and subsequent diabetes mellitus (Boriboonhirunsarn et al. 2006; Wendland et al. 2012; Hod et al. 2015; American College of Obstetricians and Gynaecologists. Committee on Practice Bulletins-Obstetrics 2018; American Diabetes Association 2018). A continuous relationship between maternal hyperglycaemia and birth weight greater than the 90th percentile, caesarean delivery, neonatal hypoglycaemia, and foetal hyperinsulinemia has been reported from the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study (The HAPO Study Cooperative Research Group 2008).
Effectiveness of multimodal nutrition interventions during pregnancy to achieve 2009 Institute of Medicine gestational weight gain guidelines: a systematic review and meta-analysis
Published in Annals of Medicine, 2021
Andrew R. Beauchesne, Kelly Copeland Cara, Jiawen Chen, Qisi Yao, Laura Paige Penkert, Wenfang Yang, Mei Chung
Pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are important determinants for pregnancy and neonatal outcomes. The Centers for Disease Control and Prevention (CDC) reported that only 32% of women in the United States achieved appropriate GWG, whereas 48% of women had excessive GWG and 20% of women had inadequate GWG [1]. Both excessive and inadequate GWG are associated with a number of adverse maternal and infant outcomes [2]. In pregnant women, excessive GWG is associated with hypertensive disorders [3], gestational diabetes [4], caesarean section [3], complications at delivery [5, 6], and post-partum weight retention [7]. In infants, excessive GWG is associated with fetal macrosomia and large for gestational age [2], future overweight and obesity [8], morbidity [6], and mortality [9]. Large for gestational age infants are at higher risk for perinatal [10] and long-term adverse health outcomes [11,12]. According to national CDC survey data, the prevalence of overweight or obesity among U.S. women of childbearing age increased from 22.8% in 1976 to 53.5% in 2014 [13]. In 2010, nearly 56% of pregnant women with overweight and 59% with obesity exceeded the recommended weight gain during pregnancy [14]. Compared to women with normal weight, excessive GWG may put women with overweight and obesity at even higher risk for hypertensive disorders in pregnancy as well as caesarean delivery [6]. Inadequate GWG, particularly among women who are underweight, is associated with increased risk of delivering an infant with low birthweight or small for gestational age [2].