[Insulin and glucagon plasma levels in very low birth weight preterm infants of appropriate weight for gestational age].
Fábio BagnoliMohamed Lamine ContéRosario MagaldiMauro RinaldiClaudio De FeliceSerafina PerronePiero VezzosiPatrizia PaffettiP. BorgogniMaria Stefania TotiSilvia Badii
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Prematurity is a known risk factor for hypoglycaemia, hyperglycemia, neonatal sepsis and other common neonatal complications, possibly associated with glucoregolatory hormone (insulin and glucagon) alterations. Insulin and glucagon levels change also in relation to gender, mode of delivery and postnatal clinical severity. Because of the lack of reference range in literature, the aim of this study is to assess plasma insulin and glucagon levels in preterm appropriate for gestational age (AGA) infants of birth weight <1500 g (very low birth weight, VLBW) as a function of gestation, birth weight, gender and mode delivery.The authors examined 48 preterm AGA infants (mean birth weight 1 163+/-286 g, mean gestational age 28.2+/-2.4 weeks). The infant population was subdivided in relation to gestational age, weight, gender, mode of delivery and assisted ventilation at 5-7(th) days. Plasma glucose, insulin and glucagon levels were assessed in all newborns at birth and at 5-7(th) days of life. Data were analyzed using t-test.A negative correlation between insulin and gestational age was observed (P<0.05). At birth, no significant differences regarding plasma glucose, insulin and glucagon levels were observed as a function of the examined category variables. At the 5-7(th) days of life, insulin levels were significantly higher in newborns with gestational age =or<27 weeks (P<0.02), in the female gender (P<0.02) and in the infants born to emergency Cesarean delivery (P<0.05).These findings indicate potentially useful reference range values for plasma insulin and glucagon in the VLBW population.Cite
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Sickle cell disease is the most common haemoglobinopathy in pregnancy that can result in small babies. Sickle cell trait's (SCT) influence is unclear with a few conflicting published studies which did not relate birth weight to gestation and maternal or fetal factors. To assess the incidence of small-for-gestation age (SGA) babies in SCT pregnancies we conducted a retrospective analysis of all SCT deliveries at St Thomas' Hospital, London between 2000 and 2005. The Gardosi bulk centile calculator was used to determine the customised birth weight centile accounting for maternal height, weight, parity, ethnicity, infant's birth weight, sex and gestational age. A total of 16.8% (79/471) SCT pregnancies analysed had SGA babies. When cases with identified pregnancy complications were excluded, the SGA rate remained higher than the anticipated 10%, at 14.8% (p
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DOI: http://dx.doi.org/10.3126/njog.v5i2.5075 NJOG 2010 Nov-Dec; 5(2): 26-31
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This study was performed to investigate the impact of hypertensive disorders of pregnancy at term on neonatal birth weight. All singleton live births delivered between 37 and 42 weeks of gestation complicated by hypertensive disorders over a 7-year period (n = 362) was compared to 34 783 uncomplicated singleton deliveries in the same period. The individualized gestation-related optimal weight (GROW) was calculated for each individual case adjusted for the effects of maternal booking weight, height, parity, gestation at delivery, and fetal sex. Small-for-gestational-age (SGA) was defined as a birth weight less than the 10th percentile of the GROW. The incidence of SGA babies was significantly higher in subjects with preeclampsia and eclampsia than in control subjects (24.6 versus 11.3%; odds ratio = 2.55; 95% CI: 1.84, 3.55). Preeclampsia significantly reduced fetal birth weight by 130 g or 4.3%. Those with eclampsia on average had a neonatal birth weight 349 g or 11.0% below that of the GROW. In contrast, there was no significant difference in the incidence of SGA babies or degree of deviation from GROW between those with or without gestational hypertension.
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Abstract Objective Firstly, to establish a reference range of birth weight with gestation at delivery; secondly, to identify maternal characteristics that are significantly associated with birth weight; and thirdly, to determine if combinations of maternal characteristics, fetal nuchal translucency thickness (NT), and serum concentrations of free beta‐human chorionic gonadotrophin (β‐hCG) and pregnancy‐associated plasma protein‐A (PAPP‐A) are significant predictors of small‐for‐gestational‐age (SGA) neonates in the absence of preeclampsia. Method Maternal characteristics were recorded; fetal NT, maternal serum free β‐hCG and PAPP‐A were measured at 11 weeks to 13 weeks 6 days in 33,602 women with singleton pregnancies. Regression analysis was used to determine the association of birth weight with gestation at delivery and to establish a reference range with gestation. Logistic regression analysis was used to determine if maternal factors, fetal NT, free β‐hCG, and PAPP‐A contribute significantly in predicting SGA in the absence of preeclampsia. Results Birth weight increased with maternal weight and height; it was higher in parous than in nulliparous women and in those with a medical history of pre‐pregnancy diabetes mellitus, and it was lower in cigarette smokers, in all racial groups other than in Caucasian women, and in those with a medical history of chronic hypertension and in those who previously delivered SGA neonates. In the SGA group compared with the unaffected group, there were lower median delta NT (0.10 vs 0.12 mm), free β‐hCG [0.9 vs 1.0 MoM (multiples of median)], and PAPP‐A (0.8 vs 1.0 MoM). The prediction of SGA provided by maternal factors was significantly improved by the addition of fetal NT and PAPP‐A (34.0 vs 37.0% at a false‐positive rate of 10%). Conclusion Prediction of the birth of SGA neonates in the absence of preeclampsia can be provided in the first trimester of pregnancy by a combination of maternal characteristics and measurements of parameters used in early screening for aneuploidies. Copyright © 2010 John Wiley & Sons, Ltd.
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