BACKGROUND: Over two-thirds of the United States population is considered overweight or obese. Bariatric surgery is often used when conservative weight loss measures fail. The majority of bariatric surgeries are performed on women of childbearing age. Women who become pregnant following bariatric surgery have a decreased occurrence of gestational diabetes, hypertensive disorders and macrosomia, but they also have an increased risk of small for gestational age infants (SGA), with the greatest risk of SGA infants following malabsorptive and mixed bariatric surgery procedures. STUDY: A gap in the literature exists regarding the risks of SGA and intrauterine growth restriction (IUGR) following Roux-en-Y gastric bypass (RYGB) compared to sleeve gastrectomy (SG), the two most common procedures in the United States in 2014. This study will be a multi-center retrospective cohort study that will identify the risk of IUGR following RYGB and SG. CONCLUSION: This study will improve our understanding of the effects on pregnancy following RYGB and SG. The most innovative, and hardest, part of this study will be the collection of data on as many SG women as possible. This will be the biggest hurdle because SG is a relatively new procedure, so the prevalence of pregnancy following SG is low. PUBLIC HEALTH SIGNIFICANCE: A better understanding of the effects of the most common bariatric procedural types on pregnancy is important given the prevalence of bariatric surgery among women of childbearing age. It will allow bariatric surgeons to better council their patients on a surgery type for those that may be considering pregnancy afterwards, and enable obstetricians to have a better understanding of the risks associated with their patient’s pregnancy.

Objective: To examine differences in the antenatal detection rate of small for gestational age (SGA) infants among several race-ethnicity groups and determine whether perinatal outcomes differ in antenatally detected versus undetected SGA infants according to race-ethnicity. Methods: A retrospective cohort study was conducted at a single tertiary care center that evaluated all deliveries of SGA infants >23 weeks gestation between January 2016-January 2020. Race and ethnicity were self-reported and categorized as non-Hispanic White, non-Hispanic Black, Hispanic, or Asian. The medical charts of those eligible were reviewed and the primary study outcomes were analyzed using multivariable logistic regression analyses with accompanying point estimates and 95% confidence intervals. Results: A total of 526 childbearing persons satisfied our predefined inclusion criteria. The predominant race-ethnicity group was non-Hispanic White who comprised 50% of the study population. Antenatal detection rate of SGA was found to be 38%. The detection rate, while not statistically different, ranged from 28-40% according to race-ethnicity with Asians having the lowest detection rates. Higher rates of preterm birth, labor induction, and lower median birthweights were observed in antenatally detected versus undetected SGA pregnancies. However, no significant differences were observed with regards to perinatal outcomes when antenatally detected versus undetected SGA was compared according to race-ethnicity. Conclusions: Antenatal detection may not be the primary solution to improving racial and ethnic disparities among SGA infants. Additional investigation to identify, address, and improve disparities in other areas of perinatal medicine is necessary to provide more equitable care. Further work to investigate the barriers to antenatal detection of SGA is warranted as an avenue for improving perinatal outcomes.

Vielfältige Studien haben bereits Zusammenhänge zwischen niedrigem Geburtsgewicht und der Entwicklung von Adipositas und eines metabolischen Syndroms im späteren Lebensalter dargestellt. Umfangreiche Daten liegen vor allem für frühgeborene Neonaten vor. Ziel dieser Arbeit ist deshalb die Bewertung perinataler Parameter und der frühen Entwicklung reifer SGA – Neugeborener. Für die vorliegende prospektive Studie wurden 50 Neugeborene mit einem Geburtsgewicht < 10. Perzentile und 50 eutrophe Neugeborene erfasst. Bei allen Kindern wurden anamnestische Befunde zum Schwangerschaftsverlauf, die Biometrie der Eltern sowie Daten zur Geburt und zum stationären Verlauf erfasst. Mit Hilfe eines standardisierten Fragebogens an die niedergelassenen Kinderärzte erfolgte die Nachbeobachtung der Kinder hinsichtlich der Gewichts–, Längen– und Kopfumfangsentwicklung sowie der Ernährung bis zur 15. Lebenswoche. Die Ergebnisse der Studie zeigen, dass nur 13% der SGA – Kinder ein genetisch vermindertes Wachstumspotential haben. Demnach liegt bei der Mehrzahl der SGA – Geborenen ein pathologischer Mechanismus zugrunde. Während der Schwangerschaft waren in der SGA – Gruppe häufiger uterine Perfusionsstörungen bei einem erhöhten Auftreten von Präeklampsien oder Nikotinabusus darstellbar. Die SGA – Kinder wurden häufiger per sectionem geboren und zeigten zu einem erhöhten Anteil Dysmaturitätszeichen als Ausdruck einer intrauterinen Stress– oder Mangelsituation. Aufgrund der perinatalen Risiken sollte die Geburt dieser Kinder in einem Perinatalzentrum erfolgen. In der SGA – Gruppe bestand eine signifikante Korrelation zwischen Gestationsalter und Geburtsgewicht, deshalb ist eine individuelle Abwägung des Geburtszeitpunktes zur Nutzung des noch vorhandenen intrauterinen Wachstumspotentials erforderlich. Kinder der SGA – Gruppe bedurften häufiger einer intensivmedizinischen Betreuung und hatten einen längeren stationären Aufenthalt als Kinder der Vergleichsgruppe; Säurebasenstatus, APGAR – Werte und Blutdruck unterschieden sich nicht. Während des stationären Aufenthaltes wurden die SGA – Neonaten vermehrt zugefüttert und zeigten eine geringere postnatale Gewichtsabnahme. Nach der Entlassung kam es, bezogen auf die Körperlänge, zu einer stärkeren und rascheren Gewichtszunahme bei SGA – Kindern, während die Längendifferenz zunächst bestehen blieb. Ein frühes Aufholwachstum, welches sich in dieser Studie isoliert auf das Gewicht bezieht, ist hinsichtlich späterer metabolischer Störungen als möglicher Risikofaktor zu werten.

Vielfältige Studien haben bereits Zusammenhänge zwischen niedrigem Geburtsgewicht und der Entwicklung von Adipositas und eines metabolischen Syndroms im späteren Lebensalter dargestellt. Umfangreiche Daten liegen vor allem für frühgeborene Neonaten vor. Ziel dieser Arbeit ist deshalb die Bewertung perinataler Parameter und der frühen Entwicklung reifer SGA – Neugeborener. Für die vorliegende prospektive Studie wurden 50 Neugeborene mit einem Geburtsgewicht < 10. Perzentile und 50 eutrophe Neugeborene erfasst. Bei allen Kindern wurden anamnestische Befunde zum Schwangerschaftsverlauf, die Biometrie der Eltern sowie Daten zur Geburt und zum stationären Verlauf erfasst. Mit Hilfe eines standardisierten Fragebogens an die niedergelassenen Kinderärzte erfolgte die Nachbeobachtung der Kinder hinsichtlich der Gewichts–, Längen– und Kopfumfangsentwicklung sowie der Ernährung bis zur 15. Lebenswoche. Die Ergebnisse der Studie zeigen, dass nur 13% der SGA – Kinder ein genetisch vermindertes Wachstumspotential haben. Demnach liegt bei der Mehrzahl der SGA – Geborenen ein pathologischer Mechanismus zugrunde. Während der Schwangerschaft waren in der SGA – Gruppe häufiger uterine Perfusionsstörungen bei einem erhöhten Auftreten von Präeklampsien oder Nikotinabusus darstellbar. Die SGA – Kinder wurden häufiger per sectionem geboren und zeigten zu einem erhöhten Anteil Dysmaturitätszeichen als Ausdruck einer intrauterinen Stress– oder Mangelsituation. Aufgrund der perinatalen Risiken sollte die Geburt dieser Kinder in einem Perinatalzentrum erfolgen. In der SGA – Gruppe bestand eine signifikante Korrelation zwischen Gestationsalter und Geburtsgewicht, deshalb ist eine individuelle Abwägung des Geburtszeitpunktes zur Nutzung des noch vorhandenen intrauterinen Wachstumspotentials erforderlich. Kinder der SGA – Gruppe bedurften häufiger einer intensivmedizinischen Betreuung und hatten einen längeren stationären Aufenthalt als Kinder der Vergleichsgruppe; Säurebasenstatus, APGAR – Werte und Blutdruck unterschieden sich nicht. Während des stationären Aufenthaltes wurden die SGA – Neonaten vermehrt zugefüttert und zeigten eine geringere postnatale Gewichtsabnahme. Nach der Entlassung kam es, bezogen auf die Körperlänge, zu einer stärkeren und rascheren Gewichtszunahme bei SGA – Kindern, während die Längendifferenz zunächst bestehen blieb. Ein frühes Aufholwachstum, welches sich in dieser Studie isoliert auf das Gewicht bezieht, ist hinsichtlich späterer metabolischer Störungen als möglicher Risikofaktor zu werten.

Introdução: O comprimento telomérico é estudado em vários processos da relação saúdedoença, tais quais estresse oxidativo, processo inflamatório e estresse crônico e parece ser modulado por fatores genéticos e ambientais, além de estar associado a doenças como aterosclerose, doença de Alzheimer, insuficiência cardíaca e disqueratose congênita. Nosso estudo buscou entender a relação entre os telômeros de recém-nascidos e a gestação sob condições adversas. Objetivo: avaliar o impacto da exposição a diferentes ambientes intrauterinos sobre o comprimento de telômeros dos recém-nascidos. Métodos: o comprimento telomérico foi avaliado através do método de qPCR (Razão T/S) de células da mucosa oral de uma amostra conveniência de 239 pares de mãe e recémnascido, divididos nos seguintes grupos de mães: diabéticas (DM) (n=39), hipertensas (HAS) (n=16), tabagistas (n=52), controle (n=99) e mães que tiveram filhos pequenos para a idade gestacional (PIG) (n=33). Resultados: Em todos os grupos observamos uma correlação fraca entre o comprimento telomérico da mãe e da criança (r= 0,229) (p<0,001). Não houve diferença significativa no comprimento telomérico entre os grupos DM, HAS, PIG, Tabaco e Controle. Entretanto, dentro do grupo Tabaco houve diferença significativa numa relação dose-resposta inversa, de maior consumo de cigarro e comprimento telomérico menor, tanto para a mãe (p=0,020) quanto para o recém-nascido (p=0,033). Conclusão: os achados deste estudo sugerem que o uso do tabaco na gestação pode exercer influência negativa sobre o comprimento dos telômeros tanto da mãe quanto do seu filho. / Background: Telomere lenght has been studied in several health-disease processes, such as oxidative stress, inflammatory process and chronic stress. It seems to be influenced by genetic and environmental issues, and it is associated with diseases such as atherosclerosis, Alzheimer's disease, heart failure and congenital dyskeratosis. Our study searched to understand the relationship between newborns telomeres and adverse intrauterine conditions. Objective: to evaluate the impact of exposure to different intrauterine environments on the telomere length of newborns. Methods: the telomere length was evaluated by qPCR (T/S ratio) on oral mucosa cells of a convenience sample of 239 pairs of mother and newborn, divided according to the following groups of mothers: diabetic (DM) (n = 39), hypertensive (HAS) (n = 16), tobacco (n = 52), controls (n = 99) and mothers who had small children for gestational age (SGA) (n = 33). Results: In all groups we observed a weak correlation between the telomere of the mother and the son (r= 0.229) (p <0.001). There was no significant difference in telomere size between DM, HAS, SGAG, Tobacco and Control groups. However, in the Tobacco group there was a significant difference in an inverse dose-response relationship: higher cigarette consumption and lower telomere length, both for the mother (p = 0.020) and for the newborn (p = 0.033). Conclusion: the findings of this study suggest that tobacco use during gestation may induce a negative influence on the telomere length of both the mother and her child.

Vitamin D status is assessed with circulating 25-hydroxyvitamin D [25(OH)D]. As some evidence suggests that low vitamin D status adversely affects neonatal health, this project aimed to determine the association between cord blood 25(OH)D levels and preterm birth (PTB; <37 weeks gestation), low birthweight (LBW; <2500 grams) and small for gestational age (SGA; <10th percentile) and to examine the relationship between maternal 25(OH)D levels during the first trimester of pregnancy and fetal 25(OH)D levels at birth in a Canadian population. This nested case-control study used serums, questionnaires and chart reviews collected in Quebec City. Compared to 25(OH)D concentrations ≥75 nmol/L, concentrations 37.5-<75, 50-<75, and <75 nmol/L were associated with lower odds of LBW, PTB and an adverse neonatal composite outcome, and PTB as well as LBW, respectively. Maternal and neonatal 25(OH)D were correlated (r=0.23, p<0.01; adjusted r=0.46, p<0.01). This study contributes to evidence for identifying further policy and research directions.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

The adverse effects of maternal smoking on infant mortality and morbidity has been well documented in the literature. Maternal tobacco use is causally associated with fetal growth restriction and correlates negatively with folate intake and metabolism. Studies have examined the association between smoking and folate levels during pregnancy, but very few have assessed this relationship using objective and accurate measures of both variables. Furthermore, despite evidence of a causal association between smoking in pregnancy and intrauterine growth restriction, and a plausible relationship between tobacco use and low maternal folate which is required for optimal fetal growth, no experimental study has investigated the potential benefit of folic acid in mitigating the adverse effects of maternal smoking on fetal outcomes. The objectives of this study were to investigate the relationship between maternal smoking and folate levels and examine the efficacy of higher-strength folic acid supplementation, in combination with enrollment in a smoking cessation program, in promoting fetal body and brain growth. Our hypothesis was that women who smoke during pregnancy have lower peri-conceptional folic acid reserves than non-smoker pregnant women and that folic acid reserves will decrease with increasing cotinine level. Additionally, smoker pregnant women on higher-strength folic acid (4mg daily) in combination with smoking cessation programs will experience faster fetal brain growth and have infants with larger body size at birth compared to smokers on the standard dose of folic acid (0.8mg daily). Participants were pregnant women (smokers and non-smokers) who received antenatal care between 2010-2014 at the Genesis Clinic of Tampa, a community health center affiliated with the Department of Obstetrics and Gynecology of the University of South Florida (USF). They were aged 18-44 years and had a gestational age of less than 21 weeks at study enrollment. To determine the peri-conceptional folic acid reserves in smoking versus nonsmoking women during pregnancy and associated sociodemographic factors, baseline (crosssectional) data from a double-blinded randomized controlled trial were analyzed using Tobit regression models (n=496). Smoking information was assessed using salivary cotinine, a sensitive and specific tobacco use biomarker. Folate reserve was measured using red blood cell folate. To investigate the efficacy of higher-strength folic acid on fetal body and brain size, baseline and follow-up data from pregnant smokers enrolled in the randomized controlled trial were utilized (n=345). All primary analyses of the clinical trial data were conducted on a modified intention-to-treat basis and included participants who completed the trial with an observed endpoint, irrespective of compliance to protocol. Multilevel modeling, linear regression, and log-binomial regression analyses were conducted. A significant inverse association between salivary cotinine level and periconceptional red blood cell folate concentration was found among pregnant women in the early to midpregnancy period. Smokers on high-dose folate during pregnancy had infants with a 140.38g higher birth weight than infants of their counterparts on standard dose folate (P =0.047). Mothers who received higher strength folate had a 31.0% lower risk of having babies with SGA compared to their mothers on the standard-dose (adjusted relative risk-ARR=0.69, 95% CI: 0.46–1.03; (P =0.073)). High-dose folate had no significant effect on the intrauterine rate of growth in head circumference, and head circumference and brain weight at birth in our trial sample. However, the brain-body ratio of infants of mothers who received high-dose treatment was 0.33 percentage-point lower than that for infants of mothers who received the standard dose of folate (P =0.044). Higher strength folic acid supplementation in pregnant women who smoke might be a cost-effective and safe option to improve birth outcomes and reduce low birth weight and SGA associated infant morbidity and mortality. Future studies with larger sample sizes and diverse populations are indicated to confirm or refute the results of this study. Randomized controlled trials starting during the preconception period and with follow-up until delivery are warranted, to identify the most folate-sensitive period of fetal growth and determine the optimal dose of folic acid supplement. Further research investigating several pathways through which the effects of prenatal smoking on adverse birth outcomes can be mitigated is needed.

Introdução: Evidências sugerem uma associação entre nascer pequeno para idade gestacional (PIG) e o risco aumentado de desenvolver problemas de comportamento. Além disso, indivíduos que relatam ter recebido menor cuidado materno apresentam mais sintomas de depressão e de ansiedade, e, de modo geral, cuidam com menos eficiência de seus filhos. Portanto, uma interação entre nascer PIG e a percepção da mãe de baixo cuidado materno recebido nos seus primeiros dezesseis anos de vida poderia estar associada a prejuízos na função cognitiva e risco aumentado para psicopatologias ao longo da vida. O objetivo deste trabalho foi avaliar a interação entre nascer PIG e o cuidado parental percebido pela mãe sobre o comportamento infantil aos 18 meses de vida. Métodos: Estudo transversal aninhado a uma coorte prospectiva canadense de nascimentos – MAVAN (Maternal Adversity, Vulnerability and Neurodevelopment) – realizada entre os anos de 2003 e 2010. Os dados analisados são provenientes de 3 questionários (Parental Bonding Instrument, PBI, Early Chidhood Behavior Questionnaire, ECBQ e Infant-Toddler Social and Emotional Assessment, ITSEA) respondidos pelas mães de 305 crianças. Para análise utilizamos Multivariate Analysis of Variance (MANOVA) com análise de interação para detecção das diferenças entre os grupos. Resultados: Observou-se uma interação entre o cuidado materno percebido pela mãe e o peso ao nascimento na habilidade atencional de crianças aos 18 meses de vida em ambos os instrumentos ECBQ e ITSEA. Crianças nascidas PIG e de mães que relataram ter recebido baixo cuidado materno alcançaram menores escores de atenção relatados nos dois questionários analisados - ECBQ (p=0,002) e ITSEA (p=0,05). Efeitos principais das variáveis preditoras peso ao nascimento sobre os domínios aconchego (p=0,011), assim como do cuidado materno sobre os domínios prazer de baixa intensidade (p=0,016) e transferência de atenção (p=0,004) do ECBQ também foram encontrados. Conclusão: Os achados reforçam a importância de uma visão sistêmica do desenvolvimento que contemple aspectos do ambiente precoce e de cuidados parentais nos primeiros anos de vida. Além disso, o comprometimento da atenção encontrado já aos 18 meses nessas crianças tem implicâncias clínicas, visto que pode servir como sinal de alerta, sugerindo a necessidade de um acompanhamento precoce para esses sujeitos. / Introduction: Evidence suggests an association between being born small for gestational age (SGA) and the increased risk for behavioral problems. Besides that, individuals who report have received lower quality of maternal care show increased prevalence of depression and anxiety, as well as in general are poorer caregivers of their offspring. Therefore, an interaction between the birth weight status and the quality of maternal care perceived by the mother could affect the cognitive functioning later in life. This study aimed to evaluate the interaction between being born SGA and the parental bonding perceived by the mother on the children’s behavior at 18 months of age. Methodology: a nested cross-sectional evaluation of a prospective Canadian birth cohort (MAVAN, Maternal Adversity, Vulnerability and Neurodevelopment), developed between the years of 2003 and 2010. Data from 305 children evaluated at 18 months of age and that had all three questionnaires completed (Parental Bonding Intrument - PBI, Early Chidhood Behavior Questionnaire - ECBQ and Infant-Toddler Social and Emotional Assessment – ITSEA) were used. Multivariate ANOVA accounting for parental interactions was used for the analysis. Results: Children born SGA from mothers reporting low maternal care had lower scores in the attentional set shifting trait (ECBQ, p=0.002) and attention construct (ITSEA, p=0.05) at 18 months of age. We also found isolated effects of SGA decreasing cuddliness (p=0.011) and high maternal care per se increased ECBQ low intensity pleasure (p=0.016) and attentional shifting (p=0.004). Conclusion: The findings reinforce the importance of a systemic developmental vision that integrates early environmental aspects and parental care in the first years of life. Besides, the effects on attention found already at 18 months have clinical relevance as it may serve as a warning sign for this population.