Variation in early neonatal mortality for different types of fetal growth retardation

Birth and first-48-hr death records were analyzed for 10,024 liveborn infants in Mexico City and 12,786 liveborn infants in Santa Cruz, Bolivia. The objective of the analysis was to characterize the early postnatal mortality rates for different types of fetal growth retardation and prematurity. Infants who were delivered prior to 37 weeks of gestation had 23-100 times the mortality risk of infants born at full term and normal weight. Light-for-gestational-age infants (birth weight less than 2,900 g) were further divided into proportionately growth-retarded with normal Rohrer's index (weight/height) and disproportionately growth-retarded with low Rohrer's index. The proportionately growth-retarded infant had nearly twice the mortality of the full-term, appropriate-weight infants, whereas the disproportionately growth-retarded infants had 2.9-5.7 times the mortality rate of the full-term, appropriate-weight infants. There were some differences between samples in mortality rates and prevalence of the different classes of small infants, but the pattern of mortality within samples was consistent between samples.     

Heritability estimates of body size in fetal life and early childhood

Background

The objective was to estimate the heritability for height and weight during fetal life and early childhood in two independent studies, one including parent and singleton offsprings and one of mono- and dizygotic twins.

Methods

This study was embedded in the Generation R Study (n = 3407, singletons) and the Netherlands Twin Register (n = 33694, twins). For the heritability estimates in Generation R, regression models as proposed by Galton were used. In the Twin Register we used genetic structural equation modelling. Parental height and weight were measured and fetal growth characteristics (femur length and estimated fetal weight) were measured by ultrasounds in 2^nd and 3^rd trimester (Generation R only). Height and weight were assessed at multiple time-points from birth to 36 months in both studies.

Results

Heritability estimates for length increased from 2^nd to 3^rd trimester from 13% to 28%. At birth, heritability estimates for length in singletons and twins were both 26% and 27%, respectively, and at 36 months, the estimates for height were 63% and 72%, respectively. Heritability estimates for fetal weight increased from 2^nd to 3^rd trimester from 17% to 27%. For birth weight, heritability estimates were 26% in singletons and 29% in twins. At 36 months, the estimate for twins was 71% and higher than for singletons (42%).

Conclusions

Heritability estimates for height and weight increase from second trimester to infancy. This increase in heritability is observed in singletons and twins. Longer follow-up studies are needed to examine how the heritability develops in later childhood and puberty.     

Gender-specific growth patterns for stature,sitting height and limbs length in Croatian children and youth (3 to 18 years of age)

In a cross-sectional study of growth, 5,155 children (2,591 females, 2,564 males) from the town of Zagreb (Croatia) were measured. Four traits of linear dimensionality (stature, sitting height, arm and leg lengths) were studied in the age span of 3 to 18 years. A significant average annual increase of all four anthropometric parameters were observed up to 14 and 15 years of age in girls and 16 years of age in boys, showing that girls had a shorter growing period. In the prepubertal period until 9 years of age, gender differences were negligible. At the age of 10, boys were overgrown by girls in all parameters due to the earlier onset of puberty in girls. The growth gains for girls, when compared with those for boys, show a different pattern across variables. The female growth advantage remained in a two years period for the limbs length, but in a three year period for stature and the longest, for 4 years, for sitting height. The male predominance in size had an onset at the age of 13 for the limbs and in the age of 14 for stature and sitting height. The patterns of sexual dimorphism in stature and sitting height during growing years are similar to those observed in other populations of Europe. Growth of Croatian children and youth is very similar to that of the tallest European populations.     

Maternal nutrition in early and late pregnancy in relation to placental and fetal growth.

OBJECTIVE: To assess how nutrient intakes of mothers in early and late pregnancy influence placental and fetal growth. DESIGN: Prospective observational study. SETTING: Princess Anne Maternity Hospital, Southampton. SUBJECTS: 538 mothers who delivered at term. MAIN OUTCOME MEASURES: Placental and birth weights adjusted for the infant''s sex and duration of gestation. RESULTS: Mothers who had high carbohydrate intakes in early pregnancy had babies with lower placental and birth weights. Low maternal intakes of dairy and meat protein in late pregnancy were also associated with lower placental and birth weights. Placental weight fell by 49 g(95% confidence interval 16 g to 81 g; P=0.002) for each log g increase in intake of carbohydrate in early pregnancy and by 1.4 g (0.4 g to 2.4 g; P=0.005) for each g decrease in intake of dairy protein in late pregnancy. Birth weight fell by 165 g (49 g to 282 g; P=0.005) for each log g increase in carbohydrate intake in early pregnancy and by 3.1 g (0.3 g to 6.0 g; P=0.03) for each g decrease in meat protein intake in late pregnancy. These associations were independent of the mother''s height and body mass index and of strong relations between the mother''s birth weight and the placental and birth weights of her offspring. CONCLUSION: These findings suggest that a high carbohydrate intake in early pregnancy suppresses placental growth, especially if combined with a low dairy protein intake in late pregnancy. Such an effect could have long term consequences for the offspring''s risk of cardiovascular disease.     

Poor growth prior to early childhood: decreased health and life-span in the adult

Previous studies in animal populations have shown that stunted neural and thymolymphatic growth early in development may result in permanently impaired neural and immune function, decreased body growth, vertebral wedging, and decreased life-span. In the human adult, small vertebral neural canal (VNC) diameters may reflect early stunted neural and immune development and impaired function that leads to decreased health (inferred by greater vertebral wedging) and life-span in the adult. VNC, which complete their growth by early childhood (age 4), are markers of early development in adults. On the other hand, features following general body growth, such as height, weight (represented here by vertebral body height) continues to grow until young adulthood. They are less reliable, because they readily experience catch-up growth (even in chronically stressed populations) and, unlike VNC, may mask poor early growth. To test associations between early growth and adult health and life-span in humans, we measured 2,060 VNC, vertebral heights, vertebral wedging, nerve-root tunnel lengths, severity of vertebral osteophytosis, and ages at death in 90 adult (aged 15-55 years) prehistoric skeletons (950-1300 A.D.). Tibial lengths were also measured in a subsample (n = 30). Multivariate, bivariate, and nonparametric analyses showed that small VNC are significantly associated with greater vertebral wedging and decreased life-span (P less than 0.05-0.00001). VNC are independent of vertebral body heights and tibial lengths (general body growth). VNC, but not statural components, are useful in predicting adult health, presumably because they reflect neural and immune development and do not readily experience catch-up growth. Thus, longitudinal retrospective measures of early growth and adult health were systematically linked within individuals regardless of confounding factors operating over the 350-year time period. Since this research was completed, this model has repeatedly been independently confirmed in four living urban industrial populations. Longitudinal retrospective analysis was employed together with direct measures of VNC, neural and immune function. Together these results suggested that it may be essential to improve growth prior to early childhood in order to maximize adult health and life-span.     

The rate of early fetal growth in the human subject

Data from 354 embryos and fetuses between 20 and 200 mm crown rump length obtained by therapeutic abortion in 3 different countries were evaluated. All Danich and Hungarian and the majority of American specimens were measured immeditely after delivery in the fresh condition. In the mathematical evaluation linear regressions were calculated by the method of least squares for arbitrarily defined ranges to 20-50 mm and 50-200 mm crown rump lenghts. The material was analyzed statistically so that confidence limits could be drawn for the estimation of gestational age from crown rump length measurements. All data in the 20-50 mm range were combined, but beyond that fetal length the statistics for the Hungarian group were calculated separatley. The equation calculated to fit the data in the 20-50 mm rage is A = 46 + 0.71 L where A is gestational age in days and L is crown rump lenght in mm. The 95% confidence limits of regression are 0.57-0.83 days/mm and the correlation between gestational age and crown rump length is 0.65. Estimates of gestational age from sitting height measurements can be made + or - 15 days with 95% confidence. The equation for the combined Danish and American data in the range 50-200 mm is A = 64 + 0.41 L. The 95% confidence limits for the regression are 0.36-0.46 days mm and the correlation between gestational age and crown rump length is 0.70. Estimates of gestational age from crown rump length can be made + or - 26 days with 95% confidence. The data from the Hungarian study in the 50-200 mm sitting height range differ from those of the combined Danish and American material. The regression of days/mm (0.22) was significantly less at p. 01 level supporting the suspected bias in the Hungarian material, but the correlation between gestational age and crown rump length, 0.62, was not significantly less than that of the combined Danish and American data. Thus, if the difference in the slope was due to a bias, the bias was relatively consistent from patient to patient. Comparison of the results with those of Streeter (1920, 1951) indicates that the considerable discrepancy at the embryonic stages diminishes gradually in the fetal period and eventually becomes quite insignificant.     

Regression analysis of four physical characteristics—stature,length of thigh,length of leg and length of foot of the male population in Sichuan Province

Using four physical characteristics of 394 adult male individuals in the Sichuan Province of China — stature, length of thigh, length of leg and length of foot, a series of linear regression equations and ternary regression equations have been established. Meanwhile three stepwise regression equations also have been established including a quarternary regression equation. Generally speaking, the established multiple equations in this study should be applied as much as possible, where there are two or three independent variables, because they predict more effectively in the individual identification of forensic practice.     

Firstborn sex defines early childhood growth of subsequent siblings

Animal studies have shown that maternal resource allocation can be sex-biased in order to maximize reproductive success, yet this basic concept has not been investigated in humans. In this study, we explored relationships between maternal factors, offspring sex and prenatal and postnatal weight gain. Sex-specific regression models not only indicated that maternal ethnicity impacted male (n = 2456) and female (n = 1871) childrens postnatal weight gain differently but also that parity and mode of feeding influenced weight velocity of female (β ± s.e. = −0.31 ± 0.11 kg, p = 0.005; β ± s.e. = −0.37 ± 0.11 kg, p < 0.001) but not male offspring. Collectively, our findings imply that maternal resource allocation to consecutive offspring increases after a male firstborn. The absence of this finding in formula fed children suggests that this observation could be mediated by breast milk. Our results warrant further mechanistic and epidemiological studies to elucidate the role of breastfeeding on the programming of infant growth as well as of metabolic and cardiovascular diseases, with potential implications for tailoring infant formulae according to sex and birth order.     

Bivariate linkage confirms genetic contribution to fetal origins of childhood growth and cardiovascular disease risk in Hispanic children

Birth weight has been shown to be associated with obesity and metabolic diseases in adulthood, however, the genetic contribution is still controversial. The objective of this analysis is to explore the genetic contribution to the relationship between birth weight and later risk for obesity and metabolic diseases in Hispanic children. Subjects were 1,030 Hispanic children in the Viva La Familia Study. Phenotypes included body size, body composition, blood pressure, fasting glucose, insulin, lipids, and liver enzymes. Birth weights were obtained from Texas birth certificates. Quantitative genetic analyses were conducted using SOLAR software. Birth weight was highly heritable, as were all other phenotypes. Phenotypically, birth weight was positively correlated to childhood body size parameters. Decomposition of these phenotypic correlations into genetic and environmental components revealed significant genetic correlations, ranging from 0.30 to 0.59. Negative genetic correlations were seen between birth weight and lipids. The genome scan of birth weight mapped to a region near marker D10S537 (LOD = 2.6). The bivariate genome-wide scan of birth weight and childhood weight or total cholesterol, improved the LOD score to 3.09 and 2.85, respectively. Chromosome 10q22 harbors genes influencing both birth weight and childhood body size and cardiovascular disease risk in Hispanic children.     

Effect of prolonged glucose infusion into fetal sheep on body growth, fat deposition and gestation length

Eleven Merino sheep fetuses were supplemented with glucose by direct continuous intravenous infusion of 50% dextrose into the fetus from day 115 of gestation until spontaneous delivery. Infusion rates of 15 or 25 g/day per kg were used and equivalent volumes of saline were infused into 11 control fetuses. Infusion periods approximated 27 days in both groups. Fetal plasma glucose concentrations were significantly (P less than 0.001) elevated throughout glucose infusion and resulted in variable but consistently higher plasma insulin concentrations in the glucose than in the saline-infused fetuses. Glucose-infused fetuses were significantly heavier than controls (mean +/- SEM; 3.86 +/- 0.16 vs 3.28 +/- 0.24 kg, P less than 0.05) and body fat depots (in g/kg body wt.) were larger in glucose-infused than control fetuses (9.91 +/- 0.65 vs 6.73 +/- 0.37, P less than 0.005, for internal brown fat depots; 1.25 +/- 0.44 vs 0.27 + 0.13, P less than 0.05, for subcutaneous white adipose tissue). The results indicate that growth and lipid deposition in the sheep fetus are responsive to increased glucose supply, an effect which may be mediated through the actions of insulin. Mean gestation length was 146.60 +/- 1.45 days for controls and 144.18 +/- 1.23 days for glucose-infused animals (normal term 150 days).     

Gastrin in fetal and neonatal pigs

1. The concentration and molecular profile of gastrin were examined in plasma and tissue extracts of fetal and neonatal pigs from 93 days gestation up to 12 weeks of age and also in the fetal gastric contents. 2. Gastrin was present in the gastrointestinal tract and plasma of fetal pigs at 93 days gestation. The concentration in both plasma and antral extracts increased progressively up to birth and continued to rise postnatally, reaching a peak at about 3 weeks of age in plasma and 6 weeks in the antrum. 3. In blood the major molecular form of gastrin was G34 (up to 80%), while in the antrum the major form was G17 (66-91%). The percentage of G34 in the antrum was highest in later gestation (21%), and reached adult proportion by 8 weeks of age (4%). 4. A considerable amount of gastrin, chiefly G17, was detected in the fetal gastric contents. Synthetic human G17 was stable in fetal gastric contents when incubated at 37 degrees C for 60 min, although, when incubated with gastric contents from a sow, it disappeared within 5 min. 5. It is suggested that the presence of gastrin in fetal gastric contents may be important in stimulation of fetal gut development.     

Gestation length, mode of delivery, and neonatal line-thickness variation

The transition from an intra- to extra-uterine environment leaves its mark in deciduous teeth (and first permanent molars) as an accentuated enamel incremental ring called the neonatal line (NL). This prominent microfeature separates the enamel formed during intrauterine life from that formed after leaving the womb. However, while the physical structure of this scar is well known, the bases of its formation are still a matter of investigation. In particular, besides the influence of the birth-related abrupt environmental and dietary changes and the role played by physiological factors such as hypocalcaemia, a direct relationship between NL thickness variation and the physical was trauma implied by the birth dynamics, the Caesarean, and the operative modes are apparently associated with the thinnest and the thickest lines, respectively. By using the histological record from a deciduous dental sample (exfoliated crowns) of 100 modern healthy school-aged children (47 males and 53 females) of reported birth histories (normal delivery mode: 55 cases; Caesarean: 40; operative: 5), we investigated the relationships between birth dynamics and NL thickness variation. The Tukey Honest Significant Difference method was used to test the differences between the means of the grouping levels. The results of our histo-morphological investigation do not support the suggestion that Caesarean-born children display, on average, a thinner enamel scar compared to children associated to a normal delivery mode. Rather, our study points to the influence exerted by factors intimately related to gestational length variation on the degree of expression of the line.     

Cigarette smoking as risk factor for late fetal and early neonatal death.

Risk factors for late fetal death and early neonatal mortality were examined in a population based prospective study. Practically all Swedish births between 1983 and 1985 were included, 281,808 births in all. The overall rates of late fetal death and early neonatal mortality were 3.5 and 3.1 per 1000, respectively. About 30% of the pregnant women were recorded as being daily smokers. Logistic regression analyses showed significant relative risks for late fetal death for high maternal age (1.4), nulliparity (1.4), multiparity (greater than or equal to 2) (1.3), smoking (1.4), and multiple births (2.8). Significant relative risks for early neonatal mortality were found for multiple births (4.9) and smoking (1.2). Smokers aged under 35 faced a relative risk of late fetal death ranging from 1.1 to 1.6, while the risk for late fetal death was doubled if the mothers were aged 35 years or more and smoked. In countries like Sweden, where maternal cigarette smoking is prevalent, smoking may be the most important preventable risk factor for late fetal death.