Repository hosted by TU Delft Library

A recent article by Little et al. (Am J Epidemiol 1994;140:544-54) reported that infants in Seattle, Washington, who were breastfed by mothers who smoked gained more weight than either infants who were breastfed by mothers who did not smoke or infants who were bottle-fed by mothers who smoked. In this study, the authors aimed to verify this result with the use of data from the Social Medical Survey of Children Attending Child Health Clinics (SMOCC) cohort, a nationally representative cohort of 2,151 children born in the Netherlands in 1988-1989. During the first year of life, data on type of milk feeding, weight, length, and head circumference were collected at 1, 2, 3, 6, 9, and 12 months of age. Infants of smokers who were mainly breastfed in the first 3 months of life (n = 117) were compared with similarly breastfed infants of nonsmokers (n =572), with infants of smokers who had been mainly bottle-fed (n = 270), and with infants of nonsmokers who had been mainly bottle-fed (n = 535). The authors failed to observe any additional increase in body mess, length, or head circumference in infants of breastfeeding smokers compared with infants of the three other groups. When the authors used all of their data to study growth with a multivariate longitudinal regression model (general estimating equations (GEE) model), the data showed clearly reduced growth in breastfed children (limited to the period after the second month of life) and some 'catch-up' growth in body mass and head circumference in children with intrauterine exposure to tobacco.

Aim - To describe the long term outcome of extremely preterm growth retarded infants in relation to obstetric management and various perinatal events. Methods - A cohort study was undertaken in two tertiary care centres with different obstetric management. All infants with fetal growth retardation due to placental insufficiency and resulting in fetal distress at 26 to 32 weeks of gestation, were included for the years 1984-89. Main outcome measures were impairment, disability, or handicap at 2 years corrected age and at school age (4 1/4 to 10 1/4 years). Results - One hundred and twenty five (98%) were followed up until 2 years corrected age in the outpatient department; 114 (90%) were assessed at school age. Impairments were found in 37% and disabilities or handicaps in 9% of the assessed infants, with no difference between centres. All disabled or handicapped children had already been identified by 2 years corrected age. Conclusions - Disability or handicap were related to neonatal complications (intracerebral haemorrhage or bronchopulmonary dysplasia) and not to obstetric variables, thus making antenatal prediction impossible. The incidence of disability or handicap in these growth retarded infants was comparable with that of other preterm infants.

Objective: To examine the effect of intrauterine and neonatal growth, prematurity and personal and environmental risk factors on intelligence in adulthood in survivors of the early neonatal intensive care era. Methods: A large geographically based cohort comprised 94% of all babies born alive in the Netherlands in 1983 with a gestational age below 32 weeks and/or a birth weight >1500 g (POPS study). Intelligence was assessed in 596 participants at 19 years of age. Intrauterine and neonatal growth were assessed at birth and 3 months of corrected age. Environmental and personal risk factors were maternal age, education of the parent, sex and origin. Results: The mean (SD) IQ of the cohort was 97.8 (15.6). In multiple regression analysis, participants with highly educated parents had a 14.2-point higher IQ than those with less well-educated parents. A 1 SD increase in birth weight was associated with a 2.6-point higher IQ, and a 1-week increase in gestational age was associated with a 1.3-point higher IQ. Participants born to young mothers (<25 years) had a 2.7-point lower IQ, and men had a 2.1-point higher IQ than women. The effect on intelligence after early (symmetric) intrauterine growth retardation was more pronounced than after later (asymmetric) intrauterine or neonatal growth retardation. These differences in mean IQ remained when participants with overt handicaps were excluded. Conclusions: Prematurity as well as the timing of growth retardation are important for later intelligence. Parental education, however, best predicted later intelligence in very preterm or very low birthweight infants.

Objective. To determine the magnitude of the growth retardation in Dutch monozygotic and dizygotic twins during infancy in comparison with the Dutch reference growth charts for general population infants from 1997 and to construct reference growth charts for twins. Design. Descriptive. Method. The growth of twins was studied using longitudinal data on over 4000 Dutch twin pairs from birth until 2.5 years of age. The LMS method was used to obtain growth charts for height, weight and body-mass index (BMI) for twin pairs during infancy. Centiles were estimated by the Box-Cox power curve (L), the median curve (M) and the coefficient of variation curve (S). Results. From birth until the age of half a year, the average height and weight of twin pairs were at about the 10th percentile of the Dutch reference population. One year later this difference had decreased to about the 25th percentile, and when the twin pairs were between 1.5 and 2.5 years of age the difference was further decreased to the 35th percentile. The BMI deviated less from that of the reference population: during the first half a year the BMI of twin pairs was at about the 25th percentile. Subsequently, the BMI improved, but remained slightly below the median of the reference population at the age of about two years. Approximately half (50% for height, 58% for weight) of the growth retardation from birth until 1.5 years was attributable to gestational age. Between 1.5 years and 2.5 years of age, this difference was reduced to one third: 33% for both height and weight. Thus, a substantial part of the growth difference could not be explained by gestational age. Conclusion. Correcting for gestational age alone is not sufficient to make possible a comparison of the growth of twin pairs with the growth of general population infants. The development of twins can, however, be followed by means of the reference growth charts designed by the authors.

Doel. Vergelijking van zwangerschappen en bevallingen tussen tieners en vrouwen van 20-29 jaar. Opzet. Observationeel. Plaats. Nederland. Methode. Met behulp van gegevens van de Landelijke Verloskunde Registratie (LVR) van 1989 werden 4500 tienerzwangerschappen bestudeerd. Onderzocht werd of zwangerschappen en bevallingen van tieners anders verlopen dan die van vrouwen van 20-29 jaar, alsmede of laag geboortegewicht, vroeggeboorte en groeivertraging meer of minder vaak voorkomen bij tieners in vergelijking met oudere vrouwen. Resultaten. Vrouwen van 13-19 jaar hadden een 1,5 maal grotere kans op vroeggeboorte dan vrouwen van 20-29 jaar (p < 0,0001), maar geen duidelijk vergroot risico voor groeivertraging. In de groep van 13-17 jarigen bestond een 4 maal vergroot risico voor intra-uterien overlijden van het kind en in de groep van 18-19 jarigen een 2 maal vergroot risico (p < 0,0001). Deze resultaten werden bij zowel allochtone als autochtone tieners gevonden. De bevalling bij tieners verliep vaker spontaan, sneller en met minder kunstgrepen dan bij vrouwen van 20-29 jaar (p < 0,001). Conclusie. Zelfs in Nederland, met het kleinste percentage tienerzwangerschappen in de westerse wereld en een prenatale zorg die in het algemeen als adequaat wordt beoordeeld, hebben zwangerschappen van tieners slechtere uitkomsten dan die van oudere vrouwen. Aangezien wij geen gegevens hadden over leefstijl, culturele achtergrond en socio-economische status is nader onderzoek naar de invloed van deze indicatoren op de uitkomsten van tienerzwangerschappen gewenst.

This prospective follow-up study of 422 19-yr-old subjects born very preterm in The Netherlands was performed to determine whether intrauterine growth retardation (IUGR) predisposes to abnormal GFR and microalbuminuria in adolescents. GFR (ml/min per 1.73 m2) was estimated using the Cockcroft-Gault equation, and albumin-creatinine ratio (mg/mmol) was calculated in a cohort of 19-yr-old subjects born very preterm (gestational age <32 wk) in 1983. Birth weights were adjusted for gestational age and expressed as standard deviation scores (sds) as a measure of IUGR. All subjects had normal renal function. Birth weight (sds) was associated negatively with serum creatinine concentration (μmol/L) (β = -1.0 μmol/L, 95% confidence interval [CI]: -1.9 to -0.2), positively with GFR (β = 3.0, 95% CI: 1.7 to 4.2), and negatively with the logarithm of albumin-creatinine ratio (β = -0.05, 95% CI: -0.09 to -0.01) in young adults born very preterm. IUGR is associated with unfavorable renal functions at young adult age in subjects born very premature. These data suggest that intrauterine growth-retarded subjects born very premature have an increased risk to develop progressive renal failure in later life. Copyright © 2005 by the American Society of Nephrology. Chemicals / CAS: creatinine, 19230-81-0, 60-27-5; Creatinine, 60-27-5

Objective: A European concerted action (the EuroNatal study) investigated the background of differences in perinatal mortality between countries of Europe. The study aimed to determine the contribution of differences in quality of care, by looking at differences in the presence of suboptimal factors in individual cases of perinatal death. Design: Retrospective audit study. Setting: Regions of 10 European countries. Population: 1619 cases of perinatal death. Methods: Perinatal deaths between 1993 and 1998 in regions of 10 European countries were identified. Reviewed were singleton fetal deaths (28 or more weeks of gestational age), intrapartum deaths (28 or more weeks) and neonatal deaths (34 or more weeks). Deaths with (major) congenital anomalies were excluded. Cases were blinded for region and an international audit panel reviewed them using explicit audit criteria. Main outcome measures: Presence of suboptimal factors. Results: The audit covered 1619 cases of perinatal death, representing 90% of eligible cases in the regions. Consensus was reached on 1543 (95%) cases. In 715 (46%) of these cases, suboptimal factors, which possibly or probably had contributed to the fatal outcome, were identified. The percentage of cases with such suboptimal care factors was significantly lower in the Finnish and Swedish regions compared with the remaining regions of Spain, the Netherlands, Scotland, Belgium, Denmark, Norway, Greece and England. Failure to detect severe IUGR (10% of all cases) and smoking in combination with severe IUGR and/or placental abruption (12%) was the most frequent suboptimal factor. There was a positive association between the proportion of cases with suboptimal factors and the overall perinatal mortality rate in the regions. Conclusions: The findings of this international audit suggest that differences exist between the regions of the 10 European countries in the quality of antenatal, intrapartum and neonatal care, and that these differences contribute to the explanation of differences in perinatal mortality between these countries. The background to these differences in quality of care needs further investigation.

Objective. To determine whether intrauterine growth restriction (IUGR) is a predisposing factor for high blood pressure (BP) in 19-year-olds who were born (very) preterm. Methods. A prospective follow-up study was conducted at age 19 in individuals who born preterm in the Netherlands in 1983. Systolic, diastolic, and mean BP values and plasma renin activity concentration were obtained in 422 young adults who were born with a gestational age (GA) <32 weeks. BP values were also measured in 174 individuals who born with a GA of ≥32 weeks and a birth weight of <1500 g. Results. An increased prevalence of hypertension and probably also of prehypertensive stage was found. IUGR, birth weight, GA, and plasma renin activity were not associated with BP. Current weight and BMI were the best predicting factors for systolic BP at the age of 19 years. Conclusions. The prevalence of hypertension is high in individuals who were born preterm when compared with the general population. In the individuals who were born very preterm, no support to the hypothesis that low birth weight is associated with increased BP at young adult age can be given. Copyright © 2005 by the American Academy of Pediatrics. Chemicals / CAS: renin, 61506-93-2, 9015-94-5

Objective: (1) To describe the sex-specific, birth weight distribution by gestational age of babies born in a malaria endemic, rural area with high maternal HIV prevalence; (2) to assess the contribution of maternal health, nutritional status and obstetric history on intra-uterine growth retardation (IUGR) and prematurity. Methods: Information was collected on all women attending antenatal services in two hospitals in Chikwawa District, Malawi, and at delivery if at the hospital facilities. New-borns were weighed and gestational age was assessed through post-natal examination (modified Ballard). Sex-specific growth curves were calculated using the LMS method and compared with international reference curves. Results: A total of 1423 live-born singleton babies were enrolled; 14.9% had a birth weight < 2500 g, 17.3% were premature (< 37 weeks) and 20.3% had IUGR. A fall-off in Malawian growth percentile values occurred between 34 and 37 weeks gestation. Significantly associated with increased IUGR risk were primiparity relative risk (RR) 1.9; 95% CI 1.4-2.6), short maternal stature (RR 1.6; 95% CI 1.0-2.4), anaemia (Hb < 8 g/dl) at first antenatal visit (RR 1.6; 95% CI 1.2-2.2) and malaria at delivery (RR 1.4; 95% CI 1.0-1.9). Prematurity risk was associated with primiparity (RR 1.7; 95% CI 1.3-2.4), number of antenatal visits (RR 2.2; 95% CI 1.6-2.9) and arm circumference < 23 cm (RR 1.9; 95% CI 1.4-2.5). HIV infection was not associated with IUGR or prematurity. Conclusion: The birth-weight-for-gestational-age, sex-specific growth curves should facilitate improved growth monitoring of new-borns in African areas where low birth weight and IUGR are common. The prevention of IUGR requires improved malaria control, possibly until late in pregnancy, and reduction of anaemia. Chemicals/CAS: Antimalarials