First trimester maternal weight influences foeto-placental growth [abstract]

OBJECTIVE: To examine the effect of maternal weight on foetoplacental growth. METHODS: Seven hundred and twelve women attending their first antenatal clinic visit at the University Hospital of the West Indies, Kingston, Jamaica, were invited to join a perspective study. Maternal anthropometry and blood pressure were performed. Abdominal ultrasound was performed at 14, 17, 20, 25, 30, and 35 weeks of gestation to determine placental and foetal growth. Placental volume was measured at the first 3 visits and foetal biparietal diameter, femoral lenght, and head and abdominal circumfrence were measured at all 6 visits. Two groups of women were created based on their first trimester weight (<55kg and o55kg) for comparison. A ratio of placental volume to foetal abdominal circumference was created and the rate of growth examined between 14 to 17 and 17 to 20 weeks' gestation. RESULTS: Women with lower maternal weight in the first trimester had significantly smaller placental volumes at 17 and 20 weeks' gestation (p<0.03 and P<0.0001, respectivley). Lighter women had foetuses with a smaller head circumference and femoral length noted at 35 weeks gestation (p<0.01 and p<0.03, respectively). A significant relation with with foetal abdominal circumferences was seen as early as 25 weeks' gestation. The rate of foeto-placental growth when first examined at 14 weeks was similar between the two groups of women. However, in the lighter women, relative growth of placenta between 14 to 17 and 17 to 20 weeks' gestation was less than in the heavier women, suggesting poorer relative placental growth in lighter mothers. CONCLUSION: Maternal weight is an important contributor to foeto-placental growth. Lighter women are more likely to have poorer placental growth and hence smaller foetuses. (AU)

Blood pressure is related to placental volume and birth weight

The objective of this study was to determine whether maternal nutrition and fetal and placental size program blood pressure. A longitudinal study linking the maternal anthropometric measurements of the first antenatal visit, ultrasound data of placental and fetal size, anthropometry at birth, and childhood growth and blood pressure was performed. The subjects were 428 women who attended the antenatal clinic at the University Hospital of the West Indies, Kingston, Jamaica, and their children, who were subsequently followed up. Systolic blood pressure at ages 1, 2, 2.5, 3, and 3.5 years was the main outcome measure. Pooling the data across ages, systolic blood pressure fell by 1.4 mm Hg for every 1-kg increase in birth weight (95 percent CI 0.2 to 2.7, P=0.02) and by 1.2 mm Hg for every 100 mL increase in placental volume at 20 weeks of gestation (95 percent CI 0.4 to 2.0, P=0.004). Blood pressure was also negatively associated with placental volume at 17 weeks and fetal abdominal circumference at 20 weeks. Measures of maternal nutritional status were strongly related to birth weight and placental volume but not directly to childhood blood pressure at these young ages. In conclusion, blood pressure is associated with fetal size in this population, as previously described among Europeans. We found associations between placental volume and abdominal circumference in the second trimester and childhood blood pressure, suggesting that the initiating events of blood pressure programming occur early in pregnancy. Measures of maternal nutritional status were not directly related to childhood blood pressure at these young ages but were strong predictors of both birth weight and placental volume, suggesting an indirect relation.(Au)

Diabetes education for the adult - position statement

There is a fourfold increase in the incidence of major malformations in pregnant diabetic women who have poor metabolic control during the period of organogenesis. The goals of preconception care are: Screening for underlying non-diabetic medical conditions, assessment of diabetes-related complications, obstetric evaluation, intensive education of woman and family, attainment of optimum diabetic control, timing and planning of pregnancy. To achieve these goals, education must be implemented to ensure that the woman understands the effects of diabetes on pregnancy. She must undergo a review of self-management skill; that is nutrition counselling, insulin administration, exercise, blood glucose monitoring. The feasibility and cost-effectiveness of such programmes can be assessed in terms of the successful outcomes for both mother and child.(AU)

The effect of maternal nutrition on foetal growth and blood pressure at age 2 years

This study was designed to examine the effects of maternal nutritional status on foetal growth and blood pressure at 2 years of age. It was a prospective study of women attending antenatal clinic at the University Hospital of the West Indies. 500 women attended the antenatal clinic and had six ultrasound measurements between 14 and 35 weeks gestation. The infants were followed at three-months intervals to 2 years. Main outcome measures were birth weight, head circumference, crown heel length, blood pressure. Measurements of the baby at birth were strongly related to maternal weight, BMI, weight gain in pregnancy (between 8 and 35 weeks), and triceps skinfold thickness. Relationships were strongest with booking weight and BMI. Women who weighed 55kg or less had the smallest, lightest babies and placentae. Placental volume was lower in the lighter women at both 17 and 20 weeks. Differences in abdominal circumference were not discernable until 35 weeks. The ratio of placental volume : abdominal circumference at 14 weeks as well as their relative rates of change between 14, 17 and 20 weeks gestation were different between the two groups of women. In the lighter women relative growth of placenta between 14 and 17 weeks was less than in the heavier women, suggesting poorer placental growth in underweight mothers. The data show that there is a relationship between maternal anthropometry, intrauterine growth, postnatal growth and blood pressure(AU)

Relationship between maternal nutritional status and infant's weight and body proportions at birth

OBJECTIVE: To examine maternal nutritional status and its relationship to infant weight and body proportions. DESIGN: Retrospective study of births from January-December 1990. SETTING: University Hospital of the West Indies, Jamaica. SUBJECTS: Records for 2394 live, singleton births, between 200-305 d gestation. MAIN OUTCOME MEASURES: Birth weight, crown heel length, head circumference, ponderal index, head circumference: length ratio, placental weight, placental: birth weight ratio. RESULTS: Mothers who were lighter had babies who had lower birth weight, were shorter, had smaller heads and had a higher HC:L ratio. Shorter and thinner women had babies who had lower birth wieghts, were shorter, had smaller heads and lighter placentas. Thinner women also had babies with a lower placental: birth weight ratio, and their BMI's were not linearly related to ponderal index and HC:L ratio. Women whose first trimester Hb levels were < 9.5 g/d1 had babies with the lowest birth weight, crown heel length, placental weight and ponderal index. These measurements increased as the Hb levels rose to 12.5 g/dl but then fell at Hb levels > 12.5 g/dl. In the second and third trimester Hb levels were negatively associated with birth weight, crown heel length, head circumference, placenta weight and ponderal index. CONCLUSIONS: The data support the hypothesis that poor maternal nutrition is associated with foetal growth restraint. Poor maternal nutrition as indicated by low weight, height, and BMI are associated with smaller, shorter babies with smaller heads. Haemoglobin levels > 12.5 g/dl in pregnancy are associated with lighter, shorter, thinner babies, with smaller heads.(AU)

Foetal growth and increased urinary excretion of 5-oxoproline in Trinidadian infants

Size at birth is related to the risk of heart disease, hypertension and diabetes mellitus in later life. Glycine is a conditionally essential amino acid during the perinatal period. The urinary execretion of 5-1-oxoproline has been used as a marker for glycine sufficiency. In Jamaican infants, excretion increased progressively during the first weeks of life and by 6 weeks of age was two-to-three times that seen in infants in the UK. We measured the rate of excretion in 42 infants aged 4-to-6 weeks, delivered at Mount Hope Maternity Hospital (Indian, 17; African, 15; mixed, 10), compared with 22 Caucasian infants born in Southampton. There were no differences between the groups in maternal age, maternal haemoglobin, or parity. Trinidadian infants were statistically significantly lighter, with smaller head circumference than the infants in UK. The differences in weight were more marked for the Indian and mixed infants than for the African infants, although head circumference in the three groups was similar. There was a highly statistically significant increase in the excretion of 5-oxoproline in all groups of Trinidadian infants, compared with UK infants. Maternal haemoglobin related to newborn size. When maternal haemoglobin was controlled, there was a statistically significant inverse relationship between 5-oxoproline excretion and birthweight (r=-0.32, p=0.02) and head circumference (r=-0.27, p=0.05). Infants in Trinidad had levels of urinary 5-oxoproline similar to those found previously in Jamaica and about twice those seen in infants in the UK. These differences do not appear to be accounted for by infant feeding patterns, but may be directly related to aspects of maternal nutrition, and the shape and size of the infant at birth. The data suggest that the availability of glycine might be limiting for foetal growth in the Caribbean, and this could have important implications for the development of diabetes mellitus, hypertension and heart disease in later life (AU)

Fetal growth and cardiovascular risk factors in Jamaican school children

OBJECTIVE-- To determine relationship between school children's blood pressure, glycated haemoglobin level and cholesterol concentration and their anthropometry, socioeconomic status, and birth measurements. DESIGN--Retrospective cohort study. SETTING--27 schools closest to University Hospital of the West Indies, Kingston, Jamaica. SUBJECTS--2337 children aged 6-16 years who were born at University Hospital were recruited, and their birth records were recovered: 1610 had suitable records, 659 had records including birth length, and 610 of these were prepubertal. MAIN OUTCOME MEASURES--Blood pressure, glycated haemoglobin level, serum cholesterol concentration, anthropometry at birth, current anthropometry, and socioeconomic status. RESULTS--Multiple regression analysis showed that children's systolic blood pressure was inversely related to their birth weight (P < 0.0001) and directly related to their currrent weight. Glycated haemoglobin level was higher in children with thicker triceps skinfolds (P < 0.001) and who had been shorter at birth (P = 0.003). Serum cholesterol concentration was inversely related to current height (P = 0.001) and to length at birth (P = 0.09) and was directly related to triceps skinfold thickness and higher socio-economic status (P = 0.001). CONCLUSIONS--Blood pressure in children was inversely related to birth weight and directly to current weight. Glycaemic control and serum cholesterol were related to short length at birth, height deficit in childhood, and childhood obesity (Au).

Maternal nutritional status in pregnancy and blood pressure in childhood

OBJECTIVE: To examine the relation between indices of maternal nutrition during pregnancy, including haemoglobin concentration, skinfold thickness and body weight, and the child's blood pressure at 10 to 12 years of age. DESIGN: Follow up study of children whose mothers had haemoglobin estimations, weights and skinflod thickness recorded during pregnancy. SETTING: Kingston, Jamaica. SUBJECTS: Seventy-seven children whose mothers took part in a prospective study of nutrition during pregnancy in relation to fetal growth. MAIN OUTCOME MEASURE: Blood pressure at 10 to 12 years of age. RESULTS: The child's mean systolic pressure adjusted for current weight rose by 2.6 mmHg (95 percent CI 0.5-4.6, P = 0.01) for each 1 g/dl fall in the mothers's lowest haemoglobin suring pergnancy. Mothers with a lower haemoglobin had thinner skinfold thickness, especially over the triceps (P=0.005). In multiple regression analyses, taking account of the child's sex and current weight, there was a strong association between thin maternal triceps skinfold thickness at 15 weeks of gestation and raised blood pressure in the offspring. Taking account of the mother's tricep skinfold thickness abolished the relation between lower haemoglobin and raised blood pressure in the child. Lower weight gain between 15 and 35 weeks of gestation was independently associated with raised children's blood pressure. Systolic pressure rose by 10.7 mmHg (95 percent CI 5.7 to 15.6, P= 0.0001) for each log mm decrease in the mother's triceps skinfold thickness, and by 0.6 mmHg (95 percent CI 0.1 to 1.0, P = 0.02) for each 1 kg decrease in the mother's weight gain during pregnancy. CONCLUSION: These results parallel animal experiments suggesting that impaired maternal nutrition may underlie the programming of adult hypertension during fetal life (AU)

Foetal adipose tissue fatty acid accretion - abstract

There are still uncertainties about the origin of the fatty acids (FA) deposited in the foetus, notably the percentage derived from the maternal circulation. This study describes a method to determine the amount of FA synthesized de novo in the foetus and the amount derived from the maternal circulation. Autopsy samples of subcutaeneous adipose tissue were obtained from 42 black foetuses and newborn infants. Samples of similar tissue were obtained from 50 pregnant women and 13 non-pregnant black women during surgery. FA analysis was done by gas chromatography. The accretion rate of FA in foetal adipose tissue was calculated by linear regression analysis of the FA data obtained from foetal/infant samples from the 22nd to 43rd week of gestation. The rate of foetal FA synthesized de novo in adipose tissue was calculated as the difference between the total foetal FA accretion rate and an estimate of the maternally derived FA. The latter was estimated from the values for accretion rates of saturated FA (SAFA), mono-unsaturated FA (MUFA), and polyunsaturated FA (PUFA) and total FA in foetal tissue, and the SAFA, MUFA and PUFA composition of adipose tissue in women (Table). Results show that of the total FA increment in foetal adipose tissue (22.7mg/g wet wt./week), 86.6 per cent was synthesized de novo by the foetus and the rest (13.2 per cent) was maternally derived (AU)

Foetal macrosomia: a continuing perinatal challenge

The incidence of foetal macrosomia at the Mount Hope Maternity Hospital is 0.34 per cent. Predisposing factors include obesity, excessive weight-gain and a family history of multiple pregnancies or diabetes mellitus. Prlonged labour, perineal laceration and post-partum haemorrhage are the chief maternal complications. The main danger to the foetus is shoulder dystocia, the occurence of which can be minimised by employing ultrasound antenatally for accurate detection of the macrosomic infant and a more liberal use of elective Caesarean section (AU)

Influence of marihuana smoking on female reproductive activity in albino rats

In recent years interest has mounted concerning the role of marihuana on reproductive physiology. Various reports in the literature suggest that marihuana influences female reproduction, and pose significant risks for the offspring. It has also been blamed for its embryotoxic/foetotoxic and teratogenic manifestations in animals. These reports are conflicting, confusing and sometimes contradictory. However, it could be conceived that marihuana use induces reproductive hazard. Moreover, marihuana has been used for facilitating childbirth and was tried in the management of menstrual disorders, but there is no evidence to establish the scientific basis for such claims. Despite the widespread use of marihuana, there are only a few studies available describing the effects of this drug in the female. This study was designed to investigate the potential effects of marihuana smoking on female reproductive process and foetal development. Albino rats were utilized for this experiment due to various practical advantages like availability, low cost, large number of animals per litter and brief gestational periods. Marihuana smoking has been employed to mimic human use and to restrict the use of heavy doses. Uterine smooth muscle contractility was studied to determine the influence of marihuana extract and the consequences of smoke exposure on uterine contractility. A chronic study, i.e. follow-up through two generations, was carried out since acute effects of marihuana may be insignificant and since continous maternal exposure could damage the foetus and chronic use could further deleterious effects. During this study a close watch was kept on the body weight to rule out the possible influence of undernutrition which may affect the reproductive function. Marihuana smoking has resulted in the reduction of body weight within the first week, but these animals later demonstrated a positive gain in weight and did not exhibit any obvious signs of undernutrition which may affect the reproductive function. Marihuana smoking has resulted in the reduction of body weight within the first week, but these animals later demonstrated a positive gain in weight and did not exhibit any obvious signs of undernutrition. A positive gain in body weight suggests development of tolerance following the smoking exposure. All the marihuana smoke-exposed rats exhibited delayed onset of oestrous activity but frequent oestrous cycles with a reduction in the duration of oestrous period. Such a change could interfere with fertility rate. Smoking also has resulted in suppression of ovalution. The fertility index (number of pregnant females/number of mated females) was significantly lowered. Other observations were shortened gestation period, low birth weight and diminished litter size. Reduction in fertility index and the gestation period may be the consequence of uterine stimulatory action of marihuana or suppressed ovarian activity. Low birth weight and reduction in the litter size could be due to probable embryotoxic effects of interference with transport mechanisms. Uterine contractile responses produced by crude aqueous marihuana extract (CAME) were significantly higher in smoke-exposed rats. CAME seems to depolarize the uterine smooth muscle, by activiting the muscarinic receptors. Chronic exposure to marihuana smoke seems to alter this response at receptor level. CAME is shown to possess both contractile and relaxing properties with dominant activity of the former. Chronic exposure to marihuana smoke resulted in appearance of tumours, like serous cystomata, follicular cysts, telengiectatic cysts, adenofibroma and adenocarcinoma in 50 percent of the experimental animals. The significance of this uterine stimulatory and tumorigenic potential of marihuana may have far-reaching consequences due to interference with foetal blood flow. Such a situation couls lead to deficient transport of O2, nutrients and toxic metabolities and precipitate not only foetal underdevelopment, but also reduction in litter size. Use of marihuana seems to influence the reproductive activity in females as evidences by delayed onset of oestrous activity, frequent oestrous cycles with reduced fertility index, shortened gestation periods, increased litter mortality, low birth weight, etc. This study clearly indicates that the marihuana smoke not only affects the maternal well-being but also jeopardizes the conditions under which the foetuses grow and develop (AU)

Teratogenicity of hypoglycin-A: some morphological and biochemical aspects

Hypoglycin-A is a toxic, non-proteinogenic amino acid of considerable biochemical interest. It is obtained fron the fruit of Blighia sapida K., and is the causative factor of the Jamaican "vomiting sickness". The toxicity of hypoglycin-A is attributed to the formation of a metabolic methylenecycclopropaneacetic acid which inhibits the oxidation of long-chain fatty acids. Hypoglycin-A induced in pregnant rats a significantly high incidence of congenital abnormalities and reabsorption. It did not reduce the fertility in mice, malformations were absent and only a small increase in reabsorption sites was observed after the adminstration of large doses. Hypoglycin-A administered to pregnant rabbits resulted in a high incidence of foetal reabsorption and overall stunting. Injected into the yolk sac of 24 and 48 hour chick embryos, hypoglycin-A was not teratogenic. Leucine, administered to pregnant rats simutaneously with hypoglycin-A, afforded no protection against the teratogenic action of hypoglycin-A. Leucine was shown to be highly teratogenic and exaggerated the teratogenicity of riboflavin and hypoglycin-A to pregnant rats the occurrence of congenital abnormalities. Inhibition of long-chain fatty acid oxidation may represent a basic cellular mechanism involved in the teratogenicity of hypoglycin-A, because of its influence on oxidative phosphorylation and the electron transport system. Reversal of the hypoglycin-induced teratogenic effects by riboflavin, suggests that inhibition of the acyl dehydrogenase flavin-dependent-oxidation reaction, occurring during the degradation of fatty acids, is the site of action of hypoglycin-A (AU)

Amino acid imbalance and embroyonic development - abstract

The effects of the essential amino acid leucine on maternal reproductive capacity and embryonic development in the rat were investigated. Leucine, 15 mg/kg body weight, was administered intraperitoneally to two groups of pregnant rats from the first through the sixth day, and from the sixth through the ninth day of gestation respectively. Control animals received physiological saline over the same gestational period. A high incidence and a wide spectrum of congenital abnormalities were induced in the leucine-treated rats; the incidence of embryonic death and foetal resorption was also significantly increased following treatment with leucine (P < 0.001). Skeletal malformations were present in a number of instances, but no microscopic changes were observed in the foetal organs studied. The embryopathic activity ofleucine may be due to an imbalance in the "amino acid pool" which is available for protein synthesis during embryonic development(AU)