Neonatal complications and neurophysiological development in twins - a long-term follow-up study.

OBJECTIVES: To investigate the association between neonatal complications and neurophysiological development in twins at 18 and 48-60 months of age. METHODS: This was a secondary analysis of 841 Danish mono- and dichorionic diamniotic twins from a randomized controlled trial (PREDICT study), which included an assessment of the twin's neurophysiological development using the Ages and Stages Questionnaire (ASQ) that had been filled out by the parents at 18 and 48 or 60 months. The correlation within twin pairs was accounted for by the method of generalized estimating equation. Models were adjusted for maternal educational score and gestational age at delivery. RESULTS: ASQ data were available for 823 children at 18 months and 425 children at 48 or 60 months. Low maternal educational score and preterm delivery <34 weeks were associated with a lower ASQ score at 48-60 months (-15.4 points (95%CI -26.4; -4.5) and -13.2 points (95%CI -23.8; -2.5), respectively). Neonatal sepsis and a compound of intraventricular hemorrhage, retinopathy of prematurity and necrotizing enterocolitis (IVH/ROP/NEC) were associated with lower ASQ score at 18 months (-15.3 points (95%CI -28.1; -2.5) and -30.8 points (95%CI -59.5; -2.1), respectively). Children with IVH/ROP/NEC had a lower ASQ score at 48-60 months (-34.2 points (95%CI -67.9; -0.6)). The associations were not specific to only one ASQ domain. CONCLUSION: Several neonatal complications are associated with poorer neurophysiological development in twins during childhood, even after adjustment for gestational age at delivery.

Cytokines and the risk of preterm delivery in twin pregnancies.

OBJECTIVE: To estimate the association between cytokine levels in twin pregnancies and risk of spontaneous preterm delivery, including the effect of progesterone treatment. METHODS: This secondary analysis of a randomized placebo-controlled trial investigating the effect of progesterone treatment on preterm delivery in twin pregnancies included 523 women with available dried blood spot samples collected before treatment with progesterone (n=258) or placebo (n=265) and after 4-8 weeks of treatment. Samples were analyzed for cytokines using a sandwich immunoassay. Cytokine levels in spontaneous preterm delivery at 34-37 weeks of gestation and spontaneous preterm delivery before 34 weeks of gestation were compared with delivery at 37 weeks of gestation or more for placebo-treated women. The association between interleukin (IL)-8 and risk of spontaneous preterm delivery before 34 weeks of gestation was estimated further, including comparison according to treatment. Statistical analyses included Kruskal-Wallis test, Mann-Whitney U test, linear regression, and Cox regression analysis. RESULTS: We found a statistically significant association between IL-8 and spontaneous preterm delivery. At 23-33 weeks of gestation, the median IL-8 level was 52 pg/mL (interquartile range 39-71, range 19-1,061) for term deliveries compared with 65 pg/mL (interquartile range 43-88, range 14-584) for spontaneous preterm delivery at 34-37 weeks of gestation and 75 pg/mL (interquartile range 57-102, range 22-1,715) for spontaneous preterm delivery before 34 weeks of gestation (P<.001). Risk of spontaneous preterm delivery was associated with a large weekly increase in IL-8 (hazard ratio 2.0, 95% confidence interval [CI] 1.2-3.3). There was no effect of progesterone treatment on IL-8 levels. Levels of IL-8 at 18-24 weeks of gestation were associated with a cervix less than 30 mm (odds ratio 1.8, 95% CI 1.2-2.7). CONCLUSION: Risk of spontaneous preterm delivery before 34 weeks of gestation is increased in women with high IL-8 levels. Progesterone treatment does not affect IL-8 levels.

[Obese pregnant women and complications in relation to pregnancy and birth]. / Overvægtige gravide og komplikationer i relation til graviditet og fødsel.

One third of the pregnant Danish women are overweight or obese. Maternal obesity is an independent risk factor for adverse maternal and foetal outcomes including infertility, miscarriage, congenital malformations, preeclampsia, gestational diabetes, complicated deliveries, caesarean section, macrosomia and childhood obesity. This article reviews the effect of maternal obesity on obstetric and neonatal outcomes and provides recommendations for management of obesity in pregnancy.

Physical activity during pregnancy in obese and normal-weight women as assessed by pedometer.

OBJECTIVE: To compare physical activity as assessed by a pedometer in obese and normal-weight pregnant women at different gestational ages. To evaluate the use of a pedometer in pregnancy. DESIGN: Cross-sectional study. SETTING: Department of obstetrics and gynecology in a university hospital in Copenhagen. POPULATION: 338 pregnant women, 175 normal-weight women with body mass index (BMI) 20-25 kg/m(2) and 163 obese women with BMI > or = 30 kg/m(2). METHODS: Physical activity was assessed by a pedometer (Yamax Digiwalker SW-700/701) on seven consecutive days in six different groups: normal-weight or obese at gestational ages 11-13, 18-22, and 36-38, and expressed as median number of daily steps during a whole week, working days, and weekends. MAIN OUTCOME MEASURES: Relation between BMI and physical activity during pregnancy and compliance with wearing the pedometer. RESULTS: Noncompliance was more frequent in obese than in normal-weight women (19 vs. 10%, p < 0.001). Physical activity was lower in obese women at all gestational ages (6,482, 7,446, 4,626 steps/day in obese vs. 7,558, 8,865, 6,289 steps/day in normal-weight, p < 0.05-0.11). The greatest difference between obese and normal-weight women was seen during weekends. The level of physical activity was higher in both groups at mid-gestation than during earlier and later gestational ages. CONCLUSION: Physical activity in pregnant women can be assessed by the pedometer and the method was well accepted by the women; however, the compliance was lower in the obese. The level of physical activity differs between different gestational groups and is lower in obese than in normal-weight women, especially during leisure time.

Obesity and pregnancy.

BACKGROUND: As obesity is an increasing problem among fertile women, it is crucial that specialists involved in the treatment of these women be aware of the risks of complications and know how to deal with them. Complications associated with obesity in pregnancy are gestational diabetes mellitus, hypertensive disorders, and thromboembolic complications. Complications associated with obesity in labor are augmentation, early amniotomy, cephalopelvic disproportion, cesarean section, and perioperative morbidity. Complications associated with obesity in children are macrosomia, shoulder dystocia, small for gestational age, late fetal death, and congenital malformations, especially neural tube defects. OBJECTIVE: The aim was to review the potential complications associated with obesity and pregnancy. RESULTS: Obesity is associated with a higher risk of all reviewed complications except small for gestational age.