The aim of this study was to address the current scenario of LBW and infant nutritional and to analyze the effect of maternal status and pattern of their breast feeding practices on perinatal and postnatal infant development.Cross-sectional study design with structured questionnaires was used among 510 mother-infant pair to collect data. Maternal anthropometric, socio-economic and demographic characteristics and breast feeding practice were used as independent variable and birth weight and infant growth status as dependent variable. Descriptive and crosstab analysis were used to analyze the effect.The study revealed that about 29.4% infants were born with low birth weight (LBW). Mother with no education and from low income family were more likely  to have LBW infant compared with mother with higher education and from higher income family. Similarly, lower maternal height, weight and MUAC  were shown to have more risk of having LBW compared with higher height, weight and MUAC . The prevalence of exclusive breastfeeding was found among 45% mother. Postnatal growth and development of infant was not found significantly different (P > 0.05) among those who breast feed exclusively and non-exclusively.The study confirms that lower level of maternal education; family income and anthropometric measurement significantly increase the risk of LBW. The prevalence of exclusive breastfeeding practice was not found satisfactory. Low birth weight (LBW) is considered as birth weight less than 2500gm and in Bangladesh, 45% child born with LBW , 2. It hBreastfeeding is considered as the pivotal factor between life and death for the vast majority of children in developing countries, but pattern of breast feeding and exclusive breast feeding is more important, which is ignored often by most mothers. Breast milk is a natural resource that has a major impact on infant's health, growth and development and it is recommended for at least the first two years of a child's life . Breast In developed countries during the last two decades a large number of studies have been conducted to identify the effect of maternal status and breastfeeding practices on infant development. In Bangladesh, few studies have been conducted to find out the effect of maternal status and breastfeeding practices on infant nutritional status and most of them are weak due to inappropriate study design and lack of statistical validity. We think it is important to investigate the relationship between these in a view to prevent infant morbidity and mortality. The objectives of this analysis was to determine how maternal socioeconomic and anthropometric status effect on birth weight, particularly in determining low birth weight (<2500 gm), and how breastfeeding practice, particularly the type and effective time of initiation and termination of breastfeeding effect on infant growth and development.A total of 510 mother-infant pairs were included and the study was continued for 6 months. Mothers and their infants attending the selected hospitals and maternal clinics in Kushtia during the study period were regarded as the study population. Infants’ of up to 24 months of age was selected and infants above 24 months of age were excluded from the study. The mothers were selected beyond any ages. Some selection and exclusion criteria were followed as women whose health status was normal and who gave normal live birth were included and women with any severe health complication and caesarian cases were excluded from the study.The cross-sectional study was conducted during the period of September 2011 to February 2012. A detailed questionnaire was used to collect data on maternal and infant characteristics. Maternal variable as maternal age, maternal education level and maternal anthropometry like maternal height, weight and mid upper arm circumference (MUAC) was used as maternal variable. Family income was also used as a variable. Whenever mothers come to maternal clinic were interviewed and investigated. Maternal age, level of education and family income was collected from direct questionaries’ and from hospital log book; maternal health card was used to collect maternal anthropometric measurement during pregnancy. Additionally maternal height and MUAC was also measured during the interview period according to standardized techniques . DetailsMaternal variables were also categorized into different groups. Descriptive statistics were used to analyze the relative distribution of birth weight in different categories of maternal variable. Each of the maternal independent variable was dichotomized into two groups as up to 20 years and more than 20 years for age; uneducated and educated and so on  and codeThis research was approved by the ethics committee of the faculty of Applied Science and Technology of Islamic University, Kushtia, Bangladesh. The objective of this study and study protocol were first described to the subjects and oral consent to participate in the study was taken. All of the maternal clinics that took part in this study also gave their approval.According to maternal age category, highest percentage (36.5%) of low birth weight infant was found in the age group of = 31 years; however the lowest percentage (23.6%) was found in the 26-30 age group . 40% infExcept age (p = 0.697), all of the maternal independent variable were significantly (p ≤ 0.003) associated with LBW . Mother Among the studied mother-infant pair 61.1% mother were shown to initiate breastfeeding within 1 hour of child birth, while the rest of the mother (38.1%) did not do that . The stuThe study was conducted on sample of 510 mothers and their infants selecting randomly to assess the effects of maternal status and breastfeeding practices on infant development. Then we selected some factors randomly to identify the effect of maternal status on infant development. Two types of characteristics of mothers were studied against different ranges of birth weight of infant to identify the effect of maternal status on infant and the effect of the pattern of the exclusive breast feeding practices on infant nutritional status were studied.In Asia the prevalence of LBW is highest and in South-East Asia one third of the newborn are with LBW . The curIt was revealed from the logistic regression analysis that maternal age is not an important predictor of LBW. However the percentages of LBW infant in the maternal age group of up to 20 years and more than 30 years were little bit higher than the age groups of 21-30 years though was not significant. Thus maternal age ranging from 21-30 years was found to be most suitable age group for giving birth with normal birth weight. The findings of the present study were in agreement with many similar studies both in developed and developing countries , 10, 25.The magnitude of effect of maternal weight and maternal MUAC were more intense than the maternal height but statistically significant. Regression analysis showed that women with height and weight < 150 cm and < 50 kg respectively were more likely to have 2 and 3 times more LBW respectively than women with more height and weight. A similar study using cut-off points for low maternal weight at < 45 kg was shown similar findings of having  LBW; however the same study shown a non-significant association between maternal height and LBW using a cut-off point of < 145cm . Some otSince the time immemorial mammalians babies were feeding with their mother's breast milk. Breast milk is considered to be the only and ideal food for the infants for the first six months of life and exclusive breast feeding for the first six months of life is an important strategy for the proper growth and development of infants. In spite of an increased focus on the necessity to ensure exclusive breast feeding for the first six months of life, the percentage of exclusive breast feeding is not appreciable both in developed and developing country. However the practice of feeding colostrum has improved in the past decade (87%) and 43% of children were exclusively breastfeed for the first six months of life , whereasLow birth weight is a common problem in developing world where malnutrition effect particularly on maternal nutrition. This study identified that lower level of maternal education and anthropometry as well as family income increases the risk of LBW. This indicates increased level of maternal education ensures maternal awareness and higher income help to ensure proper food, which is essential for proper maternal nutrition and perinatal infant development. Practices of exclusive breastfeeding were found less than half of the studied mother. It is important to ensure exclusive breastfeeding practice for all of the mothers. Though in the current study, Exclusive breastfeeding up to 6 months of infant's age were shown to have no effects on infant's nutritional status, exclusive breast feeding is important for infant nutrition. Practice of EBF was not found satisfactory in the studied mother infant pairs. Measure should need to ensure exclusive breastfeeding up to six months and early initiation of breastfeeding within one hour.


Neighbourhood level deprivation has been shown to influence adverse perinatal outcomes independent of individual level socioeconomic status (SES) in countries with high income inequality, such as the United States. The present study evaluates whether municipality level deprivation defined based on education (proportion of inhabitants with university level education), income (mean income per capita) and unemployment were associated with the prevalence of preterm birth (<37 weeks) and small for gestational age  after adjustment for individual level socio-demographics  in Finland.The study design was cross-sectional. The data gathered from the Medical Birth Register included all singleton births  in 2005–2010. We fitted Generalized Estimating Equations (GEE) models to account for correlation of preterm birth and SGA clustering within municipality.n = 15,615) gave birth preterm and 3.8%  of their newborns were classified as SGA. Individual level SES and smoking were important risk factors for each outcome in adjusted models. Controlling for individual level factors, women living in intermediate and high unemployment class municipalities were 6.0% (adjusted odds ratio (aOR) = 1.06; 95% confidence interval (CI) 1.01-1.12) and 13.0% , respectively, more likely to give birth to an SGA newborn than women living in low unemployment class municipalities.Of all the women with singleton pregnancies, 4.5% (After adjustment for individual level socio-demographics, the prevalence of SGA was around 6-13% higher in municipalities with an intermediate or high unemployment rate than municipalities with the lowest unemployment rate. The results suggested that the unemployment rate has an important public health effect with clinical implications since SGA is associated with a higher risk of adverse long-term health outcomes. To assess the sensitivity of the results to missing SES information, we performed multiple imputation analysis. Differences were deemed to be significant if the p-value was less than 0.05. The data were analyzed using SPSS for Windows 19.0, Chicago, IL.Multicollinearity between municipality level variables could have led to statistical problems. Therefore, we performed Spearman correlation tests, which gave th February, 2012 by the National Institute for Health and Welfare (THL) in Finland. (Reference number 1749/5.05.00/2011).Study plan and permission to use the confidential register data in this study was granted on 16n = 15,615) of all the included women with singleton pregnancies gave birth preterm (<37 weeks) and 3.8%  of all the newborns were classified as SGA (<2 SD below mean birth weight). Women who gave birth preterm or to an SGA newborn were more likely to be young (less than 20 years), of advanced age (40 years or more), nulliparous, continued smoking after the first trimester and in the lowest SES group (blue white collar worker) than women who gave birth in term or to a non-SGA newborn  during 2005–2010 in Finland to measure whether municipality level education, income and employment were associated with a burden of preterm birth and giving birth to a SGA newborn after adjustment for individual level socio-demographics. Our results suggested that the prevalence of preterm birth and SGA newborns was associated with individual level low SES and smoking during pregnancy, but having a SGA newborn was also independently associated with municipality level deprivation defined by the aggregate unemployment rate. Women living in municipalities with an intermediate or high unemployment rate were 6.0% and 13.0%, respectively, more likely to give birth to a SGA newborn than women living in municipalities with a low unemployment rate.We reviewed all singleton births  but not preterm births among women who lived in neighbourhoods with the highest unemployment or higher proportion of inhabitants receiving social benefits or having low income after adjustment for individual level SES and smoking [In the present study, among the three measures of deprivation investigated, only the unemployment rate and education were significantly associated with adverse perinatal outcomes. However, the association between unemployment and the prevalence of SGA newborns appeared to be stronger and dose dependent compared to any association between education and preterm birth. It might be speculated that municipalities with higher than average unemployment may have exceptional circumstances rather than there just being some individuals that are out of work. High regional unemployment may mark a decline of local industries and the concomitant decline in area institutions. Further, high unemployment may result in outward migration of the youngest and healthiest and concentration of higher risk individuals. Our results are partially consistent with a previous study on a small randomly selected cohort from the Netherlands, which reported a higher incidence of SGA newborns  we know that the prevalence of SGA was 26% (95% CI 21-29%) higher in women with a prior caesarean section (CS) . In clin


Cytokine mediated changes in paracellular permeability contribute to a multitude of pathological conditions including chronic rhinosinusitis (CRS). The purpose of this study was to investigate the effect of interferons and of Th1, Th2, and Th17 cytokines on respiratory epithelium barrier function. Cytokines and interferons were applied to the basolateral side of air-liquid interface (ALI) cultures of primary human nasal epithelial cells (HNECs) from CRS with nasal polyp patients. Transepithelial electrical resistance (TEER) and permeability of FITC-conjugated dextrans were measured over time. Additionally, the expression of the tight junction protein Zona Occludens-1 (ZO-1) was examined via immunofluorescence. Data was analysed using ANOVA, followed by Tukey HSD post hoc test. Our results showed that application of interferons and of Th1 or Th2 cytokines did not affect the mucosal barrier function. In contrast, the Th17 cytokines IL-17, IL-22, and IL-26 showed a significant disruption of the epithelial barrier, evidenced by a loss of TEER, increased paracellular permeability of FITC-dextrans, and discontinuous ZO-1 immunolocalisation. These results indicate that Th17 cytokines may contribute to the development of CRSwNP by promoting a leaky mucosal barrier.  Chronic rhinosinusitis (CRS) is characterized by severe inflammation of the sinus mucosa leading to blockage of the nasal passageway and the accumulation of mucus and pathogens in the nose and paranasal sinuses , 2. CRS γ  per High Power Field (HPF) were not different between the different patients ( on TEER .p < 0.05)  led to a significant enhancement of paracellular permeability ( < 0.05) . IL-17 hpatients .The effect of interferons and of Th1, Th2, and Th17 cytokines on cellular toxicity was examined by measuring LDH release from HNECs. There was no statistically significant increase in LDH release after 24 h incubation with any of the cytokines . In addiα, β, and γ and Th1 and Th2 cytokines, which had no effect on either TEER or paracellular permeability, led to no alterations in the localization of ZO-1. In contrast, application of Th17 cytokines, which significantly altered epithelial barrier function, resulted in profound disruption of ZO-1 immunolocalisation evidenced by faint or discontinuous regions of fluorescence  was examined by using immunofluorescence staining and confocal laser scanning microscopy, 24 hours after application of the cytokines. In untreated cells, ZO-1 was located at the periphery of the apical side of the monolayer, as expected. Similarly, interferons rescence .Cytokine mediated insult on mucosal membranes, causing disruption of tight junctions and increased paracellular permeability, contributes to a multitude of pathologic conditions in inflammatory diseases of the upper airways –20. In tγ and TNF-α does not have detrimental effects on epithelial barrier function. Rather, application of these cytokines appeared to slightly enhance the TEER of human nasal epithelial monolayers derived from some of the CRSwNP patients 24 hours after application. Whereas IFN-γ and TNF-α generally decrease barrier function in different cell lines [γ has been reported to decrease barrier function by Soyka et al. [γ could be attributed to many factors including interindividual variability in response to cytokines, different origin of cells (mucosa or polyps), and differences in experimental techniques. In the experiments by Soyka et al. [γ treatment from CRSwNP, CRSsNP and controls were pooled while in our studies, only cells from CRSwNP were used. Given the small number of samples used in most studies, further experiments using a larger number of donors will need to address the cause of these discrepancies. TNF-α can increase TEER in mammalian uterine cell monolayers in a dose-dependent manner [α inhibitor administration with a remission of the disease only after cessation of TNF-α inhibitor treatment [It has been well established that different cytokines cause different, often opposing effects on epithelial barrier function depending on the cell type used and that any observed effect is dose and time-dependent (reviewed in ). Our rell lines , 22, in a et al.  and proma et al. . These da et al. , for exareatment .n = 2) and controls (n = 2) and similarly showed significantly decreased TEER after IL-4 challenge; however, this effect was already evident after 12 and 24 hours. The reason for these discrepancies is not clear and can be dependent on numerous factors. While physiologically relevant, it is well known that experiments using primary cells have limitations due to inherent interindividual differences of age, genetic make-up and medical history [Moreover, we demonstrated no significant reduction of TEER by Th2 family cytokines  after 4 h and 24 h in our experiments. Using airway epithelial cells, Saatian et al. showed that IL-4 and IL-13 caused a reduction in TEER 72 h after challenge but not after 24 h . Soyka e history . This is history .Th17 cells play a significant role in chronic allergic airway inflammation . Th17 cyIn tight junction formation, ZO-1 plays an essential role, by linking the transmembrane proteins occludin, claudin, and Junction Adhesion Molecule (JAM) cytoplasmic components of the tight junctions to the actin cytoskeleton . DisruptIn summary, in patients with CRSwNP, Th1 and Th2 cytokines showed no significant effect on epithelial barrier structure and function. In contrast, the Th17 cytokines family  showed significant disruption of the epithelial barrier, leading to increased paracellular permeability associated with reduced tight junctionintegrity. In future studies, it will be important to determine the cellular mechanism of the effect of Th17 cytokines on the mucosal barrier in CRS patients to provide an opportunity for therapeutic modulation in inflammatory stress.


Prenatal and peripartum trauma may be associated with poor maternal–fetal outcomes. However, relatively few data on these associations exist from low-middle income countries, and populations in transition.We investigated the prevalence and risk factors for maternal trauma and posttraumatic stress disorder (PTSD), and their association with adverse birth outcomes in the Drakenstein Child Health Study, a South African birth cohort study.Pregnant women were recruited from two clinics in a peri-urban community outside Cape Town. Trauma exposure and PTSD were assessed using diagnostic interviews; validated self-report questionnaires measured other psychosocial characteristics. Gestational age at delivery was calculated and birth outcomes were assessed by trained staff. Multiple logistic regression explored risk factors for trauma and PTSD; associations with birth outcomes were investigated using linear regression. Potential confounders included study site, socioeconomic status (SES), and depression.A total of 544 mother–infant dyads were included. Lifetime trauma was reported in approximately two-thirds of mothers, with about a third exposed to past-year intimate partner violence (IPV). The prevalence of current/lifetime PTSD was 19%. In multiple logistic regression, recent life stressors were significantly associated with lifetime trauma, when controlling for SES, study site, and recent IPV. Childhood trauma and recent stressors were significantly associated with PTSD, controlling for SES and study site. While no association was observed between maternal PTSD and birth outcomes, maternal trauma was significantly associated with a 0.3 unit reduction  in infant head-circumference-for-age z-scores (HCAZ scores) at birth in crude analysis, which remained significant when adjusted for study site and recent stressors in a multivariate regression model.In this exploratory study, maternal trauma and PTSD were found to be highly prevalent, and preliminary evidence suggested that trauma may adversely affect fetal growth, as measured by birth head circumference. However, these findings are limited by a number of methodological weaknesses, and further studies are required to extend findings and delineate causal links and mechanisms of association. Exposure to psychological trauma is highly prevalent in South Africa. According to nationally representative data from the South African Stress and Health Study (SASH) , a multidisciplinary birth cohort study investigating the determinants of child health over time  and TC Newman (serving a mixed race community), in a poor, peri-urban community outside Cape Town, South Africa. Mothers were enrolled in the DCHS at 20 to 28 weeks’ gestation and will be followed longitudinally throughout their pregnancy until 5 years postnatally. Exclusion criteria were individuals who were younger than 18 years, who did not attend study clinics for postnatal care (and thus could not be readily followed up), or those who were intending to move out of the district within 2 years after the infant's birth.The DCHS was approved by the Faculty of Health Sciences human research ethics committees of the University of Cape Town (UCT) and Stellenbosch University in South Africa, and by the Western Cape Department of Health Provincial Research Committee. All study participants provided written informed consent.Women were asked to complete a battery of self-report measures administered by on-site trained fieldworkers in the participants’ preferred language . Translation of measures from English to Afrikaans and isiXhosa was done using standard forward- and back-translation processes  was adapted from the version used in the SASH   were detected on-site by trained fieldworkers, and ultimately referred to the study medical officer (MO). Following a psychiatric interview and risk assessment, the MO would then facilitate the most appropriate course of action for individual participants, including referral to emergency psychiatric services in Paarl. Educational pamphlets designed by the study team were made available to all study participants. These pamphlets included information on common mental health disorders, as well as contact details for freely accessible resources in the Drakenstein subdistrict.Anthropometric variables  at birth were measured by clinical staff at Paarl Hospital and z-scores were calculated. LBW was defined as less than 2,500 g according to the WHO parameters  were included in regression models to examine independent predictors of decreased WAZ, decreased HCAZ, SGA, and shortened gestational age at delivery, respectively. Likelihood ratio tests were used to assess model fit.All data were analyzed using Stata 12 . Frequency distributions and medians (interquartile ranges [IQR]) were used to describe sociodemographic variables of interest ; childhood and adult trauma exposure and stressful life events; PTSD, depression, and psychological distress; alcohol and substance use; and birth anthropometry/gestation. Variables significantly associated with lifetime maternal trauma exposure and, among trauma-exposed participants, with lifetime PTSD were identified using chi-square tests for categorical variables and Wilcoxon rank sum tests (Mann–Whitney tests) for non-normally distributed continuous variables. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to determine the strength of these associations. The associations between PTSD, potential confounders, birth anthropometric outcomes  and gestational age at delivery were then explored. The selection of relevant covariates was informed by model building based on directed acyclic graphs which were generated prior to conducting the analyses. This was in order to differentiate between potential confounders versus mediating variables. Variables significantly associated each with trauma exposure and with PTSD in bivariate analysis  were included in the final analysis.Women had a median age of 26 years , with most (62%) being unmarried . AlthougAlthough the median IQR score for the measure of exposure to stressful life events in the past 12 months was 1 , psychological distress (as assessed by the SRQ) was reported in 20% of participants, and approximately a quarter was found to score above threshold on measures of depression  and of exposure to recent (past-year) IPV (32%) . Again, Crude analyses yielded significant associations between recent IPV exposure, psychological distress, and recent stressful life events, and trauma exposure in this study sample. In a multiple logistic regression model, recent stressful life events remained significantly associated with trauma, when controlling for SES, study site, and recent IPV .n=366), PTSD was significantly more likely to occur among participants reporting lower levels of education, childhood trauma, recent stressful life events, depression (BDI and EPDS), and psychological distress  birthweight was 3,080  g, and the median (IQR) head circumference at birth was 34  cm. On average, infants had a median WAZ of −0.5  and a median HCAZ of −0.5  . NotableNo association was observed between maternal PTSD and any of the birth outcomes of interest . However, when examining the association between trauma exposure and adverse birth outcomes, crude analyses revealed that maternal trauma was significantly associated with a 0.3 unit reduction in infant HCAZ scores at birth  . This asThe key findings of this exploratory study of maternal psychological trauma, PTSD, and associated birth outcomes were (1) the majority of women had experienced at least one lifetime traumatic event, including childhood abuse and/or IPV, with a notable prevalence of PTSD; (2) childhood trauma and recent stressful life events were significantly associated with PTSD, when controlling for SES and study site; (3) although infant anthropometric markers at birth were within the WHO “normal” range, there was a notable site-specific difference across a number of parameters, with infants born to mothers from TC Newman fairing more poorly overall; and (4) no associations were observed between maternal PTSD and subsequent birth outcomes. However, our findings suggest that maternal psychological trauma may be significantly associated with a reduction in head circumference z-score at birth, when controlling for a number of potentially confounding variables.The high trauma burden in our study sample is largely in line with the local and international literature. For example, although the National Comorbidity Survey reported that approximately 60% of men and 50% of women had been exposed to at least one traumatic event . It may also be seen as complementary to another prior study by our group, demonstrating that maternal depression is significantly associated with reduced HCAZ scores in the Drakenstein cohort, when adjusted for study site, SES, and recent stressful life events ; or to the temporality of risk factors . Furthermore, it may be that diverse maternal risk factors are associated with different effects on fetal growth and intrauterine development. For example, our study group has previously demonstrated a significant association between maternal exposure to IPV and delivery of a LBW infant in the Drakenstein cohort   were used to supplement self-reported findings, some of these assessments were completed at a timepoint after the index infants’ birth, thus potentially complicating the temporality of the associations. Furthermore, as this study was conducted in a peri-urban region of low SES, the study sample may not be generally representative of South Africa. Another major limitation of the current study is the strong likelihood of unmeasured and residual confounding. For example, although we adjusted for the effect of study site and SES in our analysis, the standardized conceptualization and accurate measurement of the latter variable remains highly challenging (Ndhlovu & Khalema, Despite its limitations, our study constitutes a novel exploratory investigation of the prevalence of, and risk factors for, psychological trauma and PTSD during pregnancy, as well as associated birth outcomes, in a LMIC population in transition. However, given the high prevalence of PTSD found in our sample, as well as the methodological shortcomings of the current study, there is a clear need for further research in settings such as ours, focused on the association between stressful life events, traumatic exposure, and consequent PTSD. Adequate detection and appropriate treatment of trauma-exposed individuals in the pre- and peripartum period would be helpful to curb the detrimental effects on mother and child. Potential targets of such interventions may include antenatal substance use, psychosocial stress, and other mediators of the association between maternal trauma and adverse birth outcomes. Given the complexity of these causal pathways, intervention strategies may well require a multidimensional approach. Longitudinal follow-up of maternal psychological risk, mother–child attachment, and measures of developmental and child mental health will be important to evaluate the long-term functional effects of maternal trauma exposure. In the future, further work in this field would be useful to extend our findings and to delineate causal pathways and neurobiological mechanisms.


Methylmercury (MeHg) may affect fetal growth; however, prior research often lacked assessment of mercury speciation, confounders, and interactions.Our objective was to assess the relationship between MeHg and fetal growth as well as the potential for confounding or interaction of this relationship from speciated mercury, fatty acids, selenium, and sex.This cross-sectional study includes 271 singletons born in Baltimore, Maryland, 2004–2005. Umbilical cord blood was analyzed for speciated mercury, serum omega-3 highly unsaturated fatty acids (n-3 HUFAs), and selenium. Multivariable linear regression models controlled for gestational age, birth weight, maternal age, parity, prepregnancy body mass index, smoking, hypertension, diabetes, selenium, n-3 HUFAs, and inorganic mercury (IHg).3) × 100 . There was no evidence of a MeHg × sex interaction with ponderal index. Contrastingly, there was evidence of a MeHg × n-3 HUFAs interaction with birth length  and head circumference . The association of MeHg with birth weight and ponderal index was affected by n-3 HUFAs, selenium, and IHg. For birth weight, βln(MeHg) without these variables was –16.8 g  versus –29.7  with all covariates. Corresponding values for ponderal index were –0.030 (g/cm3) × 100  and –0.045 .Geometric mean cord blood MeHg was 0.94 μg/L . In adjusted models for ponderal index, βln(MeHg) = –0.045 (g/cmWe observed an association of increased MeHg with decreased ponderal index. There is evidence for interaction between MeHg and n-3 HUFAs; infants with higher MeHg and n-3 HUFAs had lower birth length and head circumference. These results should be verified with additional studies.http://dx.doi.org/10.1289/ehp.1408596Wells EM, Herbstman JB, Lin YH, Jarrett J, Verdon CP, Ward C, Caldwell KL, Hibbeln JR, Witter FR, Halden RU, Goldman LR. 2016. Cord blood methylmercury and fetal growth outcomes in Baltimore newborns: potential confounding and effect modification by omega-3 fatty acids, selenium, and sex. Environ Health Perspect 124:373–379;  Impaired fetal growth has been associated with neonatal morbidity and mortality . Additiop < 0.06) (Methylmercury (MeHg), best recognized as a developmental neurotoxicant, may also impair fetal growth. This was initially demonstrated in settings with high MeHg exposures . More re < 0.06) .In contrast, some researchers report no association of cord blood mercury and/or maternal blood mercury with gestational age , birth wInterpretation of this literature is challenging due to the potential influence of confounders and mercury speciation on mercury’s effect on fetal growth. Seafood consumption is the main source of exposure to MeHg; however, this is also a major source for n-3 highly unsaturated fatty acids (HUFAs) and selenium, nutrients that enhance fetal growth . Use of The present study was designed to address these concerns. Our goal is to determine the cross-sectional association between cord blood MeHg with measures of fetal growth, controlling for potential effects of co-exposure to n-3 HUFAs, selenium, and IHg, while assessing potential effect modification by sex.This research includes 271 infants from the Baltimore THREE Study , a cross-sectional birth study in Baltimore, Maryland, described in more detail in a previous publication . This reStudy population. This study potentially included all singleton births delivered at the Johns Hopkins Hospital in Baltimore, Maryland, between November 2004 and March 2005. There were 597 singleton births (609 deliveries) during the study period. Umbilical cord blood was collected for 341 births; 300 had sufficient quantity for initial laboratory analyses that included mercury, and this is the Baltimore THREE Study population. For this publication, 29 additional births were excluded due to missing data for birth length (n = 5), maternal smoking (n = 1), serum selenium (n = 10), and serum fatty acids (n = 12); additionally, one infant was excluded due to an unusually small birth length. Thus, the sample size for this study is 271.Laboratory analyses. Umbilical cord blood samples were collected, processed, and stored using standardized techniques  and n = 208, 76.8% (IHg) samples < LOD. A common method for addressing values < LOD is replacing them with a given value, such as LOD/2; however, this can introduce bias, particularly when the percentage of values < LOD is > 10%. Therefore, we requested additional data that were below the LOD but above the instrumentation LOD—these values were measured but too small to be declared significantly different from a blank. Although these values are notably less precise than values > LOD, they are likely more accurate than other commonly used imputation methods  and n = 130, 48.0% (IHg) values observed, yet < LOD; these values were used as replacements. This left only n = 22, 8.12% (MeHg) and n = 78, 28.9% (IHg) for which there was no information. These were replaced by the lowest observed value divided by the square root of 2. Total mercury was assessed using ICP-MS with an LOD of 0.33 μg/L; seven values were < LOD.Umbilical cord whole blood MeHg and IHg were determined using high performance liquid chromatography linked with inductively coupled plasma mass spectrometry (HPLC-ICP-MS) . The lim methods . There wUmbilical cord serum selenium was determined using inductively coupled plasma dynamic reaction cell mass spectrometry (ICP-DRC-MS) . The LODCord serum fatty acids, including total n-3 HUFAs, were determined at the National Institute of Alcohol Abuse and Alcoholism using automated high-throughput extraction based on transesterification followed by fast gas chromatography (GC) . SamplesMedical record abstraction. Maternal smoking during pregnancy was classified as umbilical cord serum cotinine ≥ 10 ng/mL (n = 3) and height (n = 7) were imputed using multivariable imputation  and prior literature  (3 HUFAs) . We consy given a 1-unit change in x equals β(x + 1) – β(x). With a 1% change in a natural-log transformed x variable, this can be written as β[ln(x + 1%)] – β[ln(x)]; given the properties of natural logs, this can be rewritten as β{ln[(x + 1%)/x]}, which is equivalent to βln(101/100). For a 100% increase (approximately a doubling), this would be βln(200/100), which is roughly β(0.693).In a nontransformed regression equation, the expected change in Potential effect modification by infant sex, selenium, or n-3 HUFAs was investigated using stratified models  as well as fully adjusted models computing an interaction term across the entire cohort. In these analyses these three variables were dichotomized: sex , selenium (below the median/above the median), and n-3 HUFAs (below the median/above the median). Post hoc sensitivity analyses included determination of the individual impact of selenium, n-3 HUFAs, and IHg; comparison of models using total mercury versus MeHg; and analyses with IHg and MeHg as categorical variables.2 . Average n-3 HUFAs were 52.6 μg/mL , and average selenium was 70.0 μg/L . Geometric mean umbilical cord blood IHg was 0.13 μg/L . Geometric mean umbilical cord blood MeHg was 0.94 μg/L  and ranged from nondetectable levels to 15.4 μg/L. Cord blood MeHg was positively correlated with IHg, total Hg, and n-3 HUFAs, with Spearman’s ρ of 0.51, 0.91, and 0.23, respectively . MeHg was not correlated with serum selenium (Spearman’s ρ = –0.02).Population characteristics and cord blood analytes are presented in p ≤ 0.1 but > 0.05) based on an unadjusted linear regression model of maternal age (in years) and ln-transformed cord blood MeHg . Unadjusted regression model results indicated that infants born to black  or Asian  mothers had significantly higher MeHg levels than did children of white mothers. Higher MeHg was significantly related to higher n-3 HUFAs  and IHg , but not selenium , in unadjusted regression models.Cord blood MeHg increased with increasing maternal age . This asn = 34 (12.5%) preterm (< 37 weeks gestation) and n = 29 (10.7%) with low birth weight  infants. For birth length, n = 4 (1.5%) and n = 52 (19.2%) were classified as small and large for gestational age, respectively. For head circumference, these were n = 14 (5.2%) and n = 30 (11.1%). There were no significant differences between MeHg concentrations by preterm birth (vs. not), low birth weight (vs. not), or small for gestational age categories  in bivariate analyses compared to ln(MeHg) using either t-tests, one-way analysis of variance, or unadjusted regression models (data not shown). Exclusion of preterm or low-birth-weight infants from regression models did not substantially change our results (data not shown).Average measures of fetal growth and development are summarized in Multivariable regression model results are presented in 3) × 100 , and model 2 + IHg βln(MeHg) = –0.045 .In the Supplemental Material, Table S2 presents data on the effect of additionally including IHg, n-3 HUFAs, or selenium as an additional covariate to model 2. The results suggest that the strength of the relationships between MeHg and birth outcomes was affected by inclusion of n-3 HUFAs or IHg, but not selenium. For example, in gestational age models without n-3 HUFAs or IHg βln(MeHg) was 0.86 days ; however, when also adjusting for n-3 HUFAs, βln(MeHg) was 0.38 , or when additionally adjusting for IHg βln(MeHg) was 0.31 . When predicting birth weight using model 2, βln(MeHg) was –16.84 g ; however, when IHg was also included as a covariate, βln(MeHg) was –39.67 . Corresponding results in ponderal index models were model 2 βln(MeHg) = –0.030 (g/cm3) × 100, 95% CI: –0.119, –0.007]; between MeHg with head circumference among the subgroup of infants with cord serum n-3 HUFAs > 50.4 μg/mL ; and between MeHg with length among the subgroup of infants with cord serum n-3 HUFAs ≤ 50.4 μg/mL .In stratified analyses , we observed a statistically significant association between MeHg with ponderal index among the subgroup of males only [βln(MeHg) = –0.063 (g/cmp-interaction = 0.048] and head circumference . Additionally, there was a possible interaction between MeHg and sex with gestational age  as well as between MeHg and selenium with birth weight .Results from interaction models are shown in There were statistically significant associations of selenium with increasing gestational age and increasing birth weight. n-3 HUFAs were significantly associated with decreasing head circumference and infant length. Increasing IHg was related to statistically significant increases in birth weight and ponderal index (data not shown).The MeHg–ponderal index association in models using categorical variables for either MeHg or IHg was attenuated, but similar to models that used continuous variables for both MeHg and IHg (data not shown). Similarly, an association for total mercury with ponderal index was attenuated, but similar to the association of MeHg with ponderal index (data not shown).We identified a statistically significant decrease in ponderal index associated with higher cord blood MeHg concentration among newborns in models controlling for selenium, n-3 HUFAs, and IHg. Additionally, our results provide evidence of an interaction of MeHg and n-3 HUFAs with birth length and head circumference.3) × 100, 95% CI: –0.099, 0.011; whereas βln(MeHg) = –0.045 95% CI: –0.084, –0.005], or inclusion of confounders, even these small changes could plausibly explain at least part of the mixed results in existing literature.Our goal was to evaluate the relationship of mercury with prenatal growth accounting for mercury speciation, negative confounding, and potential effect modification by sex. Although we did not observe substantial differences between using total versus MeHg [for ponderal index: βln = –0.044 ; however, babies with higher ponderal index may have lower or average birth weight (if babies have shorter length) and babies with lower ponderal index may have average or higher birth weight (if babies are longer). At this point it would be premature to make clinical conclusions on the basis of these data. Our findings on ponderal index need to be replicated in other studies.Similar to our study, three cohorts did not report any significant association of cord blood or maternal hair mercury with birth length ; there wSeveral studies reported no association between cord blood or maternal hair mercury with head circumference . RamirezWe observed a negative association of cord serum n-3 HUFAs with head circumference, length, and birth weight in both our main models as well as our interaction models; this was surprising given the extensive evidence of the beneficial effects of n-3 HUFAs on fetal development . The reaIn stratified analyses we found MeHg–ponderal index and MeHg–birth weight associations among males, but not females. It is possible that we had insufficient power to detect a relationship among females. However, our results are consistent with previous work. There is evidence that mercury toxicokinetics vary by sex . AdditioOur ability to control for n-3 HUFAs, selenium, and IHg is a strength of this study. The importance of n-3 HUFAs and selenium as negative confounders is that without taking these opposite effects into consideration, one may underestimate mercury’s toxicity ; indeed,In comparison, although it is known that toxicokinetics for MeHg and IHg differ, little is understood regarding this potential impact on fetal growth. Limited prior research with IHg did not identify any association of IHg with birth outcomes . In contAlthough we had precise speciated mercury measurements, many values were < LOD; therefore, we included observed values < LOD in analyses. Although more precise than a single replacement value, these values are still less precise than higher concentrations; however, the fact that we observed similar results when modeling mercury as quantiles suggests that this was not a major limitation of our study.Average cord blood mercury concentrations among this study population  are lower than concentrations reported in a recent review on low-level exposures , except This study provides supporting evidence for a relationship between mercury and fetal growth restriction. Our data also suggest that n-3 HUFAs, selenium, and sex may modify these relationships, and that n-3 HUFAs and IHg may confound these relationships. Further consideration of confounding and effect modification should be applied to future work.(227 KB) PDFClick here for additional data file.


Studies on factors of low birth weight in Malawi have neglected the flexible approach of using smooth functions for some covariates in models. Such flexible approach reveals detailed relationship of covariates with the response. The study aimed at investigating risk factors of low birth weight in Malawi by assuming a flexible approach for continuous covariates and geographical random effect. A Bayesian geo-additive model for birth weight in kilograms and size of the child at birth (less than average or average and higher) with district as a spatial effect using the 2010 Malawi demographic and health survey data was adopted. A Gaussian model for birth weight in kilograms and a binary logistic model for the binary outcome (size of child at birth) were fitted. Continuous covariates were modelled by the penalized (p) splines and spatial effects were smoothed by the two dimensional p-spline. The study found that child birth order, mother weight and height are significant predictors of birth weight. Secondary education for mother, birth order categories 2-3 and 4-5, wealth index of richer family and mother height were significant predictors of child size at birth. The area associated with low birth weight was Chitipa and areas with increased risk to less than average size at birth were Chitipa and Mchinji. The study found support for the flexible modelling of some covariates that clearly have nonlinear influences. Nevertheless there is no strong support for inclusion of geographical spatial analysis. The spatial patterns though point to the influence of omitted variables with some spatial structure or possibly epidemiological processes that account for this spatial structure and the maps generated could be used for targeting development efforts at a glance. Low birth weight (LBW) has been defined by World Health Organization  as weighEpidemiology of LBW shows that it is multi-factorial. The primary cause of LBW is preterm delivery, occurring less than 37 weeks gestation, and intra uterine growth retardation or association of these two. Other determinants of LBW are smoking , low matThe study focused on under five children in Malawi and used the standard and nationally representative 2010 Malawi demographic and health survey (MDHS) data. The 2010 MDHS was conducted from June to November in 2010. The 2010 MDHS data was downloaded from the DHS web site after being granted permission. The MDHS was a two stage cluster sampling design with enumeration areas (EAs) as primary sampling units and households as secondary sampling units. EAs were stratified as rural or urban. A total of 849 EAs were sampled with 158 in urban areas and 691 in rural areas. A representative total sample of 27307 households was selected and 25311 households were occupied in the 2010 MDHS. Data collection was by questionnaires. There were three types of questionnaires, women, men and household questionnaire. Households that were successfully interviewed were 24825, yielding a response rate of 98%. Eligible women were 23748 and 23020 were successfully interviewed, yielding a response rate of 97%. Eligible men were 7783 and those that were successfully interviewed were 7175, yielding a response rate of 92%. The data set that was used in the analysis was child record data set which was based on women and household questionnaire.Data sets were extracted and new variables generated using STATA version 12. Data variables used in this study were based on the variables used in previous studies on child birth weight –11. The First univariate logistic regression was performed in STATA version 12 to select potential covariates for the multiple regression models. Covariates that were significant at 20% significance level were considered as candidate variables for multiple regression models. The significance level of 20% rather than 5% was used in selecting covariates for multiple regression analysis so as to allow more potential covariates to be selected. Cross tabulations between categorical covariates and categorized birth weight (< 2.5kg or > = 2.5kg) and child size at birth was done to have percentage distributions of low birth weight and size at birth per covariate categories. The histogram of birth weight in kilograms was also plotted to see the plausibility of Gaussian model.Xβ + ui, and ui is the area level random effect representing unmeasured contextual factors. In case of child birth weight as a response, the link function was the identity link resulting in the Gaussian regression model. For the child size at birth as the response, the link function was the log of odds of less than average size at birth resulting in the binary logistic model. To take a more flexible approach, the continuous covariates and the area level random effects were modelled by the nonlinear smooth functions. This revealed their subtle influences which could not be shown if modelled parametrically. To reflect this flexible approach, (1) is changed toa geo-additive modelfj for j = 1, 2, 3, …,p are smooth functions expressing nonlinear relationship between the response variable and the continuous covariate and fspat(si) is the area of the child random effect. The vector of coefficients γ determine the parametric relationship between the response and the categorical covariates. The smooth functions fj were specified as Bayesian splines. According to [fj by the polynomial spline of degree l defined at equally spaced knots xj. The Bayesian spline can be written as a linear combination of d = s+l basis functions, Bm, that is,The following multiple variable hierarchical model was then fitted in Rrding to , this asεj =  where first or second order random walk priors for the regression coefficients are assigned. A first order random walk prior for equidistant knots is given by: εjm = εj,m-1 + uj.m where m = 2,3,…,d and a second order random walk prior for equidistant knots is given by: εjm = 2εj,m-1+εj,m-2+uj.m where m = 3,4,…,d and x1,x2) refers to the coordinates of the location of the data point, latitude and longitude, or location centroids based on the map. Note that fspat represents the effect of correlated unmeasured or unobserved location effects. The prior for Bspat,ij =  is based on spatial smoothness priors common in spatial statistics [Now Bayesian estimation of the penalized spline (3) is equivalent in estimating model parameters atistics . The mosi,j = 2,…,k-1 with appropriate changes for corners and edges. Since model estimation was by empirical Bayesian method, all variance parameters were treated as unknown constants that were estimated by restricted maximum likelihood (REML) method and hence their priors were not given. The fixed effects were assigned diffuse priors. An advantage of the empirical Bayesian inference over full Bayesian inference is that questions about the convergence of Markov Chain Monte Carlo (MCMC) samples or sensitivity on hyper parameters do not arise [For ot arise . Furtherot arise .The percentage of low birth infants is higher in young mothers (aged 20 years or less) and in older mothers (aged 35–49 years) than in mothers aged 20–34 years . By birtTo check the suitability of a Gaussian model, a histogram of birth weight was plotted. Fixed variables associated with child birth weight under the Gaussian model are birth order, mother weight, and mother height . The birStarting with the nonlinear effects to child birth weight  left, chMost areas in the south are associated with increased birth weight  while noThis study found that child birth order, mother weight, mother height, mother education and family wealth are significant predictors of birth weight. The findings generally confirm what is in the literature. The positive effect of birth order on birth weight in this study is in consistent with that of  which foThe study has also documented that women at the reproductive ages of 25 years or less and 35 years and over are more prone to deliver low birth weight or small sized babies  which was found to be significantly associated with the incidence of low birth weight by .The study found support for the flexible modeling of some covariates that clearly have non-linear influences. Nevertheless there is no strong support for inclusion of geographical spatial analysis as there was no significant spatial variation of child birth weight under Gaussian modelling and that most areas showed insignificant spatial effects to child size at birth under binary logistic model The spatial patterns shown though point to the influence of omitted variables with some spatial structure or possibly epidemiological processes that account for this spatial structure, and the maps generated could be used for targeting development efforts at a glance.S1 File(CSV)Click here for additional data file.S2 File(CSV)Click here for additional data file.S3 File(CSV)Click here for additional data file.


Nonparametric quantile regression was used to fit the curves. The results demonstrate decreasing PWR and dispersion, with increasing gestational age. A higher proportion of SGA infants have extreme PWRs than AGA and LGA, especially at lower gestational ages. On average, SGA infants had higher PWRs than AGA and LGA infants. The overall curves offer population standards for use in research studies. The curves stratified by fetal growth adequacy are the first of their kind, and they demonstrate that PWR differs for SGA and LGA infants.The placental weight ratio (PWR) is a health indicator that reflects the balance between fetal and placental growth. The PWR is defined as the placental weight divided by the birth weight, and it changes across gestation. Its ranges are not well established. We aimed to establish PWR distributions by gestational age and to investigate whether the PWR distributions vary by fetal growth adequacy, small, average, and large for gestational age . The data came from a hospital based retrospective cohort, using all births at two London, Ontario hospitals in the past 10 years. All women who delivered a live singleton infant between 22 and 42 weeks of gestation were included ( Placental weight is a measure which reflects many aspects of placental growth including the laterally expanding growth of the chorionic disc, increased placental thickness with arborization of the chorionic villi, and increased surface area for vascular nutrient exchange. Thus, the growth of the chorionic disc, beginning early in pregnancy, is the main determinant of its transfer capacity, which supports the fetus in achieving its genetic growth potential .Fetal growth depends on placental growth. Fetal growth restriction (FGR) is the failure of a fetus to reach his/her biological growth potential and small for gestational age (SGA) is widely used as a statistical indicator of FGR. SGA is defined as birth weight < 10th percentile for gestational age and sex based on a population standard . PlacentPlacental weight and the PWR have been found to vary with maternal conditions and, to be predictive of obstetrical outcomes, perinatal morbidity and mortality, childhood growth and development, and fetal origins of adult onset disease –14. Prevn = 881), stillbirths (n = 422), and multiple gestations (n = 2876) were excluded from the analyses. Placental weight was not available for 13,084 records, largely because one hospital did not collect placental weight for the entire study period. However, examination of the placental weights across gestational ages between the two hospitals revealed no significant differences. Therefore, total sample size consisted of 21,255 males and 20,186 females , as detailed in sample flow chart in The study included all in-hospital singleton births in the city of London, Ontario. Research ethics board approval from Western University was obtained. Data arose from a perinatal database including all births occurring at St. Joseph's Health Care and Victoria Hospital in London, Ontario, between April 1, 2001 and March 31, 2011. A dedicated research assistant collected the information in the database from the medical charts, delivery records, and neonatal records. Placentas and infants were weighed by nursing assistants with an electronic weight scale. Placentas were weighed with the membranes and umbilical cord, including the segment of cord used for cord blood sampling. No attempt was made to remove placental blood before weighing. Anomalies (Descriptive analyses were performed on all study variables. Implausible values and potential errors were excluded including birth weights above or below the mean by three SDs, placental weights that were ≤100 g or ≥2500 g, maternal age, maternal height, prepregnancy weight below the 1st and above 99th percentiles, and any unknown or ambiguous genders.Placental and birth weight distribution curves, and PWR curves, by gestational age were produced stratified by sex. The primary analysis estimated PWR curves for the total population, including referrals from outside the London-Middlesex. A sensitivity analysis was performed excluding regional referrals from outside London-Middlesex. This sample, hereinafter referred to as the “city-wide” sample, would be expected to produce estimates with high internal validity because they represent a “whole population” perspective. The citywide PWR distributions were compared to the total population PWR distributions inclusive of referrals in order to assess their similarity. Due to its larger size, particularly at earlier gestational ages, the sample including regional referrals was used to create PWR distribution curves separately for SGA, AGA, and LGA infants.We created growth charts at the 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentiles using quantile regression with quadratic terms on gestational age for the PWR. Quantile regression was also used for the placental and birth weight distributions, but quadratic splines at 22, 32, and 42 weeks of gestation were used as opposed to a quadratic term for gestational age, as it allowed for a better fit of the model. Quantile regression does not impose any parametric assumptions on the response distributions, which makes it appropriate for the anthropometric measures .Figures http://dx.doi.org/10.1155/2014/291846 present the PWR standards when inclusion criteria are relaxed to include regional referrals in the sample. All of the percentiles achieved a good fit across the range of gestational ages and reached a statistical significance of P < 0.001. Comparing the citywide population to the total sample revealed them to be similar, with minute differences presenting themselves at the extreme percentiles at the earlier gestational ages. Furthermore, comparing the 10th and 90th percentiles, which are often used as cut-off points, revealed almost no differences, even at the earlier gestational ages. The distributions of the PWR curves for males and females are illustrated in Figures Additional file 1.xlsx and Additional file 2.xlsx in Supplementary Material available online at PWR distributions for the entire sample, inclusive of regional referrals, were used in an analysis of SGA, AGA, and LGA. The proportion with PWRs <10th percentile between the 10th and the 90th percentile and >90th percentile are presented in The results of this study contribute to the current literature by creating gender-specific PWR percentile standards. While PWR is an important indicator of fetal health, there are few population standards for comparison. A few previous studies have presented the relation between placental weight and birth weight and only two of these reported percentiles curves for the PWR , 20. ThoOur standards include earlier gestational ages than both of the aforementioned studies. Both of the abovementioned studies have gestational age standards starting at 24 weeks; however, our standards provide estimates starting at 22 weeks. Comparison of our results to Thompson et al.'s  shows thA declining PWR with increasing gestational age reported here is similar to that described by others –23. The Our birth weight distributions differ from the Kramer et al.  birth weOur PWR curves are similar whether inclusive or exclusive of the referral population. This may be because, at earlier gestations, the vast majority of regional births occur in this tertiary referral center. Thus, the lower gestations represent a “whole population.” At later gestational ages, where one might expect the referral population to represent a biased sample of higher risk births, the actual numbers contributed by regional referrals are much smaller and would not substantially affect the percentile estimates for term and near-term births. Thus, the results are not unduly biased by inclusion of regional births. This is important because their inclusion had a sample size advantage, as it allowed us to use the total population for analyses stratified by fetal growth adequacy.An additional novelty is the examination of percentile curves stratified by fetal growth adequacy, specifically focusing upon how PWRs change across gestational age between SGA, AGA, and LGA infants.The literature suggests that a higher proportion of LGA infants have placenta weights above the 90th percentile and a lower share of placental weights below the 10th percentile than SGA and AGA infants . FurtherPrevious studies have indicated that overall SGA infants have higher PWRs , 5 and tOur curves show that as gestational age advances, the PWRs become more similar between SGA, AGA, and LGA infants, yet the PWR is still higher in female SGA infants. At earlier gestational ages the SGA standards are much higher than the AGA standards. This suggests that SGA may be detectable early in pregnancy. Therefore, the SGA infant is generally under grown in relation to placental size, suggesting placental function, rather than size, constraints for fetal growth. Salafia et al.  showed tA major strength of the study is the available sample size. The perinatal database provided a large number of observations with matching placental weight, birth weight, and gestational age. This allowed for the creation of accurate standards, and for the resulting percentile curves to be stratified by fetal growth adequacy standard.Birth weights vary widely from country to country , 42 and The PWR distribution curves provide a standard that researchers can apply as a reference to identify infants who have abnormal PWRs. Identifying infants with high PWRs is important for patient care in both the short and long term. These analyses have included birth weight, placental weight, and even the PWR; however, the relative magnitude of the latter, in terms of percentiles, has not been previously available for all gestational ages in a Canadian population.The supplementary material presents the placental weight ratios, inclusive of regional referrals, for both males and females at each percentile. They also include the sample sizes at each gestational age. Click here for additional data file.


Human exposure to phenols, including bisphenol A and parabens, is widespread. Evidence suggests that paternal exposure to environmental chemicals may adversely affect reproductive outcomes.We evaluated associations of paternal phenol urinary concentrations with fertilization rate, embryo quality, implantation, and live birth.in vitro fertilization (IVF) and/or intrauterine insemination (IUI) cycles in a prospective study of environmental determinants of fertility and pregnancy outcomes were included. The geometric mean of males’ specific gravity–adjusted urinary phenol concentrations measured before females’ cycle was quantified. Associations between male urinary phenol concentrations and fertilization rate, embryo quality, implantation, and live birth were investigated using generalized linear mixed models to account for multiple cycles per couple.Male–female couples who underwent n = 218) underwent 195 IUI and 211 IVF cycles. Paternal phenol concentrations were not associated with fertilization or live birth following IVF. In adjusted models, compared with the lowest quartile of methyl paraben, paternal concentrations in the second quartile were associated with decreased odds of live birth following IUI .Couples (To our knowledge, these are some of the first data on the association of paternal urinary phenol concentrations with reproduction and pregnancy outcomes. Although these results do not preclude possible adverse effects of paternal paraben exposures on such outcomes, given the modest sample size, further understanding could result from confirmation using a larger and more diverse population.http://dx.doi.org/10.1289/ehp.1408605Dodge LE, Williams PL, Williams MA, Missmer SA, Toth TL, Calafat AM, Hauser R. 2015. Paternal urinary concentrations of parabens and other phenols in relation to reproductive outcomes among couples from a fertility clinic. Environ Health Perspect 123:665–671;  The National Report on Human Exposure to Environmental Chemicals , which was slightly lower than the concentrations measured in males in NHANES 2007–2008 (2.20 ng/mL) and 2009–2010 (1.94 ng/mL), though these males include children and older men . The medCovariates associated with IUI and IVF outcomes. Given univariate models to identify covariates that were associated with the outcomes at the α = 0.20 level and that produced ≥ 10% change in the log odds, similar to other studies, each additional year of maternal age was associated with decreased odds of live birth following IVF  and IUI . Each additional year of paternal age was marginally associated with decreased odds of implantation  and live birth following IVF , whereas maternal and paternal normal weight were negatively associated with the proportion of high-quality embryos compared with participants who were overweight or obese . Each additional cycle number was negatively associated with implantation  and live birth following IVF , because couples requiring more cycles are more likely to have lower fertility. Similarly, maternal ever smoking compared with never smoking was associated with lower proportions of high-quality embryos  and decreased odds of implantation  and live birth following IVF . The use of ICSI was associated with lower odds of implantation , likely because couples using ICSI have poorer fertility, as reflected by prior failures of IVF without ICSI. Live birth following IVF was positively associated with luteal-phase stimulation protocol , a greater number of oocytes retrieved , and day 5 embryo transfer; , but it was negatively associated with a greater number of embryos transferred .Paternal urinary phenol concentrations and IUI and IVF outcomes. Paternal urinary phenol concentrations were not associated with fertilization rate , which was evaluated only in IVF cycles, or live birth following IVF  Study, has reported associations between decreased couple fecundity and maternal and paternal exposure to environmental chemicals  of BPA has been shown to be as low as 0.12 , though This study does not exclude the possibility of adverse effects of male phenol exposure on reproductive outcomes in couples undergoing assisted reproduction. Further understanding of these associations could result from replication within a larger and more diverse cohort, and investigations into exposure to mixtures of environmental chemicals, within both individuals and couples, would further elucidate the reproductive effects of these exposures.(316 KB) PDFClick here for additional data file.


The 2ndtheory explains the pathogenic mechanism of the acquired form, which may be due to theimplantation of epithelial cells subsequent to accidental or surgical injury . Lastly, the3rd theory maintains that these cysts are considered a variation of thecyst of the thyroglossal pore,Three theories with regard to the origin of cysts in the floor of the mouth were foundin literature. According to the 1,Histologically, the dermoid cyst differs from epidermoid cyst only in the presence ofnormal or dysmorphic adnexal appendages within its walls, usually sebaceous glands orabortive hair follicles. The teratoid cyst is considered if the cyst wall contains otherelements, such as muscle or boneThis paper presents a case of teratoid cyst in a child with emphasis on the managementand follow-up of six months.5-year-old male attended the oral diagnostic service, reporting swelling in the mouthfloor, with time course of approximately three months. In extraoral examination therewas evidence of a slight volume increase in the submental region of about 3 cm withfloating consistency. The intraoral examination showed proptosis of the tongue with nochange in the overlying mucosa . Magneti,During the formation of the face and neck, branchial arches fuse in the midline betweenthe third and fourth weeks of intrauterine life. It is believed that congenital dermoidcysts are a result of entrapment of a fragment of ectodermal tissue in the midline, justbehind the mandible. Some of these trapped cells are totipotential blastomeres that candevelop into any of the three germ layers,,,,Dermoid and teratoid cysts represent approximately 1.8% of all mouth floor cysts, andsuch lesions are very rare in infancy,The treatment of choice for cysts in the floor of the mouth is their total extraction(enucleation) via intraoral or extraoral approach or a combination of both, determinedon each occasion by the location and size of the cyst


After temporarily implementing stricter emissions standards and shutting down nearby industrial polluters, pollutant measurements between June and October 2008 showed reductions of 18–59% compared with pre-Olympics levels. But once the Games were over, air pollution began to rise again.The current study included two month-by-month analyses. The authors included only term births (37–41 weeks) and births in which the infant was neither large nor small for gestational age.In the first analysis, the researchers assessed records for 71,803 births at Beijing Obstetrics and Gynecology Hospital to determine which month of each pregnancy fell during the Games (8 August–24 September 2008). They compared the birth weights with those in which the same month of pregnancy occurred in the same calendar period either one year earlier or one year later. They found the strongest association when the eighth month fell during the Games, with babies born in 2008 weighing an average of 23 g (0.8 oz) more than the babies born in 2007 or 2009.2.5, CO, NO2 and SO2 during each month of pregnancy. They then looked at 32,506 birth records in which women were pregnant for at least one full month during the Games. They found that interquartile increases in the pollutants during the eighth month of pregnancy were associated with reductions of 17–34 g in birth weight, depending on the pollutant. They found no such associations for increased air pollution during other months of pregnancy.In the second analysis, the team used data on air pollution, temperature, and humidity gathered at a site in central Beijing to calculate average monthly concentrations of PMLead author David Rich, a public health sciences professor at the University of Rochester Medical Center, says it will take further study to figure out why the eighth month may be a critical time for pregnant women and air pollution exposure. “It could be that the early months are important—if pollution levels went down in the first or second month, it could have a beneficial effect on the baby’s growth—but then the pollution levels went back up after the Olympic Games, so any improvement in birth weight may be ‘washed away.’” He says another possibility is that since late pregnancy is when the fetus grows most rapidly, air pollutant exposure during this time period may affect some biologic mechanism—perhaps the placenta’s ability to deliver nutrients—that impedes fetal growth.10 and PM2.5 across the span of a pregnancy were associated with increases in the risk of low birth weight and decreased birth weight among term births.A 2014 meta-analysis of previous studies showed that increased concentrations of PMDavid Savitz, a professor of epidemiology at Brown University School of Public Health, says he found the new results more persuasive than previous studies looking at the impact of air pollution in reducing birth weights. “Some people are already convinced that it’s a known fact that pollution [lowers birth weights],” he says. “I’m not among them. I’m pretty skeptical about it.” But while this study is far from the final word on the issue, he says it “really adds a significant amount of weight to the evidence in support of an effect on birth weight.” Savitz was not involved in the study.Lyndsey Darrow, an assistant professor of epidemiology at Emory University who also was not involved in the study, says she would like to see a similar study but with a longer duration of reduced air pollution. “Ideally, future complementary studies could take advantage of other natural experiments to investigate the cumulative impact of reducing air pollution over the full course of pregnancy,” she says, adding, “Of course, such natural experiments are hard to come by.”


Introduction. Violence against women has serious consequences for their reproductive and sexual health including birth outcomes. In Ethiopia, though the average parity of pregnant women is much higher than in other African countries, the link between intimate partner violence with low birth weight is unknown. Objective. The aim of this study was to examine the association between intimate partner violence and low birth weight among pregnant women. Method. Hospital based case-control study was conducted among 387 mothers (129 cases and 258 controls). Anthropometric measurements were taken both from mothers and their live births. The association between intimate partner violence and birth weight was computed through bivariable and multivariable logistic regression analyses and statistical significance was declared at P < 0.05. Result. Out of 387 interviewed mothers, 100 (25.8%) had experienced intimate partner violence during their index pregnancy period. Relatively more mothers of low birth weight infants were abused (48%) compared with controls (16.4%). Those mothers who suffered acts of any type of intimate partner violence during pregnancy were three times more likely to have a newborn with low birth weight ). The association between overall intimate partner violence and LBW was adjusted for potential confounder variables. Conclusion. This research result gives insight for health professional about the importance of screening for intimate partner violence during pregnancy. Health care providers should consider violence in their practice and try to identify women at risk. The World Health Organization (WHO) defines violence against women as “the range of sexually, psychologically, and physically coercive acts used against women by current or former male intimate partners” . It is rDomestic violence is one of the most common forms of violence against women. It is the violence perpetrated by persons who have or had a relationship of kinship or affection with the woman and generally refers to the current or former male intimate partner , 2. IntiViolence against women has serious consequences for their reproductive and sexual health including birth outcomes –8. VioleA systematic review and meta-analysis study revealed that women who reported physical, sexual, or emotional abuse during pregnancy were more likely than nonabused women to give birth to a baby with low birth weight (LBW) . The assBut research linking intimate partner violence during pregnancy to LBW has not been conclusive and was mainly cross-sectional studies. Consequently, how much LBW is attributable to intimate partner violence during pregnancy remained unknown. Most of the research was also conducted in developed countries. In Ethiopia, the average parity of pregnant women is much higher than that in other African countries and no study has been conducted to link intimate partner violence with low birth weight . Thus, wA hospital-based case-control study design was conducted in Bale Zone, Southeast Ethiopia, from April 1 to August 30, 2013. This study was conducted at the four government hospitals: Goba, Robe, Delomena, and Ginir. All mothers who gave live births in the study hospitals were eligible for this study. Cases were mothers who gave live births of weight less than 2500 g and controls were mothers who gave live births of weight 2500 g and above. All mothers selected as cases and controls were mothers with singleton and full term births. Additionally, mothers who had serious illness, hypertension, and/or diabetes mellitus were excluded from the study. Seven cases and respective controls' data were excluded because of missing data making the response rate 94%.For each case there were two controls. Following each case two consecutive controls were included in the study until the required sample sizes were satisfied.Since the cases (LBW) were rare, all eligible cases fulfilling the inclusion criteria in each hospital were included in the study until the required sample sizes were satisfied within the study period.The data were collected by face-to-face interview method using structured and pretested questionnaire. The questionnaire was adopted from the Ethiopian Demographic and Health Survey (EDHS) and Behavioral Surveillance Survey (BSS). It consists of sociodemographic, obstetric, and experiences-of-violence related questions. The same interviewer was used to interview the mother for a case and the respective two consecutive controls. The weight of the newborns was measured within 15 minutes after birth using a balanced Seca scale. Maternal height was measured against a wall height scale to the nearest centimeter. Maternal weight was also measured by beam balance to the nearest kilogram and body mass index (BMI) was subsequently calculated.The interview and anthropometric measurements were obtained by eight  trained midwives and nurses who were working in labor ward.P < 0.05.The data were analyzed using SPSS for Windows version 20.0 . Bivariable logistic regression analyses were done to evaluate the association of low birth weight with each construct of intimate partner violence (IPV)  and overall IPV. Multivariable logistic regression analysis was used to control for potential confounding variables. A multivariable analysis was based on multiple logistic regression models. Two multivariable logistic regression models were constructed: one is to see the interaction of the three constructs of IPV, socioeconomic factors, and other maternal factors with the dependent variable low birth weight while the other model is constructed to see the interaction of overall IPV, socioeconomic factors, and other maternal factors with low birth weight. Furthermore, the relationship between the socioeconomic factors  and intimate partner violence was evaluated by logistic regression analysis. In order to evaluate the strength of association, both crude and adjusted odds ratios with 95% confidence interval were calculated for exposure to intimate partner violence, socioeconomic factors, and other maternal factors in relation to LBW. Statistical significance was defined as Emotional/psychological violence is defined as being humiliated, insulted, intimidated, or threatened and/or controlling behaviors by a partner.Physical violence is defined as being slapped or having something thrown at her that could hurt her, being pushed or shoved, being hit with a fist or something else that could hurt, being kicked, dragged, or beaten up, being choked or burnt on purpose, and/or being threatened with, or actually having, a gun, a knife, or another weapon used on her by an intimate partner.Sexual violence is defined as being physically forced to have sexual intercourse when she did not want to, having sexual intercourse because she was afraid of what her partner might do, and/or being forced to do something sexual that she found humiliating or degrading to her by an intimate partner.Overall intimate partner violence is defined as follows: those mothers who experienced any act of intimate partner violence whether they encounter physical, psychological, or sexual violence during the index pregnancy period.In this study, from a total of 408 mothers that we planned to interview, 387 mothers (mothers of 129 cases and 258 controls) completed the interview which made the response rate of 94% for both cases and controls. Fifty-one percent of mothers of LBW babies and 69.4% of mothers of normal birth weight (NBW) babies were in the age range of 21–35 years. The predominant religion was found to be Islam, 66.7% of mothers of cases and 53.9% of mothers of controls. Related to occupational status the majority, 69.8%, of LBW mothers and 45.3% of NBW mothers were housewives. The significant number, 45.7%, of mothers of low birth weight babies was illiterate compared to 15.5% of mothers of normal birth weight babies. Concerning monthly family income among the study population, relatively high percentage of mothers with low birth weight babies, 24.6%, had less than 500 ETB monthly income compared to mothers with normal birth weight babies, 7.8%.Fifty percent of mothers with LBW babies spaced between present and past pregnancy more than two years compared to 75% of mothers with NBW babies. Almost eighty-eight percent of mothers of cases and 95.3% of mothers of controls weighed more than 50 kg. Measurements of maternal height showed that 84.5% of mothers of cases and 93.8% of mothers of controls were greater than 150 cm tall. Forty-eight percent of mothers of cases and 24.8% of mothers of controls were residing in rural part of the study area. Almost all, 93%, of the study participants were currently married .A total of 387 mothers were interviewed about their experience of any violence during their current pregnancy period. Of them, 100 (25.8%) experienced some violence by their intimate partners during their index pregnancy period. Relatively more mothers of low birth weight infants were abused, 59 (48%), compared with controls, 41 (16.4%). Thirty percent of the mothers of LBW infants had been sexually abused by their partners during their current pregnancy, compared with 7.3% of mothers of the controls. Around forty-one percent of mothers of cases and 10% of mothers of controls had been abused physically by their intimate partners. In addition to physical and sexual violence, 38% of mothers of cases had been psychologically abused by their intimate partners, compared to 11.6% of mothers of controls. Overall, proportionally more mothers in the cases group reported experiences of abuse than in the controls group.More than half, 54 (14%), of the mothers faced a type of intimate partner violence: the most frequent was being slapped or punched on the face. Seven (1.8%) of the mothers experienced a type of violence less frequent which was not being allowed to enter home or being locked in. Besides the above violence, 46 (11.9%) of the mothers had their contact with friends/family members limited, 44 (11.4%) of the mothers have been criticized by partners for what they were doing, 21 (5.4%) of the mothers were verbally abused by partners somewhere, and 9 (2.3%) of the mothers were threatened with some harmful objects.Multivariable logistic regression analyses were performed to control confounding variables and to identify the strength of association with significant explanatory variables. In the logistic regression analysis, mothers with no formal education were more likely to encounter physical violence than mothers with advanced educational status , and housewife mothers were more likely to be physically violated by their partner than employed mothers . Similarly, mothers living in a family with monthly income less than 500 ETB  or in the range of 1001–1500 ETB  were at a higher risk of physical violence compared to mothers living in a family with monthly income greater than 1500 ETB. Psychological violence also significantly increased with residence and family income level. Mothers residing in rural area and with lower income level were associated with increased psychological violence. The relationship between exposure to any type of intimate partner violence and LBW was evaluated after adjusting for residence, maternal education, maternal occupational status, husband's educational and occupational status, family monthly income, maternal body mass index (BMI), antenatal care, and khat chewing and alcohol drinking status of mothers. Therefore, the multivariable logistic regression model indicated that those mothers who suffered acts of any type of intimate partner violence during pregnancy were three times more likely to have a newborn with low birth weight (95% CI: 1.57 to 7.18) .Similarly, the association was examined for subcategories of intimate partner violence  . PhysicaIn this study, 26% of the mothers had experienced intimate partner violence during their index pregnancy period. This result is consistent with other study in Nicaragua where 27% of the mothers had been abused by their intimate partners during their pregnancy , 6.Although some studies have found that abuse during pregnancy increases the risk of LBW , 4, 7 otIn our study mothers who suffered from any type of intimate partner violence during pregnancy were more likely to have a newborn with low birth weight. This result is supported by results from hospital-based case-control study in León, Nicaragua, which found that, after adjusting for other known risk factors of low birth weight, partner violence against pregnant women increased the risk of low birth weight by a factor of three . It has In our study we tried to analyze the association of birth weight for subgroups of intimate partner violence . As a result, physical violence during pregnancy was consistently associated with a significant increase in LBW. This finding is in line with other similar studies where physical violence by intimate partners during pregnancy period was independently associated with low birth weight , 13, 14.The results of the present study indicate that there is an independent effect of overall and physical violence during pregnancy on the birth weight of the offspring. But neither sexual nor psychological violence exposure yielded significant associations with low birth weight in our study.Health service providers should be aware of the impact of intimate violence on pregnant women and on their newborns and try to identify women at risk using the knowledge of maternal characteristics statistically associated with violence in pregnancy.Longitudinal studies would also be valuable in addressing the causal mechanisms between intimate violence and low birth weight.Supplementary material contains the structured questionnaire in Amharic and English languages, available online for readers.


Preterm birth is a major cause of neonatal mortality and morbidity. As preventive strategies are largely ineffective, threatened preterm labor is a frequent problem that affects approximately 10 % of pregnancies. In recent years, risk assessment in these women has incorporated cervical length measurement and fetal fibronectin testing, and this has improved the capacity to identify women at increased risk for delivery within 14 days. Despite these improvements, risk for preterm birth continues to be increased in women who did not deliver after an episode of threatened preterm labor, as indicated by a preterm birth rate between 30 to 60 % in this group of women. Currently no effective treatment is available. Studies on maintenance tocolysis and progesterone have shown ambiguous results. The pessary has not been evaluated in women with threatened preterm labor, however studies in asymptomatic women with a short cervix show reduced rates of preterm birth rates as well as perinatal complications.The APOSTEL VI trial aims to assess the effectiveness of a cervical pessary in women who did not deliver within 48 h after an episode of threatened preterm labor.This is a nationwide multicenter open-label randomized clinical trial. Women with a singleton or twin gestation with intact membranes, who were admitted for threatened preterm labor, at a gestational age between 24 and 34 weeks, a cervical length between 15 and 30 mm and a positive fibronectin test or a cervical length below 15 mm, who did not deliver after 48 h will be eligible for inclusion. Women will be allocated to a pessary or no intervention . Primary outcome is preterm delivery < 37 weeks. Secondary outcomes are amongst others a composite of perinatal morbidity and mortality. Sample size is based on an expected 50 % reduction of preterm birth before 37 weeks . Two hundred women with a singleton pregnancy need to be randomized. Analysis will be done by intention to treat.The APOSTEL VI trial will provide evidence whether a pessary is effective in preventing preterm birth in women who did not deliver 48 h after admission for threatened preterm labor and who remain at high risk for preterm birth.http://www.trialregister.nl, NTR4210, date of registration: October 16th 2013.Trial is registered at the Dutch Trial Register:  Preterm birth, defined as birth before 37 weeks gestational age, affects 5-12 % of pregnancies in the developed world . The Peto-stopping rule will be used for testing for efficacy. Given the strong association between gestational age at birth and adverse perinatal outcome there is an opportunity to expand the number of inclusions, if at interim the incidence of the primary outcome turns out to be clinically relevant lower in the pessary group. This is in order to obtain sufficient power to detect a difference in adverse perinatal outcome at the end of the study. Sufficient funds must be available to expand to number of inclusions.An independent statistician will perform interim analysis and an independent DSMC will advise whether the trial should be stopped or continued.l.The data safety monitoring board will be blinded for the treatment allocation, but can be unblinded by opening a sealed envelope. Adverse Events (AEs) and Serious Adverse Events (SAEs) will be reported to the DSMC. If the DSMC feels participating in the trial leads to safety risks, the DSMC can always advice to stop the triaPreterm birth is the major cause of neonatal morbidity and mortality. Of all perinatal mortality, 50 % to 70 % is associated with preterm birth. Similarly, neonatal morbidity is inversely proportional to gestational age and thus preterm birth. Since women who do not deliver after an episode of threatened preterm labor remain at an increased risk of preterm birth and currently no effective intervention is available, it is important to evaluate potential treatments for effectiveness. As such, the pessary seems a potential alternative in this group of women.fFN, fetal fibronectin; NICU, neonatal intensive care unit; CRF, case report form; BPD, bronchopulmonary dysplasia; PVL, periventricular leucomalacia; NEC, necrotising enterocolitis; SAE, serious adverse events; SUSAR, suspected unexpected serious adverse reactions; DSMC, data safety and monitoring committee., preterm labor, preterm labor