BackgroundBirth weight, a marker of the intrauterine environment, has been extensively studied in epidemiological research in relation to subsequent health and disease. Although numerous meta-analyses have been published examining the association between birth weight and subsequent health-related outcomes, the epidemiological credibility of these associations has not been thoroughly assessed. The objective of this study is to map the diverse health outcomes associated with birth weight and evaluate the credibility and presence of biases in the reported associations.MethodsAn umbrella review was performed to identify systematic reviews and meta-analyses of observational studies investigating the association between birth weight and subsequent health outcomes and traits. For each association, we estimated the summary effect size by random-effects and fixed-effects models, the 95 % confidence interval, and the 95 % prediction interval. We also assessed the between-study heterogeneity, evidence for small-study effects and excess significance bias. We further applied standardized methodological criteria to evaluate the epidemiological credibility of the statistically significant associations.ResultsThirty-nine articles including 78 associations between birth weight and diverse outcomes met the eligibility criteria. A wide range of health outcomes has been studied, ranging from anthropometry and metabolic diseases, cardiovascular diseases and cardiovascular risk factors, various cancers, respiratory diseases and allergies, musculoskeletal traits and perinatal outcomes. Forty-seven of 78 associations presented a nominally significant summary effect and 21 associations remained statistically significant at P < 1 × 10−6. Thirty associations presented large or very large between-study heterogeneity. Evidence for small-study effects and excess significance bias was present in 13 and 16 associations, respectively. One association with low birth weight (increased risk for all-cause mortality), two dose-response associations with birth weight (higher bone mineral concentration in hip and lower risk for mortality from cardiovascular diseases per 1 kg increase in birth weight) and one association with small-for-gestational age infants with normal birth weight (increased risk for childhood stunting) presented convincing evidence. Eleven additional associations had highly suggestive evidence.ConclusionsThe range of outcomes convincingly associated with birth weight might be narrower than originally described under the “fetal origin hypothesis” of disease. There is weak evidence that birth weight constitutes an effective public health intervention marker.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0692-5) contains supplementary material, which is available to authorized users.

Enhanced recovery after surgery (ERAS) aims to improve perioperative care, hasten recovery to the normal physiological state and shorten length of stay (LoS). There is evidence that ERAS programmes following elective caesarean section (ELCS) confer benefit through faster return to physiological state and reduced LoS for mother and baby. Baseline audit of ELCS in 2013 revealed a mean LoS of 3 days. We piloted an ERAS discharge pathway promoting day 2 discharge, which rose from 5.0% to 40.2%. 19.2% of women went home on day 1. Many women fed back that they would prefer day 1 discharge. We hypothesised that a day 1 discharge pathway for low-risk women could benefit both women and services at our maternity unit. From October 2015, we developed a ‘fast-track pathway’ (FTP) using a Plan-Do-Study-Act approach. Between October 2015 and April 2016, we prospectively audited clinical outcomes, LoS and maternal satisfaction from all women placed on the FTP. We held regular multidisciplinary team meetings to allow contemporaneous analysis. Satisfaction was analysed by Likert scale at postoperative surveys. Women were identified in antenatal clinic after meeting predefined low-risk criteria. 27.3% of women (n=131/479) delivering by ELCS entered the FTP. 76.2% of women on the FTP were discharged on day 1. Mean LoS fell to 1.31 days. 94.2% of women who established breast feeding at day 1 were still breast feeding at 7 days. Overall satisfaction at day 7 was 4.71 on a 5-point Likert scale. 73.1% of women reported good pain control. Additional financial savings are estimated at £99 886 annually. There were no related cases of readmission. Day 1 discharge after ELCS is safe and acceptable in carefully selected, low-risk women and has high satisfaction. There may be resultant financial savings and improved flow through a maternity unit with no detected adverse effect on breast feeding, maternal morbidity or postnatal readmissions.

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ObjectiveTo investigate the intrauterine fetal growth pattern and fetoplacental circulation in pregnancies following bariatric surgery.DesignProspective study.SettingMaternity Unit, UK.PopulationOne hundred and sixty‐two pregnant women; 54 with previous bariatric surgery and 108 with no surgery but similar booking body mass index.MethodsParticipants were seen at 11–14, 20–24, 30–33 and 35–37 weeks of gestation and an oral glucose tolerance test (OGTT) was performed at 27–30 weeks. Fetal head and abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW) and fetoplacental Dopplers were measured at three time‐points in pregnancy. Birthweight (BW) was recorded. Variables were modelled after adjustment for maternal/pregnancy characteristics. Model estimates are reported as posterior means and quantile‐based 90% credible intervals (CrI).Main outcome measuresFetal biometry, fetoplacental Doppler, BW.ResultsCompared with the no surgery group, the post‐bariatric surgery group had lower EFW during gestation (up to −120 g; [−189 g, −51 g] lighter) at 35–37 weeks, with smaller AC and FL. Similarly, infants of mothers with previous bariatric surgery had lower average BW [−202 g [−330 g, −72 g] lighter). Overall, there was no difference in the fetoplacental Doppler indices between groups but maternal glucose levels at OGTT were positively correlated with third‐trimester EFW and BW.ConclusionsFetuses of women with previous bariatric surgery are smaller during pregnancy and at birth, compared with those of women without such surgery, and this may be related to the lower maternal glucose levels seen in the former population. The fetoplacental circulation appears not to be altered by maternal weight loss surgery.Tweetable abstractOffspring of post‐bariatric women are smaller during pregnancy and at birth but this is not due to placental insufficiency.

ObjectiveDue to the global increase in obesity rates and success of bariatric surgery in weight reduction, an increasing number of women now present pregnant with a previous bariatric procedure. This study investigates the extent of bariatric-associated metabolic and gut microbial alterations during pregnancy and their impact on fetal development.DesignA parallel metabonomic (molecular phenotyping based on proton nuclear magnetic resonance spectroscopy) and gut bacterial (16S ribosomal RNA gene amplicon sequencing) profiling approach was used to determine maternal longitudinal phenotypes associated with malabsorptive/mixed (n=25) or restrictive (n=16) procedures, compared with women with similar early pregnancy body mass index but without bariatric surgery (n=70). Metabolic profiles of offspring at birth were also analysed.ResultsPrevious malabsorptive, but not restrictive, procedures induced significant changes in maternal metabolic pathways involving branched-chain and aromatic amino acids with decreased circulation of leucine, isoleucine and isobutyrate, increased excretion of microbial-associated metabolites of protein putrefaction (phenylacetlyglutamine, p-cresol sulfate, indoxyl sulfate and p-hydroxyphenylacetate), and a shift in the gut microbiota. The urinary concentration of phenylacetylglutamine was significantly elevated in malabsorptive patients relative to controls (p=0.001) and was also elevated in urine of neonates born from these mothers (p=0.021). Furthermore, the maternal metabolic changes induced by malabsorptive surgery were associated with reduced maternal insulin resistance and fetal/birth weight.ConclusionMetabolism is altered in pregnant women with a previous malabsorptive bariatric surgery. These alterations may be beneficial for maternal outcomes, but the effect of elevated levels of phenolic and indolic compounds on fetal and infant health should be investigated further.

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On this limited data, either mechanical or chemical IOL in suspected IUGR/SGA is reasonable. However, a sizeable RCT specifically to answer the question of chemical versus mechanical IOL in this group, ± pooling of SGA subgroup data from general IOL trials, is required to provide definitive data. Objectives: To characterise lipid metabolomic changes in maternal and umbilical cord blood of pregnancies with sub-optimal fetal growth. Methods: Prospective cohort study in singleton term gestations including 27 normally grown newborns and 51 small fetuses classified into small for gestational age (SGA) (if birthweight 3rd-9th and had normal fetoplacental Doppler. n=27) and fetal growth restriction (FGR) (if birthweight <3rd centile and/or abnormal fetoplacental Doppler; n=24). Maternal and cord blood samples were analysed by 1 H-NMR and diffusion data assessed by targeted metabolomics to determine lipoprotein content, choline and glycoprotein compounds (Liposcale ® test). Results: Targeted lipidomics could clearly discriminate between the groups. Lipoprotein profiles showed significantly lower maternal concentrations of cholesterol-IDL (-17%), and triglycerides-IDL as well as -HDL in small fetuses (both, SGA and FGR) compared to controls (all p<0.05). While FGR fetuses had significant higher levels of cholesterol-VLDL (+56%). -IDL (+24%). triglycerides-VLDL (+24%) and -IDL (+18%) than controls (all p<0.005) (Figure). Changes in phosphatidylcholines and glycoproteins were more prominent in FGR vs. controls, indicating significant alterations in their abundance and biophysical properties. Conclusions: These results provide a substantial understanding of the widespread disruption of lipid profiles in both maternal and cord blood of pregnancies with suboptimal fetal growth.

(BJOG. 2020;127:839–846) Nearly one third of the population within the United States and one fourth of the population of the UK can be classified as obese, which includes one quarter of all reproductive-aged women. There are significant short-term and long-term adverse outcomes for both baby and mother associated with pregnancy while obese. Obese mothers exhibit a higher propensity for gestational diabetes mellitus, preeclampsia, cesarean delivery, or postpartum hemorrhage, as well as the development of cardiovascular disease and type 2 diabetes later in life. In addition to macrosomia, children of obese mothers are more likely to develop type 2 diabetes and cardiovascular disease in adulthood. Bariatric surgery, an effective weight-reduction treatment, is becoming more common for women of childbearing age. This study aimed to investigate the intrauterine fetal growth pattern and placental function, in postbariatric pregnancies as compared with patients of no history of maternal weight-loss surgery.