SummaryBackgroundFetal growth restriction is a major determinant of adverse perinatal outcome. Screening procedures for fetal growth restriction need to identify small babies and then differentiate between those that are healthy and those that are pathologically small. We sought to determine the diagnostic effectiveness of universal ultrasonic fetal biometry in the third trimester as a screening test for small-for-gestational-age (SGA) infants, and whether the risk of morbidity associated with being small differed in the presence or absence of ultrasonic markers of fetal growth restriction.MethodsThe Pregnancy Outcome Prediction (POP) study was a prospective cohort study of nulliparous women with a viable singleton pregnancy at the time of the dating ultrasound scan. Women participating had clinically indicated ultrasonography in the third trimester as per routine clinical care and these results were reported as usual (selective ultrasonography). Additionally, all participants had research ultrasonography, including fetal biometry at 28 and 36 weeks' gestational age. These results were not made available to participants or treating clinicians (universal ultrasonography). We regarded SGA as a birthweight of less than the 10th percentile for gestational age and screen positive for SGA an ultrasonographic estimated fetal weight of less than the 10th percentile for gestational age. Markers of fetal growth restriction included biometric ratios, utero-placental Doppler, and fetal growth velocity. We assessed outcomes for consenting participants who attended research scans and had a livebirth at the Rosie Hospital (Cambridge, UK) after the 28 weeks' research scan.FindingsBetween Jan 14, 2008, and July 31, 2012, 4512 women provided written informed consent of whom 3977 (88%) were eligible for analysis. Sensitivity for detection of SGA infants was 20% (95% CI 15–24; 69 of 352 fetuses) for selective ultrasonography and 57% (51–62; 199 of 352 fetuses) for universal ultrasonography (relative sensitivity 2·9, 95% CI 2·4–3·5, p<0·0001). Of the 3977 fetuses, 562 (14·1%) were identified by universal ultrasonography with an estimated fetal weight of less than the 10th percentile and were at an increased risk of neonatal morbidity (relative risk [RR] 1·60, 95% CI 1·22–2·09, p=0·0012). However, estimated fetal weight of less than the 10th percentile was only associated with the risk of neonatal morbidity (pinteraction=0·005) if the fetal abdominal circumference growth velocity was in the lowest decile (RR 3·9, 95% CI 1·9–8·1, p=0·0001). 172 (4%) of 3977 pregnancies had both an estimated fetal weight of less than the 10th percentile and abdominal circumference growth velocity in the lowest decile, and had a relative risk of delivering an SGA infant with neonatal morbidity of 17·6 (9·2–34·0, p<0·0001).InterpretationScreening of nulliparous women with universal third trimester fetal biometry roughly tripled detection of SGA infants. Combined analysis of fetal biometry and fetal growth velocity identified a subset of SGA fetuses that w...

It has been suggested that malnutrition during fetal life and early childhood may lead to increased risk of cardiovascular mortality and metabolic syndrome in adults. One way to study this has been to examine pregnancies that are a result of exposure to maternal famine and their association with subsequent development of the metabolic syndrome in adulthood. Varying findings have been demonstrated in this literature. In a famine study that examined the association between fetal famine exposure and the metabolic syndrome, no statistically significant associations were found. However, the failure to show an association could be due to the relatively short Dutch winter, limiting exposure to famine during gestation. The risk of adverse long-term consequences of famine exposure during early life may be exacerbated in later life among adults who are exposed to a nutritionally rich environment represented by a Western dietary pattern or are overweight.The aim of this study was to investigate the association between famine exposure in China during fetal life and early childhood with the risk of metabolic syndrome during adulthood and to determine whether exposure in later life to nutritional rich environments affects this association. Data were obtained from the 2002 China National Nutrition and Health Survey administered on 7874 adults born between 1954 and 1964. The risk of the metabolic syndrome was assessed among adults from 5 exposure cohorts: nonexposed, and fetal, early childhood, mid-childhood, and late childhood exposed.The severity of the famine was determined using the excess death rate in the geographical region during exposure. The metabolic syndrome defined by adenosine triphosphate (ATP) III criteria included 3 or more of the following: elevated fasting plasma triglyceride, lower plasma high-density lipoprotein (HDL) cholesterol, elevated fasting glucose levels, higher waist circumference, and hypertension.The risk of the metabolic syndrome was higher among adults born in severely affected famine areas, who had been exposed to the famine during fetal life compared with nonexposed adults (odds ratio, 3.13, 95% confidence interval, 1.24 to 7.89, P ϭ 0.016). There were similar associations among adults who were exposed to the famine during early childhood, but not among adults exposed to famine during mid or late childhood. The risk of the metabolic syndrome was especially high in later life for participants born in severely affected famine areas and had Western dietary habits or were overweight in adulthood.These findings show that exposure to famine in China during fetal life and early childhood is associated with a higher risk of metabolic syndrome in adulthood. ABSTRACTStudies examining the possible association of birth order, presentation, and mode of delivery with adverse neonatal outcomes after twin delivery have had conflicting results. The contribution of each to adverse outcomes of twin delivery is unclear.This literature review investigated whether differences in birth order, presentation, and deliv...

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We sought to determine whether preeclampsia, delivery of a small for gestational age infant or spontaneous preterm birth were associated with the presence of bacterial DNA in the human placenta. Here we show that there was no evidence for the presence of bacteria in the large majority of placental samples, from both complicated and uncomplicated pregnancies. Almost all signals were related either to acquisition of bacteria during labour and delivery or contamination of laboratory reagents with bacterial DNA. The exception was Streptococcus agalactiae (Group B Streptococcus), where non-contaminant signals were detected in ~5% of samples collected prior to the onset of labour. We conclude that bacterial infection of the placenta is not a common cause of adverse pregnancy outcome and that the human placenta does not have a microbiome, but it does represent a potential site of perinatal acquisition of S. agalactiae, a major cause of neonatal sepsis.

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A retrospective cohort study of 407,503 schoolchildren by Jill Pell and colleagues finds that gestational age at delivery has a dose-dependent relationship with the risk of special educational needs that extends across the full gestational range.

Summary. Policy decisions often require synthesis of evidence from multiple sources, and the source studies typically vary in rigour and in relevance to the target question. We present simple methods of allowing for differences in rigour (or lack of internal bias) and relevance (or lack of external bias) in evidence synthesis. The methods are developed in the context of reanalysing a UK National Institute for Clinical Excellence technology appraisal in antenatal care, which includes eight comparative studies. Many were historically controlled, only one was a randomized trial and doses, populations and outcomes varied between studies and differed from the target UK setting. Using elicited opinion, we construct prior distributions to represent the biases in each study and perform a bias-adjusted meta-analysis. Adjustment had the effect of shifting the combined estimate away from the null by approximately 10%, and the variance of the combined estimate was almost tripled. Our generic bias modelling approach allows decisions to be based on all available evidence, with less rigorous or less relevant studies downweighted by using computationally simple methods.