Ponderal index (fetal weight in grams X 100 / (fetal length in centimeters)3) (PI) is one of the anthropometric methods used to diagnose impaired fetal growth. Irrespective of the infant's position on the growth-weight-for-gestational age charts, PI is low in malnourished infants and high in obese ones. As fetal growth is affected by ethnicity, geographic location and socioeconomic status, we developed standards for neonatal PI, and assessed the effects of gestational age, sex and maternal parity. Data on 5798 newborns from singleton pregnancies born in the Department of Gynecology and Obstetrics, Split University Hospital, were retrospectively analyzed. Over a 15-month period in 2000/2001, 5596 newborns from 24 to 42 weeks of gestation were born. The other 202 newborns, born from 24 to 34 weeks of gestation in the ten year period, 1990-1999, were added because of the small number of preterm infants; ensuring a minimum of 30 to fill up at least infants in each gestational week. All mothers were of Caucasian origin. Stillbirths and fetuses with congenital malformations were excluded. The 10th, 50th and 90th percentiles, mean values with standard deviation of PI and the 10th, 50th, and 90th percentiles of birth weight and birth length are presented separately at weekly intervals. PI showed linear correlation with gestational age from 24 to 39 weeks, after witch the data plateaued. Sex and parity had no impact on PI in infants born between 24 and 37 weeks. Analysis of variance revealed PI to be significantly higher in female than in male newborns, and in multiparous than in nulliparous infants after 37 weeks of gestation. In conclusion, gestational age is the most important factor of neonatal PI. The effects of sex and parity on PI should only be considered in term neonates.
Optimal weight gain in underweight women could be estimated in the very beginning of pregnancy as recommended BMI change, but recalculated in kilograms according to body height, which modulates the numerical calculation of BMI. Our proposal presents a further step forward towards individualized approach for each pregnant woman.
The aim was to determine whether discordant twin growth has an impact on preterm birth in dichorionic pregnancies. This retrospective study included dichorionic twin pregnancies in the period from January 1, 2013 to December 31, 2015. The following variables were investigated: maternal age (years), parity, body mass index (kg/m2), week (≤366/7 and ≥37) and mode of delivery (vaginal and cesarean section), birth weight (grams) and Apgar score (≤7, 8-10). Discordant twin growth in dichorionic pregnancies was found to be associated with preterm birth (χ2=4.74; p=0.03) but had no impact on the mode of delivery (χ2=0.119; p=0.73). There was a statistically significant difference in the rate of small for gestational age (SGA) neonates (χ2=16.4556; p=0.000267) and Apgar score (χ2=7.9931; p<0.05) between the study groups. Mode of conception in dichorionic pregnancies was not a risk factor for preterm delivery (χ2=1.417; p=0.23). In conclusion, discordant twin growth in dichorionic pregnancies is a risk factor for preterm delivery and has no impact on the mode of delivery but has an impact on the rate of SGA and Apgar score.
Aim: To evaluate the prevalence, assessment, and perinatal outcome of pregnancies complicated with diabetes mellitus type 1 (DM type 1) at a tertiary perinatal center in the town of Split, Dalmatia County. Materials and methods: The investigation was designed as a retrospective cohort study. All pregnant women with DM type 1 that were supervised and gave birth at Clinical Department of Obstetrics and Gynecology, Split University Hospital Center during a 7-year period (2009-2015), including those diagnosed in 2015 and having delivered in 2016, were included in the study group. Data were collected by the census method from legal protocol books. Control group included DM type 1-free pregnancies entered in the same protocol books just following a particular study woman, if meeting all inclusion and exclusion criteria. Results: There were 70 DM type 1 pregnancies, accounting for 0.2% of all deliveries. DM type 1 group newborns were statistically heavier (3650±605 vs. 3428±591g; p=0.031), more frequent large for gestational age (24.3% vs. 5.7%; p=0.002) and macrosomic (24.3% vs. 10%; p=0.033). Compared to control group, DM type 1 women had a significantly higher delivery rate in the 37th to 39th week of gestation (84.3% vs. 58.6%; p=0.001) and higher cesarean section rate (61.4% vs. 32.9%; p=0.001). Conclusion: DM type 1 significantly influences perinatal outcome. It requires multidisciplinary approach and complete supervision should be provided at specialized centers. Respecting the fetal origin of adult diseases theory, inappropriate protocol(s) and/or individual decision(s) can have many health consequences throughout newborns life, which highlights DM type 1 pregnancies to a public health level issue.
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