Fetal microcephaly

Nawathe, Aamod; Doherty, Jane; Pandya, Pranav

doi:10.1136/bmj.k2232

Cited by 15 publications

(22 citation statements)

References 29 publications

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“…Some of the associations may be explained by a large number of infants born to Cantonese mothers (eg,table 3), whose statute is smaller than women in other parts of China,29 although the underlying relationship is complex. In addition to well-established IUGR,2 4 factors such as genetics/ethnicity, nutrients (ie, excess seafood) and heavy air pollution in metro Guangzhou may relate to the increased small HC 16 17 30. Moreover, our results suggest that absolute and relative microcephaly are distinct, with relative microcephaly associated with a wide range of adverse neonatal outcomes given the significant effect of IUGR, and absolute microcephaly associated with adverse neurological outcomes but fewer comorbidities overall.…”

Section: Discussionmentioning

confidence: 65%

“…Mild microcephaly differed little from normocephaly with respect to comorbidities, in-hospital mortality and hospital length of stay. In this study, we were initially concerned by absolute microcephaly as these children are more likely to have future intellectual disability 1–4 31…”

Section: Discussionmentioning

confidence: 99%

“…Microcephaly is a clinical sign, not a diagnosis 2 4 5. Microcephaly is usually defined as an occipitofrontal HC of 2 or 3 SD below the mean on age-matched and sex-matched curves 2 5 32.…”

Section: Discussionmentioning

confidence: 99%

“…Microcephaly in the newborn is characterised by a disproportionately small head circumference (HC) for gestational age and may be categorised as absolute (asymmetrical growth retardation—where the HC is reduced to a greater extent than length and weight) or relative (symmetrical growth retardation—where the HC, the length and weight are reduced to a similar degree) 1 2. Despite considerable advances in case ascertainment, microcephaly remains a heterogeneous group of primarily neurological deficits 2–6. HC is considered a reliable assessment of the volume of the underlying brain.…”

Section: Introductionmentioning

confidence: 99%

“…Unlike intrauterine growth restriction (IUGR) or small for gestational age, the underlying cause/aetiology for microcephaly is reported to be largely genetic or unknown 2 4–6. Devakumar et al recently summarised several major maternal infections such as cytomegalovirus, herpes simplex virus (HSV), rubella virus, Toxoplasma gondii and Zika virus as known causes for congenital microcephaly 15.…”

Section: Introductionmentioning

confidence: 99%

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Small head circumference at birth: an 8-year retrospective cohort study in China

Liu

Pan

Auger

et al. 2019

bmjpo

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ObjectiveHead circumference is considered a reliable assessment of the volume of the underlying brain. We sought to identify risk factors (maternal factors or antenatal antecedents) for microcephaly and to assess the effects of microcephaly on neonatal outcomes.DesignRetrospective cohort study.SettingData for all births in 2009-2017 were obtained from the Guangzhou Maternal-Fetal Care Database.ParticipantsAll singleton liveborn infants between 33 and 42 weeks’ gestation (n=45 663) were categorised using the Intergrowth-21st standard for microcephaly.Main outcome measuresPrevalence of mild, absolute and relative microcephaly at birth. We estimated associations of (1) maternal characteristics including Cantonese origin, parity, exposure to teratogens, TORCH infections (ie, Toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex virus), in vitro fertilisation conception, pre-eclampsia and maternal congenital anomalies with risk of each category of microcephaly, and (2) microcephaly with risk of in-hospital mortality and severe morbidity.ResultsA total of 2709 infants had a head circumference z-score >2 SD, resulting in an overall prevalence of microcephaly of 59.3 per 1000 infants, consisting of mild (54.1 per 1000), absolute (2.8 per 1000) and relative microcephaly (2.4 per 1000). In multiple logistic regression, absolute microcephaly was associated with in utero exposure to teratogens (OR 4.2, 95% CI 2.0 to 8.8) and TORCH agents (OR 3.2, 95% CI 1.1 to 9.5). Mild microcephaly was associated with Cantonese descent (OR) 1.5, 95% CI 1.3 to 1.7) and primiparity (OR 1.7, 95% CI 1.5 to 2.0). Absolute microcephaly was associated with a significantly higher odds of neonatal seizure (OR 8.7, 95% CI 1.1 to 69.1). Mild microcephaly was not associated with adverse neonatal outcomes overall.ConclusionsCantonese origin, exposure to teratogens, pre-eclampsia and TORCH infection may be risk factors for microcephaly. The high prevalence of relative microcephaly and associated poor outcomes suggests that high-risk women merit closer clinical management and follow-up to maximise fetal head development during pregnancy.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

“…Microcephaly is a clinical sign, not a diagnosis 2 4 5. Microcephaly is usually defined as an occipitofrontal HC of 2 or 3 SD below the mean on age-matched and sex-matched curves 2 5 32.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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