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PubMed2006

Longitudinal follow-up of height up to five years of age in infants born preterm small for gestational age; comparison to full-term small for gestational age infants.

OBJECTIVE: This aims to conduct a comparative study of the height catch-up rate in preterm small for gestational age (SGA) infants during early childhood by gestational age and identify the factors affecting short stature in comparison to full-term SGA infants. METHODS: 449 SGA infants (214 full-term infants, 73 infants with gestation of less than 32 weeks, and 162 infants with gestation of more than 32 weeks but less than 37 weeks) from 25 institutions in Japan were assessed for catch-up (> or = -2SD) rate in growth by measuring for length/height at 1 year, 3 years and 5 years of age and the risk factors for no catch-up (< -2SD) at 5 years. RESULTS: The overall length/height catch-up rate was 68% at 1 year, 89% at 3 years and 88% at 5 years. The catch-up rate at 3 and 5 years of age in the group with gestation of less than 32 weeks had a rate of 74%, which was significantly less than the other two groups (approximately 90%). A significant factor associated with short stature at 5 years in the group with gestation of less than 32 weeks was the lower length SD score at time of birth, and for preterm infants born more than 32 weeks of gestation and full-term infants, significant factors were the lower maternal height and head circumference at birth. CONCLUSION: SGA infants born less than 32 weeks of gestation had a higher risk of no catch-up and different factors affecting catch-up compared to preterm SGA infants of gestation more than 32 weeks and full-term SGA infants.

Body Height↗

PubMed2004

Anterior lens capsule vascularity in evaluating gestation in small for gestation neonates.

This study evaluated the role of anterior lens capsule vascularity in assessing gestation in small for gestational age (SGA) neonates in a prospective manner. Neonates with birth weight less than 2000 g were recruited. Those with gross congenital malformations, including corneal opacity or cataract and evidence of TORCH infection were excluded from the study. A total of 139 subjects were enrolled into the study (60-appropriate for gestational age (AGA) and 79 small for gestational age (SGA) neonates). Clinical gestational age assessment and ophthalmoscopic examination for anterior lens capsule vascularity grading were done within 24 hours of birth by independent blinded observers. The correlation of lens capsule grading with clinical gestation in AGA neonates (r2 = 0.75) was stronger compared to SGA neonates (r2 = 0.50). Gestational age assessment by lens capsule grading had a better agreement with clinical gestation in AGA subjects (Kappa Index - 0.56 in AGA vs. 0.26 in SGA). The lens capsule grading under-estimated the gestation of SGA subjects by an average of three weeks compared to AGA neonates.

Female↗

PubMed2005

Do gestational age and weight for gestational age predict concordance in parental perceptions of infant temperament?

OBJECTIVE: To study whether infant weight for gestational age, and gestational age predict mother- and father-rated infant temperament (IBQ) at 6 months. METHODS: The sample comprised of family units with both biological parents and infants born at term (n = 152). Data on weight and gestational age were collected form obstetric database. RESULTS: Infants born small for gestational age (SGA) (weight < 10th percentile for gestational age) were rated by both parents as significantly more fearful and negatively reactive compared to infants born appropriate for gestational age (AGA). Infants born SGA defined by using the lowest 15th or 20th percentile groups did not differ from AGA group in temperament. The weekly continuum of gestational age predicted differences in parental ratings of infant temperamental attentiveness. CONCLUSIONS: The predictive significance of infant weight for gestational age and gestational age for behavioral outcomes appear true also for infants born at term. Concordance in parental perceptions of an infant born SGA emphasizes the clinical significance of the findings.

Adult↗

PubMed1978

Clinical assessment of gestational age at birth: the effects of sex, birthweight, and weight for length of gestation.

During studies on different aspects of fetal growth rate infants who were small-for-dates (SFD) large-for-dates (LFD) or within the normal range of birthweight for length of gestation (AFD) were examined within 48 h of birth. Gestational age was clinically assessed by the Dubowitz method. Among 140 AFD infants boys had higher mean values than girls for total and external scores, but there was no difference in neurological scores. Multiple regression of the score for external criteria on gestation, birthweight and sex, showed a significant contribution for birthweight and sex in addition to gestation; whereas gestation was the only singificant explanatory variable in the regression of the score for neurological criteria. When infants in the three weight groups were matched for length of gestation an sex, the SFD group had significantly lower mean total and external scores than the AFD group. The mean scores for the LFD group were not significantly higher than the AFD group. The neurological scores did not differ in the three groups. Maturation of external characteristics is related to weight as well as gestation. When assessment is made after birth by a clinical examination which includes these characteristics, the length of gestation of some SFD infants will be underestimated. The sex of the infant should also be borne in mind.

Birth Weight↗

PubMed2006

Risks for low intellectual performance related to being born small for gestational age are modified by gestational age.

OBJECTIVE: We sought to study whether the association between being born small for gestational age and risk for low intellectual performance was modified by gestational age. METHODS: A population-based cohort study was conducted of 352,125 boys who were born between 28 and 43 completed weeks of gestation from 1973 to 1981 in Sweden. Risk for low intellectual performance at military conscription, estimated as odds ratios with 95% confidence intervals was measured. RESULTS: Compared with men who were born preterm (28-36 weeks) and had normal birth weight for gestational age, men who were born preterm and had a very low birth weight for gestational age were not at increased risk for low intellectual performance. In contrast, men who were born preterm with a very short birth length or a very small head circumference for gestational age faced a near doubled risk for low intellectual performance compared with their appropriate peers. Among men who were born at term (37-41 weeks), risk for low intellectual performance was increased among those with very or moderately small birth weight, birth length, or head circumference for gestational age. CONCLUSIONS: During early stages of gestation, growth in length and head circumference may be more important for intellectual development than weight increase. Future studies on size at birth and intellectual performance should consider also including anthropometric measurements other than birth weight.

Adolescent↗

PubMed1996

Cognitive and neurologic development of the premature, small for gestational age infant through age 6: comparison by birth weight and gestational age.

OBJECTIVE: To compare the neurologic and cognitive outcomes of 129 premature small for gestational age (SGA) infants with 300 premature appropriate for gestational age (AGA) infants through 6 years of age. DESIGN: Infants born at < or = 37 weeks gestational age and < or = 2500 g with birth weight 2 standard deviations or more below the mean birth weight for gestational age were categorized as SGA. Cognitive and neurologic outcomes of SGA and AGA prematures at 1, 2, 3, and 5 and/or 6 years of age were compared when the infants were stratified by gestational age in 2-week intervals or by birth weight in 500-g intervals. The association between SGA/AGA and neurologic status on cognitive outcomes at each age was also examined. RESULTS: SGA infants had significantly poorer cognitive scores at each age when compared with AGA infants of similar gestational ages. Normal neurologic status was more likely at all assessments for the AGA than for SGA infants of comparable gestational age. There were no differences between SGA and AGA children in cognitive or neurologic outcomes at any age when grouped by birth weight. Cognitive impairment was closely associated with neurologic abnormality in both SGA and AGA groups. There was, nevertheless, a significant effect of SGA on cognitive outcome independent of neurologic status at all ages except 3 years. CONCLUSIONS: Irrespective of degree of prematurity, SGA infants are at greater risk for neurodevelopmental impairment than are equally premature AGA infants. The cognitive impairment can be largely, but not entirely, attributed to a higher incidence of neurologic abnormalities in the SGA infants at each gestational age.

Birth Weight↗

PubMed2000

Short stature and gestational diabetes in Brazil. Brazilian Gestational Diabetes Study Group.

AIMS/HYPOTHESIS: To examine the association between maternal stature and gestational diabetes mellitus. METHODS: We studied a sample of 5564 consecutive Brazilian women 20 or more years old, who were pregnant for approximately 21-28 weeks, had no history of diabetes outside pregnancy and were attending general prenatal care units in six state capitals in Brazil from 1991 to 1995. We did a 2-h, 75-g oral glucose tolerance test, defining gestational diabetes by World Health Organisation criteria. RESULTS: Those in the shortest quartile of height (< or = 151 cm) had a 60% increase in the odds of having gestational diabetes, independently of prenatal clinic, age, global obesity, family history of diabetes, skin colour, referral pattern, waist circumference, parity, previous gestational diabetes, education, ambient temperature and gestational age compared with the tallest quartile [odds ratio (OR) = 1.60, p = 0.005]. This association was observed for those with above median values of skinfold thickness (OR = 1.74, p = 0.006) but not for those with below median values (OR = 1.22, p = 0.51). Associations of short stature with high 2-h glycaemia (> or = 7.8 mmol/l) (OR = 1.61, p = 0.005) were essentially the same as those for gestational diabetes. There was, however, no association between short stature and gestational hyperglycaemia when the latter was defined exclusively by fasting values (OR = 0.97, p = 0.90). CONCLUSION/INTERPRETATION: In Brazil short stature associates with gestational diabetes, principally in women with greater fat mass. This difference in glycaemic levels is present postprandially but not in the fasting state.

Adult↗

PubMed1986

Birthweight-for-gestational age charts based on early ultrasound estimation of gestational age.

Birthweight-for-gestational age charts were based on the analysis of 3888 consecutive births in which the gestational age was estimated by measuring the fetal biparietal diameter before the 20th week of gestation. The data showed, in contrast to previous studies, a linear relation between gestational age and birthweight without inflection after term. The regression parameters showed a strongly significant difference between girls and boys. Thus, boys were 1.5% heavier than girls at 190 days gestation and 3.6% heavier at 300 days gestation. The linearity in the birthweight-for-gestational age charts could be due to the more reliable gestational age based on early ultrasound.

Birth Weight↗

PubMed2004

The rate of candidaemia in preterm infants born at a gestational age of 23-28 weeks is inversely correlated to gestational age.

AIM: To assess the rate of candidaemia and the associated case fatality rate in relation to gestational age, and the variation in the rate of candidaemia over time in the neonatal period. METHODS: Retrospective review of medical records of infants with a positive blood culture for fungi while in the neonatal unit, Uppsala University Children's Hospital or at autopsy following death in the unit from 1994 to 2001 (n = 30). RESULTS: The number of cases per year was found to vary between zero and eight. The annual rate of infection did not change significantly during the study period. The preterm infants with candidaemia (n = 29) were born at a gestational age ranging from 23-28 wk. The rate of candidaemia in this group was inversely related to gestational age and varied from 2 to 24%. Five infants (17%) died from Candida infection. Of these five, four were born at a gestational age of 23 wk. CONCLUSION: candidaemia in newborns occurs predominately in infants born at a gestational age < or =28 wk, where the rate of infection is inversely correlated to gestational age in infants born at a gestational age of 23-28 wk. The highest case fatality rate is observed in infants born at a gestational age of 23 wk.

Antifungal Agents↗

PubMed2005

[Clinical study of maternal serum leptin levels as a predictor of gestational diabetes mellitus and gestational impaired glucose tolerance].

OBJECTIVE: To investigate whether maternal serum leptin level can be used as a predictor of gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT). METHODS: Five hundred and eighty-three pregnant women were screened for GDM by the 50g oral glucose challenge test. At the same time, serum leptin levels were determined by radioimmunoassay, then the relationship between maternal serum leptin level and the incidence of GIGT and GDM was analyzed. According to the screening result, all the pregnant women were divided into three groups, the normal glucose group (NGT group), the gestational impaired glucose tolerance group (GIGT group), and gestational diabetes mellitus group (GDM group). GIGT group and GDM group were named as glucose intolerant group as a whole. RESULTS: (1) The serum leptin concentration of normal pregnant women ascended gradually from (7.0 +/- 1.8) microg/L in 24 gestational week to (9.4 +/- 2.1) microg/L during 34 - 36 gestational week, and then declined slightly but still maintained high level till delivery. (2) The serum leptin concentration of the glucose intolerant pregnant women ranged from (11.3 +/- 3.1) microg/L to(14.5 +/- 4.3) microg/L, and showed no difference among different gestational weeks (P > 0.05). (3) Serum leptin level of glucose intolerant women was (12.5 +/- 3.5) microg/L on average, much higher than that of NGT group, (8.5 +/- 2.6) microg/L (P < 0.05), and this difference remained in any gestational week (P < 0.05). (4) Most of the GDM clustered in the higher leptin level groups and 66.7% GDM had a serum leptin level higher than 14.0 microg/L. Moreover, 64.7% of women whose serum leptin level was above 17.0 microg/L had different degree of glucose intolerance. Serum leptin level positively correlated with the incidence of GIGT and GDM. CONCLUSION: Serum leptin level is correlated with glucose tolerance during pregnancy. Its abnormal increase during pregnancy might have a predictive value for GDM and GIGT.

Adult↗

PubMed1996

Early gestational glucose screening and gestational diabetes.

OBJECTIVE: The purpose of this study was to determine the benefit of early glucose screening prior to 24 weeks' gestation in detecting gestational diabetes. STUDY DESIGN: A retrospective analysis of 329 patients who received both early and complete prenatal care at the University of Illinois was performed. A 50-g, 1-hour glucose screen was performed at the first prenatal visit. An abnormal glucose screen, defined as blood sugar > 135 mg/dL, was followed by a 100-g, 3-hour glucose tolerance test. Gestational diabetes was defined as the presence of two or more abnormal values on the three-hour test. This protocol was repeated again at 28 weeks in all patients except those diagnosed as diabetic by having abnormal early three-hour tests. Data collected included maternal age, race, gravidity, presence of risk factors, pregnancy weight gain at glucose testing and delivery, neonatal birth weight and trauma. Data were analyzed using analysis of variance and chi 2 testing, with P < .05 considered significant. RESULTS: Gestational diabetes was diagnosed in 20 (6.1%) of the study patients. Eight (40%) of the gestational diabetics in the study population were detected with the early screening protocol. Factors associated with early detection of glucose intolerance included maternal age > 30 years (P < .001), black race (P < .001) and the presence of risk factors (P < .0001). Poor pregnancy weight gain was associated with the late development of glucose intolerance (P < .001). Gestational diabetes was subsequently diagnosed in 16% (6/38) of those patients who had, on early testing, an elevated one-hour glucose screen and negative three-hour glucose tolerance test when testing was repeated in the third trimester. CONCLUSION: Early gestational glucose screening may be beneficial in detecting gestational diabetes in patients over 30 years old who are black or who have risk factors for diabetes. Consideration should be given to repeat glucose testing in the early third trimester in patients with false positive early one-hour screening tests.

Adult↗

PubMed1991

Maternal hypothyroidism during the first half of gestation compromises normal catabolic adaptations of late gestation in the rat.

Female rats were mated and thyroidectomized on the same day. Some animals were kept without treatment and killed on day 12 or 21 of gestation (T). Others were subsequently treated daily with 1.8 micrograms L-T4/100 g BW for either the first 12 days and then not treated from that time until day 21 [T+T4(I+0)] or else not treated for the first 12 days and then treated from days 12-21 [T+T4(0+II)]. A final group received treatment during the entire 21-day study [T+T4(I+II)] and was used as the control. The net maternal body weight increased until day 12 of gestation in T+T4(I+II) rats, but not in T animals. On day 21 net maternal body weight was significantly lower in T and T+T4(0+II) than in T+T4(I+II) rats. Lipoprotein lipase activity in the lumbar fat pads increased from days 0 to 12 of gestation and decreased on day 21, whereas in the heart the change was in the opposite direction, and these changes were greater in T+T4(I+II) rats than in T rats. Incorporation of [U-14C]glucose administered in vivo into liver [14C]fatty acids or [14C]glycogen was significantly lower in T rats than in T+T4(I+II) on either the 12th or 21st day of gestation. The response of plasma triglyceride, glycerol, or beta-hydroxybutyrate levels to 24 h of starvation was similar in 12-day pregnant rats regardless of whether they were treated with T4, whereas on day 21 the change was greater in T+T4(I+II) or T+T4(I+0) animals than in T or T+T4(0+II) animals. Results show that maternal hypothyroidism during the first half of gestation impaired the anabolic events occurring during this phase and compromised the normal catabolic response during late gestation even when T4 treatment was restored. However, once maternal metabolic stores were built up normally during the first half of gestation, maternal hypothyroidism during late gestation did not affect the mother's normal metabolic adaptation, including the accelerated response to starvation.

Adipose Tissue↗

PubMed1995

Assessing the risk of gestational diabetes in twin gestation.

This study examines the hypothesis that twin gestation is a risk factor for gestational diabetes. In a retrospective analysis, the incidence of gestational diabetes in twin and singleton pregnancies was determined in groups matched for maternal age, weight, and parity. One-hour oral glucose challenge tests (50 g) were used to screen 9185 pregnant women. Gestational diabetes was diagnosed when abnormal screens (> or = 130 mg/dL) were followed by two or more abnormal values on a 3-hour (100 g) glucose tolerance test using National Diabetes Data Group (NDDG) criteria. A twin gestation was identified in 1.5% (138/9185) of the pregnancies. Gestational diabetes was diagnosed in 5.8% (8/138) and 5.4% (439/9047) of the twin and singleton pregnancies, respectively. The incidence of gestational diabetes is similar for singleton and twin gestations.

Adult↗

PubMed1997

High sensitivity test for the early diagnosis of gestational hypertension and preeclampsia. IV. Early detection of gestational hypertension and preeclampsia by the computation of a hyperbaric index.

UNLABELLED: The aims of this study were to examine whether the combined approach of 1) establishing tolerance intervals for the circadian variability of blood pressure as a function of gestational age, and 2) computing the hyperbaric index by comparison of any patient's blood pressure profile (obtained by ambulatory monitoring) with the tolerance limits, provides a new highly sensitive test for the early detection of gestational hypertension and preeclampsia. We analyzed a total of 745 blood pressure series sampled by ambulatory monitoring for about 48 hours in each of several occasions in 189 women with uncomplicated pregnancies, 71 with gestational hypertension, and 29 with preeclampsia. After synchronization of all data by expressing times of sampling in hours from bed-time, circadian tolerance limits were first computed from the normotensive subjects as a function of trimester of pregnancy. The hyperbaric index and the percentage time of excess were then computed for each individual blood pressure series. The maximum hyperbaric index was below 15 mmHg X hour for normotensive pregnant women in all trimesters of pregnancy, and mostly above that value for women who subsequently developed gestational hypertension or preeclampsia. Sensitivity of the test based on the maximum hyperbaric index was 97% for women sampled during the first trimester of gestation, and increased up to 100% in the third trimester. The positive predictive value was 100% in all trimesters. Moreover, the computation of the hyperbaric index provided, on the average, an early identification of gestational hypertension or preeclampsia 20 weeks prior to the clinical confirmation of the disease. CONCLUSIONS: Ambulatory monitoring of blood pressure during gestation provides sensitive endpoints for use in early risk assessment and as a guide for establishing preventive interventions. The approach presented here represents a simple, reproducible, non-invasive, and highly sensitive test for the very early identification of gestational hypertension and preeclampsia.

Blood Pressure↗

PubMed1993

The differences in growth of cerebellar vermis between appropriate-for-gestational-age and small-for-gestational-age newborns.

To determine whether there is any difference in the growth of the cerebellar vermis between appropriate-for-gestational-age (AGA) and small-for-gestational-age (SGA) infants during fetal life, the central vermian area (Cva) of the cerebellum and its anterior-posterior distance (Vap) and superior-inferior distance (Vsi) were measured by midsagittal cerebral ultrasonography in 218 newborns within 24 h of birth. Patients with congenital infections and malformations were excluded. One-hundred twenty-one infants were AGA and 97 SGA. Best curve-fit of second-degree polynominal equations were found between gestational age and Cva, Vap, Vsi in both AGA and SGA neonates. Among them, Cva correlated best with gestational age in both AGA and SGA newborns. Comparing the head circumference (HC), Cva, Vap and Vsi between AGA and SGA neonates in the four gestational age subgroups (24-28, 29-33, 34-37 and 38-41 weeks), significant differences in HC were found in the 34-37 weeks (P < 0.01) and 38-41 weeks (P < 0.001) subgroups. But the significant differences in Cva and Vsi were found only in the 38-41 weeks subgroup. There is more accelerated growth in vermis from 34 to 41 weeks of gestation than that from 24 to 33 weeks. Comparing with AGA, the non-fetal cause of intrauterine growth retarded newborns demonstrate growth retardation in the cerebellar vermis only at late gestation. The cerebellar vermis measured by cranial ultrasound may serve as part of the neurological maturation assessments in newborns. Further work is needed to establish the normogram for the cerebellar vermis in newborns, and to assess the neurodevelopmental outcomes of those with an abnormal vermis.

Biometry↗

PubMed2001

Perinatal correlates and neonatal outcomes of small for gestational age infants born at term gestation.

OBJECTIVE: We sought to examine the current perinatal correlates and neonatal morbidity associated with intrauterine growth failure among neonates born at term gestation. STUDY DESIGN: We compared 372 small for gestational age (SGA, birth weight <10th percentile) infants born at term gestation to 372 appropriate for gestational age controls (AGA, birth weight 10th to 90th percentile) matched by sex, race, and gestational age within 2 weeks. RESULTS: Compared with AGA controls, significant (P < .05) maternal risk factors for SGA status included single marital status (59% versus 53%), lower prepregnancy weight (144 +/- 41 lbs versus 153 +/- 40 lbs), lower weight gain during pregnancy (29 +/- 15 lbs versus 33 +/- 15 lbs), smoking (25% versus 17%), hypertension (14% versus 7%), and multiple gestation (9% versus 2%). Mothers of SGA infants were more likely to undergo multiple (>or=3) antenatal ultrasound evaluations (19% versus 7%), biophysical profile monitoring (11% versus 4%), and oxytocin delivery induction (28% versus 16%) (P < .05). Pediatrician attendance was more common among SGA deliveries (50% versus 37%, P < .05). SGA infants had significantly higher rates of hypothermia (18% versus 6%) and symptomatic hypoglycemia (5% versus 1%). These neonatal problems remained significant even when medical or pathologic causes of intrauterine growth failure, including pregnancy hypertension, multiple gestation, and congenital malformations, were excluded. CONCLUSION: Despite higher rates of pregnancy complications among mothers of SGA infants, the rates of neonatal adverse outcomes are low. However, SGA infants remain at risk for hypothermia and hypoglycemia and require careful neonatal surveillance.

Birth Weight↗

PubMed2000

Effects of gestation and birth weight on the growth and development of very low birthweight small for gestational age infants: a matched group comparison.

AIMS: To investigate the effects of small for gestational age (SGA) in very low birthweight (VLBW) infants on growth and development until the fifth year of life. METHODS: VLBW (< 1500 g) infants, selected from a prospective study, were classified as SGA (n = 115) on the basis of birth weight below the 10th percentile for gestational age and were compared with two groups of appropriate for gestational age (AGA) infants matched according to birth weight (AGA-BW; n = 115) or gestation at birth (AGA-GA; n = 115). Prenatal, perinatal, and postnatal risk factors were recorded, and duration and intensity of treatment were computed from daily assessments. Body weight, length, and head circumference were measured at birth, five and 20 months (corrected for prematurity), and at 56 months. General development was assessed at five and 20 months with the Griffiths scale of babies abilities, and cognitive development at 56 months with the Columbia mental maturity scales, a vocabulary (AWST) and language comprehension test (LSVTA). RESULTS: Significant group differences were found in complications (pregnancy, birth, and neonatal), parity, and multiple birth rate. The AGA-GA group showed most satisfactory growth up to 56 months, with both the AGA-BW and SGA groups lagging behind. The AGA-GA group also scored significantly more highly on all developmental and cognitive tests than the other groups. Developmental test results were similar for the SGA and AGA-BW groups at five and 20 months, but AGA-BW infants (lowest gestation) had lower scores on performance intelligence quotient and language comprehension at 56 months than the SGA group. When prenatal and neonatal complications, parity, and multiple birth were accounted for, group differences in growth remained, but differences in cognitive outcome disappeared after five months. CONCLUSIONS: Being underweight and with a short gestation (SGA and VLBW) leads to poor weight gain and head growth in infancy but does not result in poorer growth than in infants of the same birth weight but shorter gestation (AGA-BW) in the long term. SGA is related to early developmental delay and later language problems; however, neonatal complications may have a larger detrimental effect on long term cognitive development of VLBW infants than whether they are born SGA or AGA.

Birth Weight↗

PubMed1991

Northwestern University Twin Study X: Outcome of twin gestations complicated by gestational diabetes mellitus.

Existing data concerning the effect of gestational diabetes on perinatal outcome in twin pregnancies is scant. We hypothesized that altered carbohydrate metabolism would worsen perinatal outcome in twin gestation in a manner similar to singleton gestation. Thirteen twin pregnancies complicated by gestational diabetes mellitus were matched by gestational age at delivery to 13 twin pregnancies unaffected by gestational diabetes. Comparing infants of diabetic mothers to infants of control mothers, there was a trend of greater likelihood of respiratory distress syndrome, hyperbilirubinemia, and prolonged neonatal intensive care nursery admissions. Our experience suggests that altered carbohydrate metabolism in multiple gestations increases the potential for neonatal morbidity.

Adult↗