Incidence, risk factors, and feto-maternal outcomes of inappropriate birth weight for gestational age among singleton live births in Qatar : a population-based study

Background Abnormal fetal growth can be associated with factors during pregnancy and at postpartum. Objective In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes associated with small-for-gestational age (SGA) and large-for-gestational age (LGA) infants. Methods We performed a population-based retrospective study on 14,641 singleton live births registered in the PEARL-Peristat Study between April 2017 and March 2018 in Qatar. We estimated the incidence and examined the risk factors and outcomes using univariate and multivariate analysis. Results SGA and LGA incidence rates were 6.0% and 15.6%, respectively. In-hospital mortality among SGA and LGA infants was 2.5% and 0.3%, respectively, while for NICU admission or death in labor room and operation theatre was 28.9% and 14.9% respectively. Preterm babies were more likely to be born SGA (aRR, 2.31; 95% CI, 1.45–3.57) but male infants (aRR, 0.57; 95% CI, 0.4–0.81), those born to parous (aRR 0.66; 95% CI, 0.45–0.93), or overweight (aRR, 0.64; 95% CI, 0.42–0.97) mothers were less likely to be born SGA. On the other hand, males (aRR, 1.82; 95% CI, 1.49–2.19), infants born to parous mothers (aRR 2.16; 95% CI, 1.63–2.82), or to mothers with gestational diabetes mellitus (aRR 1.36; 95% CI, 1.11–1.66), or pre-gestational diabetes mellitus (aRR 2.58; 95% CI, 1.8–3.47) were significantly more likely to be LGA. SGA infants were at high risk of in-hospital mortality (aRR, 226.56; 95% CI, 3.47–318.22), neonatal intensive care unit admission or death in labor room or operation theatre (aRR, 2.14 (1.36–3.22). Conclusion Monitoring should be coordinated to alleviate the risks of inappropriate fetal growth and the associated adverse consequences.The PEARL-Peristat study was funded by Qatar National Research Fund (Grant no NPRP 6-238-3-059) and was sponsored by the Medical Research Centre, Hamad Medical Corporation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Prevalence, predictors, and outcomes of major congenital anomalies : a population-based register study

Congenital anomalies (CAs) are a leading cause of morbidity and mortality in early life. We aimed to assess the incidence, risk factors, and outcomes of major CAs in the State of Qatar. A population-based retrospective data analysis of registry data retrieved from the Perinatal Neonatal Outcomes Research Study in the Arabian Gulf (PEARL-Peristat Study) between April 2017 and March 2018. The sample included 25,204 newborn records, which were audited between April 2017 and March 2018, of which 25,073 live births were identified and included in the study. Maternal risk factors and neonatal outcomes were assessed for association with specific CAs, including chromosomal/genetic, central nervous system (CNS), cardiovascular system (CVS), facial, renal, multiple congenital anomalies (MCAs) using univariate and multivariate analyses. The incidence of any CA among live births was 1.3% (n = 332). The most common CAs were CVS (n = 117; 35%), MCAs (n = 69, 21%), chromosomal/genetic (51; 15%), renal (n = 39; 12%), CNS (n = 20; 6%), facial (14, 4%), and other (GIT, Resp, Urogenital, Skeletal) (n = 22, 7%) anomalies. Multivariable regression analysis showed that multiple pregnancies, parity ≥ 1, maternal BMI, and demographic factors (mother’s age and ethnicity, and infant’s gender) were associated with various specific CAs. In-hospital mortality rate due to CAs was estimated to be 15.4%. CAs were significantly associated with high rates of caesarean deliveries (aOR 1.51; 95% CI 1.04–2.19), Apgar < 7 at 1 min (aOR 5.44; 95% CI 3.10–9.55), Apgar < 7 at 5 min (aOR 17.26; 95% CI 6.31–47.18), in-hospital mortality (aOR 76.16; 37.96–152.8), admission to neonatal intensive care unit (NICU) or perinatal death of neonate in labor room (LR)/operation theatre (OT) (aOR 34.03; 95% CI 20.51–56.46), prematurity (aOR 4.17; 95% CI 2.75–6.32), and low birth weight (aOR 5.88; 95% CI 3.92–8.82) before and after adjustment for the significant risk factors. This is the first study to assess the incidence, maternal risk factors, and neonatal outcomes associated with CAs in the state of Qatar. Therefore, a specialized congenital anomaly data registry is needed to identify risk factors and outcomes. In addition, counselling of mothers and their families may help to identify specific needs for pregnant women and their babies.Open Access funding provided by the Qatar National Library. The PEARL-Peristat study was funded by Qatar National Research Fund (Grant no NPRP 6-238-3-059) and was sponsored by the Medical Research Centre, Hamad Medical Corporation.Scopu

Natural history, with clinical, biochemical and molecular characterization, of classical homocystinuria in the Qatari population

Classical homocystinuria (HCU) is the most common inborn error of metabolism in Qatar, with an incidence of 1:1800, and is caused by the Qatari founder p.R336C mutation in the CBS gene. This study describes the natural history and clinical manifestations of HCU in the Qatari population. A single center study was performed between 2016 and 2017 in 126 Qatari patients, from 82 families. Detailed clinical and biochemical data were collected and Stanford-Binet intelligence, quality of life and adherence to treatment assessments were conducted prospectively. Patients were assigned to one of three groups, according to mode of diagnosis: 1) Late Diagnosis Group (LDG), 2) Family Screening Group (FSG), and 3) Newborn Screening Group (NSG). Of the 126 patients, 69 (55%) were in the LDG, 44 (35%) in the NSG, and 13 (10%) in the FSG. The leading factors for diagnosis in the LDG were ocular manifestations (49%), neurological manifestations (45%), thromboembolic events (4%), and hyperactivity and behavioral changes (1%). Both FSG and NSG groups were asymptomatic at time of diagnosis. NSG had significantly higher IQ, QoL, and adherence values compared with the LDG. The LDG and FSG had significantly higher Met levels than the NSG. The LDG also had significantly higher tHcy levels than the NSG and FSG. Regression analysis confirmed these results even when adjusting for age at diagnosis, current age or adherence. These findings increase understanding of the natural history of HCU and highlight the importance of early diagnosis and treatment. This article is protected by copyright. All rights reserved.Qatar National Research Fund , Grant/Award Number: 7‐355‐3‐08

Outcomes of 28+1 to 32+0 Weeks Gestation Babies in the State of Qatar: Finding Facility-Based Cost Effective Options for Improving the Survival of Preterm Neonates in Low Income Countries

In this retrospective study we did a comparative analysis of the outcome of 28+1 to 32+0 weeks gestation babies between the State of Qatar and some high income countries with an objective of providing an evidence base for improving the survival of preterm neonates in low income countries. Data covering a five year period (2002–2006) was ascertained on a pre-designed Performa. A comparative analysis with the most recent data from VON, NICHD, UK, France and Europe was undertaken. Qatar’s 28+1 to 32+0 weeks Prematurity Rate (9.23 per 1,000 births) was less than the UK’s (p < 0.0001). Of the 597 babies born at 28+1 to 32+0 weeks of gestation, 37.5% did not require any respiratory support, while 31.1% required only CPAP therapy. 80.12% of the MV and 96.28% of CPAP therapy was required for <96 hours. 86.1% of the mothers had received antenatal steroids. The 28+1 to 32+0 weeks mortality rate was 65.3/1,000 births with 30.77% deaths attributable to a range of lethal congenital and chromosomal anomalies. The survival rate increased with increasing gestational age (p < 0.001) and was comparable to some high income countries. The incidence of in hospital pre discharge morbidities in Qatar (CLD 2.68%, IVH Grade III 0.84%, IVH Grade IV 0.5%, Cystic PVL 0.5%) was less as compared to some high income countries except ROP ≥ Stage 3 (5.69%), which was higher in Qatar. The incidence of symptomatic PDA, NEC and severe ROP decreased with increasing gestational age (p < 0.05). We conclude that the mortality and in hospital pre discharge morbidity outcome of 28+1 to 32+0 weeks babies in Qatar are comparable with some high income countries. In two thirds of this group of preterm babies, the immediate postnatal respiratory distress can be effectively managed by using two facility based cost effective interventions; antenatal steroids and postnatal CPAP. This finding is very supportive to the efforts of international perinatal health care planners in designing facility-based cost effective options for low income countries

The impact of abnormal maternal body mass index during pregnancy on perinatal outcomes: A retrospective cohort study

Background Abnormal Body mass index (BMI) during pregnancy is a growing public health concern as it has been associated with an increased risk of maternal and neonatal complications. This study aimed to investigate the impact of abnormal BMI on maternal and neonatal outcomes compared to normal BMI. Methods A total of 14,624 singleton births were included in a retrospective cohort study conducted in a tertiary maternity hospital in Qatar. Women were categorised as underweight (BMI Results Compared to women with normal BMI, women with increasing BMI had increasingly higher odds of developing specific adverse outcomes, the highest being in the class III obesity group (GDM- aOR 2.71, 95% CI 2.25-3.27, p Conclusion The findings of this study have important implications for the clinical management of pregnant women with abnormal BMI. They suggest that interventions to improve maternal and neonatal outcomes are crucial in directing prenatal care optimisation, focusing on enhancing prepregnancy BMI to minimise adverse maternal and neonatal outcomes.</p

Perinatal outcomes in women with class IV obesity compared to women in the normal or overweight body mass index categories: A population‐based cohort study in Qatar

Abstract Background The prevalence of childhood and adult obesity is rising exponentially worldwide. Class IV obesity (body mass index, BMI ≥50 kg/m2) is associated with a higher risk of adverse perinatal outcomes. This study compared these outcomes between women with class IV obesity and women in the normal or overweight categories during pregnancy. Methods A retrospective cohort study was performed in Qatar, including women having singleton live births beyond 24 weeks of gestation, classified into two class IV obesity and normal/overweight (BMI between 18.5 and 30.0 kg/m2). The outcome measures included the mode of delivery, development of gestational diabetes and hypertension, fetal macrosomia, small for date baby, preterm birth and neonatal morbidity. Adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were determined using multivariable logistic regression models. Results A total of 247 women with class IV obesity were compared with 6797 normal/overweight women. Adjusted analysis showed that women with class IV obesity had 3.2 times higher odds of cesarean delivery (aOR: 3.19, CI: 2.26–4.50), 3.4 times higher odds of gestational diabetes (aOR: 3.39, CI: 2.55–4.50), 4.2 times higher odds of gestational hypertension (aOR: 4.18, CI: 2.45–7.13) and neonatal morbidity (aOR: 4.27, CI: 3.01–6.05), and 6.5 times higher odds of macrosomia (aOR 6.48, CI 4.22–9.99). Conclusions Class IV obesity is associated with more adverse perinatal outcomes compared with the normal or overweight BMI categories. The study results emphasized the need for specialized antenatal obesity clinics to address the associated risks and reduce complications

Gestational Age Specific Neonatal Survival in the State of Qatar (2003-2008) - A Comparative Study with International Benchmarks

Objective: To analyze and compare the current gestational age specific neonatal survival rates between Qatar and international benchmarks

The impact of metformin therapy for gestational diabetes on fetal growth in women with risk factors for fetal growth restriction- a registry-based study from Qatar

Background Gestational diabetes mellitus (GDM) has been the most prevalent medical condition in pregnancy, often managed by a multidisciplinary team. Numerous studies have demonstrated that metformin therapy for GDM offers advantages including a reduced risk of macrosomia, neonatal hypoglycemia, and admission to neonatal intensive care units (NICU). However, its use has been linked to fetal growth restriction (FGR) as well. Our study aims to investigate the effect of metformin when given to women with GDM and additional risk factors for FGR like hypertension, inherited or acquired thrombophilia, anemia, and autoimmune disorders such as anti-phospholipid syndrome, lupus erythematosus. Methods Women who had singleton live births and diagnosed with gestational diabetes (GDM) were selected. They were divided into two groups based on the presence of additional risk factors for FGR during their pregnancies. Each of these groups were further divided based on use of metformin for the management of GDM- resulting in four comparison groups. The outcomes were birthweight (BW), birthweight centiles, small for date baby (SFD), low birth weight (LBW), preterm birth (PTB), large for date baby (LGA), macrosomia, admission to NICU and mode of delivery. Results Of the 4,290 women included in the study, 18% had risk factors for FGR, 27% of whom took metformin for GDM. Among the women with no risk factors, 29% took metformin. In women who were taking metformin, those having risk factors had lower mean BW (3015± 608.1 gms vs 3179.2± 506.2 grams; p Conclusion The results of this study suggest that in women with additional risk factors for FGR, the concurrent use of metformin significantly decreases the birthweight and increases the risk for LBW, SFD, PTB and admission to NICU. The use of metformin in these women should be judicious and increased fetal surveillance during pregnancy is warranted.</p