Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Anestesia y monitorización intraoperatoria en la cirugía intrauterina de los defectos del tubo neural

La espina bífida representa el defecto congénito del tubo neural más grave compatible con la vida. Su forma más frecuente es el mielomeningocele, caracterizado por la falta de cierre del arco posterior vertebral en las semanas 3ª-4ª del desarrollo embrionario, momento en el cual la placa neural no completaría su desarrollo provocando un canal espinal abierto, con exposición al líquido amniótico de las meninges y otros elementos neurales durante el resto de la gestación. Los beneficios de la cirugía prenatal de los defectos del tubo neural y, concretamente del mielomeningocele, han sido ampliamente demostrados, proporcionando un cierre del defecto para proteger los elementos neurológicos desprovistos del mismo, prevenir la fuga de líquido cefalorraquídeo y disminuir el riesgo de infección, con la menor morbilidad materno-fetal posible. En la unidad de Medicina Materno-fetal del Hospital Vall d´Hebron se ofrece a las gestantes la posibilidad de cirugía intrauterina de los defectos del tubo neural. El abordaje quirúrgico de la cirugía intrauterina se puede realizar mediante cirugía fetoscópica o mediante cirugía fetal abierta, siendo el objetivo general de este estudio el análisis del manejo anestésico en estos dos tipos de cirugía. Creemos que la monitorización continua del binomio materno-fetal permitiría anticiparnos y adaptar de manera individualizada las dosis de fármacos vasoactivos y fluidos, minimizando los episodios de hipotensión materna y, por consiguiente, de hipoperfusión placentaria, así como disminuir las complicaciones respiratorias en el periodo perioperatorio. Además, consideramos que la cirugía fetoscópica para la corrección intrauterina de los defectos del tubo neural estaría asociada a menos cambios hemodinámicos maternos que la cirugía abierta, con el consiguiente efecto sobre la disminución de los requerimientos de fármacos vasoactivos y sobre la morbimortalidad materno-fetal asociada. Para ello, hemos realizado un estudio descriptivo retrospectivo en el Hospital Universitario Vall d´Hebron de Barcelona, durante el periodo comprendido entre los años 2011-2016, siendo nuestras principales conclusiones: -En la corrección intrauterina del mielomeningocele fetal mediante cirugía abierta o fetoscópica, no se encontraron diferencias en las dosis maternas de mórficos ni de relajantes musculares entre los dos tipos de cirugía. Sí hubo diferencias en la dosis requerida de halogenados y de nitroglicerina, siendo mayor en la cirugía abierta. -La fluidoterapia con cristaloides no difirió entre los dos grupos, mientras que el volumen administrado de coloides fue inferior en las gestantes del grupo de cirugía fetoscópica. El consumo de vasoconstrictores estuvo directamente relacionado con el tiempo de exposición uterina, sin encontrarse diferencias entre ambos grupos. -La tensión arterial media de las pacientes sometidas a cirugía abierta fue menor que en grupo de la fetoscópica y este grupo de pacientes experimentó más episodios de hipotensión arterial. Las tensiones arteriales sistólicas, diastólicas y medias disminuyeron en ambos grupos durante la exteriorización uterina y este descenso fue mayor en el grupo de cirugía abierta. -No se encontraron diferencias en los parámetros gasométricos maternos durante la insuflación con CO2 en la cirugía fetoscópica. -La tasa de rotura prematura de membranas fue similar en ambos grupos. La tasa de oligoamnios y la necesidad de tocolíticos en el postoperatorio fue superior en el grupo de cirugía abierta. -La frecuencia cardiaca fetal permaneció estable en los dos tipos de cirugía. La tasa de prematuridad fue superior en el grupo de la cirugía abierta.Spina bifida represents the most serious congenital neural tube deffect compatible with life. Its most frequent form is myelomeningocele, which is caracterized by the lack of closure of the posterior vertebral arch during third-fourth embrionary development weeks, moment in which the neural plate wouldn't complete its development causing an open spinal canal, with exposure to the amniotic fluid of the meninges and other neural elements during the rest of the pregnancy. The benefits of the prenatal surgery of the neural tube deffects and, specifically of the myelomeningocele, have been widely demostrated, providing a closure of the deffect to protect the neurological elements devoid of it, to prevent the leak of cerebrospinal fluid and to decrease the risk of infection, with the minimal possible maternal-fetal morbidity. In the Materno-fetal Unit of Vall d'Hebron Hospital it is offered to pregnant women the possibility of intrauterine surgery of the neural tube deffects. The surgical approach of intrauterine surgery can be performed through fetoscopic surgery or open fetal surgery, being the general objective of this study the analysis of the anesthetic management in these two types of surgery. We believe that continous monitoring of maternal-fetal binomial would allow us to anticipate and adapt in an individualized way the doses of vaoactive drugs and fluids, minimizing episodes of maternal hypotension and therefore, of placental hypoperfusion, as well as decrease respiratory complications during the perioperative period. We also consider that fetoscopic surgery for the intrauterine correction of neural tube deffects would be associated with fewer hemodynamic maternal changes than open surgery, with the consequent effect about the decrease of the requirements of vasoactive drugs and about maternal-fetal associated morbimortality. Therefore, we have carried out a retrospective descriptive study in Vall d'Hebron Hospital, Barcelona, during the period between years 2011-2016, being our main conclusions: - In the intrauterine fetal myelomeningocele correction through open surgery or fetoscopic, no differences were found in the maternal morphic doses neither muscle relaxants between two types of surgery. There were differences between the required dose of halogenated and nytroglicerin, being higher in open surgery. - Fluidotherapy with crystalloids wasn't different between groups, while the administered volum of colloids was lower in the pregnant women of the fetoscopic surgery group. The consumption of vasoconstrictors was directly related to the uterine exposure time, without finding differences between both groups. - The mean arterial blood pressure of the patients urdergoing open surgery was lower than in the fetoscopic group, and this group of patients experienced more episodes of arterial hypotension. The arterial tensions systolics, diastolics and mean decreased in both groups during the uterine exteriorization and this decrease was higher in the open surgery group. - No differences were found in gasometric maternal parameters during the CO2 insufflation in fetoscopic surgery. - The rate of premature rupture of membranes was similar in both groups. The rate of olighydramnios and the need for tocolytics in the postoperative period was higher in the open surgery group. - The fetal heart rate remained stable in both types of surgery. The prematurity rate was higher in the open surgery group

Anestesia y monitorización intraoperatoria en la cirugía intrauterina de los defectos del tubo neural

La espina bífida representa el defecto congénito del tubo neural más grave compatible con la vida. Su forma más frecuente es el mielomeningocele, caracterizado por la falta de cierre del arco posterior vertebral en las semanas 3ª-4ª del desarrollo embrionario, momento en el cual la placa neural no completaría su desarrollo provocando un canal espinal abierto, con exposición al líquido amniótico de las meninges y otros elementos neurales durante el resto de la gestación. Los beneficios de la cirugía prenatal de los defectos del tubo neural y, concretamente del mielomeningocele, han sido ampliamente demostrados, proporcionando un cierre del defecto para proteger los elementos neurológicos desprovistos del mismo, prevenir la fuga de líquido cefalorraquídeo y disminuir el riesgo de infección, con la menor morbilidad materno-fetal posible. En la unidad de Medicina Materno-fetal del Hospital Vall d´Hebron se ofrece a las gestantes la posibilidad de cirugía intrauterina de los defectos del tubo neural. El abordaje quirúrgico de la cirugía intrauterina se puede realizar mediante cirugía fetoscópica o mediante cirugía fetal abierta, siendo el objetivo general de este estudio el análisis del manejo anestésico en estos dos tipos de cirugía. Creemos que la monitorización continua del binomio materno-fetal permitiría anticiparnos y adaptar de manera individualizada las dosis de fármacos vasoactivos y fluidos, minimizando los episodios de hipotensión materna y, por consiguiente, de hipoperfusión placentaria, así como disminuir las complicaciones respiratorias en el periodo perioperatorio. Además, consideramos que la cirugía fetoscópica para la corrección intrauterina de los defectos del tubo neural estaría asociada a menos cambios hemodinámicos maternos que la cirugía abierta, con el consiguiente efecto sobre la disminución de los requerimientos de fármacos vasoactivos y sobre la morbimortalidad materno-fetal asociada. Para ello, hemos realizado un estudio descriptivo retrospectivo en el Hospital Universitario Vall d´Hebron de Barcelona, durante el periodo comprendido entre los años 2011-2016, siendo nuestras principales conclusiones: -En la corrección intrauterina del mielomeningocele fetal mediante cirugía abierta o fetoscópica, no se encontraron diferencias en las dosis maternas de mórficos ni de relajantes musculares entre los dos tipos de cirugía. Sí hubo diferencias en la dosis requerida de halogenados y de nitroglicerina, siendo mayor en la cirugía abierta. -La fluidoterapia con cristaloides no difirió entre los dos grupos, mientras que el volumen administrado de coloides fue inferior en las gestantes del grupo de cirugía fetoscópica. El consumo de vasoconstrictores estuvo directamente relacionado con el tiempo de exposición uterina, sin encontrarse diferencias entre ambos grupos. -La tensión arterial media de las pacientes sometidas a cirugía abierta fue menor que en grupo de la fetoscópica y este grupo de pacientes experimentó más episodios de hipotensión arterial. Las tensiones arteriales sistólicas, diastólicas y medias disminuyeron en ambos grupos durante la exteriorización uterina y este descenso fue mayor en el grupo de cirugía abierta. -No se encontraron diferencias en los parámetros gasométricos maternos durante la insuflación con CO2 en la cirugía fetoscópica. -La tasa de rotura prematura de membranas fue similar en ambos grupos. La tasa de oligoamnios y la necesidad de tocolíticos en el postoperatorio fue superior en el grupo de cirugía abierta. -La frecuencia cardiaca fetal permaneció estable en los dos tipos de cirugía. La tasa de prematuridad fue superior en el grupo de la cirugía abierta.Spina bifida represents the most serious congenital neural tube deffect compatible with life. Its most frequent form is myelomeningocele, which is caracterized by the lack of closure of the posterior vertebral arch during third-fourth embrionary development weeks, moment in which the neural plate wouldn't complete its development causing an open spinal canal, with exposure to the amniotic fluid of the meninges and other neural elements during the rest of the pregnancy. The benefits of the prenatal surgery of the neural tube deffects and, specifically of the myelomeningocele, have been widely demostrated, providing a closure of the deffect to protect the neurological elements devoid of it, to prevent the leak of cerebrospinal fluid and to decrease the risk of infection, with the minimal possible maternal-fetal morbidity. In the Materno-fetal Unit of Vall d'Hebron Hospital it is offered to pregnant women the possibility of intrauterine surgery of the neural tube deffects. The surgical approach of intrauterine surgery can be performed through fetoscopic surgery or open fetal surgery, being the general objective of this study the analysis of the anesthetic management in these two types of surgery. We believe that continous monitoring of maternal-fetal binomial would allow us to anticipate and adapt in an individualized way the doses of vaoactive drugs and fluids, minimizing episodes of maternal hypotension and therefore, of placental hypoperfusion, as well as decrease respiratory complications during the perioperative period. We also consider that fetoscopic surgery for the intrauterine correction of neural tube deffects would be associated with fewer hemodynamic maternal changes than open surgery, with the consequent effect about the decrease of the requirements of vasoactive drugs and about maternal-fetal associated morbimortality. Therefore, we have carried out a retrospective descriptive study in Vall d'Hebron Hospital, Barcelona, during the period between years 2011-2016, being our main conclusions: - In the intrauterine fetal myelomeningocele correction through open surgery or fetoscopic, no differences were found in the maternal morphic doses neither muscle relaxants between two types of surgery. There were differences between the required dose of halogenated and nytroglicerin, being higher in open surgery. - Fluidotherapy with crystalloids wasn't different between groups, while the administered volum of colloids was lower in the pregnant women of the fetoscopic surgery group. The consumption of vasoconstrictors was directly related to the uterine exposure time, without finding differences between both groups. - The mean arterial blood pressure of the patients urdergoing open surgery was lower than in the fetoscopic group, and this group of patients experienced more episodes of arterial hypotension. The arterial tensions systolics, diastolics and mean decreased in both groups during the uterine exteriorization and this decrease was higher in the open surgery group. - No differences were found in gasometric maternal parameters during the CO2 insufflation in fetoscopic surgery. - The rate of premature rupture of membranes was similar in both groups. The rate of olighydramnios and the need for tocolytics in the postoperative period was higher in the open surgery group. - The fetal heart rate remained stable in both types of surgery. The prematurity rate was higher in the open surgery group

Anestesia y monitorización intraoperatoria en la cirugía intrauterina de los defectos del tubo neural

La espina bífida representa el defecto congénito del tubo neural más grave compatible con la vida. Su forma más frecuente es el mielomeningocele, caracterizado por la falta de cierre del arco posterior vertebral en las semanas 3ª-4ª del desarrollo embrionario, momento en el cual la placa neural no completaría su desarrollo provocando un canal espinal abierto, con exposición al líquido amniótico de las meninges y otros elementos neurales durante el resto de la gestación. Los beneficios de la cirugía prenatal de los defectos del tubo neural y, concretamente del mielomeningocele, han sido ampliamente demostrados, proporcionando un cierre del defecto para proteger los elementos neurológicos desprovistos del mismo, prevenir la fuga de líquido cefalorraquídeo y disminuir el riesgo de infección, con la menor morbilidad materno-fetal posible. En la unidad de Medicina Materno-fetal del Hospital Vall d́Hebron se ofrece a las gestantes la posibilidad de cirugía intrauterina de los defectos del tubo neural. El abordaje quirúrgico de la cirugía intrauterina se puede realizar mediante cirugía fetoscópica o mediante cirugía fetal abierta, siendo el objetivo general de este estudio el análisis del manejo anestésico en estos dos tipos de cirugía. Creemos que la monitorización continua del binomio materno-fetal permitiría anticiparnos y adaptar de manera individualizada las dosis de fármacos vasoactivos y fluidos, minimizando los episodios de hipotensión materna y, por consiguiente, de hipoperfusión placentaria, así como disminuir las complicaciones respiratorias en el periodo perioperatorio. Además, consideramos que la cirugía fetoscópica para la corrección intrauterina de los defectos del tubo neural estaría asociada a menos cambios hemodinámicos maternos que la cirugía abierta, con el consiguiente efecto sobre la disminución de los requerimientos de fármacos vasoactivos y sobre la morbimortalidad materno-fetal asociada. Para ello, hemos realizado un estudio descriptivo retrospectivo en el Hospital Universitario Vall d́Hebron de Barcelona, durante el periodo comprendido entre los años 2011-2016, siendo nuestras principales conclusiones: -En la corrección intrauterina del mielomeningocele fetal mediante cirugía abierta o fetoscópica, no se encontraron diferencias en las dosis maternas de mórficos ni de relajantes musculares entre los dos tipos de cirugía. Sí hubo diferencias en la dosis requerida de halogenados y de nitroglicerina, siendo mayor en la cirugía abierta. -La fluidoterapia con cristaloides no difirió entre los dos grupos, mientras que el volumen administrado de coloides fue inferior en las gestantes del grupo de cirugía fetoscópica. El consumo de vasoconstrictores estuvo directamente relacionado con el tiempo de exposición uterina, sin encontrarse diferencias entre ambos grupos. -La tensión arterial media de las pacientes sometidas a cirugía abierta fue menor que en grupo de la fetoscópica y este grupo de pacientes experimentó más episodios de hipotensión arterial. Las tensiones arteriales sistólicas, diastólicas y medias disminuyeron en ambos grupos durante la exteriorización uterina y este descenso fue mayor en el grupo de cirugía abierta. -No se encontraron diferencias en los parámetros gasométricos maternos durante la insuflación con CO2 en la cirugía fetoscópica. -La tasa de rotura prematura de membranas fue similar en ambos grupos. La tasa de oligoamnios y la necesidad de tocolíticos en el postoperatorio fue superior en el grupo de cirugía abierta. -La frecuencia cardiaca fetal permaneció estable en los dos tipos de cirugía. La tasa de prematuridad fue superior en el grupo de la cirugía abierta.Spina bifida represents the most serious congenital neural tube deffect compatible with life. Its most frequent form is myelomeningocele, which is caracterized by the lack of closure of the posterior vertebral arch during third-fourth embrionary development weeks, moment in which the neural plate wouldn't complete its development causing an open spinal canal, with exposure to the amniotic fluid of the meninges and other neural elements during the rest of the pregnancy. The benefits of the prenatal surgery of the neural tube deffects and, specifically of the myelomeningocele, have been widely demostrated, providing a closure of the deffect to protect the neurological elements devoid of it, to prevent the leak of cerebrospinal fluid and to decrease the risk of infection, with the minimal possible maternal-fetal morbidity. In the Materno-fetal Unit of Vall d'Hebron Hospital it is offered to pregnant women the possibility of intrauterine surgery of the neural tube deffects. The surgical approach of intrauterine surgery can be performed through fetoscopic surgery or open fetal surgery, being the general objective of this study the analysis of the anesthetic management in these two types of surgery. We believe that continous monitoring of maternal-fetal binomial would allow us to anticipate and adapt in an individualized way the doses of vaoactive drugs and fluids, minimizing episodes of maternal hypotension and therefore, of placental hypoperfusion, as well as decrease respiratory complications during the perioperative period. We also consider that fetoscopic surgery for the intrauterine correction of neural tube deffects would be associated with fewer hemodynamic maternal changes than open surgery, with the consequent effect about the decrease of the requirements of vasoactive drugs and about maternal-fetal associated morbimortality. Therefore, we have carried out a retrospective descriptive study in Vall d'Hebron Hospital, Barcelona, during the period between years 2011-2016, being our main conclusions: - In the intrauterine fetal myelomeningocele correction through open surgery or fetoscopic, no differences were found in the maternal morphic doses neither muscle relaxants between two types of surgery. There were differences between the required dose of halogenated and nytroglicerin, being higher in open surgery. - Fluidotherapy with crystalloids wasn't different between groups, while the administered volum of colloids was lower in the pregnant women of the fetoscopic surgery group. The consumption of vasoconstrictors was directly related to the uterine exposure time, without finding differences between both groups. - The mean arterial blood pressure of the patients urdergoing open surgery was lower than in the fetoscopic group, and this group of patients experienced more episodes of arterial hypotension. The arterial tensions systolics, diastolics and mean decreased in both groups during the uterine exteriorization and this decrease was higher in the open surgery group. - No differences were found in gasometric maternal parameters during the CO2 insufflation in fetoscopic surgery. - The rate of premature rupture of membranes was similar in both groups. The rate of olighydramnios and the need for tocolytics in the postoperative period was higher in the open surgery group. - The fetal heart rate remained stable in both types of surgery. The prematurity rate was higher in the open surgery group

Biodiversidad 2018. Reporte de estado y tendencias de la biodiversidad continental de Colombia

Las cifras y temáticas contenidos en el presente Reporte, aunque no son el panorama completo del estado del conocimiento de la biodiversidad en Colombia, son un compendio seleccionado de los temas que, desde el Instituto Humboldt, consideramos son relevantes y merecen ser discutidos por el público general. En muchos de los casos, las cifras no son esperanzadoras u son un llamado urgente a la acción. En otro casos son la evidencia de que se requieren acciones a nivel nacional, y más allá de esto, son muchas las iniciativas que están germinando desde los territorios, cada vez desde una mayor variedad de actores.Bogotá, D. C., Colombi

The impact of excluding adverse neonatal outcomes on the creation of gestational weight gain charts among women from low- and middle-income countries with normal and overweight BMI

Background Existing gestational weight gain (GWG) charts vary considerably in their choice of exclusion/inclusion criteria, and it is unclear to what extent these criteria create differences in the charts’ percentile values. Objectives We aimed to establish the impact of including/excluding pregnancies with adverse neonatal outcomes when constructing GWG charts. Methods This is an individual participant data analysis from 31 studies from low- and middle-income countries. We created a dataset that included all participants and a dataset restricted to those with no adverse neonatal outcomes: preterm 4000 g. Quantile regression models were used to create GWG curves from 9 to 40 wk, stratified by prepregnancy BMI, in each dataset. Results The dataset without the exclusion criteria applied included 14,685 individuals with normal weight and 4831 with overweight. After removing adverse neonatal outcomes, 10,479 individuals with normal weight and 3466 individuals with overweight remained. GWG distributions at 13, 27, and 40 wk were virtually identical between the datasets with and without the exclusion criteria, except at 40 wk for normal weight and 27 wk for overweight. For the 10th and 90th percentiles, the differences between the estimated GWG were larger for overweight (∼1.5 kg) compared with normal weight (<1 kg). Removal of adverse neonatal outcomes had minimal impact on GWG trajectories of normal weight. For overweight, the percentiles estimated in the dataset without the criteria were slightly higher than those in the dataset with the criteria applied. Nevertheless, differences were <1 kg and virtually nonexistent at the end of pregnancy. Conclusions Removing pregnancies with adverse neonatal outcomes has little or no influence on the GWG trajectories of individuals with normal and overweight