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1.  Perinatal Outcomes of Multiple Births in Southwest Nigeria 
Compared to singletons, multiple births are associated with a substantially-higher risk of maternal and perinatal mortality worldwide. However, little evidence exists on the perinatal profile and risk of neurodevelopmental disabilities among the survivors, especially in developing countries. This cross-sectional study, therefore, set out to determine the adverse perinatal outcomes that are potential markers for neurodevelopmental disabilities in infants with multiple gestations in a developing country. In total, 4,573 mothers, and their 4,718 surviving offspring in an inner-city maternity hospital in Lagos, Nigeria, from May 2005 to December 2007, were recruited. Comparisons of maternal and infant outcomes between single and multiple births were performed using multivariable logistic regression and generalized estimation equation analyses. Odds ratio (OR) and the corresponding 95% confidence interval (CI) for each marker were estimated. Of the 4,573 deliveries, there were 4,416 (96.6%) singletons and 157 (3.4%) multiples, comprising 296 twins and six triplets together (6.4% of all live 4,718 infants). After adjusting for maternal age, ethnicity, occupation, parity, and antenatal care, multiple gestations were associated with increased risks of hypertensive disorders and caesarean delivery. Similarly, after adjusting for potential maternal confounders, multiple births were associated with low five-minute Apgar score (OR: 1.47, 95% CI 1.13-1.93), neonatal sepsis (OR: 2.16, 95% CI 1.28-3.65), severe hyperbilirubinaemia (OR: 1.60, 95% CI 1.00-2.56), and admission to a special-care baby unit (OR: 1.56, 95% CI 1.12-2.17) underpinned by preterm delivery before 34 weeks (OR: 1.91, 95% CI 1.14-3.19), birthweight of less than 2,500 g (OR: 6.45, 95% CI 4.80-8.66), and intrauterine growth restriction (OR: 9.04, 95% CI 6.62-12.34). Overall, the results suggest that, in resource-poor settings, infants of multiple gestations are associated with a significantly-elevated risk of adverse perinatal outcomes. Since these perinatal outcomes are related to the increased risk of later neurodevelopmental disabilities, multiple-birth infants merit close developmental surveillance for timely intervention.
PMCID: PMC3259727  PMID: 22283038
Cross-sectional studies; Multiple gestations; Perinatal outcomes; Retrospective studies; Twins; Nigeria
2.  Body Size and Intelligence in 6-year-olds 
Maternal and child health journal  2008;13(6):847-856.
Objectives
Children born to teenage mothers are at risk for more physical and cognitive problems than those born to adult mothers. Our objective was to examine differences in size and intelligence between two cohorts of offspring born to adolescent (n = 357) and adult mothers (n = 668) who attended the same prenatal clinic.
Methods
Two prospective study cohorts were assessed children from gestation through age 6 years. The adult cohort was studied in the mid-1980’s and the teen cohort was evaluated in the mid-1990’s. Both samples were of low socio-economic status. The same study design and measures allowed us to adjust for the covariates of size and IQ.
Results
Offspring of adolescent mothers had a significantly smaller mean head circumference (5 mm) (HC) and higher body mass index (BMI) than offspring of adult mothers. Offspring of adolescent mothers scored significantly lower than the offspring of adult mothers on the Stanford-Binet (SBIS) composite score (4 points), and the quantitative (6.2 points), verbal reasoning (4.8 points), and short-term memory (3.9 points) area scores. Additional predictors of child IQ were maternal IQ, home environment, race, and number of siblings. When child HC was entered into our final regression model for the SBIS, maternal age and HC significantly predicted the composite score, the verbal reasoning, and short-term memory area scores. A 1 cm decrease in HC predicted a 1 point decrease in the SBIS composite score.
Conclusions
Compared to offspring of adult women, children of adolescent mothers have lower mean scores on cognitive measures, smaller head circumference, and higher BMI. These differences were significant after adjusting for differences between the two groups. Adolescent mothers and their children would benefit from interventions such as parenting support, education about nutritional needs, and advice on enriching the environments of their children.
doi:10.1007/s10995-008-0399-0
PMCID: PMC2759844  PMID: 18683038
children; teenage mothers; cognitive development; growth; IQ; BMI
3.  Racial/Ethnic Differences in Breastfeeding Initiation and Duration Among Low-income, Inner-city Mothers 
Social science quarterly  2009;90(5):1251-1271.
Objectives
Despite the promotion of breastfeeding as the “ideal” infant feeding method by health experts, breastfeeding continues to be less common among low-income and minority mothers than among other women. This paper investigates how maternal socio-demographic and infant characteristics, household environment, and health behaviors are related to breastfeeding initiation and duration among low-income, inner-city mothers, with a specific focus on differences in breastfeeding behavior by race/ethnicity and nativity status.
Methods
Using data from a community-based, longitudinal study of women in Philadelphia, PA (N=1,140), we estimate logistic regression and Cox proportional hazard models to predict breastfeeding initiation and duration.
Results
Both foreign-born black mothers and Hispanic mothers (most of whom were foreign-born) were significantly more likely to breastfeed their infants than non-Hispanic white women, findings that were partly explained by foreign-born and Hispanic mothers’ prenatal intention to breastfeed. In contrast to previous studies, we also found that native-born black women were more likely to breastfeed than non-Hispanic white women.
Conclusion
Our findings suggest that when poor whites and African Americans are similarly situated in an inner-city context, the disparity in their behavior with respect to infant feeding is not as distinct as documented in national surveys. Breastfeeding was also more common among low-income immigrant black women than white or native-born black mothers.
doi:10.1111/j.1540-6237.2009.00656.x
PMCID: PMC2768401  PMID: 20160902
Breastfeeding; Inner-city; Nativity; Race/Ethnicity; SES
4.  In utero pesticide exposure, maternal paraoxonase activity, and head circumference. 
Environmental Health Perspectives  2004;112(3):388-391.
Although the use of pesticides in inner-city homes of the United States is of considerable magnitude, little is known about the potentially adverse health effects of such exposure. Recent animal data suggest that exposure to pesticides during pregnancy and early life may impair growth and neurodevelopment in the offspring. To investigate the relationship among prenatal pesticide exposure, paraoxonase (PON1) polymorphisms and enzyme activity, and infant growth and neurodevelopment, we are conducting a prospective, multiethnic cohort study of mothers and infants delivered at Mount Sinai Hospital in New York City. In this report we evaluate the effects of pesticide exposure on birth weight, length, head circumference, and gestational age among 404 births between May 1998 and May 2002. Pesticide exposure was assessed by a prenatal questionnaire administered to the mothers during the early third trimester as well as by analysis of maternal urinary pentachlorophenol levels and maternal metabolites of chlorpyrifos and pyrethroids. Neither the questionnaire data nor the pesticide metabolite levels were associated with any of the fetal growth indices or gestational age. However, when the level of maternal PON1 activity was taken into account, maternal levels of chlorpyrifos above the limit of detection coupled with low maternal PON1 activity were associated with a significant but small reduction in head circumference. In addition, maternal PON1 levels alone, but not PON1 genetic polymorphisms, were associated with reduced head size. Because small head size has been found to be predictive of subsequent cognitive ability, these data suggest that chlorpyrifos may have a detrimental effect on fetal neurodevelopment among mothers who exhibit low PON1 activity.
PMCID: PMC1241872  PMID: 14998758
5.  Gender, smoking during pregnancy and gestational age influence cord leptin concentrations in newborn infants 
European Journal of Endocrinology  2008;159(3):217-224.
Background
Low birth weight (BW), small head circumference, reduced length, increased preterm births and neuro-endocrine dysfunctions are among known consequences of smoking during pregnancy. Few studies have linked leptin to clinical features of growth restriction associated with maternal smoking and explored interaction with other determinants of size at birth, such as gender.
Methods
Cord serum leptin concentrations were measured in 1215 term infants born to Caucasian mothers at completion of uneventful pregnancy. Serum concentrations were related to BW, gestational length, gender and maternal smoking and interaction with other determinants of size at birth evaluated.
Results
Smoking was more frequent in younger (P<0.001) and shorter mothers (P=0.03) from lower socio-economic groups (SEGPs) (P<0.001). Infants born to smokers were lighter (190 g less), shorter and with smaller head circumference. Cord serum leptin concentrations were higher in girls (9.8 s.d. 7.6 ng/ml) than in boys (7.05 s.d. 5.8 ng/ml) (P<0.001). Boys were heavier (BW 3.52 s.d. 0.49 kg) than girls (3.39 s.d. 0.44 kg) (P<0.001), but girls had greater skinfold thickness measurements (sub-scapular and quadriceps skinfold thicknesses 5.5 s.d. 1.6 mm and 7.6 s.d. 1.9 mm respectively; boys 5.3 s.d. 1.6 vs 7.24±1.90 mm, P<0.001 respectively). Multivariate analyses showed gender (P<0.001), BW SDS (P<0.001), gestational length (P<0.001) and maternal smoking (P<0.042) as factors that influenced umbilical cord serum leptin concentrations in newborns.
Conclusion
Maternal smoking restrains foetal growth through placental vascular effects, and likely also via associated effects on leptin metabolism. More studies are needed to determine the influence that maternal smoking may have on placental syncytiotrophoblast and foetal adipose tissue.
doi:10.1530/EJE-08-0171
PMCID: PMC2754114  PMID: 18524794
6.  Impact of Maternal Thyroperoxidase Status on Fetal Body and Brain Size 
Journal of Thyroid Research  2014;2014:872410.
The obstetric consequences of abnormal thyroid function during pregnancy have been established. Less understood is the influence of maternal thyroid autoantibodies on infant outcomes. The objective of this study was to examine the influence of maternal thyroperoxidase (TPO) status on fetal/infant brain and body growth. Six-hundred thirty-one (631) euthyroid pregnant women were recruited from prenatal clinics in Tampa Bay, Florida, and the surrounding area between November 2007 and December 2010. TPO status was determined during pregnancy and fetal/infant brain and body growth variables were assessed at delivery. Regression analysis revealed maternal that TPO positivity was significantly associated with smaller head circumference, reduced brain weight, and lower brain-to-body ratio among infants born to TPO+ white, non-Hispanic mothers only, distinguishing race/ethnicity as an effect modifier in the relationship. No significant differences were noted in body growth measurements among infants born to TPO positive mothers of any racial/ethnic group. Currently, TPO antibody status is not assessed as part of the standard prenatal care laboratory work-up, but findings from this study suggest that fetal brain growth may be impaired by TPO positivity among certain populations; therefore autoantibody screening among high-risk subgroups may be useful for clinicians to determine whether prenatal thyroid treatment is warranted.
doi:10.1155/2014/872410
PMCID: PMC3929063  PMID: 24624307
7.  Normal children with large heads--benign familial megalencephaly. 
Archives of Disease in Childhood  1979;54(7):512-517.
Fifteen normal children with large heads (circumference greater than 0.5 cm above the 98th centile) were studied. CAT scans were pefrormed to exclude hydrocephalus, and ventricular size was compared with that of hydrocephalic children. In 11 of the 13 families in which the parents' heads were measured, one parent (10 fathers and one mother) was found to have a large head, as had 6 of 17 siblings. Head circumference at birth was large in 7 of 10 babies and rate of head growth was excessive in 8 of 13. Skull x-ray showed suture diastasis in 7 infants. These families have a benign familial megalencephaly. It is important to recognise this so as to avoid unnecessary investigation and anxiety about normal children with large heads.
Images
PMCID: PMC1545478  PMID: 314781
8.  Self-medication for infants with colic in Lagos, Nigeria 
BMC Pediatrics  2009;9:9.
Background
Infantile colic is a self-limiting condition that is distributed worldwide. It is often misdiagnosed as an organic disease for which an infant is admitted to the hospital. Many studies have described the aetiopathogenesis, pharmacologic and non-pharmacologic management of colic but none has evaluated self-medication for infants with colic. The aim of this study was therefore to determine the knowledge of Nigerian mothers about colic, their home-based management, extent of self-medication for the infants with colic and the types of medicines involved.
Methods
It is a prospective study conducted at the vaccination clinics of 20 primary health care centres, each from different Local Government Areas in Lagos, Nigeria. Eight hundred mothers that brought their infants for vaccination between April and September, 2006 were interviewed with open-and close-ended questionnaire.
Results
Six hundred and eighty three (85.4%) mothers claimed they had a good knowledge of colic. Incessant and excessive cry was the main clinical feature of colic identified by 430(62.9%) mothers. Three hundred and seventy eight (67.7%) infants were treated by self-medication, 157 (28.1%) sought medical intervention and 17 (3.1%) were treated at a traditional birth attendant home. Herbal medicines constituted 51.8% of the self-medicated medicines, of which 48 (26.2%) were "Ororo Ogiri". Nospamin® (49.5%) and Gripe water® (43.0%) were the two frequently prescribed and self-medicated medicines for infants with colic.
Conclusion
Nigerian mothers are deficient in their knowledge of colic. Self-medication was the most frequently used home-based intervention. Health education would appear necessary to improve parental management of this self-limiting condition.
doi:10.1186/1471-2431-9-9
PMCID: PMC2645392  PMID: 19193235
9.  Maternal and fetal nutrition in south India. 
British Medical Journal  1978;1(6126):1517-1518.
The relation between the nutrition of the mother and that of her baby was assessed in a south Indian community where malnutrition is common and women do not smoke. Unselected mothers and their infants of over 37 weeks' gestation were studied in two groups: those who paid for their care (150) and a poorer group who did not (172). There were significnat differences between the paying and non-paying groups in maternal triceps skinfold thickness, infant weight, and infant length. Overall there was a significant positive correlation between maternal triceps thickness and infant weight, length, and triceps and subscapular skinfold thickness. The correlation with the infant head circumference was less significant. These findings are further evidence that the nutrition of the mother has an important effect on the nutrition of her baby and that malnutrition is an important reason why Indian babies are lighter than European ones.
PMCID: PMC1605046  PMID: 656780
10.  Mothers’ human papilloma virus knowledge and willingness to vaccinate their adolescent daughters in Lagos, Nigeria 
Introduction
Human papillomavirus (HPV) is one of the most common sexually transmitted infections in sexually active adolescents and young women and has been implicated as a cause of the majority of cases of cervical cancer, which is the second most common cancer in women in Nigeria. HPV is preventable with the use of HPV vaccines.
Objectives
The objective of this study was to assess mothers’ HPV knowledge and their willingness to vaccinate their adolescent daughters in Lagos, Nigeria.
Materials and methods
This study was a community-based, descriptive cross-sectional study carried out in July, 2012 in Shomolu Local Government Area (LGA) of Lagos State, Nigeria. Multistage sampling method was employed to select the 290 respondents who participated in the study. Structured, pretested, interviewer-administered questionnaires were used for data collection. Data was analyzed with Epi Info™ version 7.
Results
The study revealed low awareness of HPV (27.9%) and HPV vaccines (19.7%) among the mothers that participated. There was a high awareness for cervical cancer but little knowledge of its link to HPV. Awareness and utilization of HPV vaccines increased with increasing educational level (P < 0.05). There was a high willingness and intention among the mothers to vaccinate their girls (88.9%) and to recommend the vaccine to others (91.0%). Accessibility and affordability of the HPV vaccines were found to be possible barriers to future utilization of the vaccines.
Conclusion
Despite low knowledge about HPV and HPV vaccines, mothers were willing to vaccinate their daughters. We recommend improving mothers’ knowledge by education and the possible inclusion of the vaccine in the national immunization schedule to eliminate the financial barrier.
Video abstract
doi:10.2147/IJWH.S44483
PMCID: PMC3711756  PMID: 23874123
HPV; vaccine; Nigeria
11.  Frequency of twinning in southwest Nigeria 
BACKGROUND:
In the human species, twin is a type of multiple birth in which the mother gives birth to two offspring from the same pregnancy. The occurrence and frequency of twinning, however, varies across human populations. The maternal age, socio-environmental factors, increase in the use of contraceptives, the race of human population, increase in the spontaneous abortion rate, and seasonal variations are among the factors that could influence twinning rate. Information on twinning rates in southwest Nigeria is limited.
AIMS:
This study presents information on the frequency of twinning, as well as its analysis by maternal age, in four urban settings in southwest Nigeria. This is with the aim of extending current knowledge on the frequency of twinning in southwest Nigeria and contributing to the demographic studies in the country.
MATERIALS AND METHODS:
Data on single births and twin births from January 1995 to December 2004 were collected from the Oyo State General Hospital (OSGH), Wesley Guild Hospital (WGH), Obafemi Awolowo University Teaching Hospital (OAUTH), and Ekiti State Specialist Hospital (ESSH) in Ogbomoso, Ilesa, Ile-Ife, and Ado-Ekiti respectively. These were analyzed by year and maternal age groups of 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, and 45-49 years according to the standard method.
RESULTS:
A frequency of twin births of 46.5 per 1000 deliveries and 46.2 per 1000 deliveries was recorded for Ilesa and Ile-Ife respectively. The frequency recorded for Ogbomoso and Ado-Ekiti was 38.5 and 22.1 per 1000 deliveries respectively. The overall average frequency of 40.2 per 1000 deliveries for the four hospitals ranks among the highest recorded rates of twin births in the world. The maternal age group of 25-29 years had the highest occurrence of twin births, while the lowest was recorded in the 45-49 years age group.
CONCLUSION:
This analysis reveals high incidence of twinning in the studied areas and supports previous assertion that the southwestern part of Nigeria has the highest twinning rate in the country and in the whole world. It is our opinion that diet, maternal history of twinning, and some socio-environmental factors may have influenced the results.
doi:10.4103/0971-6866.44104
PMCID: PMC2840794  PMID: 20300293
Diet; maternal influence; southwest Nigeria; twinning rate
12.  Maternal and neonatal factors associated with mode of delivery under a universal newborn hearing screening programme in Lagos, Nigeria 
Background
Emerging evidence from a recent pilot universal newborn hearing screening (UNHS) programme suggests that the burden of obstetric complications associated with mode of delivery is not limited to maternal and perinatal mortality but may also include outcomes that undermine optimal early childhood development of the surviving newborns. However, the potential pathways for this association have not been reported particularly in the context of a resource-poor setting. This study therefore set out to establish the pattern of delivery and the associated neonatal outcomes under a UNHS programme.
Methods
A cross-sectional study in which all consenting mothers who delivered in an inner-city tertiary maternity hospital in Lagos, Nigeria from May 2005 to December 2007 were enrolled during the UNHS programme. Socio-demographic, obstetric and neonatal factors independently associated with vaginal, elective and emergency caesarean deliveries were determined using multinomial logistic regression analyses.
Results
Of the 4615 mothers enrolled, 2584 (56.0%) deliveries were vaginal, 1590 (34.4%) emergency caesarean and 441 (9.6%) elective caesarean section. Maternal age, parity, social class and all obstetric factors including lack of antenatal care, maternal HIV and multiple gestations were associated with increased risk of emergency caesarean delivery compared with vaginal delivery. Only parity, lack of antenatal care and prolonged/obstructed labour were associated with increased risk of emergency compared with elective caesarean delivery. Infants delivered by vaginal method or by emergency caesarean section were more likely to be associated with the risk of sensorineural hearing loss but less likely to be associated with hyperbilirubinaemia compared with infants delivered by elective caesarean section. Emergency caesarean delivery was also associated with male gender, low five-minute Apgar scores and admission into special care baby unit compared with vaginal or elective caesarean delivery.
Conclusions
The vast majority of caesarean delivery in this population occur as emergencies and are associated with socio-demographic factors as well as several obstetric complications. Mode of delivery is also associated with the risk of sensorineural hearing loss and other adverse birth outcomes that lie on the causal pathways for potential developmental deficits.
doi:10.1186/1471-2393-9-41
PMCID: PMC2749799  PMID: 19732443
13.  Follow-up of children of diabetic mothers. 
Archives of Disease in Childhood  1980;55(4):259-264.
The results of a follow-up study of infants of diabetic mothers are presented. The antenatal care of all such mothers was supervised in a combined clinic by obstetricians and physicians, and good diabetic control was achieved in most of them. 51 mothers delivered 73 infants, all liveborn, between the years 1964 and 1972 inclusive at Hammersmith Hospital. There were no fetal deaths. 66 infants survived the neonatal period, and 63 the first 2 years of life. 51 children, including all those seriously ill in the neonatal period, could be traced. Detailed neurological and general examinations including skinfold measurements were made, and the IQ measured. Four children were found to have major handicaps. These were severe deafness, epilepsy, low IQ, and myopia. No other neurological abnormalities were detected, and the distribution of full-scale IQs was normal. The distribution of height and head circumference centiles was near normal, but an increased number of children had weights above the 90th centile. No significant congenital malformations were found in these 51 survivors, and none has so far developed diabetes.
PMCID: PMC1626811  PMID: 7416774
14.  Iron-deficiency anemia (IDA) in infancy and mother-infant interaction during feeding 
Objective
This study was conducted to compare quality of mother-infant interactions during feeding in infants with or without iron deficiency anemia (IDA).
Method
Infants and caregivers were screened at their 9- to 10-month-old health maintenance visits at an inner-city clinic in Detroit. Those who were full-term and healthy received a venipuncture blood sample to assess iron status. Of the 77 infants who met final iron status criteria, 68 infants and mothers were videotaped during feeding interaction at the Child Development Research Laboratory. The quality of mother-infant interaction during feeding was scored on the Nursing Child Assessment Feeding Scale (NCAFS). Twenty-five infants with IDA (HB < 110 g/L and at least 2 abnormal iron measures) were compared to 43 non-anemic infants (HB ≥ 110 g/L) using ANOVA and GLM models with covariate control.
Results
Mothers of IDA infants responded with significantly less sensitivity to infant cues and less cognitive and social-emotional growth fostering behavior than mothers of non-anemic infants. The pattern of results was similar for scales of contingent behaviors. The magnitude of the differences in maternal ratings was large (0.8-1.0 SD after covariate adjustment). IDA infants were rated significantly lower on clarity of cues and overall (effect sizes 0.5 SD).
Conclusion
IDA in infancy was associated with less optimal mother-infant interactions during feeding. Future interventions might target feeding interaction and consider effects on infant iron status and developmental/behavioral outcomes among IDA infants, as well as infant feeding practices per se.
doi:10.1097/DBP.0b013e3181dc525d
PMCID: PMC3147183  PMID: 20431398
Iron-deficiency anemia; mother-infant interaction; NCAFS; feeding
15.  Prenatal and Neonatal Brain Structure and White Matter Maturation in Children at High Risk for Schizophrenia 
The American journal of psychiatry  2010;167(9):1083-1091.
Objective
Schizophrenia is a neurodevelopmental disorder associated with abnormalities of brain structure and white matter, although little is known about when these abnormalities arise. This study was conducted to identify structural brain abnormalities in the prenatal and neonatal periods associated with genetic risk for schizophrenia.
Method
Prenatal ultrasound scans and neonatal structural magnetic resonance imaging (MRI) and diffusion tensor imaging were prospectively obtained in the offspring of mothers with schizophrenia or schizoaffective disorder (N=26) and matched comparison mothers without psychiatric illness (N=26). Comparisons were made for prenatal lateral ventricle width and head circumference, for neonatal intracranial, CSF, gray matter, white matter, and lateral ventricle volumes, and for neonatal diffusion properties of the genu and splenium of the corpus callosum and corticospinal tracts.
Results
Relative to the matched comparison subjects, the offspring of mothers with schizophrenia did not differ in prenatal lateral ventricle width or head circumference. Overall, the high-risk neonates had nonsignificantly larger intracranial, CSF, and lateral ventricle volumes. Subgroup analysis revealed that male high-risk infants had significantly larger intracranial, CSF, total gray matter, and lateral ventricle volumes; the female high-risk neonates were similar to the female comparison subjects. There were no group differences in white matter diffusion tensor properties.
Conclusions
Male neonates at genetic risk for schizophrenia had several larger than normal brain volumes, while females did not. To the authors' knowledge, this study provides the first evidence, in the context of its limitations, that early neonatal brain development may be abnormal in males at genetic risk for schizophrenia.
doi:10.1176/appi.ajp.2010.09101492
PMCID: PMC3105376  PMID: 20516153
16.  Growth of infants’ length, weight, head and arm circumferences in relation to low levels of blood lead measured serially 
To determine whether levels of blood lead during gestation and infancy that are below the CDC action of level of 10 μg/dL affect infant growth, we studied 211 disadvantaged mother-infant pairs from Albany, NY. Mothers’ lead levels were low (2nd trimester x=2.8 μg/dL) as were infants’ (x= 3.3 μg/dL at 6 months; 6.4 μg/dL at 12 months). Multiple linear regression analyses showed that 2nd trimester lead levels were related to reduced head circumference at 6 and 12 months. Infants of mothers with 2nd trimester lead at or above the median (≥ 3 ug/dL) exhibited negative associations between blood lead and head circumference at 6 and 12 months, and with weight-for-age, weight-for-length and upper arm circumference at 6 months, but those below the median did not. Infants’ 6 month lead level was related to head circumference at 12 months in the total sample, and in the sub-sample of infants whose blood lead was above the infants’ 6 month blood lead median. Infants also were grouped by changes in their relative blood lead status, i.e., above vs. below the median, from 2nd trimester to 12 months of age. Infants whose lead levels changed from above to below the median were larger than infants whose lead levels went from below to above the median. The results suggest that lead may affect some dimensions of infant growth at levels below 10 ug/dL, but effects of lead levels less than 3 ug/dL are not evident in this sample.
doi:10.1002/ajhb.20842
PMCID: PMC3099262  PMID: 18991336
lead; children; growth; development; height; weight; head circumference
17.  Maternal perception of body size as a determinant of infant adiposity in an African-American community. 
For 10 weeks, a sample of 105 postpartum African-American clients of three inner-city clinics, were recruited for this nine-month prospective study. Data from 54 mother-infant dyads were used to explore the associations between maternal perceptions of infant body size and the development of adiposity at six- to seven months of age. Correlations, chi-square, paired t-test, ANOVA, and logistic regression analyses were performed. Quantitative assessments of BMI using weight and length measures and qualitative assessments of body size perceptions using questionnaires, silhouette, and ranking scales were conducted. At six- to seven months of age, 40% of the infants were above the 85th percentile and 31% were above the 95th percentile of the NCHS standards for weight for height. Maternal perception of infant body size was positively correlated with early introduction of nonmilk foods. Significantly, more infants perceived as small were introduced to nonmilk foods earlier, compared to infants perceived as average, p=0.03. Additionally, it was observed that the earlier the introduction of nonmilk foods, the greater the infant's BMI at six- to seven months of age (r=0.59, p=0.02). Finally, one-third of mothers were obese with BMI's exceeding 30, and 31.1% were overweight with BMI's between 25 and 30.
PMCID: PMC2594865  PMID: 15040517
18.  Investigation of Infant Brain with or without Hydrocephalous in Our Environment Using Anterior Transfontanelle Ultrasound Scan 
Aim:
A prospective study aimed to suggest easy and simple reproducible ventricular site that will be basic measurement plane and normal dimension determined, correlated to sizes of infants for comparative evaluation of hydrocephalous infants and should be reproducible in follow-up.
Materials and Methods:
A prospective study done in University of Benin Teaching Hospital Benin, Nigeria. This study used 50 consecutive infants with Ultrasound scan (US) diagnosis of hydrocephalus and a control group of 50 US normal from 1st January 2007 to 30th June 2008. The infants were scan through the mid-patent anterior fontanelle in sagittal, and transverse planes with minor angulations to properly outline the ventricles and the position of measurement determined at the foramen of Monro of lateral ventricles and the diameter measured. The infants’ weight, crown-heel length, and head circumference were measured and body mass index (BMI) calculated and correlated to lateral ventricular measurement. Data analysis was conducted using the Statistical Package for Social Sciences (SPSS Inc, USA), Version 11.0.
Results:
There was no statistically sex and age-related difference. There is statistically comparative high mean weight and height and lower BMI in hydrocephalic infants as against the control group (P < 0.001). The mean head circumference for hydrocephalus was 45.6 (± 10.5 standard deviation [SD]), whereas the control group was 35.9 (± 2.7 SD) with P < 0.001. The mean diameter of the anterior horn of left and right lateral ventricles at the level of foramen of Monro in hydrocephalic subjects is 18.4 mm ± 14.3 mm and 20.1 mm ± 16.8 mm with median diameter of 14.1 mm and 15.2 mm, respectively, whereas control group is 2.5 mm ± 0.6 mm and 2.5 mm ± 0.7 mm with median diameter of 2.5 mm and 2.4 mm, respectively.
Conclusion:
Transfontanelle US was found highly useful in investigation of hydrocephalous in infant.
doi:10.4103/1117-6806.111497
PMCID: PMC3762032  PMID: 24027410
Anterior fontanelle; brain; hydrocephalus; ultrasound; ventricle
19.  A Study on Causes and Types of Abnormal Increase in Infants’ Head Circumference in Kashan/Iran 
Objective
Head circumference is a valuable index of brain growth and its disturbances can indicate different disorders of nervous system. Abnormal increased head circumference (macrocephaly) is common and observed in about 2% of infants. In this study, the causes and clinical types of abnormal increase in infants’ head circumference were investigated in Kashan, Iran.
Materials and Methods
This cross-sectional study was performed on 90 infants less than 2 years of age with abnormal increase in head circumference in Kashan, during 2009-
2011. The data were collected by history taking, physical examination, growth chart, and imaging.
Results
65 (72%) cases out of 90 infants were male and 25 ( 28%) cases were female. Fifty-three (58.8%) cases had familial megalencephaly, 30 (33.4%) had hydrocephalus, and other causes were observed in 7 (7.8%) cases. Eighty-three percent of Infants with familial megalencephaly and
50% with hydrocephalus had normal fontanels. In 90.6% of cases with familial megalencephaly, family history for large head was positive. Motor development was normal in 100% of cases with familial megalencephaly and 76.7% of hydrocephalic infants.
Conclusion
Familial megalencephaly was the most common cause of macrocephaly in the studied infants, and most of them had normal physical examination and development, so, parental head circumferences should be considered in the interpretation of infant’s head circumference and in cases of abnormal physical examination or development, other diagnostic modalities, including brain imaging should be done.
PMCID: PMC3943068  PMID: 24665303
Macrocephaly; Infants; Hydrocephalus; Fontanel
20.  Standards for the measurement of birth weight, length and head circumference at term in neonates of European, Chinese and South Asian ancestry 
Open Medicine  2007;1(2):e74-e88.
Background
Fetal growth restriction is associated with metabolic derangements in the newborn, impaired functioning in childhood and chronic diseases in adulthood. Differences between ethnic groups with respect to fetal growth may result in the misclassification of constitutionally small or large babies as having abnormal growth for their gestational age. We have developed intrauterine growth charts based on precise measurements of newborns whose parents were both of European, Chinese or South Asian ethnicity.
Methods
Weight, length and head circumference were measured in 2695 infants born to healthy non-smoking mothers in British Columbia at 37–41 completed weeks of gestation. Gestational age was confirmed by ultrasound before 20 weeks of gestation. Weight was measured by digital scale, length by stadiometer and head circumference by firm plastic tape measures. Means and 95% confidence intervals were compared among newborns grouped by ethnicity and sex. Smoothed graphs were constructed for visual interpretation.
Results
At 40 weeks, infants of European descent (“European” infants) weighed 225.5 g more on average than infants of Chinese descent (“Chinese” infants) (p < 0.001) and 254.6 g more than infants of South Asian descent (“South Asian” infants) (p < 0.001). The mean difference in birth weight between Chinese and South Asian infants (19.1 g) was not statistically significant. The mean length of European infants at 40 weeks of gestation was 0.89 cm greater than that of Chinese infants (p < 0.001). Differences in mean length between European and South Asian babies or between Chinese and South Asian babies was not statistically significant. The mean head circumferance of European babies was 0.50 cm larger than that of Chinese babies at 40 weeks (p < 0.001) but did not differ significantly from that of South Asian babies. South Asian and Chinese babies had similar mean head circumferences at 40 weeks. When differences in mean birth weight, length and head circumference were examined within boys and girls, the observed differences according to ethnicity remained statistically significant.
Conclusion
Important differences in weight, length and head circumferences are reported among babies according to ethnicity. The use of sex- and ethnicity-specific growth charts may prevent the misclassification of newborns as small or large for gestational age.
PMCID: PMC2802014  PMID: 20101298
21.  Maternal and child under-nutrition in rural and urban communities of Lagos state, Nigeria: the relationship and risk factors 
BMC Research Notes  2013;6:286.
Background
Poor nutritional status of mothers has a direct and indirect consequence on their own health and that of their children. The objective of this study was to determine the relationship between nutritional status of mothers and their children and the risk factors for under-nutrition among mothers and children in rural and urban communities of Lagos State, Nigeria.
Methods
This was a cross sectional survey conducted using the multistage random sampling technique. A total of 300 mother-child pairs were studied, consisting of 150 each from rural and urban communities. Under-nutrition in mothers and children was determined using standard criteria.
Results
The prevalence of under-nutrition among mothers was significantly higher in rural than urban communities (10.7% vs. 2.7%, p = 0.014). The prevalences of underweight and stunted children were also significantly higher in rural than urban communities (19.4% vs. 9.3%, p < 0.001) and (43.3% vs. 12.6%, p < 0.001) respectively. In rural communities, the risk of stunted mothers having children with stunting was about 7 times higher than those who were not (OR 6.7, 95% CI = 1.4-32.0, p = 0.007). In urban communities, undernourished mothers have about 11 and 12 times risk of having children with underweight and wasting respectively (OR 11.2, 95% CI = 1.4-86.5, p = 0.005) and (OR 12.3, 95% CI = 1.6-95.7, p = 0.003) respectively. The identified risk factors for maternal and child under nutrition differs across rural and urban communities.
Conclusions
The prevalence of maternal and child under-nutrition is high in both communities although higher in rural communities. Efforts at reducing the vicious cycle of under-nutrition among mothers and children should concentrate on addressing risk factors specific for each community.
doi:10.1186/1756-0500-6-286
PMCID: PMC3725170  PMID: 23880121
Mother; Children; Under-nutrition; Risk factors; Rural; Urban; Nigeria
22.  Sub-optimal breastfeeding of infants during the first six months and associated factors in rural communities of Jimma Arjo Woreda, Southwest Ethiopia 
BMC Public Health  2012;12:363.
Background
Studies have shown that sub-optimal breastfeeding is major contributor to infant and young child mortality in Ethiopia. To address this problem, infant and young child feeding guideline was developed in 2004 and interventions have been going on based on the guidelines. There is no study that assessed whether the infant and child feeding practices are according the guideline or not. This study was carried out to assess sub-optimal breastfeeding practices and associated factors among infants from birth to six months in rural communities of Jimma Arjo Woreda in the Southwest Ethiopia.
Methods
A cross-sectional study was carried out from December to January 2009. Quantitative data were collected from a sample of 382 respondents supplemented by qualitative data generated using in-depth interviews of 15 index mothers. Multivariable logistic regression model was used to identify predictors of timely initiation of breast feeding and non-exclusive breast feeding among mother-infant pairs.
Results
More than three fourth of mothers breastfeed their infants sub-optimally. Thirty-seven percent of mothers initiated breastfeeding later than one hour after delivery, which was significantly associated with not attending formal education (AOR = 1.05[95%CI: 1.03, 1.94]) and painful breastfeeding experiences (AOR = 5.02[95%CI: 1.01, 10.08]). The majority (67.02%) of mothers had no knowledge about exclusive breastfeeding. Non-exclusive breastfeeding was negatively associated with child’s age of 0-2 months (AOR: 0.27[95%CI: 0.16, 0.47) and 3-4 months (AOR = 0.43 [95%CI: 0.25, 0.73) and ownership of radio (AOR = 0.56[95%CI: 0.37, 0.88]), but positively associated with the practice of discarding colostrums (AOR = 1.78[95%CI: 1.09, 4.94]).
Conclusion
The findings showed that the majority of mothers sub-optimally breastfeed their children in the study area. As most of the mothers do not have knowledge on the exclusive breast feeding. Enhancing community based behavior change communications using multiple channels including radio and folk media is recommended to reduce sub-optimal breast feeding practices and associated consequences among children in the study area.
doi:10.1186/1471-2458-12-363
PMCID: PMC3439284  PMID: 22607266
23.  Fetal growth in different racial groups. 
Three racial groups of mothers and their newborn babies-- North European 75, Negro 75, and "Indian" Asian 37--were matched for parity, gestational age, sex, maternal age, maternal smoking habits, and social class. Multiple anthropometric measurements, including skinfold thickness, limb circumferences, and various linear measurements were made on the mothers and their infants to determine the effects of race and smoking on fetal size. Indian-Asian mothers, though shorter and lighter than Europeans and Negroes, had similar skinfold thickness and weight: height2 ratios and gained as much weight during pregnancy. Their infants, however, were lighter than the others, and had smaller head and limb circumferences, although their linear measurements were the same. Negro and European infants were almost identical in size. We found no effect on any of the fetal measurements which could be attributed to smoking.
PMCID: PMC1544839  PMID: 626515
24.  Antecedents of teenage pregnancy from a 14-year follow-up study using data linkage 
BMC Public Health  2010;10:63.
Background
Many western nations continue to have high rates of teenage pregnancies and births, which can result in adverse outcomes for both mother and child. This study identified possible antecedents of teenage pregnancy using linked data from administrative sources to create a 14-year follow-up from a cross-sectional survey.
Methods
Data were drawn from two sources - the 1993 Western Australian Child Health Survey (WACHS), a population-based representative sample of 2,736 children aged 4 to 16 years (1,374 girls); and administrative data relating to all their subsequent births and hospital admissions. We used weighted population estimates to examine differences between rates for teenage pregnancy, motherhood and abortion. We used Cox proportional hazards regression to model risk for teenage pregnancy.
Results
There were 155 girls aged less than 20 years at the time of their first recorded pregnancy. Teenage pregnancy was significantly associated with: family type; highest school year completed by primary carer; combined carer income; whether the primary carer was a smoker; and whether the girl herself displayed aggressive and delinquent behaviours. An age-interaction analysis on the association with aggressive and delinquent behaviours found that while girls with aggressive and delinquent behaviours who were older at the time of the survey were at highest risk of teenage pregnancy, there was elevated risk for future teenage pregnancy across all ages.
Conclusions
Our findings suggest that interventions to reduce teenage pregnancy rates could be introduced during primary school years, including those that are focused on the prevention and management of aggressive and delinquent behaviour.
doi:10.1186/1471-2458-10-63
PMCID: PMC2834626  PMID: 20149221
25.  Estimating the relative contributions of maternal genetic, paternal genetic and intrauterine factors to offspring birth weight and head circumference 
Early Human Development  2010;86(7):425-432.
Background
Genetic factors and the prenatal environment contribute to birth weight. However, very few types of study design can disentangle their relative contribution.
Aims
To examine maternal genetic and intrauterine contributions to offspring birth weight and head circumference. To compare the contribution of maternal and paternal genetic effects.
Study design
Mothers and fathers were either genetically related or unrelated to their offspring who had been conceived by in vitro fertilization.
Subjects
423 singleton full term offspring, of whom 262 were conceived via homologous IVF (both parents related), 66 via sperm donation (mother only related) and 95 via egg donation (father only related).
Measures
Maternal weight at antenatal booking, current weight and maternal height. Paternal current weight and height were all predictors. Infant birth weight and head circumference were outcomes.
Results
Genetic relatedness was the main contributing factor between measures of parental weight and offspring birth weight as correlations were only significant when the parent was related to the child. However, there was a contribution of the intrauterine environment to the association between maternal height and both infant birth weight and infant head circumference as these were significant even when mothers were unrelated to their child.
Conclusions
Both maternal and paternal genes made contributions to infant birth weight. Maternal height appeared to index a contribution of the intrauterine environment to infant growth and gestational age. Results suggested a possible biological interaction between the intrauterine environment and maternal inherited characteristics which suppresses the influence of paternal genes.
doi:10.1016/j.earlhumdev.2010.05.021
PMCID: PMC2954294  PMID: 20646882
Birth weight; IVF; Prenatal; Genetic; Intrauterine; Growth

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