Seminars in Fetal & Neonatal Medicine RSS feed: Current Issue. Seminars in Fetal & Neonatal Medicine (formerly Seminars in Neonatology ) is a bi-monthly journal which publishes topic-based issues, including current 'Hot Topics' on the latest advances in fetal and neonatal medicine. The change in title relates to the growing interest amongst obstetricians, midwives and fetal medicine specialists. The Journal commissions review-based content covering current clinical opinion on the care and treatment of the neonate and draws on the necessary specialist knowledge, including that of the respiratory physician, the infectious disease physician, the surgeon, as well as the paediatrician and obstetrician. Each topic-based issue is edited by an authority in their field and contains 8-10 articles. Recent Issues have included: • Newer Concepts in Neonatal Respiratory Care • Perinatal Infection: Detection and Prevention • Multiple Births • Neonatal Jaundice • Inborn Errors of Metabolism Seminars in Fetal & Neonatal Medicine provides: • coverage of major developments in neonatal care; • value to practising neonatologists, consultant and trainee paediatricians, obstetricians, midwives and fetal medicine specialists wishing to extend their knowledge in this field; • up-to-date information in an attractive and relevant format. Book Reviews Seminars in Fetal and Neonatal Medicine accepts relevant books for inclusion in the book review section. Please contact Associate Publisher, Lindsay Campbell, Elsevier, 32 Jamestown Road, London, NW1 7BY; l.campbell@elsevier.com for further information or to submit books for consideration.http://www.sfnmjournal.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Seminars in Fetal & Neonatal Medicine1744-165X152April 2010 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.sfnmjournal.com/article/PIIS1744165X10000041/abstract?rss=yesTitle Page/Aims and Scope/Editorial Board10.1016/S1744-165X(10)00004-1Seminars in Fetal & Neonatal Medicine 15, 2 (2010)2010-04-01Seminars in Fetal & Neonatal Medicine2010-04-01152S1744-165X(10)X0002-6IFCIFChttp://www.sfnmjournal.com/article/PIIS1744165X09001188/abstract?rss=yesThe rapid rise in obesity in young women has seen new challenges posed for the management of these women in pregnancy and for their babies. The obesity rate in young pregnant women has doubled in just over ten years in the UK bringing qualitative and quantitative increases in obesity associated with morbidities in pregnancy. The issues range from fetal problems such as miscarriage, congenital anomalies and macrosomia through to medical problems such as hypertension, diabetes, venous thromboembolism, and extend to special considerations around delivery, high operative delivery rates and particular post delivery problems including infection and difficulty breastfeeding. The complications encountered during pregnancy in turn pose particular problems for service delivery in antenatal, intrapartum and neonatal care, as well as issues with regards to foetal programming, obesity in childhood and long term implications for the mother.EditorialIan A. Greer10.1016/j.siny.2009.12.001Seminars in Fetal & Neonatal Medicine 15, 2 (2010)2009-12-11Seminars in Fetal & Neonatal Medicine2009-12-11152S1744-165X(10)X0002-66969http://www.sfnmjournal.com/article/PIIS1744165X09000985/abstract?rss=yesSummary: Rates of obesity have increased exponentially worldwide to almost epidemic proportions. This is associated with a marked increase in adverse maternal and perinatal outcomes and subsequent burden on health care resources. In particular, maternal obesity is linked to numerous metabolic complications including subfertility, gestational diabetes, hypertensive disorders of pregnancy and thromboembolism with potential long-term health consequences for both mother and child. The underlying pathophysiology linking maternal obesity and adverse outcomes is complex but is likely to involve alterations in glucose and lipid metabolism, inflammation, perturbances in adipokines and vascular dysfunction all seen in obese women. Intervention studies are underway to determine whether alteration of maternal lifestyle can improve maternal and fetal outcomes.Obesity in pregnancy: prevalence and metabolic consequencesShahzya S. Huda, Lauren E. Brodie, Naveed Sattar10.1016/j.siny.2009.09.006Seminars in Fetal & Neonatal Medicine 15, 2 (2010)2009-11-09Seminars in Fetal & Neonatal Medicine2009-11-09152S1744-165X(10)X0002-67076http://www.sfnmjournal.com/article/PIIS1744165X09001036/abstract?rss=yesSummary: The prevalence of obesity is high and rising worldwide. The greatest prevalence of obesity is found in the western world and in urban developing countries. There is an increased maternal mortality associated with maternal obesity. There are increased risks of most maternal complications in pregnancy including pre-eclampsia, gestational and pre-existing type 2 diabetes mellitus and thromboembolic disorders. There is an increased perinatal mortality associated with maternal obesity; there are increased risks of congenital malformation, fetal macrosomia and indeed risks for the fetus as a child and adult in the years to come. There are increased risks of complications of pregnancy including caesarean section, traumatic delivery and a reduced chance of breastfeeding. Maternal obesity in pregnancy predicts long-term risks for that mother. The management includes increased surveillance for these risks and lifestyle modulation during pregnancy. This includes dietary measures and encouraging modest increase in exercise. Ideally, the mother should achieve closer to an ideal body mass index prior to pregnancy using lifestyle intervention but possibly with pharmacological therapy or bariatric surgery. The ideal weight gain for an obese mother is less than the ideal weight gain for a lean mother.Management of maternal obesity prior to and during pregnancyH. Shaikh, S. Robinson, T.G. Teoh10.1016/j.siny.2009.10.003Seminars in Fetal & Neonatal Medicine 15, 2 (2010)2009-11-30Seminars in Fetal & Neonatal Medicine2009-11-30152S1744-165X(10)X0002-67782http://www.sfnmjournal.com/article/PIIS1744165X09000997/abstract?rss=yesSummary: Rates of obesity among the pregnant population have increased substantially and adiposity has a damaging effect on every aspect of female reproductive life. This review summarises epidemiological data concerning obesity-related complications of pregnancy. Obesity is linked to a number of adverse obstetric outcomes as well as increased maternal and neonatal morbidity and mortality. These complications include miscarriage, congenital abnormalities, pre-eclampsia, gestational diabetes mellitus, iatrogenic preterm delivery, postdates pregnancy with increased rates of induction of labour, caesarean section, postpartum haemorrhage, shoulder dystocia, infection, venous thromboembolism, and increased hospital stay. It is important to consider obese pregnant women as a high risk group with a linear increase in risk of complications associated with their degree of obesity. Their obstetric management should be consultant-led and involve a multidisciplinary team approach to improve outcome.Obstetric management of obesity in pregnancyEleanor Jarvie, Jane E. Ramsay10.1016/j.siny.2009.10.001Seminars in Fetal & Neonatal Medicine 15, 2 (2010)2009-11-02Seminars in Fetal & Neonatal Medicine2009-11-02152S1744-165X(10)X0002-68388http://www.sfnmjournal.com/article/PIIS1744165X09000882/abstract?rss=yesSummary: The prevalence of both obesity and gestational diabetes mellitus (GDM) is increasing worldwide. GDM affects about 7% of all pregnancies and is defined as any degree of impaired glucose tolerance during gestation. The presence of obesity has a significant impact on both maternal and fetal complications associated with GDM. These complications can be addressed, at least in part, by good glycaemic control during pregnancy. The significance and impact of obesity in women with GDM are discussed in this article, together with treatment options, the need for long-term risk modification and postpartum follow-up.Obesity and gestational diabetesT. Sathyapalan, D. Mellor, S.L. Atkin10.1016/j.siny.2009.09.002Seminars in Fetal & Neonatal Medicine 15, 2 (2010)2009-10-30Seminars in Fetal & Neonatal Medicine2009-10-30152S1744-165X(10)X0002-68993http://www.sfnmjournal.com/article/PIIS1744165X09000894/abstract?rss=yesSummary: Maternal obesity is an important aspect of reproductive care. It is the commonest risk factor for maternal mortality in developed countries and is also associated with a wide spectrum of adverse pregnancy outcomes. Maternal obesity may have longer-term implications for the health of the mother and infant, which in turn will have economic implications. Efforts to prevent, manage and treat obesity in pregnancy will be costly, but may pay dividends from reduced future economic costs, and subsequent improvements to maternal and infant health. Decision-makers working in this area of health services should understand whether the problem can be reduced, at what cost; and then, what cost savings and health benefits will accrue in the future from a reduction of the problem.Obesity in pregnancy: outcomes and economicsIngrid Rowlands, Nick Graves, Susan de Jersey, H. David McIntyre, Leonie Callaway10.1016/j.siny.2009.09.003Seminars in Fetal & Neonatal Medicine 15, 2 (2010)2009-10-12Seminars in Fetal & Neonatal Medicine2009-10-12152S1744-165X(10)X0002-69499http://www.sfnmjournal.com/article/PIIS1744165X09000900/abstract?rss=yesSummary: Obesity is associated with an increased risk of pregnancy-related complications that affect both the mother and baby. National clinical care guidelines have been developed by the Centre for Maternal and Child Enquiries, as part of its Confidential Enquiry into Maternal and Child Health (CEMACH) programme. These guidelines are intended to minimise and manage the risks associated with maternal obesity, and they were developed using formal consensus methods based on the Delphi technique. A multidisciplinary group of 25 members participated in the iterative process. Standards of care were based on the best available evidence and expert clinical knowledge and experience. This article describes the process used to develop standards of maternity care for women with obesity, and the resulting recommendations are presented.Setting maternity care standards for women with obesity in pregnancyKate J. Fitzsimons, J. Modder10.1016/j.siny.2009.09.004Seminars in Fetal & Neonatal Medicine 15, 2 (2010)2009-11-26Seminars in Fetal & Neonatal Medicine2009-11-26152S1744-165X(10)X0002-6100107http://www.sfnmjournal.com/article/PIIS1744165X09000912/abstract?rss=yesSummary: In many industrialised countries almost one in five pregnant women is obese. Maternal obesity has major implications for the fetus and newborn infants, and may have adverse consequences for lifelong health and well-being. We discuss the current epidemiological evidence for the association of maternal obesity with congenital structural neural tube and cardiac defects, fetal macrosomia that predisposes infants to birth injuries and to problems with physiological and metabolic transition, as well as potential for long-term effects secondary to prenatal and neonatal programming effects compounded by a reduction in sustained breastfeeding. We summarise the evidence for the effect of maternal weight management interventions on fetal and neonatal outcomes and discuss areas where further research is needed to clarify uncertainties.Maternal obesity: consequences for children, challenges for clinicians and carersW. McGuire, L. Dyson, M. Renfrew10.1016/j.siny.2009.09.005Seminars in Fetal & Neonatal Medicine 15, 2 (2010)2009-10-15Seminars in Fetal & Neonatal Medicine2009-10-15152S1744-165X(10)X0002-6108112http://www.sfnmjournal.com/article/PIIS1744165X09000870/abstract?rss=yesSummary: Since the hypothesis linking low birth weight and poor fetal growth with future risk of cardiovascular disease was first proposed, there has been much interest in the early origins of disease. As rates of obesity increase and as maternal obesity has become common, interest has been directed towards the early origins of obesity. It is likely that a complex interaction of inherited gene effects and in-utero environment may interact in the developing fetus to programme pathways leading to future obesity. It is clear that maternal metabolism is disturbed in pregnancy in obese women, and that offspring of obese mothers have a higher percentage of body fat and are insulin resistant. This review discusses the ideas contributing to the current working concept of obesity programming, and discusses several potential mechanisms that may underlie obesity programming and susceptibility to future metabolic and vascular disease.Effects of maternal obesity on fetal growth and body composition: implications for programming and future healthDilys J. Freeman10.1016/j.siny.2009.09.001Seminars in Fetal & Neonatal Medicine 15, 2 (2010)2009-10-26Seminars in Fetal & Neonatal Medicine2009-10-26152S1744-165X(10)X0002-6113118http://www.sfnmjournal.com/article/PIIS1744165X10000028/abstract?rss=yesIn this retrospective cohort study, the authors assess the risks of late prematurity for cerebral palsy (CP), developmental delay/mental retardation (DD/MR) and seizure disorders in early childhood. Hospitalization and outpatient databases from the Northern California Kaiser Permanente Medical Care Program include 141,321 children >30 weeks born between 2000 and 2004. Presence of CP, DD/MR, and seizures is based on ICD-9 CM codes. Cox proportional hazard models are used for each of the outcomes, with crude and adjusted hazard ratios calculated for each gestational age group. The authors observe a three-fold increased risk of CP (OR 3.39; 95% CI 2.54–4.52) and significantly higher rates of DD/MR (OR 1.25; 95% CI 1.01–1.54) for late preterm infants compared with term infants. It is concluded that decreasing gestational age is associated with increased incidence of CP and DD/MR, even for those infants born at 34 to 36 weeks gestation.Increased risk of adverse neurological development for late preterm infantsLuc Cornette10.1016/j.siny.2010.01.001Seminars in Fetal & Neonatal Medicine 15, 2 (2010)2010-02-11Seminars in Fetal & Neonatal Medicine2010-02-11152S1744-165X(10)X0002-6119119