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Aims/hypothesis Low birthweight is a risk factor for type 2 diabetes. Most previous studies are based on cross-sectional prevalence data, not designed to study the timing of onset of type 2 diabetes in relation to birthweight. We aimed to examine associations of birthweight with age-specific incidence rate of type 2 diabetes in middle-aged to older adults over two decades. Methods Adults aged 30–60 years enrolled in the Danish Inter99 cohort in 1999–2001 (baseline examination), with information on birthweight from original birth records from 1939–1971 and without diabetes at baseline, were eligible. Birth records were linked with individual-level data on age at diabetes diagnosis and key covariates. Incidence rates of type 2 diabetes as a function of age, sex and birthweight were modelled using Poisson regression, adjusting for prematurity status at birth, parity, polygenic scores for birthweight and type 2 diabetes, maternal and paternal diabetes history, socioeconomic status and adult BMI. Results In 4590 participants there were 492 incident type 2 diabetes cases during a mean follow-up of 19 years. Type 2 diabetes incidence rate increased with age, was higher in male participants, and decreased with increasing birthweight (incidence rate ratio [95% CI per 1 kg increase in birthweight] 0.60 [0.48, 0.75]). The inverse association of birthweight with type 2 diabetes incidence was statistically significant across all models and in sensitivity analysis. Conclusions/interpretation A lower birthweight was associated with increased risk of developing type 2 diabetes independent of adult BMI and genetic risk of type 2 diabetes and birthweight. Graphical Abstract

Aminu S Abdullahi,1 Abubaker Suliman,1 Yasir Ahmed Mohammed Elhadi,1 Hassib Narchi,2 Shamsa Al Awar,3 Kornelia Zaręba,3 Marwa Alhaj Ahmad,1 Mohammed Khogali,1 Luai A Ahmed1,4 1Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates; 2Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates; 3Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates; 4Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab EmiratesCorrespondence: Abubaker Suliman, Email ababaker.suliman@uaeu.ac.aeBackground: Maternal hemoglobin (Hb) concentration and changes in Hb across trimesters have been linked to low birth weight (LBW) and small-for-gestational-age (SGA). However, these associations have shown inconsistent results and have not been investigated in pregnant women in the United Arab Emirates (UAE). We investigated the association between changes in Hb concentration during the first and second trimesters and birth weight, LBW, and SGA among pregnant women in the UAE.Methods: We utilized data from the Mutaba’ah Study. Change in Hb was computed as the difference between the first and second trimester Hb concentrations. LBW and SGA were defined as birth weight below 2500 grams and birth weight below the 10th percentile, respectively. Multivariable regression models were used to investigate the association between changes in maternal Hb and birth weight, LBW and SGA.Results: A total of 1500 pregnant women were included. The mean maternal age was 32 years (SD 6). Overall, Hb concentration declined from the first to the second trimesters by a median of − 9 g/L (IQR: − 14, − 3). LBW and SGA were observed among 6% and 10% of the newborns, respectively. Pregnant women who experienced the least reduction or an increase in Hb concentration had a higher risk of both LBW (adjusted odds ratio [aOR]: 3.43, 95% confidence interval [CI]: 1.77 to 6.96) and SGA (aOR: 2.08, 95% CI: 1.28 to 3.40) compared to those with the greatest reduction in Hb concentration.Conclusion: Minimal reductions in Hb levels from the first to the second trimester were associated with LBW and SGA. The average Hb levels during the second trimester were inversely associated with birth weight and SGA. Monitoring variations in maternal Hb early in pregnancy may enhance the early identification of pregnancies at risk.Keywords: hemoglobin, Hb change, birthweight, SGA, pregnancy

Background Small-for-gestational-age neonates (SGA) are at increased risk of neonatal morbidity. Nulliparity represents a risk factor for SGA; birthweight charts may perform differently for the detection of SGA among nulliparas. This study aimed at describing the prevalence of SGA in nulliparas according to different birthweight charts and evaluating the diagnostic performance of these charts to maternal and perinatal outcomes. Methods This is a secondary analysis of a Brazilian cohort of nulliparas named Preterm SAMBA study. Birthweight centiles were calculated using the Intergrowth-21st, WHO-Fetal Growth Charts, Birth in Brazil population chart and GROW-customised chart. The risks of outcomes among SGA neonates and their mothers in comparison to neonates with birthweights between the 40 th -60 th centiles were calculated, according to each chart. ROC curves were used to detect neonatal morbidity in neonates with birth weights below different cutoff centiles for each chart. Results A sample of 997 nulliparas was assessed. The rate of SGA infants varied between 7.0–11.6%. All charts showed a significantly lower risk of caesarean sections in women delivering SGA neonates compared to those delivering adequate-for-gestational-age neonates (OR 0.55–0.64, p  < .05). The charts had poor performance (AUC 0.492 – 0.522) for the detection of neonatal morbidity related to SGA born at term. Conclusion The populational and customised birthweight charts detected different prevalence of small-for-gestational-age neonates and showed similar and poor performance to identify related neonatal adverse outcomes in this population.

BACKGROUND:A recent meta-analysis of 15 studies found a change in birthweight of -12.8 grams (95% CI -23.1, -2.38) per ng/ml PFOA in maternal or cord blood, and -27.1 grams (-50.6, -3.6) per log ng/ml PFOA (Negri E et al. Crit Rev Toxicol 2017;47:482-508). Almost all studies were done in low-exposed populations. There are nine new studies, adding 6019 births to the previous 6937 births. METHODS:We conducted a meta-analysis of 24 studies. To combine all results, we approximated results for untransformed PFOA from nine studies using log-transformed PFOA. We also included another large study, excluded from previous analyses, in a sensitivity analysis. RESULTS:We found a change of birthweight of -10.5 grams (-16.7, -4.4) for every ng/ml PFOA in maternal or cord blood. After adding one previously excluded large study, we found little evidence of an association (-1.0 grams, 95% CI -2.4, 0.4). Restricting to studies where blood was sampled from mothers early in the pregnancy or shortly before conception (5393 births), we found little association of PFOA with birthweight (-3.3 grams (-9.6, 3.0)). In studies where blood was sampled late in the pregnancy (7563 pregnancies), lower birthweight was associated with higher PFOA (-17.8 (-25.0, -10.6)). CONCLUSION:Present human evidence provides only modest support for decreased birthweight with increasing PFOA. Studies with a wide range of exposure, and studies with blood sampled early in pregnancy, showed little or no association of PFOA with birthweight. These are studies in which confounding and reverse causality would be of less concern.

Background: Birthweight is a widely accepted indicator of infant health and has signifcant and lasting associations. Several studies have found that low and high birthweight have signifcant negative associations with adult health. A new study in the feld of social sciences has established that birthweight has signifcant negative associations with not only adult health but also social attributes, such as income and occupation; however, no studies have evaluated the associations between birthweight and quality-of-life (QOL) attributes such as happiness. Methods: In this study, we use data from Japan, the U.S., and India, collected in 2011, in which the respondents were asked about their own birthweights to examine the long-term associations between low and high birthweight and eight outcome variables related to the QOL: adolescent academic performance, height, education, marital status, body mass index, income, health, and happiness. We regressed each of the eight outcome variables on low and high birthweight and the interaction terms of the old age and the birthweight dummies for each country. We estimated both the reduced and the recursive-structural forms. While the former estimates the total, that is, the sum of direct and indirect associations between birthweight and each outcome, the latter reports the direct association between birthweight and each outcome. Results: In Japan, while low birthweight is negatively associated with all outcomes, the associations of high birthweight were limited. In the U.S., low birthweight was not associated with any outcomes, but high birthweight had signifcantly negative associations with health and happiness. In contrast, in India, high birthweight was signifcantly and positively associated with income, health, and happiness, while low birthweight was associated with several outcomes negatively, similar to Japan. These associations were stronger in youth than in old age. Conclusion: Our study demonstrated that the associations of birthweight with QOL are widely diversifed across countries: low birthweight, rather than high birthweight, is a problem in Japan and India. However, the opposite is true for the U.S., indicating that policymakers in developed countries must pay closer attention to the problems caused by high birthweight, whereas those in developing countries are better to focus on low birthweight.

Background/Objectives: Intermittent fasting (IF), such as Ramadan fasting, is common among pregnant women despite religious exemptions. The possible impact of fasting on pregnancy outcome and, in particular, on birthweight is uncertain and was documented with conflicting evidence. Methods: The aim of this meta-analysis and systematic review was to investigate the association between intermittent fasting during pregnancy and neonatal birthweight, along with low birthweight (LBW, <2500 g) risk. Studies evaluating fasting during pregnancy with reported neonatal outcomes were included. We searched (PubMed, Scopus, Web of Science) from 2004 through June 2025. All contributing studies were observational in design; no randomized trials were identified. The risk of bias was assessed using the Newcastle-Ottawa Scale. The pooled relative risks (RR) and mean differences (MD) were calculated according to random-effects models (DerSimonian–Laird method) and heterogeneity was quantified with the I2 statistic. Results: Nineteen studies, all observational in design, were included for qualitative synthesis, and six studies yielded quantitative data to conduct meta-analyses. No randomized controlled trials were identified. Intermittent fasting during pregnancy, encompassing more than 1.3 million pregnancies, was associated with a small but statistically significant reduction in neonatal birth weight. The pooled mean difference was −94 g (95% CI: −176 to −12 g; p = 0.03; I2 = 70%), indicating a minor but statistically significant effect that is unlikely to be clinically meaningful. The pooled RR for LBW was 0.96 (95% CI: 0.88–1.05; p = 0.38; I2 < 10%), showing no association between fasting and low birthweight risk. Sensitivity analyses reduced heterogeneity (I2 ≈ 55%) and confirmed the robustness of these findings. According to the GRADE approach, the certainty of evidence was moderate for birthweight and high for LBW. Conclusions: Intermittent fasting during pregnancy, including Ramadan fasting, was associated with a minor but statistically significant reduction in neonatal birthweight without increasing the risk of low birthweight. This difference was small and clinically negligible. Further prospective studies are needed to clarify trimester-specific effects and long-term developmental outcomes.

Clinical estimation of fetal weight is an integral component of obstetric care that might dictate the timing and mode of delivery. Inaccurate fetal weight estimation might result in unnecessary interventions or in underestimating potential risks, resulting in inappropriate intrapartum care. This retrospective study assessed factors associated with under- or overestimation of birthweight and evaluated the obstetric implications. It included singleton births ≥24 w with clinically estimated fetal weight (EFW) up to 1 week before delivery, during 2014–2020. Estimates >±10% of the actual birthweight were considered inaccurate and categorized as overestimation (>10% heavier than the actual birthweight) or underestimation (>10% smaller than the birthweight). Multivariable logistic regression was performed to reveal factors associated with inaccurate EFW. Maternal characteristics and obstetric outcomes were compared. The primary outcomes for the overestimation group were the neonatal composite adverse outcome, induction of labor and cesarean delivery rates. The primary outcomes for the underestimation group were rates of shoulder dystocia, 3rd- or 4th-degree perineal lacerations, and failed vacuum extraction. Among 38,615 EFW, 5172 (13.4%) were underestimated, 6695 (17.3%) were overestimated and 27,648 (69.3%) accurate. Multivariable logistic regression found increasing gestational age as an independent risk-factor for underestimation (odds ratio (OR) 1.15 for every additional week, 95% confidence interval (CI) 1.12–1.2). Major factors independently associated with overestimation were nulliparity (OR 1.95, CI 1.76–2.16), maternal obesity (OR 1.52, CI 1.33–1.74), smoking (OR 1.6, CI 1.33–1.93), and oligohydramnios (OR 1.92, CI 1.47–2.5). Underestimation was an independent risk-factor for shoulder dystocia (OR 1.61, CI 1.05–2.46) and 3rd- or 4th-degree perineal lacerations (OR 1.59, CI 1.05–2.43). Overestimation was an independent risk-factor for neonatal composite adverse outcome (OR 1.15, CI 1.02–1.3), induced labor (OR 1.30, CI 1.21–1.40) and cesarean delivery (OR 1.59, CI 1.41–1.79). Clinicians should be aware of factors and adverse obstetric implications associated with over- or underestimation of birthweight.

Recent scholarship points to a protective association between green space and birth outcomes as well a positive relationship between blue space and wellbeing. We add to this body of literature by exploring the relationship between expectant mothers’ exposure to green and blue spaces and adverse birth outcomes in New York City. The Normalized Difference Vegetation Index (NDVI), the NYC Street Tree Census, and access to major green spaces served as measures of greenness, while proximity to waterfront areas represented access to blue space. Associations between these factors and adverse birth outcomes, including preterm birth, term birthweight, term low birthweight, and small for gestational age, were evaluated via mixed-effects linear and logistic regression models. The analyses were conducted separately for women living in deprived neighborhoods to test for differential effects on mothers in these areas. The results indicate that women in deprived neighborhoods suffer from higher rates adverse birth outcomes and lower levels of residential greenness. In adjusted models, a significant inverse association between nearby street trees and the odds of preterm birth was found for all women. However, we did not identify a consistent significant relationship between adverse birth outcomes and NDVI, access to major green spaces, or waterfront access when individual covariates were taken into account.

Investigate an association between severe tropical cyclones (TCs) and birth outcomes in an Australian population. We analysed over 600,000 singleton livebirths collected through the Queensland Perinatal Data Collection between 2008 and 2018. We estimated the odds ratios (ORs) of adverse birth outcomes using logistic multi‐level modelling. Exposure to TCs in early pregnancy was associated with significantly higher odds of preterm births in affected compared to unaffected areas during the TC year [OR=1.28, 95%CI=1.11, 1.49, p=0.001] and slightly significant higher odds in affected areas during TC years compared to non‐TC years. Significantly higher odds of low birthweight births were associated with mid‐pregnancy exposure to cyclone Marcia [OR=1.62, 95%CI=1.00, 2.40, p=0.016] . Findings aligned with studies demonstrating an association between exposure to environmental stressors in early to mid‐pregnancy and adverse birth outcomes. There is limited research into TCs and perinatal health in Australia despite most of the population residing along coastlines and TCs presenting one of the nation's most devastating weather events. This study will inform public health practice and contribute to further research into mitigating environmental risks faced by pregnant women.

Background It has been shown that active exposure to tobacco is associated with adverse pregnancy outcomes including, but not limited to, intrauterine fetal death, reduced fetal weight, and higher risk of preterm birth. We want to investigate these effects in a high-income country. Methods This cross-sectional study examined 20,843 pregnant women who delivered over 10 years at the Maternity Hospital of the Centre Hospitalier Universitaire Vaudois (CHUV) in Lausanne, Switzerland. The objective was to evaluate a dose–response relationship between daily cigarette use during pregnancy and possible adverse perinatal outcomes. The social and clinical characteristics as well as obstetric and neonatal outcomes were compared between the smoking and the non-smoking groups. Adjusted odds ratios (aOR) and trend analyses (p trend ) were calculated. Results Nineteen thousand five hundred fifty-four pregnant women met the inclusion criteria and 2,714 (13.9%) of them were smokers. Even after adjusting for confounding factors, smoking during pregnancy was associated with preterm birth, birthweight < 2500 g, intrauterine growth restriction, neonatal respiratory and gastrointestinal diseases, transfer to the neonatal intensive care unit, and neonatal intensive care unit admissions > 7 days. Intrauterine death and neonatal infection were associated with heavy smoking (≥ 20 cigarettes/day). Smoking appeared to be a protective factor for pre-eclampsia and umbilical cord arterial pH below 7.1. A significant trend (p trend  < 0.05) was identified for preterm birth, intrauterine growth restriction, birthweight < 2500 g, umbilical cord arterial pH below 7.1, transfers to our neonatal intensive care unit, and neonatal intensive care unit admissions more than 7 days. Conclusion Cigarette smoking is associated with several adverse perinatal outcomes of pregnancy with a dose-dependent effect.