Biological and pathological mechanisms leading to the birth of a small vulnerable newborn.

Patricia J Hunter, Toluwalase Awoyemi, Adejumoke I Ayede, R Matthew Chico, Anna L David, Kathryn G Dewey, Christopher P Duggan, Michael Gravett, Andrew J Prendergast, Usha Ramakrishnan, Per Ashorn, Nigel Klein

Journal: Lancet (London, England) 2023;401(10389):1720-1732

PMID: 37167990

Full Text on Elsevier Science View on PubMed

Abstract

The pathway to a thriving newborn begins before conception and continues in utero with a healthy placenta and the right balance of nutrients and growth factors that are timed and sequenced alongside hormonal suppression of labour until a mature infant is ready for birth. Optimal nutrition that includes adequate quantities of quality protein, energy, essential fats, and an extensive range of vitamins and minerals not only supports fetal growth but could also prevent preterm birth by supporting the immune system and alleviating oxidative stress. Infection, illness, undernourishment, and harmful environmental exposures can alter this trajectory leading to an infant who is too small due to either poor growth during pregnancy or preterm birth. Systemic inflammation suppresses fetal growth by interfering with growth hormone and its regulation of insulin-like growth factors. Evidence supports the prevention and treatment of several maternal infections during pregnancy to improve newborn health. However, microbes, such as Ureaplasma species, which are able to ascend the cervix and cause membrane rupture and chorioamnionitis, require new strategies for detection and treatment. The surge in fetal cortisol late in pregnancy is essential to parturition at the right time, but acute or chronically high maternal cortisol levels caused by psychological or physical stress could also trigger labour onset prematurely. In every pathway to the small vulnerable newborn, there is a possibility to modify the course of pregnancy by supporting improved nutrition, protection against infection, holistic maternal wellness, and healthy environments.

Address: UCL Great Ormond Street Institute of Child Health, University College London, London, UK. Electronic address: [email protected].; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.; Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria.; Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.; UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.; Department of Nutrition, University of California at Davis, Davis, CA, USA.; Department of Nutrition and Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; Center for Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.; Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA.; Blizard Institute, Queen Mary University of London, London, UK; Zvitambo Institute for Maternal & Child Health Research, Harare, Zimbabwe.; Rollins School of Public Health, Emory University, Atlanta, GA, USA.; Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland.; UCL Great Ormond Street Institute of Child Health, University College London, London, UK.

DOI: 10.1016/S0140-6736(23)00573-1

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MeSH Terms: Humans, Pregnancy, Infant, Newborn, Infant, Female, Premature Birth, Hydrocortisone, Parturition, Prenatal Care, Chorioamnionitis