TY - JOUR
T1 - Biological and pathological mechanisms leading to the birth of a small vulnerable newborn
AU - Lancet Small Vulnerable Newborn Steering Committee
AU - Hunter, Patricia J.
AU - Awoyemi, Toluwalase
AU - Ayede, Adejumoke I.
AU - Chico, R. Matthew
AU - David, Anna L.
AU - Dewey, Kathryn G.
AU - Duggan, Christopher P.
AU - Gravett, Michael
AU - Prendergast, Andrew J.
AU - Ramakrishnan, Usha
AU - Ashorn, Per
AU - Klein, Nigel
AU - Black, Robert E.
AU - Lawn, Joy E.
AU - Ashorn, Ulla
AU - Hofmeyr, G. Justus
AU - Temmerman, Marleen
AU - Askari, Sufia
N1 - Publisher Copyright:
© 2023 Elsevier Ltd
PY - 2023/5/20
Y1 - 2023/5/20
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85159408206&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(23)00573-1
DO - 10.1016/S0140-6736(23)00573-1
M3 - Review article
C2 - 37167990
AN - SCOPUS:85159408206
SN - 0140-6736
VL - 401
SP - 1720
EP - 1732
JO - The Lancet
JF - The Lancet
IS - 10389
ER -