Browsing by Author "Hesse, Volker"

Background and Aim: We have previously presented analyses of data obtained from the German Perinatal Survey for the years 1995-1997. Here we present an analysis of data from the years 2007-2011 and compare the data to the previous data from the 1990s. Material and Methods: For the years 1995-1997, the data on 1815318 singleton pregnancies were provided by the Chambers of Physicians of all the states of Germany except Baden-Wurttemberg. For the years 2007-2011, the data on 3187920 singleton pregnancies from the German Perinatal Survey (all states of Germany) were obtained from the AQUA Institute in Gottingen, Germany. SPSS was used for data analysis. Plausibility checks were performed on the data. Results: Mean maternal age has increased over the years, from 28.7 years in 1995 to 30.2 years in 2011. We observed a decrease in smoking. While not all cases included data on maternal smoking after the pregnancy was known, when the cases with data on smoking were analysed, in 1995-1997 23.5% of pregnant women were smokers compared to 11.2% smokers in 2007-2011. Maternal body mass index (BMI) also changed; 8.2% of women were obese (BMI: 3040 kg/m(2)), while 13.0% were obese in 2011. In 1995, 0.6% of women were morbidly obese (BMI >= 40 kg/m(2)) compared to 1.8% of women in 2011. The mean maternal body weight at the time of the first obstetric consultation also increased from 65.9 kg in 1995 to 68.7 kg in 2011. Conclusions: While the decrease in the number of women smoking over time is clearly a positive development, increasing maternal age and obesity present challenges in clinical practice.

Aim: To compare anthropometric characteristics of German-born vs. Asian-born mothers and their neonates. Material and Methods: We analysed data from the German Perinatal Survey of 1995 -2000; 1907265 singleton pregnancies occurred in women originating from Germany and 23206 occurred in women originating from Asia. We compared maternal height, weight, and bodymass index (BMI) as well as birth weight, neonatal body length, and neonatal head circumference. Neonates were classified by birth weight percentiles: neonates < 10th birth weight percentile were " small for gestational age" (SGA), those > 90th birthweight percentilewere " large for gestational age" (LGA), all others were " appropriate for gestational age" (AGA). Results: German-born and Asian-born mothers differed considerably in anthropometric measures; German-born women were taller, heavier, and more likely to be obese. Neonatal anthropometric measures also differed; mean birth weight, body length, and head circumference all indicated that neonates of Asian-born mothers were smaller. For term births, birth weight percentiles of neonates of Asian-born mothers were mostly below those of neonates of German-born mothers. Neonates of Asian-born mothers were more often classified as SGA and less often as LGA when birth weight percentiles of the overall population (regardless of maternal country of origin) were used. Conclusions: Considerable differences exist in the anthropometric characteristics of German-born vs. Asian-born mothers and their neonates. Awareness of such differences is important in obstetric and neonatal practice, especially with regard to the somatic classification of neonates as SGA, AGA, or LGA.

Dieback-affected trees of a boggy stand of Picea abies in the Harz Mountains, northern Germany, bore a richer epiphytic lichen vegetation than healthy trees. Cover of the foliose epiphytic lichen Hypogymnia physodes decreased with increasing Mn/Ca ratio in stemflow. The total of lichen species per tree decreased both with the Mn/Ca ratio in stemflow and with the Mn concentration in bark. The results agree with experimental tests of Mn toxicity to H. physodes. Comparison with other dieback-affected spruce stands of the Harz Mountains revealed that Mn attained unusually high concentrations in the study site because of high Mn concentrations in the soil. Mn concentrations in soil, bark, stemflow, and incident precipitation suggest that Picea abies removes excess Mn taken up from the soil by the root system by transferring it into the bark. Mn in stemflow is supposed to derive primarily from leaching of Mn from bark and needles. SO42- concentration that was found to be decisive for epiphytic lichen distribution in other dieback-affected spruce stands of the Harz Mountains was of subordinate significance to lichen vegetation in the present case.

Background and Aim: Smoking during pregnancy has a negative influence on prenatal growth. We investigated the relationship between the number of cigarettes smoked per day and anthropometric measurements of the neonate. Material and Methods: Datasets of 508926 singleton pregnancies were available (441409 of which included information on maternal smoking) from the German Perinatal Survey of 1998-2000. We analysed the birth weight, length, and head circumference as well as the neonatal growth indices weight/length, weight/head circumference, body mass index, and length/head circumference. Comparisons were made between the children of non-smoking women and those of women smoking 1-5, 6-10, 11-15, 16-20, 21-25, 26-30, or > 30 cigarettes per day (ANOVA, post-hoc tests according to Bonferroni). Analyses were performed for the total study population and for a restricted sample (deliveries after 37-41 completed weeks of gestation by women with a height >= 157 cm and a weight >= 54 kg) to limit confounding variables. Results: Analyses of birth weight, length, head circumference, weight/length, weight/head circumference, and body mass index revealed highly significant decreases (p < 0.001) in all smoking groups compared with non-smokers. There were monotonic decreases in these neonatal growth parameters with increasing smoking over the range 0-20 cigarettes per day. For more than 20 cigarettes per day "dose dependence" was less convincing but group sizes were relatively small. The growth index length/head circumference was not suitable to demonstrate a "dose-dependent" effect of smoking. Conclusions: Because smoking has a "dose-dependent" effect on a number of parameters of foetal growth, any reduction in cigarette consumption during pregnancy should be encouraged.

Background and Aim: The classification of weight gain during pregnancy and the somatic classification of neonates according to birth weight and duration of pregnancy can be done using percentile values. We aimed to compare such classifications using percentiles of the overall study population with classifications using percentiles that were calculated taking account of maternal height and weight. Material and Methods: Using data from the German Perinatal Survey (1995-2000, over 2.2 million singleton pregnancies) we classified weight gain during pregnancy as low (< 10th percentile), high (> 90th percentile), or medium (10th-90th percentile). Neonates were classified by birth weight as small for gestational age (SGA, < 10th percentile), large for gestational age (LGA, > 90th percentile), or appropriate for gestational age (AGA, 10th-90th percentile). Classifications were performed for 12 groups of women and their neonates formed according to maternal height and weight, either with the percentiles calculated from the total study population or with group-specific percentiles. Results: Using percentiles of the total study population there was large variability between the 12 groups in the proportions with low and high weight gain and in the proportions of SGA and LGA neonates. The variability was much lower when group-specific percentiles were used. Conclusions: Classifications of maternal weight gain during pregnancy and birth weight differ substantially, depending on whether percentiles calculated from the total study population or group-specific percentiles are used. The impact of using percentiles that take account of maternal anthropometric parameters for the medical care and health of neonates needs to be elucidated in future research.

Background: Maternal height and weight are important determinants of perinatal outcomes. Height and weight can be combined in the measure of body mass index (BMI). We aimed to investigate the utility of maternal BMI as a predictor of perinatal outcomes. Materials and Methods: Based on data collected between 1995 and 2000 as part of the German perinatal survey, we examined singleton pregnancies of women with BMIs of 18, 24, or 30. We compared preterm birth rate, birth weight, and the somatic classification of neonates as small, appropriate, or large for gestational age (SGA, AGA, LGA) for women with heights of 150 cm and 180 cm for each BMI. Results: For women with a BMI of 18 (24; 30) and a height of 150 cm, the preterm birth rate was 13.9% (9.1%; 12.5%); for women with the same BMI and a height of 180 cm the preterm birth rate was 12.1% (6.1%; 4.4%). Birth weight for women with a BMI of 18 (24; 30) and a height of 150 cm was 2 889 g (3 170 g; 3 147 g); for women with the same BMI and a height of 180 cm it was 3 314 g (3 629 g; 3 753 g). The LGA rate for women with a BMI of 18 (24; 30) and a height of 150 cm was 2.1% (5.2%; 5.2%); for women with the same BMI and a height of 180 cm it was 7.7% (20.5%; 27.7%). Conclusions: There is considerable variability in perinatal outcomes between women with the same BMI but different heights. This limits the utility of BMI as a predictor of perinatal outcomes.

Aim: "Late motherhood" is associated with greater perinatal risks but the term lacks precise definition. We present an approach to determine what "late motherhood" associated with "high risk" is, based on parity and preterm birth rate. Materials and Methods: Using data from the German Perinatal Survey of 1998-2000 we analysed preterm birth rates in women with zero, one, or two previous live births. We compared groups of "late" mothers (with high preterm birth rates) with "control" groups of younger women (with relatively low preterm birth rates). Data of 208342 women were analysed. For women with zero (one; two) previous live births, the "control" group included women aged 22-26 (27-31; 2933) years. Women in the "late motherhood" group were aged > 33 (> 35; > 38) years. Results: The "late motherhood" groups defined in this way were also at higher risk of adverse perinatal events other than preterm birth. For women with zero (one; two) previous live births, normal cephalic presentation occurred in 89% (92.7%; 93.3%) in the "control" group, but only in 84.5% (90%; 90.4%) in the "late motherhood" group. The mode of delivery was spontaneous or at most requiring manual help in 71.3% (83.4%; 85.8%) in the "control" group, but only in 51.4% (72.2%; 76.4%) in the "late motherhood" group. Five-minute APGAR scores were likewise worse for neo-nates of "late" mothers and the proportion with a birth weight <= 2499 g was greater. Conclusion: "Late motherhood" that is associated with greater perinatal risks can be defined based on parity and preterm birth rate.

We defined neonates as small, appropriate, or large for gestational age (SGA, AGA, LGA) based on birth weight, length, and head circumference. We analyzed the effects on the somatic classification of maternal body mass index (BMI) (< 18.5, 18.5-24.99, 25.0-29.99, >= 30) and smoking during pregnancy (0, 1-7, 8-14, >= 15 cigarettes daily). Data were from the German Perinatal Survey (1998-2000; 433,669 cases). The following refers to the classification by birth weight. In the normal maternal weight population SGA rates increased with cigarette consumption: 9.8%, 17.8%, 21.6%, and 25.4% for non-smokers, and smokers of 1-7, 8-14, and >= 15 cigarettes daily, respectively. In non-smoking underweight women the SGA rate was 17.4%. In underweight smokers of >= 15 cigarettes daily the SGA rate was 38.5% [odds ratio 5.77, 95% confidence interval 5.10-6.53, compared with normal weight non-smokers]. In the normal maternal weight population, LGA rates were 9.9%, 5.3%, 4.6%, and 3.5% for non-smokers, and smokers of 1-7, 8-14, and >= 15 cigarettes daily, respectively. In the obese, LGA rates were 20.9% (non-smokers) and 11.4% (>= 15 cigarettes). Similar findings were obtained for the somatic classifications based on birth length and head circumference. Results for the various combinations of maternal BMI and smoking status in the three classification systems are described. Our findings may assist in individualized risk assessment for SGA and LGA births.

Background and aim: Maternal smoking and body mass index (BMI) affect the somatic classifications of neonates based on birth weight, length, and head circumference. Here we investigate the somatic classifications of neonates based on weight-for-length and Rohrer's ponderal index. Material and Methods: Singleton neonates (n = 433643; data from the German perinatal survey of 1998-2000) were classified as small, appropriate or large for gestational age (SGA, AGA, LGA) based on the 10th and 90th population percentiles of weight-for-length (weight/length) and ponderal index (weight/length(3)). Maternal BMI was classified as underweight (< 18.5kg/m(2)), normal weight (18.5-24.99 kg/m(2)), overweight (25-29.99 kg/m(2)), or obese (>= 30 kg/m(2)). Smoking during pregnancy was categorized as 0, 1-7, 8-14, or >= 15 cigarettes per day. The somatic classification of neonates was compared between different maternal BMI and smoking groups. Results: Classifying neonates by weight-for-length we found that the SGA rate was greater for underweight women (16.3%) and smaller for overweight (7.5%) and obese women (7.0%) compared with the normal weight reference population (9.9%, all data for non-smokers). Furthermore, SGA rates increased with increasing cigarette consumption. The combination of smoking >= 15 cigarettes per day and being underweight was associated with a very high SGA rate of 35.7%. Classifying neonates according to ponderal index showed qualitatively similar but smaller changes: here smoking >= 15 cigarettes per day and being underweight was associated with an SGA rate of 14.4%. Conclusions: The somatic classification of neonates according to weight-for-length illustrates the effects of maternal BMI and smoking more clearly than the classification according to the ponderal index.

Epiphytic lichen diversity in a boggy stand of Norway spruce (Picea abies) was studied in the eastern Harz Mountains, northern Germany. Spruce trees at wet sites were affected by forest dieback, whereas trees on drier sites remained unaffected. Lichen diversity was higher on dieback-affected trees than on healthy ones. The foliose lichen Hypogymnia physodes was significantly more frequent on dead trees, whereas the crustose, extremely toxitolerant Lecanora conizaeoides occurred more frequently on healthy trees. Stemflow concentrations of NH4+ NO3-, PO3-, and SO42- were lower on affected trees. This is attributed to reduced interception from the atmosphere due to needle loss. Cover of H. physodes decreased with increasing mean SO42- concentration in stemflow. The total of lichen species per sample tree also decreased with increasing SO42- concentration in stemflow, indicating that most species reacted in a similar way as H. physodes. Cover of L. conizaeoides increased with increasing SO42- concentration, but decreased at higher SO42- concentrations. Bark chemistry had a minor influence on lichen diversity. (C) 2002 The British Lichen Society. Published by Elsevier Science Ltd. All rights reserved.