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ranged from 11%-61%; no guideline was deemed suitable for use. Only Swiss and Canadian guidelines were considered useable with significant modifications. Conclusion Several international guidelines on perinatal care of 22-25 wk GA infants exist. Using the AGREE-II tool, we identified many deficits in the quality of these guidelines. Not a single guideline was deemed suitable for use using the AGREE-II tool. Use of poorly developed guidelines may be detrimental to decision-making, thus there is a need for transparent and rigorous guidelines regarding the perinatal care of 22-25 wk GA infants.

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Background Preterm birth is the single most important determinant of adverse infant outcomes in terms of survival, quality of life, psychosocial and emotional impact on the family, and health care costs. Research agenda in this area has been determined primarily by researchers, and the processes for priority setting in research have often lacked transparency. Objectives To identify 15 most important priorities for future research for practitioners and service users in the area of preterm birth. Methods A priority setting partnership was established by involving clinicians, adults who were born preterm, and parents and families with experience of preterm birth. Research uncertainties were gathered from surveys of service users and clinicians, and analyses of systematic reviews and clinical guidance, and then prioritised in a transparent process, using a methodology advocated by the James Lind Alliance. Results 593 uncertainties were submitted by 386 respondents and 52 were identified from literature reviews. After merging similar questions, a long list of 104 questions were distributed for voting. The 30 most popular items were then prioritised at a workshop. The top 15 research priorities included prevention of preterm birth, management of neonatal infection, necrotising enterocolitis, pain and lung damage, care package at discharge, feeding strategies, pre-eclampsia, emotional and practical support, attachment and bonding, premature rupture of membranes and best time for cord clamping. Conclusions These top research priorities in preterm birth provide guidance for researchers and funding bodies to ensure that future research addresses questions that are important to both clinicians and service users.

Fetal macrosomia or delivery of a large for gestational age (LGA) infant (birthweight > 4000 g) in uncomplicated pregnancies is increasing in many Western countries which may have serious implications for maternal and neonatal morbidity (1) . While fetal macrosomia has an established link with maternal diabetes the majority of macrosomic infants are born to non-diabetic mothers (2) , with maternal obesity now considered an established risk factor for delivering a macrosomic baby (3) . Evidence relating to maternal nutrition and macrosomia is inconclusive with the majority of studies to date investigating associations between maternal nutrition and birthweight rather than macrosomia specifically. The aim of this study was to investigate maternal nutrition as a potential modifiable risk factor for fetal macrosomia.Low risk pregnant women predicted to deliver LGA infants (study group) and women predicted to deliver appropriate for gestational age (AGA) infants (control group) were recruited from antenatal clinics. Participants maintained a four day food diary in the third trimester of pregnancy. Demographic and obstetric data were collected from maternity records. Completed food diaries were imported into a food analysis database (WISP g ). Total energy intake (TEI) and nutrient intakes were calculated. Data were analysed by recruitment groups (study and control group) and by delivery birthweight groups: predicted to and delivered a LGA infant (LGA:LGA); predicted to deliver a LGA infant but delivered an AGA infant (LGA:AGA); and, predicted to and delivered an AGA infant (AGA:AGA).Of the 114 women who participated in the study, 100 women completed the food diary at 32 (2.6) weeks gestation. Intake of PUFA n-3 was significantly higher in the study group (women predicted to deliver LGA infants) when compared to the control group, after adjustment for known variables associated with birthweight (p = 0.047). Further analyses by delivery birthweight demonstrated that intake of PUFA n-3 remained significantly different between delivery groups (p = 0.015), and post hoc analyses revealed that women in the LGA:AGA group consumed significantly higher PUFA n-3 than women in the LGA:LGA group (p = 0.044). Furthermore, LGA:AGA women had significantly higher TEI (p = 0.038), significantly higher intake of total fats (p = 0.029) and PUFA n-6 (p = 0.034) and significantly lower intake of carbohydrates (p = 0.032) after adjustment for variables associated with birthweight.Results suggest that an increased intake of PUFAs, combined with a decreased carbohydrate intake in the third trimester may have had a modifying effect on subsequent birthweight, in women predicted to have macrosomic babies. Further research is required to determine if adopting a diet high in PUFAs and low in carbohydrate can reduce the risk of macrosomia in low risk pregnancies.