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Beyramzadeh M, Dikmen ZG, Erturk NK, Tuncer ZS, Akbiyik F. Placental respiratory chain complex activities in high risk pregnancies. J Matern Fetal Neonatal Med 2017; 30:2911-2917. [PMID: 27915495 DOI: 10.1080/14767058.2016.1268594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Mitochondrial oxidative phosphorylation is the key energy source for placental functions and fetal growth. The purpose of this study was to investigate the function of placenta in high risk pregnancies by measuring mitochondrial respiratory chain complex (RCC) activities, and to evaluate the correlation between double test risk ratio and RCC activities. METHODS The placenta samples were collected from 50 pregnant women. The controls consisted of 20 normal uncomplicated pregnancies and the study group (n = 30) consisted of preeclampsia (PE), intrauterin growth restriction (IUGR), advanced maternal age (AMA), twins and preterm deliveries. Complexes I, II-III, IV and citrate synthase (CS) activities were measured by spectrophotometric assays. RESULTS Complexes I, II-III and IV activities were significantly lower in the study group than the controls (p < 0.05). Complexes I and II-III activities were significantly reduced in placenta of preterm deliveries compared with the controls (p < 0.003). Double test risk ratio was above the cut-off limit (1:300) in 43% of the study group in which decreased complexes I and II-III activities were observed. CONCLUSIONS Impaired placental mitochondria RCC functions can lead to adverse pregnancy outcomes. Pregnant women with high risk in double test should be monitored carefully in terms of PE, IUGR and preterm delivery.
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Affiliation(s)
- Mojtaba Beyramzadeh
- a Department of Medical Biochemistry, Faculty of Medicine , Hacettepe University , Ankara , Turkey
| | - Zeliha Gunnur Dikmen
- a Department of Medical Biochemistry, Faculty of Medicine , Hacettepe University , Ankara , Turkey
| | - Nergiz K Erturk
- b Department of Gynecology and Obstetrics, Faculty of Medicine , Hacettepe University , Ankara , Turkey
| | - Zafer Selcuk Tuncer
- b Department of Gynecology and Obstetrics, Faculty of Medicine , Hacettepe University , Ankara , Turkey
| | - Filiz Akbiyik
- a Department of Medical Biochemistry, Faculty of Medicine , Hacettepe University , Ankara , Turkey
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Small for gestational age and low birth weight term admissions to a tertiary perinatal centre in northern Queensland, Australia. J Immigr Minor Health 2016; 17:227-31. [PMID: 23934552 DOI: 10.1007/s10903-013-9891-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Northern Queensland is unique in that the proportion of Aboriginal and Torres Straits Islander (ATSI) communities is higher than the rest of Australia. The aim of this study was to describe the characteristics of term admissions of low birth weight (LBW; birth weight < 2,500 g) and small for gestational age (SGA; birth weight < 10th centile) infants to a neonatal unit. All term infants (>37 weeks of gestation) with LBW and/or SGA admitted to the neonatal unit over the last 10 years (2002-2011) were identified and the percentage calculated. Ethnicity was determined by the mother and that information was recorded in the patient's medical record. The average percentage of LBW ATSI infants was 20.2 ± 5.7%, which was significantly higher (almost double) compared with the percentage of LBW non-ATSI infants (10.2 ± 1.9%; p < 0.001). The average percentage of SGA ATSI infants was also significantly higher than the percentage of SGA non-ATSI infants (31.8 ± 6.0 vs. 18.6 ± 2.8%, respectively; p < 0.001). The mean percentage of LBW indigenous infants admitted to the neonatal unit was significantly higher than non-ATSI infants.
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McGillick EV, Orgeig S, Williams MT, Morrison JL. Risk of Respiratory Distress Syndrome and Efficacy of Glucocorticoids. Reprod Sci 2016; 23:1459-1472. [DOI: 10.1177/1933719116660842] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Erin V. McGillick
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
- Molecular and Evolutionary Physiology of the Lung Laboratory, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Sandra Orgeig
- Molecular and Evolutionary Physiology of the Lung Laboratory, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Marie T. Williams
- Health and Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Janna L. Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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Hoftiezer L, Hukkelhoven CWPM, Hogeveen M, Straatman HMPM, van Lingen RA. Defining small-for-gestational-age: prescriptive versus descriptive birthweight standards. Eur J Pediatr 2016; 175:1047-57. [PMID: 27255904 DOI: 10.1007/s00431-016-2740-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/01/2016] [Accepted: 05/25/2016] [Indexed: 01/08/2023]
Abstract
UNLABELLED Descriptive population-based birthweight standards possess low sensitivity in detecting infants with growth impairment. A prescriptive birthweight standard based on a 'healthy' subpopulation without risk factors for intrauterine growth restriction might be superior. We created two birthweight standards based on live born, singleton infants with gestational age 24-42 weeks and born in The Netherlands between 2000 and 2007. Inclusion criteria for the prescriptive birthweight standard were restricted to infants without congenital malformations, born to healthy mothers after uncomplicated pregnancies. We defined small-for-gestational-age (SGA) as birthweight <10th percentile and assessed the ability of both standards to predict adverse neonatal outcomes. The prescriptive birthweight standard identified significantly more infants as SGA, up to 38.0 % at 29 weeks gestation. SGA infants classified according to both standards as well as those classified according to the prescriptive birthweight standard only, were at increased risk of both major and minor adverse neonatal outcomes. The prescriptive birthweight standard was both more sensitive and less specific, with a maximum increase in sensitivity predicting bronchopulmonary dysplasia (+42.6 %) and a maximum decrease in specificity predicting intraventricular haemorrhage (-26.9 %) in infants aged 28-31 weeks. CONCLUSION Prescriptive birthweight standards could improve identification of infants born SGA and at risk of adverse neonatal outcomes. WHAT IS KNOWN • Descriptive birthweight standards possess low sensitivity in detecting growth restricted infants at risk of adverse neonatal outcomes. • Prescriptive standards could improve identification of very preterm small-for-gestational-age (SGA) infants at risk of intraventricular haemorrhage. What is New: • Prescriptive standards identify more preterm and term SGA infants at risk of major adverse neonatal outcomes. • Late preterm and term SGA infants classified according to the prescriptive standard are at increased risk of minor adverse neonatal outcomes with potentially harmful implications.
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Affiliation(s)
- Liset Hoftiezer
- Princess Amalia Department of Paediatrics, Department of Neonatology, P.O. Box 10400, 8000 GK, Isala, Zwolle, The Netherlands.
| | | | - Marije Hogeveen
- Amalia Children's Hospital, Department of Neonatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Richard A van Lingen
- Princess Amalia Department of Paediatrics, Department of Neonatology, P.O. Box 10400, 8000 GK, Isala, Zwolle, The Netherlands
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Sharma D, Shastri S, Sharma P. Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clin Med Insights Pediatr 2016; 10:67-83. [PMID: 27441006 PMCID: PMC4946587 DOI: 10.4137/cmped.s40070] [Citation(s) in RCA: 437] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/07/2016] [Accepted: 06/13/2016] [Indexed: 12/14/2022] Open
Abstract
Intrauterine growth restriction (IUGR), a condition that occurs due to various reasons, is an important cause of fetal and neonatal morbidity and mortality. It has been defined as a rate of fetal growth that is less than normal in light of the growth potential of that specific infant. Usually, IUGR and small for gestational age (SGA) are used interchangeably in literature, even though there exist minute differences between them. SGA has been defined as having birth weight less than two standard deviations below the mean or less than the 10th percentile of a population-specific birth weight for specific gestational age. These infants have many acute neonatal problems that include perinatal asphyxia, hypothermia, hypoglycemia, and polycythemia. The likely long-term complications that are prone to develop when IUGR infants grow up includes growth retardation, major and subtle neurodevelopmental handicaps, and developmental origin of health and disease. In this review, we have covered various antenatal and postnatal aspects of IUGR.
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Affiliation(s)
- Deepak Sharma
- Department of Neonatology, NEOCLINIC, TN Mishra Marg, Everest Vihar, Nirman Nagar, Jaipur, Rajasthan, India
| | - Sweta Shastri
- Department of Pathology, N.K.P Salve Medical College, Nagpur, Maharashtra, India
| | - Pradeep Sharma
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Jaipur, Rajasthan, India
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Roifman M, Choufani S, Turinsky AL, Drewlo S, Keating S, Brudno M, Kingdom J, Weksberg R. Genome-wide placental DNA methylation analysis of severely growth-discordant monochorionic twins reveals novel epigenetic targets for intrauterine growth restriction. Clin Epigenetics 2016; 8:70. [PMID: 27330572 PMCID: PMC4915063 DOI: 10.1186/s13148-016-0238-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/12/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Intrauterine growth restriction (IUGR), which refers to reduced fetal growth in the context of placental insufficiency, is etiologically heterogeneous. IUGR is associated not only with perinatal morbidity and mortality but also with adult-onset disorders, such as cardiovascular disease and diabetes, posing a major health burden. Placental epigenetic dysregulation has been proposed as one mechanism that causes IUGR; however, the spectrum of epigenetic pathophysiological mechanisms leading to IUGR remains to be elucidated. Monozygotic monochorionic twins are particularly affected by IUGR, in the setting of severe discordant growth. Because monozygotic twins have the same genotype at conception and a shared maternal environment, they provide an ideal model system for studying epigenetic dysregulation of the placenta. RESULTS We compared genome-wide placental DNA methylation patterns of severely growth-discordant twins to identify novel candidate genes for IUGR. Snap-frozen placental samples for eight severely growth-discordant monozygotic monochorionic twin pairs were obtained at delivery from each twin. A high-resolution DNA methylation array platform was used to identify methylation differences between IUGR and normal twins. Our analysis revealed differentially methylated regions in the promoters of eight genes: DECR1, ZNF300, DNAJA4, CCL28, LEPR, HSPA1A/L, GSTO1, and GNE. The largest methylation differences between the two groups were in the promoters of DECR1 and ZNF300. The significance of these group differences was independently validated by bisulfite pyrosequencing, implicating aberrations in fatty acid beta oxidation and transcriptional regulation, respectively. Further analysis of the array data identified methylation changes most prominently affecting the Wnt and cadherin pathways in the IUGR cohort. CONCLUSIONS Our results suggest that IUGR in monozygotic twins is associated with impairments in lipid metabolism and transcriptional regulation as well as cadherin and Wnt signaling. We show that monozygotic monochorionic twins discordant for growth provide a useful model to study one type of the epigenetic placental dysregulation that drives IUGR.
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Affiliation(s)
- Maian Roifman
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario Canada ; Department of Paediatrics, University of Toronto, Toronto, Ontario Canada ; Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Ontario Canada ; The Prenatal and Medical Genetics Program, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario Canada
| | - Sanaa Choufani
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Ontario Canada
| | - Andrei L Turinsky
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Ontario Canada ; Centre for Computational Medicine, The Hospital for Sick Children, Toronto, Ontario Canada
| | - Sascha Drewlo
- C.S. Mott Center for Human Growth and Development, Wayne State School of Medicine, Wayne State University, Detroit, MI USA
| | - Sarah Keating
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario Canada ; Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario Canada
| | - Michael Brudno
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Ontario Canada ; Centre for Computational Medicine, The Hospital for Sick Children, Toronto, Ontario Canada ; Department of Computer Science, University of Toronto, Toronto, Ontario Canada
| | - John Kingdom
- Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario Canada ; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario Canada
| | - Rosanna Weksberg
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario Canada ; Department of Paediatrics, University of Toronto, Toronto, Ontario Canada ; Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Ontario Canada ; Institute of Medical Science, University of Toronto, Toronto, Ontario Canada
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Programación epigenética placentaria en restricción del crecimiento intrauterino. ACTA ACUST UNITED AC 2016; 87:154-61. [DOI: 10.1016/j.rchipe.2016.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 04/28/2016] [Indexed: 01/28/2023]
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Saliem S, Patenaude V, Abenhaim HA. Pregnancy outcomes among renal transplant recipients and patients with end-stage renal disease on dialysis. J Perinat Med 2016; 44:321-7. [PMID: 25719292 DOI: 10.1515/jpm-2014-0298] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/23/2015] [Indexed: 12/21/2022]
Abstract
AIM The purpose of our study is to compare pregnancy outcomes between women with a functioning renal transplant and women with end-stage renal disease (ESRD). METHODS We carried out a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2006 to 2011. Logistic regression analysis was used to estimate the age-adjusted effect of functioning renal transplant vs. ESRD requiring dialysis on pregnancy outcomes. RESULTS We identified 264 birth records to women with a functional renal transplant and 267 birth records to women with ESRD on dialysis among 5,245,452 births. As compared to women with ESRD on dialysis, renal transplant recipients were less likely to have placental abruption [odds ratio, OR 0.23 (95% confidence interval, CI 0.08-0.70)], to receive blood transfusions [OR 0.17 (95% CI 0.09-0.30)], and to have growth-restricted and small-for-gestational-age babies [OR 0.45 (95% CI 0.23-0.85)]. Renal transplant recipients were more likely to have an instrumental delivery [OR 15.38 (95% CI 1.92-123.3)]. Among renal transplant women, there was a trend towards delivery by cesarean section as compared to patients with ESRD [OR 1.31 (95% CI 0.93-1.85)]. However, these results were not statistically significant. Fetal deaths were less likely to occur in women with a renal transplant [OR 0.41 (95% CI 0.17-0.96)]. There were four maternal deaths among patients with ESRD on dialysis and no maternal deaths among renal transplant patients. CONCLUSION Patients with a functional renal graft had an overall lower rate of morbidity and adverse pregnancy complications when compared to patients with ESRD on dialysis.
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Sharma D, Shastri S, Farahbakhsh N, Sharma P. Intrauterine growth restriction - part 1. J Matern Fetal Neonatal Med 2016; 29:3977-87. [PMID: 26856409 DOI: 10.3109/14767058.2016.1152249] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Intrauterine growth restriction (IUGR) is a major and silent cause of various morbidity and mortality for the fetal and neonatal population. It is defined as a rate of fetal growth that is less than normal for the growth potential of that specific infant. The terms IUGR and small for gestational age (SGA) are often used interchangeably, although there exists subtle differences between the two. IUGR/SGA is an end result of various etiologies that includes maternal, placental and fetal factors and recently added genetic factors too, also contribute to IUGR. In this review article we will cover the antenatal aspect of IUGR and management with proven preventive intervention.
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Affiliation(s)
- Deepak Sharma
- a Department of Pediatrics , Pt. B.D. Sharma PGIMS , Rohtak , India
| | - Sweta Shastri
- b Department of Pathology , N.K.P Salve Medical College , Nagpur , India
| | - Nazanin Farahbakhsh
- c Department of Pediatrics , Shiraz University of Medicine , Shiraz , Iran , and
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60
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McGillick EV, Orgeig S, Morrison JL. Regulation of lung maturation by prolyl hydroxylase domain inhibition in the lung of the normally grown and placentally restricted fetus in late gestation. Am J Physiol Regul Integr Comp Physiol 2016; 310:R1226-43. [PMID: 26936783 DOI: 10.1152/ajpregu.00469.2015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/23/2016] [Indexed: 12/28/2022]
Abstract
Intrauterine growth restriction induced by placental restriction (PR) in sheep leads to chronic hypoxemia and reduced surfactant maturation. The underlying molecular mechanism involves altered regulation of hypoxia signaling by increased prolyl hydroxylase domain (PHD) expression. Here, we evaluated the effect of intratracheal administration of the PHD inhibitor dimethyloxalylglycine (DMOG) on functional, molecular, and structural determinants of lung maturation in the control and PR sheep fetus. There was no effect of DMOG on fetal blood pressure or fetal breathing movements. DMOG reduced lung expression of genes regulating hypoxia signaling (HIF-3α, ACE1), antioxidant defense (CAT), lung liquid reabsorption (SCNN1-A, ATP1-A1, AQP-1, AQP-5), and surfactant maturation (SFTP-A, SFTP-B, SFTP-C, PCYT1A, LPCAT, ABCA3, LAMP3) in control fetuses. There were very few effects of DMOG on gene expression in the PR fetal lung (reduced lung expression of angiogenic factor ADM, water channel AQP-5, and increased expression of glucose transporter SLC2A1). DMOG administration in controls reduced total lung lavage phosphatidylcholine to the same degree as in PR fetuses. These changes appear to be regulated at the molecular level as there was no effect of DMOG on the percent tissue, air space, or numerical density of SFTP-B positive cells in the control and PR lung. Hence, DMOG administration mimics the effects of PR in reducing surfactant maturation in the lung of control fetuses. The limited responsiveness of the PR fetal lung suggests a potential biochemical limit or reduced plasticity to respond to changes in regulation of hypoxia signaling following exposure to chronic hypoxemia in utero.
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Affiliation(s)
- Erin V McGillick
- Early Origins of Adult Health Research Group and Molecular and Evolutionary Physiology of the Lung Laboratory, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Sandra Orgeig
- Molecular and Evolutionary Physiology of the Lung Laboratory, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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Young JM, Morgan BR, Powell TL, Moore AM, Whyte HEA, Smith ML, Taylor MJ. Associations of Perinatal Clinical and Magnetic Resonance Imaging Measures with Developmental Outcomes in Children Born Very Preterm. J Pediatr 2016; 170:90-6. [PMID: 26707586 DOI: 10.1016/j.jpeds.2015.11.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/25/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify perinatal risk factors associated with long-term neurocognitive and behavioral impairments in children born very preterm using a multivariate, partial least squares approach. STUDY DESIGN Twenty-seven perinatal clinical and magnetic resonance imaging measures were collected at birth and during the neonatal intensive care stay for 105 neonates born very preterm (≤ 32 weeks gestational age). One-half of the children returned for neuropsychological assessments at 2 and 4 years of age. Parent-reported behavioral measures were also obtained at 4 years of age. Three partial least squares analyses were performed to determine associations between clinical and radiologic measures with cognitive outcomes at 2 and 4 years of age, as well as with behavioral measures at 4 years of age. RESULTS Within the first components of each analysis, only intrauterine growth restriction, male sex, and absence of antenatal corticosteroid use were associated with poorer cognitive and language ability at 2 and 4 years of age, accounting for 79.6% and 71.4% of the total variance, respectively. In addition, white matter injury at term-equivalent age contributed to more problematic internalizing behaviors, behavioral symptoms, and impaired executive function at 4 years of age, accounting for 67.9% of the total variance. CONCLUSIONS Using this data-driven multivariate approach, specific measures in prenatal and early postnatal life are shown to be selectively and significantly associated with cognitive and behavioral outcomes in children born very preterm. Early detection of risk factors can help inform prognoses of children at greatest risk of long-term impairments.
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Affiliation(s)
- Julia M Young
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
| | - Benjamin R Morgan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tamara L Powell
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aideen M Moore
- Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hilary E A Whyte
- Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Margot J Taylor
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Herrera EA, Alegría R, Farias M, Díaz-López F, Hernández C, Uauy R, Regnault TRH, Casanello P, Krause BJ. Assessment of in vivo fetal growth and placental vascular function in a novel intrauterine growth restriction model of progressive uterine artery occlusion in guinea pigs. J Physiol 2016; 594:1553-61. [PMID: 26719023 DOI: 10.1113/jp271467] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/21/2015] [Indexed: 01/31/2023] Open
Abstract
Intra-uterine growth restriction (IUGR) is associated with short and long-term metabolic and cardiovascular alterations. Mice and rats have been extensively used to study the effects of IUGR, but there are notable differences in fetal and placental physiology relative to those of humans that argue for alternative animal models. This study proposes that gradual occlusion of uterine arteries from mid-gestation in pregnant guinea pigs produces a novel model to better assess human IUGR. Fetal biometry and in vivo placental vascular function were followed by sonography and Doppler of control pregnant guinea pigs and sows submitted to surgical placement of ameroid constrictors in both uterine arteries (IUGR) at mid-gestation (35 days). The ameroid constrictors induced a reduction in the fetal abdominal circumference growth rate (0.205 cm day(-1) ) compared to control (0.241 cm day(-1) , P < 0.001) without affecting biparietal diameter growth. Umbilical artery pulsatility and resistance indexes at 10 and 20 days after surgery were significantly higher in IUGR animals than controls (P < 0.01). These effects were associated with a decrease in the relative luminal area of placental chorionic arteries (21.3 ± 2.2% vs. 33.2 ± 2.7%, P < 0.01) in IUGR sows at near term. Uterine artery intervention reduced fetal (∼30%), placental (∼20%) and liver (∼50%) weights (P < 0.05), with an increased brain to liver ratio (P < 0.001) relative to the control group. These data demonstrate that the ameroid constrictor implantations in uterine arteries in pregnant guinea pigs lead to placental vascular dysfunction and altered fetal growth that induces asymmetric IUGR.
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Affiliation(s)
- Emilio A Herrera
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Av. Salvador 486, Providencia, 7500922, Santiago, Chile
| | - René Alegría
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Av. Salvador 486, Providencia, 7500922, Santiago, Chile
| | - Marcelo Farias
- División de Obstetricia y Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago, 8330024, Chile
| | - Farah Díaz-López
- División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cherie Hernández
- División de Obstetricia y Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago, 8330024, Chile.,División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Uauy
- División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Timothy R H Regnault
- Departments of Obstetrics and Gynaecology and Physiology and Pharmacology, Western University, London, Ontario, Canada.,Lawson Health Research Institute and Children's Health Research Institute, London, Ontario, Canada
| | - Paola Casanello
- División de Obstetricia y Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago, 8330024, Chile.,División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bernardo J Krause
- División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Chisholm KM, Folkins AK. Placental and Clinical Characteristics of Term Small-for-Gestational-Age Neonates: A Case-Control Study. Pediatr Dev Pathol 2016; 19:37-46. [PMID: 26368794 DOI: 10.2350/15-04-1621-oa.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Numerous conditions, including placental vascular compromise, can lead to small-for-gestational-age (SGA) infants. As few studies have investigated primarily term placentas from SGA infants, we compared placentas from 67 SGA infants to placentas from 67 infants with appropriate weights for gestational age (AGA) in this population, matched for gestational age and gender. Placental histology was reviewed and electronic records were queried for maternal and fetal birth data, infant morbidities, and infant follow-up weights. Comparison of these 2 cohorts showed that placentas from SGA infants were more likely to have smaller weights and thinner umbilical cords than those from AGA infants. SGA placentas had a significant increase in another uteroplacental malperfusion feature: single and multiple infarctions. Rates of preeclampsia, infant cardiac anomalies, and infant genetic abnormalities were not statistically different between groups. Fetal and maternal inflammatory responses, nongestational diabetes, and gestational hypertension were more common in the controls, but these are common indications for placental examination. No statistical differences were present for decidual vasculopathy, chronic villitis, intervillous thrombi, or meconium. More SGA neonates had hypoglycemia compared to their AGA counterparts. SGA infants tended to have decreased weights up to 7 months of age; however, the low number of infants with follow-up limited the statistical significance. This study confirms that small placental size and select features of uteroplacental malperfusion are more common in SGA versus AGA term placentas. The lack of other significant differences may be due to the inclusion of only term infants, with more severe pathology leading to preterm delivery.
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Affiliation(s)
- Karen M Chisholm
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ann K Folkins
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
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Orgeig S, McGillick EV, Botting KJ, Zhang S, McMillen IC, Morrison JL. Increased lung prolyl hydroxylase and decreased glucocorticoid receptor are related to decreased surfactant protein in the growth-restricted sheep fetus. Am J Physiol Lung Cell Mol Physiol 2015; 309:L84-97. [PMID: 25934670 DOI: 10.1152/ajplung.00275.2014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 04/24/2015] [Indexed: 11/22/2022] Open
Abstract
Experimental placental restriction (PR) by carunclectomy in fetal sheep results in intrauterine growth restriction (IUGR), chronic hypoxemia, increased plasma cortisol, and decreased lung surfactant protein (SP) expression. The mechanisms responsible for decreased SP expression are unknown but may involve decreased glucocorticoid (GC) action or changes in hypoxia signaling. Endometrial caruncles were removed from nonpregnant ewes to induce PR. Lungs were collected from control and PR fetuses at 130-135 (n = 19) and 139-145 (n = 28) days of gestation. qRT-PCR and Western blotting were used to quantify lung mRNA and protein expression, respectively, of molecular regulators and downstream targets of the GC and hypoxia-signaling pathways. We confirmed a decrease in SP-A, -B, and -C, but not SP-D, mRNA expression in PR fetuses at both ages. There was a net downregulation of GC signaling with a reduction in GC receptor (GR)-α and -β protein expression and a decrease in the cofactor, GATA-6. GC-responsive genes including transforming growth factor-β1, IL-1β, and β2-adrenergic receptor were not stimulated. Prolyl hydroxylase domain (PHD)2 mRNA and protein and PHD3 mRNA expression increased with a concomitant increase in hypoxia-inducible factor-1α (HIF-1α) and HIF-1β mRNA expression. There was an increase in mRNA expression of several, but not all, hypoxia-responsive genes. Hence, both GC and hypoxia signaling may contribute to reduced SP expression. Although acute hypoxia normally inactivates PHDs, chronic hypoxemia in the PR fetus increased PHD abundance, which normally prevents HIF signaling. This may represent a mechanism by which chronic hypoxemia contributes to the decrease in SP production in the IUGR fetal lung.
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Affiliation(s)
- Sandra Orgeig
- Molecular and Evolutionary Physiology of the Lung Laboratory, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Erin V McGillick
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia; Molecular and Evolutionary Physiology of the Lung Laboratory, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Kimberley J Botting
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Song Zhang
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - I Caroline McMillen
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Janna L Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia;
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Longitudinal changes in gestational weight gain and the association with intrauterine fetal growth. Eur J Obstet Gynecol Reprod Biol 2015; 190:41-7. [PMID: 25978857 DOI: 10.1016/j.ejogrb.2015.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Total pregnancy weight gain has been associated with infant birthweight; however, most prior studies lacked repeat ultrasound measurements. Understanding of the longitudinal changes in maternal weight gain and intrauterine changes in fetal anthropometrics is limited. STUDY DESIGN Prospective data from 1314 Scandinavian singleton pregnancies at high-risk for delivering small-for-gestational-age (SGA) were analyzed. Women had ≥1 (median 12) antenatal weight measurements. Ultrasounds were targeted at 17, 25, 33, and 37 weeks of gestation. Analyses involved a multi-step process. First, trajectories were estimated across gestation for maternal weight gain and fetal biometrics [abdominal circumference (AC, mm), biparietal diameter (BPD, mm), femur length (FL, mm), and estimated fetal weight (EFW, g)] using linear mixed models. Second, the association between maternal weight changes (per 5 kg) and corresponding fetal growth from 0 to 17, 17 to 28, and 28 to 37 weeks was estimated for each fetal parameter adjusting for prepregnancy body mass index, height, parity, chronic diseases, age, smoking, fetal sex, and weight gain up to the respective period as applicable. Third, the probability of fetal SGA, EFW <10th percentile, at the 3rd ultrasound was estimated across the spectrum of maternal weight gain rate by SGA status at the 2nd ultrasound. RESULTS From 0 to 17 weeks, changes in maternal weight were most strongly associated with changes in BPD [β=0.51 per 5 kg (95%CI 0.26, 0.76)] and FL [β=0.46 per 5 kg (95%CI 0.26, 0.65)]. From 17 to 28 weeks, AC [β=2.92 per 5 kg (95%CI 1.62, 4.22)] and EFW [β=58.7 per 5 kg (95%CI 29.5, 88.0)] were more strongly associated with changes in maternal weight. Increased maternal weight gain was significantly associated with a reduced probability of intrauterine SGA; for a normal weight woman with SGA at the 2nd ultrasound, the probability of fetal SGA with a weight gain rate of 0.29 kg/w (10th percentile) was 59%, compared to 38% with a rate of 0.67 kg/w (90th percentile). CONCLUSION Among women at high-risk for SGA, maternal weight gain was associated with fetal growth throughout pregnancy, but had a differential relationship with specific biometrics across gestation. For women with fetal SGA identified mid-pregnancy, increased antenatal weight gain was associated with a decreased probability of fetal SGA approximately 7 weeks later.
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Alterations of protein expression in serum of infants with intrauterine growth restriction and different gestational ages. J Proteomics 2015; 119:169-82. [DOI: 10.1016/j.jprot.2015.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/16/2015] [Indexed: 01/19/2023]
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Coenders A, Koopmans NK, Broekhuijsen K, Groen H, Karstenberg-Kramer JMA, van Goor K, Groenewout M, van Loon AJ, Faas MM, van Pampus MG. Adjuvanted vaccines in pregnancy: no evidence for effect of the adjuvanted H1N1/09 vaccination on occurrence of preeclampsia or intra-uterine growth restriction. Eur J Obstet Gynecol Reprod Biol 2015; 187:14-9. [PMID: 25681994 DOI: 10.1016/j.ejogrb.2015.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/13/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE During the H1N1/09 pandemic, pregnant women in the Netherlands were vaccinated with an adjuvanted vaccine. During pregnancy, the maternal immune system changes to enable placental development and growth and acceptance of the semi-allogeneic fetus. As an adjuvant is a pro-inflammatory substance, it may interfere with these immunological changes, resulting in poor placentation or placental growth, which may result in preeclampsia (PE) and fetal intra-uterine growth restriction (IUGR). This study investigated a possible association between adjuvanted H1N1/09 vaccination and the development of PE and/or IUGR. STUDY DESIGN Case-control study. Cases were Dutch women with PE and/or IUGR occurring during H1N1/09 vaccination program. Controls had uncomplicated pregnancies during the same period. Maternal characteristics, pregnancy and neonatal outcomes were collected from medical files. Participants were contacted by telephone to enquire about vaccination. Data were analyzed using t-tests, Chi-square tests or Fisher's exact tests. Multivariate analysis was conducted to control for confounders. RESULTS We included 254 cases and 247 controls. Of the cases, 90 (35.4%) were vaccinated, compared to 87 (35.2%) of the controls (OR:1.009, 95% CI:0.70-1.46, p:0.961). The majority (73.5%) had been vaccinated in second and third trimester. In multivariate analysis, there were no confounders influencing these results. Exploratory subgroup analysis did not show an association between vaccination status in subgroups of women with either PE or IUGR. CONCLUSION Our study showed no association between adjuvanted H1N1/09 vaccination and PE and/or IUGR.
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Affiliation(s)
- Alies Coenders
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - Nienke K Koopmans
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - Kim Broekhuijsen
- Martini Hospital Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - Henk Groen
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Janna M A Karstenberg-Kramer
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical biology, Section Medical biology, Groningen, The Netherlands
| | - Kim van Goor
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical biology, Section Medical biology, Groningen, The Netherlands
| | - Mariette Groenewout
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - Aren J van Loon
- Martini Hospital Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands
| | - Marijke M Faas
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical biology, Section Medical biology, Groningen, The Netherlands
| | - Maria G van Pampus
- Onze Lieve Vrouwe Gasthuis, Department of Obstetrics and Gynecology, PO Box 95500, 1090 HM Amsterdam, The Netherlands.
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Renal developmental defects resulting from in utero hypoxia are associated with suppression of ureteric β-catenin signaling. Kidney Int 2015; 87:975-83. [PMID: 25587709 DOI: 10.1038/ki.2014.394] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 12/21/2022]
Abstract
Gestational stressors, including glucocorticoids and protein restriction, can affect kidney development and hence final nephron number. Since hypoxia is a common insult during pregnancy, we studied the influence of oxygen tension on kidney development in models designed to represent a pathological hypoxic insult. In vivo mouse models of moderate, transient, midgestational (12% O₂, 48 h, 12.5 dpc) or severe, acute, early-gestational (5.5-7.5% O₂, 8 h, 9.5-10.5 dpc) hypoxia were developed. The embryo itself is known to mature under hypoxic conditions with embryonic tissue levels of oxygen estimated to be 5%-8% (physiological hypoxia) when the mother is exposed to ambient normoxia. Both in vivo models generated phenotypes seen in patients with congenital anomalies of the kidney and urinary tract (CAKUT). Severe, acute, early hypoxia resulted in duplex kidney, while moderate, transient, midgestational hypoxia permanently reduced ureteric branching and nephron formation. Both models displayed hypoxia-induced reductions in β-catenin signaling within the ureteric tree and suppression of the downstream target gene, Ccnd1. Thus, we show a link between gestational hypoxia and CAKUT, the phenotype of which varies with timing, duration, and severity of the hypoxic insult.
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Smith TF, Anastopoulos AD, Garrett ME, Arias-Vasquez A, Franke B, Oades RD, Sonuga-Barke E, Asherson P, Gill M, Buitelaar JK, Sergeant JA, Kollins SH, Faraone SV, Ashley-Koch A. Angiogenic, neurotrophic, and inflammatory system SNPs moderate the association between birth weight and ADHD symptom severity. Am J Med Genet B Neuropsychiatr Genet 2014; 165B:691-704. [PMID: 25346392 DOI: 10.1002/ajmg.b.32275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 09/25/2014] [Indexed: 12/31/2022]
Abstract
Low birth weight is associated with increased risk for Attention-Deficit/Hyperactivity Disorder (ADHD); however, the etiological underpinnings of this relationship remain unclear. This study investigated if genetic variants in angiogenic, dopaminergic, neurotrophic, kynurenine, and cytokine-related biological pathways moderate the relationship between birth weight and ADHD symptom severity. A total of 398 youth from two multi-site, family-based studies of ADHD were included in the analysis. The sample consisted of 360 ADHD probands, 21 affected siblings, and 17 unaffected siblings. A set of 164 SNPs from 31 candidate genes, representing five biological pathways, were included in our analyses. Birth weight and gestational age data were collected from a state birth registry, medical records, and parent report. Generalized Estimating Equations tested for main effects and interactions between individual SNPs and birth weight centile in predicting ADHD symptom severity. SNPs within neurotrophic (NTRK3) and cytokine genes (CNTFR) were associated with ADHD inattentive symptom severity. There was no main effect of birth weight centile on ADHD symptom severity. SNPs within angiogenic (NRP1 & NRP2), neurotrophic (NTRK1 & NTRK3), cytokine (IL16 & S100B), and kynurenine (CCBL1 & CCBL2) genes moderate the association between birth weight centile and ADHD symptom severity. The SNP main effects and SNP × birth weight centile interactions remained significant after adjusting for multiple testing. Genetic variability in angiogenic, neurotrophic, and inflammatory systems may moderate the association between restricted prenatal growth, a proxy for an adverse prenatal environment, and risk to develop ADHD.
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Affiliation(s)
- Taylor F Smith
- Department of Psychology and Child Development, California Polytechnic State University, San Luis Obispo, California; Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina
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Peyter AC, Delhaes F, Baud D, Vial Y, Diaceri G, Menétrey S, Hohlfeld P, Tolsa JF. Intrauterine growth restriction is associated with structural alterations in human umbilical cord and decreased nitric oxide-induced relaxation of umbilical vein. Placenta 2014; 35:891-9. [DOI: 10.1016/j.placenta.2014.08.090] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 08/17/2014] [Accepted: 08/25/2014] [Indexed: 01/07/2023]
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71
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Kowalski WJ, Pekkan K, Tinney JP, Keller BB. Investigating developmental cardiovascular biomechanics and the origins of congenital heart defects. Front Physiol 2014; 5:408. [PMID: 25374544 PMCID: PMC4204442 DOI: 10.3389/fphys.2014.00408] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 10/02/2014] [Indexed: 11/24/2022] Open
Abstract
Innovative research on the interactions between biomechanical load and cardiovascular (CV) morphogenesis by multiple investigators over the past 3 decades, including the application of bioengineering approaches, has shown that the embryonic heart adapts both structure and function in order to maintain cardiac output to the rapidly growing embryo. Acute adaptive hemodynamic mechanisms in the embryo include the redistribution of blood flow within the heart, dynamic adjustments in heart rate and developed pressure, and beat to beat variations in blood flow and vascular resistance. These biomechanically relevant events occur coincident with adaptive changes in gene expression and trigger adaptive mechanisms that include alterations in myocardial cell growth and death, regional and global changes in myocardial architecture, and alterations in central vascular morphogenesis and remodeling. These adaptive mechanisms allow the embryo to survive these biomechanical stresses (environmental, maternal) and to compensate for developmental errors (genetic). Recent work from numerous laboratories shows that a subset of these adaptive mechanisms is present in every developing multicellular organism with a “heart” equivalent structure. This chapter will provide the reader with an overview of some of the approaches used to quantify embryonic CV functional maturation and performance, provide several illustrations of experimental interventions that explore the role of biomechanics in the regulation of CV morphogenesis including the role of computational modeling, and identify several critical areas for future investigation as available experimental models and methods expand.
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Affiliation(s)
- William J Kowalski
- Cardiovascular Innovation Institute, University of Louisville Louisville, KY, USA ; Department of Pediatrics, University of Louisville Louisville, KY, USA
| | - Kerem Pekkan
- Department of Biomedical Engineering, Carnegie Mellon University Pittsburgh, PA, USA
| | - Joseph P Tinney
- Cardiovascular Innovation Institute, University of Louisville Louisville, KY, USA ; Department of Pediatrics, University of Louisville Louisville, KY, USA
| | - Bradley B Keller
- Cardiovascular Innovation Institute, University of Louisville Louisville, KY, USA ; Department of Pediatrics, University of Louisville Louisville, KY, USA ; Department of Biomedical Engineering, Carnegie Mellon University Pittsburgh, PA, USA
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Besharat Pour M, Bergström A, Bottai M, Magnusson J, Kull I, Wickman M, Moradi T. Body mass index development from birth to early adolescence; effect of perinatal characteristics and maternal migration background in a Swedish cohort. PLoS One 2014; 9:e109519. [PMID: 25303283 PMCID: PMC4193784 DOI: 10.1371/journal.pone.0109519] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 09/05/2014] [Indexed: 11/18/2022] Open
Abstract
Background Well documented diversity in risk of developing overweight and obesity between children of immigrant and of native mothers, might be explained by different body mass index (BMI) development trajectories in relation to maternal and perinatal characteristics of offspring. Objectives To assess BMI development trajectories among children born to immigrant and to Swedish mothers from birth to adolescence in relation to perinatal characteristics. Methods A cohort of 2517 children born in Stockholm during 1994 to 1996 was followed with repeated measurement of height and weight at eleven time points until age 12 years. We estimated changes over time for BMI in relation to maternal and perinatal characteristics of offspring using mixed linear model analysis for repeated measure data. Results We observed a significant BMI change over time in children and time interaction with maternal migration status (P<0.0001). Estimated BMI over time adjusted for maternal and perinatal characteristics of offspring, showed slower BMI growth before age of 5, followed by an earlier plateau and steeper BMI growth after 5 years among children of immigrant mothers compared with children of Swedish mothers. These differences in BMI growth were more prominent among children with mothers from outside Europe. Conclusion Beside reinforcing early childhood as a crucial period in development of overweight, the observed slower BMI development at early childhood among children of immigrants followed by a steeper increase in BMI compared with children of Swedish mothers is important for further studies and for planning of preventive public health programs.
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Affiliation(s)
- Mohsen Besharat Pour
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Anna Bergström
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Institute of Environmental Medicine, Unit of Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jessica Magnusson
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Inger Kull
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden
| | - Magnus Wickman
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden
| | - Tahereh Moradi
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
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Elevated plasma norepinephrine inhibits insulin secretion, but adrenergic blockade reveals enhanced β-cell responsiveness in an ovine model of placental insufficiency at 0.7 of gestation. J Dev Orig Health Dis 2014; 4:402-10. [PMID: 24358443 DOI: 10.1017/s2040174413000093] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In pregnancies complicated by placental insufficiency (PI), fetal hypoglycemia and hypoxemia progressively worsen during the third trimester, which increases circulating norepinephrine (NE). Pharmacological adrenergic blockade (ADR-block) at 0.9 gestation revealed that NE inhibits insulin secretion and enhanced β-cell responsiveness in fetuses with PI-induced intrauterine growth restriction (IUGR). NE concentrations in PI fetuses at 0.7 gestation were threefold greater compared with age-matched controls, but the levels were similar to near-term controls. Therefore, our objective was to determine whether elevations in plasma NE concentrations inhibit insulin secretion and produce compensatory β-cell responsiveness in PI fetuses at 0.7 gestation. Fetal insulin was measured under basal, glucose-stimulated insulin secretion (GSIS) and glucose-potentiated arginine-stimulated insulin secretion (GPAIS) conditions in the absence and presence of an ADR-block. Placental weights were 38% lower (P < 0.05) in PI fetus than in controls, but fetal weights were not different. PI fetuses had lower (P < 0.05) basal blood oxygen content, plasma glucose, insulin-like growth factor-1 and insulin concentrations and greater plasma NE concentrations (891 ± 211 v. 292 ± 65 pg/ml; P < 0.05) than controls. GSIS was lower in PI fetuses than in controls (0.34 ± 0.03 v. 1.08 ± 0.06 ng/ml; P < 0.05). ADR-block increased GSIS in PI fetuses (1.19 ± 0.11 ng/ml; P < 0.05) but decreased GSIS in controls (0.86 ± 0.02 ng/ml; P < 0.05). Similarly, GPAIS was 44% lower (P < 0.05) in PI fetuses than in controls, and ADR-block increased (P < 0.05) GPAIS in PI fetuses but not in controls. Insulin content per islet was not different between treatments. We conclude that elevations in fetal plasma NE suppress insulin concentrations, and that compensatory β-cell stimulus-secretion responsiveness is present before IUGR.
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Napolitano R, Dhami J, Ohuma EO, Ioannou C, Conde-Agudelo A, Kennedy SH, Villar J, Papageorghiou AT. Pregnancy dating by fetal crown-rump length: a systematic review of charts. BJOG 2014; 121:556-65. [DOI: 10.1111/1471-0528.12478] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2013] [Indexed: 11/29/2022]
Affiliation(s)
- R Napolitano
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
| | - J Dhami
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
| | - EO Ohuma
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
| | - C Ioannou
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
| | - A Conde-Agudelo
- Perinatology Research Branch; Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institutes of Health; Department of Health and Human Services; Bethesda Maryland and Detroit Michigan USA
| | - SH Kennedy
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
- Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford UK
| | - J Villar
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
- Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford UK
| | - AT Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology; University of Oxford; Oxford UK
- Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford UK
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Calvert S, Jones C, Sibley C, Aplin J, Heazell A. Analysis of syncytial nuclear aggregates in preeclampsia shows increased sectioning artefacts and decreased inter-villous bridges compared to healthy placentas. Placenta 2013; 34:1251-4. [DOI: 10.1016/j.placenta.2013.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 09/18/2013] [Accepted: 10/01/2013] [Indexed: 11/26/2022]
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Flamant C, Gascoin G. Devenir précoce et prise en charge néonatale du nouveau-né petit pour l’âge gestationnel. ACTA ACUST UNITED AC 2013; 42:985-95. [DOI: 10.1016/j.jgyn.2013.09.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Benyshek DC. The “early life” origins of obesity-related health disorders: New discoveries regarding the intergenerational transmission of developmentally programmed traits in the global cardiometabolic health crisis. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2013; 152 Suppl 57:79-93. [DOI: 10.1002/ajpa.22393] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 09/17/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Daniel C. Benyshek
- Department of Anthropology, University of Nevada; Las Vegas Las Vegas, NV 89154-5003
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Baker MS, Li G, Kohorst JJ, Waterland RA. Fetal growth restriction promotes physical inactivity and obesity in female mice. Int J Obes (Lond) 2013; 39:98-104. [PMID: 23924758 PMCID: PMC3872504 DOI: 10.1038/ijo.2013.146] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/10/2013] [Accepted: 07/20/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Environmental exposures during critical periods of prenatal and early postnatal life affect the development of mammalian body weight regulatory mechanisms, influencing lifelong risk of obesity. The specific biological processes that mediate the persistence of such effects, however, remain poorly understood. OBJECTIVE The objectives of this study were to determine the developmental timing and physiological basis of the obesity-promoting effect previously reported in offspring of obese agouti viable yellow (A(vy)/a) mothers. DESIGN Newborn offspring of obese A(vy)/a and lean (a/a) mothers were cross-fostered shortly after birth to study separately the effects of in utero or suckling period exposure to A(vy)/a dams. Body composition, food intake, physical activity and energy expenditure were measured in offspring shortly after weaning and in adulthood. RESULTS Offspring of obese A(vy)/a dams paradoxically experienced fetal growth restriction, which was followed by adult-onset obesity specifically in females. Our main analyses focused on wild-type (a/a) offspring, because a subset of adult A(vy)/a offspring contracted a kidney disease resembling diabetic nephropathy. Detailed physiological characterization demonstrated that, both shortly after weaning and in adulthood, female wild-type mice born to A(vy)/a mothers are not hyperphagic but have reduced physical activity and energy expenditure. No such coordinated changes were detected in male offspring. Mediational regression analysis of our longitudinal data supported a causal pathway in which fetal growth restriction persistently reduces physical activity, leading to adult obesity. CONCLUSIONS Our data are consistent with several recent human epidemiological studies showing female-specific effects of perinatal nutritional restriction on later obesity, and provide the novel mechanistic insight that this may occur via permanent and sex-specific changes in one's inherent propensity for physical activity.
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Affiliation(s)
- M S Baker
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - G Li
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - J J Kohorst
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - R A Waterland
- 1] Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA [2] Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
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Huisma F, Thomas M, Armstrong L. Severe hypospadias and its association with maternal-placental factors. Am J Med Genet A 2013; 161A:2183-7. [PMID: 23913586 DOI: 10.1002/ajmg.a.36050] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 04/25/2013] [Indexed: 11/07/2022]
Abstract
The neonate born small for gestational age (SGA, birth weight <10th centile) with severe hypospadias, and without the presence of other malformations, is a presentation which clinical geneticists are asked to assess. However, this combination is not well addressed in the literature. Epidemiological studies point to an increased incidence and severity of hypospadias in SGA infants, but leave open the possibility that the association is attributable to the population subset who have multiple congenital abnormalities or genetic syndromes. Epidemiological studies unselected for birth weight have also identified an association between hypospadias with some risk factors tied to SGA, including prematurity, preeclampsia, and placental insufficiency. This study was developed after being involved in the care of several boys with SGA and severe hypospadias who were premature, with gestational histories of maternal hypertension and oligohydramnios. No underlying syndromes, hormonal abnormalities, or contributory family histories could be found. We hypothesized that severe hypospadias may in some cases be causally related to maternal-placental factors rather than primary fetal abnormalities. A retrospective study of a cohort of singletons born SGA with unexplained hypospadias was conducted. We compared their gestational histories and hypospadias severities with those born at normal birth weights. The cohort with SGA had an increased ratio of severe to mild hypospadias. Further, within the cohort of SGA boys, there was a higher prevalence of prematurity, maternal hypertension, and oligohydramnios among those with severe vs mild hypospadias. Small sample sizes are limiting.
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Affiliation(s)
- Felicity Huisma
- Provincial Medical Genetics Program, Children's and Women's Health Centre of British Columbia, University of British Columbia, Vancouver, Canada.
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Intrauterine Growth Restriction (IUGR): Etiology and Diagnosis. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-013-0041-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Naing Z, Rayner B, Killikulangara A, Vunnam K, Leach S, McIver CJ, Scott GM, Craig ME, Lui K, Rawlinson WD. Prevalence of viruses in stool of premature neonates at a neonatal intensive care unit. J Paediatr Child Health 2013; 49:E221-6. [PMID: 23432694 DOI: 10.1111/jpc.12113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2012] [Indexed: 11/30/2022]
Abstract
AIM Premature neonates represent a population highly vulnerable to infection. This study aims to profile viral colonisation of gut and the associated clinical manifestations among premature neonates admitted to a neonatal intensive care unit (NICU) in Australia. METHODS In a cohort of 75 premature neonates born at less than 32 weeks gestation, who were followed for 4 weeks following admission to a NICU in Sydney, Australia, multiplex polymerase chain reaction assays were used to determine viral presence in stool, and clinical data were examined. RESULTS Overall, viral RNA or DNA was detected in 24/419 (5.7%) of specimens, including norovirus genogroup 2 (1.9%), enterovirus (1.2%), herpes simplex virus-2 (1.2%), cytomegalovirus (0.7%), Epstein-Barr virus (0.5%) and rotavirus (0.2%). Viral infection was detected in 13/75 (17%) of premature neonates at some time point, including five (7%) neonates shedding more than one type of virus in stool. A higher rate of infection was observed among premature neonates with intrauterine growth restriction (56%) compared with those infants born appropriate for gestational age (12%. P = 0.006). CONCLUSION The overall viral detection rate in stool of 5.7% (affecting 17% of neonates) indicates viral infections are an important health risk for premature infants in NICU.
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Affiliation(s)
- Zin Naing
- Virology, Department of Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital
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Curtis S, Jones CJP, Garrod A, Hulme CH, Heazell AEP. Identification of autophagic vacuoles and regulators of autophagy in villous trophoblast from normal term pregnancies and in fetal growth restriction. J Matern Fetal Neonatal Med 2013; 26:339-46. [PMID: 23039021 DOI: 10.3109/14767058.2012.733764] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Fetal growth restriction (FGR) is a serious pregnancy complication associated with increased perinatal mortality and morbidity. Although the majority of cases with FGR result from placental dysfunction, the pathophysiology is incompletely understood. Autophagy is a physiological form of cell degradation exacerbated by nutrient and oxygen restriction, which are both thought to play a role in the aetiology of FGR. We hypothesized that autophagy is present in the normal human placenta and is exaggerated in FGR. Autophagy was assessed in electron micrographs from normal and FGR placentas and by Western blotting for LC3B and LAMP-2. The localization of regulators of autophagy was examined by immunohistochemistry. Culture of BeWo cells was used to investigate whether nutrient and/or oxygen deprivation can induce autophagy in trophoblast. Autophagy predominantly localized to the syncytiotrophoblast layer and autophagosomes were more frequent in FGR. The regulators LAMP-2, LC3B, Beclin-1, ATG 5, ATG9 and ATG16L1 were all present in villous trophoblast. LAMP-2 immunostaining was more punctate in FGR. In BeWo cells, culture in reduced oxygen tension and/or serum depleted conditions led to the appearance of autophagosomes which was associated with changes in LAMP-2 configuration. We conclude that autophagy in human term placenta may be involved in the placental dysfunction present in FGR.
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Affiliation(s)
- Sophie Curtis
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Auger N, Park AL, Zoungrana H, McHugh NGL, Luo ZC. Rates of stillbirth by gestational age and cause in Inuit and First Nations populations in Quebec. CMAJ 2013; 185:E256-62. [PMID: 23422443 DOI: 10.1503/cmaj.120945] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Inuit and First Nations populations have higher rates of stillbirth than non-Aboriginal populations in Canada do, but little is known about the timing and cause of stillbirth in Aboriginal populations. We compared gestational age- and cause-specific stillbirth rates in Inuit and First Nations populations with the rates in the non-Aboriginal population in Quebec. METHODS Data included singleton stillbirths and live births at 24 or more gestational weeks among Quebec residents from 1981 to 2009. We calculated odds ratios (ORs), rate differences and 95% confidence intervals (CIs) for the retrospective cohort of Inuit and First Nations births relative to non-Aboriginal births using fetuses at risk (i.e., ongoing pregnancies) as denominators and adjusting for maternal characteristics. The main outcomes were stillbirth by gestational age (24-27, 28-36, ≥ 37 wk) and cause of death. RESULTS Rates of stillbirth per 1000 births were greater among Inuit (6.8) and First Nations (5.7) than among non-Aboriginal (3.6) residents. Relative to the non-Aboriginal population, the risk of stillbirth was greater at term (≥ 37 wk) than before term for both Inuit (OR 3.1, 95% CI 1.9 to 4.8) and First Nations (OR 2.6, 95% CI 2.1 to 3.3) populations. Causes most strongly associated with stillbirth were poor fetal growth, placental disorders and congenital anomalies among the Inuit, and hypertension and diabetes among the First Nations residents. INTERPRETATION Stillbirth rates in Aboriginal populations were particularly high at term gestation. Poor fetal growth, placental disorders and congenital anomalies were important causes of stillbirth among the Inuit, and diabetic and hypertensive complications were important causes in the First Nations population. Prevention may require improvements in pregnancy and obstetric care.
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Affiliation(s)
- Nathalie Auger
- Institut national de santé publique du Québec, Montréal, Que.
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Malaria and fetal growth alterations in the 3(rd) trimester of pregnancy: a longitudinal ultrasound study. PLoS One 2013; 8:e53794. [PMID: 23326508 PMCID: PMC3543265 DOI: 10.1371/journal.pone.0053794] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 12/03/2012] [Indexed: 11/20/2022] Open
Abstract
Background Pregnancy associated malaria is associated with decreased birth weight, but in-utero evaluation of fetal growth alterations is rarely performed. The objective of this study was to investigate malaria induced changes in fetal growth during the 3rd trimester using trans-abdominal ultrasound. Methods An observational study of 876 pregnant women (398 primi- and secundigravidae and 478 multigravidae) was conducted in Tanzania. Fetal growth was monitored with ultrasound and screening for malaria was performed regularly. Birth weight and fetal weight were converted to z-scores, and fetal growth evaluated as fetal weight gain from the 26th week of pregnancy. Results Malaria infection only affected birth weight and fetal growth among primi- and secundigravid women. Forty-eight of the 398 primi- and secundigravid women had malaria during pregnancy causing a reduction in the newborns z-score of −0.50 (95% CI: −0.86, −0.13, P = 0.008, multiple linear regression). Fifty-eight percent (28/48) of the primi- and secundigravidae had malaria in the first half of pregnancy, but an effect on fetal growth was observed in the 3rd trimester with an OR of 4.89 for the fetal growth rate belonging to the lowest 25% in the population (95%CI: 2.03–11.79, P<0.001, multiple logistic regression). At an individual level, among the primi- and secundigravidae, 27% experienced alterations of fetal growth immediately after exposure but only for a short interval, 27% only late in pregnancy, 16.2% persistently from exposure until the end of pregnancy, and 29.7% had no alterations of fetal growth. Conclusions The effect of malaria infections was observed during the 3rd trimester, despite infections occurring much earlier in pregnancy, and different mechanisms might operate leading to different patterns of growth alterations. This study highlights the need for protection against malaria throughout pregnancy and the recognition that observed changes in fetal growth might be a consequence of an infection much earlier in pregnancy.
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Kulandavelu S, Whiteley KJ, Bainbridge SA, Qu D, Adamson SL. Endothelial NO Synthase Augments Fetoplacental Blood Flow, Placental Vascularization, and Fetal Growth in Mice. Hypertension 2013; 61:259-66. [DOI: 10.1161/hypertensionaha.112.201996] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is not known whether eNOS deficiency in the mother or the conceptus (ie, placenta and fetus) causes fetal growth restriction in mice lacking the endothelial NO synthase gene (eNOS knockout [KO]). We hypothesized that eNOS sustains fetal growth by maintaining low fetoplacental vascular tone and promoting fetoplacental vascularity and that this is a conceptus effect and is independent of maternal genotype. We found that eNOS deficiency blunted fetal growth, and blunted the normal increase in umbilical blood flow and umbilical venous diameter and the decrease in umbilical arterial Resistance Index in late gestation (14.5–17.5 days) in eNOS KO relative to C57Bl/6J controls. On day 17.5, fetoplacental capillary lobule length and capillary density in vascular corrosion casts were reduced in eNOS KO placentas. Reduced vascularization may be a result of decreased vascular endothelial growth factor mRNA and protein expression in eNOS KO placentas at this stage. These factors, combined with significant anemia found in eNOS KO fetuses, would be anticipated to reduce fetal oxygen delivery and contribute to the fetal tissue hypoxia that was detected in the heart, lung, kidney, and liver by immunohistochemistry using pimonidazole. Although maternal eNOS deficiency impairs uteroplacental adaptations to pregnancy, maternal genotype was not a significant factor affecting growth in heterozygous conceptuses. This indicates that fetal growth restriction was primarily caused by conceptus eNOS deficiency. In mice, placental hemodynamic and vascular changes with gestation and growth restriction showed strong parallels with human pregnancy. Thus, the eNOS KO model could provide insights into the pathogenesis of human intrauterine growth restriction.
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Affiliation(s)
- Shathiyah Kulandavelu
- From the Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (S.K., K.J.W., S.A.B., D.Q., S.L.A.); and the Departments of Physiology, and Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada (S.K., S.A.B., S.L.A.)
| | - Kathie J. Whiteley
- From the Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (S.K., K.J.W., S.A.B., D.Q., S.L.A.); and the Departments of Physiology, and Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada (S.K., S.A.B., S.L.A.)
| | - Shannon A. Bainbridge
- From the Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (S.K., K.J.W., S.A.B., D.Q., S.L.A.); and the Departments of Physiology, and Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada (S.K., S.A.B., S.L.A.)
| | - Dawei Qu
- From the Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (S.K., K.J.W., S.A.B., D.Q., S.L.A.); and the Departments of Physiology, and Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada (S.K., S.A.B., S.L.A.)
| | - S. Lee Adamson
- From the Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (S.K., K.J.W., S.A.B., D.Q., S.L.A.); and the Departments of Physiology, and Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada (S.K., S.A.B., S.L.A.)
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Pourrat O, Pierre F. Retard de la croissance fœtale d’origine vasculaire : l’interniste a son rôle à jouer ! Rev Med Interne 2012; 33:603-6. [DOI: 10.1016/j.revmed.2012.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 04/08/2012] [Indexed: 10/28/2022]
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Schmiegelow C, Scheike T, Oesterholt M, Minja D, Pehrson C, Magistrado P, Lemnge M, Rasch V, Lusingu J, Theander TG, Nielsen BB. Development of a fetal weight chart using serial trans-abdominal ultrasound in an East African population: a longitudinal observational study. PLoS One 2012; 7:e44773. [PMID: 23028617 PMCID: PMC3448622 DOI: 10.1371/journal.pone.0044773] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 08/07/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To produce a fetal weight chart representative of a Tanzanian population, and compare it to weight charts from Sub-Saharan Africa and the developed world. Methods A longitudinal observational study in Northeastern Tanzania. Pregnant women were followed throughout pregnancy with serial trans-abdominal ultrasound. All pregnancies with pathology were excluded and a chart representing the optimal growth potential was developed using fetal weights and birth weights. The weight chart was compared to a chart from Congo, a chart representing a white population, and a chart representing a white population but adapted to the study population. The prevalence of SGA was assessed using all four charts. Results A total of 2193 weight measurements from 583 fetuses/newborns were included in the fetal weight chart. Our chart had lower percentiles than all the other charts. Most importantly, in the end of pregnancy, the 10th percentiles deviated substantially causing an overestimation of the true prevalence of SGA newborns if our chart had not been used. Conclusions We developed a weight chart representative for a Tanzanian population and provide evidence for the necessity of developing regional specific weight charts for correct identification of SGA. Our weight chart is an important tool that can be used for clinical risk assessments of newborns and for evaluating the effect of intrauterine exposures on fetal and newborn weight.
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Affiliation(s)
- Christentze Schmiegelow
- Centre for Medical Parasitology, Institute of International Health, Immunology, and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark.
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Ioannou C, Talbot K, Ohuma E, Sarris I, Villar J, Conde-Agudelo A, Papageorghiou AT. Systematic review of methodology used in ultrasound studies aimed at creating charts of fetal size. BJOG 2012; 119:1425-39. [PMID: 22882780 DOI: 10.1111/j.1471-0528.2012.03451.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reliable ultrasound charts are necessary for the prenatal assessment of fetal size, yet there is a wide variation of methodologies for the creation of such charts. OBJECTIVE To evaluate the methodological quality of studies of fetal biometry using a set of predefined quality criteria of study design, statistical analysis and reporting methods. SEARCH STRATEGY Electronic searches in MEDLINE, EMBASE and CINAHL, and references of retrieved articles. SELECTION CRITERIA Observational studies whose primary aim was to create ultrasound size charts for bi-parietal diameter, head circumference, abdominal circumference and femur length in fetuses from singleton pregnancies. DATA COLLECTION AND ANALYSIS Studies were scored against a predefined set of independently agreed methodological criteria and an overall quality score was given to each study. Multiple regression analysis between quality scores and study characteristics was performed. MAIN RESULTS Eighty-three studies met the inclusion criteria. The highest potential for bias was noted in the following fields: 'Inclusion/exclusion criteria', as none of the studies defined a rigorous set of antenatal or fetal conditions which should be excluded from analysis; 'Ultrasound quality control measures', as no study demonstrated a comprehensive quality assurance strategy; and 'Sample size calculation', which was apparent in six studies only. On multiple regression analysis, there was a positive correlation between quality scores and year of publication: quality has improved with time, yet considerable heterogeneity in study methodology is still observed today. CONCLUSIONS There is considerable methodological heterogeneity in studies of fetal biometry. Standardisation of methodologies is necessary in order to make correct interpretations and comparisons between different charts. A checklist of recommended methodologies is proposed.
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Affiliation(s)
- C Ioannou
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, UK
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Vesco KK, Sharma AJ, Dietz PM, Rizzo JH, Callaghan WM, England L, Bruce FC, Bachman DJ, Stevens VJ, Hornbrook MC. Newborn size among obese women with weight gain outside the 2009 Institute of Medicine recommendation. Obstet Gynecol 2012; 117:812-818. [PMID: 21422851 DOI: 10.1097/aog.0b013e3182113ae4] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate risk of delivering macrosomic, large-for-gestational-age and small-for-gestational-age neonates in obese women with gestational weight gain outside the 2009 Institute of Medicine recommendation (11-20 pounds). METHODS In a retrospective cohort study, we evaluated 2,080 obese women (body mass index 30 or higher) with singleton pregnancies that resulted in term live births within one health maintenance organization between 2000 and 2005; women with diabetes or hypertensive disorders were excluded. Gestational weight gain was categorized as less than 0, 0 to less than 11, 11-20 (referent), greater than 20-30, greater than 30-40, and greater than 40 pounds and as above, below, or within Institute of Medicine recommendations. We conducted multivariable logistic regression to estimate the odds of large for gestational age and small for gestational age (birth weights greater than the 90th percentile and less than the 10th percentile for gestational age, respectively) and macrosomia (greater than 4,500 g) adjusting for potential confounders. RESULTS Eighteen percent gained below, 25% within, and 57% above Institute of Medicine recommendations. Prevalence of macrosomia, large for gestational age, and small for gestational age were 4.3%, 19.8%, and 4.3%, respectively. Compared with weight gain of 11-20 pounds, weight gain above recommendations did not significantly decrease small-for-gestational-age risk but was associated with increased odds of macrosomia (adjusted odds ratio [OR] 3.36; 95% confidence interval [CI] 1.74-6.51; 6.0% compared with 2.1%) and large for gestational age (adjusted OR 1.80; 95% CI 1.36-2.38; 23.8% compared with 16.6%). Weight gain below recommendations was associated with increased odds of small for gestational age (adjusted OR 3.94; 95% CI 2.04-7.61; 8.8% compared with 2.7%) and decreased odds of large for gestational age (adjusted OR 0.56; 95% CI 0.37-0.84; 11.2% compared with 16.6%). CONCLUSION Regarding small for gestational age and large for gestational age, there is no benefit of weight gain above Institute of Medicine recommendations. Weight gain below recommendations decreases large for gestational age but increases small-for-gestational-age risk. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Kimberly K Vesco
- From The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon; and the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Tiscia G, Colaizzo D, Favuzzi G, Vergura P, Martinelli P, Margaglione M, Grandone E. The M2 haplotype in the ANXA5 gene is an independent risk factor for idiopathic small-for-gestational age newborns. Mol Hum Reprod 2012; 18:510-3. [PMID: 22679123 DOI: 10.1093/molehr/gas023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hereditary thrombophilias can impair vascular placental functions and predispose to the birth of small-for-gestational age (SGA) babies. The placental anticoagulant protein annexin A5 (ANXA5) may contribute to this process. A functional haplotype (M2) within the ANXA5 gene is associated with fetal loss and venous thrombosis. This study investigated the prevalence of the M2 haplotype in a group of women with idiopathic SGA newborn babies. Seventy-eight women with at least one previous unexplained SGA birth and 195 controls all from Southern Italy were investigated. Hereditary thrombophilia was found in 13 (16.5%) cases and 21 (11%) controls (P < 0.05.). The M2 haplotype was found in 29% of cases (n = 23) and 15% of controls [n = 30; P = 0.001; OR = 2.3, 95% CI (1.17-4.48)]. Within the case group, 82.5% of the M2 haplotype carriers gave birth to babies with a birthweight below the 3rd percentile [P = 0.01; OR = 2.4, 95% CI (1.26-4.73)]. A logistic regression, corrected for age, parity and gravity showed that the M2 haplotype was independently associated with the delivery of an SGA new born [P = 0.029; OR = 2.6, 95% CI (1.1-6.0)]. In conclusion, the M2 haplotype of the ANXA5 gene confers a risk of delivering SGA babies.
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Affiliation(s)
- G Tiscia
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
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Smits MM, Boyko EJ, Utzschneider KM, Leonetti DL, McNeely MJ, Suvag S, Wright LA, Fujimoto WY, Kahn SE. Arm length is associated with type 2 diabetes mellitus in Japanese-Americans. Diabetologia 2012; 55:1679-84. [PMID: 22361981 PMCID: PMC3678981 DOI: 10.1007/s00125-012-2500-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 01/23/2012] [Indexed: 01/14/2023]
Abstract
AIMS/HYPOTHESIS The aim of the study was to examine the association of type 2 diabetes mellitus with arm length as a marker for early life environment and development. METHODS This was a cross-sectional analysis of 658 second- and third-generation Japanese-Americans (349 men and 309 women). Different arm length (total, upper and forearm length) and leg length (total and lower leg length) measurements were performed. Type 2 diabetes was defined by the use of hypoglycaemic medication, fasting plasma glucose (FPG) ≥ 7 mmol/l or glucose at 2 h ≥ 11.1 mmol/l during an OGTT. Persons meeting the criteria for impaired glucose tolerance were excluded from these analyses (FPG <7 mmol/l and 2 h glucose during an OGGT <11.1 but ≥ 7.8 mmol/l). Multivariable logistic regression was used to estimate associations between prevalence of diabetes and limb length while adjusting for possible confounders. RESULTS A total of 145 individuals had diabetes. On univariate analysis, arm and leg length were not associated with diabetes. After adjustment for age, sex, computed tomography-measured intra-abdominal fat area, height, weight, smoking status and family history of diabetes, total arm length and upper arm length were inversely related to diabetes (OR for a 1 SD increase 0.49, 95% CI 0.29, 0.84 for total arm length, and OR 0.56, 95% CI 0.36, 0.87 for upper arm length). Forearm length, height and leg length were not associated with diabetes after adjustment for confounding variables. CONCLUSIONS/INTERPRETATION Our findings of associations between arm lengths and prevalence of type 2 diabetes supports a role for factors that determine bone growth or their correlates in the development of this condition.
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Affiliation(s)
- M M Smits
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA
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93
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Kandasamy Y, Smith R, Wright IMR, Hartley L. Relationship between birth weight and retinal microvasculature in newborn infants. J Perinatol 2012; 32:443-7. [PMID: 21941229 PMCID: PMC3365284 DOI: 10.1038/jp.2011.118] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purposes of this study were to determine the normal retinal microvasculature measurements in human infants who are born at term and to determine whether birth weight influences measurements of retinal microvasculature. STUDY DESIGN Retinal arteriole and venule measurements were obtained in a cohort of 24 infants who were born at term. Digital images of both the retinas were obtained using a digital retinal camera after pupillary dilation. RESULT In all, 24 newborn infants born at term (12 females and 12 males) were analyzed in this study. The measured retinal arteriole diameters were from 66.8 to 147.8 μm (mean, 94.2±19.6 μm), and the venule diameters were from 102.0 to 167.8 μm (mean, 135.2±19.1 μm). Seven babies in the sample had low birth weight (LBW), while 17 babies were born with normal weight. Babies with lower birth weights had larger arteriole (113.1±17.9 μm vs 86.4±14.4 μm; P=0.0009) and venule diameters (151.7±14.9 μm vs 128.4±16.9 μm; P=0.0040). CONCLUSION Retinal venules and arterioles in LBW babies are larger compared with those of normal-birth-weight babies. We postulate that the difference observed in our study was due to in utero pathophysiological changes that occurred in the cerebral circulation of growth-restricted fetuses.
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Affiliation(s)
- Y Kandasamy
- Department of Neonatology, The Townsville Hospital, Douglas, QLD, Australia.
| | - R Smith
- Mother and Babies' Research Unit/University of Newcastle John Hunter Hospital, Hunter Region Mail Centre, Newcastle, NSW, Australia
| | - I M R Wright
- Mother and Babies' Research Unit/University of Newcastle John Hunter Hospital, Hunter Region Mail Centre, Newcastle, NSW, Australia
| | - L Hartley
- Department of Neonatology, The Townsville Hospital, Douglas, QLD, Australia
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Li KK, Powls A, Holton M, Aitken C. A dilemma in management of an unwell infant: short term mortality vs. long term morbidity. J Clin Virol 2012; 54:102-5. [PMID: 22421536 DOI: 10.1016/j.jcv.2012.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 02/06/2012] [Accepted: 02/13/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Kathy K Li
- West of Scotland Specialist Virology Centre, United Kingdom.
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Hasegawa J, Nakamura M, Hamada S, Okuyama A, Matsuoka R, Ichizuka K, Sekizawa A, Okai T. Gestational weight loss has adverse effects on placental development. J Matern Fetal Neonatal Med 2012; 25:1909-12. [DOI: 10.3109/14767058.2012.664666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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96
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Domínguez R, Diago V, Monleon J, Perales A. Arteria umbilical única aislada. Feto polimalformado. Cariotipo normal. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2012. [DOI: 10.1016/j.gine.2010.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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97
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Krause B, Hanson M, Casanello P. Role of nitric oxide in placental vascular development and function. Placenta 2011; 32:797-805. [PMID: 21798594 PMCID: PMC3218217 DOI: 10.1016/j.placenta.2011.06.025] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 06/28/2011] [Accepted: 06/29/2011] [Indexed: 11/27/2022]
Abstract
Nitric oxide (NO) is one of the most pleiotropic signaling molecules at systemic and cellular levels, participating in vascular tone regulation, cellular respiration, proliferation, apoptosis and gene expression. Indeed NO actively participates in trophoblast invasion, placental development and represents the main vasodilator in this tissue. Despite the large number of studies addressing the role of NO in the placenta, its participation in placental vascular development and the effect of altered levels of NO on placental function remains to be clarified. This review draws a time-line of the participation of NO throughout placental vascular development, from the differentiation of vascular precursors to the consolidation of vascular function are considered. The influence of NO on cell types involved in the origin of the placental vasculature and the expression and function of the nitric oxide synthases (NOS) throughout pregnancy are described. The developmental processes involved in the placental vascular bed are considered, such as the participation of NO in placental vasculogenesis and angiogenesis through VEGF and Angiopoietin signaling molecules. The role of NO in vascular function once the placental vascular tree has developed, in normal pregnancy as well as in pregnancy-related diseases, is then discussed.
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Affiliation(s)
- B.J. Krause
- Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago, Chile
| | - M.A. Hanson
- Institute of Developmental Sciences, Academic Unit of Human Development & Health, Faculty of Medicine, University of Southampton, SO16 6YD, UK
| | - P. Casanello
- Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago, Chile
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98
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Debbink MP, Bader MDM. Racial residential segregation and low birth weight in Michigan's metropolitan areas. Am J Public Health 2011; 101:1714-20. [PMID: 21778487 PMCID: PMC3154240 DOI: 10.2105/ajph.2011.300152] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the influence of racial residential segregation, independent of neighborhood economic factors, on the overall and specific etiological risks of low birth weight. METHODS We geocoded all singleton births in Michigan metropolitan areas during 2000 to census tracts. We used hierarchical generalized linear models to investigate the association between low birth weight (< 2500 g) and neighborhood-level economic and racial segregation, controlling for individual and neighborhood characteristics. We analyzed competing risks of the 2 etiologies of low birth weight: intrauterine growth restriction and preterm birth. RESULTS Living in a Black segregated area was associated with increased odds (odds ratio [OR] = 1.15; 95% confidence interval [CI] = 1.03, 1.29; P < .05) of low birth weight after adjusting for individual- and tract-level measures. The analysis suggested that the association between low birth weight and racial segregation was attributable primarily to increased risk of intrauterine growth restriction (OR = 1.19; 95% CI = 1.03, 1.37; P < .05). CONCLUSIONS Odds of low birth weight are higher in racially segregated Black neighborhoods in Michigan's metropolitan areas, independent of economic factors. The association appears to operate through intrauterine growth restriction rather than preterm birth.
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Affiliation(s)
- Michelle Precourt Debbink
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA.
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99
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Hasegawa J, Arakawa K, Nakamura M, Matsuoka R, Ichizuka K, Katsufumi O, Sekizawa A, Okai T. Analysis of placental weight centiles is useful to estimate cause of fetal growth restriction. J Obstet Gynaecol Res 2011; 37:1658-65. [DOI: 10.1111/j.1447-0756.2011.01600.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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100
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Adams SS, Eberhard-Gran M, Hofoss D, Eskild A. Maternal emotional distress in pregnancy and delivery of a small-for-gestational age infant. Acta Obstet Gynecol Scand 2011; 90:1267-73. [PMID: 21644934 DOI: 10.1111/j.1600-0412.2011.01204.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the association between maternal emotional distress in pregnancy and delivery of a small-for-gestational age offspring. DESIGN A cohort study in pregnancy. SETTING Fifty hospitals with a maternity ward in Norway during 1998-2008. POPULATION Seventy-one thousand eight hundred and ninety-eight women with a singleton pregnancy in the Norwegian Mother and Child Cohort Study were followed from early pregnancy to delivery. METHODS Information on presence of emotional distress was obtained through self-administered questionnaires in pregnancy weeks 17 and 30 and on birthweight, gestational length at delivery and sex by linkage to the Medical Birth Registry of Norway. Emotional distress was measured by short forms of the Hopkins Symptom Checklist-25. MAIN OUTCOME MEASURE Small-for-gestational age offspring (birthweight <2.5th percentile). RESULTS Being emotionally distressed at gestational weeks 17 and 30 was not significantly associated with subsequent delivery of a small-for-gestational age infant (adjusted odds ratio 1.16; 95% confidence interval 0.87-1.54). This estimate was adjusted for smoking in pregnancy, parity, diabetes, pre-eclampsia, body mass index, education and maternal age. CONCLUSIONS Emotional distress during pregnancy was not associated with subsequent delivery of a small-for-gestational age infant.
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Affiliation(s)
- Samantha S Adams
- Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway.
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