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Nobles CJ, Grantz KL, Liu D, Williams A, Ouidir M, Seeni I, Sherman S, Mendola P. Ambient air pollution and fetal growth restriction: Physician diagnosis of fetal growth restriction versus population-based small-for-gestational age. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 650:2641-2647. [PMID: 30296771 PMCID: PMC6203640 DOI: 10.1016/j.scitotenv.2018.09.362] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/24/2018] [Accepted: 09/28/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND Ambient air pollution may affect fetal growth restriction (FGR) through several mechanisms. However, prior studies of air pollution and small-for-gestational age (SGA), a common proxy for FGR, have reported inconsistent findings. OBJECTIVE We assessed air pollution in relation to physician-diagnosed FGR and population-based SGA in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Consecutive Pregnancy Study (2002-2010). METHODS Among 50,005 women (112,203 singleton births), FGR was captured from medical records and ICD-9 codes, and SGA determined by population standards for birthweight <10th, <5th and <3rd percentile. Community Multiscale Air Quality models estimated ambient levels of seven criteria pollutants for whole pregnancy, 3-months preconception, and 1st, 2nd and 3rd trimesters. Generalized estimating equations with robust standard errors accounted for interdependency of pregnancies within participant. Models adjusted for maternal age, race/ethnicity, pre-pregnancy body mass index, smoking, alcohol, parity, insurance, marital status, asthma and temperature. RESULTS FGR was diagnosed in 1.5% of infants, and 6.7% were <10th, 2.7% <5th and 1.5% <3rd percentile for SGA. Positive associations of SO2, NO2 and PM10 and negative associations of O3 with FGR were observed throughout preconception and pregnancy. For example, an interquartile increase in whole pregnancy SO2 was associated with 16% (95% CI 8%, 25%) increased FGR risk, 17% for NO2 (95% CI 9%, 26%) and 12% for PM10 (95% CI 6%, 19%). Associations with SGA were less clear. CONCLUSIONS Chronic exposure to air pollution may be associated with FGR but not SGA in this low-risk population.
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Affiliation(s)
- Carrie J Nobles
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Danping Liu
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Andrew Williams
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Marion Ouidir
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Indulaxmi Seeni
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
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Mustieles V, Mínguez-Alarcón L, Christou G, Ford JB, Dimitriadis I, Hauser R, Souter I, Messerlian C. Placental weight in relation to maternal and paternal preconception and prenatal urinary phthalate metabolite concentrations among subfertile couples. ENVIRONMENTAL RESEARCH 2019; 169:272-279. [PMID: 30497002 PMCID: PMC6347561 DOI: 10.1016/j.envres.2018.11.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Phthalates are known reproductive toxicants that reduce placental and fetal weight in experimental animal studies. Although phthalate exposure has been associated with reduced birth weight in humans, there is limited epidemiologic evidence on whether the placenta is also affected. OBJECTIVE To assess whether maternal and paternal preconception and prenatal urinary phthalate metabolite concentrations are associated with placental weight, and the birth weight: placental weight (BW:PW) ratio among singletons conceived by subfertile couples. METHODS The present analysis included 132 mothers and 68 fathers, and their corresponding 132 singletons recruited in an academic hospital fertility center in Boston, Massachusetts. Urinary concentrations of eleven phthalate metabolites were measured and averaged in multiple paternal (n = 196) and maternal (n = 596) preconception, and maternal prenatal (n = 328) samples. Placental weight and birth weight (grams) were abstracted from delivery records, and the BW:PW was calculated. We estimated the association of natural log-phthalate metabolite concentrations across windows of exposure with placental weight and the BW:PW ratio using multivariable linear regression models, adjusting for a priori covariates. RESULTS In adjusted models, each log-unit increase in paternal urinary concentrations of the sum of di-(2-ethylhexyl) phthalate (ΣDEHP) metabolites was associated with a 24 g (95% CI: -48, -1) decrease in placental weight. We also observed a significant negative association between maternal preconception monoethyl phthalate (MEP) metabolite concentrations and the BW:PW ratio (β = -0.26; 95%CI: -0.49, -0.04). Additionally, each log-unit increase in prenatal MEP metabolite concentrations was associated with a 24 g (95% CI: -41, -7) decrease in placental weight. CONCLUSIONS Our results suggest that certain paternal and maternal urinary phthalate metabolites may affect placental weight and the BW:PW ratio. However, given the small sample size within a subfertile cohort and the novelty of these findings, more studies are needed to confirm the present results.
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Affiliation(s)
- Vicente Mustieles
- Biosanitary Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada, Spain; Center for Biomedical Research (CIBM), University of Granada, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), 18100, Spain
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - George Christou
- Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology, Boston, MA 02114, USA
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology, Boston, MA 02114, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology, Boston, MA 02114, USA
| | - Carmen Messerlian
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
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Heck JE, He D, Janzen C, Federman N, Olsen J, Ritz B, Hansen J. Fetal programming and Wilms tumor. Pediatr Blood Cancer 2019; 66:e27461. [PMID: 30255546 PMCID: PMC6530460 DOI: 10.1002/pbc.27461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The "fetal programming" hypothesis has been evaluated in many adult diseases including cancer, but not for Wilms tumor. Wilms tumor has been related to high birthweight, but little is known about other growth metrics such as a baby's birth length, ponderal index, or placenta size, which can shed additional light on growth patterns. METHODS Cases of Wilms tumor (N = 217) were taken from the Danish Cancer Registry, and controls (N = 4340) were randomly selected from the Population Register and matched to cases by sex and age. Linkage to the Medical Births Registry provided information on gestational factors and fetal growth measurements, while linkage to the Patient Register provided information on maternal and child health conditions. RESULTS Despite having typically normal to higher birthweights, Wilms tumor cases had smaller placentas (≤540 g; odds ratio (OR) = 4.24; 95% confidence interval (CI), 1.84-9.78) and a lower placenta-to-birthweight ratio (OR = 1.81; 95% CI, 1.17-2.82, per 1 SD decrease). Small placentas were more common among Wilms cases without congenital anomalies (OR = 6.43; 95% CI, 1.95-21.21). Wilms tumor cases had a higher prevalence of high birthweight (>4000 g; OR = 1.57; 95% CI, 1.11-2.22), birth length 55 cm or longer (OR = 1.74; 95% CI, 1.09-2.78), and being large for gestational age (OR = 1.79; 95% CI, 1.08-2.96). CONCLUSIONS Our study corroborates earlier studies showing associations with high birthweight and suggests associations between Wilms tumor and decreased placental size and low placenta-to-birthweight ratio.
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Affiliation(s)
- Julia E Heck
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, USA
| | - Di He
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Carla Janzen
- Department of Obstetrics and Gynecology, Geffen School of Medicine, University of California, Los Angeles, USA
| | - Noah Federman
- Department of Pediatrics, Geffen School of Medicine, University of California, Los Angeles, USA
| | - Jorn Olsen
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
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Mikelson CK, Troisi J, LaLonde A, Symes SJK, Thurston SW, DiRe LM, David Adair C, Miller RK, Richards SM. Placental concentrations of essential, toxic, and understudied metals and relationships with birth outcomes in Chattanooga, TN. ENVIRONMENTAL RESEARCH 2019; 168:118-129. [PMID: 30296639 PMCID: PMC6288679 DOI: 10.1016/j.envres.2018.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Comprehensive examinations of placental metal concentrations and correlations with infant parameters are under-investigated. Chattanooga, Tennessee's consistently high incidence of low birth weight and potential for metal exposure provides an ideal opportunity to investigate potential correlations. OBJECTIVES To investigate the associations between a wide variety of metals in placental tissue and multiple infant parameters. METHODS A total of 31 elements were screened via ICP-MS in 374 individual placental samples. Of those, 14 were quantifiable in > 86% of the samples. We examined correlations between metal concentrations and infant parameters (birth weight, gestational age, birth weight centile, placental weight, birth length and head circumference). We fit multivariable regression models to estimate the covariate-adjusted associations of birth weight with ln-transformed concentrations of each of the 14 metals and used generalized additive models to examine nonlinear relationships. RESULTS Some of the strongest relationships with infant parameters came from several lesser-studied metals. Placental rhodium concentrations were negatively correlated with almost all infant parameters. In the fully adjusted regression model, birth weight was significantly associated with several metals. On an IQR (25th to the 75th percentile) basis, estimated changes in birthweight were: for cobalt (82.5 g, IQR=6.05 µg/kg, p = 0.006), iron (-51.5 g, IQR = 171800 µg/kg, p = 0.030), manganese (-27.2 g, IQR=152.1 µg/kg, p = 0.017), lead (-72.7 g, IQR=16.55 µg/kg, p = 0.004) and rhodium (-1365.5 g, IQR = 0.33 µg/kg, p < 0.001). Finally, a generalized additive model showed significant nonlinear relationships between birth weight and concentrations of Co and Rh. CONCLUSIONS Our comprehensive examination of placental metals illustrate many strong associations between lesser-studied metals and infant parameters. These data, in combination with our correlations of well-studied metals, illustrate a need to consider in utero exposure to a broad array of metals when considering fetal development.
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Affiliation(s)
- Colleen K Mikelson
- Department of Biology, Geology and Environmental Sciences, University of Tennessee Chattanooga, 615 McCallie Ave., Chattanooga, TN 37403, United States.
| | - Jacopo Troisi
- Department of Medicine, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, SA, Italy
| | - Amy LaLonde
- Department of Biostatistics and Computational Biology, University of Rochester, School of Medicine and Dentistry, 265 Crittenden Boulevard, Box 630, Rochester, NY 14642, United States
| | - Steven J K Symes
- Department of Chemistry and Physics, University of Tennessee Chattanooga, 615 McCallie Ave., Chattanooga, TN 37403, United States; University of Tennessee College of Medicine, Department of Obstetrics and Gynecology, Section on Maternal Fetal Medicine, 960 East Third Street, Suite 100, Chattanooga, TN 37403, United States
| | - Sally W Thurston
- Department of Biostatistics and Computational Biology, University of Rochester, School of Medicine and Dentistry, 265 Crittenden Boulevard, Box 630, Rochester, NY 14642, United States
| | - Lauren M DiRe
- College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, United States
| | - C David Adair
- University of Tennessee College of Medicine, Department of Obstetrics and Gynecology, Section on Maternal Fetal Medicine, 960 East Third Street, Suite 100, Chattanooga, TN 37403, United States
| | - Richard K Miller
- Departments of Obstetrics and Gynecology, of Environmental Medicine and of Pathology, University of Rochester, School of Medicine and Dentistry, 601 Elmwood Ave, Box 668, Rochester, NY 14642, United States
| | - Sean M Richards
- Department of Biology, Geology and Environmental Sciences, University of Tennessee Chattanooga, 615 McCallie Ave., Chattanooga, TN 37403, United States; University of Tennessee College of Medicine, Department of Obstetrics and Gynecology, 979 E. Third Street - Suite C720, Chattanooga, TN 37403, United States
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Feenstra ME, Schoots MH, Plösch T, Prins JR, Scherjon SA, Timmer A, van Goor H, Gordijn SJ. More Maternal Vascular Malperfusion and Chorioamnionitis in Placentas After Expectant Management vs. Immediate Delivery in Fetal Growth Restriction at (Near) Term: A Further Analysis of the DIGITAT Trial. Front Endocrinol (Lausanne) 2019; 10:238. [PMID: 31105647 PMCID: PMC6499154 DOI: 10.3389/fendo.2019.00238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: Management of late fetal growth restriction (FGR) is limited to adequate fetal monitoring and optimal timing of delivery. The Disproportionate Intrauterine Growth Intervention Trial At Term (DIGITAT) trial compared induction of labor with expectant management in pregnancies at (near) term complicated by suspected FGR. Findings of the DIGITAT trial were that expectant monitoring prolonged pregnancy for 10 days and increased birth weight with only 130 grams. This resulted in more infants born below the 2.3rd percentile compared to induction of labor, respectively, 12.5% in induction of labor and 30.6% in expectant monitoring group. The main placental lesions associated with FGR are maternal vascular malperfusion, fetal vascular malperfusion, and villitis of unknown etiology. We investigated whether placentas of pregnancies complicated with FGR in the expectant monitoring group reveal more and more severe pathology due to pregnancy prolongation. Material and methods: The DIGITAT trial was a multicenter, randomized controlled trial with suspected FGR beyond 36 + 0 weeks. We now analyzed all available cases (n = 191) for placental pathology. The macroscopic details were collected and histological slides were recorded and classified by a single perinatal pathologist, blinded for pregnancy details and outcome. The different placental lesions were scored based on the latest international criteria for placental lesions as defined in the Amsterdam Placental Workshop Group Consensus Statement. Results: The presence of maternal vascular malperfusion and chorioamnionitis were higher in the expectant management group (p < 0.05 and p < 0.01, respectively). No differences in placental weight and maturation of the placenta between the induction of labor and the expectant management group were seen. Fetal vascular malperfusion, villitis of unknown etiology and nucleated red blood cell count did not differ between the groups. Conclusion: Expectant management of late FGR is associated with increased maternal vascular malperfusion and chorioamnionitis. This may have implications for fetal and neonatal outcome, such as programming in the developing child influencing health outcomes later in life.
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Affiliation(s)
- Marjon E. Feenstra
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Mirthe H. Schoots
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Torsten Plösch
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jelmer R. Prins
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sicco A. Scherjon
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Albertus Timmer
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sanne J. Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- *Correspondence: Sanne J. Gordijn
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The Relationship Between Pregnancy Exposure to Antidepressant and Atypical Antipsychotic Medications and Placental Weight and Birth Weight Ratio: A Retrospective Cohort Study. J Clin Psychopharmacol 2018; 38:563-569. [PMID: 30346334 DOI: 10.1097/jcp.0000000000000964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychotropic medication use in pregnancy has been associated with altered fetal growth. The aim of this study was to investigate the relationship between placental weight and placental weight-to-birth weight (PBW) ratio, as a potential marker of placental efficiency, and medication use in a cohort of women with severe mental illness in pregnancy. METHODS A retrospective database analysis was carried out on a cohort of pregnant women with severe mental illness (242 singleton pregnancies) and grouped according to their psychotropic medication use. Demographic, obstetric, neonatal, and psychiatric variables were analyzed using t tests, χ, analysis of variance, univariate, binary, and multiple regression adjusting for potential confounders. RESULTS Multiple regression analysis demonstrated a mean adjusted increase in placental weight of 114 g (95% confidence interval [CI], 60.2-165.6 g) in women taking antidepressant medication and 113 g (CI, 65.1-162.8 g) in women taking combined antidepressant and atypical antipsychotic medication in pregnancy. There was also a significantly elevated PBW ratio in these 2 medication groups (B 0.02: CI, 0.006-0.034; and B 0.025: CI, 0.012-0.038). Binary regression, adjusted for sex and gestational age, showed a significant odds ratio of 4.57 (95% CI, 2.17-9.62) for PBW ratio of greater than 90% in those taking antidepressant medication, either alone or in combination, compared with unmedicated women. CONCLUSIONS The use of antidepressant medication, alone or in combination, has a significant effect on placental weight and PBW ratio after adjusting for confounding variables. Given that this may reflect adverse effects on intrauterine growth and have possible long-term implications for the fetus, further research is warranted to confirm these findings.
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Huang L, Tian FY, Fan L, He YH, Peng D, Xie C, Tao L, Yuan SX, Jia DQ, Chen WQ. Appetite during the second and third trimesters mediates the impact of prenatal environmental tobacco smoke exposure on symmetric full-term low birth weight. J Matern Fetal Neonatal Med 2018; 33:1544-1553. [PMID: 30198354 DOI: 10.1080/14767058.2018.1522299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: To examine the relationship of prenatal environmental tobacco smoke (ETS) exposure and full-term low birth weight (FT-LBW) when taking anthropometric proportionality into consideration, and explore whether appetite mediates their association.Study design: We conducted a case-control study among pregnant women at two Women and Children's Hospitals in Guangdong, China. Information was collected through interview and medical records review. A series of logistic and linear regressions were used to examine the relationships of prenatal ETS exposure, appetite, and FT-LBW.Results: After adjusting for the potential confounders, prenatal ETS exposure was significantly negatively associated with FT-LBW (OR: 1.83, 95%CI: 1.35-2.48) and negatively correlated with maternal appetite in second and third trimester during pregnancy (β: -0.11, standard error: 0.03). Moreover, mediation analysis illustrated that maternal appetite partially mediated 12.00% of their relationship. However, subgroup analysis showed that prenatal ETS exposure was linked to higher risk of symmetric FT-LBW (OR: 2.26, 95%CI: 1.56-3.26) but not asymmetric FT-LBW. And maternal appetite explained only 6.45% of their relationship.Conclusions: Maternal prenatal ETS exposure increased risk of having symmetric FT-LBW infant, and appetite might mediate their relationship partially. This study emphasizes the importance of sample homogeneity and stresses the needs to improve the public awareness of the harmful effects of ETS.
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Affiliation(s)
- Lihua Huang
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Fu-Ying Tian
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lijun Fan
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan-Hui He
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ding Peng
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chuanbo Xie
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Liu Tao
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shi-Xin Yuan
- Shenzhen Women and Children's Hospital, Shenzhen, China
| | - De-Qin Jia
- Foshan Women and Children's Hospital, Foshan, China
| | - Wei-Qing Chen
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Department of Information Management, Xinhua College, Sun Yat-sen University, Guangzhou, China
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Genome-wide identification of enhancer elements in the placenta. Placenta 2018; 79:72-77. [PMID: 30268337 DOI: 10.1016/j.placenta.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/03/2018] [Accepted: 09/10/2018] [Indexed: 12/25/2022]
Abstract
Normal placental development is essential for a healthy pregnancy, and is contingent upon tight spatiotemporal regulation of gene expression. One level of transcriptional control is via enhancer elements in the genome. Enhancers are distal cis-regulatory elements that can impact gene expression regardless of their position or orientation. The study of enhancers in the placenta is usually focused on one or two at a time, and the simultaneous identification of all enhancers has been limited. However, such a holistic approach is necessary if we are to gain a systems-level understanding of gene expression regulation in the placenta. Here, we review current methods for genome-scale enhancer identification, as well as studies that have applied those techniques in the placenta, with the aim of guiding future research.
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Beune IM, Bloomfield FH, Ganzevoort W, Embleton ND, Rozance PJ, van Wassenaer-Leemhuis AG, Wynia K, Gordijn SJ. Consensus Based Definition of Growth Restriction in the Newborn. J Pediatr 2018; 196:71-76.e1. [PMID: 29499988 DOI: 10.1016/j.jpeds.2017.12.059] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 11/10/2017] [Accepted: 12/19/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop a consensus definition of growth restriction in the newborn that can be used clinically to identify newborn infants at risk and in research to harmonize reporting and definition in the current absence of a gold standard. STUDY DESIGN An international panel of pediatric leaders in the field of neonatal growth were invited to participate in an electronic Delphi procedure using standardized methods and predefined consensus rules. Responses were fed back at group-level and the list of participants was provided. Nonresponders were excluded from subsequent rounds. In the first round, variables were scored on a 5-point Likert scale; in subsequent rounds, inclusion of variables and cut-offs were determined with a 70% level of agreement. In the final round participants selected the ultimate algorithm. RESULTS In total, 57 experts participated in the first round; 79% completed the procedure. Consensus was reached on the following definition: birth weight less than the third percentile, or 3 out of the following: birth weight <10th percentile; head circumference <10th percentile; length <10th percentile; prenatal diagnosis of fetal growth restriction; and maternal pregnancy information. CONCLUSIONS Consensus was reached on a definition for growth restriction in the newborn. This definition recognizes that infants with birth weights <10th percentile may not be growth restricted and that infants with birth weights >10th percentile can be growth restricted. This definition can be adopted in clinical practice and in clinical trials to better focus on newborns at risk, and is complementary to the previously determined definition of fetal growth restriction.
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Affiliation(s)
- Irene M Beune
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | | | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicholas D Embleton
- Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Paul J Rozance
- Perinatal Research Center, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO
| | | | - Klaske Wynia
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Dutta A, Khramtsova G, Brito K, Alexander D, Mueller A, Chinthala S, Adu D, Ibigbami T, Olamijulo J, Odetunde A, Adigun K, Pruitt L, Hurley I, Olopade O, Ojengbede O, Rana S, Olopade CO. Household air pollution and chronic hypoxia in the placenta of pregnant Nigerian women: A randomized controlled ethanol Cookstove intervention. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 619-620:212-220. [PMID: 29149745 DOI: 10.1016/j.scitotenv.2017.11.091] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/02/2017] [Accepted: 11/08/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Household air pollution (HAP) is associated with adverse pregnancy outcomes. OBJECTIVES Investigate impact of in-utero HAP exposure on placental development and chronic hypoxia. METHODS Markers of chronic placental hypoxia [Hofbauer cells (HBC), syncytial knots (SK), chorionic vascular density (cVD) and hypoxia-inducible factor (HIF)] were stained by hematoxylin-eosin and/or immunohistochemically in placenta samples collected from firewood-/kerosene-users (A,n=16), and ethanol-users (B,n=20) that participated in a randomized controlled intervention trial in Ibadan, Nigeria. A third group of non-smoking and presumed natural gas-using Chicago women (C,n=12) were included in this exploratory pilot to assess for possible differences in placenta histology between similar racial groups. All patients had uncomplicated pregnancies and delivered at term. RESULTS HBC, SK and cVD were significantly increased among firewood-/kerosene-users compared to ethanol-users and natural gas-using Chicago women (HBC medians 5.5, 3.5, and 2.0, respectively; SK means 55.6, 41.8 and 30.1; cVD means 8.8, 6.2, and 5.2; all p<0.01). HIF expression was significantly higher in Group A compared to B and C (all p<0.001). CONCLUSIONS In-utero exposure to HAP is associated with pathologic changes and HIF expression consistent with chronic hypoxia in placenta of firewood/kerosene-users compared to ethanol-users with less HAP exposure and Chicago women with no presumed HAP exposure. Presence of chronic hypoxic signature in placenta of women exposed to HAP has implications for adverse pregnancy complications and future growth and development of the young children. Future larger studies need to focus on HAP exposure and placental disorders like preeclampsia and long-term health impact of in-utero exposure to HAP.
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Affiliation(s)
- Anindita Dutta
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Center for Clinical Cancer Genetics, Department of Medicine, University of Chicago, IL 60637, USA
| | - Galina Khramtsova
- Center for Clinical Cancer Genetics, Department of Medicine, University of Chicago, IL 60637, USA
| | - Katherine Brito
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Center for Clinical Cancer Genetics, Department of Medicine, University of Chicago, IL 60637, USA
| | - Donee Alexander
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Sireesha Chinthala
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Damilola Adu
- Healthy Life for All Foundation, Ibadan, Nigeria
| | | | | | - Abayomi Odetunde
- Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Kehinde Adigun
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Liese Pruitt
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Ian Hurley
- Center for Clinical Cancer Genetics, Department of Medicine, University of Chicago, IL 60637, USA
| | - Olufunmilayo Olopade
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Center for Clinical Cancer Genetics, Department of Medicine, University of Chicago, IL 60637, USA
| | - Oladosu Ojengbede
- Department of Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria; Centre for Population and Reproductive Health, College of Medicine/University College Hospital, University of Ibadan, Nigeria
| | - Sarosh Rana
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Christopher O Olopade
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Center for Clinical Cancer Genetics, Department of Medicine, University of Chicago, IL 60637, USA.
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Ruchob R, Rutherford JN, Bell AF. A Systematic Review of Placental Biomarkers Predicting Small-for-Gestational-Age Neonates. Biol Res Nurs 2018; 20:272-283. [DOI: 10.1177/1099800418760997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Neonates born small for gestational age (SGA) face increased risk of neonatal mortality, childhood developmental problems, and adult disease. The placenta is a key factor in SGA development because of its multiple biological processes that underlie fetal growth. However, valid and reliable placental biomarkers of SGA have not been determined. Objectives: The objective of this article was to systematically identify and review studies examining associations between placental biomarkers and SGA and assess those biomarkers’ predictive value. Methods: Use of the matrix method and the PRISMA guidelines ensured systematic identification of relevant articles based on selection criteria. PubMed, CINAHL, and EMBASE were searched for English articles published in 2005–2016 that addressed relationships between placental biomarkers and SGA. Results: The search captured 466 articles; 13 met selection criteria. The review identified 14 potential placental biomarkers for SGA, with placental growth factor and soluble fms-like tyrosine kinase 1 being the most commonly studied. However, findings for these and other biomarkers have often been contradictory. Thus, no placental biomarkers have been confirmed as reliable for predicting SGA. Conclusion: The inconsistent findings suggest low placental biomarker reliability, perhaps due to the multifactorial nature of SGA. This review is novel in its focus on identifying potential placental biomarkers for SGA, producing a better understanding of how placental function underlies fetal growth. Nevertheless, use of placental biomarkers alone may not be adequate for predicting SGA. Therefore, combinations of biomarkers and other predictive tests should be evaluated for their ability to predict risk of SGA.
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Affiliation(s)
- Rungnapa Ruchob
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Julienne N. Rutherford
- Department of Women, Children & Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Aleeca F. Bell
- Department of Women, Children & Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Behaviour of the Foramen Ovale Flow in Fetuses with Intrauterine Growth Restriction. Obstet Gynecol Int 2018; 2018:1496903. [PMID: 29581724 PMCID: PMC5822859 DOI: 10.1155/2018/1496903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/30/2017] [Accepted: 09/20/2017] [Indexed: 12/05/2022] Open
Abstract
Background Foramen ovale (FO) flow may be altered in IUGR. This study was designed to test this hypothesis. Methods Forty pregnant women (24–38 weeks) were divided into 3 groups: group I (IUGR), group II (adequate growth and maternal hypertension), and group III (normal controls). Impedance across the FO was assessed by the FO pulsatility index (FOPI): (systolic velocity − presystolic velocity)/mean velocity. Statistical analysis utilized ANOVA, Tukey test, and ROC curves. Results Mean FOPI in IUGR fetuses (n = 15) was 3.70 ± 0.99 (3.15–4.26); in the group II (n = 12), it was 2.84 ± 0.69 (2.40–3.28), and in the group III (n = 13), it was 2.77 ± 0.44 (2.50–3.04) (p=0.004). FOPI and UtA RI were correlated (r = 0.375, p=0.017), as well as FOPI and UA RI (r = 0.356, p=0.024) and, inversely, FOPI and MCA RI (r = −0.359, p=0.023). Conclusions The FO flow pulsatility index is increased in fetuses with IUGR, probably as a result of impaired left ventricular diastolic function.
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Matsuda Y, Itoh T, Itoh H, Ogawa M, Sasaki K, Kanayama N, Matsubara S. Impact of placental weight and fetal/placental weight ratio Z score on fetal growth and the perinatal outcome. Int J Med Sci 2018; 15:484-491. [PMID: 29559837 PMCID: PMC5859771 DOI: 10.7150/ijms.23107] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/03/2018] [Indexed: 11/24/2022] Open
Abstract
Objective: To classify the infants into 9 blocks based on the deviation of both placental weight (PW) and fetal/placental weight ratio (F/P) Z score and compared the incident rate of perinatal death in each of the small for date (SFD) vs. appropriate for date (AFD) vs. heavy for date (HFD) groups. Methods: The study population consisted of 93,034 placentas/infants from women who vaginally delivered a singleton infant. They were classified into 3 groups according to infants' weight: SFD (n=3,379), AFD (n=81,143) and HFD (n=8,512). The population was classified into 9 blocks according to the combination of i) low vs. middle vs. high placental weight (PW: a sex-, parity- and gestational-age-specific placental weight) and ii) low vs. middle vs. high F/P. In both i) and ii), ± 1.28 standard deviations in the in the Z scores was used for classifying low vs. middle vs. high, with 3x3 making 9 blocks. We then determined whether or not the perinatal death in each block differed among the three groups (SFD vs. AFD vs. HFD). Results: (1) The proportions of 'balanced growth of placenta and infant' (appropriate PW and F/P based on Z-score) were 37.6% in the SFD group, 78.8% in the AFD group, and 51.2% in HFD group. (2) The proportion of 'inappropriately heavy placenta' in the SFD group and that of 'inappropriately light placenta' in the HFD group were 0.3 and 0.4%, respectively, a very rare phenomenon. The proportions of 'inappropriately heavy placenta' and 'inappropriately light placenta' accounted for 4.1 and 5.5% in AFD group, respectively. (3) The rates of perinatal death in those with 'balanced growth of placenta and infant' were lowest in the SFD and AFD groups. Conclusion: By showing the fact that perinatal death was lowest in cases with balanced fetal/ placental growth, we conclude that 9-block categorization of PW and F/P based on deviation in the Z-score may be a candidate factor employable for understanding fetal and placental growth and perinatal deaths.
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Affiliation(s)
- Yoshio Matsuda
- Department of Obstetrics and Gynecology, Japan Community Health Care Organization (JCHO) Mishima General Hospital 2276 Yata Aza Fujikubo, Mishima- City, Shizuoka 411-0801 JAPAN.,Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3 Iguchi Nasushiobara, Tochigi 329-2763 Japan
| | - Toshiya Itoh
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine 1-20-1 Handayama, Higashi-ku, Hamamatsu city, Shizuoka, Japan 431-3192
| | - Hiroaki Itoh
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine 1-20-1 Handayama, Higashi-ku, Hamamatsu city, Shizuoka, Japan 431-3192
| | - Masaki Ogawa
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Kemal Sasaki
- Faculty of Childhood Education, Yokohama Soei University, 1 Miho-cho, Midori-ku, Yokohama, Kanagawa 226-0015
| | - Naohiro Kanayama
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine 1-20-1 Handayama, Higashi-ku, Hamamatsu city, Shizuoka, Japan 431-3192
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
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Lo JO, Roberts VHJ, Schabel MC, Wang X, Morgan TK, Liu Z, Studholme C, Kroenke CD, Frias AE. Novel Detection of Placental Insufficiency by Magnetic Resonance Imaging in the Nonhuman Primate. Reprod Sci 2018; 25:64-73. [PMID: 28330415 PMCID: PMC5993076 DOI: 10.1177/1933719117699704] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The placenta is a vital organ necessary for healthy fetal development. Placental insufficiency creates an in utero environment where the fetus is at risk of insufficient oxygen or nutrient exchange. This is primarily caused by impairment of either maternal or fetal circulation or vascular thrombosis such as placental infarction. As a result of placental dysfunction, affected fetuses may be growth restricted, neurologically impaired, and at risk of increased morbidity and mortality. In a cohort of 4 pregnant Rhesus macaques, we describe antenatal detection of naturally occurring intrauterine growth restriction (IUGR) and aberrant fetal neurodevelopment in 1 animal. Abnormal growth parameters were detected by Doppler ultrasound, and vascular insufficiency in the intervillous space was characterized by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Furthermore, placental oxygen reserve was shown to be reduced compared to control animals by measurements of placental water T2*. To characterize the effects of IUGR on fetal brain development, T2 and diffusion anisotropy images of the fetal brain were acquired in utero. Reduced brain volume and cerebral cortical surface area were apparent macroscopically. Microstructural abnormalities within the developing white matter and cerebral cortex were also observed through analysis of water diffusion anisotropy. After delivery by cesarean section, pathological examination confirmed placental insufficiency with hypoxia. These findings exemplify how DCE-MRI and T2*-based measurements of blood oxygenation within the placenta can provide noninvasive imaging methods for assessing in vivo placental health to potentially identify pregnancies affected by placental insufficiency and abnormal fetal neurodevelopment prior to the onset of fetal and neonatal distress.
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Affiliation(s)
- Jamie O. Lo
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Victoria H. J. Roberts
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR, USA
| | - Matthias C. Schabel
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Xiaojie Wang
- Division of Neuroscience, Oregon National Primate Research Center, Portland, OR, USA
| | - Terry K. Morgan
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Zheng Liu
- Division of Neuroscience, Oregon National Primate Research Center, Portland, OR, USA
| | - Colin Studholme
- Division of Neonatology, University of Washington, Seattle, WA, USA
| | - Christopher D. Kroenke
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
| | - Antonio E. Frias
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR, USA
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Zhang N, Sun L, Zhang L, Li Z, Han J, Wu Q. Assessment of Fetal Myocardial Performance Index in Women with Placenta Previa. Med Sci Monit 2017; 23:5933-5942. [PMID: 29242496 PMCID: PMC5741044 DOI: 10.12659/msm.907576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background This study investigated whether fetuses of placenta previa pregnancies have cardiac dysfunction by use of a modified myocardial performance index (Mod-MPI). Material/Methods A prospective cross-sectional study was conducted including 178 fetuses at 28–40 weeks of gestation. Eighty-nine fetuses of mothers with placenta previa and without pregnancy complications were recruited (placenta previa group) and matched with 89 fetuses of mothers with normal pregnancies (control group). Fetal cardiac function parameters and perinatal outcomes as well as the Mod-MPI were compared between the 2 groups. Results The median Mod-MPI was significantly increased in fetuses of mothers with placenta previa compared with controls (0.47±0.05 vs. 0.45±0.05; P<0.01). Among fetuses of mothers with or without placenta previa, the Mod-MPI was significantly higher in the incomplete placenta previa group compared with the complete placenta previa group and control group (P<0.01). An increased Mod-MPI in placenta previa pregnancies was independently associated with fetal cord pH <7.2 (odds ratio, 4.8; 95% confidence interval, 0.98–23.54; P=0.003). Conclusions There is impairment of fetal cardiac function in pregnancies with placenta previa. An increased MPI was independently associated with adverse perinatal outcomes to some extent in the placenta previa pregnancies.
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Affiliation(s)
- Na Zhang
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China (mainland)
| | - Lijuan Sun
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China (mainland)
| | - Lina Zhang
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China (mainland)
| | - Zhen Li
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China (mainland)
| | - Jijing Han
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China (mainland)
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China (mainland)
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Dutta A, Brito K, Khramstova G, Mueller A, Chinthala S, Alexander D, Adu D, Ibigbami T, Olamijulo J, Odetunde A, Adigun K, Pruitt L, Olopade O, Ojengbede O, Rana S, Olopade CO. Household air pollution and angiogenic factors in pregnant Nigerian women: A randomized controlled ethanol cookstove intervention. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 599-600:2175-2181. [PMID: 28575932 DOI: 10.1016/j.scitotenv.2017.05.130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/09/2017] [Accepted: 05/15/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Maternal exposure to ambient air pollution affects placental growth markers. OBJECTIVES Investigate impact of household air pollution (HAP) on placental growth markers. METHODS Two groups of pregnant women were identified: firewood/kerosene stove-users (A, n=33) and bioethanol stove-users (B, n=44) that participated in a randomized control trial in Ibadan, Nigeria. A third group of non-smoking and presumed liquefied petroleum gas-using Chicago women (C, n=19) were included in this exploratory pilot to assess for possible differences between similar racial groups. Levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1) were measured in maternal and cord plasma using ELISA. RESULTS Maternal and cord blood sFlt-1 and PlGF did not differ significantly between women of groups A and B. Nevertheless, both groups differed significantly from the Chicago group in that group A women had lower maternal sFlt-1 (1372.50 vs. 3194.19) but higher PlGF (1607.87 vs. 442.80), and higher cord blood sFlt-1 (2925.02 vs. 107.53) and PlGF (223.68 vs. 6.92), all p≤0.001. Group B showed similar trends (all p≤0.002). Maternal PlGF levels were positively correlated to minutes of HAP exposure when PM2.5 concentration was above 100μg/m3 in Nigerian women. CONCLUSIONS Maternal levels of PlGF and cord blood levels of sFlt-1 and PlGF in Nigerian women with varying HAP exposures were significantly higher than Chicago-based women who had no presumed HAP exposure. It suggests that in-utero exposure to HAP influenced levels of angiogenic factors involved in normal placentation and growth and could represent compensation for pollutants exposure to preserve fetal viability.
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Affiliation(s)
- Anindita Dutta
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Center for Clinical Cancer Genetics and Department of Medicine, University of Chicago, IL 60637, USA
| | - Katherine Brito
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Center for Clinical Cancer Genetics and Department of Medicine, University of Chicago, IL 60637, USA
| | - Galina Khramstova
- Center for Clinical Cancer Genetics and Department of Medicine, University of Chicago, IL 60637, USA
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sireesha Chinthala
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Donee Alexander
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Damilola Adu
- Healthy Life for All Foundation, Ibadan, Nigeria
| | | | | | - Abayomi Odetunde
- Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Kehinde Adigun
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Liese Pruitt
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Olufunmilayo Olopade
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Center for Clinical Cancer Genetics and Department of Medicine, University of Chicago, IL 60637, USA
| | - Oladosu Ojengbede
- Department of Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria; Centre for Population and Reproductive Health, College of Medicine/University College Hospital, University of Ibadan, Nigeria
| | - Sarosh Rana
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Christopher O Olopade
- Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Center for Clinical Cancer Genetics and Department of Medicine, University of Chicago, IL 60637, USA.
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Kibel M, Kahn M, Sherman C, Kingdom J, Zaltz A, Barrett J, Melamed N. Placental abnormalities differ between small for gestational age fetuses in dichorionic twin and singleton pregnancies. Placenta 2017; 60:28-35. [DOI: 10.1016/j.placenta.2017.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/02/2017] [Accepted: 10/09/2017] [Indexed: 11/29/2022]
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Taylor T, Quinton A, Hyett J. The developmental origins of placental function. Australas J Ultrasound Med 2017; 20:141-146. [PMID: 34760487 DOI: 10.1002/ajum.12071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The placenta is the link between mother and fetus and its function is central to a successful pregnancy. The predominant theory within the literature is that the development of placental dysfunction is a result of abnormal trophoblast invasion early in pregnancy. Knowledge of the development of the early placenta and the establishment of the fetomaternal circulation assists in understanding the origins of placental dysfunction which manifest later in pregnancy. Perinatally, chronic placental dysfunction may result in a growth-restricted fetus, maternal problems such as gestational hypertension, pre-eclampsia, eclampsia and pregnancy complications such as placental abruption, preterm labour and delivery. In addition, the growth-restricted fetus and the mother are at an increased risk of a myriad of disorders later in life. The role of ultrasound in the assessment of first trimester pregnancy is evolving with the potential for value in the prediction of placental function in later pregnancy. This review will address two aims, first to describe the development of the placenta from fertilisation to 12 weeks' gestation, correlating this with first trimester ultrasound findings. Second, to describe the link between placental development and function later in pregnancy. Understanding the link between early placental development and later placental function is essential in directing the focus of new research addressing the role of ultrasound in the first trimester in the prediction of adverse obstetric outcomes.
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Affiliation(s)
- Tracey Taylor
- South Coast Ultrasound for Women 10/363 Crown Street Wollongong New South Wales 2500 Australia.,Discipline of Obstetrics, Gynaecology and Neonatology Central Clinical School Faculty of Medicine University of Sydney Camperdown New South Wales 2006 Australia
| | - Ann Quinton
- School of Health, Medical and Applied Science Central Queensland University 400 Kent Street Sydney New South Wales 2000 Australia.,Discipline of Obstetrics, Gynaecology and Neonatology Nepean School Faculty of Medicine University of Sydney Camperdown New South Wales 2006 Australia
| | - Jonathan Hyett
- Discipline of Obstetrics, Gynaecology and Neonatology Central Clinical School Faculty of Medicine University of Sydney Camperdown New South Wales 2006 Australia.,RPA Women and Babies Royal Prince Alfred Hospital 50 Missenden Road Camperdown New South Wales 2050 Australia
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Pásztor N, Sikovanyecz J, Keresztúri A, Kozinszky Z, Németh G. Evaluation of the relation between placental weight and placental weight to foetal weight ratio and the causes of stillbirth: a retrospective comparative study. J OBSTET GYNAECOL 2017; 38:74-80. [DOI: 10.1080/01443615.2017.1349084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Norbert Pásztor
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - János Sikovanyecz
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Attila Keresztúri
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Zoltan Kozinszky
- Department of Obstetrics and Gynecology, Blekinge Hospital, Karlskrona, Sweden
| | - Gábor Németh
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
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Li X, Huang S, Jiao A, Yang X, Yun J, Wang Y, Xue X, Chu Y, Liu F, Liu Y, Ren M, Chen X, Li N, Lu Y, Mao Z, Tian L, Xiang H. Association between ambient fine particulate matter and preterm birth or term low birth weight: An updated systematic review and meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2017; 227:596-605. [PMID: 28457735 DOI: 10.1016/j.envpol.2017.03.055] [Citation(s) in RCA: 270] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/18/2017] [Accepted: 03/24/2017] [Indexed: 05/19/2023]
Abstract
An increasing number of studies have been conducted to determine a possible linkage between maternal exposure to ambient fine particulate matter and effects on the developing human fetus that can lead to adverse birth outcomes, but, the present results are not consistent. A total of 23 studies published before July 2016 were collected and analyzed and the mean value of reported exposure to fine particulate matter (PM2.5) ranged from 1.82 to 22.11 We found a significantly increased risk of preterm birth with interquartile range increase in PM2.5 exposure throughout pregnancy (odds ratio (OR) = 1.03; 95% conditional independence (CI): 1.01-1.05). The pooled OR for the association between PM2.5 exposure, per interquartile range increment, and term low birth weight throughout pregnancy was 1.03 (95% CI: 1.02-1.03). The pooled ORs for the association between PM2.5 exposure per 10 increment, and term low birth weight and preterm birth were 1.05 (95% CI: 0.98-1.12) and 1.02 (95% CI: 0.93-1.12), respectively throughout pregnancy. There is a significant heterogeneity in most meta-analyses, except for pooled OR per interquartile range increase for term low birth weight throughout pregnancy. We here show that maternal exposure to fine particulate air pollution increases the risk of preterm birth and term low birth weight. However, the effect of exposure time needs to be further explored. In the future, prospective cohort studies and personal exposure measurements needs to be more widely utilized to better characterize the relationship between ambient fine particulate exposure and adverse birth outcomes.
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Affiliation(s)
- Xiangyu Li
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Shuqiong Huang
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, Hubei Province, China.
| | - Anqi Jiao
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Xuhao Yang
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Junfeng Yun
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Yuxin Wang
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Xiaowei Xue
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Yuanyuan Chu
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Feifei Liu
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Yisi Liu
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Meng Ren
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Xi Chen
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Na Li
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Yuanan Lu
- Environmental Health Laboratory, Department of Public Health Sciences, University of Hawaii at Manoa, 1960 East-West Rd, Biomed Bldg, D105, Honolulu, HI, 96822, USA.
| | - Zongfu Mao
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
| | - Liqiao Tian
- State Key Laboratory of Information Engineering in Surveying, Mapping and Remote Sensing, Wuhan University, Wuhan, 430079, China.
| | - Hao Xiang
- Department of Epidemiology and Biostatistics, School of Health Science, Wuhan University, 115# Donghu Road, Wuhan, 430071, China.
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The relationship between birth and placental weights changes with placental size. Early Hum Dev 2017; 111:56-59. [PMID: 28618274 DOI: 10.1016/j.earlhumdev.2017.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/14/2017] [Accepted: 05/26/2017] [Indexed: 02/01/2023]
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Ahn KH, Lee JH, Cho GJ, Hong SC, Oh MJ, Kim HJ. Placental thickness-to-estimated foetal weight ratios and small-for-gestational-age infants at delivery. J OBSTET GYNAECOL 2017. [PMID: 28631507 DOI: 10.1080/01443615.2017.1312306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to determine the correlation between the placental thickness-to-estimated foetal weight ratio on midterm ultrasonography and small-for-gestational-age (SGA) infants. In this retrospective study, the placental thickness at the umbilical cord insertion site was measured and adjusted for foetal body weight at 18-24 weeks gestation. Investigators compared the data of women who delivered SGA infants (birth weight <10th percentile) with those of women who delivered non-SGA infants. Among the 1281 women in this study, those who delivered SGA infants were younger and less likely to be obese. Women with higher placental thickness-to-estimated foetal weight ratios delivered more SGA infants. In logistic regression analysis, a higher placental thickness-to-estimated foetal weight ratio remained associated with SGA infants. Since the placental thickness-to-estimated foetal weight ratio in midterm pregnancy was associated with infant body weight at delivery, this ratio could be an effective, adjunctive screening marker for predicting SGA status.
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Affiliation(s)
- Ki Hoon Ahn
- a Department of Obstetrics and Gynecology , Korea University College of Medicine , Seoul , Republic of Korea
| | - Joo Hak Lee
- a Department of Obstetrics and Gynecology , Korea University College of Medicine , Seoul , Republic of Korea
| | - Geum Joon Cho
- a Department of Obstetrics and Gynecology , Korea University College of Medicine , Seoul , Republic of Korea
| | - Soon-Cheol Hong
- a Department of Obstetrics and Gynecology , Korea University College of Medicine , Seoul , Republic of Korea
| | - Min-Jeong Oh
- a Department of Obstetrics and Gynecology , Korea University College of Medicine , Seoul , Republic of Korea
| | - Hai-Joong Kim
- a Department of Obstetrics and Gynecology , Korea University College of Medicine , Seoul , Republic of Korea
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73
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Churchill SJ, Wang ET, Akhlaghpour M, Goldstein EH, Eschevarria D, Greene N, Macer M, Zore T, Williams J, Pisarska MD. Mode of conception does not appear to affect placental volume in the first trimester. Fertil Steril 2017; 107:1341-1347.e1. [PMID: 28501362 PMCID: PMC5628758 DOI: 10.1016/j.fertnstert.2017.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To study whether infertility treatments, including IVF and non-IVF fertility treatments, are associated with diseases of placental insufficiency in early gestation. First trimester placental volumes by ultrasound and chorionic villi weight during sampling (CVS) were performed to detect differences between pregnancies conceived spontaneously versus with fertility treatments. DESIGN Retrospective cohort. SETTING Academic tertiary center. PATIENT(S) Women with singleton pregnancies undergoing CVS and first trimester ultrasound from April 2007 to November 2015. INTERVENTION(S) Estimated placental volume (EPV) was calculated from ultrasound images using a validated computation and CVS estimated tissue weight was performed using a validated visual analogue scale. MAIN OUTCOME MEASURE(S) Adjusted linear regression was used to compare EPV and CVS weight based on mode of conception. RESULT(S) A total of 1,977 spontaneous and 334 conceived with fertility treatments (133 non-IVF and 201 IVF) pregnancies were included. Significant differences in maternal age, gravidity, hypertension, and smoking status were identified. EPV and CVS weight were correlated with maternal age, gestational age, and maternal hypertension. Adjusted linear regression showed no difference in EPV in pregnancies conceived with fertility treatments versus spontaneously. The CVS weight was significantly lower in the IVF conceptions in unadjusted univariate analyses. However, after adjusted regression, this was no longer significant. CONCLUSION(S) Mode of conception does not appear to affect first trimester placental size. As differences in maternal age, hypertension, and smoking status differ among the groups and are correlated to placental size, it may be the underlying patient population leading to abnormal placentation and insufficiency, not the fertility treatments used.
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Affiliation(s)
- Sara J Churchill
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California
| | - Erica T Wang
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, California
| | - Marcy Akhlaghpour
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ellen H Goldstein
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, California
| | - Dina Eschevarria
- David Geffen School of Medicine, University of California, Los Angeles, California
| | - Naomi Greene
- David Geffen School of Medicine, University of California, Los Angeles, California
| | - Matthew Macer
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, California
| | - Temeka Zore
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, California
| | - John Williams
- David Geffen School of Medicine, University of California, Los Angeles, California; Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Margareta D Pisarska
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, California.
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Abstract
Epidemiological evidence links an individual's susceptibility to chronic disease in adult life to events during their intrauterine phase of development. Biologically this should not be unexpected, for organ systems are at their most plastic when progenitor cells are proliferating and differentiating. Influences operating at this time can permanently affect their structure and functional capacity, and the activity of enzyme systems and endocrine axes. It is now appreciated that such effects lay the foundations for a diverse array of diseases that become manifest many years later, often in response to secondary environmental stressors. Fetal development is underpinned by the placenta, the organ that forms the interface between the fetus and its mother. All nutrients and oxygen reaching the fetus must pass through this organ. The placenta also has major endocrine functions, orchestrating maternal adaptations to pregnancy and mobilizing resources for fetal use. In addition, it acts as a selective barrier, creating a protective milieu by minimizing exposure of the fetus to maternal hormones, such as glucocorticoids, xenobiotics, pathogens, and parasites. The placenta shows a remarkable capacity to adapt to adverse environmental cues and lessen their impact on the fetus. However, if placental function is impaired, or its capacity to adapt is exceeded, then fetal development may be compromised. Here, we explore the complex relationships between the placental phenotype and developmental programming of chronic disease in the offspring. Ensuring optimal placentation offers a new approach to the prevention of disorders such as cardiovascular disease, diabetes, and obesity, which are reaching epidemic proportions.
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Affiliation(s)
- Graham J Burton
- Centre for Trophoblast Research and Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom; and Department of Medicine, Knight Cardiovascular Institute, and Moore Institute for Nutrition and Wellness, Oregon Health and Science University, Portland, Oregon
| | - Abigail L Fowden
- Centre for Trophoblast Research and Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom; and Department of Medicine, Knight Cardiovascular Institute, and Moore Institute for Nutrition and Wellness, Oregon Health and Science University, Portland, Oregon
| | - Kent L Thornburg
- Centre for Trophoblast Research and Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom; and Department of Medicine, Knight Cardiovascular Institute, and Moore Institute for Nutrition and Wellness, Oregon Health and Science University, Portland, Oregon
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75
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Huang L, Fan L, Ding P, He YH, Xie C, Niu Z, Tian FY, Yuan S, Jia D, Chen WQ. The mediating role of placenta in the relationship between maternal exercise during pregnancy and full-term low birth weight. J Matern Fetal Neonatal Med 2017; 31:1561-1567. [DOI: 10.1080/14767058.2017.1319936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Lihua Huang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lijun Fan
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Peng Ding
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan-Hui He
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chuanbo Xie
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhongzheng Niu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Fu-Ying Tian
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shixin Yuan
- Department of Science and Education, Shenzhen Women and Children's Hospital, Shenzhen, China
| | - Deqin Jia
- Department of Obstetrics, Foshan Women and Children's Hospital, Foshan, China
| | - Wei-Qing Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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76
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Barakat R, Vargas M, Brik M, Fernandez I, Gil J, Coteron J, Santacruz B. Does Exercise During Pregnancy Affect Placental Weight?: A Randomized Clinical Trial. Eval Health Prof 2017; 41:400-414. [PMID: 29179559 DOI: 10.1177/0163278717706235] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Placental weight (PW) is a measure commonly used to summarize growth and aspects of placental function. In a normal pregnancy, it is reasonable to assume that PW is related to aspects of the functional capacity of the placenta. The placenta, as the site for all maternal-fetal oxygen and nutrient exchange, influences birth weight and is thus central to a successful pregnancy outcome. PW is the most common way to characterize placental growth, which relates to placental function. With physical exercise becoming an integral part of life for many women, the question of whether exercise during pregnancy has an adverse effect on the growing fetus is very important. The aim was to examine the influence of an aerobic exercise program throughout pregnancy on PW among healthy pregnant women. A randomized control trial was used (registration trial number: NCT02420288). Women were randomized into an exercise group (EG; n = 33) or a control group (CG; n = 32) that received standard care. The EG trained 3 days/week (55-60 min/session) from gestational Weeks 9-11 until Weeks 38-39. The 85 training sessions involved aerobic, muscular and pelvic floor strength, and flexibility exercises. PW and other pregnancy outcomes were measured. There was high attendance to the exercise program, and no differences in the PW at delivery were observed between study groups (CG = 493.2 ± 119.6 g vs. EG = 495.4 ± 150 g, p = .95). A regular, supervised exercise program throughout pregnancy does not affect the PW in healthy pregnant women.
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Affiliation(s)
- Ruben Barakat
- 1 Department of Social Sciences, Physical Activity, Sports and Leisure, Faculty of Physical Activity and Sport Sciences, INEF, Technical University of Madrid (UPM), Madrid, Spain
| | - Marina Vargas
- 1 Department of Social Sciences, Physical Activity, Sports and Leisure, Faculty of Physical Activity and Sport Sciences, INEF, Technical University of Madrid (UPM), Madrid, Spain
| | - Maia Brik
- 2 Gynecology and Obstetrics Department, Torrejón Hospital, Madrid, Spain
| | - Irene Fernandez
- 2 Gynecology and Obstetrics Department, Torrejón Hospital, Madrid, Spain
| | - Javier Gil
- 1 Department of Social Sciences, Physical Activity, Sports and Leisure, Faculty of Physical Activity and Sport Sciences, INEF, Technical University of Madrid (UPM), Madrid, Spain
| | - Javier Coteron
- 1 Department of Social Sciences, Physical Activity, Sports and Leisure, Faculty of Physical Activity and Sport Sciences, INEF, Technical University of Madrid (UPM), Madrid, Spain
| | - Belen Santacruz
- 2 Gynecology and Obstetrics Department, Torrejón Hospital, Madrid, Spain
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77
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Jung YM, Choi MJ. Nutrient Intake according to Weight Gain during Pregnancy, Job Status, and Household Income. Clin Nutr Res 2017; 6:27-37. [PMID: 28168179 PMCID: PMC5288550 DOI: 10.7762/cnr.2017.6.1.27] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 12/20/2022] Open
Abstract
The objective of this study was to investigate the association of nutrient intake and pregnancy outcome mediated by weight gain during pregnancy, job status, and household income. Maternal age, educational level, self-reported pre-pregnancy weights, educational level, and household income were collected from the women at 2 months postpartum. For each offspring, weight at birth, length at birth, and gestational age were collected. Participants were asked to report the frequency of consumption of foods between 28–42 weeks into the pregnancy. Diet was assessed by using a validated 106-item semi-quantitative food-frequency questionnaire (SQFFQ) and women were asked portions and quantities based on pictures, food models, and measuring tools such as cups or teaspoons. Results showed that women who gained below the recommended weight gain during pregnancy, within, and over were 25.3%, 38.7%, 36.0%, respectively. In comparison to weight gain and the offspring's length and weight at birth, the offspring of mothers with a lower weight gain had a higher length. Energy, protein, vitamin B2, vitamin C, calcium, and potassium were significantly lower at employed group. We did not observe a significant difference between birth characteristics and maternal nutrient intake by income. Infants with a higher ponderal index at birth were born to women with a higher pre-pregnancy body mass index (BMI).
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Affiliation(s)
- You-Mi Jung
- Department of Food and Nutrition, Keimyung University, Daegu 42601, Korea
| | - Mi-Ja Choi
- Department of Food and Nutrition, Keimyung University, Daegu 42601, Korea
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78
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Angiogenic proteins, placental weight and perinatal outcomes among pregnant women in Tanzania. PLoS One 2016; 11:e0167716. [PMID: 27936130 PMCID: PMC5147955 DOI: 10.1371/journal.pone.0167716] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/14/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Placental vascular development, and ultimately placental weight, is essential to healthy fetal development. Here, we examined placental weight in a cohort of Tanzanian women in association with angiogenic proteins known to regulate placental vascular development and perinatal outcomes. Methods A total of n = 6579 women with recorded placental weight were included in this study. The relative risk of adverse perinatal outcomes (Apgar score, death, asphyxia, respiratory distress, seizures, pneumonia and sepsis) was compared between placental weight in the bottom and top 10th percentiles. We quantified angiogenic mediators (Ang-1, Ang-2, VEGF, PGF and sFlt-1) in plasma samples (n = 901) collected between 12 to 27 weeks of pregnancy using ELISA and assessed the relative risk of placental weight in the bottom and top 10th percentiles by protein levels in quartiles. Results Women with Ang-2 levels in the highest quartile had an increased relative risk of placental weight in the bottom 10th percentile (RR = 1.45 (1.10, 1.91), p = 0.01). Women with VEGF-A (RR = 0.73 (0.56, 0.96), p = 0.05) and PGF (RR = 0.58 (0.44, 0.72), p = 0.002) in the highest quartile had a reduced relative risk of placental weight in the bottom 10th percentile. Low placental weight (in bottom 10th percentile) was associated with an increased relative risk of Apgar score of <7 at 1 minute (RR = 2.31 (1.70, 3.13), p = 0.001), at 5 minutes (RR = 3.53 (2.34, 5.33), p = 0.001), neonatal death (RR = 5.02 (3.61, 7.00), p = 0.001), respiratory distress (RR = 4.80(1.71, 13.45), p = 0.001), and seizures (RR = 4.18 (1.16, 15.02), p = 0.03). Discussion The association between low placental weight and risk of adverse perinatal outcomes in this cohort suggests that placental weight could serve as a useful indicator, providing additional insight into high-risk pregnancies and identifying neonates that may require additional monitoring and follow-up.
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79
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Implantation and pregnancy outcome of Sprague–Dawley rats fed with low and high salt diet. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2016.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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80
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Embryonic/fetal mortality and intrauterine growth restriction is not exclusive to the CBA/J sub-strain in the CBA × DBA model. Sci Rep 2016; 6:35138. [PMID: 27767070 PMCID: PMC5073309 DOI: 10.1038/srep35138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 09/19/2016] [Indexed: 11/24/2022] Open
Abstract
Inbred strains of mice are powerful models for understanding human pregnancy complications. For example, the exclusive mating of CBA/J females to DBA/2J males increases fetal resorption to 20–35% with an associated decline in placentation and maintenance of maternal Th1 immunity. More recently other complications of pregnancy, IUGR and preeclampsia, have been reported in this model. The aim of this study was to qualify whether the CBA/CaH substrain female can substitute for CBA/J to evoke a phenotype of embryonic/fetal mortality and IUGR. (CBA/CaH × DBA/2J) F1 had significantly higher embryonic/fetal mortality mortality (p = 0.0063), smaller fetuses (p < 0.0001), and greater prevalence of IUGR (<10th percentile; 47% vs 10%) than (CBA/CaH × Balb/c) F1. Placentae from IUGR fetuses from all mating groups were significantly smaller (p < 0.0001) with evidence of thrombosis and fibrosis when compared to normal-weight fetuses ( > 10th percentile). In addition, placentae of “normal-weight” (CBA/CaH × DBA/2J) F1 were significantly smaller (p < 0.0006) with a greater proportion of labyrinth (p = 0.0128) and an 11-fold increase in F4/80 + macrophage infiltration (p < 0.0001) when compared to placentae of (CBA/CaH × Balb/c) F1. In conclusion, the embryonic/fetal mortality and IUGR phenotype is not exclusive to CBA/J female mouse, and CBA/CaH females can be substituted to provide a model for the assessment of novel therapeutics.
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81
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Natural Killer Cell Reduction and Uteroplacental Vasculopathy. Hypertension 2016; 68:964-73. [DOI: 10.1161/hypertensionaha.116.07800] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/31/2016] [Indexed: 01/02/2023]
Abstract
Uterine natural killer cells are important for uteroplacental development and pregnancy maintenance. Their role in pregnancy disorders, such as preeclampsia, is unknown. We reduced the number of natural killer cells by administering rabbit anti-asialo GM1 antiserum in an established rat preeclamptic model (female human angiotensinogen×male human renin) and evaluated the effects at the end of pregnancy (day 21), compared with preeclamptic control rats receiving normal rabbit serum. In 100% of the antiserum-treated, preeclamptic rats (7/7), we observed highly degenerated vessel cross sections in the mesometrial triangle at the end of pregnancy. This maternal uterine vasculopathy was characterized by a total absence of nucleated/living cells in the vessel wall and perivascularly and prominent presence of fibrosis. Furthermore, there were no endovascular trophoblast cells within the vessel lumen. In the control, normal rabbit serum–treated, preeclamptic rats, only 20% (1/5) of the animals displayed such vasculopathy. We confirmed the results in healthy pregnant wild-type rats: after anti-asialo GM1 treatment, 67% of maternal rats displayed vasculopathy at the end of pregnancy compared with 0% in rabbit serum–treated control rats. This vasculopathy was associated with a significantly lower fetal weight in wild-type rats and deterioration of fetal brain/liver weight ratio in preeclamptic rats. Anti-asialo GM1 application had no influence on maternal hypertension and albuminuria during pregnancy. Our results show a new role of natural killer cells during hypertensive pregnancy in maintaining vascular integrity. In normotensive pregnancy, this integrity seems important for fetal growth.
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82
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Hjortebjerg D, Andersen AMN, Ketzel M, Pedersen M, Raaschou-Nielsen O, Sørensen M. Associations between maternal exposure to air pollution and traffic noise and newborn's size at birth: A cohort study. ENVIRONMENT INTERNATIONAL 2016; 95:1-7. [PMID: 27475729 DOI: 10.1016/j.envint.2016.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 06/10/2016] [Accepted: 07/05/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Maternal exposure to air pollution and traffic noise has been suggested to impair fetal growth, but studies have reported inconsistent findings. Objective To investigate associations between residential air pollution and traffic noise during pregnancy and newborn's size at birth. METHODS From a national birth cohort we identified 75,166 live-born singletons born at term with information on the children's size at birth. Residential address history from conception until birth was collected and air pollution (NO2 and NOx) and road traffic noise was modeled at all addresses. Associations between exposures and indicators of newborn's size at birth: birth weight, placental weight and head and abdominal circumference were analyzed by linear and logistic regression, and adjusted for potential confounders. RESULTS In mutually adjusted models we found a 10μg/m(3) higher time-weighted mean exposure to NO2 during pregnancy to be associated with a 0.35mm smaller head circumference (95% confidence interval (CI): 95% CI: -0.57; -0.12); a 0.50mm smaller abdominal circumference (95% CI: -0.80; -0.20) and a 5.02g higher placental weight (95% CI: 2.93; 7.11). No associations were found between air pollution and birth weight. Exposure to residential road traffic noise was weakly associated with reduced head circumference, whereas none of the other newborn's size indicators were associated with noise, neither before nor after adjustment for air pollution. CONCLUSIONS This study indicates that air pollution may result in a small reduction in offspring's birth head and abdominal circumference, but not birth weight, whereas traffic noise seems not to affect newborn's size at birth.
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Affiliation(s)
| | | | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Marie Pedersen
- Danish Cancer Society Research Centre, Copenhagen, Denmark
| | | | - Mette Sørensen
- Danish Cancer Society Research Centre, Copenhagen, Denmark
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83
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Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, Silver RM, Wynia K, Ganzevoort W. Consensus definition of fetal growth restriction: a Delphi procedure. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:333-9. [PMID: 26909664 DOI: 10.1002/uog.15884] [Citation(s) in RCA: 859] [Impact Index Per Article: 107.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 02/10/2016] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To determine, by expert consensus, a definition for early and late fetal growth restriction (FGR) through a Delphi procedure. METHOD A Delphi survey was conducted among an international panel of experts on FGR. Panel members were provided with 18 literature-based parameters for defining FGR and were asked to rate the importance of these parameters for the diagnosis of both early and late FGR on a 5-point Likert scale. Parameters were described as solitary parameters (parameters that are sufficient to diagnose FGR, even if all other parameters are normal) and contributory parameters (parameters that require other abnormal parameter(s) to be present for the diagnosis of FGR). Consensus was sought to determine the cut-off values for accepted parameters. RESULTS A total of 106 experts were approached, of whom 56 agreed to participate and entered the first round, and 45 (80%) completed all four rounds. For early FGR (< 32 weeks), three solitary parameters (abdominal circumference (AC) < 3(rd) centile, estimated fetal weight (EFW) < 3(rd) centile and absent end-diastolic flow in the umbilical artery (UA)) and four contributory parameters (AC or EFW < 10(th) centile combined with a pulsatility index (PI) > 95(th) centile in either the UA or uterine artery) were agreed upon. For late FGR (≥ 32 weeks), two solitary parameters (AC or EFW < 3(rd) centile) and four contributory parameters (EFW or AC < 10(th) centile, AC or EFW crossing centiles by > two quartiles on growth charts and cerebroplacental ratio < 5(th) centile or UA-PI > 95(th) centile) were defined. CONCLUSION Consensus-based definitions for early and late FGR, as well as cut-off values for parameters involved, were agreed upon by a panel of experts. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S J Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - I M Beune
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B Thilaganathan
- Department of Obstetrics and Gynaecology, St George's, University of London, London, UK
| | - A Papageorghiou
- Department of Obstetrics and Gynaecology, St George's, University of London, London, UK
| | - A A Baschat
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P N Baker
- College of Medicine, Biological Sciences & Psychology, University of Leicester, Leicester, UK
| | - R M Silver
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - K Wynia
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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84
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Decorin expression is decreased in first trimester placental tissue from pregnancies with small for gestation age infants at birth. Placenta 2016; 45:58-62. [DOI: 10.1016/j.placenta.2016.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/16/2016] [Accepted: 07/25/2016] [Indexed: 11/23/2022]
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85
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Lykkedegn S, Sorensen GL, Beck-Nielsen SS, Pilecki B, Duelund L, Marcussen N, Christesen HT. Vitamin D Depletion in Pregnancy Decreases Survival Time, Oxygen Saturation, Lung Weight and Body Weight in Preterm Rat Offspring. PLoS One 2016; 11:e0155203. [PMID: 27571350 PMCID: PMC5003352 DOI: 10.1371/journal.pone.0155203] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/28/2016] [Indexed: 01/20/2023] Open
Abstract
Animal studies suggest a role of vitamin D in fetal lung development although not studied in preterm animals. We tested the hypothesis that vitamin D depletion aggravates respiratory insufficiency in preterm rat offspring. Furthermore, the effects of vitamin D depletion on growth and lung surfactant were investigated. Female Sprague-Dawley rats were randomly assigned low vitamin D (VDL) or control diet before mating and followed with serum 25-hydroxyvitamin D (s-25(OH)D) determinations. After cesarean section at gestational day 19 (E19) or day 22 (E22), placental weight, birth weight, crown-rump-length (CRL), oxygenation (SaO2) at 30 min and survival time were recorded. The pup lungs were analyzed for phospholipid levels, surfactant protein A-D mRNA and the expression of the vitamin D receptor (VDR). S-25(OH)D was significantly lower in the VDL group at cesarean section (12 vs. 30nmol/L, p<0.0001). Compared to the controls, E19 VDL pups had lower birth weight (2.13 vs. 2.29g, p<0.001), lung weight (0.09 vs. 0.10g, p = 0.002), SaO2(54% vs. 69%, p = 0.002) as well as reduced survival time (0.50 vs. 1.25h, p<0.0001). At E22, the VDL-induced pulmonary differences were leveled out, but VDL pups had lower CRL (4.0 vs. 4.5cm, p<0.0001). The phospholipid levels and the surfactant protein mRNA expression did not differ between the dietary groups. In conclusion, Vitamin D depletion led to lower oxygenation and reduced survival time in the preterm offspring, associated with reduced lung weight and birth weight. Further studies of vitamin D depletion in respiratory insufficiency in preterm neonates are warranted.
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Affiliation(s)
- Sine Lykkedegn
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Grith Lykke Sorensen
- Institute of Molecular Medicine, Department of Cancer and Inflammation, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Signe Sparre Beck-Nielsen
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Bartosz Pilecki
- Institute of Molecular Medicine, Department of Cancer and Inflammation, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lars Duelund
- MEMPHYS, University of Southern Denmark, Odense, Denmark
| | - Niels Marcussen
- Institute of Pathology, Odense University Hospital, Odense, Denmark
| | - Henrik Thybo Christesen
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Clinical Institute, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- * E-mail:
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86
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Disproportion fœto-placentaire à terme : physiologique ou pathologique. ACTA ACUST UNITED AC 2016; 45:502-8. [DOI: 10.1016/j.jgyn.2015.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/30/2015] [Accepted: 06/09/2015] [Indexed: 11/22/2022]
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87
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Niu Z, Xie C, Wen X, Tian F, Yuan S, Jia D, Chen WQ. Potential pathways by which maternal second-hand smoke exposure during pregnancy causes full-term low birth weight. Sci Rep 2016; 6:24987. [PMID: 27126191 PMCID: PMC4850398 DOI: 10.1038/srep24987] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/05/2016] [Indexed: 12/31/2022] Open
Abstract
It is well documented that maternal exposure to second-hand smoke (SHS) during pregnancy causes low birth weight (LBW), but its mechanism remains unknown. This study explored the potential pathways. We enrolled 195 pregnant women who delivered full-term LBW newborns, and 195 who delivered full-term normal birth weight newborns as the controls. After controlling for maternal age, education level, family income, pre-pregnant body mass index, newborn gender and gestational age, logistic regression analysis revealed that LBW was significantly and positively associated with maternal exposure to SHS during pregnancy, lower placental weight, TNF-α and IL-1β, and that SHS exposure was significantly associated with lower placental weight, TNF-α and IL-1β. Structural equation modelling identified two plausible pathways by which maternal exposure to SHS during pregnancy might cause LBW. First, SHS exposure induced the elevation of TNF-α, which might directly increase the risk of LBW by transmission across the placenta. Second, SHS exposure first increased maternal secretion of IL-1β and TNF-α, which then triggered the secretion of VCAM-1; both TNF-α and VCAM-1 were significantly associated with lower placental weight, thus increasing the risk of LBW. In conclusion, maternal exposure to SHS during pregnancy may lead to LBW through the potential pathways of maternal inflammation and lower placental weight.
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Affiliation(s)
- Zhongzheng Niu
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,School of Community and Global Health, Claremont Graduate University, Claremont, CA, USA
| | - Chuanbo Xie
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, USA
| | - Fuying Tian
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shixin Yuan
- Shenzhen Women and Children's Hospital, Shenzhen, China
| | - Deqin Jia
- Foshan Women and Children's Hospital, Foshan, China
| | - Wei-Qing Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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88
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Stanek J, Biesiada J. Clustering and classical analysis of clinical and placental phenotypes in fetal growth restriction and constitutional fetal smallness. Placenta 2016; 42:93-105. [PMID: 27238719 DOI: 10.1016/j.placenta.2016.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 04/04/2016] [Accepted: 04/09/2016] [Indexed: 11/18/2022]
Abstract
This study aims to determine whether placental examination can be used to distinguish between pathologic fetal growth restriction (FGR) and constitutional fetal smallness. Data were extracted from a clinicoplacental database of high risk pregnancies during the period 1994-2013. These data were used to compare the 590 consecutive cases having birth weights below the 10th percentile with the 5201 remaining cases having gestational ages ≥20 weeks. The authors analyzed 20 clinical and 46 placental phenotypes using classical statistics, clustering analysis, and multidimensional scaling. Of the low-birth-weight babies, the following types of cases were compared: Four categories of placental phenotypes (those with features of poor uteroplacental perfusion, postuterine placental pathology, chronic inflammation, and a mixed category) better defined the presumably true FGR than did the clinical phenotypes. Maternal smoking and oligohydramnios were associated with fewer abnormal placental phenotypes than were maternal hypertensive diseases and abnormal Dopplers. Early-onset cases of fetal smallness clustered with placental features of poor uteroplacental perfusion, whereas late onset cases did not. Placental examination helps to retrospectively distinguish constitutionally small fetuses from those that are pathologically growth restricted. The latter correlate best with the clinical risk for FGR and with early-onset FGR. This correlation may have prognostic significance for the child and for future pregnancies, since hypoxic placental lesions can occur without clinical risk factors but with a tendency to recur in future pregnancies.
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Affiliation(s)
- Jerzy Stanek
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.
| | - Jacek Biesiada
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.
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89
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Rosner J, Gupta M, McGill M, Xue X, Chatterjee P, Yoshida-Hay M, Robeson W, Metz C. Magnesium deficiency during pregnancy in mice impairs placental size and function. Placenta 2016; 39:87-93. [DOI: 10.1016/j.placenta.2016.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/23/2015] [Accepted: 01/08/2016] [Indexed: 02/06/2023]
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90
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Strand KM, Andersen GL, Haavaldsen C, Vik T, Eskild A. Association of placental weight with cerebral palsy: population-based cohort study in Norway. BJOG 2015; 123:2131-2138. [DOI: 10.1111/1471-0528.13827] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/27/2022]
Affiliation(s)
- KM Strand
- Department of Laboratory Medicine, Children's and Women's Health; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
| | - GL Andersen
- Department of Laboratory Medicine, Children's and Women's Health; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- The Cerebral Palsy Register of Norway; Habilitation Centre; Vestfold Hospital Trust; Tønsberg Norway
| | - C Haavaldsen
- Department of Obstetrics and Gynecology; Akershus University Hospital; Lørenskog Norway
| | - T Vik
- Department of Laboratory Medicine, Children's and Women's Health; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
| | - A Eskild
- Department of Obstetrics and Gynecology; Akershus University Hospital; Lørenskog Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
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91
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Mir IN, Johnson-Welch SF, Nelson DB, Brown LS, Rosenfeld CR, Chalak LF. Placental pathology is associated with severity of neonatal encephalopathy and adverse developmental outcomes following hypothermia. Am J Obstet Gynecol 2015; 213:849.e1-7. [PMID: 26408082 DOI: 10.1016/j.ajog.2015.09.072] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 08/19/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Although neonatal encephalopathy (NE) due to perinatal asphyxia accounts for a notable proportion of brain injury, the causal pathway remains largely unexplained. We sought to determine the association of placental pathology with: (1) severity of NE in the first 6 hours postnatal, and (2) abnormal neurodevelopmental outcomes (NDO) in neonates requiring hypothermia therapy. STUDY DESIGN This is a retrospective cohort study of neonates ≥36 weeks' gestation born at Parkland Hospital, Dallas, TX, from January 2006 through November 2011 with NE. Placental histology was reviewed and validated by a pediatric pathologist blinded to outcomes. Abnormal NDO was defined as death or Bayley-III score of <85 at 18-24 months of age. RESULTS Of 86,274 neonates ≥36 weeks' gestation, 120 had evidence of a combination of perinatal acidosis and NE. In all, 47 had mild NE and received no treatment, while 73 had moderate (n = 70) or severe (n = 3) NE and received systemic hypothermia. Nine neonates died and all survivors receiving hypothermia had a Bayley-III assessment at 22 ± 7 (SD) months of age. Chorioamnionitis with or without fetal response and patchy/diffuse chronic villitis were found to be independently associated with severity of NE (P < .001). Univariate logistic regression revealed an association with a diagnosis of major placental pathology (odds ratio, 3.5; 95% confidence interval, 1.1-11.4) and abnormal outcomes following cooling. Specifically, diffuse chronic villitis (odds ratio, 9.29; 95% confidence interval, 1.11-77.73) was the only individual predictor of abnormal NDO following hypothermia therapy. CONCLUSION Placental inflammatory villitis appears to be a harbinger of abnormal outcomes in neonates with NE, spanning to the 18-24 month NDO.
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92
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Delforce SJ, Wang Y, Van-Aalst ME, Corbisier de Meaultsart C, Morris BJ, Broughton-Pipkin F, Roberts CT, Lumbers ER, Pringle KG. Effect of oxygen on the expression of renin-angiotensin system components in a human trophoblast cell line. Placenta 2015; 37:1-6. [PMID: 26748156 DOI: 10.1016/j.placenta.2015.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/18/2015] [Accepted: 11/23/2015] [Indexed: 01/22/2023]
Abstract
During the first trimester, normal placental development occurs in a low oxygen environment that is known to stimulate angiogenesis via upregulation of vascular endothelial growth factor (VEGF). Expression of the placental renin-angiotensin system (RAS) is highest in early pregnancy. While the RAS and oxygen both stimulate angiogenesis, how they interact within the placenta is unknown. We postulated that low oxygen increases expression of the proangiogenic RAS pathway and that this is associated with increased VEGF in a first trimester human trophoblast cell line (HTR-8/SVneo). HTR-8/SVneo cells were cultured in one of three oxygen tensions (1%, 5% and 20%). RAS and VEGF mRNA expression were determined by qPCR. Prorenin, angiotensin converting enzyme (ACE) and VEGF protein levels in the supernatant, as well as prorenin and ACE in cell lysates, were measured using ELISAs. Low oxygen significantly increased the expression of both angiotensin II type 1 receptor (AGTR1) and VEGF (both P < 0.05). There was a positive correlation between AGTR1 and VEGF expression at low oxygen (r = 0.64, P < 0.005). Corresponding increases in VEGF protein were observed with low oxygen (P < 0.05). Despite no change in ACE1 mRNA expression, ACE levels in the supernatant increased with low oxygen (1% and 5%, P < 0.05). Expression of other RAS components did not change. Low oxygen increased AGTR1 and VEGF expression, as well as ACE and VEGF protein levels, suggesting that the proangiogenic RAS pathway is activated. This highlights a potential role for the placental RAS in mediating the proangiogenic effects of low oxygen in placental development.
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Affiliation(s)
- Sarah J Delforce
- School of Biomedical Sciences and Pharmacy, Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Yu Wang
- School of Biomedical Sciences and Pharmacy, Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Meg E Van-Aalst
- School of Biomedical Sciences and Pharmacy, Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Celine Corbisier de Meaultsart
- School of Biomedical Sciences and Pharmacy, Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Brian J Morris
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Fiona Broughton-Pipkin
- Department of Obstetrics & Gynaecology, School of Medicine, University of Nottingham, NG5 1PB, UK
| | - Claire T Roberts
- Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Eugenie R Lumbers
- School of Biomedical Sciences and Pharmacy, Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kirsty G Pringle
- School of Biomedical Sciences and Pharmacy, Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.
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93
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Hubinont C, Lewi L, Bernard P, Marbaix E, Debiève F, Jauniaux E. Anomalies of the placenta and umbilical cord in twin gestations. Am J Obstet Gynecol 2015; 213:S91-S102. [PMID: 26428508 DOI: 10.1016/j.ajog.2015.06.054] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 02/08/2023]
Abstract
The frequency of twin gestations has increased over the last few decades, mainly due to maternal age at childbearing, and the use of assisted reproductive technologies. Twins are at higher risk of aneuploidy, structural anomalies, and placental abnormalities. Some of the placental and umbilical cord abnormalities found in twin gestations are nonspecific and can be found in singleton gestations (ie, placenta previa, placental abruption, single umbilical artery, velamentous cord insertion, vasa previa, etc). However, other anomalies are unique to twin gestations, and are mainly associated with monochorionic twins-these include intraplacental anastomosis and cord entanglement. Most of these conditions can be diagnosed with ultrasound. An accurate and early diagnosis is important in the management of twin gestations. Determination of chorionicity, amnionicity, and the identification of placental anomalies are key issues for the adequate management of twin pregnancies. Pathologic placental examination after delivery can help in assessing the presence of placental and umbilical cord abnormalities, as well as providing information about chorionicity and gaining insight into the potential mechanisms of disease affecting twin gestations.
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94
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Kozinszky Z, Surányi A, Péics H, Molnár A, Pál A. Placental Volumetry by 2-D Sonography with a New Mathematical Formula: Prospective Study on the Shell of a Spherical Sector Model. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2252-2258. [PMID: 25959054 DOI: 10.1016/j.ultrasmedbio.2015.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 03/12/2015] [Accepted: 04/06/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to determine the utility of a new mathematical model in volumetric assessment of the placenta using 2-D ultrasound. Placental volumetry was performed in a prospective cross-sectional survey by virtual organ computer-aided analysis (VOCAL) with the help of a shell-off method in 346 uncomplicated pregnancies according to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Furthermore, placental thickness, length and height were measured with the 2-D technique to estimate placental volume based on the mathematical formula for the volume of "the shell of the spherical sector." Fetal size was also assessed by 2-D sonography. The placental volumes measured by 2-D and 3-D techniques had a correlation of 0.86. In the first trimester, the correlation was 0.82, and later during pregnancy, it was 0.86. Placental volumetry using "the circle-shaped shell of the spherical sector" mathematical model with 2-D ultrasound technique may be introduced into everyday practice to screen for placental volume deviations associated with adverse pregnancy outcome.
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Affiliation(s)
- Zoltan Kozinszky
- Reproductive Medicine, Department of Obstetrics and Gynecology, Huddinge Karolinska University Hospital, Stockholm, Sweden.
| | - Andrea Surányi
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Hajnalka Péics
- Faculty of Civil Engineering, University of Novi Sad, Subotica, Serbia
| | - András Molnár
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Attila Pál
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
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95
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Niu Z, Xie C, Wen X, Tian F, Ding P, He Y, Lin J, Yuan S, Guo X, Jia D, Chen WQ. Placenta mediates the association between maternal second-hand smoke exposure during pregnancy and small for gestational age. Placenta 2015; 36:876-80. [DOI: 10.1016/j.placenta.2015.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/22/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
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96
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Pala HG, Artunc-Ulkumen B, Koyuncu FM, Bulbul-Baytur Y. Three-dimensional ultrasonographic placental volume in gestational diabetes mellitus. J Matern Fetal Neonatal Med 2015; 29:610-4. [PMID: 25731652 DOI: 10.3109/14767058.2015.1012066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We aimed to evaluate the placental volume and placental mean gray value in gestational diabetes mellitus (GDM) and healthy placentas using three-dimensional (3D) ultrasound and Virtual Organ Computer-aided AnaLysis (VOCAL). METHODS This case-control prospective study consisted of 39 singleton pregnancies complicated by GDM and 42 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm(3)) was analyzed using the VOCAL imaging analysis program and 3D histogram was used to calculate the volumetric mean gray value (%). RESULTS Placental volume was significantly larger in GDM (411.59 ± 170.82 versus 343.86 ± 128.94 cm(3); p = 0.046). There was no significant difference in mean gray value between GDM and healthy placentas (36.65 ± 7.02 versus 38.71 ± 7.91, respectively; p = 0.277). Placental volume was significantly correlated with gestational week (r = 0.219, p = 0.035) and parity (r = 0.228, p = 0.048). There was negative significant relation between placental volume and umbilical artery systolic/diastolic ratio, pulsatility index and resistance index (r = -0.278, p = 0.007; r = -0.315, p = 0.002; r = -0.322, p = 0.001, respectively). CONCLUSIONS Placental volume increases significantly in GDM, whereas mean gray values do not alter significantly. These data may reflect the placental changes in GDM placentas that may help to understand the pathophysiology better.
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Affiliation(s)
- Halil Gursoy Pala
- a Obstetrics and Gynecology Department, Perinatology Division , Celal Bayar University School of Medicine , Manisa , Turkey
| | - Burcu Artunc-Ulkumen
- a Obstetrics and Gynecology Department, Perinatology Division , Celal Bayar University School of Medicine , Manisa , Turkey
| | - Faik Mumtaz Koyuncu
- a Obstetrics and Gynecology Department, Perinatology Division , Celal Bayar University School of Medicine , Manisa , Turkey
| | - Yesim Bulbul-Baytur
- a Obstetrics and Gynecology Department, Perinatology Division , Celal Bayar University School of Medicine , Manisa , Turkey
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97
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Abstract
The placental lesions classically ascribed to placental hypoxia, here denoted maternal malperfusion (MMP), are among the more significant that a placental pathologist may encounter. Yet the appearance of these lesions may be subtle, and the clinical implication of their diagnosis is frequently unclear. The aim of this review is to provide a more nuanced perspective on the clinical utility of placental pathology for the detection of MMP. The review will first detail MMP lesions in the placenta and discuss their associations with pregnancy complications. The review will then delve into the diagnostic and interpretive difficulties of these lesions. Finally, recent research findings that may aid in the development of better diagnostic tools will be briefly discussed.
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Affiliation(s)
- W Tony Parks
- Department of Pathology, Magee-Women׳s Hospital, University of Pittsburgh School of Medicine, 300 Halket St, Pittsburgh, PA 15213.
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98
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Luque-Fernandez MA, Ananth CV, Jaddoe VWV, Gaillard R, Albert PS, Schomaker M, McElduff P, Enquobahrie DA, Gelaye B, Williams MA. Is the fetoplacental ratio a differential marker of fetal growth restriction in small for gestational age infants? Eur J Epidemiol 2015; 30:331-41. [PMID: 25630563 DOI: 10.1007/s10654-015-9993-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 01/09/2015] [Indexed: 12/28/2022]
Abstract
Higher placental weight relative to birthweight has been described as an adaptive mechanism to fetal hypoxia in small for gestational age (SGA) infants. However, placental weight alone may not be a good marker reflecting intrauterine growth restriction. We hypothesized that fetoplacental ratio (FPR)-the ratio between birthweight and placental weight-may serve as a good marker of SGA after adjustment for surrogates of fetal hypoxemia (maternal iron deficiency anemia, smoking and choriodecidual necrosis). We conducted a within-sibling analysis using data from the US National Collaborative Perinatal Project (1959-1966) of 1,803 women who delivered their first two (or more) consecutive infants at term (n = 3,494). We used variance-component fixed-effect linear regression models to explore the effect of observed time-varying factors on placental weight and conditional logistic regression to estimate the effects of the tertiles of FPRs (1st small, 2nd normal and 3rd large) on the odds of SGA infants. We found placental weights to be 15 g [95 % confidence interval (CI) 8, 23] higher and -7 g (95 % CI -13, -2) lower among women that had anemia and choriodecidual necrosis, respectively. After multivariable adjustment, newborns with a small FPR (1st-tertile ≤7) had twofold higher odds of being SGA (OR 2.0, 95 % CI 1.2, 3.5) than their siblings with a large FPR (3nd-tertile ≥9). A small FPR was associated with higher odds of SGA, suggesting that small FPR may serve as an indicator suggestive of adverse intrauterine environment. This observation may help to distinguish pathological from constitutional SGA.
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Affiliation(s)
- Miguel Angel Luque-Fernandez
- Department of Epidemiology, Harvard T.H. Chan School of Public Health Boston, 677 Huntington Avenue, Boston, MA, 02215, USA,
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99
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Effects of Advanced Maternal Age and Race/Ethnicity on Placental Weight and Placental Weight/Birthweight Ratio in Very Low Birthweight Infants. Matern Child Health J 2015; 19:1553-8. [DOI: 10.1007/s10995-014-1662-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Matsuda Y, Ogawa M, Nakai A, Hayashi M, Satoh S, Matsubara S. Fetal/Placental weight ratio in term Japanese pregnancy: its difference among gender, parity, and infant growth. Int J Med Sci 2015; 12:301-5. [PMID: 25897290 PMCID: PMC4402432 DOI: 10.7150/ijms.11644] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/27/2015] [Indexed: 11/05/2022] Open
Abstract
PURPOSE The "inappropriately heavy placenta" has been considered to be associated with various pregnancy disorders; however, data is scarce what factors affect it. To determine whether the following three affect it; (1) infant gender and mother's parity, (2) growth restriction, and (3) preeclampsia. METHODS We employed fetal/placental weight ratio (F/P). Subjects consisted of 53,650 infants and their placentas from women who vaginally delivered singleton live term infants. First, we examined whether F/P differs among the infant's gender or mother's parity. We classified the population into 4 categories according to gender and parity: male, nulliparous (n=7,431), male, multiparous (n=7,859), female, nulliparous (n=7,559), female, multiparous (n=7,800), and, compared F/P among the four groups. Next, we determined whether F/P differs in "small" or "large" for gestational age (SGA or LGA) infants, compared with appropriate for gestational age infants. Last, we determined whether preeclampsia (representative disorder of SGA) affects F/P. RESULTS (1) F/P significantly differed according to infant gender and parity: female and nulliparity had significantly smaller F/P. F/P was significantly smaller in (2) SGA infants, and (3) infants from preeclamptic mothers. CONCLUSION We for the first time showed that in Japanese term vaginally-delivered singleton population, the following three had significantly smaller F/P than controls thus had "inappropriately heavy placenta": (1) female gender and nulliparity, (2) SGA infants, and (3) infants from preeclamptic mothers. We recommend that these factors should be taken into account in evaluating placental weight. These data may also be useful for further clarifying the fetal-placental pathophysiology in these conditions.
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Affiliation(s)
- Yoshio Matsuda
- 1. Department of Obstetrics and Gynecology, Professor, International University of Health and Welfare Hospital, Professor, 537-3 Iguchi Nasushiobara, Tochigi 329-2763, Japan
| | - Masaki Ogawa
- 2. Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Associate professor, Kawada-cho, 8-1, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Akihito Nakai
- 3. Department of Obstetrics and Gynecology, Tama-Nagayama Hospital, Nippon Medical School, Professor, 1-7-1 Nagayama, Tama-City, Tokyo 206-8512, Japan
| | - Masako Hayashi
- 3. Department of Obstetrics and Gynecology, Tama-Nagayama Hospital, Nippon Medical School, Professor, 1-7-1 Nagayama, Tama-City, Tokyo 206-8512, Japan
| | - Shoji Satoh
- 4. Maternal and Perinatal Care Center, Oita Prefectural Hospital, Director, Bunyo 476, Oita 870-8511, Japan
| | - Shigeki Matsubara
- 5. Department of Obstetrics and Gynecology, Jichi Medical University, Professor, 3311-1 Shimotsuke, Tochigi 329-0498, Japan
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