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Starodubtseva NL, Tokareva AO, Volochaeva MV, Kononikhin AS, Brzhozovskiy AG, Bugrova AE, Timofeeva AV, Kukaev EN, Tyutyunnik VL, Kan NE, Frankevich VE, Nikolaev EN, Sukhikh GT. Quantitative Proteomics of Maternal Blood Plasma in Isolated Intrauterine Growth Restriction. Int J Mol Sci 2023; 24:16832. [PMID: 38069155 PMCID: PMC10706154 DOI: 10.3390/ijms242316832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
Intrauterine growth restriction (IUGR) remains a significant concern in modern obstetrics, linked to high neonatal health problems and even death, as well as childhood disability, affecting adult quality of life. The role of maternal and fetus adaptation during adverse pregnancy is still not completely understood. This study aimed to investigate the disturbance in biological processes associated with isolated IUGR via blood plasma proteomics. The levels of 125 maternal plasma proteins were quantified by liquid chromatography-multiple reaction monitoring mass spectrometry (LC-MRM MS) with corresponding stable isotope-labeled peptide standards (SIS). Thirteen potential markers of IUGR (Gelsolin, Alpha-2-macroglobulin, Apolipoprotein A-IV, Apolipoprotein B-100, Apolipoprotein(a), Adiponectin, Complement C5, Apolipoprotein D, Alpha-1B-glycoprotein, Serum albumin, Fibronectin, Glutathione peroxidase 3, Lipopolysaccharide-binding protein) were found to be inter-connected in a protein-protein network. These proteins are involved in plasma lipoprotein assembly, remodeling, and clearance; lipid metabolism, especially cholesterol and phospholipids; hemostasis, including platelet degranulation; and immune system regulation. Additionally, 18 proteins were specific to a particular type of IUGR (early or late). Distinct patterns in the coagulation and fibrinolysis systems were observed between isolated early- and late-onset IUGR. Our findings highlight the complex interplay of immune and coagulation factors in IUGR and the differences between early- and late-onset IUGR and other placenta-related conditions like PE. Understanding these mechanisms is crucial for developing targeted interventions and improving outcomes for pregnancies affected by IUGR.
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Affiliation(s)
- Natalia L. Starodubtseva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, 117997 Moscow, Russia; (A.O.T.); (M.V.V.); (A.S.K.); (A.G.B.); (A.E.B.); (A.V.T.); (E.N.K.); (V.L.T.); (N.E.K.); (V.E.F.); (G.T.S.)
- Moscow Institute of Physics and Technology, 141700 Moscow, Russia
| | - Alisa O. Tokareva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, 117997 Moscow, Russia; (A.O.T.); (M.V.V.); (A.S.K.); (A.G.B.); (A.E.B.); (A.V.T.); (E.N.K.); (V.L.T.); (N.E.K.); (V.E.F.); (G.T.S.)
| | - Maria V. Volochaeva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, 117997 Moscow, Russia; (A.O.T.); (M.V.V.); (A.S.K.); (A.G.B.); (A.E.B.); (A.V.T.); (E.N.K.); (V.L.T.); (N.E.K.); (V.E.F.); (G.T.S.)
| | - Alexey S. Kononikhin
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, 117997 Moscow, Russia; (A.O.T.); (M.V.V.); (A.S.K.); (A.G.B.); (A.E.B.); (A.V.T.); (E.N.K.); (V.L.T.); (N.E.K.); (V.E.F.); (G.T.S.)
| | - Alexander G. Brzhozovskiy
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, 117997 Moscow, Russia; (A.O.T.); (M.V.V.); (A.S.K.); (A.G.B.); (A.E.B.); (A.V.T.); (E.N.K.); (V.L.T.); (N.E.K.); (V.E.F.); (G.T.S.)
| | - Anna E. Bugrova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, 117997 Moscow, Russia; (A.O.T.); (M.V.V.); (A.S.K.); (A.G.B.); (A.E.B.); (A.V.T.); (E.N.K.); (V.L.T.); (N.E.K.); (V.E.F.); (G.T.S.)
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 119334 Moscow, Russia
| | - Angelika V. Timofeeva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, 117997 Moscow, Russia; (A.O.T.); (M.V.V.); (A.S.K.); (A.G.B.); (A.E.B.); (A.V.T.); (E.N.K.); (V.L.T.); (N.E.K.); (V.E.F.); (G.T.S.)
| | - Evgenii N. Kukaev
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, 117997 Moscow, Russia; (A.O.T.); (M.V.V.); (A.S.K.); (A.G.B.); (A.E.B.); (A.V.T.); (E.N.K.); (V.L.T.); (N.E.K.); (V.E.F.); (G.T.S.)
- V.L. Talrose Institute for Energy Problems of Chemical Physics, N.N. Semenov Federal Research Center for Chemical Physics, Russian Academy of Sciences, 119334 Moscow, Russia
| | - Victor L. Tyutyunnik
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, 117997 Moscow, Russia; (A.O.T.); (M.V.V.); (A.S.K.); (A.G.B.); (A.E.B.); (A.V.T.); (E.N.K.); (V.L.T.); (N.E.K.); (V.E.F.); (G.T.S.)
| | - Natalia E. Kan
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, 117997 Moscow, Russia; (A.O.T.); (M.V.V.); (A.S.K.); (A.G.B.); (A.E.B.); (A.V.T.); (E.N.K.); (V.L.T.); (N.E.K.); (V.E.F.); (G.T.S.)
| | - Vladimir E. Frankevich
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, 117997 Moscow, Russia; (A.O.T.); (M.V.V.); (A.S.K.); (A.G.B.); (A.E.B.); (A.V.T.); (E.N.K.); (V.L.T.); (N.E.K.); (V.E.F.); (G.T.S.)
- Laboratory of Translational Medicine, Siberian State Medical University, 634050 Tomsk, Russia
| | - Evgeny N. Nikolaev
- V.L. Talrose Institute for Energy Problems of Chemical Physics, N.N. Semenov Federal Research Center for Chemical Physics, Russian Academy of Sciences, 119334 Moscow, Russia
| | - Gennady T. Sukhikh
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, 117997 Moscow, Russia; (A.O.T.); (M.V.V.); (A.S.K.); (A.G.B.); (A.E.B.); (A.V.T.); (E.N.K.); (V.L.T.); (N.E.K.); (V.E.F.); (G.T.S.)
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152
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Abella L, D'Adamo E, Strozzi M, Botondi V, Abella E, Cassinari M, Mazzucco L, Maconi A, Testa M, Zanelli C, Patacchiola R, Librandi M, Osmelli J, Carabotta M, Chiarelli F, Gazzolo D. Early changes in S100B maternal blood levels can predict fetal intrauterine growth restriction. Clin Chem Lab Med 2023; 61:2205-2211. [PMID: 37366015 DOI: 10.1515/cclm-2023-0294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Intrauterine growth restriction (IUGR) represents one of the main causes of perinatal mortality and morbidity. Nowadays, IUGR early diagnosis is mandatory in order to limit the occurrence of multiorgan failure, especially the brain. Therefore, we investigated whether longitudinal S100B assessment in maternal blood could be a trustable predictor of IUGR. METHODS We conducted a prospective study in 480 pregnancies (IUGR: n=40; small for gestational age, SGA: n=40; controls: n=400) in whom S100B was measured at three predetermined monitoring time-points (T1: 8-18 GA; T2: 19-23 GA; T3: 24-28 GA). RESULTS Lower S100B in IUGR fetuses than SGA and controls (p<0.05, for all) at T1-T3. Receiver operating characteristic curve showed that S100B at T1 was the best predictor of IUGR (sensitivity: 100 %; specificity: 81.4 %) than T2, T3. CONCLUSIONS The early lower S100B concentration in pregnant women lately complicated by IUGR support the notion that non-invasive early IUGR diagnosis and monitoring is becoming feasible. Results open the way to further studies aimed at diagnosing and monitoring fetal/maternal diseases at earliest time.
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Affiliation(s)
| | - Ebe D'Adamo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | - Mariachiara Strozzi
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Valentina Botondi
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | | | - Maurizio Cassinari
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Laura Mazzucco
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Antonio Maconi
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Michela Testa
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Cristian Zanelli
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | | | | | - Jacopo Osmelli
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Maura Carabotta
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | | | - Diego Gazzolo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
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153
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Collée J, Noel L, Seidel L, Chantraine F, Nisolle M, Henry L. Impact of Assisted Reproduction Techniques on Adverse Maternal Outcomes and on the Rate of Hospitalization in Maternal Intensive Care. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2030. [PMID: 38004079 PMCID: PMC10672995 DOI: 10.3390/medicina59112030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
Background and Objective: The aim of this retrospective cohort study is to evaluate the impact of assisted reproductive treatment (ART) on adverse maternal outcomes and the rate of hospitalization in maternal intensive care (MIC) in a tertiary university center in Liege, Belgium. Materials and Methods: This is a retrospective cohort study comparing two groups, 6557 patients who achieved pregnancy spontaneously and 330 patients who achieved pregnancy after ART, between January 2020 and December 2022. These patients were followed in the academic obstetrics department of Citadelle Hospital, Liège. The database of the ART center was compared with the database of the delivery unit to determine the cohort of patients who conceived after ART. Adverse maternal outcomes and MIC hospitalization rates were compared with between spontaneous pregnancies and ART groups. ART groups were also compared with each other. Results: The rate of hospitalization in maternal intensive care for patients who achieved pregnancy spontaneously was 12.1%, compared to 17.3% after ART. Comparing the rate of pre-eclampsia, 3.5% of spontaneous pregnancies were complicated by pre-eclampsia, while after ART, 10.9% of patients developed this complication during pregnancy. This rate was higher after IVF (12%) compared to intrauterine insemination and particularly after frozen embryo transfer (FET) in artificial cycle (17.9%). The birthweight of newborns after ART was also analyzed. A significant difference was obtained when comparing fresh embryo transfer with FET. Conclusions: Our study confirmed that FET in artificial cycle is a risk factor for pre-eclampsia and that fresh embryo transfer is associated with a higher rate of newborns with a lower percentile of birthweight. Our data showed that the rate of MIC hospitalization was significantly higher after ART but did not differ between groups.
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Affiliation(s)
- Julie Collée
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Liège, Citadelle Hospital, Boulevard du 12ème de Ligne 1, 4000 Liege, Belgium (L.H.)
- Center for Reproductive Medicine, University of Liège, Citadelle Hospital, Boulevard du 12ème de Ligne 1, 4000 Liege, Belgium
| | - Laure Noel
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Liège, Citadelle Hospital, Boulevard du 12ème de Ligne 1, 4000 Liege, Belgium (L.H.)
| | - Laurence Seidel
- Department of Statistical Analysis, University of Liège (ULiège), 4000 Liege, Belgium
| | - Frédéric Chantraine
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Liège, Citadelle Hospital, Boulevard du 12ème de Ligne 1, 4000 Liege, Belgium (L.H.)
| | - Michelle Nisolle
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Liège, Citadelle Hospital, Boulevard du 12ème de Ligne 1, 4000 Liege, Belgium (L.H.)
| | - Laurie Henry
- Obstetrics and Gynecology Department, Centre Hospitalier Universitaire de Liège, Citadelle Hospital, Boulevard du 12ème de Ligne 1, 4000 Liege, Belgium (L.H.)
- Center for Reproductive Medicine, University of Liège, Citadelle Hospital, Boulevard du 12ème de Ligne 1, 4000 Liege, Belgium
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154
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Wang T, Chen B, Luo M, Xie L, Lu M, Lu X, Zhang S, Wei L, Zhou X, Yao B, Wang H, Xu D. Microbiota-indole 3-propionic acid-brain axis mediates abnormal synaptic pruning of hippocampal microglia and susceptibility to ASD in IUGR offspring. MICROBIOME 2023; 11:245. [PMID: 37932832 PMCID: PMC10629055 DOI: 10.1186/s40168-023-01656-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/23/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) has been associated with intrauterine growth restriction (IUGR), but the underlying mechanisms are unclear. RESULTS We found that the IUGR rat model induced by prenatal caffeine exposure (PCE) showed ASD-like symptoms, accompanied by altered gut microbiota and reduced production of indole 3-propionic acid (IPA), a microbiota-specific metabolite and a ligand of aryl hydrocarbon receptor (AHR). IUGR children also had a reduced serum IPA level consistent with the animal model. We demonstrated that the dysregulated IPA/AHR/NF-κB signaling caused by disturbed gut microbiota mediated the hippocampal microglia hyperactivation and neuronal synapse over-pruning in the PCE-induced IUGR rats. Moreover, postnatal IPA supplementation restored the ASD-like symptoms and the underlying hippocampal lesions in the IUGR rats. CONCLUSIONS This study suggests that the microbiota-IPA-brain axis regulates ASD susceptibility in PCE-induced IUGR offspring, and supplementation of microbiota-derived IPA might be a promising interventional strategy for ASD with a fetal origin. Video Abstract.
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Affiliation(s)
- Tingting Wang
- Department of Obstetrics, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Beidi Chen
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, 100191, China
| | - Mingcui Luo
- Department of Obstetrics, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Lulu Xie
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430071, China
| | - Mengxi Lu
- Department of Obstetrics, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Xiaoqian Lu
- Department of Pharmacology, Taikang Medical School (School of Basic Medical Sciences), Wuhan University, Wuhan, 430071, China
| | - Shuai Zhang
- Department of Obstetrics, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Liyi Wei
- Department of Obstetrics, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Xinli Zhou
- Department of Pharmacology, Taikang Medical School (School of Basic Medical Sciences), Wuhan University, Wuhan, 430071, China
| | - Baozhen Yao
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430071, China
| | - Hui Wang
- Department of Pharmacology, Taikang Medical School (School of Basic Medical Sciences), Wuhan University, Wuhan, 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan, 430071, China
| | - Dan Xu
- Department of Obstetrics, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China.
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan, 430071, China.
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155
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Hurtado I, Bonacina E, Garcia-Manau P, Serrano B, Armengol-Alsina M, Mendoza M, Maiz N, Carreras E. Usefulness of angiogenic factors in prenatal counseling of late-onset fetal growth-restricted and small-for-gestational-age gestations: a prospective observational study. Arch Gynecol Obstet 2023; 308:1485-1495. [PMID: 36401095 DOI: 10.1007/s00404-022-06833-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/19/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To create a predictive model including biomarkers and evaluate its ability to predict adverse perinatal outcomes in late-onset small fetuses, ultimately helping to provide individualized counseling at the time of diagnosis. METHODS This was a prospective observational study, including singleton pregnancies with an estimated fetal weight (EFW) below the 10th percentile, at a gestational age between 32 + 0 and 36 + 6 weeks of gestation (WG). Variables recorded at diagnosis to predict adverse pregnancy outcomes were: soluble fms-like tyrosine-kinase-1 to placental growth factor ratio (sFlt-1/PlGF), fetal Doppler (umbilical artery and middle cerebral artery), uterine artery pulsatility index (UtAPI), EFW percentile, gestational age, and the presence of maternal risk factors for placental insufficiency. Logistic regression models were developed for the prediction of three co-primary outcomes: composite adverse perinatal outcomes (APO), and the need for elective delivery before 35 or 37 WG. RESULTS Sixty (52.2%) fetal growth restricted (FGR) and 55 (47.8%) small for gestational age (SGA) were enrolled. Thirteen (11.3%) women needed elective delivery before 35 WG and 27 (23.5%) women before 37 WG. At least one APO occurred in 43 (37.4%) pregnancies. The best marker in univariate analyses was the sFlt-1/PlGF ratio [AUC = 0.932 (95% CI, 0.864-0.999)]. The multivariate model including sFlt-1/PlGF showed a better predictive performance for APO than the multivariate model without sFlt-1/PlGF (P < 0.024). CONCLUSIONS sFlt-1/PlGF is a good predictor of APO at the time of late-onset FGR/SGA diagnosis. Our predictive models may be useful to provide early individualized prenatal counseling in this group of women. Further studies are needed to validate these preliminary findings in a larger cohort.
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Affiliation(s)
- Ivan Hurtado
- Department of Obstetrics, Maternal Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Erika Bonacina
- Department of Obstetrics, Maternal Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Pablo Garcia-Manau
- Department of Obstetrics, Maternal Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Berta Serrano
- Department of Obstetrics, Maternal Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Mireia Armengol-Alsina
- Department of Obstetrics, Maternal Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Manel Mendoza
- Department of Obstetrics, Maternal Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Nerea Maiz
- Department of Obstetrics, Maternal Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Elena Carreras
- Department of Obstetrics, Maternal Fetal Medicine Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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156
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Oyang M, Piscopo BR, Zahra V, Malhotra A, Sutherland AE, Sehgal A, Hooper SB, Miller SL, Polglase GR, Allison BJ. Cardiovascular responses to mild perinatal asphyxia in growth-restricted preterm lambs. Am J Physiol Heart Circ Physiol 2023; 325:H1081-H1087. [PMID: 37656131 PMCID: PMC10908401 DOI: 10.1152/ajpheart.00485.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/02/2023]
Abstract
Growth-restricted neonates have worse outcomes after perinatal asphyxia, with more severe metabolic acidosis than appropriately grown neonates. The cardiovascular physiology associated with fetal growth restriction (FGR) may alter their response to asphyxia. However, research on asphyxia in FGR is limited. Here we compared cardiovascular hemodynamics in preterm FGR and control lambs during mild perinatal asphyxia. We induced FGR in one twin at 89 days gestation (term 148 days), while the other served as a control. At 126 days gestation, lambs were instrumented to allow arterial blood pressure and regional blood flow recording, and then mild perinatal asphyxia was induced by umbilical cord clamping, and resuscitation followed neonatal guidelines. FGR lambs maintained carotid blood flow (CBF) for 7 min, while control lambs rapidly decreased CBF (P < 0.05). Fewer growth-restricted lambs needed chest compressions for return of spontaneous circulation (ROSC) (17 vs. 83%, P = 0.02). The extent of blood pressure overshoot after ROSC was similar, but it took longer for MAP to return to baseline in FGR lambs (18.83 ± 0.00 vs. 47.67 ± 0.00 min, P = 0.003). Growth-restricted lambs had higher CBF after ROSC (P < 0.05) and displayed CBF overshoot, unlike control lambs (P < 0.03). In conclusion, preterm growth-restricted lambs show resilience during perinatal asphyxia based on prolonged CBF maintenance and reduced need for chest compressions during resuscitation. However, CBF overshoot after ROSC may increase the risk of cerebrovascular injury in FGR.NEW & NOTEWORTHY Preterm growth-restricted lambs maintain carotid blood flow for longer than control lambs during asphyxia and have a lower requirement for chest compressions than control lambs during resuscitation. Preterm growth-restricted, but not control, lambs displayed an overshoot in carotid blood flow following return of spontaneous circulation.
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Affiliation(s)
- Matthew Oyang
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Beth R Piscopo
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Valerie Zahra
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Atul Malhotra
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Amy E Sutherland
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Arvind Sehgal
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Beth J Allison
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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157
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Powel JE, Chavan NR, Tomlinson TM. Fetal growth restriction or small for gestational age? Consideration of biometry alone and criteria performance. Am J Obstet Gynecol 2023; 229:571-572. [PMID: 37290566 DOI: 10.1016/j.ajog.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Jennifer E Powel
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ
| | - Niraj R Chavan
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology & Women's Health, Saint Louis University School of Medicine, 6420 Clayton Rd, Ste 2800, St. Louis, MO 63117
| | - Tracy M Tomlinson
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology & Women's Health, Saint Louis University School of Medicine, 6420 Clayton Rd, Ste 2800, St. Louis, MO 63117.
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Verspyck E, Thill C, Ego A, Machevin E, Brasseur-Daudruy M, Ickowicz V, Blondel C, Degré S, Lefebure A, Braund S, Benichou J. Screening for small for gestational age infants in early vs late third-trimester ultrasonography: a randomized trial. Am J Obstet Gynecol MFM 2023; 5:101162. [PMID: 37717697 DOI: 10.1016/j.ajogmf.2023.101162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/01/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Recent studies have demonstrated that a routine third-trimester ultrasound scan may improve the detection of small for gestational age infants when compared with clinically indicated ultrasound scans but with no reported reduction in severe perinatal morbidity. Establishing the optimal gestational age for the third-trimester examination necessitates evaluation of the ability to detect small for gestational age infants and to predict maternal and perinatal outcomes. Intrauterine growth restriction most often corresponds with small for gestational age infants associated with pathologic growth patterns. OBJECTIVE This study aimed to assess the performance of routine early ultrasound scans vs late ultrasound scans during the third trimester of pregnancy to identify small for gestational age infants and fetuses with intrauterine growth restriction. STUDY DESIGN This was an open-label, randomized, parallel trial conducted in Upper Normandy, France, from 2012 to 2015. The study eligibility criteria were heathy, nulliparous women older than 18 years with gestational age determined using the crown-rump length at the first trimester routine scan and with no fetal malformation or suspected small for gestational age fetus at the routine second trimester scan. Pregnant women were randomly assigned to a third-trimester scan group at 31 weeks gestational age ±6 days (early ultrasound scan) or at 35 weeks gestational age ±6 days (late ultrasound scan). The primary outcome of this trial was the ability of a third trimester scan to predict small for gestational age infants (customized birth weight <10th percentile) and intrauterine growth restriction (customized birth weight RESULTS Results from 1853 women assigned to the early ultrasound scan group and 1848 women assigned to the late ultrasound scan group were analyzed. The sensitivity was found to be higher in the late ultrasound scan group than in the early ultrasound scan group, both for identifying small for gestational age infants (27%; 22%-32% vs 17%; 13%-22%; P=.004) and intrauterine growth restriction (44%; 35%-54% vs 18%; 11%-27%; P<.001). There was little difference in the specificity between the late ultrasound scan and early ultrasound scan groups in identifying cases of small for gestational age (97%; 96%-98% and 98%; 97%-99%, respectively; P=.04) and intrauterine growth restriction (96%; 95%-97% and 97%; 96%;-97%, respectively; P=.24). Overall, the maternal and neonatal outcomes were comparable between the early ultrasound scan and late ultrasound scan groups with the exception of additional (at least 1) ultrasound scans performed (25% in the early ultrasound scan group vs 19% in the late ultrasound scan group; P<.001). Rates of perinatal death (0.4% vs 0.8%; P=.12) and adverse perinatal outcomes (1.8% vs 2.7%; P=.08) were comparable between the early ultrasound scan and late ultrasound scan assigned groups, and the overall sensitivity to detect small for gestational age infants and intrauterine growth restriction, including in the last ultrasound scan performed before delivery, were also similar (30%; 25%-36% vs 26%; 21%-31%; P=.23; and 50%; 40%-60% vs 38%; 28%-48%; P=.07). CONCLUSION A late ultrasound scan performed in the third trimester increases the probability of detecting small for gestational age infants and intrauterine growth restriction with fewer additional scans reported than for the early ultrasound scan group. The overall perinatal outcome risk was comparable between the 2 groups. However, the overall sensitivity for detecting small for gestational age fetuses and intrauterine growth restriction, including in the last ultrasound scan performed before delivery, remains comparable between the late ultrasound scan and early ultrasound scan groups.
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Affiliation(s)
- Eric Verspyck
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France (Drs Verspyck, Brasseur-Daudruy, Braund, and Benichou).
| | - Caroline Thill
- Department of Biostatistics, Rouen University Hospital, Rouen, France (Dr Thill)
| | - Anne Ego
- University Grenoble Alpes, CNRS, Public Health Department CHU Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG, 38000 Grenoble, France (Dr Ego); INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA, Paris Descartes University, Paris, France (Dr Ego)
| | - Elise Machevin
- Department of Obstetrics and Gynecology, Evreux Hospital, Evreux, France (Dr Machevin)
| | - Marie Brasseur-Daudruy
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France (Drs Verspyck, Brasseur-Daudruy, Braund, and Benichou)
| | - Valentine Ickowicz
- Department of Obstetrics and Gynecology, Belvedere Hospital, Mont Saint Aignan, France (Dr Ickowicz)
| | - Caroline Blondel
- Department of Obstetrics and Gynecology, Mathilde Private Clinic, Rouen, France (Dr Blondel)
| | - Sophie Degré
- Department of Obstetrics and Gynecology, Le Havre Hospital, Le Havre, France (Dr Degré)
| | - Anne Lefebure
- Department of Obstetrics and Gynecology, Elbeuf Hospital, Elbeuf, France (Dr Lefebure)
| | - Sophia Braund
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France (Drs Verspyck, Brasseur-Daudruy, Braund, and Benichou)
| | - Jacques Benichou
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France (Drs Verspyck, Brasseur-Daudruy, Braund, and Benichou); Inserm U1018, University of Rouen and University Paris-Saclay, Rouen, France (Dr Benichou); Department of Biostatistics, Rouen University Hospital, Rouen, France (Dr Benichou)
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Lingam I, Okell J, Maksym K, Spencer R, Peebles D, Buquis G, Ambler G, Morsing E, Ley D, Singer D, Tenorio V, Dyer J, Ginsberg Y, Weissbach T, Huertas-Ceballos A, Marlow N, David A. Neonatal outcomes following early fetal growth restriction: a subgroup analysis of the EVERREST study. Arch Dis Child Fetal Neonatal Ed 2023; 108:599-606. [PMID: 37185272 DOI: 10.1136/archdischild-2022-325285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To quantify the risks of mortality, morbidity and postnatal characteristics associated with extreme preterm fetal growth restriction (EP-FGR). DESIGN The EVERREST (Do e s v ascular endothelial growth factor gene therapy saf e ly imp r ove outcome in seve r e e arly-onset fetal growth re st riction?) prospective multicentre study of women diagnosed with EP-FGR (singleton, estimated fetal weight (EFW) <3rd percentile, <600 g, 20+0-26+6 weeks of gestation). The UK subgroup of EP-FGR infants (<36 weeks) were sex-matched and gestation-matched to appropriate for age (AGA) infants born in University College London Hospital (1:2 design, EFW 25th-75th percentile). SETTING Four tertiary perinatal units (UK, Germany, Spain, Sweden). MAIN OUTCOMES Antenatal and postnatal mortality, bronchopulmonary dysplasia (BPD), sepsis, surgically treated necrotising enterocolitis (NEC), treated retinopathy of prematurity (ROP). RESULTS Of 135 mothers recruited with EP-FGR, 42 had a stillbirth or termination of pregnancy (31%) and 93 had live births (69%). Postnatal genetic abnormalities were identified in 7/93 (8%) live births. Mean gestational age at birth was 31.4 weeks (SD 4.6). 54 UK-born preterm EP-FGR infants (<36 weeks) were matched to AGA controls. EP-FGR was associated with increased BPD (43% vs 26%, OR 3.6, 95% CI 1.4 to 9.4, p=0.01), surgical NEC (6% vs 0%, p=0.036) and ROP treatment (11% vs 0%, p=0.001). Mortality was probably higher among FGR infants (9% vs 2%, OR 5.0, 95% CI 1.0 to 25.8, p=0.054). FGR infants more frequently received invasive ventilation (65% vs 50%, OR 2.6, 95% CI 1.1 to 6.1, p=0.03), took longer to achieve full feeds and had longer neonatal stays (median difference 6.1 days, 95% CI 3.8 to 8.9 and 19 days, 95% CI 9 to 30 days, respectively, p<0.0001). CONCLUSIONS Mortality following diagnosis of EP-FGR is high. Survivors experience increased neonatal morbidity compared with AGA preterm infants. TRIAL REGISTRATION NUMBER NCT02097667.
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Affiliation(s)
- Ingran Lingam
- EGA Institute for Women's Health, University College London, London, UK
- Woodland Neonatal Unit, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK
| | - Jade Okell
- EGA Institute for Women's Health, University College London, London, UK
| | - Katarzyna Maksym
- EGA Institute for Women's Health, University College London, London, UK
| | - Rebecca Spencer
- EGA Institute for Women's Health, University College London, London, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Donald Peebles
- Neonatal Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | - Gina Buquis
- EGA Institute for Women's Health, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Eva Morsing
- Department of Paediatrics, Lund University, Lund, Sweden
| | - David Ley
- Department of Paediatrics, Lund University, Lund, Sweden
| | - Dominique Singer
- Division of Neonatology and Pediatric Critical Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Violeta Tenorio
- Institut D'Investigacions Biomèdiques August Pi í Sunyer, University of Barcelona, Barcelona, Spain
| | - Jade Dyer
- EGA Institute for Women's Health, University College London, London, UK
| | - Yuval Ginsberg
- EGA Institute for Women's Health, University College London, London, UK
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Tal Weissbach
- EGA Institute for Women's Health, University College London, London, UK
- Institute of Obstetrical and Gynecological Imaging, Diagnostic Ultrasound Unit, Sheba Medical Center, Tel-Hashomer, Israel
| | - Angela Huertas-Ceballos
- Neonatal Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil Marlow
- EGA Institute for Women's Health, University College London, London, UK
| | - Anna David
- EGA Institute for Women's Health, University College London, London, UK
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Yakoub N, Reinelt T, Natalucci G. Behavioural outcomes of children born with intrauterine growth restriction: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e074417. [PMID: 37914302 PMCID: PMC10626825 DOI: 10.1136/bmjopen-2023-074417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/30/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Intrauterine growth restriction (IUGR) is a pregnancy condition, which is associated with poor perinatal outcomes and long-term neurodevelopmental impairment. Several studies also investigated the impact of IUGR on child behaviour (eg, internalising and externalising behaviour, social competencies). However, so far, no systematic review or meta-analysis has been conducted that summarises these effects while considering relevant third variables such as type of IUGR diagnosis and control group, or concurrent cognitive abilities. The objective of this study is to summarise the current evidence regarding the relationship between IUGR and behavioural outcomes from early childhood to young adulthood. Additionally, to explore how third variables such as type of control group, or cognitive abilities, relate to this association. METHODS Search strategy: The following electronic databases will be searched-Web of Science, Medline Ovid, PsycInfo, Cochrane Library, Scopus and Embase. INCLUSION CRITERIA observational (eg, cohort studies and case-control studies) and intervention studies (if standard care is used and norm values are reported for the control group) will be included if they quantitatively compare children with and without IUGR from the age of 2 to 18 years. The main outcomes are internalising and externalising behaviour, and social competencies. ETHICS AND DISSEMINATION No ethics approval was necessary for this protocol. Dissemination of findings will be done by publishing the results in peer-reviewed journals. The results of this systematic review will provide guidance for practice and counselling for clinicians and therapists facing patients affected by IUGR and their families. PROSPERO REGISTRATION NUMBER CRD42022347467.
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Affiliation(s)
- Ninib Yakoub
- Family Larsson-Rosenquist Foundation Center for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tilman Reinelt
- Family Larsson-Rosenquist Foundation Center for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giancarlo Natalucci
- Family Larsson-Rosenquist Foundation Center for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Mylrea-Foley B, Napolitano R, Gordijn S, Wolf H, Lees CC, Stampalija T. Do differences in diagnostic criteria for late fetal growth restriction matter? Am J Obstet Gynecol MFM 2023; 5:101117. [PMID: 37544409 DOI: 10.1016/j.ajogmf.2023.101117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Criteria for diagnosis of fetal growth restriction differ widely according to national and international guidelines, and further heterogeneity arises from the use of different biometric and Doppler reference charts, making the diagnosis of fetal growth restriction highly variable. OBJECTIVE This study aimed to compare fetal growth restriction definitions between Delphi consensus and Society for Maternal-Fetal Medicine definitions, using different standards/charts for fetal biometry and different reference ranges for Doppler velocimetry parameters. STUDY DESIGN From the TRUFFLE 2 feasibility study (856 women with singleton pregnancy at 32+0 to 36+6 weeks of gestation and at risk of fetal growth restriction), we selected 564 women with available mid-pregnancy biometry. For the comparison, we used standards/charts for estimated fetal weight and abdominal circumference from Hadlock, INTERGROWTH-21st, and GROW and Chitty. Percentiles for umbilical artery pulsatility index and its ratios with middle cerebral artery pulsatility index were calculated using Arduini and Ebbing reference charts. Sensitivity and specificity for low birthweight and adverse perinatal outcome were evaluated. RESULTS Different combinations of definitions and reference charts identified substantially different proportions of fetuses within our population as having fetal growth restriction, varying from 38% (with Delphi consensus definition, INTERGROWTH-21st biometric standards, and Arduini Doppler reference ranges) to 93% (with Society for Maternal-Fetal Medicine definition and Hadlock biometric standards). None of the different combinations tested appeared effective, with relative risk for birthweight <10th percentile between 1.4 and 2.1. Birthweight <10th percentile was observed most frequently when selection was made with the GROW/Chitty charts, slightly less with the Hadlock standard, and least frequently with the INTERGROWTH-21st standard. Using the Ebbing Doppler reference ranges resulted in a far higher proportion identified as having fetal growth restriction compared with the Arduini Doppler reference ranges, whereas Delphi consensus definition with Ebbing Doppler reference ranges produced similar results to those of the Society for Maternal-Fetal Medicine definition. Application of Delphi consensus definition with Arduini Doppler reference ranges was significantly associated with adverse perinatal outcome, with any biometric standards/charts. The Society for Maternal-Fetal Medicine definition could not accurately detect adverse perinatal outcome irrespective of estimated fetal weight standard/chart used. CONCLUSION Different combinations of fetal growth restriction definitions, biometry standards/charts, and Doppler reference ranges identify different proportions of fetuses with fetal growth restriction. The difference in adverse perinatal outcome may be modest, but can have a significant impact in terms of rate of intervention.
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Affiliation(s)
- Bronacha Mylrea-Foley
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom (Drs Mylrea-Foley and Lees); Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (Drs Mylrea-Foley and Lees)
| | - Raffaele Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom (Dr Napolitano); Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom (Dr Napolitano)
| | - Sanne Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (Dr Gordijn)
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands (Dr Wolf)
| | - Christoph C Lees
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom (Drs Mylrea-Foley and Lees); Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (Drs Mylrea-Foley and Lees).
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy (Dr Stampalija); Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy (Dr Stampalija)
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Ahmadzadeh E, Polglase GR, Stojanovska V, Herlenius E, Walker DW, Miller SL, Allison BJ. Does fetal growth restriction induce neuropathology within the developing brainstem? J Physiol 2023; 601:4667-4689. [PMID: 37589339 PMCID: PMC10953350 DOI: 10.1113/jp284191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
Fetal growth restriction (FGR) is a complex obstetric issue describing a fetus that does not reach its genetic growth potential. The primary cause of FGR is placental dysfunction resulting in chronic fetal hypoxaemia, which in turn causes altered neurological, cardiovascular and respiratory development, some of which may be pathophysiological, particularly for neonatal life. The brainstem is the critical site of cardiovascular, respiratory and autonomic control, but there is little information describing how chronic hypoxaemia and the resulting FGR may affect brainstem neurodevelopment. This review provides an overview of the brainstem-specific consequences of acute and chronic hypoxia, and what is known in FGR. In addition, we discuss how brainstem structural alterations may impair functional control of the cardiovascular and respiratory systems. Finally, we highlight the clinical and translational findings of the potential roles of the brainstem in maintaining cardiorespiratory adaptation in the transition from fetal to neonatal life under normal conditions and in response to the pathological environment that arises during development in growth-restricted infants. This review emphasises the crucial role that the brainstem plays in mediating cardiovascular and respiratory responses during fetal and neonatal life. We assess whether chronic fetal hypoxaemia might alter structure and function of the brainstem, but this also serves to highlight knowledge gaps regarding FGR and brainstem development.
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Affiliation(s)
- Elham Ahmadzadeh
- The Ritchie CentreHudson Institute of Medical ResearchClaytonVictoriaAustralia
- Department of Obstetrics and GynaecologyMonash UniversityClaytonVictoriaAustralia
| | - Graeme R. Polglase
- The Ritchie CentreHudson Institute of Medical ResearchClaytonVictoriaAustralia
- Department of Obstetrics and GynaecologyMonash UniversityClaytonVictoriaAustralia
| | - Vanesa Stojanovska
- The Ritchie CentreHudson Institute of Medical ResearchClaytonVictoriaAustralia
- Department of Obstetrics and GynaecologyMonash UniversityClaytonVictoriaAustralia
| | - Eric Herlenius
- Department of Women's and Children's HealthKarolinska InstitutetSolnaSweden
- Astrid Lindgren Children´s HospitalKarolinska University Hospital StockholmSolnaSweden
| | - David W. Walker
- The Ritchie CentreHudson Institute of Medical ResearchClaytonVictoriaAustralia
- Neurodevelopment in Health and Disease Research Program, School of Health and Biomedical SciencesRoyal Melbourne Institute of Technology (RMIT)MelbourneVictoriaAustralia
| | - Suzanne L. Miller
- The Ritchie CentreHudson Institute of Medical ResearchClaytonVictoriaAustralia
- Department of Obstetrics and GynaecologyMonash UniversityClaytonVictoriaAustralia
| | - Beth J. Allison
- The Ritchie CentreHudson Institute of Medical ResearchClaytonVictoriaAustralia
- Department of Obstetrics and GynaecologyMonash UniversityClaytonVictoriaAustralia
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Giouleka S, Tsakiridis I, Mamopoulos A, Kalogiannidis I, Athanasiadis A, Dagklis T. Fetal Growth Restriction: A Comprehensive Review of Major Guidelines. Obstet Gynecol Surv 2023; 78:690-708. [PMID: 38134339 DOI: 10.1097/ogx.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Importance Fetal growth restriction (FGR) is a common pregnancy complication and a significant contributor of fetal and neonatal morbidity and mortality, mainly due to the lack of effective screening, prevention, and management policies. Objective The aim of this study was to review and compare the most recently published influential guidelines on the management of pregnancies complicated by FGR. Evidence Acquisition A descriptive review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine, the International Federation of Gynecology and Obstetrics, the International Society of Ultrasound in Obstetrics and Gynecology, the Royal College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada (SOGC), the Perinatal Society of Australia and New Zealand, the Royal College of Physicians of Ireland, the French College of Gynecologists and Obstetricians (FCGO), and the German Society of Gynecology and Obstetrics on FGR was carried out. Results Several discrepancies were identified regarding the definition of FGR and small-for-gestational-age fetuses, the diagnostic criteria, and the need of testing for congenital infections. On the contrary, there is an overall agreement among the reviewed guidelines regarding the importance of early universal risk stratification for FGR to accordingly modify the surveillance protocols. Low-risk pregnancies should unanimously be evaluated by serial symphysis fundal height measurement, whereas the high-risk ones warrant increased sonographic surveillance. Following FGR diagnosis, all medical societies agree that umbilical artery Doppler assessment is required to further guide management, whereas amniotic fluid volume evaluation is also recommended by the ACOG, the SOGC, the Perinatal Society of Australia and New Zealand, the FCGO, and the German Society of Gynecology and Obstetrics. In case of early, severe FGR or FGR accompanied by structural abnormalities, the ACOG, the Society for Maternal-Fetal Medicine, the International Federation of Gynecology and Obstetrics, the Royal College of Obstetricians and Gynecologists, the SOGC, and the FCGO support the performance of prenatal diagnostic testing. Consistent protocols also exist on the optimal timing and mode of delivery, the importance of continuous fetal heart rate monitoring during labor, and the need for histopathological examination of the placenta after delivery. On the other hand, guidelines concerning the frequency of fetal growth and Doppler velocimetry evaluation lack uniformity, although most of the reviewed medical societies recommend an average interval of 2 weeks, reduced to weekly or less when umbilical artery abnormalities are detected. Moreover, there is a discrepancy on the appropriate timing for corticosteroids and magnesium sulfate administration, as well as the administration of aspirin as a preventive measure. Cessation of smoking, alcohol consumption, and illicit drug use are proposed as preventive measures to reduce the incidence of FGR. Conclusions Fetal growth restriction is a clinical entity associated with numerous adverse antenatal and postnatal events, but currently, it has no definitive cure apart from delivery. Thus, the development of uniform international protocols for the early recognition, the adequate surveillance, and the optimal management of growth-restricted fetuses seem of paramount importance to safely guide clinical practice, thereby improving perinatal outcomes of such pregnancies.
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Affiliation(s)
| | | | | | | | | | - Themistoklis Dagklis
- Assistant Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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Cluver CA, Bergman L, Bergkvist J, Imberg H, Geerts L, Hall DR, Mol BW, Tong S, Walker SP. Impact of fetal growth restriction on pregnancy outcome in women undergoing expectant management for preterm pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:660-667. [PMID: 37289938 PMCID: PMC10947051 DOI: 10.1002/uog.26282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To assess whether coexisting fetal growth restriction (FGR) influences pregnancy latency among women with preterm pre-eclampsia undergoing expectant management. Secondary outcomes assessed were indication for delivery, mode of delivery and rate of serious adverse maternal and perinatal outcomes. METHODS We conducted a secondary analysis of the Pre-eclampsia Intervention (PIE) and the Pre-eclampsia Intervention 2 (PI2) trial data. These randomized controlled trials evaluated whether esomeprazole and metformin could prolong gestation of women diagnosed with pre-eclampsia between 26 and 32 weeks of gestation undergoing expectant management. Delivery indications were deteriorating maternal or fetal status, or reaching 34 weeks' gestation. FGR (defined by Delphi consensus) at the time of pre-eclampsia diagnosis was examined as a predictor of outcome. Only placebo data from PI2 were included, as the trial showed that metformin use was associated with prolonged gestation. All outcome data were collected prospectively from diagnosis of pre-eclampsia to 6 weeks after the expected due date. RESULTS Of the 202 women included, 92 (45.5%) had FGR at the time of pre-eclampsia diagnosis. Median pregnancy latency was 6.8 days in the FGR group and 15.3 days in the control group (difference 8.5 days; adjusted 0.49-fold change (95% CI, 0.33-0.74); P < 0.001). FGR pregnancies were less likely to reach 34 weeks' gestation (12.0% vs 30.9%; adjusted relative risk (aRR), 0.44 (95% CI, 0.23-0.83)) and more likely to be delivered for suspected fetal compromise (64.1% vs 36.4%; aRR, 1.84 (95% CI, 1.36-2.47)). More women with FGR underwent a prelabor emergency Cesarean section (66.3% vs 43.6%; aRR, 1.56 (95% CI, 1.20-2.03)) and were less likely to have a successful induction of labor (4.3% vs 14.5%; aRR, 0.32 (95% CI, 0.10-1.00)), compared to those without FGR. The rate of maternal complications did not differ significantly between the two groups. FGR was associated with a higher rate of infant death (14.1% vs 4.5%; aRR, 3.26 (95% CI, 1.08-9.81)) and need for intubation and mechanical ventilation (15.2% vs 5.5%; aRR, 2.97 (95% CI, 1.11-7.90)). CONCLUSION FGR is commonly present in women with early preterm pre-eclampsia and outcome is poorer. FGR is associated with shorter pregnancy latency, more emergency Cesarean deliveries, fewer successful inductions and increased rates of neonatal morbidity and mortality. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C. A. Cluver
- Department of Obstetrics and GynaecologyStellenbosch University and Tygerberg HospitalCape TownSouth Africa
- Mercy PerinatalMercy Hospital for WomenMelbourneVIAustralia
- Translational Obstetrics GroupUniversity of MelbourneMelbourneVIAustralia
| | - L. Bergman
- Department of Obstetrics and GynaecologyStellenbosch University and Tygerberg HospitalCape TownSouth Africa
- Department of Obstetrics and GynecologyInstitute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - J. Bergkvist
- Department of Obstetrics and GynecologyInstitute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - H. Imberg
- Statistiska KonsultgruppenGothenburgSweden
- Department of Mathematical SciencesChalmers University of Technology and University of GothenburgGothenburgSweden
| | - L. Geerts
- Department of Obstetrics and GynaecologyStellenbosch University and Tygerberg HospitalCape TownSouth Africa
| | - D. R. Hall
- Department of Obstetrics and GynaecologyStellenbosch University and Tygerberg HospitalCape TownSouth Africa
| | - B. W. Mol
- Department of Obstetrics and Gynaecology, Monash School of MedicineMonash UniversityMelbourneVIAustralia
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | - S. Tong
- Mercy PerinatalMercy Hospital for WomenMelbourneVIAustralia
- Translational Obstetrics GroupUniversity of MelbourneMelbourneVIAustralia
| | - S. P. Walker
- Mercy PerinatalMercy Hospital for WomenMelbourneVIAustralia
- Translational Obstetrics GroupUniversity of MelbourneMelbourneVIAustralia
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Ushida T, Nakatochi M, Kobayashi Y, Nakamura N, Fuma K, Iitani Y, Imai K, Sato Y, Hayakawa M, Kajiyama H, Kotani T. Antenatal corticosteroids and outcomes of small for gestational age infants born at 24-31 gestational weeks: a population-based propensity score matching analysis. Arch Gynecol Obstet 2023; 308:1463-1471. [PMID: 36352162 DOI: 10.1007/s00404-022-06834-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the effect of antenatal corticosteroid (ACS) treatment on neonatal outcomes in small for gestational age (SGA) infants born at 24-31 gestational weeks compared with non-SGA infants. METHODS A population-based retrospective study was conducted that analyzed clinical data from the Neonatal Research Network of Japan database, which enrolls neonates born at < 32 gestational weeks and weighing 1500 g or less (n = 22,414). Propensity score matching (with the ratio of ACS to no-ACS groups of 1:1) was performed in SGA (n = 7028) and non-SGA (n = 15,386) infants, respectively. Univariate logistic and interaction analyses were performed to compare the short-term neonatal outcomes of infants with and without ACS treatment in utero. RESULTS In the SGA and non-SGA infants, ACS treatment significantly reduced in-hospital mortality (odds ratio 0.67 95% confidence interval [0.50-0.88] and 0.62 [0.50-0.78], respectively), respiratory distress syndrome (0.77 [0.69-0.87] and 0.63 [0.58-0.68], respectively), and composite adverse outcomes (0.73 [0.58-0.91] and 0.57 [0.50-0.65], respectively). ACS treatment also significantly reduced intraventricular hemorrhage (grade III/IV), periventricular leukomalacia, and sepsis in the non-SGA infants, but not in the SGA infants. However, interaction analyses revealed no significant differences between the SGA and non-SGA infants in the efficacy of ACS treatment on short-term outcomes except for respiratory distress syndrome. CONCLUSIONS ACS treatment was associated with beneficial effects on mortality, respiratory distress syndrome, and adverse composite outcomes in extremely and very preterm SGA infants, with similar efficacy on all neonatal outcomes except for respiratory distress syndrome observed in the non-SGA infants.
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Affiliation(s)
- Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
- Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
| | - Masahiro Nakatochi
- Public Health Informatics Unit, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yumiko Kobayashi
- Data Science Division, Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Noriyuki Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Kazuya Fuma
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yukako Iitani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
- Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
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166
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Alameddine S, Capannolo G, Rizzo G, Khalil A, Di Girolamo R, Iacovella C, Liberati M, Patrizi L, Acharya G, Odibo AO, D'Antonio F. A systematic review and critical evaluation of quality of clinical practice guidelines on fetal growth restriction. J Perinat Med 2023; 51:970-980. [PMID: 36976902 DOI: 10.1515/jpm-2022-0590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/08/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION To systematically identify and critically assess the quality of clinical practice guidelines (CPGs) on management fetal growth restriction (FGR). CONTENT Medline, Embase, Google Scholar, Scopus and ISI Web of Science databases were searched to identify all relevant CPGs on FGR. SUMMARY Diagnostic criteria of FGR, recommended growth charts, recommendation for detailed anatomical assessment and invasive testing, frequency of fetal growth scans, fetal monitoring, hospital admission, drugs administrations, timing at delivery, induction of labor, postnatal assessment and placental histopathological were assessed. Quality assessment was evaluated by AGREE II tool. Twelve CPGs were included. Twenty-five percent (3/12) of CPS adopted the recently published Delphi consensus, 58.3% (7/12) an estimated fetal weight (EFW)/abdominal circumference (AC) EFW/AC <10th percentile, 8.3% (1/12) an EFW/AC <5th percentile while one CPG defined FGR as an arrest of growth or a shift in its rate measured longitudinally. Fifty percent (6/12) of CPGs recommended the use of customized growth charts to assess fetal growth. Regarding the frequency of Doppler assessment, in case of absent or reversed end-diastolic flow in the umbilical artery 8.3% (1/12) CPGs recommended assessment every 24-48, 16.7% (2/12) every 48-72 h, 1 CPG generically recommended assessment 1-2 times per week, while 25 (3/12) did not specifically report the frequency of assessment. Only 3 CPGs reported recommendation on the type of Induction of Labor to adopt. The AGREE II standardized domain scores for the first overall assessment (OA1) had a mean of 50%. OUTLOOK There is significant heterogeneity in the management of pregnancies complicated by FGR in published CPGs.
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Affiliation(s)
- Sara Alameddine
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Giulia Capannolo
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynaecology Fondazione Policlinico Tor Vergata Università Roma Tor Vergata, Roma, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
| | - Raffaella Di Girolamo
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
- Department of Public Health, School of Medicine, Federico II University of Naples, Naples, Italy
| | | | - Marco Liberati
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Lodovico Patrizi
- Department of Obstetrics and Gynaecology Fondazione Policlinico Tor Vergata Università Roma Tor Vergata, Roma, Italy
| | - Ganesh Acharya
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Anthony O Odibo
- Divisions of Maternal-Fetal Medicine and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesco D'Antonio
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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167
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Cortez Ferreira M, Mafra J, Dias A, Santos Silva I, Taborda A. Impact of early-onset fetal growth restriction on the neurodevelopmental outcome of very preterm infants at 24 months: a retrospective cohort study. BMC Pediatr 2023; 23:533. [PMID: 37884935 PMCID: PMC10601105 DOI: 10.1186/s12887-023-04361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The association between fetal growth restriction (FGR) and childhood neurodevelopmental delay is unclear and the evidence available to the present date shows conflicting results. Our aim was to analyse the impact of early-onset FGR on the neurodevelopmental outcome at 24 months of corrected age in very preterm infants. METHODS Retrospective cohort study of very preterm infants (≤ 32 weeks' gestation) admitted to a neonatal intensive care unit between 1 January 2013-31 December 2019. The control group comprised appropriate for gestational age (AGA) newborns. Griffiths III Mental Development Scale was performed at 24 months of corrected age. RESULTS 132 infants were included: 44 FGR and 88 AGA. Mean Global Development Quotient (GDQ) was lower for FGR infants (p = 0.004) even after adjusting for maternal and perinatal factors (βadjusted -16.703; p = 0.009). The average scores for the neurodevelopmental domains were highest for personal-social-emotional skills (107.02 ± 16.34), followed by eye/hand coordination (105.61 ± 14.20) and foundation of learning skills (102.23 ± 13.74) and were lowest for gross motor (97.90 ± 11.88) and language/communication skills (96.39 ± 18.88). FGR had a significant negative impact on all domains except for gross motor skills. After adjustment, FGR continued to have a significant adverse impact on language/communication (βadjusted -21.924; p = 0.013), eye/hand coordination (βadjusted -15.446; p = 0.015) and foundation of learning skills (βadjusted -15.211; p = 0.013). CONCLUSIONS In very preterm infants, FGR was associated with a significantly increased risk of poor neurodevelopmental outcome at 24 months of corrected age compared to age-matched AGA infants.
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Affiliation(s)
- Mariana Cortez Ferreira
- Neonatology Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Joana Mafra
- Obstetrics Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Dias
- Neonatology Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Isabel Santos Silva
- Obstetrics Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Adelaide Taborda
- Neonatology Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Kramer AC, Jansson T, Bale TL, Powell TL. Maternal-fetal cross-talk via the placenta: influence on offspring development and metabolism. Development 2023; 150:dev202088. [PMID: 37831056 PMCID: PMC10617615 DOI: 10.1242/dev.202088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Compelling epidemiological and animal experimental data demonstrate that cardiometabolic and neuropsychiatric diseases originate in a suboptimal intrauterine environment. Here, we review evidence suggesting that altered placental function may, at least in part, mediate the link between the maternal environment and changes in fetal growth and development. Emerging evidence indicates that the placenta controls the development and function of several fetal tissues through nutrient sensing, modulation of trophoblast nutrient transporters and by altering the number and cargo of released extracellular vesicles. In this Review, we discuss the development and functions of the maternal-placental-fetal interface (in humans and mice) and how cross-talk between these compartments may be a mechanism for in utero programming, focusing on mechanistic target of rapamycin (mTOR), adiponectin and O-GlcNac transferase (OGT) signaling. We also discuss how maternal diet and stress influences fetal development and metabolism and how fetal growth restriction can result in susceptibility to developing chronic disease later in life. Finally, we speculate how interventions targeting placental function may offer unprecedented opportunities to prevent cardiometabolic disease in future generations.
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Affiliation(s)
- Avery C. Kramer
- Departments of Obstetrics & Gynecology, Psychiatry and Pediatrics, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
| | - Thomas Jansson
- Departments of Obstetrics & Gynecology, Psychiatry and Pediatrics, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
| | - Tracy L. Bale
- Departments of Obstetrics & Gynecology, Psychiatry and Pediatrics, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
| | - Theresa L. Powell
- Departments of Obstetrics & Gynecology, Psychiatry and Pediatrics, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
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169
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Menon A, Meena J, Manchanda S, Singhal S, Shivhare S, Kumar S. Role of Placental Vascularization Indices and Shear Wave Elastography in Fetal Growth Restriction. J Obstet Gynaecol India 2023; 73:75-82. [PMID: 37916019 PMCID: PMC10615985 DOI: 10.1007/s13224-023-01826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/04/2023] [Indexed: 11/03/2023] Open
Abstract
Objective To evaluate the role of placental vascularisation indices using 3D-Power Doppler and placental elasticity using Shear Wave Elastography (SWE) in Fetal Growth Restricted (FGR) pregnancies and to assess their correlation with perinatal outcomes. Methods This prospective case-control study was conducted from June 2018-2020. Thirty women with FGR and thirty controls (24-36 weeks) underwent grayscale and Doppler ultrasonography followed by measurement of vascularisation indices and SWE from the central and peripheral parts of fetal and maternal surfaces of the placenta. Participants were followed till delivery and perinatal outcomes were noted. Results Vascularisation indices were significantly reduced among FGR vs. controls: Vascularisation Index (VI): 20.90 ± 5.46 vs. 31.49 ± 3.89, Flow Index (FI): 26.29 ± 1.70 vs. 30.85 ± 2.02, Vascularisation- Flow Index (VFI): 7.06 ± 2.42 vs. 12.37 ± 2.43, p < 0.001. The mean placental SWE (17.36 ± 1.50 kPa) in FGR pregnancies was significantly higher as compared to controls (4.14 ± 1.14 kPa), p < 0.001. Neonatal polycythaemia and hyperbilirubinemia were significantly increased in FGR pregnancies with higher SWE value. Receiver operating characteristic curve-based cut-off of VI for intensive care requirement was 23.0 (sensitivity: 75%, specificity: 71%) and for tachypnea was 22.8 (73% sensitivity and specificity). The cut-off of FI for low birth weight was 25.7 (sensitivity: 69.6%, specificity: 71.4%). Conclusion This study demonstrates that increased placental stiffness and reduced vascularisation in FGR indicate possible placental pathology. Both modalities help in predicting perinatal complications. Hence, vascularisation indices and SWE reflect the extent of placental insufficiency and can be useful adjuncts in diagnosis.
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Affiliation(s)
- Anagha Menon
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Meena
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Shivhare
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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170
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Horn-Oudshoorn EJJ, Russo FM, Deprest JA, Kipfmueller F, Geipel A, Schaible T, Rafat N, Cordier AG, Benachi A, Abbasi N, Chiu PPL, de Boode WP, Sikkel E, Peters NCJ, Hansen BE, Reiss IKM, DeKoninck PLJ. Survival in very preterm infants with congenital diaphragmatic hernia and association with prenatal imaging markers: A retrospective cohort study. BJOG 2023; 130:1403-1411. [PMID: 37069727 DOI: 10.1111/1471-0528.17497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES To describe the outcomes of preterm born infants with congenital diaphragmatic hernia (CDH; ≤32.0 weeks of gestation) and the associations between prenatal imaging markers and survival. DESIGN Retrospective cohort study. SETTING Multicentre study in large referral centres. POPULATION Infants with an isolated unilateral CDH, live born at 32.0 weeks or less of gestation, between January 2009 and January 2020. METHODS Neonatal outcomes were evaluated for infants that were expectantly managed during pregnancy and infants that underwent fetoscopic endoluminal tracheal occlusion (FETO) therapy, separately. We evaluated the association between prenatal imaging markers and survival to discharge. Prenatal imaging markers included observed to expected lung-to-head ratio (o/e LHR), side of the defect, liver position, stomach position grade, and observed to expected total fetal lung volume (o/e TFLV). MAIN OUTCOME MEASURE Survival to discharge. RESULTS We included 53 infants born at 30+4 (interquartile range 29+1 -31+2 ) weeks. Survival in fetuses expectantly managed during pregnancy was 48% (13/27) in left-sided CDH and 33% (2/6) in right-sided CDH. Survival in fetuses that underwent FETO therapy was 50% (6/12) in left-sided CDH and 25% (2/8) in right-sided CDH. The o/e LHR at baseline was positively associated with survival in cases expectantly managed during pregnancy (odds ratio [OR] 1.20, 95% CI 1.07-1.42, p < 0.01), but not in cases that received FETO therapy (OR 1.01, 95% CI 0.88-1.15, p = 0.87). Stomach position grade (p = 0.03) and o/e TFLV were associated with survival (p = 0.02); liver position was not (p = 0.13). CONCLUSIONS In infants with CDH born at or before 32 weeks of gestation, prenatal imaging markers of disease severity were associated with postnatal survival.
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Affiliation(s)
- Emily J J Horn-Oudshoorn
- Division of Neonatology, Department of Paediatrics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Francesca M Russo
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium
| | - Jan A Deprest
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium
| | - Florian Kipfmueller
- Department of Neonatology and Paediatric Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Thomas Schaible
- Department of Neonatology, University Hospital Mannheim, Mannheim, Germany
| | - Neysan Rafat
- Department of Neonatology, University Hospital Mannheim, Mannheim, Germany
| | - Anne-Gael Cordier
- Centre Reference Maladie Rare, Hernie de Coupole Diaphragmatique, Clamart, France
- Department of Obstetrics and Gynaecology, Hospital Antoine Béclère, University Paris-Saclay, Clamart, France
| | - Alexandra Benachi
- Centre Reference Maladie Rare, Hernie de Coupole Diaphragmatique, Clamart, France
- Department of Obstetrics and Gynaecology, Hospital Antoine Béclère, University Paris-Saclay, Clamart, France
| | - Nimrah Abbasi
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Priscilla P L Chiu
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Esther Sikkel
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Nina C J Peters
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Bettina E Hansen
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Irwin K M Reiss
- Division of Neonatology, Department of Paediatrics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Philip L J DeKoninck
- Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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171
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Xodo S, Celante L, Liviero S, Orsaria M, Mariuzzi L, De Luca M, Damante G, Driul L, Cagnacci A, Ferino A, Di Giorgio E, Xodo L, Londero AP. Fetal growth at term and placental oxidative stress in a tissue micro-array model: a histological and immunohistochemistry study. Histochem Cell Biol 2023; 160:293-306. [PMID: 37306741 PMCID: PMC10509069 DOI: 10.1007/s00418-023-02212-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/13/2023]
Abstract
This study examines 8-hydroxyguanine (8-oxo-Gua) staining in placental tissue samples based on fetal size at birth as well as its relationships with placental histology and other pregnancy variables. This prospective cohort study included women > 18 years with a singleton pregnancy, a live fetus, fluency in Italian, and delivery at term. A total of 165 pregnancies were included in the study. The nuclear syncytiotrophoblast 8-oxo-Gua staining score in LGA was substantially greater than in late FGR (p < 0.05), although the cytoplasm score was lower in SGA and LGA than in AGA (p < 0.05). Furthermore, a sex-specific pattern of 8-oxo-Gua staining was discovered in single-term placentas, with more oxidative damage found in the nuclei of syncytiotrophoblast cells and stromal and endothelial cells in AGA males compared to AGA females (p < 0.05). Second, the histological pattern of late FGR placentae differed by gender. Finally, a significant correlation (p < 0.05) was found between high-intensity 8-oxo-Gua staining in the cytoplasm of syncytiotrophoblast cells and thrombi in the chorionic plate or villi in males. On the other hand, female fetuses demonstrated a significant connection (p < 0.05) between high-intensity 8-oxo-Gua staining in endothelial and stromal cells and high birthweight MoM values. Our findings indicated a significant variation in the oxidative stress pattern between male and female placentae, implying that fetal growth is regulated differently in the two sexes.
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Affiliation(s)
- Serena Xodo
- Clinic of Obstetrics and Gynecology, DAME, University of Udine, 33100, Udine, Italy.
| | - Lisa Celante
- Clinic of Obstetrics and Gynecology, DAME, University of Udine, 33100, Udine, Italy
| | - Stefania Liviero
- Clinic of Obstetrics and Gynecology, DAME, University of Udine, 33100, Udine, Italy
| | - Maria Orsaria
- Institute of Pathology, Academic Hospital "Azienda Sanitaria Universitaria Integrata di Udine", 33100, Udine, Italy
| | - Laura Mariuzzi
- Institute of Pathology, DAME, University of Udine, 33100, Udine, Italy
| | - Matteo De Luca
- Institute of Pathology, Academic Hospital "Azienda Sanitaria Universitaria Integrata di Udine", 33100, Udine, Italy
| | - Giuseppe Damante
- Institute of Medical Genetics, Academic Hospital "Azienda Sanitaria Universitaria Integrata di Udine", DAME, University of Udine, 33100, Udine, Italy
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, DAME, University of Udine, 33100, Udine, Italy
| | - Angelo Cagnacci
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Infant Health, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Annalisa Ferino
- Laboratory of Biochemistry, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Eros Di Giorgio
- Laboratory of Biochemistry, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Luigi Xodo
- Laboratory of Biochemistry, Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Ambrogio Pietro Londero
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Infant Health, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, 16147, Genova, GE, Italy
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172
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Kose C, Korpe B, Yakut Yucel K, Arat O, Bucak M, Engin Ustun Y. A New Antioxidant Marker in Cord Blood of Fetuses with Late Fetal Growth Restriction: Humanin. Fetal Pediatr Pathol 2023; 42:775-784. [PMID: 37366369 DOI: 10.1080/15513815.2023.2229432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
Purpose: This study investigated the Humanin levels in the umbilical cord blood of fetuses with late fetal growth restriction (FGR) and -evaluated their association with perinatal outcomes. Materials and Methods: A total of 95 single pregnancies between 32-41 wk (45 with late FGR and 50 controls) were included. Doppler parameters, birth weight and the need for neonatal intensive care unit admission (NICU) were assessed. Correlations between Humanin levels and these parameters were analyzed. Results: Higher Humanin levels were found in fetuses with late FGR compared to the control group (p < 0.05). No significant correlation was observed between Humanin levels and Doppler parameters. Elevated Humanin levels were associated with an increased need for NICU (p < 0.05). Conclusions: The statistically higher levels of Humanin in fetuses with late FGR may suggest the potential of Humanin as an indicator of late FGR. Further research is needed to explore the clinical utility of Humanin.
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Affiliation(s)
- Caner Kose
- Ankara Etlik City Hospital, Ankara, Turkey
| | | | | | - Ozgur Arat
- Ankara Etlik City Hospital, Ankara, Turkey
| | | | - Yaprak Engin Ustun
- University of Health Sciences Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
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173
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Agaoglu MO, Agaoglu Z, Yucel KY, Ozturk FH, Caglar T. Evaluation of maternal serum sestrin-2 levels in intrauterine growth restriction. Ir J Med Sci 2023; 192:2259-2264. [PMID: 36877413 DOI: 10.1007/s11845-023-03329-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Sestrin-2 (SESN2) is a antioxidant protein that can be activated by a number of conditions, including DNA damage and hypoxia. AIMS Our objective was to evaluate maternal serum SESN2 levels in patients with intrauterine growth restriction (IUGR) and its association with adverse perinatal outcomes. METHODS This prospective study included a total of 87 pregnant women admitted to our tertiary care center between 2018 August and 2019 July. The study group consisted of a total of 44 patients who had been diagnosed with IUGR. Forty-three low-risk and gestational age-matched pregnant women were taken as control group. Demographic data, maternal serum SESN2 levels, and maternal-neonatal outcomes were evaluated. SESN2 levels were analyzed by the enzyme-linked immunosorbent assay (ELISA) method and compared between groups. RESULTS Maternal serum SESN2 levels were significantly higher in the IUGR group compared to control group (22.38 ng/ml vs. 13.0 ng/ml, p < 0.001). In correlation analysis, a negative significant correlation was found between SESN2 levels and gestational week at delivery (r = - 0.387, p < 0.001). The ideal cut-off value for detecting IUGR was 9.5 ng/ml, and the area under the curve was 0.719 (95%CI: 0.610-0.827). Birth interval, gestational week at birth, birth weight, and 1-5-min Apgar scores were lower in the IUGR group (p < 0.001). CONCLUSIONS Maternal serum SESN2 levels are elevated in IUGR and are associated with adverse neonatal outcome. Considering that SESN2 is involved in pathogenesis, it can be used as a new marker for the evaluation of IUGR.
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Affiliation(s)
- Merve Ozturk Agaoglu
- Department of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Zahid Agaoglu
- Department of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Kadriye Yakut Yucel
- Department of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Filiz Halıcı Ozturk
- Department of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Turhan Caglar
- Department of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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Mula C, Hidalgo J, Peguero A, Mazarico E, Martinez J, Figueras F, Meler E. Third-trimester uterine artery Doppler for prediction of adverse outcome in late small-and adequate for-gestational-age fetuses. Minerva Obstet Gynecol 2023; 75:440-448. [PMID: 36943257 DOI: 10.23736/s2724-606x.23.05229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Fetal growth restriction includes all those fetuses that do not reach their own growth potential due to placental insufficiency and therefore at higher risk of adverse perinatal outcomes. Identification and follow-up of these fetuses is essential to decrease this additional risk. Although estimated fetal weight under the 3rd centile and pathological cerebroplacental ratio are the most accepted predictive criteria, some evidence suggests that abnormal uterine artery Doppler may be a useful prognostic parameter in late-onset growth restriction fetuses at the moment of diagnosis. However, its prediction capacity as a standalone parameter is limited. In that context, integrated models of biometric and hemodynamic ultrasound parameters including uterine Doppler have been proposed as an effective approach to stratify the risk and improve perinatal outcomes. Moreover, an association of abnormal uterine artery Doppler and histological findings of placental underperfusion due to vascular obstruction has been described. Finally, it has also been suggested that the evaluation of uterine artery Doppler at third trimester in appropriate-for-gestational-age fetuses could identify cases of subclinical placental insufficiency, but further evidence is needed to define such predictive strategies.
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Affiliation(s)
- Cristina Mula
- BCNatal - Hospital Sant Joan de Déu, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal (ICGON), i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Judit Hidalgo
- BCNatal - Hospital Sant Joan de Déu, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal (ICGON), i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Anna Peguero
- BCNatal - Hospital Sant Joan de Déu, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal (ICGON), i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Edurne Mazarico
- BCNatal - Hospital Sant Joan de Déu, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal (ICGON), i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Judit Martinez
- BCNatal - Hospital Sant Joan de Déu, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal (ICGON), i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Francesc Figueras
- BCNatal - Hospital Sant Joan de Déu, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal (ICGON), i+D Fetal Medicine Research Center, Barcelona, Spain -
| | - Eva Meler
- BCNatal - Hospital Sant Joan de Déu, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal (ICGON), i+D Fetal Medicine Research Center, Barcelona, Spain
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Kingdom J, Ashwal E, Lausman A, Liauw J, Soliman N, Figueiro-Filho E, Nash C, Bujold E, Melamed N. Directive clinique n o 442 : Retard de croissance intra-utérin : Dépistage, diagnostic et prise en charge en contexte de grossesse monofœtale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102155. [PMID: 37730301 DOI: 10.1016/j.jogc.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIF Le retard de croissance intra-utérin est une complication obstétricale fréquente qui touche jusqu'à 10 % des grossesses dans la population générale et qui est le plus souvent due à une pathologie placentaire sous-jacente. L'objectif de la présente directive clinique est de fournir des déclarations sommaires et des recommandations pour appuyer un protocole clinique de dépistage, diagnostic et prise en charge du retard de croissance intra-utérin pour les grossesses à risque ou atteintes. POPULATION CIBLE Toutes les patientes enceintes menant une grossesse monofœtale. BéNéFICES, RISQUES ET COûTS: La mise en application des recommandations de la présente directive devrait améliorer la compétence des cliniciens quant à la détection du retard de croissance intra-utérin et à la réalisation des interventions indiquées. DONNéES PROBANTES: La littérature publiée a été colligée par des recherches effectuées jusqu'en septembre 2022 dans les bases de données PubMed, Medline, CINAHL et Cochrane Library en utilisant un vocabulaire contrôlé au moyen de termes MeSH pertinents (fetal growth retardation and small for gestational age) et de mots-clés (fetal growth, restriction, growth retardation, IUGR, FGR, low birth weight, small for gestational age, Doppler, placenta, pathology). Seuls les résultats de revues systématiques, d'essais cliniques randomisés ou comparatifs et d'études observationnelles ont été retenus. La littérature grise a été obtenue par des recherches menées dans des sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, des registres d'essais cliniques et des sites Web de sociétés de spécialité médicale nationales et internationales. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Obstétriciens, médecins de famille, infirmières, sages-femmes, spécialistes en médecine fœto-maternelle, radiologistes et autres professionnels de la santé qui prodiguent des soins aux patientes enceintes. RéSUMé POUR TWITTER: Mise à jour de la directive sur le dépistage, le diagnostic et la prise en charge du retard de croissance intra-utérin pour les grossesses à risque ou atteintes. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS: Prédiction du retard de croissance intra-utérin Prévention du retard de croissance intra-utérin Détection du retard de croissance intra-utérin Examens en cas de retard de croissance intra-utérin soupçonné Prise en charge du retard de croissance intra-utérin précoce Prise en charge du retard de croissance intra-utérin tardif Prise en charge du post-partum et consultations préconception.
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Powel JE, Chavan NR, Zantow EW, Bialko MF, Farley LG, McCormick KM, Tomlinson TM. Risk of adverse perinatal outcomes in pregnancies with "small" fetuses not meeting Delphi consensus criteria for fetal growth restriction. Am J Obstet Gynecol 2023; 229:447.e1-447.e13. [PMID: 37767605 DOI: 10.1016/j.ajog.2023.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Previous research endeavors examining the association between clinical characteristics, sonographic indices, and the risk of adverse perinatal outcomes in pregnancies complicated by fetal growth restriction have been hampered by a lack of agreement regarding its definition. In 2016, a consensus definition was reached by an international panel of experts via the Delphi procedure, but as it currently stands, this has not been endorsed by all professional organizations. OBJECTIVE This study aimed to assess whether an independent association exists between estimated fetal weight and/or abdominal circumference of <10th percentile and adverse perinatal outcomes when consensus criteria for growth restriction are not met. STUDY DESIGN Data were derived from a passive prospective cohort of singleton nonanomalous pregnancies at a single academic tertiary care institution (2010-2022) that fell into 3 groups: (1) consecutive fetuses that met the Delphi criteria for fetal growth restriction, (2) small-for-gestational-age fetuses that failed to meet the consensus criteria, and (3) fetuses with birthweights of 20th to 80th percentile randomly selected as an appropriately grown (appropriate-for-gestational-age) comparator group. This nested case-control study used 1:1 propensity score matching to adjust for confounders among the 3 groups: fetal growth restriction cases, small-for-gestational-age cases, and controls. Our primary outcome was a composite: perinatal demise, 5-minute Apgar score of <7, cord pH of ≤7.10, or base excess of ≥12. Pregnancy characteristics with a P value of <.2 on univariate analyses were considered for incorporation into a multivariable model along with fetal growth restriction and small-for-gestational-age to evaluate which outcomes were independently predictive of adverse perinatal outcomes. RESULTS Overall, 2866 pregnancies met the inclusion criteria. After propensity score matching, there were 2186 matched pairs, including 511 (23%), 1093 (50%), and 582 (27%) patients in the small-for-gestational-age, appropriate-for-gestational-age, and fetal growth restriction groups, respectively. Moreover, 210 pregnancies (10%) were complicated by adverse perinatal outcomes. None of the pregnancies with small-for-gestational-age OR appropriate-for-gestational-age fetuses resulted in perinatal demise. Twenty-three of 511 patients (5%) in the small-for-gestational-age group had adverse outcomes based on 5-minute Apgar scores and/or cord gas results compared with 77 of 1093 patients (7%) in the appropriate-for-gestational-age group (odds ratio, 0.62; 95% confidence interval, 0.39-1.00). Furthermore, 110 of 582 patients (19%) with fetal growth restriction that met the consensus criteria had adverse outcomes (odds ratio, 3.08; 95% confidence interval, 2.25-4.20), including 34 patients with perinatal demise or death before discharge. Factors independently associated with increased odds of adverse outcomes included chronic hypertension, hypertensive disorders of pregnancy, and early-onset fetal growth restriction. Small-for-gestational age was not associated with the primary outcome after adjustment for 6 other factors included in a model predicting adverse perinatal outcomes. The bias-corrected bootstrapped area under the receiver operating characteristic curve for the model was 0.72 (95% confidence interval, 0.66-0.74). The bias-corrected bootstrapped area under the receiver operating characteristic curve for a 7-factor model predicting adverse perinatal outcomes was 0.72 (95% confidence interval, 0.66-0.74). CONCLUSION This study found no evidence that fetuses with an estimated fetal weight and/or abdominal circumference of 3rd to 9th percentile that fail to meet the consensus criteria for fetal growth restriction (based on Doppler waveforms and/or growth velocity of ≥32 weeks) are at increased risk of adverse outcomes. Although the growth of these fetuses should be monitored closely to rule out evolving growth restriction, most cases are healthy constitutionally small fetuses. The management of these fetuses in the same manner as those with suspected pathologic growth restriction may result in unnecessary antenatal testing and increase the risk of iatrogenic complications resulting from preterm or early term delivery of small fetuses that are at relatively low risk of adverse perinatal outcomes.
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Affiliation(s)
- Jennifer E Powel
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University School of Medicine, St. Louis, MO
| | - Niraj R Chavan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University School of Medicine, St. Louis, MO
| | - Emily W Zantow
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University School of Medicine, St. Louis, MO
| | - Matthew F Bialko
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University School of Medicine, St. Louis, MO
| | | | | | - Tracy M Tomlinson
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University School of Medicine, St. Louis, MO.
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Kingdom J, Ashwal E, Lausman A, Liauw J, Soliman N, Figueiro-Filho E, Nash C, Bujold E, Melamed N. Guideline No. 442: Fetal Growth Restriction: Screening, Diagnosis, and Management in Singleton Pregnancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102154. [PMID: 37730302 DOI: 10.1016/j.jogc.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Fetal growth restriction is a common obstetrical complication that affects up to 10% of pregnancies in the general population and is most commonly due to underlying placental diseases. The purpose of this guideline is to provide summary statements and recommendations to support a clinical framework for effective screening, diagnosis, and management of pregnancies that are either at risk of or affected by fetal growth restriction. TARGET POPULATION All pregnant patients with a singleton pregnancy. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in this guideline should increase clinician competency to detect fetal growth restriction and provide appropriate interventions. EVIDENCE Published literature in English was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library through to September 2022 using appropriate controlled vocabulary via MeSH terms (fetal growth retardation and small for gestational age) and key words (fetal growth, restriction, growth retardation, IUGR, FGR, low birth weight, small for gestational age, Doppler, placenta, pathology). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. Grey literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Table A1 for definitions and Table A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Obstetricians, family physicians, nurses, midwives, maternal-fetal medicine specialists, radiologists, and other health care providers who care for pregnant patients. TWEETABLE ABSTRACT Updated guidelines on screening, diagnosis, and management of pregnancies at risk of or affected by FGR. SUMMARY STATEMENTS RECOMMENDATIONS: Prediction of FGR Prevention of FGR Detection of FGR Investigations in Pregnancies with Suspected Fetal Growth Restriction Management of Early-Onset Fetal Growth Restriction Management of Late-Onset FGR Postpartum management and preconception counselling.
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178
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Della Gatta AN, Aceti A, Spinedi SF, Martini S, Corvaglia L, Sansavini A, Zuccarini M, Lenzi J, Seidenari A, Dionisi C, Pilu G, Simonazzi G. Neurodevelopmental outcomes of very preterm infants born following early foetal growth restriction with absent end-diastolic umbilical flow. Eur J Pediatr 2023; 182:4467-4476. [PMID: 37490110 PMCID: PMC10587239 DOI: 10.1007/s00431-023-05104-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
This study aims to assess the impact of time of onset and features of early foetal growth restriction (FGR) with absent end-diastolic flow (AEDF) on pregnancy outcomes and on preterm infants' clinical and neurodevelopmental outcomes up to 2 years corrected age. This is a retrospective, cohort study led at a level IV Obstetric and Neonatal Unit in Bologna, Italy. Pregnant women were eligible if having singleton pregnancies, with no major foetal anomaly detected, and diagnosed with early FGR + AEDF (defined as FGR + AEDF detected before 32 weeks gestation). Early FGR + AEDF was further classified according to time of onset and specific features into very early and persistent (VEP, FGR + AEDF first detected at 20-24 weeks gestation and persistent at the following scans), very early but transient (VET, FGR + AEDF detected at 20-24 weeks gestation and progressively improving at the following scans) and later (LA, FGR + AEDF detected between 25 and 32 weeks gestation). Pregnancy and neonatal outcomes and infant follow-up data were collected and compared among groups. Neurodevelopment was assessed using the revised Griffiths Mental Developmental Scales (GMDS-R) 0-2 years. A regression analysis was performed to identify early predictors of preterm infants' neurodevelopmental impairment. Fifty-two pregnant women with an antenatal diagnosis of early FGR + AEDF were included in the study (16 VEP, 14 VET, 22 LA). Four intrauterine foetal deaths occurred, all in the VEP group (p = 0.010). Compared to LA infants, VEP infants were born with lower gestational age and lower birth weight, had lower arterial cord blood pH and were at higher risk for intraventricular haemorrhage and periventricular leukomalacia (p < 0.05 for all comparisons). At 12 months, VEP infants had worse GMDS-R scores, both in the general quotient (mean [SD] 91.8 [12.4] vs 104.6 [8.7] in LA) and in the performance domain (mean [SD] 93.3 [15.4] vs 108.8 [8.8] in LA). This latter difference persisted at 24 months (mean [SD] 68.3 [17.0] vs 92.9 [17.7] in LA). In multivariate analysis, at 12 months corrected age, PVL was found to be an independent predictor of impaired general quotient, while the features and timing of antenatal Doppler alterations predicted worse scores in the performance domain. Conclusion: Timing of onset and features of early FGR + AEDF might impact differently on neonatal clinical and neurodevelopmental outcomes. Shared awareness of the importance of FGR + AEDF features between obstetricians and neonatologists may offer valuable tools for antenatal counselling and for tailoring pregnancy management and neonatal follow-up in light of specific antenatal and neonatal risk factors. What is Known: • Foetal growth restriction (FGR), together with antenatal umbilical Doppler abnormalities, is known to affect maternal and neonatal outcomes. • Infants born preterm and growth-restricted face the highest risk for neurodevelopmental impairment, especially when FGR occurs early during pregnancy (early FGR, before 32 weeks gestation). What is New: • The timing of onset and features of FGR and antenatal umbilical Doppler abnormalities impact differently on maternal and neonatal outcomes; when FGR and Doppler abnormalities occur very early, at the limit of neonatal viability, and persist until delivery, infants face the highest risk for neurodevelopmental impairment. • Shared knowledge between obstetricians and neonatologists about timing of onset and features of FGR would provide a valuable tool for informed antenatal counselling in high-risk pregnancies.
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Affiliation(s)
- Anna Nunzia Della Gatta
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
| | - Arianna Aceti
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy.
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy.
| | - Sofia Fiore Spinedi
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
| | - Silvia Martini
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
| | - Luigi Corvaglia
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
| | - Alessandra Sansavini
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | | | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Anna Seidenari
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
| | - Camilla Dionisi
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
| | - Gianluigi Pilu
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
| | - Giuliana Simonazzi
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
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Calek E, Binder J, Palmrich P, Eibensteiner F, Thajer A, Kainz T, Harreiter K, Berger A, Binder C. Effects of Intrauterine Growth Restriction (IUGR) on Growth and Body Composition Compared to Constitutionally Small Infants. Nutrients 2023; 15:4158. [PMID: 37836441 PMCID: PMC10574227 DOI: 10.3390/nu15194158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Intrauterine growth restriction (IUGR) is associated with multiple morbidities including growth restriction and impaired neurodevelopment. Small for gestational age (SGA) is defined as a birth weight <10th percentile, regardless of the etiology. The term is commonly used as a proxy for IUGR, but it may represent a healthy constitutionally small infant. Differentiating between IUGR and constitutionally small infants is essential for the nutritional management. (2) Infants born at <37 weeks of gestation between 2017 and 2022, who underwent body composition measurement (FFM: fat-free mass; FM: fat mass) at term-equivalent age, were included in this study. Infants with IUGR and constitutionally small infants (SGA) were compared to infants appropriate for gestational age (AGA). (3) A total of 300 infants (AGA: n = 249; IUGR: n = 40; SGA: n = 11) were analyzed. FFM (p < 0.001) and weight growth velocity (p = 0.022) were significantly lower in IUGR compared to AGA infants, but equal in SGA and AGA infants. FM was not significantly different between all groups. (4) The FFM Z-score was significantly lower in IUGR compared to AGA infants (p = 0.017). Being born constitutionally small compared to AGA had no impact on growth and body composition. These data showed that early aggressive nutritional management is essential in IUGR infants to avoid impaired growth and loss of FFM.
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Affiliation(s)
- Elisabeth Calek
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Julia Binder
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (P.P.)
| | - Pilar Palmrich
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (P.P.)
| | - Felix Eibensteiner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Alexandra Thajer
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Theresa Kainz
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Karin Harreiter
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Christoph Binder
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
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Sayres L, Flockton AR, Ji S, Rey Diaz C, Gumina DL, Su EJ. Angiogenic Function of Human Placental Endothelial Cells in Severe Fetal Growth Restriction Is Not Rescued by Individual Extracellular Matrix Proteins. Cells 2023; 12:2339. [PMID: 37830553 PMCID: PMC10572031 DOI: 10.3390/cells12192339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023] Open
Abstract
Severe fetal growth restriction (FGR) is characterized by increased placental vascular resistance resulting from aberrant angiogenesis. Interactions between endothelial cells (ECs) and the extracellular matrix (ECM) are critical to the complex process of angiogenesis. We have previously found that placental stromal abnormalities contribute to impaired angiogenesis in severe FGR. The objective of this research is to better characterize the effect of individual ECM proteins on placental angiogenic properties in the setting of severe FGR. ECs were isolated from human placentae, either control or affected by severe FGR, and subjected to a series of experiments to interrogate the role of ECM proteins on adhesion, proliferation, migration, and apoptosis. We found impaired proliferation and migration of growth-restricted ECs. Although individual substrates did not substantially impact migratory capacity, collagens I, III, and IV partially mitigated proliferative defects seen in FGR ECs. Differences in adhesion and apoptosis between control and FGR ECs were not evident. Our findings demonstrate that placental angiogenic defects that characterize severe FGR cannot be explained by a singular ECM protein, but rather, the placental stroma as a whole. Further investigation of the effects of stromal composition, architecture, stiffness, growth factor sequestration, and capacity for remodeling is essential to better understand the role of ECM in impaired angiogenesis in severe FGR.
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Affiliation(s)
- Lauren Sayres
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Amanda R. Flockton
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Shuhan Ji
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Carla Rey Diaz
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Diane L. Gumina
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Emily J. Su
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
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181
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Clark AR, Fontinha H, Thompson J, Couper S, Jani D, Mirjalili A, Bennet L, Stone P. Maternal Cardiovascular Responses to Position Change in Pregnancy. BIOLOGY 2023; 12:1268. [PMID: 37759669 PMCID: PMC10525953 DOI: 10.3390/biology12091268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/07/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
The maternal cardiovascular-circulatory system undergoes profound changes almost from the conception of a pregnancy until the postpartum period to support the maternal adaptions required for pregnancy and lactation. Maintenance of cardiovascular homeostasis requires changes in the cardiovascular autonomic responses. Here, we present a longitudinal study of the maternal cardiovascular autonomic responses to pregnancy and maternal position. Over a normal gestation, in the left lateral position there are significant changes in both time and frequency domain parameters reflecting heart rate variability. We show that cardiovascular autonomic responses to physiological stressors (standing and supine positions in late pregnancy) became significantly different with advancing gestation. In the third trimester, 60% of the subjects had an unstable heart rate response on standing, and these subjects had a significantly reduced sample entropy evident in their heart rate variability data. By 6 weeks, postpartum function returned to near the non-pregnant state, but there were consistent differences in high-frequency power when compared to nulligravid cases. Finally, we review complementary evidence, in particular from magnetic resonance imaging, that provides insights into the maternal and fetal impacts of positioning in pregnancy. This demonstrates a clear relationship between supine position and maternal hemodynamic parameters, which relates to compression of the inferior vena cava (p = 0.05). Together, these studies demonstrate new understanding of the physiology of physiological stressors related to position.
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Affiliation(s)
- Alys R. Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - Hanna Fontinha
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - John Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Sophie Couper
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Devanshi Jani
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Laura Bennet
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Peter Stone
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
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182
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Miranda J, Paules C, Noell G, Youssef L, Paternina-Caicedo A, Crovetto F, Cañellas N, Garcia-Martín ML, Amigó N, Eixarch E, Faner R, Figueras F, Simões RV, Crispi F, Gratacós E. Similarity network fusion to identify phenotypes of small-for-gestational-age fetuses. iScience 2023; 26:107620. [PMID: 37694157 PMCID: PMC10485038 DOI: 10.1016/j.isci.2023.107620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/19/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Fetal growth restriction (FGR) affects 5-10% of pregnancies, is the largest contributor to fetal death, and can have long-term consequences for the child. Implementation of a standard clinical classification system is hampered by the multiphenotypic spectrum of small fetuses with substantial differences in perinatal risks. Machine learning and multiomics data can potentially revolutionize clinical decision-making in FGR by identifying new phenotypes. Herein, we describe a cluster analysis of FGR based on an unbiased machine-learning method. Our results confirm the existence of two subtypes of human FGR with distinct molecular and clinical features based on multiomic analysis. In addition, we demonstrated that clusters generated by machine learning significantly outperform single data subtype analysis and biologically support the current clinical classification in predicting adverse maternal and neonatal outcomes. Our approach can aid in the refinement of clinical classification systems for FGR supported by molecular and clinical signatures.
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Affiliation(s)
- Jezid Miranda
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de Cartagena, Cartagena de Indias, Colombia
| | - Cristina Paules
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
- Aragon Institute of Health Research (IIS Aragon), Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Guillaume Noell
- University of Barcelona, Biomedicine Department, IDIBAPS, Centre for Biomedical Research on Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Lina Youssef
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | | | - Francesca Crovetto
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Nicolau Cañellas
- Metabolomics Platform, IISPV, DEEiA, Universidad Rovira i Virgili, Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Tarragona, Spain
| | - María L. Garcia-Martín
- BIONAND, Andalusian Centre for Nanomedicine and Biotechnology, Junta de Andalucía, Universidad de Málaga, Málaga, Spain
| | | | - Elisenda Eixarch
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Rosa Faner
- University of Barcelona, Biomedicine Department, IDIBAPS, Centre for Biomedical Research on Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Francesc Figueras
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Rui V. Simões
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
- Institute for Research & Innovation in Health (i3S), University of Porto, Porto, Portugal
| | - Fàtima Crispi
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Eduard Gratacós
- BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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183
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Spencer R, Maksym K, Hecher K, Maršál K, Figueras F, Ambler G, Whitwell H, Nené NR, Sebire NJ, Hansson SR, Diemert A, Brodszki J, Gratacós E, Ginsberg Y, Weissbach T, Peebles DM, Zachary I, Marlow N, Huertas-Ceballos A, David AL. Maternal PlGF and umbilical Dopplers predict pregnancy outcomes at diagnosis of early-onset fetal growth restriction. J Clin Invest 2023; 133:e169199. [PMID: 37712421 PMCID: PMC10503803 DOI: 10.1172/jci169199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/27/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUNDSevere, early-onset fetal growth restriction (FGR) causes significant fetal and neonatal mortality and morbidity. Predicting the outcome of affected pregnancies at the time of diagnosis is difficult, thus preventing accurate patient counseling. We investigated the use of maternal serum protein and ultrasound measurements at diagnosis to predict fetal or neonatal death and 3 secondary outcomes: fetal death or delivery at or before 28+0 weeks, development of abnormal umbilical artery (UmA) Doppler velocimetry, and slow fetal growth.METHODSWomen with singleton pregnancies (n = 142, estimated fetal weights [EFWs] below the third centile, less than 600 g, 20+0 to 26+6 weeks of gestation, no known chromosomal, genetic, or major structural abnormalities) were recruited from 4 European centers. Maternal serum from the discovery set (n = 63) was analyzed for 7 proteins linked to angiogenesis, 90 additional proteins associated with cardiovascular disease, and 5 proteins identified through pooled liquid chromatography and tandem mass spectrometry. Patient and clinician stakeholder priorities were used to select models tested in the validation set (n = 60), with final models calculated from combined data.RESULTSThe most discriminative model for fetal or neonatal death included the EFW z score (Hadlock 3 formula/Marsal chart), gestational age, and UmA Doppler category (AUC, 0.91; 95% CI, 0.86-0.97) but was less well calibrated than the model containing only the EFW z score (Hadlock 3/Marsal). The most discriminative model for fetal death or delivery at or before 28+0 weeks included maternal serum placental growth factor (PlGF) concentration and UmA Doppler category (AUC, 0.89; 95% CI, 0.83-0.94).CONCLUSIONUltrasound measurements and maternal serum PlGF concentration at diagnosis of severe, early-onset FGR predicted pregnancy outcomes of importance to patients and clinicians.TRIAL REGISTRATIONClinicalTrials.gov NCT02097667.FUNDINGThe European Union, Rosetrees Trust, Mitchell Charitable Trust.
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Affiliation(s)
- Rebecca Spencer
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Kasia Maksym
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karel Maršál
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Francesc Figueras
- Institut D’Investigacions Biomèdiques August Pi í Sunyer, University of Barcelona, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Barcelona, Spain
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, United Kingdom
| | - Harry Whitwell
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
- National Phenome Centre and Imperial Clinical Phenotyping Centre, Department of Metabolism, Digestion and Reproduction and
- Section of Bioanalytical Chemistry, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Nuno Rocha Nené
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
| | - Neil J. Sebire
- Population, Policy and Practice Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Stefan R. Hansson
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Brodszki
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Eduard Gratacós
- Institut D’Investigacions Biomèdiques August Pi í Sunyer, University of Barcelona, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Barcelona, Spain
| | - Yuval Ginsberg
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
- Department of Obstetrics and Gynecology, Rambam Medical Centre, Haifa, Israel
| | - Tal Weissbach
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
- Department of Obstetrics and Gynecology, Sheba Medical Center Tel Hashomer, Tel Aviv, Israel
| | - Donald M. Peebles
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
| | - Ian Zachary
- Division of Medicine, Faculty of Medical Sciences, University College London, United Kingdom
| | - Neil Marlow
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
| | - Angela Huertas-Ceballos
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Anna L. David
- UCL Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom
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Barak O, Lovelace T, Piekos S, Chu T, Cao Z, Sadovsky E, Mouillet JF, Ouyang Y, Parks WT, Hood L, Price ND, Benos PV, Sadovsky Y. Integrated unbiased multiomics defines disease-independent placental clusters in common obstetrical syndromes. BMC Med 2023; 21:349. [PMID: 37679695 PMCID: PMC10485945 DOI: 10.1186/s12916-023-03054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Placental dysfunction, a root cause of common syndromes affecting human pregnancy, such as preeclampsia (PE), fetal growth restriction (FGR), and spontaneous preterm delivery (sPTD), remains poorly defined. These common, yet clinically disparate obstetrical syndromes share similar placental histopathologic patterns, while individuals within each syndrome present distinct molecular changes, challenging our understanding and hindering our ability to prevent and treat these syndromes. METHODS Using our extensive biobank, we identified women with severe PE (n = 75), FGR (n = 40), FGR with a hypertensive disorder (FGR + HDP; n = 33), sPTD (n = 72), and two uncomplicated control groups, term (n = 113), and preterm without PE, FGR, or sPTD (n = 16). We used placental biopsies for transcriptomics, proteomics, metabolomics data, and histological evaluation. After conventional pairwise comparison, we deployed an unbiased, AI-based similarity network fusion (SNF) to integrate the datatypes and identify omics-defined placental clusters. We used Bayesian model selection to compare the association between the histopathological features and disease conditions vs SNF clusters. RESULTS Pairwise, disease-based comparisons exhibited relatively few differences, likely reflecting the heterogeneity of the clinical syndromes. Therefore, we deployed the unbiased, omics-based SNF method. Our analysis resulted in four distinct clusters, which were mostly dominated by a specific syndrome. Notably, the cluster dominated by early-onset PE exhibited strong placental dysfunction patterns, with weaker injury patterns in the cluster dominated by sPTD. The SNF-defined clusters exhibited better correlation with the histopathology than the predefined disease groups. CONCLUSIONS Our results demonstrate that integrated omics-based SNF distinctively reclassifies placental dysfunction patterns underlying the common obstetrical syndromes, improves our understanding of the pathological processes, and could promote a search for more personalized interventions.
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Affiliation(s)
- Oren Barak
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Tyler Lovelace
- Department of Computational and Systems Biology, University of Pittsburgh, 800 Murdoch Building, 3420 Forbes Avenue, Pittsburgh, PA, 15260, USA
- Joint CMU-Pitt PhD Program in Computational Biology, 800 Murdoch Building, 3420 Forbes Avenue, Pittsburgh, PA, 15260, USA
| | - Samantha Piekos
- Institute for Systems Biology, 401 Terri Avenue North, Seattle, WA, 98109, USA
| | - Tianjiao Chu
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Zhishen Cao
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
| | - Elena Sadovsky
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
| | - Jean-Francois Mouillet
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Yingshi Ouyang
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - W Tony Parks
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Simcoe Hall, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Leroy Hood
- Institute for Systems Biology, 401 Terri Avenue North, Seattle, WA, 98109, USA
| | - Nathan D Price
- Institute for Systems Biology, 401 Terri Avenue North, Seattle, WA, 98109, USA
- Thorne HealthTech, 152 West 57th Street, New York, NY, 10019, USA
| | - Panayiotis V Benos
- Department of Computational and Systems Biology, University of Pittsburgh, 800 Murdoch Building, 3420 Forbes Avenue, Pittsburgh, PA, 15260, USA
- Joint CMU-Pitt PhD Program in Computational Biology, 800 Murdoch Building, 3420 Forbes Avenue, Pittsburgh, PA, 15260, USA
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Yoel Sadovsky
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA.
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA.
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA, 15219, USA.
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Hansen DN, Kahr HS, Torp-Pedersen C, Feifel J, Uldbjerg N, Sinding M, Sørensen A. The Danish newborn standard and the International Fetal and Newborn Growth Consortium for the 21st Century newborn standard: a nationwide register-based cohort study. Am J Obstet Gynecol 2023; 229:290.e1-290.e8. [PMID: 36907534 DOI: 10.1016/j.ajog.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/16/2023] [Accepted: 02/25/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND It is a matter of debate whether 1 universal standard, such as the International Fetal and Newborn Growth Consortium for the 21st Century standard, can be applied to all populations. OBJECTIVE The primary objective was to establish a Danish newborn standard based on the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century standard to compare the percentiles of these 2 standards. A secondary objective was to compare the prevalence and risk of fetal and neonatal deaths related to small for gestational age defined by the 2 standards when used in the Danish reference population. STUDY DESIGN This was a register-based nationwide cohort study. The Danish reference population included 375,318 singletons born at 33 to 42 weeks of gestation in Denmark between January 1, 2008, and December 31, 2015. The Danish standard cohort included 37,811 newborns who fulfilled the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century standard. Birthweight percentiles were estimated using smoothed quantiles for each gestational week. The outcomes included birthweight percentiles, small for gestational age (defined as a birthweight of 3rd percentile), and adverse outcomes (defined as either fetal or neonatal death). RESULTS At all gestational ages, the Danish standard median birthweights at term were higher than the International Fetal and Newborn Growth Consortium for the 21st Century standard median birthweights: 295g for females and 320 g for males. Therefore, the estimates of the prevalence rate of small for gestational age within the entire population were different: 3.9% (n=14,698) using the Danish standard vs 0.7% (n=2640) using the International Fetal and Newborn Growth Consortium for the 21st Century standard. Accordingly, the relative risk of fetal and neonatal deaths among small-for-gestational-age fetuses differed by SGA status defined by the different standards (4.4 [Danish standard] vs 9.6 [International Fetal and Newborn Growth Consortium for the 21st Century standard]). CONCLUSION Our finding did not support the hypothesis that 1 universal standard birthweight curve can be applied to all populations.
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Affiliation(s)
- Ditte N Hansen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.
| | - Henriette S Kahr
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Jan Feifel
- Institute of Statistics, Ulm University, Ulm, Germany
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marianne Sinding
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Sørensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
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Dankó I, Kelemen E, Tankó A, Cserni G. Correlations of Placental Histopathology, Neonatal Outcome, and Cardiotocogram Baseline Variability and Acceleration Patterns in the Growth Restricted Preterm Population. Pediatr Dev Pathol 2023; 26:447-457. [PMID: 37334626 DOI: 10.1177/10935266231178615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To evaluate the possible connections of cardiotocography (CTG) signs with neonatal outcome and placental histopathology between growth restricted preterms. MATERIALS AND METHODS Placental slides, baseline variability, and acceleration patterns of cardiotocograms, and neonatal parameters were studied retrospectively. Placental histopathological changes were diagnosed according to the Amsterdam criteria; percentage of intact terminal villi and capillarization of villi were also studied. 50 cases were analyzed: 24 were early-onset fetal growth restriction (FGR), 26 were late-onset FGR. RESULTS Reduced baseline variability was related to poor neonatal outcome; lack of accelerations similarly had associations with poor outcomes. Maternal vascular malperfusion, avascular villi, VUE, and chorangiosis were more common in the background of reduced baseline variability and absence of accelerations. Lower percentage of intact terminal villi was significantly associated with lower umbilical artery pH, higher lactate levels, and reduced baseline variability on CTG; absence of accelerations was correlated with decreased capillarization of terminal villi. CONCLUSIONS Baseline variability and absence of accelerations seem to be useful and reliable markers in predicting poor neonatal outcome. Maternal and fetal vascular malperfusion signs, decreased capillarization, and lower percentage of intact villi in placenta could contribute to pathologic CTG signs and poor prognosis.
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Affiliation(s)
- István Dankó
- Bács-Kiskun County Teaching Hospital, Department of Obstetrics and Gynecology, Kecskemét, Hungary
| | - Edit Kelemen
- Bács-Kiskun County Teaching Hospital, Perinatal Intensive Centre, Kecskemét, Hungary
| | - András Tankó
- Bács-Kiskun County Teaching Hospital, Department of Obstetrics and Gynecology, Kecskemét, Hungary
| | - Gábor Cserni
- Bács-Kiskun County Teaching Hospital, Department of Pathology, Kecskemét, Hungary
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187
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Galán Arévalo MS, Mahillo-Fernández I, Saenz De Pipaon M, Esteban LM, Hernández Martín D, Rodriguez Delgado J, Estevez Muñoz JC, Andeyro-García M, Piñeiro Perez R, Savirón-Cornudella R. Postnatal catch-up growth in term newborns with altered fetal weight patterns. The GROWIN study. Pediatr Res 2023; 94:1180-1188. [PMID: 37069223 DOI: 10.1038/s41390-023-02593-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Small for gestational age (SGA) perform a postnatal catch-up growth to recover their genetic trajectory. We studied the postnatal catch-up growth pattern of fetuses born with an appropriate-for-gestational-age (AGA) weight but with fetal growth deceleration (FGD) to explore whether they catch up. METHODS Nine hundred and sixty-six newborns at Villalba University General Hospital (HUGV), were followed from 34 to 37 weeks to birth. Z-scores, adjusted for sex and age, of weight, length, and BMI at 3, 6, 9, and 12 months were calculated. We define catch-up as an increase in z-score greater than 0.67 SD in the growth curves. RESULTS AGA FGD had lower mean weight and length than AGA non-FGD at all time points; BMI was lower until 3 months. AGA FGD had a lower weight, length, and BMI z-score (until 9, 6 months, and at birth, respectively) than AGA non-FGD. AGA FGD newborns had a significantly increased likelihood of weight catch-up at 3 months (OR 1.79; 95% CI: 1.16, 2.78; p = 0.009) and BMI in all investigated periods (OR 1.90; 95% CI 1.30, 2.78; p < 0.001 at 3 months), compared to AGA non-FGD newborns. CONCLUSIONS AGA FGD newborns perform catch-up growth, especially in weight and BMI, in the first year of life, compared to AGA non-FGD. IMPACT Appropriate-for-gestational-age (AGA) newborns with fetal growth deceleration (FGD), between the third trimester of pregnancy and delivery, present a lower weight and height, during the first year of life, compared to AGA non-FGD. Appropriate-for-gestational-age (AGA) newborns with fetal growth deceleration (FGD), between the third trimester of pregnancy and delivery, present a higher likelihood of weight catch-up in the first 3 months of life and of BMI in the first year compared to AGA non-FGD. AGA FGD experienced early weight and BMI catch-up, especially in the first 3 months of life, like SGA. This finding should be considered in the future follow-up.
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Affiliation(s)
| | - Ignacio Mahillo-Fernández
- Biostatistics and Epidemiology Unit, Hospital Universitario Fundación Jiménez Díaz and Fundación Instituto de Investigación Sanitaria, Madrid, Spain
| | - Miguel Saenz De Pipaon
- Neonatology, Instituto de Investigación Sanitaria del Hospital Universitario La Paz - IdiPAZ (La Paz University Hospital - Universidad Autónoma de Madrid), Madrid, Spain.
| | - Luis Mariano Esteban
- Escuela Universitaria Politécnica de La Almunia, University of Zaragoza, Zaragoza, Spain
| | | | | | - José Carlos Estevez Muñoz
- Technical Direction of Health Information System, Health Care Deputy Management, Primary Care Assistance Management, Madrid, Spain
| | - Mercedes Andeyro-García
- Department of Obstetrics and Gynecology, Villalba University General Hospital, Madrid, Spain
| | - Roi Piñeiro Perez
- Department of Paediatrics, Villalba University General Hospital, Madrid, Spain
| | - Ricardo Savirón-Cornudella
- Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, and Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
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Beneventi F, Bellingeri C, De Maggio I, Cavagnoli C, Boschetti A, Giannico S, Pandolfi MP, Spada C, Montecucco C, Spinillo A. Impact of pregnancy on progression of preclinical autoimmune disorders: a prospective cohort study. Rheumatology (Oxford) 2023; 62:2971-2978. [PMID: 36342202 DOI: 10.1093/rheumatology/keac637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/27/2022] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the role of pregnancies in the progression from the preclinical phase of autoimmune disorder to a definite rheumatic disease. METHODS A cohort study of women with symptoms and laboratory findings suggestive for autoimmune disorder were enrolled during the first trimester of pregnancy and followed-up for 5 years with clinical and laboratory assessment. Multinomial logistic regression was used to compute the risk of progression to definite autoimmune disease correcting for confounders. RESULTS At the end of follow-up, out of 208 subjects, 81 (38.9%) were considered negative, 53 (25.5%) had symptoms and abnormalities of autoantibody profile compatible with a non-criteria rheumatic status and 74 (35.6%) had a definite rheumatic disease (43 undifferentiated connective tissue disease, 5 systemic lupus erythematosus, 3 SS, 10 antiphospholipid syndrome, and 12 miscellaneous autoimmune disorders). The median time from enrolment to definite diagnosis was 28 months (interquartile range = 18-42). The rate of progression towards a definite autoimmune disease was 47.1% (48/102) among subjects with one or more subsequent viable pregnancies compared with 24.5% (26/106) of those with no subsequent pregnancies (adjusted odds ratio = 4.9, 95% CI: 2.4, 10). The occurrence of preeclampsia during the index pregnancy or subsequent pregnancy was an additional and independent risk factor for progression to a definite autoimmune disease (adjusted odds ratio = 4.3, 95% CI: 1.2, 14.8). CONCLUSIONS Among women with suspected autoimmune disease during pregnancy, additional viable pregnancies and diagnosis of preeclampsia were independently associated with an increased rate of progression to definite rheumatic disorder. Hormonal modifications associated with pregnancy could worsen preclinical rheumatic disorders favouring their progression to a defined autoimmune disease.
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Affiliation(s)
- Fausta Beneventi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Camilla Bellingeri
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Irene De Maggio
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Cavagnoli
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Boschetti
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Serena Giannico
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Maria Paola Pandolfi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Carolina Spada
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Huang SJ, Huang M, Liu XL, Hong LC, Su YQ, Lin YT, Wang YQ, Lin JR, Zhang XD, Zhou Y, Su YM. The Ratio of Clavicle Length to Head Circumference: A Novel Date-Independent Clavicle Index. Ultrasound Q 2023; 39:129-133. [PMID: 36802413 DOI: 10.1097/ruq.0000000000000637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
ABSTRACT We aimed to plot the growth curve of the fetal clavicle, identify gestational date-independent parameters. Using 2-dimensional ultrasonography, we obtained the clavicle lengths (CLs) from 601 normal fetuses between 12 and 40 gestational age (GA). The CL/fetal growth parameters ratio was calculated. Moreover, 27 cases of fetal growth restriction (FGR) and 9 cases of small for GA (SGA) were detected. In normal fetuses, the mean CL (mm) = -68.2 + 29.80 × ln(GA) ± Z × (1.07 + 0.02 × GA). A linear relationship was detected between CL and head circumference (HC), biparietal diameter, abdominal circumference and femoral length with R2 values of 0.973, 0.970, 0.962, and 0.972, respectively. The CL/HC ratio (mean value 0.130) showed no significant correlation with GA. Clavicle lengths in the FGR group significantly decreased compared with the SGA group ( P < 0.01). This study determined a reference range of fetal CL in a Chinese population. Furthermore, the CL/HC ratio, which is independent of GA, is a novel parameter for the evaluation of the fetal clavicle.
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Borrell A, Figueras F. Placental and genetic origins of fetal growth restriction are independent and may overlap. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:317-319. [PMID: 37428946 DOI: 10.1002/uog.26304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/12/2023]
Affiliation(s)
- A Borrell
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic Barcelona, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - F Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic Barcelona, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
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191
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Zhu S, Liu N, Gong H, Liu F, Yan G. Identification of biomarkers and sex differences in the placenta of fetal growth restriction. J Obstet Gynaecol Res 2023; 49:2324-2336. [PMID: 37553225 DOI: 10.1111/jog.15735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/20/2023] [Indexed: 08/10/2023]
Abstract
AIM Fetal growth restriction (FGR) can lead to short-term and long-term impairments in the fetus. The placenta functions as an exchanger for substance transport, playing a critical role in fetal growth. However, the mechanism from the placental standpoint is still not fully understood. In this study, we aimed to investigate the pathophysiological mechanisms in the placenta that mediated the development of FGR and sex differences. METHODS We analyzed the gene expression profiles of GSE100415 containing specific normotensive FGR placental samples and GSE114691 with canonical samples using three different methods, differentially expressed gene analysis, weighted gene co-expression network analysis, and gene set enrichment analysis. Gene enrichment was performed, including the gene ontology and pathway from the Kyoto Encyclopedia of Genes and Genomes. The important process was then validated in pregnant Wistar rats subcutaneously administered dexamethasone (0.2 mg/kg/d) or saline from gestation Day 9 to 21. RESULTS Our results revealed little difference between the comparison of normal and normotensive FGR placental samples but confirmed the sex difference. Further analyses of the canonical samples identified the occurrence of vascular dysfunction, which was validated by the calculation of the vascular lumen area, showing that the vascular lumen in the FGR group was more than in the control. We also discovered 17 significantly expressed genes from the involved eigengenes. CONCLUSION Our study provides an important theoretical and experimental basis to reevaluate the development of FGR from the placental standpoint and suggests a series of biomarkers for future clinical use.
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Affiliation(s)
- Sha Zhu
- Department of Obstetrics and Gynecology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei, China
| | - Niying Liu
- Department of Obstetrics and Gynecology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, Hubei, China
| | - Hongjun Gong
- Department of Obstetrics and Gynecology, Hubei Province Dongxihu District Maternal and Child Health Care Hospital, Wuhan, Hubei, China
| | - Fulin Liu
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Center for Medical Genetics, Department of Laboratory Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology, Chengdu, Sichuan, China
- Research Unit for Blindness Prevention, Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
- Université Paris Cité, Paris, France
| | - Ge Yan
- Department of Obstetrics and Gynecology, Hubei Province Dongxihu District Maternal and Child Health Care Hospital, Wuhan, Hubei, China
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192
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Karakuş SS, Karakuş R, Akalın EE, Akalın M. Pregnancy outcomes with a copper 380 mm 2 intrauterine device in place: A retrospective cohort study in Turkey, 2011-2021. Contraception 2023; 125:110090. [PMID: 37331462 DOI: 10.1016/j.contraception.2023.110090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES To investigate pregnancy outcomes in patients with pregnancies with a copper 380 mm2 intrauterine device (IUD) in situ at conception. STUDY DESIGN In this retrospective study, we identified patients with pregnancies with a copper 380 mm2 IUD between 2011 and 2021 from the electronic health record system. According to their initial diagnosis, we classified the patients as having nonviable intrauterine pregnancies (IUPs), viable IUPs, or ectopic pregnancies. Among the viable IUPs, we divided the ongoing pregnancies into two subgroups as IUD-removed and IUD-retained. We compared the pregnancy loss (miscarriage before 22 weeks) rates and adverse pregnancy outcomes (at least one of preterm birth, preterm premature rupture of membranes, chorioamnionitis, placental abruption, or postpartum hemorrhage) of IUD-removed and IUD-retained pregnancies. RESULTS We identified a total of 246 patients with pregnancies with an IUD. We excluded six (2.4%) patients without follow-up data and seven (2.8%) patients with levonorgestrel-IUD and included the remaining 233 (44 [18.9%] ectopic pregnancy, 31 [13.3%] nonviable IUP, and 158 [67.5%] viable IUP) patients. Among the 158 women with viable IUP, 21 (13.3%) underwent abortion, leaving 137 (86.7%) who elected to continue the pregnancy. A total of 54 (39.4%) patients with ongoing pregnancy had the IUD removed. We found a lower rate of pregnancy loss among those who underwent removal (18/54 [33.3%]) compared to those with a retained IUD (51/83 [61.4%], p < 0.001). After accounting for pregnancy loss, adverse pregnancy outcomes remained increased in the IUD-retained group (17/32 [53.1%]) compared to the IUD-removed group (10/36 [27.8%], p = 0.03). CONCLUSIONS Pregnancy in the setting of a copper 380 mm2 IUD is high risk. Our results demonstrate that pregnancy outcomes improve by removal of the copper 380 mm2 IUD. IMPLICATIONS Prior studies have suggested that the removal of the IUD improves outcomes, but all have limitations. Our results from a very large series with care in a single institution provide contemporary evidence to support copper 380 mm2 IUD removal to reduce the risk of both early pregnancy loss and later adverse outcomes.
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Affiliation(s)
- Sultan Seren Karakuş
- Department of Obstetrics and Gynecology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Resul Karakuş
- Department of Obstetrics and Gynecology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Emine Eda Akalın
- Department of Obstetrics and Gynaecology, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Münip Akalın
- Department of Perinatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey.
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193
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Sinelli M, Zannin E, Doni D, Ornaghi S, Acampora E, Roncaglia N, Vergani P, Ventura ML. Association of intrauterine growth restriction and low birth weight with acute kidney injury in preterm neonates. Pediatr Nephrol 2023; 38:3139-3144. [PMID: 36988690 DOI: 10.1007/s00467-023-05936-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Preterm birth alters nephrogenesis and reduces the total nephron number. Intrauterine growth restriction (IUGR) seems to worsen nephron loss, but only a few studies have investigated its role in neonatal kidney impairment. We investigated whether IUGR, defined as reduced estimated fetal growth and/or placental flow alterations and low birth weight z-score, increases the risk of developing acute kidney injury (AKI) in very preterm infants. METHODS We performed a retrospective study including infants born with a birth weight (BW) ≤ 1500 g and/or gestational age (GA) ≤ 32 weeks admitted to our center between January 2016 and December 2021. Neonatal AKI was defined according to the neonatal KDIGO classification based on the decline of urine output and/or creatinine elevation. We used multivariable linear regressions to verify the association between AKI and GA, BW z-score, IUGR definition, and hemodynamically significant patent ductus arteriosus (PDA). RESULTS We included 282 infants in the analysis, with a median (IQR) GA = 29.4 (27.4, 31.3) weeks, BW = 1150 (870, 1360) g, and BW z-score = - 0.57 (- 1.64, 0.25). AKI was diagnosed in 36 (13%) patients, and 58 (21%) had PDA. AKI was significantly associated with BW z-score (beta (std. error) = - 0.08 (0.03), p = 0.008) and severe IUGR (beta (std. error) = 0.21 (0.08), p = 0.009), after adjusting for GA and PDA. CONCLUSIONS Our data suggest that low BW z-score and IUGR could represent adjunctive risk factors for kidney impairment in preterm babies. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Mariateresa Sinelli
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900, Monza, Italy.
| | - Emanuela Zannin
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900, Monza, Italy
| | - Daniela Doni
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900, Monza, Italy
| | - Sara Ornaghi
- Unit of Obstetrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Bicocca School of Medicine and Surgery, University of Milan, Monza, Italy
| | - Eleonora Acampora
- Unit of Obstetrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Nadia Roncaglia
- Unit of Obstetrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Patrizia Vergani
- Unit of Obstetrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Bicocca School of Medicine and Surgery, University of Milan, Monza, Italy
| | - Maria Luisa Ventura
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900, Monza, Italy
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194
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Paz Y Miño MF, Pauta M, Meler E, Matas I, Mazarico E, Camacho A, Segura M, Figueras F, Borrell A. Postnatal genetic and neurodevelopmental assessment in infants born at term with severely low birth weight of non-placental origin. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:361-368. [PMID: 36840980 DOI: 10.1002/uog.26188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To determine the frequency of genetic syndromes and childhood neurodevelopmental impairment in non-malformed infants born at term with severely low birth weight and no evidence of placental insufficiency. METHODS This case series was constructed from the data of infants delivered at term between 2013 and 2018 with severely low birth weight, defined as birth weight more than 2.5 SD below the mean, with normal maternal and fetal Doppler (umbilical artery, fetal middle cerebral artery, cerebroplacental ratio and uterine artery) and no maternal hypertensive disorder during pregnancy or fetal structural anomaly on prenatal ultrasound examination. Clinical exome sequencing and copy number variation (CNV) analysis were performed using DNA extracted from the children's saliva. Cognitive and psychomotor development was evaluated using the Bayley Scales of Infant and Toddler Development, 3rd edition or the Wechsler Intelligence Scale for Children, 5th edition tests, according to the child's age at testing. RESULTS Among the 36 405 infants born within the study period, 274 (0.75%) had a birth weight below -2.5 SD, of whom 98 met the inclusion criteria. Among the 63 families contacted, seven (11%) reported a postnatal diagnosis of a genetic syndrome and a further 18 consented to participate in the study. Median gestational age at delivery was 38.0 (interquartile range (IQR), 37.3-38.5) weeks and median birth weight was 2020 (IQR, 1908-2248) g. All 18 children showed a normal result on clinical exome sequencing and CNV analysis, but six (33%) obtained a low score on neurodevelopmental testing. CONCLUSION Non-malformed severely small term infants with no clinical or Doppler signs of placental insufficiency present a high rate of genetic syndromes and neurodevelopmental impairment during childhood. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M F Paz Y Miño
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic Barcelona and Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - M Pauta
- IDIBAPS, University of Barcelona, Fetal i+D Fetal Medicine Research, Barcelona, Catalonia, Spain
| | - E Meler
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic Barcelona and Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - I Matas
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic Barcelona and Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - E Mazarico
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic Barcelona and Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - A Camacho
- Mental Health and Perinatal Nursing, Hospital Clínic Barcelona, Barcelona, Catalonia, Spain
| | - M Segura
- qGenomics, Esplugues de Llobregat, Catalonia, Spain
| | - F Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic Barcelona and Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
- IDIBAPS, University of Barcelona, Fetal i+D Fetal Medicine Research, Barcelona, Catalonia, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - A Borrell
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic Barcelona and Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
- IDIBAPS, University of Barcelona, Fetal i+D Fetal Medicine Research, Barcelona, Catalonia, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Catalonia, Spain
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195
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Tousty P, Fraszczyk-Tousty M, Golara A, Zahorowska A, Sławiński M, Dzidek S, Jasiak-Jóźwik H, Nawceniak-Balczerska M, Kordek A, Kwiatkowska E, Cymbaluk-Płoska A, Torbé A, Kwiatkowski S. Screening for Preeclampsia and Fetal Growth Restriction in the First Trimester in Women without Chronic Hypertension. J Clin Med 2023; 12:5582. [PMID: 37685649 PMCID: PMC10488103 DOI: 10.3390/jcm12175582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Nowadays, it is possible to identify a group at increased risk of preeclampsia (PE) and fetal growth restriction (FGR) using the principles of the Fetal Medicine Foundation (FMF). It has been established for several years that acetylsalicylic acid (ASA) reduces the incidence of PE and FGR in high-risk populations. This study aimed to evaluate the implementation of ASA use after the first-trimester screening in a Polish population without chronic hypertension, as well as its impact on perinatal complications. MATERIAL AND METHODS A total of 874 patients were enrolled in the study during the first-trimester ultrasound examination. The risk of PE and FGR was assessed according to the FMF guidelines, which include the maternal history, mean arterial pressure (MAP), uterine artery pulsatility index (UtPI), pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PLGF). Among patients with a risk higher than >1:100, ASA was administered at a dose of 150 mg. Perinatal outcomes were assessed among the different groups. RESULTS When comparing women in the high-risk group with those in the low-risk group, a statistically significantly higher risk of pregnancy complications was observed in the high-risk group. These complications included pregnancy-induced hypertension (PIH) (OR 3.6 (1.9-7)), any PE (OR 7.8 (3-20)), late-onset PE (OR 8.5 (3.3-22.4)), FGR or small for gestational age (SGA) (OR 4.8 (2.5-9.2)), and gestational diabetes mellitus type 1 (GDM1) (OR 2.4 (1.4-4.2)). The pregnancies in the high-risk group were more likely to end with a cesarean section (OR 1.9 (1.2-3.1)), while the newborns had significantly lower weights (<10 pc (OR 2.9 (1.2-6.9)), <3 pc (OR 10.2 (2.5-41.7))). CONCLUSIONS The first-trimester screening test for PE and FGR is a necessary and effective tool in identifying high-risk pregnancies. ASA prophylaxis among high-risk patients may have the most beneficial effect. Furthermore, this screening tool may significantly reduce the incidence of early-onset PE (eo-PE).
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Affiliation(s)
- Piotr Tousty
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Magda Fraszczyk-Tousty
- Department of Neonatology and Neonatal Intensive Care, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Anna Golara
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Adrianna Zahorowska
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Michał Sławiński
- Department of Laboratory Diagnostics, Public Clinical Hospital No. 2, 70-111 Szczecin, Poland
| | - Sylwia Dzidek
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Hanna Jasiak-Jóźwik
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | | | - Agnieszka Kordek
- Department of Neonatology and Neonatal Intensive Care, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Ewa Kwiatkowska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aneta Cymbaluk-Płoska
- Department of Reconstructive Surgery and Gynecological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Andrzej Torbé
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sebastian Kwiatkowski
- Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland
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196
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Lip-Sosa DL, Pérez-Cruz M, Ahumada-Droguett P, Ribas-Prats T, Puertollano M, García-Gómez MA, Mazarico E, Eixarch E, Escera C, Gómez-Roig MD. Corpus callosum-fastigium and tectal lengths in late-onset small fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:226-233. [PMID: 36722073 DOI: 10.1002/uog.26169] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/19/2022] [Accepted: 12/06/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To investigate measurements on neurosonography of midbrain morphology, including corpus callosum-fastigium length and tectal length, in late-onset small fetuses subclassified as small-for-gestational-age (SGA) or growth-restricted (FGR). METHODS This was a case-control study of consecutive singleton pregnancies delivered at term at a single center between January 2019 and July 2021, including those with late-onset smallness (estimated fetal weight (EFW) < 10th centile) and appropriate-for-gestational-age controls matched by age at neurosonography. Small fetuses were further subdivided into SGA (EFW between 3rd and 9th centile and normal fetoplacental Doppler) and FGR (EFW < 3rd centile or EFW < 10th centile with abnormal cerebroplacental ratio and/or uterine artery Doppler). Transvaginal neurosonography was performed at a mean ± SD gestational age of 33 ± 1 weeks in all fetuses to evaluate corpus callosum-fastigium length and tectal length in the midsagittal plane. Intra- and interobserver agreement was evaluated using the intraclass correlation coefficient and Bland-Altman plots. RESULTS A total of 70 fetuses with late-onset smallness (29 with SGA and 41 with FGR) and 70 controls were included. Compared with controls, small fetuses showed significantly shorter corpus callosum-fastigium length (median (interquartile range), 44.7 (43.3-46.8) mm vs 43.7 (42.4-45.5) mm, P < 0.001) and tectal length (mean ± SD, 10.5 ± 0.9 vs 9.6 ± 1.0 mm, P < 0.001). These changes were more prominent in FGR fetuses, with a linear trend across groups according to severity of smallness. Corpus callosum-fastigium length and tectal length measurements showed excellent intra- and interobserver reliability. CONCLUSIONS Small fetuses exhibited shorter corpus callosum-fastigium length and tectal length compared with controls, and these differences were more pronounced in fetuses with more severe smallness. These findings illustrate the potential value of midbrain measurements assessed on neurosonography as biomarkers for brain development in a high-risk population. However, further studies correlating these parameters with postnatal functional tests and follow-up are needed. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D L Lip-Sosa
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - M Pérez-Cruz
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, Madrid, Spain
| | - P Ahumada-Droguett
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - T Ribas-Prats
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Brainlab-Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - M Puertollano
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Brainlab-Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - M A García-Gómez
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - E Mazarico
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, Madrid, Spain
| | - E Eixarch
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - C Escera
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Brainlab-Cognitive Neuroscience Research Group, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - M D Gómez-Roig
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, Madrid, Spain
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197
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Bendall A, Schreiber V, Crawford K, Kumar S. Predictive utility of the fetal cerebroplacental ratio for hypoxic ischaemic encephalopathy, severe neonatal morbidity and perinatal mortality in late-preterm and term infants. Aust N Z J Obstet Gynaecol 2023; 63:491-498. [PMID: 37029609 DOI: 10.1111/ajo.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/17/2023] [Indexed: 04/09/2023]
Abstract
AIMS The aim of this study was to evaluate the association of a low cerebroplacental ratio (CPR) with hypoxic ischaemic encephalopathy (HIE), severe neonatal morbidity (SNM) and perinatal mortality (PNM). METHODS This was a retrospective cohort study of late-preterm and term births at Mater Mothers' Hospital, Brisbane, between 2016 and 2020. Study outcomes were HIE, PNM and SNM (a composite of severe acidosis, Apgar score less than four at 5 min, severe respiratory distress or need for significant cardiopulmonary resuscitation at birth). Univariate and multivariable logistic regressions were used to determine if a low CPR was associated with HIE, SNM or PNM. RESULTS A total of 51 870 births met the inclusion criteria. Of these, 216 (0.42%) were complicated by HIE, 10 224 (19.7%) had SNM and 251 (0.48%) had PNM. Rates of low CPR (<10th and <5th centile) were significantly higher in the SNM cohort (20.1 and 13.2%, respectively) and PNM cohort (21.1 and 15.1%, respectively) compared to the overall cohort. A low CPR was associated with significantly increased adjusted odds for SNM but not for HIE or PNM. The area under the receiver operating characteristic curve for CPR <10th centile was greatest for SNM (0.768) and lowest for HIE (0.595). Predictive margins of a low CPR for HIE, SNM and PNM were significant only for SNM at late-preterm gestations. CONCLUSIONS A low CPR is associated with increased odds of SNM in infants born >34 weeks' gestation but not for HIE or PNM.
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Affiliation(s)
- Alexa Bendall
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Veronika Schreiber
- Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Kylie Crawford
- Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
- NHMRC Centre for Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
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198
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Fierro JJ, Prins JR, Verstappen GM, Bootsma H, Westra J, de Leeuw K. Preconception clinical factors related to adverse pregnancy outcomes in patients with systemic lupus erythematosus or primary Sjögren's syndrome: a retrospective cohort study. RMD Open 2023; 9:e003439. [PMID: 37652559 PMCID: PMC10476138 DOI: 10.1136/rmdopen-2023-003439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE To identify preconception clinical factors associated with adverse pregnancy outcomes (APO) in patients with systemic lupus erythematosus (SLE) or primary Sjögren's syndrome (pSS). METHODS A single-centre, retrospective cohort study was conducted, which included pregnant women treated at the University Medical Center Groningen between January 2010 and August 2021 who fulfilled classification criteria for SLE or pSS. Demographic data, relevant comorbidities, disease duration, disease activity before and during pregnancy, APO, laboratory parameters and treatment regimens were recorded. Associations between the presence of APO and preconception characteristics were evaluated. RESULTS Our study population included 48 (70%) SLE and 21 (30%) pSS pregnancies concerning 70 fetuses (one twin). Preterm birth (n=9, 19%) was the most frequent APO in SLE pregnancies, while in pSS pregnancies this was miscarriages (n=3, 14%). There were no associations between the presence of APO in SLE pregnancies and clinical parameters, laboratory parameters or medication use prior to conception. In the pSS group, significant associations were found between the presence of APO and body mass index (p=0.010), parity (p=0.046), C4 (p=0.021) and low C4 levels (p=0.002). CONCLUSIONS No preconception risk factors related to APO were found in SLE pregnancies, whereas preconception complement levels were associated with APO development in patients with pSS.
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Affiliation(s)
- Juan J Fierro
- Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
- Microbiología y Parasitología, Grupo Reproduccion, Universidad de Antioquia UdeA, Medellin, Antioquia, Colombia
| | - Jelmer R Prins
- Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Gwenny M Verstappen
- Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrika Bootsma
- Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna Westra
- Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Karina de Leeuw
- Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
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199
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Nestaas E, Bjarkø L, Kiserud T, Haugen G, Fugelseth D. Heart function by M-mode and tissue Doppler in the early neonatal period in neonates with fetal growth restriction. Early Hum Dev 2023; 183:105809. [PMID: 37331046 DOI: 10.1016/j.earlhumdev.2023.105809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Fetal growth restricted (FGR) neonates have increased risk of circulatory compromise due to failure of normal transition of circulation after birth. AIM Echocardiographic assessment of heart function in FGR neonates first three days after birth. STUDY DESIGN Prospective observational study. SUBJECTS FGR- and non-FGR neonates. OUTCOME MEASURES M-mode excursions and pulsed-wave tissue Doppler velocities normalised for heart size and E/e' of the atrioventricular plane day one, two and three after birth. RESULTS Compared with controls (non-FGR of comparable gestational age, n = 41), late-FGR (gestational age ≥ 32 weeks, n = 21) exhibited higher septal excursion (15.9 (0.6) vs. 14.0 (0.4) %, p = 0.021) (mean (SEM)) and left E/e' (17.3 (1.9) vs.11.5 (1.3), p = 0.019). Relative to day three, indexes on day one were higher for left excursion (21 (6) % higher on day one, p = 0.002), right excursion (12 (5) %, p = 0.025), left e' (15 (7) %, p = 0.049), right a' (18 (6) %, p = 0.001), left E/e' (25 (10) %, p = 0.015) and right E/e' (17 (7) %, p = 0.013), whereas no index changed from day two to day three. Late-FGR had no impact on changes from day one and two to day three. No measurements differed between early-FGR (n = 7) and late-FGR. CONCLUSIONS FGR impacted neonatal heart function the early transitional days after birth. Late-FGR hearts had increased septal contraction and reduced left diastolic function compared with controls. The dynamic changes in heart function between first three days were most evident in lateral walls, with similar pattern in late-FGR and non-FGR. Early-FGR and late-FGR exhibited similar heart function.
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Affiliation(s)
- Eirik Nestaas
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Clinic of Paediatrics and Adolescence, Akershus University Hospital, Lørenskog, Norway.
| | - Lisa Bjarkø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Torvid Kiserud
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - Guttorm Haugen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Fetal Medicine, Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Drude Fugelseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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200
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van Roekel M, Henrichs J, Franx A, Verhoeven CJ, de Jonge A. Implication of third-trimester screening accuracy for small-for-gestational age and additive value of third-trimester growth-trajectory indicators in predicting severe adverse perinatal outcome in low-risk population: pragmatic secondary analysis of IRIS study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:209-218. [PMID: 36704993 DOI: 10.1002/uog.26167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 11/23/2022] [Accepted: 12/30/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To examine the implications of third-trimester small-for-gestational-age (SGA) screening accuracy on severe adverse perinatal outcome (SAPO) and obstetric intervention in a low-risk population. Furthermore, we aimed to explore the additive value of third-trimester sonographic growth-trajectory measurements in predicting SAPO and obstetric intervention. METHODS This was a secondary analysis of a Dutch national multicenter stepped-wedge-cluster randomized trial among 11 820 low-risk pregnant women. Using multilevel multivariable logistic regression analysis, we compared SAPO and obstetric interventions in SGA neonates with and without SGA suspected prenatally (true positives and false negatives) and non-SGA neonates with and without SGA suspected prenatally (false positives and true negatives). In a subsample (n = 7989), we analyzed the associations of abdominal circumference (AC) and estimated fetal weight (EFW) < 10th centile (p10) and third-trimester growth-trajectory indicators AC and EFW crossing > 20 and AC crossing > 50 centiles and the lowest decile of AC growth-velocity Z-scores (ACGV < 10%) with SAPO and obstetric interventions. RESULTS SGA infants, i.e. the true-positive and false-negative cases, had an increased risk of SAPO (adjusted odds ratio (aOR), 4.46 (95% CI, 2.28-8.75) and aOR 2.61 (95% CI, 1.74-3.89), respectively), and obstetric intervention (aOR for: induction of labor, 2.99 (95% CI, 2.15-4.17) and 1.38 (95% CI, 1.14-1.66); Cesarean section, 1.82 (95% CI, 1.25-2.66) and 1.27 (95% CI, 1.05-1.54); medically indicated preterm delivery, 2.67 (95% CI, 1.97-3.62) and 1.20 (95% CI, 1.03-1.40)). The false-positive cases did not differ from the true negatives for all outcomes, including obstetric intervention. Of the third-trimester growth-trajectory indicators, only ACGV < 10% was associated moderately with SAPO (aOR, 2.15 (95% CI, 1.17-3.97)), while AC and EFW crossing > 20 and AC crossing > 50 centiles were not. Both EFW < p10 alone (aOR, 1.95 (95% CI, 1.13-3.38)) and EFW < p10 combined with ACGV < 10% (aOR, 4.69 (95% CI, 1.99-11.07)) were associated with SAPO, and they performed equally well in predicting SAPO (area under the receiver-operating-characteristics curve, 0.71 (95% CI, 0.65-0.76) vs 0.72 (95% CI, 0.67-0.77), P = 0.51). CONCLUSION Neonates who had been suspected falsely of being SGA during pregnancy had no higher rates of obstetric intervention than did those without suspicion of SGA prenatally. Our results do not support that third-trimester low fetal growth velocity (ACGV < 10%) may be of additive value for the identification of fetuses at risk of SAPO in populations remaining at low risk throughout pregnancy. AC and EFW crossing > 20 and AC crossing > 50 centiles performed poorly in identifying abnormal fetal growth. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M van Roekel
- Amsterdam UMC, location Vrije Universiteit, Department of Midwifery Science/AVAG, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - J Henrichs
- Amsterdam UMC, location Vrije Universiteit, Department of Midwifery Science/AVAG, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - A Franx
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C J Verhoeven
- Amsterdam UMC, location Vrije Universiteit, Department of Midwifery Science/AVAG, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
- Department of Midwifery, University of Nottingham, Nottingham, UK
| | - A de Jonge
- Amsterdam UMC, location Vrije Universiteit, Department of Midwifery Science/AVAG, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC, location Vrije Universiteit, Department of Midwifery Science/AVAG, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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