Usefulness of ultrasound fetal anthropometry in primary and secondary screening to identify small for gestational age: A meta-analysis

Late pregnancy ultrasound parameters identifying fetuses at risk of adverse perinatal outcomes: a protocol for a systematic review of systematic reviews

INTRODUCTION

Stillbirths and neonatal deaths are leading contributors to the global burden of disease and pregnancy ultrasound has the potential to help decrease this burden. In the absence of high-Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence on universal obstetric ultrasound screening at or close to term, many different screening strategies have been proposed. Systematic reviews have rapidly increased over the past decade owing to the diverse nature of ultrasound parameters and the wide range of possible adverse perinatal outcomes. This systematic review will summarise the evidence on key ultrasound parameters in the published literature to help develop an obstetric ultrasound protocol that identifies pregnancies at risk of adverse perinatal outcomes at or close to term.

METHODS

This study will follow the recent Cochrane guidelines for a systematic review of systematic reviews. A comprehensive literature search will be conducted using Embase (OvidSP), Medline (OvidSP), CDSR, CINAHL (EBSCOhost) and Scopus. Systematic reviews evaluating at least one ultrasound parameter in late pregnancy to detect pregnancies at risk of adverse perinatal outcomes will be included. Two independent reviewers will screen, assess the quality including the risk of bias using the ROBIS tool, and extract data from eligible systematic reviews that meet the study inclusion criteria. Overlapping data will be assessed and managed with decision rules, and study evidence including the GRADE assessment of the certainty of results will be presented as a narrative synthesis as described in the Cochrane guidelines for an overview of reviews.

ETHICS AND DISSEMINATION

This research uses publicly available published data; thus, an ethics committee review is not required. The findings will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42021266108.

Diagnostic value of sonographic fetal anthropometries and anthropometric formulas to identify macrosomia: a meta-analysis

INTRODUCTION

This study evaluated whether sonographic fetal anthropometries and anthropometric formulas can identify macrosomia, with increases in mortality and morbidity rates in infanthood and probably later in life.

EVIDENCE ACQUISITION

Meta-analysis including good-quality studies determined summarized sensitivity, specificity, and positive and negative likelihood ratios (PLR and NLR, respectively) and area under the curve (AUC). PLR and NLR divided informational usability into exclusion and confirmation strategies (10<PLR and NLR<0.1), confirmation strategies only (10<PLR and NLR>0.1), exclusion strategies only (10>PLR and NLR<0.1), or neither exclusion nor confirmation strategies (10>PLR and NLR>0.1). Subgroup and meta-regression analyses were performed.

EVIDENCE SYNTHESIS

Abdominal circumference showed moderately high sensitivity and moderately high specificity (N.=4). However, informational usability classified it as a neither exclusion nor confirmation strategy. Anthropometric formulas showed high specificity (N.=21). However, use of anthropometric formulas showed low sensitivity, and informational usability classified it as a neither exclusion nor confirmation strategy. On the other hand, limiting to Hadlock IV (1985) formula changed this to a confirmation strategy only (N.=7). Hadlock IV (1985) formula versus other formulas may have been a true confounder.

CONCLUSIONS

Abdominal circumference and varying anthropometric formulas are not highly useful for identification of macrosomia. However, Hadlock IV (1985) formula may be useful for secondary screening of macrosomia.

Current Resources for Evidence-Based Practice, March 2020

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of the concept of overdiagnosis and implications for research and commentaries on reviews focused on exogenous progestogen to maintain pregnancies and cancer risk among children conceived using fertility treatments.

Ultrasound fetal anthropometry to identify large-for-gestational-age: a meta-analysis

INTRODUCTION

Large-for-gestational-age (LGA) has been suggested to show high rates of mortality and morbidity in pregnant women and their neonates. This study was based on data from 2015 or later to determine whether ultrasound fetal anthropometry is helpful for identifying LGA.

EVIDENCE ACQUISITION

Sensitivity, specificity, positive and negative likelihood ratios (LRs), and diagnostic odds ratio (DOR) of studies published in English were summarized using bivariate diagnostic meta-analysis. Study quality was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies tool. Deeks' funnel plot asymmetry test was assessed to identify publication bias.

EVIDENCE SYNTHESIS

The findings of abdominal circumference were based on a single article. Despite high specificity (0.92), anthropometric formulas showed moderate sensitivity (0.71) and DOR (26) and were categorized as providing "neither exclusion (positive LR<10) nor confirmation (negative LR>0.1)" strategy based on 28 good-quality studies in five articles. However, they were more promising than previous meta-analytic findings not limited to 2015 or later. No publication bias was identified with respect to assessment of anthropometric formulas (P=0.286).

CONCLUSIONS

Current ultrasound fetal anthropometry is not strongly helpful, but the values of anthropometric formulas provided by future ultrasound are expected especially as the secondary screening of LGA.

MALAT1 modulates miR-146's protection of microvascular endothelial cells against LPS-induced NF-κB activation and inflammatory injury

To investigate the role of miR-146 and its possible relationship with MALAT1 in LPS-induced inflammation in human microvascular endothelial cells (HMECs), HMEC-1 cells were treated with LPS to construct an inflammatory injury cell model, and the cell viability, TNF-α and IL-6 secretion and the expression levels of VCAM-1, SELE and ICAM-1 were analysed as markers of inflammatory injury. The regulation mechanisms of miR-146 interacted with MALAT1 and the downstream NF-κB signalling were also verified by dual-luciferase assay and knockdown technology. LPS significantly decreased the cell viability, increased levels of VCAM-1, SELE and ICAM-1 and also up-regulated miR-146a/b, TNF-α and IL-6 in a dose-dependent manner. Over-expression of miR-146a resulted in down-regulation of TNF-α and IL-6, as well as VCAM-1, SELE and ICAM-1, while inhibition of miR-146a led to opposite results. The dual-luciferase reporter assay showed both miR-146a and miR-146b directly targeted and negatively regulated the expression of MALAT1. Silencing of MALAT1 suppressed LPS-induced NF-κB activation and TNF-α and IL-6 secretion, reducing the cell inflammatory injury, but these changes were reversed after combined treatment with miR-146a inhibitor. Taken together, we demonstrate that miR-146 protects HMECs against inflammatory injury by inhibiting NF-κB activation. This process is modulated by MALAT1.