1
|
Dal Y, Akkuş F, Karagün Ş, Nessar AZ, Karaca SG, Kıllı MÇ, Coşkun A. Fetal epicardial fat thickness and modified myocardial performance index in late-onset fetal growth restriction. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39189700 DOI: 10.1002/jcu.23804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/14/2024] [Accepted: 08/07/2024] [Indexed: 08/28/2024]
Abstract
AIM In our study, we aimed to investigate the value of fetal epicardial fat thickness (EFT) and modified myocardial performance index (mod-MPI) in fetal growth restriction (FGR) that develops after the 32nd week of gestation. MATERIALS AND METHODS Fifty-six pregnant women who met the inclusion and exclusion criteria were included in the study and were divided into two groups: pregnancies diagnosed with FGR after the 32nd week of gestation (FGR group) and those without (control group). Demographic and obstetric histories, ultrasonographic and clinical characteristics, fetal EFT and mod-MPI values, and neonatal outcomes of the groups were recorded, and comparisons were made between the groups. Additionally, the diagnostic performance of fetal EFT value in late FGR was investigated. RESULTS The FGR group had fetal EFT that was statistically significantly lower (1.11 ± 0.21 vs. 1.34 ± 0.23, p = 0.001). The FGR group had a significantly lower isovolumetric contraction time (ICT) (31.04 ± 6.88 vs. 35.14 ± 7.58, p = 0.048). The two groups' isovolumetric relaxation time (IRT), ejection time (ET), and mod-MPI values (p values 0.871, 0.55, and 0.750, respectively) were comparable. Receiver operating characteristic (ROC) analysis at a cutoff of 1.2 revealed 76.1% sensitivity and 74.2% specificity, respectively, for the diagnostic performance of the fetal EFT value in late-onset FGR. There was a positive predictive value (PPV) and negative predictive value (NPV) of 64.0% and 83.8%, respectively. CONCLUSION We found that fetal EFT was significantly lower in FGR and may be useful in diagnosing FGR. However, we observed that mode-MPI did not change in FGR.
Collapse
Affiliation(s)
- Yusuf Dal
- Division of Perinatology, Department of Obstetrics and Gynecology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Fatih Akkuş
- Division of Perinatology, Department of Obstetrics and Gynecology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Şebnem Karagün
- Division of Perinatology, Department of Obstetrics and Gynecology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ahmet Zeki Nessar
- Division of Perinatology, Department of Obstetrics and Gynecology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Sefanur Gamze Karaca
- Division of Perinatology, Department of Obstetrics and Gynecology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Mürşide Çevikoğlu Kıllı
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ayhan Coşkun
- Division of Perinatology, Department of Obstetrics and Gynecology, Mersin University Faculty of Medicine, Mersin, Turkey
| |
Collapse
|
2
|
Doğru Ş, Akkuş F, Metin ÜS, Acar A. Fetal Epicardial Fat Thickness in Obese Pregnant Women: Its Effect on Fetal Cardiac Function and Neonatal Outcomes. Z Geburtshilfe Neonatol 2024. [PMID: 38503305 DOI: 10.1055/a-2267-5478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE This study aimed to evaluate fetal epicardial fat thickness (EFT) together with fetal myocardial performance index (MPI) and its effects on neonatal outcomes in obese pregnant women. MATERIALS AND METHODS A total of 102 pregnant women, 51 obese and 51 of normal weight, were included in this prospective study. Fetal EFT, and MPI measurements were performed for all patients. RESULTS Fetal EFT and Mod-MPI showed a statistically significant difference between obese pregnant women and the control group (p=0.0001, p=0.001). The optimal fetal EFT predictive cut-off value for the 5th-minute APGAR score below 7 was 1.22 mm, with a sensitivity of 86.96% and a specificity of 54.43% (p=0.001). CONCLUSION Fetal EFT and mod-MPI were higher in obese pregnant women. It is encouraging that fetal EFT predicts low APGAR, but more important information can be obtained if postnatal follow-up of these cardiac changes caused by obesity can be performed.
Collapse
Affiliation(s)
- Şükran Doğru
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Meram, Turkey
| | - Fatih Akkuş
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Meram, Turkey
| | - Ülfet Sena Metin
- Obstetrics and Gynecology, Necmettin Erbakan Universitesi Meram Tip Fakultesi, Konya, Turkey
| | - Ali Acar
- Obstetrics and Gynecology, Necmettin Erbakan Universitesi Meram Tip Fakultesi, Konya, Turkey
| |
Collapse
|
3
|
Sever B, Bayraktar B, Adıyaman D, Gölbaşı H, Ömeroğlu İ, Çolak S, Pala HG, Ekin A. Association of increased fetal epicardial fat thickness with maternal pregestational and gestational diabetes. J Matern Fetal Neonatal Med 2023; 36:2183474. [PMID: 36859818 DOI: 10.1080/14767058.2023.2183474] [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: 03/03/2023]
Abstract
OBJECTIVE To evaluate the changes of fetal epicardial fat thickness (EFT) in pregnancies with pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) and to identify the diagnostic effectiveness of fetal EFT in differentiating PGDM and GDM from normal pregnancies. METHODS The study was conducted with pregnant women who admitted to perinatology department between October 2020 and August 2021. Patients were grouped as PGDM (n = 110), GDM (n = 110), and control (n = 110) for comparison of fetal EFT. EFT was measured in all three groups at 29 weeks of gestation. Demographic characteristics and ultrasonographic findings were recorded and compared. RESULTS The mean fetal EFT was significantly higher in PGDM (1.47 ± 0.083 mm, p < .001) and GDM (1.40 ± 0.082 mm, p < .001) groups compared to control group (1.19 ± 0.049 mm) and was also significantly higher in PGDM group than GDM group (p < .001). Fetal EFT was significantly positively correlated with maternal age, fasting, 1st hour, 2nd hour glucose values, HbA1c, fetal abdominal circumference, and deepest vertical pocket of amniotic fluid (p < .001). Fetal EFT value of 1.3 mm diagnosed PGDM patients with a sensitivity of 97.3% and a specificity of 98.2%. Fetal EFT value of 1.27 mm diagnosed GDM patients with a sensitivity of 94% and a specificity of 95%. CONCLUSIONS Fetal EFT is greater in pregnancies with diabetes than in normal pregnancies, and also greater in PGDM than in GDM. In addition, fetal EFT is strongly correlated with maternal blood glucose levels in diabetic pregnancies.
Collapse
Affiliation(s)
- Barış Sever
- Department of Obstetrics and Gynecology Division of Perinatology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Burak Bayraktar
- Department of Obstetrics and Gynecology Division of Perinatology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Duygu Adıyaman
- Department of Obstetrics and Gynecology Division of Perinatology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | | | | | | | | | - Atalay Ekin
- Department of Obstetrics and Gynecology Division of Perinatology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
4
|
Wan Y, Chen Y, Wu X, Yin A, Tian F, Zhang H, Huang X, Wu L, Niu J. Mediation effect of maternal triglyceride and fasting glucose level on the relationship between maternal overweight/ obesity and fetal growth: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:449. [PMID: 37328759 PMCID: PMC10276493 DOI: 10.1186/s12884-023-05716-0] [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: 05/17/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Previous studies have suggested that maternal overweight/obesity is asscociated with macrosomia. The present study aimed to investigate the mediation effects of fasting plasma glucose (FPG) and maternal triglyceride (mTG) in the relationship between maternal overweight/obesity and large for gestational age (LGA) among non-diabetes pregnant women. METHODS This prospective cohort study was conducted in Shenzhen from 2017 to 2021. A total of 19,104 singleton term non-diabetic pregnancies were enrolled form a birth cohort study. FPG and mTG were measured at 24-28 weeks. We analyzed the association of maternal prepregancy overweight/obesity with LGA and mediation effects of FPG and mTG. Multivariable logistic regression analysis and serial multiple mediation analysis were performed. The odds ratio (OR) and 95% confidence intervals (CIs) were calculated. RESULTS Mothers who were overweight or obese had higher odds of giving birth to LGA after adjusting potential confounders (OR:1.88, 95%CI: 1.60-2.21; OR:2.72, 95%CI: 1.93-3.84, respectively). The serial multiple mediation analysis found prepregnancy overweight can not only have a direct positive effect on LGA (effect = 0.043, 95% CI: 0.028-0.058), but also have an indirect effect on the LGA through two paths: the independent mediating role of FPG (effect = 0.004, 95% CI: 0.002-0.005); the independent mediating role of mTG (effect = 0.003,95% CI: 0.002-0.005). The chain mediating role of FPG and mTG has no indirect effect. The estimated proportions mediated by FPG and mTG were 7.8% and 5.9%. Besides, the prepregnancy obesity also has a direct effect on LGA (effect = 0.076; 95%CI: 0.037-0.118) and an indirect effect on LGA through three paths: the independent mediating role of FPG (effect = 0.006; 95%CI: 0.004-0.009); the independent mediating role of mTG (effect = 0.006; 95%CI: 0.003-0.008), and the chain mediating role of FPG and mTG (effect = 0.001; 95%CI: 0.000-0.001). The estimated proportions were 6.7%, 6.7%, and 1.1%, respectively. CONCLUSION This study found that in nondiabetic women, maternal overweight/obesity was associated with the occurence of LGA, and this positive association was partly mediated by FPG and mTG, suggesting that FPG and mTG in overweight/obese nondiabetic mothers deserve the attention of clinicians.
Collapse
Affiliation(s)
- Yanmei Wan
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Yixuan Chen
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Xiaoxia Wu
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Aiqi Yin
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Fuying Tian
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Huafan Zhang
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Xuna Huang
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China
| | - Linlin Wu
- Department of Obstetrics and Gynecology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China.
| | - Jianmin Niu
- Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China.
| |
Collapse
|
5
|
Singh A, Josan AS, Gupta K, Pahwa S. Fetal Epicardial Fat Thickness: Its Role as Marker for Gestational Diabetic Mellitus. Indian J Radiol Imaging 2023. [DOI: 10.1055/s-0043-1762936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Abstract
Background There are very few studies on the association between fetal epicardial fat thickness (EFT) and gestational diabetes mellitus (GDM).
Aims To evaluate the role of fetal epicardial fat thickness as a marker and use it in pregnancies to screen for GDM.
Settings and Design A cross-sectional analytical study was conducted in the Department of Radiodiagnosis and Imaging at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, after the due clearance from the institutional research and ethics committee.
Materials and Methods The study included pregnant patients at 24 + 0/6 to 28 + 0/6 weeks of gestation scheduled for a 75 g oral glucose tolerance test from December 1, 2020 to March 30, 2022. Antenatal ultrasound was performed on Voluson E8 Expert BT12 (Wipro GE) ultrasound machine. Out of 180 patients, 60 patients were selected, that is, 30 patients with raised 75 g OGTT results (cases of GDM) and 30 patients with normal 75 g OGTT results.
Statistical Analysis The collected data were transformed into variables, coded, and entered into Microsoft Excel. Data were analyzed using the Shapiro–Wilk normality test, student's t-test or Mann–Whiney U test, chi-square test, or Fisher's exact test and statistically evaluated using the SPSS-PC-25 version.
Results Fetal EFT was found to be significantly more in the GDM group in comparison to controls without GDM, and the increased fetal EFT was positively associated with 2-hour OGTT serum glucose values.The mean fetal epicardial fat thickness (EFT) in mothers with GDM was significantly larger, i.e., 0.17 ± 0.02 cm than in mothers without GDM, i.e., 0.12 ± 0.01 cm (p < 0.001). The receiver operating characteristic (ROC) curve plotted from values calculated from our results shows high sensitivity (i.e., 96.67%) and specificity (i.e., 90%) of fetal EFT as a predictor for GDM with an AUROC value of 0.96 and 95% confidence interval of 0.92 to 1.0.
Conclusions EFT was significantly higher in fetuses of diabetic versus nondiabetic mothers. The mean difference in EFT of GDM cases and controls was relatively small but was statistically significant. The study concluded that measuring the epicardial fat thickness in fetuses can serve as a novel marker in GDM.
Collapse
Affiliation(s)
- Amandeep Singh
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Punjab, India
| | - Amitojveer S Josan
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Punjab, India
| | - Kamlesh Gupta
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Punjab, India
| | - Sangeeta Pahwa
- Department of Obstetrics and Gynaecology, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Punjab, India
| |
Collapse
|
6
|
Iskender C, Yakut Yücel K, Dereli ML, Sağlam E, Çelen Ş, Çağlar T, Engin-Üstün Y. Increased fetal epicardial fat thickness: A reflecting finding for GDM and perinatal outcomes. Echocardiography 2022; 39:1082-1088. [PMID: 35808919 DOI: 10.1111/echo.15416] [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: 03/28/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To study the value of fetal epicardial fat thickness (EFT) in gestational diabetes mellitus in the third trimester of pregnancy and its relationship with clinical parameters and perinatal outcomes. METHODS A total of 80 participants, including 40 with diagnosed GDM and 40 healthy pregnant women, were included in the study. Demographic data were obtained from medical records. Sonographic examinations were performed, such as amniotic fluid value, fetal biometric measurements, and Doppler parameters of the umbilical artery. Fetal EFT values were measured at the free wall of the right ventricle using a reference line with echocardiographic methods. Correlation tests were performed to evaluate the relationship between fetal EFT and clinical and perinatal parameters. p < .05 were interpreted as statistically significant. RESULTS The fetal EFT value was statistically higher in the GDM group than in the control group (p: .000). Spearman and Pearson correlation tests revealed statistically significant but weak positive correlations between fetal EFT value, 1-h 100-g OGTT, birth weight, and BMI (r: .198, p: .047; r: .395, p: .012; r: .360, p: .042, respectively). The optimal fetal EFT threshold for predicting GDM disease was found as 1.55 mm, with a specificity of 74.4% and sensitivity of 75.0%. Statistically significant differences between the two groups in umbilical artery Doppler resistance index (RI), pulsatility index (PI), and systolic/diastolic ratio (S/D) were not found (p: .337; p: .503; p: .155;). BMI and amniotic fluid volume were higher in the GDM group compared to the control group (p: .009; p < .01). CONCLUSION This study demonstrated that increased fetal EFT may occur as a reflection of changes in glucose metabolism in intrauterine life. Future studies with larger series, including the study of neonatal metabolic parameters, will contribute to the understanding of the importance of fetal EFT in determining the metabolic status of the fetus.
Collapse
Affiliation(s)
- Cantekin Iskender
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health, Teaching and Research Hospital, Ankara, Turkey
| | - Kadriye Yakut Yücel
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health, Teaching and Research Hospital, Ankara, Turkey
| | - Murat Levent Dereli
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health, Teaching and Research Hospital, Ankara, Turkey
| | - Erkan Sağlam
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health, Teaching and Research Hospital, Ankara, Turkey
| | - Şevki Çelen
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health, Teaching and Research Hospital, Ankara, Turkey
| | - Turhan Çağlar
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health, Teaching and Research Hospital, Ankara, Turkey
| | - Yaprak Engin-Üstün
- Department of Perinatology, Etlik Zübeyde Hanım Maternity and Women's Health, Teaching and Research Hospital, Ankara, Turkey
| |
Collapse
|
7
|
Ahmad S, Lyngman LK, Mansouryar M, Dhakal R, Agerholm JS, Khanal P, Nielsen MO. Depot and sex-specific implications for adipose tissue expandability and functional traits in adulthood of late prenatal and early postnatal malnutrition in a precocial sheep model. Physiol Rep 2021; 8:e14600. [PMID: 33038074 PMCID: PMC7547587 DOI: 10.14814/phy2.14600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 11/24/2022] Open
Abstract
The aim was to investigate long‐term, tissue and sex‐specific impacts of pre and postnatal malnutrition on expandability and functional traits of different adipose tissues. Twin‐pregnant ewes were fed NORM (~requirements), LOW (50% of NORM) or HIGH (150%/110% of energy/protein) diets the last 6 weeks prepartum (term ~147‐days). Lambs received moderate, low‐fat (CONV) or high‐carbohydrate‐high‐fat (HCHF) diets from 3 days until 6 months of age, and thereafter CONV diet. At 2½ years of age (adulthood), histomorphometric and gene expression patterns were characterized in subcutaneous (SUB), perirenal (PER), mesenteric (MES), and epicardial (EPI) adipose tissues. SUB had sex‐specific (♂<♀) upper‐limits for adipocyte size and cell‐number indices, irrespective of early life nutrition. PER mass and contents of adipocytes were highest in females and HIGH♂, whereas adipocyte cross‐sectional area was lowest in LOW♂. Pre/postnatal nutrition affected gene expression sex‐specifically in SUB + PER, but unrelated to morphological changes. In PER, LOW/LOW♂ were specific targets of gene expression changes. EPI was affected by postnatal nutrition, and HCHF sheep had enlarged adipocytes and upregulated expressions for adipogenic and lipogenic genes. Conclusion: upper‐limits for SUB expandability were markedly lower in males. Major targets for prenatal malnutrition were PER and males. LOW♂ had the lowest PER expandability, whereas HIGH♂ had an adaptive advantage due to increased hypertrophic ability equivalent to females. Fixed expandability in SUB meant PER became a determining factor for MES and ectopic fat deposition, rendering LOW♂ particularly predisposed for obesity‐associated metabolic risks. EPI, in contrast to other tissues, was targeted particularly by early postnatal obesity, resulting in adipocyte hypertrophy in adulthood.
Collapse
Affiliation(s)
- Sharmila Ahmad
- Nutrition Research Unit, Department of Animal Science, Aarhus University, Tjele, Denmark
| | - Lise Kirstine Lyngman
- Section of Production, Nutrition and Health, Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Morteza Mansouryar
- Section of Production, Nutrition and Health, Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Rajan Dhakal
- Section of Production, Nutrition and Health, Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Jørgen Steen Agerholm
- Section for Reproduction and Obstetrics, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Prabhat Khanal
- Faculty of Biosciences and Aquaculture, Division for Animal science, Production and Welfare, Nord University, Steinkjer, Norway
| | - Mette Olaf Nielsen
- Nutrition Research Unit, Department of Animal Science, Aarhus University, Tjele, Denmark
| |
Collapse
|
8
|
Vela-Huerta MM, Amador-Licona N, Domínguez-Damiá R, Heredia-Ruiz A, Orozco-Villagomez HV, Guízar-Mendoza JM, Alarcon-Santos S. Epicardial fat thickness in infants of diabetic mothers. J Neonatal Perinatal Med 2021; 15:75-80. [PMID: 34334430 DOI: 10.3233/npm-210787] [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: 11/15/2022]
Abstract
BACKGROUND Epicardial fat thickness (EFT) in adults and children has been related to the metabolic syndrome and other cardiovascular risk factors; however, scarce studies have evaluated it in infants of diabetic mothers (IDM) in whom, alterations in the thickness of the interventricular septum have been reported. This study compares the EFT in IDM versus infants of non-diabetic mothers (INDM) and its association with others echocardiographic parameters. METHODS We performed a cross sectional study in 93 infants (64 IDM and 29 INDM). To evaluate EFT dimensions, an echocardiogram was performed within the first 24h of extrauterine life in both groups. In diabetic mothers, HbA1c was also determined. RESULTS There was no significant difference in birth weight between the groups although gestational age was lower in IDM. The EFT (3.6 vs. 2.5 mm, p < 0.0001), the interventricular septum thickness (IVST) (6.2 vs. 5.2 mm, p < 0.0001) and the IVST / left ventricle posterior wall (1.3 vs. 1.1, p = 0.001) were higher in the IDM; while the left ventricular expulsion fraction [LVFE] (71.1 vs. 77.8; p < 0.0001) was lower than in the INDM, respectively. We found a positive correlation between EFT with IVST (r = 0.577; p = 0.0001), LVPW (r = 0.262; p = 0.011), IVST/LVPW index (r = 0.353; p = 0.001), and mitral integral early velocity (r = 0.313; p = 0.002), while a negative correlation with LVFE was observed (r = -0.376; p = 0.0001). CONCLUSIONS The EFT is higher in IDM than in INDM. It was positively related with echocardiographic parameters of left ventricular thickness and negatively with left ventricular ejection function.
Collapse
Affiliation(s)
- M M Vela-Huerta
- Department of Neonatology, Hospital General, Leon, Secretaria de Salud de Guanajuato, Mexico
| | | | - R Domínguez-Damiá
- Department of Neonatology, Hospital General, Leon, Secretaria de Salud de Guanajuato, Mexico
| | - A Heredia-Ruiz
- Department of Neonatology, Hospital General, Leon, Secretaria de Salud de Guanajuato, Mexico
| | - H V Orozco-Villagomez
- Department of Neonatology, Hospital General, Leon, Secretaria de Salud de Guanajuato, Mexico
| | | | - S Alarcon-Santos
- Department of Neonatology, Hospital General, Leon, Secretaria de Salud de Guanajuato, Mexico
| |
Collapse
|
9
|
Yakut K, Öcal DF, Sanhal Yaşar C, Halıcı Öztürk F, Şanlı C, Çelen Ş. Fetal epicardial fat thickness in fetal growth restriction; effects on fetal heart function and relationship with the severity of disease. J Matern Fetal Neonatal Med 2021; 35:6946-6952. [PMID: 34058950 DOI: 10.1080/14767058.2021.1931676] [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: 10/21/2022]
Abstract
OBJECTIVE To investigate fetal epicardial fat thickness (EFT) value in fetal growth restriction (FGR) and its relationship with clinical parameters, fetal modified myocardial index (Mod-MPI), and the Doppler parameters. MATERIAL METHODS Eighty-five pregnant women, with 30 diagnosed with FGR and 55 healthy pregnant women as control group participated in this prospective case-control study. FGR group was divided into 2 subgroups as early (n = 9) and late FGR (n = 21) groups. Demographic data were taken from the medical records. Amnion fluid value, fetal biometric measurements, and Doppler parameters were obtained. Fetal EFT and fetal Mod-MPI were measured by using the echocardiographic methods. The correlation tests were performed to assess the association between EFT and clinical and ultrasonographic parameters. p < .05 was interpreted as statistically significant. RESULTS EFT value was found statistically lower in the early and late FGR groups than the control group (p = .003). Higher umbilical artery pulsatility index (PI) and lower cerebroplacental ratio (CPR) values were found in the early and late FGR (p < .001, p = .001). The optimal EFT cutoff level to predict FGR disease was measured as 1.25 with 63.3% specificity and 77.4% sensitivity. Lower ejection time (ET) and higher Mod-MPI and isovolumetric contraction time (ICT) values were found in the group FGR with absent UAEDF than in the group FGR with no absent UAEDF (p = .001, p < .000, p < .000, respectively). Correlation tests showed statistically negative and weak correlations among EFT, umbilical artery PI, and mean Ut A-PI (p = .019, p = .019). Positive correlations were found in regard to gestational age, EFW, and EFT (p = .002, p < .000). CONCLUSION Our study showed that the measurement of EFT may contribute to predicting the diagnosis of FGR. Moreover, lower EFT values can be related to the severity of FGR. Future randomized control studies are needed to understand the effects and pathways of fetal EFT on fetal cardiac function.
Collapse
Affiliation(s)
- Kadriye Yakut
- Perinatology Department, Turkish Ministry of Health, Fethi Sekin City Hospital, Elazığ, Turkey
| | - Doğa Fatma Öcal
- Perinatology Department, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | | | - Filiz Halıcı Öztürk
- Perinatology Department, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Cengiz Şanlı
- Obstetrics and Gynecology Department, Turkish Ministry of Health, Fethi Sekin City Hospital, Elazığ, Turkey
| | - Şevki Çelen
- Perinatology Department, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| |
Collapse
|
10
|
Aydin S, Fatihoglu E. Fetal Epicardial Fat Thickness: Can It Serve as a Sonographic Screening Marker for Gestational Diabetes Mellitus? J Med Ultrasound 2020; 28:239-244. [PMID: 33659164 PMCID: PMC7869731 DOI: 10.4103/jmu.jmu_29_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/22/2020] [Accepted: 04/09/2020] [Indexed: 01/11/2023] Open
Abstract
Background Gestational diabetes mellitus (GDM) is defined as the new onset of impairment in carbohydrate tolerance during pregnancy. The aim of the current study was to define fetal epicardial fat thickness (fEFT) changes that developed before 24 weeks of gestation, to evaluate the diagnostic effectiveness of fEFT in predicting GDM diagnosis, and to correlate fEFT values with hemoglobin A1C (HbA1C) values. Methods The study included a total of 60 GDM patients and 60 control subjects. A record consisted of fEFT measurements, maternal body mass index, maternal subcutaneous fat thickness, and fetal subcutaneous fat thickness during sonographic screening performed at 18-22 gestational weeks. Fetal abdominal circumference (AC) values, estimated fetal weight (EFW), and fetal gender were also recorded. Results The median fEFT measurement of the whole study population was 0.9 ± 0.21 mm; 1.05 ± 0.21 mm in the GDM patients, and 0.8 ± 0.15 mm in the control group. The median fEFT values of the GDM patients were significantly higher than those of the control group (P < 0.01). According to the correlation analysis results, a strong positive correlation was determined between the fEFT and HbA1C values (r = 0.71, P < 0.01), gestational week of the fetus (r = 0.76, P = P < 0.01), AC (r = 0.81, P < 0.01), and EFW (r = 0.71, P < 0.01). According to the receiver operating characteristic analysis results, a fEFT value of > 0.95 can predict GDM diagnosis with sensitivity of 65% and specificity of 88% (odds ratio = 13). Conclusion fEFT values are increased in GDM cases, and the increase can be detected earlier than 24 weeks of gestation. fEFT values are positively correlated with HbA1C values and can serve as an early predictor for GDM diagnosis.
Collapse
Affiliation(s)
- Sonay Aydin
- Department of Radiology, Dr. Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - Erdem Fatihoglu
- Department of Radiology, Erzincan University, Erzincan, Turkey
| |
Collapse
|
11
|
Aydin E, Tanacan A, Bulut AN. A cut-off value of epicardial fat thickness for the prediction of large for gestational age foetuses. J OBSTET GYNAECOL 2020; 41:224-228. [DOI: 10.1080/01443615.2020.1732895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Emine Aydin
- Department of Obstetrics and Gynecology, Istanbul Medipol University, Istanbul, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Perinatology Division, Hacettepe University, Ankara, Turkey
| | - A. Nazli Bulut
- Department of Obstetrics and Gynecology, Kayseri City Hospital, Kayseri, Turkey
| |
Collapse
|
12
|
Khanal P, Pandey D, Binti Ahmad S, Safayi S, Kadarmideen HN, Olaf Nielsen M. Differential impacts of late gestational over-and undernutrition on adipose tissue traits and associated visceral obesity risk upon exposure to a postnatal high-fat diet in adolescent sheep. Physiol Rep 2020; 8:e14359. [PMID: 32026612 PMCID: PMC7002533 DOI: 10.14814/phy2.14359] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/30/2019] [Accepted: 01/05/2020] [Indexed: 11/24/2022] Open
Abstract
We hypothesized that late gestation malnutrition differentially affects expandability of adipose tissues to predispose for early postnatal visceral adiposity. Twin-lambs born to dams fed HIGH (150%/110% of required energy/protein, respectively), NORM (100% of requirements) or LOW (50% of NORM) diets during the last trimester were used. Postnatally, lambs were raised on moderate (CONV) or high-carbohydrate-high-fat (HCHF) diets. Adipose tissues were sampled at autopsy at 6 months of age (~puberty) to characterize cellularity, adipocyte cross-sectional area and gene expression patterns. HIGH and LOW compared to NORM lambs had reduced intrinsic (under CONV diet) cellularity in subcutaneous and mesenteric (particularly LOW), and reduced obesity-induced (under HCHF diet) hyperplasia in subcutaneous, mesenteric and perirenal (particularly HIGH) adipose tissues. This corresponded with more pronounced HCHF diet-induced hypertrophy in mesenteric (particularly LOW), perirenal (particularly HIGH) and subcutaneous (particularly HIGH) adipose tissues, and tissue-specific reductions in mRNA expressions for lipid metabolism, angiogenesis and adipose development. Gene expression for inflammation and lipid metabolism markers were increased and decreased, respectively, in HCHF lambs (HCHF lambs became obese) in all tissues. Both prenatal over- and undernutrition predisposed for abdominal adiposity and extreme perirenal hypertrophy due to reduced intrinsic (observed under CONV diet) cellularity and impaired ability of subcutaneous, mesenteric and perirenal adipose tissues to expand by hyperplasia rather than hypertrophy on an obesogenic (HCHF) diet.
Collapse
Affiliation(s)
- Prabhat Khanal
- Animal Science, Production and Welfare DivisionFaculty of Biosciences and AquacultureNord UniversitySteinkjer CampusNorway
| | - Deepak Pandey
- Animal Science, Production and Welfare DivisionFaculty of Biosciences and AquacultureNord UniversitySteinkjer CampusNorway
| | - Sharmila Binti Ahmad
- Department of Veterinary and Animal SciencesFaculty of Health and Medical SciencesUniversity of Copenhagen, DenmarkFrederiksbergDenmark
| | | | - Haja N. Kadarmideen
- Department of Applied Mathematics and Computer ScienceTechnical University of DenmarkKongens LyngbyDenmark
| | | |
Collapse
|
13
|
Akkurt MO, Turan OM, Crimmins S, Harman CR, Turan S. Increased fetal epicardial fat thickness: A novel ultrasound marker for altered fetal metabolism in diabetic pregnancies. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:397-402. [PMID: 29740837 DOI: 10.1002/jcu.22602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 02/23/2018] [Accepted: 04/13/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate whether fetal epicardial fat thickness (EFT) differs in diabetic and nondiabetic pregnant women. METHODS Retrospective case-control study of pregnancies between 24 and 36 weeks complicated by preexisting (PDM) or gestational (GDM) diabetes mellitus, matched one to one with controls for body mass index and gestational age (GA). Epicardial fat was identified as the hypoechogenic area between myocardium and visceral pericardium over the right ventricle and its thickness was measured by a single observer blinded to clinical condition and outcomes. A linear regression analysis was performed to assess the relationship between GA and EFT, and regression lines were compared between diabetics and controls. RESULTS 53 PDM and 53 GDM pregnant women were matched with controls. With the exception of maternal age, the demographics were similar among groups. EFT increased significantly with advancing gestation in both diabetics and controls (P < 0.0001) and was significantly greater in diabetics than in controls (P < 0.0001). The best fit lines were different between diabetics (EFT = 0.05 × GA + 0.07 mm; R2 = 0.70) and controls (EFT = 0.07 × GA + 0.04 mm; R2 = 0.93) (P < 0.0001). CONCLUSION Fetal EFT was greater in diabetics than in nondiabetics, and even greater in pregestational diabetics. EFT maybe an additional and/or earlier marker to identify early changes in fetal metabolism before accelerated fetal growth and polyhydramnios is apparent.
Collapse
Affiliation(s)
- Mehmet O Akkurt
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland, Baltimore, MD
| | - Ozhan M Turan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland, Baltimore, MD
| | - Sarah Crimmins
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland, Baltimore, MD
| | - Christopher R Harman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland, Baltimore, MD
| | - Sifa Turan
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland, Baltimore, MD
| |
Collapse
|