Predicting adverse neonatal outcome in severe fetal compromise: A pivotal role for estimated fetal weight Z scores

Correlation between maternal first trimester plasma leptin levels and birth weight among normotensive and preeclamptic women

OBJECTIVE

To determine the connection between maternal first trimester serum leptin levels and newborn weight.

METHODS

The study included 37 preeclamptic women and 53 normotensive women who considered the control group. Maternal blood samples were withdrawn at 13 weeks of gestation for the measurement of leptin concentrations. Birth weights were transformed to z-scores according to maternal and obstetrical features, based on customized centiles. Non-parametric tests, student's t-test, Pearson's correlation, Spearman's correlation and linear regression analysis were performed in our analysis.

RESULTS

Pre-pregnancy body mass index and first trimester maternal plasma leptin levels were significantly higher among women with preeclampsia (p=0.015 and p<0.001, respectively). Birth weight z-score was negatively correlated with leptin levels (r= -0.570, p<0.001), in preeclamptic group and in control group (r= -0.477, p<0.001). The regression modelling demonstrated a significant negative association between birth weight z-scores and leptin for both groups.

CONCLUSION

Maternal first trimester serum leptin demonstrates a significant negative association with neonatal weight in preeclamptic pregnancies and to a lesser extent in normotensive pregnancies. A possible leptin's involvement in pathophysiological adaptations that define the foetal growth potential can be supported.

Relationship between aortic isthmus and ductus venosus velocity waveforms in severe growth restricted fetuses

OBJECTIVE

To evaluate the incidence of abnormalities in velocity waveforms from ductus venosus (DV) and aortic isthmus (AoI) in fetuses with intrauterine growth restriction (IUGR) and their reciprocal temporal relationship.

METHODS

DV and AoI velocity waveforms were recorded in 31 IUGR fetuses characterized either by absent end diastolic (20) or reverse flow (11) in umbilical artery. Abnormal velocity waveforms in DV and AoI were defined in presence of reverse diastolic flows.

RESULTS

Abnormal DV velocity waveforms were present in 10 fetuses and were always associated with abnormalities. Abnormal AoI flows were also present in 10 fetuses of the remaining 21 fetuses with normal DV velocity waveforms (47.6%). Longitudinal monitoring of fetuses with normal DV flows showed a significantly shorter time interval in the onset of reverse flow in DV when abnormalities in AoI were present (4 vs 14 days p=0.001) irrespectively of gestational age or other potential confounding variables.

CONCLUSIONS

Our data suggest that AoI velocity waveforms become abnormal at an earlier stage of fetal compromise than DV.