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Vincze M, Sikovanyecz J, Földesi I, Surányi A, Várbíró S, Németh G, Kozinszky Z, Sikovanyecz J. How the Soluble Human Leukocyte Antigen-G levels in Amniotic Fluid and Maternal Serum Correlate with the Feto-Placental Growth in Uncomplicated Pregnancies. Bioengineering (Basel) 2024; 11:509. [PMID: 38790375 PMCID: PMC11117885 DOI: 10.3390/bioengineering11050509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/18/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Introduction: Trophoblast-derived angiogenic factors are considered to play an important role in the pathophysiology of various complications of pregnancy. Human Leukocyte Antigen-G (HLA-G) belongs to the non-classical human major histocompatibility complex (MHC-I) molecule and has membrane-bound and soluble forms. HLA-G is primarily expressed by extravillous cytotrophoblasts located in the placenta between the maternal and fetal compartments and plays a pivotal role in providing immune tolerance. The aim of this study was to establish a relationship between concentrations of soluble HLA-G (sHLA-G) in maternal serum and amniotic fluid at 16-22 weeks of gestation and the sonographic measurements of fetal and placental growth. Materials and methods: sHLA-G in serum and amniotic fluid, as well as fetal biometric data and placental volume and perfusion indices, were determined in 41 singleton pregnancies with no complications. The level of sHLA-G (U/mL) was tested with a sandwich enzyme-linked immunosorbent assay (ELISA) kit. Results: The sHLA-G levels were unchanged both in amniotic fluid and serum during mid-pregnancy. The sHLA-G level in serum correlated positively with amniotic sHLA-G level (β = 0.63, p < 0.01). Serum sHLA-G level was significantly correlated with abdominal measurements (β = 0.41, p < 0.05) and estimated fetal weight (β = 0.41, p < 0.05). Conversely, amniotic sHLA-G level and placental perfusion (VI: β = -0.34, p < 0.01 and VFI: β = -0.44, p < 0.01, respectively) were negatively correlated. A low amniotic sHLA-G level was significantly associated with nuchal translucency (r = -0.102, p < 0.05). Conclusions: sHLA-G assayed in amniotic fluid might be a potential indicator of placental function, whereas the sHLA-G level in serum can be a prognostic factor for feto-placental insufficiency.
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Affiliation(s)
- Márió Vincze
- Department of Obstetrics and Gynecology, Albert Szent-Gyorgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (M.V.); (J.S.J.); (A.S.); (S.V.); (G.N.); (J.S.)
| | - János Sikovanyecz
- Department of Obstetrics and Gynecology, Albert Szent-Gyorgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (M.V.); (J.S.J.); (A.S.); (S.V.); (G.N.); (J.S.)
| | - Imre Földesi
- Department of Laboratory Medicine, Albert Szent-Gyorgyi Medical School, University of Szeged, H-6720 Szeged, Hungary;
| | - Andrea Surányi
- Department of Obstetrics and Gynecology, Albert Szent-Gyorgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (M.V.); (J.S.J.); (A.S.); (S.V.); (G.N.); (J.S.)
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, Albert Szent-Gyorgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (M.V.); (J.S.J.); (A.S.); (S.V.); (G.N.); (J.S.)
| | - Gábor Németh
- Department of Obstetrics and Gynecology, Albert Szent-Gyorgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (M.V.); (J.S.J.); (A.S.); (S.V.); (G.N.); (J.S.)
| | - Zoltan Kozinszky
- Capio Specialized Center for Gynecology, Postgången 53, 171 45 Solna, Sweden
| | - János Sikovanyecz
- Department of Obstetrics and Gynecology, Albert Szent-Gyorgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (M.V.); (J.S.J.); (A.S.); (S.V.); (G.N.); (J.S.)
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Vincze M, Sikovanyecz J, Molnár A, Földesi I, Surányi A, Várbíró S, Németh G, Sikovanyecz J, Kozinszky Z. Predictive Capabilities of Human Leukocyte Antigen-G and Galectin-13 Levels in the Amniotic Fluid and Maternal Blood for the Pregnancy Outcome. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:85. [PMID: 38256346 PMCID: PMC10820789 DOI: 10.3390/medicina60010085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Increasing evidence points to the significant role of the angiogenic factor levels in screening for pregnancy outcome. To examine the potential relationship between concentrations of placental protein 13 (PP13) and soluble human leukocyte antigen-G (sHLA-G) in maternal serum and amniotic fluid at 16-23 weeks of gestation and the sonographic features of pregnancy as well as pregnancy outcome. Materials and Methods: PP13 and sHLA-G in serum and amniotic fluid, fetal biometrical data, and placental volume and perfusion indices were determined in 71 euploid, singleton pregnancies. Results: The serum sHLA-G level exhibits a negative correlation with the serum PP13 level (r = -0.186, p < 0.001) and a positive correlation with the sHLA-G level in amniotic fluid (r = 0.662, p < 0.001). A significant correlation was found between serum sHLA-G level and placental volume (r = 0.142, p < 0.05) and between amniotic sHLA-G level and placental perfusion (r = -0.450, p < 0.001). A low amniotic PP13 level significantly predicted the birth weight (r = -0.102, p < 0.05), the duration of pregnancy (r = -0.155, p < 0.05), and the fetal abdominal circumference (r = -0.098, p < 0.05). Conclusions: PP13 assayed in amniotic fluid might be a potential marker of fetal growth, and sHLA-G can be an adjunct modality reflecting placental sonographic parameters.
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Affiliation(s)
- Márió Vincze
- Department of Obstetrics and Gynecology, University of Szeged, H-6725 Szeged, Hungary; (M.V.); (J.S.J.); (A.M.); (A.S.); (S.V.); (G.N.); (J.S.)
| | - János Sikovanyecz
- Department of Obstetrics and Gynecology, University of Szeged, H-6725 Szeged, Hungary; (M.V.); (J.S.J.); (A.M.); (A.S.); (S.V.); (G.N.); (J.S.)
| | - András Molnár
- Department of Obstetrics and Gynecology, University of Szeged, H-6725 Szeged, Hungary; (M.V.); (J.S.J.); (A.M.); (A.S.); (S.V.); (G.N.); (J.S.)
| | - Imre Földesi
- Department of Laboratory Medicine, University of Szeged, H-6720 Szeged, Hungary;
| | - Andrea Surányi
- Department of Obstetrics and Gynecology, University of Szeged, H-6725 Szeged, Hungary; (M.V.); (J.S.J.); (A.M.); (A.S.); (S.V.); (G.N.); (J.S.)
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, University of Szeged, H-6725 Szeged, Hungary; (M.V.); (J.S.J.); (A.M.); (A.S.); (S.V.); (G.N.); (J.S.)
| | - Gábor Németh
- Department of Obstetrics and Gynecology, University of Szeged, H-6725 Szeged, Hungary; (M.V.); (J.S.J.); (A.M.); (A.S.); (S.V.); (G.N.); (J.S.)
| | - János Sikovanyecz
- Department of Obstetrics and Gynecology, University of Szeged, H-6725 Szeged, Hungary; (M.V.); (J.S.J.); (A.M.); (A.S.); (S.V.); (G.N.); (J.S.)
| | - Zoltan Kozinszky
- Department of Obstetrics and Gynecology, Danderyd Hospital, 182 88 Stockholm, Sweden
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Sirico A, Raffone A, Maruotti GM, Travaglino A, Paciullo C, Diterlizzi A, Mollo A, Rizzo G, Zullo F, Lanzone A. Third Trimester Myocardial Performance Index in Fetuses from Women with Hyperglycemia in Pregnancy: A Systematic Review and Meta-Analysis. ULTRASCHALL IN DER MEDIZIN 2021; 44:e99-e107. [PMID: 34425601 DOI: 10.1055/a-1499-7265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The myocardial performance index (MPI) has been proposed to evaluate cardiac dysfunction in newborns from diabetic mothers. Although MPI is routinely assessed in newborns, its role in the evaluation of fetuses from women with hyperglycemia in pregnancy (HIP) is still under evaluation. We aimed to evaluate the differences in third trimester fetal MPI in pregnant women with hyperglycemia compared to healthy controls. MATERIALS AND METHODS Seven electronic databases were searched for all studies assessing women with HIP who underwent evaluation of fetal left MPI during pregnancy compared to a control group. The summary measures were reported as mean differences (MD) in the mean fetal left MPI between women with HIP and healthy controls, with a 95 % confidence interval (CI). A post hoc subgroup analysis based on the type of HIP - pregestational diabetes, GDM, or gestational impaired glucose tolerance (GIGT) - was performed as an additional analysis. RESULTS 14 studies assessing 1326 fetuses (580 from women with HIP and 746 from controls) were included. Women with HIP had a significantly higher mean left fetal MPI compared to controls (MD 0.08; 95 %CI: 0.05 to 0.11; p < 0.00 001). Subgroup analysis according to the type of HIP concurred with the overall analysis for women with DM (MD 0.07; 95 %CI: 0.01 to 0.13; p = 0.02) and for women with GDM (MD 0.012; 95 %CI: 0.07 to 0.17; p < 0.00 001) but not for women with GIGT (MD -0.01, 95 % CI -0.28 to 0.27; p = 0.96). CONCLUSION Fetal left MPI is increased in pregnancies with HIP appearing as a potential marker of cardiac dysfunction.
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Affiliation(s)
- Angelo Sirico
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Maria Maruotti
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Travaglino
- Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Carmela Paciullo
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Alice Diterlizzi
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re - University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology The First I.M. Sechenov Moscow State Medical University
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Lanzone
- Obstetrics and High-Risk Pregnancy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
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Elhelaly AM, Elnaggar AK, Mohamed MEDM, Abdelfattah MH, Farag AH. First trimester placental volume and vascular indices in pregestational diabetic compared to nondiabetic pregnant women. J Obstet Gynaecol Res 2020; 46:1326-1332. [PMID: 32585732 DOI: 10.1111/jog.14271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/13/2020] [Accepted: 04/09/2020] [Indexed: 12/11/2022]
Abstract
AIM Comparing placental volume (PV) and vascular indices in pregestational diabetic and nondiabetic pregnant women at 11 and 13 weeks gestation. METHODS A case-control study conducted at Ain Shams University Maternity Hospital in collaboration with Feto-maternal Unit for Ultrasound Assessment, Ain Shams University Maternity Hospital, Egypt. Ninety-two pregnant women divided into two groups: Group A included 46 women with pregestational diabetes mellitus and group B included 46 nondiabetic pregnant women as control. All participants had PV, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) calculated using three-dimensional (3D) ultrasonography and 3D power Doppler at 11 and 13 weeks of pregnancy. RESULTS At 11 weeks, the mean VI, FI and VFI in diabetic group (17.70 ± 12.62, 40.72 ± 11.03 and 7.77 ± 6.37, respectively) were insignificantly higher than in nondiabetic group (12.14 ± 12.62, 34.59 ± 9.66 and 6.52 ± 14.20, respectively) while mean PV in diabetic group (26.90 ± 14.74) was insignificantly lower than in nondiabetic group (27.53 ± 17.46). Also at 13 weeks, the results were not different as the mean VI, FI and VFI in diabetic group (16.51 ± 9.81, 42.52 ± 7.47 and 8.12 ± 7.55, respectively) were insignificantly higher than in nondiabetic group (16.37 ± 14.17, 40.29 ± 17.52 and 7.08 ± 4.35, respectively), and mean PV in diabetic group (52.04 ± 17.95) was insignificantly lower than in nondiabetic group (54.46 ± 17.85). There was strong positive correlation between HbA1C level and VFI measured at 13 weeks gestation. CONCLUSIONS Placental indices in early pregnancy do not seem to be useful markers to anticipate placental pathology in pregestational diabetes, however there might be a role for HbA1C level measurement to anticipate such complications.
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Affiliation(s)
- Amr M Elhelaly
- Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Cairo, Egypt
| | - Ahmed K Elnaggar
- Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Cairo, Egypt
| | - Magd El Din M Mohamed
- Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Cairo, Egypt
| | - Mahmoud H Abdelfattah
- Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Cairo, Egypt
| | - Amr H Farag
- Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Cairo, Egypt.,Department of Obstetrics and Gynecology, Walsall Manor Hospital, Walsall, UK
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Shub A, Lappas M. Pregestational diabetes in pregnancy: Complications, management, surveillance, and mechanisms of disease-A review. Prenat Diagn 2020; 40:1092-1098. [PMID: 32333803 DOI: 10.1002/pd.5718] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/12/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022]
Abstract
Diabetes is an increasingly common diagnosis among pregnant women. Pregestational diabetes is associated with an increase in many adverse pregnancy outcomes, which impact both on the woman and her fetus. The models of pregnancy care for women with diabetes are based largely on observational data or consensus opinion. Strategies for aneuploidy screening and monitoring for fetal well-being should be modified in women with diabetes. There is an increasing understanding of the mechanisms by which congenital anomalies and disorders of fetal growth occur, involving epigenetic modifications, changes in gene expression in critical developmental pathways, and oxidative stress. This knowledge may lead to pathways for improved care for these high-risk pregnancies.
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Affiliation(s)
- Alexis Shub
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Australia.,Perinatal Department, Mercy Hospital for Women, Heidelberg, Australia
| | - Martha Lappas
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Australia
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Hoch D, Gauster M, Hauguel-de Mouzon S, Desoye G. Diabesity-associated oxidative and inflammatory stress signalling in the early human placenta. Mol Aspects Med 2019; 66:21-30. [DOI: 10.1016/j.mam.2018.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/08/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022]
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Kozinszky Z, Altorjay A, Molnar A, Nyári T, Vari SG, Nemeth G, Suranyi A. Ultrasonographic Evaluation of Glycemic Control Effect on Placental Vascularization in Pregnancy with Type 1 Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2019; 128:788-795. [PMID: 30641608 DOI: 10.1055/a-0824-6362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS The aim of our study was to assess the effect of glycemic control on placental vascularization in pregnancies complicated by type 1 diabetes mellitus (T1DM) and to compare dataset of optimal/suboptimal glycemic control to normal placental 3-dimensional power Doppler (3-DPD) indices in 2nd and 3rd trimester. METHODS Placental vascularization of pregnant women was prospectively evaluated by 3-DPD ((vascularization-index (VI); flow-index (FI); vascularization-flow-index (VFI)) ultrasound technique. The normal pregnancies (n=214) were compared to those complicated by T1DM (n=53) with optimal (HbA1C≤6%;≤ 42 mmol/mol) and suboptimal (HbA1C>6%;>42 mmol/mol) glycemic control. RESULTS Pregnancies complicated by T1DM expressed lower placental vascularization indices as compared with normal pregnancies (adjusted odds ratio (AOR) for VI:0.86; FI:0.94; VFI:0.76). Placental 3-DPD indices have a significant correlation with HbA1C and optimal glycemic control is associated with lower placental perfusion (AOR for VI:1.64; FI:1.13; VFI:2.34). Short-term adverse neonatal outcome was predicted by lower 3-DPD indices (AORVI:0.83, AORFI:0.93, AORVFI:0.66, p<0.05 for each index). Besides the glycemic control, the pregestational body mass index (BMI), had significant influences on placental perfusion. CONCLUSIONS VI displayed the best screening ability for suboptimal glycemic control with a sensitivity of 90.9%. The suboptimal glycemic control has a direct deteriorating effect on placental vasculature. Therefore the ultrasound examination could be an adjunct diagnostic modality for pregnant women with T1DM.
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Affiliation(s)
- Zoltan Kozinszky
- Department of Obstetrics and Gynecology, Blekinge Hospital, Karlskrona, Sweden
| | - AbelT Altorjay
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Andras Molnar
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Sandor G Vari
- International Research and Innovation in Medicine Program, Cedars - Sinai Medical Center, Los Angeles, CA, USA
| | - Gabor Nemeth
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Andrea Suranyi
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
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Sun W, Yin S, Wei Q, Zhang Y, Yang Z, Cai A, Wang Y, Lei W. Three-dimensional power Doppler ultrasound evaluation of placental blood flow in normal monochorionic diamniotic twin pregnancies. BMC Pregnancy Childbirth 2018; 18:443. [PMID: 30428855 PMCID: PMC6237010 DOI: 10.1186/s12884-018-2080-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/31/2018] [Indexed: 01/08/2023] Open
Abstract
Background Monochorionic diamniotic (MCDA) twin pregnancies are at higher risk of adverse outcomes and complications, which are attributed to the influence of placental morphology in MCDA twins. Monitoring of placental function is an important index for clinical decisions. The aim of our study was to evaluate the placental blood flow estimated using three-dimensional power Doppler (3D-PD) ultrasound and the vascular indices distribution with gestational age (GA) in normal MCDA twin pregnancies. Methods One hundred four MCDA twin pregnancies and 106 singleton pregnancies (GA range, 14–32 weeks) were included in this prospective study. 3D-PD volume data of each fetus was obtained separately from the placenta at the site of umbilical cord insertion. We analyzed the volume data using sonobiopsy technique. The placental vascularization index (VI), flow index (FI) and vascularizationflow index (VFI), were auto-calculated. The means and standard deviation values of three vascular indices per fetus were calculated and regression analysis of the vascular indices as a function of GA was performed in twin pregnancies. The vascular indices of twin and singleton pregnancies were compared using independent t-test. Results There were no significant differences in VI, FI or VFI among the fetuses of twins (p > 0.05). These vascular indices increased over the course of pregnancy (p < 0.05). We obtained the regression equations for the indices as a function of GA in days: VI = exp. (4.369–28.533/GA) (R2 = 0.699, p < 0.05), FI = exp. (3.916–13.003/GA) (R2 = 0.511, p < 0.05), and VFI = exp. (3.577–37.468/GA) (R2 = 0.675, p < 0.05). There were no significant differences in three vascular indices between MCDA twin and singleton groups (p > 0.05). Conclusions 3D-PD placental data using sonobiopsy technique could reflect the placental blood flow of each twin, which could be applied to the study of placental perfusion in MCDA twin pregnancies. This study also presented the vascular indices distribution with GA in normal twin pregnancies, which might be useful for early detection of MCDA complications.
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Affiliation(s)
- Wei Sun
- Department of Sonography, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shaowei Yin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiuju Wei
- Department of Obstetrics and Gynecology, the University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ying Zhang
- Department of Sonography, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zeyu Yang
- Department of Sonography, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ailu Cai
- Department of Sonography, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Yu Wang
- Department of Sonography, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wenjia Lei
- Department of Sonography, Shengjing Hospital of China Medical University, Shenyang, China
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Placental vascularization indices and prediction of pre-eclampsia in high-risk women. Placenta 2018; 70:53-59. [PMID: 30316328 DOI: 10.1016/j.placenta.2018.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 09/05/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess ability of first and second trimester Placental Vascularization Indices (PVIs) to predict pre-eclampsia (PE) in high-risk pregnancies. METHOD PVIs derived from 3-Dimensional power Doppler imaging were measured at 11+0-13 + 6 (n = 194) and 19+0-21 + 6 weeks (n = 195). Logistic regression (LR) models used PE as the outcome. To quantify added value of PVIs to baseline characteristics in predicting PE, integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices were calculated. RESULTS Overall rate of PE was 12% (n = 26). Lower first trimester PVIs were seen in women with PE (mean, SD); Vascularization Index (VI,%): 10.0 (6.2) v 14.7 (7.6), P = 0.005, Flow Index (FI): 37.7 (9.1) v 42.9 (10.4), P = 0.03, Vascularization Flow Index (VFI): 3.8 (2.5) v 6.6 (4.0), P < 0.001). All first trimester PVIs predicted PE in LR models adjusted for covariates. IDI and NRI analyses confirmed added clinical utility of VI (IDI 0.05, P = 0.004; NRI 0.66, P < 0.001) and VFI (IDI 0.06, P = 0.004; NRI 0.53, P = 0.91). In the second trimester, FI was lower in women with PE (39.6 (9.1) v 44.4 (8.6), P = 0.01) and predicted PE in adjusted LR models (standardised OR 0.53, 95% CI 0.29-0.97, P = 0.04). FI discriminated between cases and non-cases of PE (IDI 0.04, P = 0.04). CONCLUSION First trimester placental vascularization indices (VI, FI and VFI) have the potential to predict PE in high-risk pregnancies, with FI remaining predictive in the second trimester.
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Wong CH, Chen CP, Sun FJ, Chen CY. Comparison of placental three-dimensional power Doppler indices and volume in the first and the second trimesters of pregnancy complicated by gestational diabetes mellitus. J Matern Fetal Neonatal Med 2018; 32:3784-3791. [PMID: 29716432 DOI: 10.1080/14767058.2018.1472226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective: To compare the changes of placental three-dimensional power Doppler indices and volume in the first and the second trimesters of pregnancy with gestational diabetes mellitus (GDM). Methods: This was a prospective case-control study of singleton pregnancies with risk factors for GDM. Data on placental vascular indices including vascularization index (VI), flow index (FI), and vascularization flow index (VFI), as well as placental volume were obtained and analyzed during the first and the second trimesters between pregnant women with and without GDM. Results: Of the 155 pregnant women enrolled, 31 developed GDM and 124 did not. VI and VFI were significantly lower in the GDM group during the first and second trimesters (VI: p = .023, and VFI: p = .014 in the first trimester; VI: p = .049, and VFI: p = .031 in the second trimester). However, the placental volume was similar in both the groups during the first trimester, while it was significantly increased in the GDM group during the second trimester (p = .022). There were no significant differences in FI and uterine artery pulsatility index between the two groups. After adjustments in multivariate logistic regression analysis, significant differences were observed in the first trimester VFI (adjusted odds ratio (OR) 0.76, 95% confidence interval (CI) 0.61-0.93), second trimester VFI (adjusted or 0.83, 95%CI 0.71-0.96), and second trimester placental volume (adjusted or 1.03, 95%CI 1.01-1.05). Conclusions: Placental vascular indices can provide an insight into placental vascularization in GDM during early pregnancy. VFI rather than placental volume may be a sensitive sonographic marker in the first trimester of GDM placentas.
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Affiliation(s)
- Chian-Huey Wong
- a Department of Medicine , Mackay Medical College , New Taipei City , Taiwan.,b Department of Obstetrics and Gynecology , Mackay Memorial Hospital , Taipei , Taiwan
| | - Chie-Pein Chen
- a Department of Medicine , Mackay Medical College , New Taipei City , Taiwan.,b Department of Obstetrics and Gynecology , Mackay Memorial Hospital , Taipei , Taiwan
| | - Fang-Ju Sun
- c Department of Medical Research , Mackay Memorial Hospital , Taipei , Taiwan
| | - Chen-Yu Chen
- a Department of Medicine , Mackay Medical College , New Taipei City , Taiwan.,b Department of Obstetrics and Gynecology , Mackay Memorial Hospital , Taipei , Taiwan
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Sun W, Liu J, Zhang Y, Cai A, Yang Z, Zhao Y, Wang Y, Cao Z, Wei Q. Quantitative assessment of placental perfusion by three-dimensional power Doppler ultrasound for twins with selective intrauterine growth restriction in one twin. Eur J Obstet Gynecol Reprod Biol 2018; 226:15-20. [DOI: 10.1016/j.ejogrb.2018.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/08/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
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Altorjay ÁT, Nyári T, Gyurkovits Z, Németh G, Surányi A. Evaluation of placental vascularization indices in monochorionic diamniotic and dichorionic diamniotic twin pregnancies. Eur J Obstet Gynecol Reprod Biol 2018; 228:225-231. [PMID: 30014928 DOI: 10.1016/j.ejogrb.2018.05.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/07/2018] [Accepted: 05/31/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We aimed to investigate and compare placental vascularization indices between monochorionic-diamniotic, dichorionic-diamniotic normal twin pregnancies, and normal singular pregnancies. We hypothesized that there is correlation between placental three-dimensional power Doppler vascularization indices and birth weight in case of twin pregnancies, and that normal singular pregnancies have higher placental vascularization indices than normal twin pregnancies. STUDY DESIGN Placental three-dimensional power Doppler vascularization indices, such as vascularization index, flow index, and vascularization-flow index were measured in monochorionic-diamniotic (N = 15) and dichorionic-diamniotic (N = 36) normal twin pregnancies, and in normal singular (N = 109) pregnancies. Correlations were analyzed between vascularization indices, and birth weight, APGAR score, umbilical pH, umbilical venous bicarbonate, lactate, and base excess. RESULTS Vascularization indices and birth weight were significantly (p < 0.01) higher in normal singular gestations (vascularization index = 10.36, flow index = 46.08, vascularization-flow index = 4.08, average birth weight = 3377 g at 38.2 weeks average gestational age) compared to monochorionic-diamniotic and dichorionic-diamniotic normal twin pregnancies. No significant differences were found in vascularization indices between monochorionic-diamniotic and dichorionic-diamniotic normal twins. There were no significant differences in APGAR score, umbilical pH, umbilical venous bicarbonate, lactate, and base excess between groups examined (p < 0.01). We found strong linear correlations between placental vascularization indices and birth weight in both twin groups. CONCLUSION Placental three-dimensional power Doppler vascularization indices seem appropriate for predicting birth weight in monochorionic-diamniotic and dichorionic-diamniotic normal twin pregnancies. Our pilot study revealed reference values for vascularization indices in case of twin pregnancies examined.
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Affiliation(s)
- Ábel Tamás Altorjay
- Szeged, Csongrád, Hungary; Department of Obstetrics and Gynecology, University of Szeged, Faculty of Medicine, Szeged, Hungary.
| | - Tibor Nyári
- Szeged, Csongrád, Hungary; Department of Medical Physics and Informatics, University of Szeged, Faculty of Medicine, Szeged, Hungary.
| | - Zita Gyurkovits
- Szeged, Csongrád, Hungary; Department of Obstetrics and Gynecology, University of Szeged, Faculty of Medicine, Szeged, Hungary
| | - Gábor Németh
- Szeged, Csongrád, Hungary; Department of Obstetrics and Gynecology, University of Szeged, Faculty of Medicine, Szeged, Hungary
| | - Andrea Surányi
- Szeged, Csongrád, Hungary; Department of Obstetrics and Gynecology, University of Szeged, Faculty of Medicine, Szeged, Hungary
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Altorjay ÁT, Surányi A, Nyári T, Németh G. Use of placental vascularization indices and uterine artery peak systolic velocity in early detection of pregnancies complicated by gestational diabetes, chronic or gestational hypertension, and preeclampsia at risk. Croat Med J 2017; 58:161-169. [PMID: 28409499 PMCID: PMC5410734 DOI: 10.3325/cmj.2017.58.161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM We aimed to investigate correlations between uterine artery peak systolic velocity (AUtPSV), and placental vascularization in groups of normal blood pressure (NBP) and hypertensive disorders of pregnancy (chronic hypertension (CHT), gestational hypertension (GHT) and preeclampsia (PE)) alone or in combination with gestational diabetes mellitus (GDM), and hypothesized that AUtPSV rises when GDM complicates pregnancy hypertension. METHODS Placental 3-dimensional power Doppler indices, such as vascularization index (VI), flow index (FI), and vascularization-flow index (VFI), and uterine artery peak systolic velocity (AUtPSV) were measured in CHT (N=43), CHT+GDM (N=15), GHT (N=57), GHT+GDM (N=23) and PE (N=17) pregnancies, and compared to NBP (N=109). Correlations were analyzed between vascularization indices, AUtPSV, pregestational BMI and adverse pregnancy outcome rates. RESULTS In our results VI was higher in CHT (P=0.010), while FI was lower in CHT (P=0.009), GHT and PE (P=0.001) compared to NBP. In case of VFI, significant difference was found between CHT and GHT (P=0.002), and NBP and PE (P=0.001). FI was found prognostic for umbilical pH and neonatal birth weight. Pre-gestational BMI was significantly higher in GHT+GDM compared to GHT, and in CHT+GDM compared to the CHT group. As for AUtPSV, significant difference was found between NBP and CHT (P=0.012), NBP and CHT+GDM (P=0.045), NBP and GHT+GDM (P=0.007), NBP and PE (P=0.032), and GHT and GHT+GDM (P=0.048) groups. CONCLUSION Our study revealed that vascularization indices and AUtPSV show significant differences due to gestational pathology, and can be useful in detection of pregnancies at risk.
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Affiliation(s)
| | - Andrea Surányi
- Andrea Surányi, Semmelweis str. 1., Szeged, Csongrád, H-6725, Hungary,
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Gibbons A, Flatley C, Kumar S. The fetal cerebro-placental ratio in diabetic pregnancies is influenced more by the umbilical artery rather than middle cerebral artery pulsatility index. Eur J Obstet Gynecol Reprod Biol 2017; 211:56-61. [PMID: 28189724 DOI: 10.1016/j.ejogrb.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to assess the relationship between the cerebro-placental ratio (CPR) and intrapartum and perinatal outcomes in pregnancies complicated by pre-existing insulin dependent diabetes (pT1DM) mellitus, pre-existing non-insulin dependent diabetes mellitus (pT2DM) and gestational diabetes mellitus (GDM). STUDY DESIGN This was a retrospective cohort study of 1281 women with diabetes mellitus birthing at the Mater Mothers' Hospital in Brisbane between 2007 and 2015. The CPR in non-anomalous singleton fetuses was measured between 34+0 and 36+6 weeks gestation and compared between types of DM treatment groups and correlated with intrapartum and perinatal outcomes. RESULTS Of the study cohort, 9.7% (124/1281) had pT1DM, 5.3% (68/1281) had pT2DM and 85.0% (1089/1281) had GDM. Of women with pT2DM and GDM, 61.8% (42/68) and 28.9% (315/1089) respectively, required insulin during pregnancy. Women with pT1DM had an increased odds of having a CPR <5th centile (OR 3.73, 95%CI: 1.90-6.96, p=0.0001) or a CPR <10th centile (OR 3.01, 95% CI: 1.80-4.91, p<0.0001) respectively. The odds of a UA PI >90th centile (OR 2.69, 95% CI: 1.60-4.39, p=0.0001) was higher in the pT1DM cohort. There was however no significant difference in the mean MCA PI between the three groups. Stratification by CPR centiles (<10th centile vs. ≥10th centile) demonstrated a lower birth weight in the CPR <10th centile cohort for all DM categories. The proportion of neonates with birth weights <10th centile were higher in the CPR <10th centile cohort with the GDM cohort having an odds ratio of 8.28 (95% CI 4.22-16.13, p<0.0001) of this complication. The CPR <10th centile cohort also had a greater proportion of adverse composite neonatal outcome regardless of type of DM. CONCLUSIONS Regardless of the type of DM, a low CPR was associated with poorer neonatal outcomes. Women with pT1DM also had the highest mean UA PI and lowest mean CPR despite no difference in the mean MCA PI between the three groups.
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Affiliation(s)
- Anthea Gibbons
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Christopher Flatley
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia; School of Medicine, The University of Queensland, Brisbane, Australia.
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Márton V, Zádori J, Kozinszky Z, Keresztúri A. Prevalences and pregnancy outcome of vanishing twin pregnancies achieved by in vitro fertilization versus natural conception. Fertil Steril 2016; 106:1399-1406. [PMID: 27565251 DOI: 10.1016/j.fertnstert.2016.07.1098] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/07/2016] [Accepted: 07/18/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate whether vanishing twin (VT) pregnancies achieved by in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) had a more adverse perinatal outcome than those after natural conception. DESIGN Longitudinal, retrospective cohort study. SETTING Tertiary university hospital. PATIENT(S) Three hundred and six (78 after IVF-ICSI and 228 after natural conception) VT pregnancies over a 22-year period, with VT cases matched to primarily singleton controls. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Obstetric and neonatal outcome data. RESULT(S) The incidence of VT was statistically significantly higher after natural conception (18.2% of twins) than after IVF-ICSI (12.6% of twins). The odds of VT in pregnancies complicated with pregestational or gestational diabetes were disproportionally higher in IVF-ICSI cases than in spontaneously conceived VT pregnancies (adjusted odds ratio [AOR]: 0.80 vs. 3.10 and 1.00 vs. 1.07, respectively). Previous induced abortion (AOR 1.34) or second-trimester fetal loss (AOR 3.3) increased the risk of VT pregnancies after spontaneous conception. Gestational diabetes mellitus in both the previous (AOR 5.41) and the present (AOR 2.3) pregnancy as well as chronic maternal diseases (AOR 3.5) and placentation anomalies all represented independent risk factors for VT after IVF-ICSI. CONCLUSION(S) Vanishing twin pregnancies had a lower prevalence and a worse perinatal outcome after IVF-ICSI as compared with those of their spontaneously conceived counterparts.
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Affiliation(s)
- Virág Márton
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary.
| | - János Zádori
- Center for Assisted Reproduction, Kaáli Institute, University of Szeged, Szeged, Hungary
| | - Zoltan Kozinszky
- Department of Obstetrics and Gynecology, Blekinge Hospital, Karlskrona, Sweden
| | - Attila Keresztúri
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
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Farina A. Placental vascular indices (VI, FI and VFI) in intrauterine growth retardation (IUGR). A pooled analysis of the literature. Prenat Diagn 2015; 35:1065-72. [DOI: 10.1002/pd.4646] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Antonio Farina
- Division of Obstetrics and Gynecology, Department of Medicine and Surgery (DIMEC); University of Bologna; Bologna Italy
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Kozinszky Z, Surányi A, Péics H, Molnár A, Pál A. Placental Volumetry by 2-D Sonography with a New Mathematical Formula: Prospective Study on the Shell of a Spherical Sector Model. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2252-2258. [PMID: 25959054 DOI: 10.1016/j.ultrasmedbio.2015.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 03/12/2015] [Accepted: 04/06/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to determine the utility of a new mathematical model in volumetric assessment of the placenta using 2-D ultrasound. Placental volumetry was performed in a prospective cross-sectional survey by virtual organ computer-aided analysis (VOCAL) with the help of a shell-off method in 346 uncomplicated pregnancies according to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Furthermore, placental thickness, length and height were measured with the 2-D technique to estimate placental volume based on the mathematical formula for the volume of "the shell of the spherical sector." Fetal size was also assessed by 2-D sonography. The placental volumes measured by 2-D and 3-D techniques had a correlation of 0.86. In the first trimester, the correlation was 0.82, and later during pregnancy, it was 0.86. Placental volumetry using "the circle-shaped shell of the spherical sector" mathematical model with 2-D ultrasound technique may be introduced into everyday practice to screen for placental volume deviations associated with adverse pregnancy outcome.
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Affiliation(s)
- Zoltan Kozinszky
- Reproductive Medicine, Department of Obstetrics and Gynecology, Huddinge Karolinska University Hospital, Stockholm, Sweden.
| | - Andrea Surányi
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Hajnalka Péics
- Faculty of Civil Engineering, University of Novi Sad, Subotica, Serbia
| | - András Molnár
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Attila Pál
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
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Surányi A, Kozinszky Z, Molnár A, Németh G. Placental volume relative to fetal weight estimated by sonography in diabetic pregnancies. J Matern Fetal Neonatal Med 2015; 29:1229-32. [DOI: 10.3109/14767058.2015.1040985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Maruotti GM, Rizzo G, Sirico A, Sarno L, Cirigliano L, Arduini D, Martinelli P. Are there any relationships between umbilical artery Pulsatility Index and macrosomia in fetuses of type I diabetic mothers? J Matern Fetal Neonatal Med 2014; 27:1776-81. [PMID: 24397275 DOI: 10.3109/14767058.2013.879706] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To establish whether there are relationships between umbilical artery Pulsatility Index (PI) and fetal macrosomia in pregnancies complicated by type I diabetes. METHODS In a retrospective observational study, 102 singleton pregnant women with type I diabetes were considered. Umbilical artery PI was measured by Doppler ultrasonography within one week from delivery and related to neonatal weight. Pregnancies were grouped according to birtweight in macrosomic group (≥4000 g) and normal growth group (<4000 g). Relationships between umbilical artery PI and birth weight and birth weight centile were tested by Pearson's correlation analysis. Further umbilical artery PI values were compared between macrosomic and normally grown fetuses. RESULTS Birth weight was ≥4000 g in 24 pregnancies (23.5%). A significant relationship was found between umbilical artery PI and neonatal weight (r = 0.512; p < 0.01) and neonatal weight centile (r = 0.400; p < 0.01). Umbilical artery PI were significantly lower (t = -6.013; p < 0.001) in the macrosomic group (0.78; 95% confidence interval (CI) 0.73-0.84) than in the normal growth group (1.00; 95% CI 0.97-1.04). CONCLUSIONS In pregnancies complicated by type I diabetes there is a significant relationship between umbilical artery PI value before delivery and absolute birth weight and birth weight centile. Macrosomic fetuses show a significant reduction in umbilical artery PI when compared with diabetic pregnancies without fetal overgrowth.
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Affiliation(s)
- G M Maruotti
- High Risk Pregnancy Centre, Department of Gynaecology and Obstetrics, University Federico II Naples , Naples , Italy and
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Glucose, insulin, and oxygen interplay in placental hypervascularisation in diabetes mellitus. BIOMED RESEARCH INTERNATIONAL 2014; 2014:145846. [PMID: 25258707 PMCID: PMC4167234 DOI: 10.1155/2014/145846] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/06/2014] [Indexed: 02/07/2023]
Abstract
The placental vasculature rapidly expands during the course of pregnancy in order to sustain the growing needs of the fetus. Angiogenesis and vascular growth are stimulated and regulated by a variety of growth factors expressed in the placenta or present in the fetal circulation. Like in tumors, hypoxia is a major regulator of angiogenesis because of its ability to stimulate expression of various proangiogenic factors. Chronic fetal hypoxia is often found in pregnancies complicated by maternal diabetes as a result of fetal hyperglycaemia and hyperinsulinemia. Both are associated with altered levels of hormones, growth factors, and proinflammatory cytokines, which may act in a proangiogenic manner and, hence, affect placental angiogenesis and vascular development. Indeed, the placenta in diabetes is characterized by hypervascularisation, demonstrating high placental plasticity in response to diabetic metabolic derangements. This review describes the major regulators of placental angiogenesis and how the diabetic environment in utero alters their expression. In the light of hypervascularized diabetic placenta, the focus was placed on proangiogenic factors.
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Gonzalez Gonzalez NL, Gonzalez Davila E, Castro A, Padron E, Plasencia W. Effect of pregestational diabetes mellitus on first trimester placental characteristics: three-dimensional placental volume and power Doppler indices. Placenta 2014; 35:147-51. [PMID: 24456657 DOI: 10.1016/j.placenta.2014.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/11/2013] [Accepted: 01/05/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate whether pregestational diabetes mellitus (DM) induces changes in vascular placental development detectable at first trimester. METHODS This was a prospective case-control study in 69 women with pregestational DM and 94 controls undergoing first-trimester combined screening for aneuploidies. Maternal characteristics, fetal nuchal translucency thickness, maternal serum pregnancy-associated plasma protein A (PAPP-A) and free β human chorionic gonadotrophin (β-hCG) were evaluated. Three-dimensional ultrasound was used to measure placental volume and three dimensional power Doppler (3D-PD) placental vascular indices including: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Pregnancy-associated hypertensive complications (PAHC) and perinatal outcomes were analyzed. The total group of diabetic women and the group of diabetic women without PAHC were compared separately with the control group. RESULTS 3D-PD placental vascular indexes were significantly lower in women with DM than in controls (VI p = 0.007, FI p = 0.003 and VFI p = 0.04). These differences remained on excluding cases with PAHC in the DM group. No differences were found in placental volumes between the DM group and controls. Serum PAPP-A levels were also lower in diabetic women (p < 0.02) and negatively correlated with the degree of maternal metabolic control at first trimester. CONCLUSIONS Pregestational DM induces demonstrable alterations in first trimester placental development, with significantly reduced placental vascularization indices and PAPP-A values. This effect is independent of the later development of PAHC.
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Affiliation(s)
- N L Gonzalez Gonzalez
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Tenerife, Universidad de La Laguna, Canary Islands, Spain.
| | - E Gonzalez Davila
- Departmento de Estadística, I.O. y Computación, Universidad de La Laguna, Tenerife, Canary Islands, Spain
| | - A Castro
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Tenerife, Universidad de La Laguna, Canary Islands, Spain
| | - E Padron
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Tenerife, Universidad de La Laguna, Canary Islands, Spain
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Fractional volume of placental vessels in women with diabetes using a novel stereological 3D power Doppler technique. Placenta 2013; 34:1002-8. [DOI: 10.1016/j.placenta.2013.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/09/2013] [Accepted: 08/27/2013] [Indexed: 11/22/2022]
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Ferland S, Bujold E, Giguère Y, Girard M, Demers S, Forest JC. Association Between Physical Activity in Early Pregnancy and Markers of Placental Growth and Function. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:787-792. [DOI: 10.1016/s1701-2163(15)30834-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Surányi A, Kozinszky Z, Molnár A, Nyári T, Bitó T, Pál A. Placental three-dimensional power Doppler indices in mid-pregnancy and late pregnancy complicated by gestational diabetes mellitus. Prenat Diagn 2013; 33:952-8. [DOI: 10.1002/pd.4172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/23/2013] [Accepted: 05/31/2013] [Indexed: 11/10/2022]
Affiliation(s)
- A. Surányi
- Department of Obstetrics and Gynecology; University of Szeged; 1, Semmelweis u H-6725 Szeged Hungary
| | - Z. Kozinszky
- Department of Obstetrics and Gynecology; Blekinge Hospital; Kvinnokliniken, Blekinge Sjukhuset 371 81 Karlskrona Sweden
| | - A. Molnár
- Department of Obstetrics and Gynecology; University of Szeged; 1, Semmelweis u H-6725 Szeged Hungary
| | - T. Nyári
- Department of Medical Physics and Informatics; University of Szeged; 9, Korányi fasor H-6720 Szeged Hungary
| | - T. Bitó
- Department of Obstetrics and Gynecology; University of Szeged; 1, Semmelweis u H-6725 Szeged Hungary
| | - A. Pál
- Department of Obstetrics and Gynecology; University of Szeged; 1, Semmelweis u H-6725 Szeged Hungary
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