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Hernandez-Andrade E, Valentini B, Gerulewicz D. Practical Evaluation of the Fetal Cardiac Function. Clin Obstet Gynecol 2024; 67:753-764. [PMID: 39431495 DOI: 10.1097/grf.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2024]
Abstract
The fetal heart adapts dynamically to nutrient and oxygen needs from all fetal organs. These continuous changes make it difficult to define normal/abnormal cardiac function based only on the evaluation of a few cycles. Many signs of fetal cardiac dysfunction have been suggested; however, very few can stand as true manifestations of cardiac deterioration, and none has emerged as a single reliable marker of cardiac dysfunction. It is the combination of abnormal findings that provides a more accurate assessment of the status of the fetal heart function.
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Affiliation(s)
- Edgar Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, Health Science Center at Houston (UTHealth), University of Texas, Houston, Texas
| | - Beatrice Valentini
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Donatella Gerulewicz
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, Health Science Center at Houston (UTHealth), University of Texas, Houston, Texas
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2
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Demircan T, Atakul BK, Güven B, Yıldız K, Karadeniz C, Emir B, Özeren M, Narin N. Ductus arteriosus diameters in fetuses with early- and late-onset fetal growth restriction. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:1010-1018. [PMID: 38830837 DOI: 10.1002/jcu.23737] [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: 01/31/2024] [Revised: 04/15/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE Fetal growth restriction (FGR) is a common pregnancy complication that can be associated with several adverse perinatal outcomes. One of these negative outcomes is ductus arteriosus, especially in preterm babies. In this study, intrauterine heart function and ductus diameter were evaluated in babies with FGR. METHODS Thirty-seven fetuses with FGR were compared with 37 normal-weight fetuses at the same gestational week. In our study, ventricular diameters, aorta, pulmonary artery, ductus arteriosus (DA), aortic arch diameter, and flow traces were examined. In addition, the aorta and aortic isthmus diameters were proportioned to the ductus diameter, and the left ventricular myocardial performance index (MPI) [(ICT + IRT)/ET] was evaluated. RESULTS There was no difference in DA diameters between the patient and control groups. The intragroup comparison of the cases with early- and late-onset FGR revealed no statistically significant difference between DA diameters. However, the ratios of the aortic annulus diameter/ductus diameter (AOD/DAD) and aortic isthmus diameter/ductus diameter (AID/DAD) were significantly lower in early-onset FGR because the diameter of the DA was greater. In addition, the mod-MPI values were higher in the patient group. CONCLUSIONS In our study, although the ductal diameters did not change significantly in the patient group, the ductal diameter was greater in the early-onset intrauterine growth restriction (FGR) group compared with other cardiac measurements. The mod-MPI value, a cardiac function indicator, was higher in fetuses with FGR. These findings may be useful for evaluating postnatal cardiac functions in FGR.
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Affiliation(s)
- Tülay Demircan
- School of Medicine, Department of Pediatric Cardiology, Dokuz Eylul University, Izmir, Turkey
| | | | - Barış Güven
- Department of Pediatric Cardiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Kaan Yıldız
- Department of Pediatric Cardiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Cem Karadeniz
- School of Medicine, Department of Pediatric Cardiology, Katip Celebi University, Izmir, Turkey
| | - Büşra Emir
- Faculty of Medicine, Department of Biostatistics, Katip Celebi University, Izmir, Turkey
| | - Mehmet Özeren
- Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Nazmi Narin
- School of Medicine, Department of Pediatric Cardiology, Katip Celebi University, Izmir, Turkey
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3
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Schaak R, Fabian Danzer M, Steinhard J, Schmitz R, Köster HA, Möllers M, Sondern K, De Santis C, Willy D, Oelmeier K. Prediction of fetal growth restriction and small for gestational age by ultrasound cardiac parameters. Eur J Obstet Gynecol Reprod Biol 2024; 300:142-149. [PMID: 39002400 DOI: 10.1016/j.ejogrb.2024.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 06/28/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE Prediction of fetal growth restriction (FGR) and small of gestational age (SGA) infants by using various ultrasound cardiac parameters in a logistic regression model. METHODS In this retrospective study we obtained standardized ultrasound images of 357 fetuses between the 20th and 39th week of gestation, 99 of these fetuses were between the 3rd and 10th growth percentile, 61 smaller than 3rd percentile and 197- appropriate for gestational age over the 10th percentile (control group). Several cardiac parameters were studied. The cardiothoracic ratio and sphericity of the ventricles was calculated. A binary logistic regression model was developed for prediction of growth restriction using the cardiac and biometric parameters. RESULTS There were noticeable differences between the control and study group in the sphericity of the right ventricle (p = 0.000), left and right longitudinal ventricle length (pright = 0.000, pleft = 0.000), left ventricle transverse length (p = 0.000), heart diameter (p = 0.002), heart circumference (p = 0.000), heart area (p = 0.000), and thoracic diameter limited by the ribs (p = 0.002). There was no difference of the cardiothoracic ratio between groups. The logistic regression model achieved a prediction rate of 79.4 % with a sensitivity of 74.5 % and specificity of 83.2 %. CONCLUSION The heart of growth restricted infants is characterized by a more globular right ventricle, shorter ventricle length and smaller thorax diameter. These parameters could improve prediction of FGR and SGA.
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Affiliation(s)
- Ricarda Schaak
- Department of Obstetrics and Gynecology, University Hospital of Muenster, Germany.
| | - Moritz Fabian Danzer
- Institute of Biostatistics and Clinical Research, University of Muenster, Germany
| | - Johannes Steinhard
- Fetal Cardiology, Center for Congenital Heart Disease, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Ruhr University Bochum, Bochum, Germany
| | - Ralf Schmitz
- Department of Obstetrics and Gynecology, University Hospital of Muenster, Germany
| | - Helen A Köster
- Department of Obstetrics and Gynecology, University Hospital of Muenster, Germany
| | - Mareike Möllers
- Department of Obstetrics and Gynecology, University Hospital of Muenster, Germany
| | - Kathleen Sondern
- Department of Obstetrics and Gynecology, University Hospital of Muenster, Germany
| | - Chiara De Santis
- Department of Obstetrics and Gynecology, University Hospital of Muenster, Germany
| | - Daniela Willy
- Department of Obstetrics and Gynecology, University Hospital of Muenster, Germany
| | - Kathrin Oelmeier
- Department of Obstetrics and Gynecology, University Hospital of Muenster, Germany.
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Scholz AS, Rónay V, Wallwiener M, Fluhr H, von Au A, Spratte J, Wallwiener S, Elsaesser M. Association between Doppler assessment and secondary cesarean delivery for intrapartum fetal compromise in small-for-gestational-age fetuses. Arch Gynecol Obstet 2024; 310:719-728. [PMID: 38789851 PMCID: PMC11258169 DOI: 10.1007/s00404-024-07559-2] [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: 01/27/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE To elucidate the association between arterial and venous Doppler ultrasound parameters and the risk of secondary cesarean delivery for intrapartum fetal compromise (IFC) and neonatal acidosis in small-for-gestational-age (SGA) fetuses. METHODS This single-center, prospective, blinded, cohort study included singleton pregnancies with an estimated fetal weight (EFW) < 10th centile above 36 gestational weeks. Upon study inclusion, all women underwent Doppler ultrasound, including umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, fetal aortic isthmus (AoI) PI, umbilical vein blood flow (UVBF), and modified myocardial performance index (mod-MPI). Primary outcome was defined as secondary cesarean section due to IFC. RESULTS In total, 87 SGA pregnancies were included, 16% of which required a cesarean section for IFC. Those fetuses revealed lower UVBF corrected for abdominal circumference (AC) (5.2 (4.5-6.3) vs 7.2 (5.5-8.3), p = 0.001). There was no difference when comparing AoI PI, UA PI, ACM PI, or mod-MPI. No association was found for neonatal acidosis. After multivariate logistic regression, UVBF/AC remained independently associated with cesarean section due to IFC (aOR 0.61 [0.37; 0.91], p = 0.03) and yielded an area under the curve (AUC) of 0.78 (95% CI, 0.67-0.89). A cut-off value set at the 50th centile of UVBF/AC reached a sensitivity of 86% and specificity of 58% for the occurrence of cesarean section due to IFC (OR 8.1; 95% CI, 1.7-37.8, p = 0.003). CONCLUSION Low levels of umbilical vein blood flow (UVBF/AC) were associated with an increased risk among SGA fetuses to be delivered by cesarean section for IFC.
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Affiliation(s)
- Anna S Scholz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Vanessa Rónay
- Department of Urology, Nuernberg Hospital, Nuernberg, Germany
| | - Markus Wallwiener
- Department of Gynecology, University Hospital Halle (Saale), Halle, Germany
| | - Herbert Fluhr
- Department of Gynecology and Obstetrics, Graz University Hospital, Graz, Austria
| | - Alexandra von Au
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Julia Spratte
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Fetal Medicine, University Hospital Halle (Saale), Halle, Germany
| | - Michael Elsaesser
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
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Umapathy A, Clark A, Sehgal A, Karanam V, Rajaraman G, Kalionis B, Jones H, James J, Murthi P. Molecular regulators of defective placental and cardiovascular development in fetal growth restriction. Clin Sci (Lond) 2024; 138:761-775. [PMID: 38904187 PMCID: PMC11193155 DOI: 10.1042/cs20220428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/12/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024]
Abstract
Placental insufficiency is one of the major causes of fetal growth restriction (FGR), a significant pregnancy disorder in which the fetus fails to achieve its full growth potential in utero. As well as the acute consequences of being born too small, affected offspring are at increased risk of cardiovascular disease, diabetes and other chronic diseases in later life. The placenta and heart develop concurrently, therefore placental maldevelopment and function in FGR may have profound effect on the growth and differentiation of many organ systems, including the heart. Hence, understanding the key molecular players that are synergistically linked in the development of the placenta and heart is critical. This review highlights the key growth factors, angiogenic molecules and transcription factors that are common causes of defective placental and cardiovascular development.
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Affiliation(s)
- Anandita Umapathy
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Alys Clark
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Auckland Bioengineering Institute, Bioengineering Institute, New Zealand
| | - Arvind Sehgal
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia and Monash Newborn, Monash Children’s Hospital, Melbourne, VIC, Australia
| | - Vijaya Karanam
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Royal Women’s Hospital, Victoria, Australia
| | - Gayathri Rajaraman
- First year college, Victoria University, St Albans, Victoria 3021, Australia
| | - Bill Kalionis
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Royal Women’s Hospital, Victoria, Australia
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, Royal Women’s Hospital, Victoria, Australia
| | - Helen N. Jones
- Department of Physiology and Aging, University of Florida College of Medicine, Gainesville, FL, U.S.A
- Center for Research in Perinatal Outcomes, University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - Jo James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Auckland Bioengineering Institute, Bioengineering Institute, New Zealand
| | - Padma Murthi
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Royal Women’s Hospital, Victoria, Australia
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, Royal Women’s Hospital, Victoria, Australia
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
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Menekse Beser D, Oluklu D, Uyan Hendem D, Yildirim M, Laleli Koc B, Sahin D. Fetal cardiac functional changes in pregnancies with Behcet's disease: A case-control study. Early Hum Dev 2024; 192:106006. [PMID: 38598864 DOI: 10.1016/j.earlhumdev.2024.106006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Behcet's disease usually progresses with remission during pregnancy, but early subtle changes might be detected in the heart of these fetuses due to inflammation. AIMS We aimed to evaluate the cardiac functions in fetuses of pregnant women with Behcet's disease (BD). STUDY DESIGN Prospective case-control study. SUBJECTS This prospective study enrolled pregnant women diagnosed with Behcet's disease before pregnancy. Twenty-four pregnancies with Behcet's disease and 48 healthy pregnancies were included at 32-34 gestational weeks. OUTCOME MEASURES Pulsed-wave Doppler and tissue Doppler imaging (TDI) were used to assess cardiac functions. RESULTS Right ventricle (RV) E (early) wave and left ventricle (LV) E were significantly increased in pregnancies with BD (p = .008, p = .041, respectively). Decreased right ventricle E' (peak systolic velocity) was detected with TDI in the case group (6.2 ± 0.5, p < .001). E/E' ratios for RV and LV were significantly increased in the case group (p < .001, p = .001, respectively). The correlation between the duration of the disease and fetal cardiac functions was also evaluated. For RV, E (r = 0.735, p < .001), E' (r = -0.735, p < .001), E/E' (r = 0.894, p < .001), were strongly correlated with the disease duration. The study also showed the correlation between disease duration and LV E' (r = -0.735, p = .005), LV E (r = 0.750, p < .001), and LV E/E' (r = 0.820, p < .001). CONCLUSION This is the first study to evaluate the fetal cardiac functions in fetuses of pregnancies with BD. Although BD usually progresses with remission during pregnancy, early subclinical diastolic changes might occur in the heart of these fetuses due to inflammation.
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Affiliation(s)
- Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Bergen Laleli Koc
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- University of Health Sciences, Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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Domínguez-Gallardo C, Ginjaume-García N, Ullmo J, Parra J, Vázquez A, Cruz-Lemini M, Llurba E. Fetal Left Ventricle Function Evaluated by Two-Dimensional Speckle-Tracking Echocardiography across Clinical Stages of Severity in Growth-Restricted Fetuses. Diagnostics (Basel) 2024; 14:548. [PMID: 38473020 DOI: 10.3390/diagnostics14050548] [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: 02/06/2024] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
Fetal growth restriction (FGR) can result in adverse perinatal outcomes due to cardiac dysfunction. This study used 2D speckle-tracking echocardiography to assess left ventricle (LV) longitudinal strain across FGR severity stages. A prospective longitudinal cohort study measured global (GLS) and segmental LV longitudinal strain in FGR fetuses, with evaluations conducted at various time points. FGR was classified into subtypes based on published criteria using fetal weight centile and Doppler parameters. A linear mixed model was employed to analyze repeated measures and compare Z-score measurements between groups throughout gestational age. The study included 40 FGR fetuses and a total of 107 evaluations were performed: 21 from small for gestational age (SGA), 74 from the FGR stage I, and 12 from the FGR stage ≥ II. The results indicate that SGA and stage I FGR fetuses exhibit higher LV GLS than stages ≥ II. Throughout gestation, SGA and FGR stage I fetuses showed similar behavior with consistently better LV GLS values when compared to FGR stages ≥ II. No significant differences were observed in LV GLS strain behavior between SGA and FGR stage I. In conclusion, all FGRs show signs of early cardiac dysfunction, with severe cases demonstrating significantly a lower LV GLS when compared to mild cases, suggesting deterioration of cardiac dysfunction with progression of fetal compromise.
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Affiliation(s)
- Carla Domínguez-Gallardo
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Nuria Ginjaume-García
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
| | - Johana Ullmo
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Juan Parra
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana Vázquez
- Applied Statistics Department, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
| | - Mónica Cruz-Lemini
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Elisa Llurba
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Women and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08025 Barcelona, Spain
- Maternal and Child Health and Development Network (SAMID), RD16/0022, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Mecacci F, Romani E, Clemenza S, Zullino S, Avagliano L, Petraglia F. Early Fetal Growth Restriction with or Without Hypertensive Disorders: a Clinical Overview. Reprod Sci 2024; 31:591-602. [PMID: 37684516 DOI: 10.1007/s43032-023-01330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023]
Abstract
Early onset fetal growth restriction (FGR) is one of the main adverse pregnancy conditions, often associated with poor neonatal outcomes. Frequently, early onset FGR is associated with early onset hypertensive disorders of pregnancy (HDP), and in particular preeclampsia (PE). However, to date, it is still an open question whether pregnancies complicated by early FGR plus HDP (FGR-HDP) and those complicated by early onset FGR without HDP (normotensive-FGR (n-FGR)) show different prenatal and postnatal outcomes and, consequently, should benefit from different management and long-term follow-up. Recent data support the hypothesis that the presence of PE may have an additional impact on maternal hemodynamic impairment and placental lesions, increasing the risk of poor neonatal outcomes in pregnancy affected by early onset FGR-HDP compared to pregnancy affected by early onset n-FGR. This review aims to elucidate this poor studied topic, comparing the clinical characteristics, perinatal outcomes, and potential long-term sequelae of early onset FGR-HDP and early onset n-FGR.
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Affiliation(s)
- Federico Mecacci
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Eleonora Romani
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Sara Clemenza
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Sara Zullino
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | | | - Felice Petraglia
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
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Yang Y, Hou G, Ji F, Zhou H, Lv R, Hu C. Maternal Supplementation with Ornithine Promotes Placental Angiogenesis and Improves Intestinal Development of Suckling Piglets. Animals (Basel) 2024; 14:689. [PMID: 38473074 DOI: 10.3390/ani14050689] [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: 12/18/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
The blood vessels of the placenta are crucial for fetal growth. Here, lower vessel density and ornithine (Orn) content were observed in placentae for low-birth-weight fetuses versus normal-birth-weight fetuses at day 75 of gestation. Furthermore, the Orn content in placentae decreased from day 75 to 110 of gestation. To investigate the role of Orn in placental angiogenesis, 48 gilts (Bama pig) were allocated into four groups. The gilts in the control group were fed a basal diet (CON group), while those in the experimental groups were fed a basal diet supplemented with 0.05% Orn (0.05% Orn group), 0.10% Orn (0.10% Orn group), and 0.15% Orn (0.15% Orn group), respectively. The results showed that 0.15% Orn and 0.10% Orn groups exhibited increased birth weight of piglets compared with the CON group. Moreover, the 0.15% Orn group was higher than the CON group in the blood vessel densities of placenta. Mechanistically, Orn facilitated placental angiogenesis by regulating vascular endothelial growth factor-A (VEGF-A). Furthermore, maternal supplementation with 0.15% Orn during gestation increased the jejunal and ileal villi height and the concentrations of colonic propionate and butyrate in suckling piglets. Collectively, these results showed that maternal supplementation with Orn promotes placental angiogenesis and improves intestinal development of suckling piglets.
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Affiliation(s)
- Yun Yang
- Tropical Crop Genetic Resource Research Institute, Chinese Academy of Tropical Agricultural Sciences, Haikou 571101, China
- College of Animal Science and Technology, Huazhong Agricultural University, Wuhan 430070, China
| | - Guanyu Hou
- Tropical Crop Genetic Resource Research Institute, Chinese Academy of Tropical Agricultural Sciences, Haikou 571101, China
| | - Fengjie Ji
- Tropical Crop Genetic Resource Research Institute, Chinese Academy of Tropical Agricultural Sciences, Haikou 571101, China
| | - Hanlin Zhou
- Tropical Crop Genetic Resource Research Institute, Chinese Academy of Tropical Agricultural Sciences, Haikou 571101, China
| | - Renlong Lv
- Tropical Crop Genetic Resource Research Institute, Chinese Academy of Tropical Agricultural Sciences, Haikou 571101, China
| | - Chengjun Hu
- Tropical Crop Genetic Resource Research Institute, Chinese Academy of Tropical Agricultural Sciences, Haikou 571101, China
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Fernández-Buhigas I, Martin Arias A, Vargas-Terrones M, Brik M, Rolle V, Barakat R, Muñoz-Gonzalez MD, Refoyo I, Gil MM, Santacruz B. Fetal and maternal Doppler adaptation to maternal exercise during pregnancy: a randomized controlled trial. J Matern Fetal Neonatal Med 2023; 36:2183759. [PMID: 36889747 DOI: 10.1080/14767058.2023.2183759] [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: 03/10/2023]
Abstract
BACKGROUND Regular and supervised exercise during pregnancy is worldwide recommended due to its proven benefits, but, during exercise, maternal blood flow is redirected from the viscera to the muscles and how fetal wellbeing may be affected by this redistribution is still not well known. OBJECTIVE To analyze the longitudinal effect of a supervised moderate physical exercise program during pregnancy on uteroplacental and fetal Doppler parameters. METHODS This is a planned secondary analysis of an randomized controlled trial (RCT), performed at Hospital Universitario de Torrejón, Madrid, Spain, including 124 women randomized from 12+0 to 15+6 weeks of gestation to exercise vs. control group. Fetal umbilical artery (UA), middle cerebral artery, and uterine artery pulsatility index (PI), were longitudinally collected by Doppler ultrasound assessment throughout gestation, and derived cerebroplacental ratio (normalized by z-score), and maternal mean PI in the uterine arteries (normalized by multiplies of the median). Obstetric appointments were scheduled at 12 (baseline, 12+0 to 13+5), 20 (19+0 to 24+2), 28 (26+3 to 31+3) and 35 weeks (32+6 to 38+6) of gestation. Generalized estimating equations were adjusted to assess longitudinal changes in the Doppler measurements according to the randomization group. RESULTS No significant differences in the fetal or maternal Doppler measurements were found at any of the different checkup time points studied. The only variable that consistently affected the Doppler standardized values was gestational age at the time of assessment. The evolution of the UA PI z-score during the pregnancy was different in the two study groups, with a higher z-score in the exercise group at 20 weeks and a subsequent decrease until delivery while in the control group it remained stable at around zero. CONCLUSIONS A regular supervised moderate exercise program during pregnancy does not deteriorate fetal or maternal ultrasound Doppler parameters along the pregnancy, suggesting that the fetal well-being is not compromised by the exercise intervention. Fetal UA PI z-score decreases during pregnancy to lower levels in the exercise group compared with the control group.
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Affiliation(s)
- Irene Fernández-Buhigas
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Madrid, Spain.,School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Aranzazu Martin Arias
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Madrid, Spain.,School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Marina Vargas-Terrones
- AFIPE Research Group, Faculty of Sciences for Physical Activity and Sport, INEF, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Maia Brik
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Madrid, Spain.,School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Valeria Rolle
- Biostatistics and Epidemiology Platform at Fundación para la Investigación e Innovación Biosanitaria del Principado de Asturias, Oviedo, Spain
| | - Rubén Barakat
- AFIPE Research Group, Faculty of Sciences for Physical Activity and Sport, INEF, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - María D Muñoz-Gonzalez
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Madrid, Spain.,School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Ignacio Refoyo
- AFIPE Research Group, Faculty of Sciences for Physical Activity and Sport, INEF, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Maria M Gil
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Madrid, Spain.,School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Belén Santacruz
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Madrid, Spain.,School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
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11
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Li L, Sun JP, Zuo R, Shen Y, Zhao M, Zhao W, Luo Z. Cardiac function evaluated by two-dimensional speckle tracking imaging in fetuses with congenital heart disease of ventricular afterload increase. J Matern Fetal Neonatal Med 2023; 36:2214663. [PMID: 37217449 DOI: 10.1080/14767058.2023.2214663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023]
Abstract
AIMS To study myocardial deformation in fetuses with ventricular afterload increase compared with gestational age-matched controls using speckle tracking echocardiography. METHODS AND RESULTS Eighty-nine fetuses were retrospectively selected from the pregnancy screen by echocardiography. There are 41 fetuses with gestational age-matched normal heart served as the control group, 25 fetuses with congenital heart disease (CHD) leading to left ventricular (LV) afterload increase as group LVA and 23 fetuses with CHD leading to right ventricular(RV) afterload increases as group RVA. LV and RV fractional shortening (FS) were measured by conventional methods. The longitudinal strain (LS) and strain rate (LSr) were analyzed by EchoPac software. Group LVA and RVA compared with control group, the LV FS was no significant difference, but LS and LSr values of LV were lower in fetuses with LVA compared to the control group (LS:-15.97(-12.50,-22.52)vs -27.53(-24.33,-29.16) %, p < .01; systolic strain rate (SRs):-1.34(-1.12,-2.16) vs -2.55(-2.28,-2.92) 1/sec, p < .01; early diastolic strain rate (SRe):1.70 ± 0.57 vs 2.46 ± 0.61 1/sec, p < 0.01; late diastolic strain rate (SRa):1.62 ± 0.82 vs 2.39 ± 0.81 1/sec, p < .01). LS and LSr values of LV or RV were lower in fetuses with RVA compared to the control group (LV: LS:-21.52 ± 6.68 vs -26.79 ± 3.22%, p < .01; SRs:-2.11 ± 0.78 vs -2.56 ± 0.43 1/sec; p = .02; RV: LS:-17.64 ± 7.58 vs -26.38 ± 3.97%, p < .01; SRs:-1.62 ± 0.67 vs -2.37 ± 0.44 1/sec; p < .01). CONCLUSION The results of this study showed that the ventricular LS, LSr, SRs, SRe, SRa values were lower in fetuses with LV or RV afterload increasing CHD estimated by speckle tracking imaging but LV and RV FS were normal,which indicated the strain imaging is feasible in evaluating cardiac function of fetus, and may be more sensitive.
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Affiliation(s)
- Li Li
- Fuwai Yunnan Cardiovascular Hospital, Yunnan, China
| | | | - Rongyu Zuo
- Fuwai Yunnan Cardiovascular Hospital, Yunnan, China
| | - Yan Shen
- Fuwai Yunnan Cardiovascular Hospital, Yunnan, China
| | - Miao Zhao
- Fuwai Yunnan Cardiovascular Hospital, Yunnan, China
| | - Wanyu Zhao
- Fuwai Yunnan Cardiovascular Hospital, Yunnan, China
| | - Zhiling Luo
- Fuwai Yunnan Cardiovascular Hospital, Yunnan, China
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12
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Oluklu D, Uyan Hendem D, Menekse Beser D, Yildirim M, Laleli Koc B, Kara O, Tanacan A, Sahin D. The influence of maternal inflammatory bowel diseases on fetal cardiac functions: A case-control study. Early Hum Dev 2023; 187:105877. [PMID: 37866290 DOI: 10.1016/j.earlhumdev.2023.105877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/28/2023] [Accepted: 10/14/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The altered maternal inflammatory milieu and changes in maternal vascular structure (arterial stiffness) and function may affect the fetal heart in pregnant women diagnosed with inflammatory bowel disease (IBD). AIMS To investigate fetal cardiac functions in IBD pregnancies and to reveal the relationship between IBD duration and fetal cardiac functions. STUDY DESIGN Prospective case-control study. SUBJECTS The case group included 19 pregnant women with ulcerative colitis and seven with Crohn's disease who were in remission at the time of the study. The control group consisted of 52 healthy pregnant women matched for gestational age in the third trimester of pregnancy (at 32 to 33 weeks). OUTCOME MEASURES Fetal cardiac functions. The assessment was blinded as to whether the patients were cases or controls. RESULTS The right ventricular E', E'/A', S', and tricuspid annular plane systolic excursion (TAPSE) were significantly lower, and E/E', myocardial performance index (MPI'), and isovolumetric relaxation time (IVRT') were significantly higher in fetuses of IBD pregnancies. Diastolic functions (E/E', E', E'/A', and IVRT'), systolic functions (S' and TAPSE), and global function (MPI') were changed in the case group. A significantly strong correlation was between maternal disease duration and fetal right ventricle diastolic function parameters (E/E', E, E', E'/A') in the case group (r2 = 0.780; p ≤0.001, r2 = 0.570; p ≤0.001, r2 = 0.604; p ≤0.001, r2 = 0.638; p ≤0.001, respectively). CONCLUSION Diastolic and systolic fetal cardiac functions changed in IBD pregnancies. As the disease duration increases, especially fetal cardiac diastolic functions may be affected.
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Affiliation(s)
- Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Bergen Laleli Koc
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ozgur Kara
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- University of Health Sciences, Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- University of Health Sciences, Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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13
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Oyang M, Piscopo BR, Zahra V, Malhotra A, Sutherland AE, Sehgal A, Hooper SB, Miller SL, Polglase GR, Allison BJ. Cardiovascular responses to mild perinatal asphyxia in growth-restricted preterm lambs. Am J Physiol Heart Circ Physiol 2023; 325:H1081-H1087. [PMID: 37656131 PMCID: PMC10908401 DOI: 10.1152/ajpheart.00485.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/02/2023]
Abstract
Growth-restricted neonates have worse outcomes after perinatal asphyxia, with more severe metabolic acidosis than appropriately grown neonates. The cardiovascular physiology associated with fetal growth restriction (FGR) may alter their response to asphyxia. However, research on asphyxia in FGR is limited. Here we compared cardiovascular hemodynamics in preterm FGR and control lambs during mild perinatal asphyxia. We induced FGR in one twin at 89 days gestation (term 148 days), while the other served as a control. At 126 days gestation, lambs were instrumented to allow arterial blood pressure and regional blood flow recording, and then mild perinatal asphyxia was induced by umbilical cord clamping, and resuscitation followed neonatal guidelines. FGR lambs maintained carotid blood flow (CBF) for 7 min, while control lambs rapidly decreased CBF (P < 0.05). Fewer growth-restricted lambs needed chest compressions for return of spontaneous circulation (ROSC) (17 vs. 83%, P = 0.02). The extent of blood pressure overshoot after ROSC was similar, but it took longer for MAP to return to baseline in FGR lambs (18.83 ± 0.00 vs. 47.67 ± 0.00 min, P = 0.003). Growth-restricted lambs had higher CBF after ROSC (P < 0.05) and displayed CBF overshoot, unlike control lambs (P < 0.03). In conclusion, preterm growth-restricted lambs show resilience during perinatal asphyxia based on prolonged CBF maintenance and reduced need for chest compressions during resuscitation. However, CBF overshoot after ROSC may increase the risk of cerebrovascular injury in FGR.NEW & NOTEWORTHY Preterm growth-restricted lambs maintain carotid blood flow for longer than control lambs during asphyxia and have a lower requirement for chest compressions than control lambs during resuscitation. Preterm growth-restricted, but not control, lambs displayed an overshoot in carotid blood flow following return of spontaneous circulation.
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Affiliation(s)
- Matthew Oyang
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Beth R Piscopo
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Valerie Zahra
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Atul Malhotra
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Amy E Sutherland
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Arvind Sehgal
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Beth J Allison
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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14
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李 墨, 丁 瑛, 崔 红, 姜 丽, 王 子, 来 艳, 李 白, 丁 文. [Characteristics of the left heart structure and function in 86 term neonates with intrauterine growth restriction]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:1016-1021. [PMID: 37905757 PMCID: PMC10621062 DOI: 10.7499/j.issn.1008-8830.2304045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/16/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES To study the left heart structure and functional characteristics of term neonates with intrauterine growth restriction (IUGR). METHODS This study included 86 term neonates with IUGR admitted to the Neonatal Ward of Beijing Friendship Hospital, Capital Medical University from January 2019 to January 2022 as the IUGR group, as well as randomly selected 86 term neonates without IUGR born during the same period as the non-IUGR group. The clinical data and echocardiographic data were compared between the two groups. RESULTS The analysis of left heart structure and function showed that compared with the non-IUGR group, the IUGR group had significantly lower left ventricular mass, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left atrial diameter, end-diastolic interventricular septal thickness, left ventricular posterior wall thickness, left ventricular end-diastolic volume, left ventricular end-systolic volume, and stroke volume (P<0.05) and significantly higher ratio of end-diastolic interventricular septal thickness to left ventricular posterior wall thickness, proportion of neonates with a mitral peak E/A ratio of ≥1, and cardiac index (P<0.05). The Spearman correlation analysis suggested that stroke volume was positively correlated with birth weight and body surface area (rs=0.241 and 0.241 respectively; P<0.05) and that the ratio of end-diastolic interventricular septal thickness to left ventricular posterior wall thickness was negatively correlated with birth weight and body surface area (rs=-0.229 and -0.225 respectively; P<0.05). CONCLUSIONS The left ventricular systolic function of neonates with IUGR is not significantly different from that of neonates without IUGR. However, the ventricular septum is thicker in neonates with IUGR. This change is negatively correlated with birth weight and body surface area. The left ventricular diastolic function may be impaired in neonates with IUGR.
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Affiliation(s)
| | | | | | | | | | | | | | - 文虹 丁
- 首都医科大学附属北京安贞医院小儿心脏科北京100029
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15
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Kucukbas GN, Bağcı M, Şahin HG. The Relationship Between Fetal Central Nervous System Malformations and Modified Myocardial Performance Index. Cureus 2023; 15:e47287. [PMID: 37859680 PMCID: PMC10584431 DOI: 10.7759/cureus.47287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Fetal ventriculomegaly, the most commonly identified abnormality of the fetal central nervous system (CNS), has been associated with elevated levels of the modified myocardial performance index (mMPI). However, the impact of other CNS pathologies on mMPI has not yet been evaluated. This study aimed to investigate whether there were changes in the myocardial performance index of fetuses with CNS pathologies without congenital heart diseases. METHODS A total of 126 singleton pregnant women were included in this study. Sixty-three fetuses had fetal CNS abnormalities of acrania, anencephaly, encephalocele, Dandy-Walker malformation, hydrocephalus, and meningocele. The control group consisted of 63 healthy and gestational age-matched fetuses. All ultrasonographic examinations were done in the second trimester of gestation. The data related to the characteristics of pregnant women were evaluated, and fetal left ventricular mMPI was obtained by ultrasound scan. RESULTS The study and the control group participants were not significantly different by means of pregnancy characteristics. The mean mMPI was higher in the fetal CNS malformation group compared to the control groups (0.39±0.02 vs. 0.45±0.04, P<0.001). The mean mMPI value was similar for fetuses with both closed and open calvarium defects of fetal CNS malformation. CONCLUSION Fetal CNS anomalies may be associated with prenatal cardiac dysfunction. Moreover, this relationship might be independent of the type of fetal CNS malformation, whether a closed or open calvarium defect.
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Affiliation(s)
- Gokce Naz Kucukbas
- Obstetrics and Gynecology/Perinatology, Kocaeli City Hospital, Kocaeli, TUR
| | - Mustafa Bağcı
- Obstetrics and Gynecology, Van Yüzüncü Yıl University, Van, TUR
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16
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Cauzzo C, Chiavaroli V, Di Valerio S, Chiarelli F. Birth size, growth trajectory and later cardio-metabolic risk. Front Endocrinol (Lausanne) 2023; 14:1187261. [PMID: 37342257 PMCID: PMC10277632 DOI: 10.3389/fendo.2023.1187261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/19/2023] [Indexed: 06/22/2023] Open
Abstract
There is increasing evidence of a strong association between intrauterine growth and subsequent development of chronic disease in adult life. Birth size and growth trajectory have been demonstrated to have an impact on cardio-metabolic health, both in childhood and adult life. Hence, careful observation of the children's growth pattern, starting from the intrauterine period and the first years of life, should be emphasized to detect the possible onset of cardio-metabolic sequelae. This allows to intervene on them as soon as they are detected, first of all through lifestyle interventions, whose efficacy seems to be higher when they are started early. Recent papers suggest that prematurity may constitute an independent risk factor for the development of cardiovascular disease and metabolic syndrome, regardless of birth weight. The purpose of the present review is to examine and summarize the available knowledge about the dynamic association between intrauterine and postnatal growth and cardio-metabolic risk, from childhood to adulthood.
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Affiliation(s)
- Chiara Cauzzo
- Department of Pediatrics, University of Chieti, Chieti, Italy
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17
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D'Agostin M, Di Sipio Morgia C, Vento G, Nobile S. Long-term implications of fetal growth restriction. World J Clin Cases 2023; 11:2855-2863. [PMID: 37215406 PMCID: PMC10198075 DOI: 10.12998/wjcc.v11.i13.2855] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/08/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
Fetal growth restriction (FGR), or intrauterine growth restriction (IUGR), is a complication of pregnancy where the fetus does not achieve its genetic growth potential. FGR is characterized by a pathological retardation of intrauterine growth velocity in the curve of intrauterine growth. However, the FGR definition is still debated, and there is a lack of a uniform definition in the literature. True IUGR, compared to constitutional smallness, is a pathological condition in which the placenta fails to deliver an adequate supply of oxygen and nutrients to the developing fetus. Infants with IUGR, compared to appropriately grown gestational age infants, have a significantly higher risk of mortality and neonatal complications with long-term consequences. Several studies have demonstrated how suboptimal fetal growth leads to long-lasting physiological alterations for the developing fetus as well as for the newborn and adult in the future. The long-term effects of fetal growth retardation may be adaptations to poor oxygen and nutrient supply that are effective in the fetal period but deleterious in the long term through structural or functional alterations. Epidemiologic studies showed that FGR could be a contributing factor for adult chronic diseases including cardiovascular disease, metabolic syndrome, diabetes, respiratory diseases and impaired lung function, and chronic kidney disease. In this review we discussed pathophysiologic mechanisms of FGR-related complications and potential preventive measures for FGR.
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Affiliation(s)
- Martina D'Agostin
- Department of Pediatrics, University of Trieste, Trieste 34100, Italy
| | - Chiara Di Sipio Morgia
- Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 000168, Italy
| | - Stefano Nobile
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 000168, Italy
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18
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Biomarkers of cardiovascular disease risk in the neonatal population. J Dev Orig Health Dis 2023; 14:155-165. [PMID: 35920277 DOI: 10.1017/s2040174422000459] [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: 11/07/2022]
Abstract
The consistently high prevalence of cardiovascular disease (CVD) has urged the need for punctual and effective prevention. Extended research on this specific area has demonstrated the influence of fetal and neonatal periods on the risk of developing CVD in adulthood. Thus, the role of traditional and novel biological markers to the effective screening of CVD among the neonatal population is widely investigated. The objective of the present narrative review is to examine those neonatal biomarkers that may play a role in the development of CVD, to exhibit scientific data that appertain to their association with various perinatal conditions leading to CVD predisposition, and their potential role on prediction and prevention strategies. Multiple biomarkers, traditional and novel, have been mined across the studied literature. Adiposity, insulin resistance, altered lipid profile, inflammation, and endothelial dysfunction seem among the headliners of CVD. Even though various novel molecules have been studied, their clinical utility remains controversial. Therefore, it is quite important for the scientific community to find elements with strong predictive value and practical clinical use.
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Oluklu D, Menekse Beser D, Uyan Hendem D, Yıldırım M, Lalelı Koc B, Tanacan A, Sahin D. Assessment of fetal cardiac morphology and functional changes in early-onset and late-onset fetal growth restriction. Int J Gynaecol Obstet 2023; 161:241-249. [PMID: 36453150 DOI: 10.1002/ijgo.14602] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To compare the fetal cardiac morphology and functions of early-onset fetal growth restriction (EO-FGR) and late-onset fetal growth restriction (LO-FGR) groups with gestational weeks-matched controls. METHODS A total of 164 pregnant women were included, 28 of whom were in the EO-FGR group, 54 in the LO-FGR group, and 82 in the control group. Fetal echocardiographic evaluation was performed with two-dimensional, M-mode, tissue Doppler imaging (TDI), and pulsed wave Doppler. RESULTS Fetal cardiac morphologic measurements and diastolic and systolic functions changed in EO-FGR and LO-FGR fetuses compared with controls. The EO- and LO-FGR fetuses had reduced right and left cardiac output, increased myocardial performance index, and significantly higher mitral and tricuspid E/E' ratios compared with controls. The EO-FGR fetuses had lower mitral and tricuspid E and E' values. In LO-FGR fetuses, mitral and tricuspid E' values were lower than in their controls (P = 0.001 and P < 0.001). On the other hand, the mitral and tricuspid E values were not significantly changed (P = 0.107 and P = 0.196). CONCLUSION We hypothesized that EO-FGR and LO-FGR fetuses had insufficient myocardial maturation. Especially in the LO-FGR fetuses, TDI is the earliest and most sensitive technique to show subtle changes in fetal cardiac functions.
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Affiliation(s)
- Deniz Oluklu
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Menekse Beser
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Derya Uyan Hendem
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yıldırım
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Bergen Lalelı Koc
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Dilek Sahin
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Domínguez-Gallardo C, Ginjaume-García N, Ullmo J, Fernández-Oliva A, Parra J, Vázquez A, Cruz-Lemini M, Llurba E. Longitudinal Behavior of Left-Ventricular Strain in Fetal Growth Restriction. Diagnostics (Basel) 2023; 13:diagnostics13071252. [PMID: 37046470 PMCID: PMC10093576 DOI: 10.3390/diagnostics13071252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 03/29/2023] Open
Abstract
Fetal growth restriction (FGR) is associated with an increased risk of adverse outcomes resulting from adaptive cardiovascular changes in conditions of placental insufficiency, leading to cardiac deformation and dysfunction, which can be evaluated with 2D speckle tracking echocardiography (2D-STE). The aim of the present study was to evaluate whether reduced fetal growth is associated with cardiac left-ventricle (LV) dysfunction, using 2D-STE software widely used in postnatal echocardiography. A prospective longitudinal cohort study was performed, and global (GLO) and segmental LV longitudinal strain was measured offline and compared between FGR and appropriate-for-gestational-age (AGA) fetuses throughout gestation. All cases of FGR fetuses were paired 1:2 to AGA fetuses, and linear mixed model analysis was performed to compare behavior differences between groups throughout pregnancy. Our study shows LV fetal longitudinal strain in FGR and AGA fetuses differed upon diagnosis and behaved differently throughout gestation. FGR fetuses had lower LV strain values, both global and segmental, in comparison to AGA, suggesting subclinical cardiac dysfunction. Our study provides more data regarding fetal cardiac function in cases of placental dysfunction, as well as highlights the potential use of 2D-STE in the follow-up of cardiac function in these fetuses.
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21
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Avnet H, Thomas S, Beirne G, Alphonse J, Welsh A. Poor Correlation between Fetal Tissue Doppler Imaging and Pulsed Wave Myocardial Performance Indices. Fetal Diagn Ther 2023; 50:225-235. [PMID: 36948159 DOI: 10.1159/000529945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/21/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION Both tissue Doppler imaging (TDI) and pulsed wave Doppler (PWD) Myocardial Performance Indices (MPIs) have been proposed as tools for functional fetal cardiology. We wished to determine if there was any correlation between TDI-MPI and PWD-MPI. METHODS A cohort of uncomplicated women with morphologically normal singleton fetuses between 22 and 39 weeks of gestation was recruited. A single sonologist acquired Doppler waveforms for evaluation of both left and right TDI-MPI and PWD-MPI. The PWD-MPI values were calculated using a previously published algorithm and the TDI-MPI time intervals were measured manually by a single operator. RESULTS Achievability and repeatability were high for both modalities. TDI produced significantly lower right MPI values yet significantly higher left MPI values, potentially reflecting their evaluation of physiologically different events, blood flow versus myocardial contraction. CONCLUSION This study demonstrates that MPIs measured from PWD and TDI have a weak correlation and cannot be used interchangeably, even with the exclusion of suboptimal TDI-MPI scans from the analysis. Given the lack of correlation between the two methods, the high variation in TDI waveform, and the lack of unified approach to TDI analysis, we feel further research is needed before adoption of this technique.
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Affiliation(s)
- Hagai Avnet
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women Sydney, Randwick, New South Wales, Australia
| | - Samantha Thomas
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Geraldene Beirne
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jennifer Alphonse
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alec Welsh
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women Sydney, Randwick, New South Wales, Australia
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22
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Vasciaveo L, Zanzarelli E, D'Antonio F. Fetal cardiac function evaluation: A review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:215-224. [PMID: 36785505 DOI: 10.1002/jcu.23421] [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: 10/28/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 06/18/2023]
Abstract
The aim of this review is to provide an up to date on the current use of fetal echocardiography in assessing the fetal cardiac function and its potential research and clinical applications. Despite classically is been used for prenatal diagnosis of fetal heart defects, assessment of fetal cardiac function has been recently proposed as a fundamental tool to assess pregnancies complicated by several disorders with long-term impact on post-natal cardiovascular health, such as placental insufficiency and fetal growth restriction. In this review we present anatomical and functional fetal cardiac development mechanisms and an overview of the currently available techniques for evaluating fetal heart function.
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Affiliation(s)
- Lorenzo Vasciaveo
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Erika Zanzarelli
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Francesco D'Antonio
- Centre for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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23
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Bjarkø L, Fugelseth D, Harsem N, Kiserud T, Haugen G, Nestaas E. Cardiac morphology in neonates with fetal growth restriction. J Perinatol 2023; 43:187-195. [PMID: 36284207 DOI: 10.1038/s41372-022-01538-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Assess effects of fetal growth restriction (FGR) on cardiac modelling in premature and term neonates. STUDY DESIGN Prospective echocardiographic study of a cohort of FGR neonates (n = 21) and controls (n = 41) with normal prenatal growth and circulation. RESULTS Unadjusted for gestational age, birth weight, sex, and twin/singleton, Late-FGR neonates had smaller hearts than controls, with globular left ventricles and symmetrical right ventricles. Adjusted estimates showed smaller left ventricles and similarly sized right ventricles, with symmetrical left and right ventricles. Early-FGR (compared with Late-FGR) had smaller hearts and globular left ventricles in unadjusted estimates, but after adjustment, sizes and shapes were similar. CONCLUSION FGR had significant impact on cardiac modelling, seen in both statistical models unadjusted and adjusted for gestational age, birth weight, sex, and twin/singleton. The adjustments, however, refined the results and revealed more specific effects of FGR, thus underscoring the importance of statistical adjustments in such studies.
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Affiliation(s)
- Lisa Bjarkø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Drude Fugelseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Nina Harsem
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Torvid Kiserud
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Guttorm Haugen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Fetal Medicine, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Eirik Nestaas
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Clinic of Pediatrics and Adolescence, Akershus University Hospital, Loerenskog, Norway.
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24
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Bernardino G, Sepúlveda-Martínez Á, Rodríguez-López M, Prat-González S, Pajuelo C, Perea RJ, Caralt MT, Crovetto F, González Ballester MA, Sitges M, Bijnens B, Crispi F. Association of central obesity with unique cardiac remodelling in young adults born small for gestational age. Eur Heart J Cardiovasc Imaging 2023:6986711. [PMID: 36644919 DOI: 10.1093/ehjci/jeac262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/05/2022] [Indexed: 01/17/2023] Open
Abstract
AIMS Being born small for gestational age (SGA, 10% of all births) is associated with increased risk of cardiovascular mortality in adulthood together with lower exercise tolerance, but mechanistic pathways are unclear. Central obesity is known to worsen cardiovascular outcomes, but it is uncertain how it affects the heart in adults born SGA. We aimed to assess whether central obesity makes young adults born SGA more susceptible to cardiac remodelling and dysfunction. METHODS AND RESULTS A perinatal cohort from a tertiary university hospital in Spain of young adults (30-40 years) randomly selected, 80 born SGA (birth weight below 10th centile) and 75 with normal birth weight (controls) was recruited. We studied the associations between SGA and central obesity (measured via the hip-to-waist ratio and used as a continuous variable) and cardiac regional structure and function, assessed by cardiac magnetic resonance using statistical shape analysis. Both SGA and waist-to-hip were highly associated to cardiac shape (F = 3.94, P < 0.001; F = 5.18, P < 0.001 respectively) with a statistically significant interaction (F = 2.29, P = 0.02). While controls tend to increase left ventricular end-diastolic volumes, mass and stroke volume with increasing waist-to-hip ratio, young adults born SGA showed a unique response with inability to increase cardiac dimensions or mass resulting in reduced stroke volume and exercise capacity. CONCLUSION SGA young adults show a unique cardiac adaptation to central obesity. These results support considering SGA as a risk factor that may benefit from preventive strategies to reduce cardiometabolic risk.
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Affiliation(s)
- Gabriel Bernardino
- CREATIS, UMR 5220, U1294, University Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, Inserm, 21 Av. Jean Capelle O, Villeurbanne 69621, France
| | - Álvaro Sepúlveda-Martínez
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Universitat de Barcelona, 1 Sabino Arana, Barcelona 08028, Spain.,Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico de la Universidad de Chile, 999 Dr. Carlos Lorca Tobar, Independencia, Región Metropolitana, Santiago de Chile 13108, Chile
| | - Mérida Rodríguez-López
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Universitat de Barcelona, 1 Sabino Arana, Barcelona 08028, Spain.,Public Health and Epidemiology Department & Clinical Specialties Department, Pontificia Universidad Javeriana Seccional Cali, Cl. 18 #118-250, Barrio Pance, Cali, Valle del Cauca 760031, Colombia
| | - Susanna Prat-González
- Institut Clínic Cardiovascular, Hospital Clínic, Centre for Biomedical Research on CardioVascular Diseases (CIBERCV), Universitat de Barcelona, 170 Villarroel, Barcelona 08036, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, 149 Roselló, Barcelona 08036, Spain
| | - Carolina Pajuelo
- Centre de Diagnòstic per la Imatge, Hospital Clínic, Universitat de Barcelona, 170 Villarroel, Barcelona 08036, Spain
| | - Rosario J Perea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, 149 Roselló, Barcelona 08036, Spain.,Centre de Diagnòstic per la Imatge, Hospital Clínic, Universitat de Barcelona, 170 Villarroel, Barcelona 08036, Spain
| | - Maria T Caralt
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, 149 Roselló, Barcelona 08036, Spain
| | - Francesca Crovetto
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Universitat de Barcelona, 1 Sabino Arana, Barcelona 08028, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, 149 Roselló, Barcelona 08036, Spain.,Public Health and Epidemiology Department & Clinical Specialties Department, Pontificia Universidad Javeriana Seccional Cali, Cl. 18 #118-250, Barrio Pance, Cali, Valle del Cauca 760031, Colombia
| | - Miguel A González Ballester
- BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 122 Tànger, Barcelona 08018, Spain.,ICREA, 23 Passeig de Lluís Companys, Barcelona 08010, Spain
| | - Marta Sitges
- Institut Clínic Cardiovascular, Hospital Clínic, Centre for Biomedical Research on CardioVascular Diseases (CIBERCV), Universitat de Barcelona, 170 Villarroel, Barcelona 08036, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, 149 Roselló, Barcelona 08036, Spain
| | - Bart Bijnens
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, 149 Roselló, Barcelona 08036, Spain.,ICREA, 23 Passeig de Lluís Companys, Barcelona 08010, Spain
| | - Fàtima Crispi
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Universitat de Barcelona, 1 Sabino Arana, Barcelona 08028, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, 149 Roselló, Barcelona 08036, Spain
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25
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Owen JC, Garrick SP, Peterson BM, Berger PJ, Nold MF, Sehgal A, Nold-Petry CA. The role of interleukin-1 in perinatal inflammation and its impact on transitional circulation. Front Pediatr 2023; 11:1130013. [PMID: 36994431 PMCID: PMC10040554 DOI: 10.3389/fped.2023.1130013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/13/2023] [Indexed: 03/31/2023] Open
Abstract
Preterm birth is defined as delivery at <37 weeks of gestational age (GA) and exposes 15 million infants worldwide to serious early life diseases. Lowering the age of viability to 22 weeks GA entailed provision of intensive care to a greater number of extremely premature infants. Moreover, improved survival, especially at extremes of prematurity, comes with a rising incidence of early life diseases with short- and long-term sequelae. The transition from fetal to neonatal circulation is a substantial and complex physiologic adaptation, which normally happens rapidly and in an orderly sequence. Maternal chorioamnionitis or fetal growth restriction (FGR) are two common causes of preterm birth that are associated with impaired circulatory transition. Among many cytokines contributing to the pathogenesis of chorioamnionitis-related perinatal inflammatory diseases, the potent pro-inflammatory interleukin (IL)-1 has been shown to play a central role. The effects of utero-placental insufficiency-related FGR and in-utero hypoxia may also be mediated, in part, via the inflammatory cascade. In preclinical studies, blocking such inflammation, early and effectively, holds great promise for improving the transition of circulation. In this mini-review, we outline the mechanistic pathways leading to abnormalities in transitional circulation in chorioamnionitis and FGR. In addition, we explore the therapeutic potential of targeting IL-1 and its influence on perinatal transition in the context of chorioamnionitis and FGR.
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Affiliation(s)
- Josephine C. Owen
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Steven P. Garrick
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Briana M. Peterson
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Philip J. Berger
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Marcel F. Nold
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- Monash Newborn, Monash Children’s Hospital, Melbourne, VIC, Australia
| | - Arvind Sehgal
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- Monash Newborn, Monash Children’s Hospital, Melbourne, VIC, Australia
| | - Claudia A. Nold-Petry
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- Correspondence: Claudia A. Nold-Petry
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26
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Reddy CD, Van den Eynde J, Kutty S. Artificial intelligence in perinatal diagnosis and management of congenital heart disease. Semin Perinatol 2022; 46:151588. [PMID: 35396036 DOI: 10.1016/j.semperi.2022.151588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prenatal diagnosis and management of congenital heart disease (CHD) has progressed substantially in the past few decades. Fetal echocardiography can accurately detect and diagnose approximately 85% of cardiac anomalies. The prenatal diagnosis of CHD results in improved care, with improved risk stratification, perioperative status and survival. However, there is much work to be done. A minority of CHD is actually identified prenatally. This seemingly incongruous gap is due, in part, to diminished recognition of an anomaly even when present in the images and the need for increased training to obtain specialized cardiac views. Artificial intelligence (AI) is a field within computer science that focuses on the development of algorithms that "learn, reason, and self-correct" in a human-like fashion. When applied to fetal echocardiography, AI has the potential to improve image acquisition, image optimization, automated measurements, identification of outliers, classification of diagnoses, and prediction of outcomes. Adoption of AI in the field has been thus far limited by a paucity of data, limited resources to implement new technologies, and legal and ethical concerns. Despite these barriers, recognition of the potential benefits will push us to a future in which AI will become a routine part of clinical practice.
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Affiliation(s)
- Charitha D Reddy
- Division of Pediatric Cardiology, Stanford University, Palo Alto, CA, USA.
| | - Jef Van den Eynde
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Shelby Kutty
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
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27
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Chen H, Ma Y, Wang Y, Luo H, Xiao Z, Chen Z, Liu Q, Xiao Y. Progress of Pathogenesis in Pediatric Multifocal Atrial Tachycardia. Front Pediatr 2022; 10:922464. [PMID: 35813391 PMCID: PMC9256911 DOI: 10.3389/fped.2022.922464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/23/2022] [Indexed: 11/18/2022] Open
Abstract
Multifocal atrial tachycardia (MAT) is defined as irregular P-P, R-R, and P-R intervals, isoelectric baseline between P waves, and ventricular rate over 100 beats/min. Although the prognosis of pediatric MAT in most patients is favorable, adverse outcomes of MAT have been reported, such as cardiogenic death (3%), respiratory failure (6%), or persistent arrhythmia (7%), due to delayed diagnosis and poorly controlled MAT. Previous studies demonstrated that pediatric MAT is associated with multiple enhanced automatic lesions located in the atrium or abnormal automaticity of a single lesion located in the pulmonary veins via multiple pathways to trigger electrical activity. Recent studies indicated that pediatric MAT is associated with the formation of a re-entry loop, abnormal automaticity, and triggering activity. The occurrence of pediatric MAT is affected by gestational disease, congenital heart disease, post-cardiac surgery, pulmonary hypertension, and infectious diseases, which promote MAT via inflammation, redistribution of the autonomic nervous system, and abnormal ion channels. However, the pathogenesis of MAT needs to be explored. This review is aimed to summarize and analyze the pathogenesis in pediatric MAT.
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Affiliation(s)
- Huaiyang Chen
- Academy of Pediatrics, University of South China, Changsha, China.,Hunan Children's Hospital, Changsha, China
| | - Yingxu Ma
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | | | - Haiyan Luo
- Hunan Children's Hospital, Changsha, China
| | - Zhenghui Xiao
- Academy of Pediatrics, University of South China, Changsha, China.,Hunan Children's Hospital, Changsha, China
| | - Zhi Chen
- Hunan Children's Hospital, Changsha, China
| | - Qiming Liu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yunbin Xiao
- Academy of Pediatrics, University of South China, Changsha, China.,Hunan Children's Hospital, Changsha, China
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28
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Oliveira M, Dias JP, Guedes-Martins L. Fetal Cardiac Function: Myocardial Performance Index. Curr Cardiol Rev 2022; 18:e271221199505. [PMID: 34961451 PMCID: PMC9893141 DOI: 10.2174/1573403x18666211227145856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/22/2022] Open
Abstract
The Myocardial Performance Index (MPI) or Tei index, presented by Tei in 1995, is the ratio of the sum of the duration of the isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) to the duration of the ejection time (ET). The Modified Myocardial Performance Index (Mod-MPI), proposed in 2005, is considered a reliable and useful tool in the study of fetal heart function in several conditions, such as growth restriction, twin-twin transfusion syndrome, maternal diabetes, preeclampsia, intrahepatic cholestasis of pregnancy, and adverse perinatal outcomes. Nevertheless, clinical translation is currently limited by poorly standardised methodology as variations in the technique, machine settings, caliper placement, and specific training required can result in significantly different MPI values. This review aims to provide a survey of the relevant literature on MPI, present a strict methodology and technical considerations, and propose future research.
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Affiliation(s)
- Mariana Oliveira
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
| | - Joana Portela Dias
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar do Porto EPE, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
- Unidade de Investigação e Formação, Centro Materno Infantil do Norte, 4099-001 Porto, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar do Porto EPE, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
- Unidade de Investigação e Formação, Centro Materno Infantil do Norte, 4099-001 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Porto, Portugal
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29
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Braginsky L, Weiner SJ, Saade GR, Varner MW, Blackwell SC, Reddy UM, Thorp JM, Tita AT, Miller RS, McKenna DS, Chien EK, Rouse DJ, El-Sayed YY, Sorokin Y, Caritis SN. Intrapartum Fetal Electrocardiogram in Small- and Large-for-Gestational Age Fetuses. Am J Perinatol 2021; 38:1465-1471. [PMID: 34464982 PMCID: PMC8608729 DOI: 10.1055/s-0041-1735285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate whether intrapartum fetal electrocardiogram (ECG) tracings with ST-elevation or depression occur more frequently in each stage of labor in small-for-gestational age (SGA) or large-for-gestational age (LGA), as compared with appropriate-for-gestational age (AGA) fetuses. STUDY DESIGN We conducted a secondary analysis of a large, multicenter trial in which laboring patients underwent fetal ECG waveform-analysis. We excluded participants with diabetes mellitus and major fetal anomalies. Birth weight was categorized as SGA (<10th percentile), LGA (>90th percentile), or AGA (10-90th percentile) by using a gender and race/ethnicity specific nomogram. In adjusted analyses, the frequency of ECG tracings with ST-depression or ST-elevation without depression was compared according to birthweight categories and labor stage. RESULTS Our study included 4,971 laboring patients in the first stage and 4,074 in the second stage. During the first stage of labor, there were no differences in the frequency of ST-depression in SGA fetuses compared with AGA fetuses (6.7 vs. 5.5%; adjusted odds ratio [aOR]: 1.41, 95% confidence interval [CI]: 0.93-2.13), or in ST-elevation without depression (35.8 vs. 34.1%; aOR: 1.17, 95% CI: 0.94-1.46). During the second stage, there were no differences in the frequency of ST-depression in SGA fetuses compared with AGA fetuses (1.6 vs. 2.0%; aOR: 0.69, 95% CI: 0.27-1.73), or in ST-elevation without depression (16.2 vs. 18.1%; aOR: 0.90, 95% CI: 0.67-1.22). During the first stage of labor, there were no differences in the frequency of ST-depression in LGA fetuses compared with AGA fetuses (6.3 vs. 5.5%; aOR: 0.97, 95% CI: 0.60-1.57), or in ST-elevation without depression (33.1 vs. 34.1%; aOR: 0.80, 95% CI: 0.62-1.03); during the second stage of labor, the frequency of ST-depression in LGA compared with AGA fetuses (2.5 vs. 2.0%, aOR: 1.36, 95% CI: 0.61-3.03), and in ST-elevation without depression (15.5 vs. 18.1%; aOR: 0.83, 95% CI: 0.58-1.18) were similar as well. CONCLUSION The frequency of intrapartum fetal ECG tracings with ST-events is similar among SGA, AGA, and LGA fetuses. KEY POINTS · SGA and LGA neonates are at increased risk of cardiac dysfunction.. · Fetal ECG has been used to evaluate fetal response to hypoxia.. · Fetal ST-elevation and ST-depression occur during hypoxia.. · Frequency of intrapartum ST-events is similar among SGA, AGA and LGA fetuses..
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Affiliation(s)
- Lena Braginsky
- Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Steven J. Weiner
- Departments of Obstetrics and Gynecology, George Washington University Biostatistics Center, Washington, District of Columbia
| | - George R. Saade
- Departments of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Michael W. Varner
- Departments of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Sean C. Blackwell
- Departments of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas
| | - Uma M. Reddy
- Departments of Obstetrics and Gynecology, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - John M. Thorp
- Departments of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alan T.N. Tita
- Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Russell S. Miller
- Departments of Obstetrics and Gynecology, Columbia University, New York City, New York
| | - David S. McKenna
- Departments of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Edward K.S. Chien
- Departments of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio
| | - Dwight J. Rouse
- Departments of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Yasser Y. El-Sayed
- Departments of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Yoram Sorokin
- Departments of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Steve N. Caritis
- Departments of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Bar J, Weiner E, Levy M, Gilboa Y. The thrifty phenotype hypothesis: The association between ultrasound and Doppler studies in fetal growth restriction and the development of adult disease. Am J Obstet Gynecol MFM 2021; 3:100473. [PMID: 34481995 DOI: 10.1016/j.ajogmf.2021.100473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022]
Abstract
Barker pioneered the idea that the epidemic of coronary heart disease in Western countries in the 20th century, which paradoxically coincided with improved standards of living and nutrition, has its origin in fetal life. Indeed, there is substantial evidence associating low birthweight because of fetal growth restriction with an increased risk of vascular disease in later adult life. These conclusions led to the second part of the Barker hypothesis, the thrifty phenotype, in which adaptation to undernutrition in fetal life leads to permanent metabolic and endocrine changes. Such changes are beneficial if the undernutrition persists after birth but may predispose the individual to obesity and impaired glucose tolerance if conditions improve. The hypothesis assumes that a poor nutrient supply during a critical period of in utero life may "program" a permanent structural or functional change in the fetus, thereby altering the distribution of cell types, gene expression, or both. The fetus, in response to placental undernutrition and to maintain sufficient vascular supply to the brain, decreases resistance to blood flow in the middle cerebral artery. Simultaneously, because of the limited blood supply to the fetus, the arterial redistribution process is accompanied by increased resistance to flow to other fetal vital organs, such as the heart, kidneys, liver, and pancreas. It may explain why individuals exposed to ischemic changes in utero develop dyslipidemia, lower nephron number, and impaired glucose tolerance, all factors contributing to metabolic syndrome later in life. Nevertheless, support for the hypotheses comes mainly from studies in rodents and retrospective epidemiologic studies. This review focused on ultrasound and Doppler studies of human fetal growth restriction in several fetal organs: the placenta, fetal circulation, brain, heart, kidneys, adrenal glands, liver, and pancreas. Support for the hypothesis was provided by animal studies involving conditions that create fetuses with growth restriction with effects on various fetal organs and by human studies that correlate impaired fetal circulation with the in utero development and function of fetal organs.
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Affiliation(s)
- Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Dr. Bar, Dr Weiner, and Dr. Levy); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr. Bar, Dr. Weiner, Dr. Levy, and Dr. Gilboa)
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Dr. Bar, Dr Weiner, and Dr. Levy); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr. Bar, Dr. Weiner, Dr. Levy, and Dr. Gilboa).
| | - Michal Levy
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Dr. Bar, Dr Weiner, and Dr. Levy)
| | - Yinon Gilboa
- Ultrasound Unit, Helen Schneider Comprehensive Women's Health Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel (Dr. Gilboa); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr. Bar, Dr. Weiner, Dr. Levy, and Dr. Gilboa)
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31
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Borna S, Khanjany S, Hantoushzade S, Khazardoost S, Mirzaeian S, Ariana S, Hashemnezhad M. Evaluation of cardiac sphericity index among intrauterine growth restriction and normal fetuses. J OBSTET GYNAECOL 2021; 42:614-619. [PMID: 34472415 DOI: 10.1080/01443615.2021.1945005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Foetal growth restriction (FGR) describes the pregnancy complications of pathological reduced foetal growth, leading to significant perinatal mortality and morbidity, and subsequent long-term cardiovascular outcomes. This prospective case-control study was performed on pregnant women referred to the hospitals of Tehran University of Medical Sciences in 2017-2019. All pregnant women underwent ultrasound scan and doppler sonography. FGR was defined as a sonographic estimation of foetal weight below the tenth percentile for a given gestational age. Cardiac sphericity index, including basal-apical length (BAL), transverse length (TL), global sphericity index (GSI), umbilical artery pulsatility index (PI), middle cerebral artery (MCA) PI and cerebroplacental ratio (CPR) were assessed. Mean gestational age in FGR and control groups were 233.90 ± 22.00 days and 229.00 ± 25.02 days, respectively. Foetal size index and estimated foetal weight in FGR foetuses were significantly lower than the control group (p < .05). BAL, TL and GSI were significantly affected by FGR (p = .0001, p = .018 and p = .0001, respectively). Abnormal GSI, MCA PI, umbilical artery PI and CPR were significantly more prevalent among FGR foetuses (p = .017, p = .0001, p = .0001 and p = .0001, respectively). Cardiac sphericity index, as well as uterine PI, MCA PI and CPR, were the determinants of FGR in foetuses with normal Doppler and abnormal GSI.IMPACT STATEMENTWhat is already known on this subject? Foetal growth restriction (FGR) describes the foetus that does not grow to its expected biological potential in utero, and is a relatively common complication of pregnancy. FGR is accosted with negative birth outcomes and long-term cardiovascular outcomes. One of the indicators of FGR is cardiac sphericity.What do the results of this study add? The findings of this study revealed that the cardiac sphericity index as well as umbilical PI, MCA PI and CPR ratio change in FGR foetuses.What are the implications of these findings for clinical practice and/or further research? It is recommended that more studies be performed to follow FGR foetuses longitudinally and evaluate the long-term cardiac abnormalities in infancy and childhood and compare it between FGR foetuses and normal foetuses.
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Affiliation(s)
- Sedigheh Borna
- Department of Obstetrics and Gynecology, Maternal, Fetal and Neonatal Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Khanjany
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Tehran, Iran
| | - Sedigheh Hantoushzade
- Department of Obstetrics and Gynecology, Maternal, Fetal and Neonatal Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Soghra Khazardoost
- Department of Obstetrics and Gynecology, Maternal, Fetal and Neonatal Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Mirzaeian
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shideh Ariana
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Hashemnezhad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alborz University of Medical Sciences, Tehran, Iran
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32
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Ortiz JU, Torres X, Bennasar M, Eixarch E, Gómez O, Crovetto F, Lobmaier SM, Martinez JM, Gratacós E, Crispi F. Left myocardial performance index in monochorionic diamniotic twin pairs complicated by selective fetal growth restriction with abnormal umbilical artery Doppler. Prenat Diagn 2021; 41:1504-1509. [PMID: 34437722 DOI: 10.1002/pd.6037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/07/2021] [Accepted: 08/24/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate left myocardial performance index (MPI) and its time intervals in monochorionic diamniotic (MCDA) twin pairs complicated by selective fetal growth restriction (sFGR) with abnormal (persistent -type II- or intermittent -type III- absent or reversed end-diastolic flow) umbilical artery Doppler. METHODS Retrospective study including 16 MCDA twin pairs with sFGR type II, 26 MCDA twin pairs with sFGR type III and 42 gestational age-matched uncomplicated MCDA twin pairs in a single tertiary center. Left isovolumetric contraction time (ICT), ejection time (ET), and isovolumetric relaxation time (IRT) were measured and MPI calculated by conventional Doppler at diagnosis of sFGR. RESULTS In sFGR type II, the smaller twin had shorter ET and prolonged IRT and MPI, while the larger twin showed prolonged ICT and MPI as compared to uncomplicated MCDA twins. In sFGR type III, the smaller twin had shorter ICT and ET, while the larger twin showed prolonged ICT, IRT, and MPI in comparison to controls. CONCLUSION A differential pattern of MPI time intervals could be observed in MCDA twins with sFGR type II and III. All twins had echocardiographic signs of pressure/volume overload, except the smaller twin type III with shorter systolic times probably reflecting reduced volume load.
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Affiliation(s)
- Javier U Ortiz
- Division of Obstetrics and Perinatal Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ximena Torres
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Mar Bennasar
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Elisenda Eixarch
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Olga Gómez
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Francesca Crovetto
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Silvia M Lobmaier
- Division of Obstetrics and Perinatal Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Josep M Martinez
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Eduard Gratacós
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Fatima Crispi
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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33
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Crispi F, Rodríguez-López M, Bernardino G, Sepúlveda-Martínez Á, Prat-González S, Pajuelo C, Perea RJ, Caralt MT, Casu G, Vellvé K, Crovetto F, Burgos F, De Craene M, Butakoff C, González Ballester MÁ, Blanco I, Sitges M, Bijnens B, Gratacós E. Exercise Capacity in Young Adults Born Small for Gestational Age. JAMA Cardiol 2021; 6:1308-1316. [PMID: 34287644 DOI: 10.1001/jamacardio.2021.2537] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Being born small for gestational age (SGA), approximately 10% of all births, is associated with increased risk of cardiovascular mortality in adulthood, but mechanistic pathways are unclear. Cardiac remodeling and dysfunction occur in fetuses SGA and children born SGA, but it is uncertain whether and how these changes persist into adulthood. Objective To evaluate baseline cardiac function and structure and exercise capacity in young adults born SGA. Design, Setting, and Participants This cohort study conducted from January 2015 to January 2018 assessed a perinatal cohort born at a tertiary university hospital in Spain between 1975 and 1995. Participants included 158 randomly selected young adults aged 20 to 40 years born SGA (birth weight below the 10th centile) or with intrauterine growth within standard reference ranges (controls). Participants provided their medical history, filled out questionnaires regarding smoking and physical activity habits, and underwent incremental cardiopulmonary exercise stress testing, cardiac magnetic resonance imaging, and a physical examination, with blood pressure, glucose level, and lipid profile data collected. Exposure Being born SGA. Main Outcomes and Measures Cardiac structure and function assessed by cardiac magnetic resonance imaging, including biventricular end-diastolic shape analysis. Exercise capacity assessed by incremental exercise stress testing. Results This cohort study included 81 adults born SGA (median age at study, 34.4 years [IQR, 30.8-36.7 years]; 43 women [53%]) and 77 control participants (median age at study, 33.7 years [interquartile range (IQR), 31.0-37.1 years]; 33 women [43%]). All participants were of White race/ethnicity and underwent imaging, whereas 127 participants (80% of the cohort; 66 control participants and 61 adults born SGA) completed the exercise test. Cardiac shape analysis showed minor changes at rest in right ventricular geometry (DeLong test z, 2.2098; P = .02) with preserved cardiac function in individuals born SGA. However, compared with controls, adults born SGA had lower exercise capacity, with decreased maximal workload (mean [SD], 180 [62] W vs 214 [60] W; P = .006) and oxygen consumption (median, 26.0 mL/min/kg [IQR, 21.5-33.5 mL/min/kg vs 29.5 mL/min/kg [IQR, 24.0-36.0 mL/min/kg]; P = .02). Exercise capacity was significantly correlated with left ventricular mass (ρ = 0.7934; P < .001). Conclusions and Relevance This cohort of young adults born SGA had markedly reduced exercise capacity. These results support further research to clarify the causes of impaired exercise capacity and the potential association with increased cardiovascular mortality among adults born SGA.
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Affiliation(s)
- Fàtima Crispi
- Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Mérida Rodríguez-López
- Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.,Pontificia Universidad Javeriana seccional Cali, Cali, Colombia
| | - Gabriel Bernardino
- BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Álvaro Sepúlveda-Martínez
- Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.,Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico de la Universidad de Chile, Santiago de Chile, Chile
| | - Susanna Prat-González
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Centre for Biomedical Research on CardioVascular Diseases (CIBERCV), Barcelona, Spain
| | - Carolina Pajuelo
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Centre for Biomedical Research on CardioVascular Diseases (CIBERCV), Barcelona, Spain
| | - Rosario J Perea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Centre de Diagnòstic per la Imatge, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Maria T Caralt
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Centre de Diagnòstic per la Imatge, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Giulia Casu
- Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Kilian Vellvé
- Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Francesca Crovetto
- Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Felip Burgos
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Respiratory Medicine Department, Hospital Clínic, Universitat de Barcelona, Centre for Biomedical Research on Respiratory Diseases (CIBERES), Barcelona, Spain
| | | | | | - Miguel Á González Ballester
- BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Isabel Blanco
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Respiratory Medicine Department, Hospital Clínic, Universitat de Barcelona, Centre for Biomedical Research on Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Marta Sitges
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Centre for Biomedical Research on CardioVascular Diseases (CIBERCV), Barcelona, Spain
| | - Bart Bijnens
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Eduard Gratacós
- Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia Obstetricia i Neonatologia, Universitat de Barcelona, Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
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Abstract
Almost 2 billion adults in the world are overweight, and more than half of them are classified as obese, while nearly one-third of children globally experience poor growth and development. Given the vast amount of knowledge that has been gleaned from decades of research on growth and development, a number of questions remain as to why the world is now in the midst of a global epidemic of obesity accompanied by the "double burden of malnutrition," where overweight coexists with underweight and micronutrient deficiencies. This challenge to the human condition can be attributed to nutritional and environmental exposures during pregnancy that may program a fetus to have a higher risk of chronic diseases in adulthood. To explore this concept, frequently called the developmental origins of health and disease (DOHaD), this review considers a host of factors and physiological mechanisms that drive a fetus or child toward a higher risk of obesity, fatty liver disease, hypertension, and/or type 2 diabetes (T2D). To that end, this review explores the epidemiology of DOHaD with discussions focused on adaptations to human energetics, placental development, dysmetabolism, and key environmental exposures that act to promote chronic diseases in adulthood. These areas are complementary and additive in understanding how providing the best conditions for optimal growth can create the best possible conditions for lifelong health. Moreover, understanding both physiological as well as epigenetic and molecular mechanisms for DOHaD is vital to most fully address the global issues of obesity and other chronic diseases.
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Affiliation(s)
- Daniel J Hoffman
- Department of Nutritional Sciences, Program in International Nutrition, and Center for Childhood Nutrition Research, New Jersey Institute for Food, Nutrition, and Health, Rutgers, the State University of New Jersey, New Brunswick, New Jersey
| | - Theresa L Powell
- Department of Pediatrics and Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, School of Public Health and Division of Exposure Science and Epidemiology, Rutgers Environmental and Occupational Health Sciences Institute, Rutgers, the State University of New Jersey, New Brunswick, New Jersey
| | - Daniel B Hardy
- Department of Biostatistics and Epidemiology, School of Public Health and Division of Exposure Science and Epidemiology, Rutgers Environmental and Occupational Health Sciences Institute, Rutgers, the State University of New Jersey, New Brunswick, New Jersey
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35
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Torres X, Martínez JM, Gómez O, MartÍnez-Portilla RJ, García-Otero L, Crispi F, Masoller N, Sepúlveda-Martínez Á, Marimón E, Gratacós E, Figueras F, Bennasar M. Prescriptive standards of echocardiographic morphometric and functional parameters in uncomplicated monochorionic diamniotic fetuses. Prenat Diagn 2021; 41:1486-1497. [PMID: 34176152 DOI: 10.1002/pd.5999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/20/2021] [Accepted: 05/30/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To create prescriptive standards of cardiac morphometric and functional parameters in a cohort of uncomplicated monochorionic diamniotic (MCDA) twins. METHOD Fetal echocardiography was performed in a cohort of uncomplicated monochorionic twin fetuses scanned longitudinally, including comprehensive morphometric and functional parameters, using 2-D imaging, M-mode and conventional Doppler. A multilevel polynomial hierarchical model adjusted by gestational age and estimated fetal weight was used to fit each cardiac parameter. RESULTS The global heart dimensions including the atrial and ventricular areas, the ventricles dimensions and myocardial wall thicknesses and most of the functional parameters, such as the longitudinal myocardial motion and the biventricular cardiac output showed a positive quadratic increment throughout pregnancy. On the other hand, the left ejection fraction, shortening fraction and right fractional area change decreased with gestational age. Scatterplots for the main structural and functional parameters and ratios by gestational age, with mean, 5th, 10th, 90th, and 95th percentiles are provided. Regression equations by estimated fetal weight are also created. CONCLUSION We provide specific comprehensive echocardiographic prescriptive standards for uncomplicated MCDA twin fetuses following current standardized methodology. The implementation of these charts will potentially help to better identify abnormal cardiovascular parameters associated to monochorionic complications.
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Affiliation(s)
- Ximena Torres
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain.,Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Josep M Martínez
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain.,Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Olga Gómez
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain.,Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Raigam J MartÍnez-Portilla
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain.,Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Laura García-Otero
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
| | - Fátima Crispi
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain.,Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Narcís Masoller
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain.,Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Álvaro Sepúlveda-Martínez
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain.,Fetal Medicine Unit, Departament of Obstetrics and Gynecology Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Edda Marimón
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
| | - Eduard Gratacós
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain.,Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Francesc Figueras
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain.,Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Mar Bennasar
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Sex-dependent vulnerability of fetal nonhuman primate cardiac mitochondria to moderate maternal nutrient reduction. Clin Sci (Lond) 2021; 135:1103-1126. [PMID: 33899910 DOI: 10.1042/cs20201339] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023]
Abstract
Poor maternal nutrition in pregnancy affects fetal development, predisposing offspring to cardiometabolic diseases. The role of mitochondria during fetal development on later-life cardiac dysfunction caused by maternal nutrient reduction (MNR) remains unexplored. We hypothesized that MNR during gestation causes fetal cardiac bioenergetic deficits, compromising cardiac mitochondrial metabolism and reserve capacity. To enable human translation, we developed a primate baboon model (Papio spp.) of moderate MNR in which mothers receive 70% of control nutrition during pregnancy, resulting in intrauterine growth restriction (IUGR) offspring and later exhibiting myocardial remodeling and heart failure at human equivalent ∼25 years. Term control and MNR baboon offspring were necropsied following cesarean-section, and left ventricle (LV) samples were collected. MNR adversely impacted fetal cardiac LV mitochondria in a sex-dependent fashion. Increased maternal plasma aspartate aminotransferase, creatine phosphokinase (CPK), and elevated cortisol levels in MNR concomitant with decreased blood insulin in male fetal MNR were measured. MNR resulted in a two-fold increase in fetal LV mitochondrial DNA (mtDNA). MNR resulted in increased transcripts for several respiratory chain (NDUFB8, UQCRC1, and cytochrome c) and adenosine triphosphate (ATP) synthase proteins. However, MNR fetal LV mitochondrial complex I and complex II/III activities were significantly decreased, possibly contributing to the 73% decreased ATP content and increased lipid peroxidation. MNR fetal LV showed mitochondria with sparse and disarranged cristae dysmorphology. Conclusion: MNR disruption of fetal cardiac mitochondrial fitness likely contributes to the documented developmental programming of adult cardiac dysfunction, indicating a programmed mitochondrial inability to deliver sufficient energy to cardiac tissues as a chronic mechanism for later-life heart failure.
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Crispi F, Crovetto F, Rodriguez-López M, Sepúlveda-Martinez Á, Miranda J, Gratacós E. Postnatal persistence of cardiac remodeling and dysfunction in late fetal growth restriction. Minerva Obstet Gynecol 2021; 73:471-481. [PMID: 33949826 DOI: 10.23736/s2724-606x.21.04823-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fetal growth restriction is one of the most common obstetric complications, affecting 7-10% of all pregnancies. Affected fetuses are exposed to an adverse environment in utero during a critical time of development and may face long-term health consequences such as increased cardiovascular risk in adulthood. Growth restricted fetuses develop remodeled hearts with signs of systolic and diastolic dysfunction. Cardiac adaptations are more evident in early severe cases, but also present in late onset fetal growth restriction. Cardiovascular remodeling persists into postnatal life, from the neonatal period to adolescence, encompassing an increased susceptibility to adult disease. In this review, we summarize the current evidence on cardiovascular programming associated to fetal growth restriction, its postnatal consequences and potential strategies to reduce their cardiovascular risk.
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Affiliation(s)
- Fatima Crispi
- Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Center for Biomedical Research on Rare Diseases (CIBER-ER), Instituto Clínic de Ginecología, Obstetricia y Neonatología (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
| | - Francesca Crovetto
- Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Center for Biomedical Research on Rare Diseases (CIBER-ER), Instituto Clínic de Ginecología, Obstetricia y Neonatología (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain -
| | - Mérida Rodriguez-López
- Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Center for Biomedical Research on Rare Diseases (CIBER-ER), Instituto Clínic de Ginecología, Obstetricia y Neonatología (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain.,Pontificia Universidad Javeriana seccional Cali, Cali, Colombia
| | - Álvaro Sepúlveda-Martinez
- Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Center for Biomedical Research on Rare Diseases (CIBER-ER), Instituto Clínic de Ginecología, Obstetricia y Neonatología (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain.,Unit of Fetal Medicine, Department of Obstetrics and Gynecology, Hospital Clínico de la Universidad de Chile, Santiago de Chile, Chile
| | - Jezid Miranda
- Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Center for Biomedical Research on Rare Diseases (CIBER-ER), Instituto Clínic de Ginecología, Obstetricia y Neonatología (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain.,Grupo de Investigación en Cuidado Intensivo (GRICIO), Department of Obstetrics and Gynecology, Universidad de Cartagena, Cartagena, Colombia
| | - Eduard Gratacós
- Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Center for Biomedical Research on Rare Diseases (CIBER-ER), Instituto Clínic de Ginecología, Obstetricia y Neonatología (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
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Ruano CSM, Apicella C, Jacques S, Gascoin G, Gaspar C, Miralles F, Méhats C, Vaiman D. Alternative splicing in normal and pathological human placentas is correlated to genetic variants. Hum Genet 2021; 140:827-848. [PMID: 33433680 PMCID: PMC8052246 DOI: 10.1007/s00439-020-02248-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Abstract
Two major obstetric diseases, preeclampsia (PE), a pregnancy-induced endothelial dysfunction leading to hypertension and proteinuria, and intra-uterine growth-restriction (IUGR), a failure of the fetus to acquire its normal growth, are generally triggered by placental dysfunction. Many studies have evaluated gene expression deregulations in these diseases, but none has tackled systematically the role of alternative splicing. In the present study, we show that alternative splicing is an essential feature of placental diseases, affecting 1060 and 1409 genes in PE vs controls and IUGR vs controls, respectively, many of those involved in placental function. While in IUGR placentas, alternative splicing affects genes specifically related to pregnancy, in preeclamptic placentas, it impacts a mix of genes related to pregnancy and brain diseases. Also, alternative splicing variations can be detected at the individual level as sharp splicing differences between different placentas. We correlate these variations with genetic variants to define splicing Quantitative Trait Loci (sQTL) in the subset of the 48 genes the most strongly alternatively spliced in placental diseases. We show that alternative splicing is at least partly piloted by genetic variants located either in cis (52 QTL identified) or in trans (52 QTL identified). In particular, we found four chromosomal regions that impact the splicing of genes in the placenta. The present work provides a new vision of placental gene expression regulation that warrants further studies.
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Affiliation(s)
- Camino S M Ruano
- Université de Paris, Institut Cochin, Inserm U1016, CNRS, 24 rue du Faubourg St Jacques, 75014, Paris, France
| | - Clara Apicella
- Université de Paris, Institut Cochin, Inserm U1016, CNRS, 24 rue du Faubourg St Jacques, 75014, Paris, France
| | - Sébastien Jacques
- Université de Paris, Institut Cochin, Inserm U1016, CNRS, 24 rue du Faubourg St Jacques, 75014, Paris, France
| | - Géraldine Gascoin
- Unité Mixte de Recherche MITOVASC, Équipe Mitolab, CNRS 6015, INSERM U1083, Université d'Angers, Angers, France
- Réanimation et Médecine Néonatales, Centre Hospitalier Universitaire, Angers, France
| | - Cassandra Gaspar
- Sorbonne Université, Inserm, UMS Production et Analyse des Données en Sciences de la vie et en Santé, PASS, Plateforme Post-génomique de la Pitié-Salpêtrière, P3S, 75013, Paris, France
| | - Francisco Miralles
- Université de Paris, Institut Cochin, Inserm U1016, CNRS, 24 rue du Faubourg St Jacques, 75014, Paris, France
| | - Céline Méhats
- Université de Paris, Institut Cochin, Inserm U1016, CNRS, 24 rue du Faubourg St Jacques, 75014, Paris, France
| | - Daniel Vaiman
- Université de Paris, Institut Cochin, Inserm U1016, CNRS, 24 rue du Faubourg St Jacques, 75014, Paris, France.
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Peixoto AB, Bravo-Valenzuela NJ, Rocha LA, Araujo Júnior E. Spectral Doppler, tissue Doppler, and speckle-tracking echocardiography for the evaluation of fetal cardiac function: an update. Radiol Bras 2021; 54:99-106. [PMID: 33854264 PMCID: PMC8029930 DOI: 10.1590/0100-3984.2020.0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The functional assessment of the fetal heart has been incorporated into cardiac ultrasound screening as a routine procedure, encompassing fetuses with and without structural heart diseases. It has long been known that various cardiac and extracardiac conditions, such as fetal growth restriction, fetal tumors, twin-to-twin transfusion syndrome, fetal anemia, diaphragmatic hernia, arteriovenous fistula with high cardiac output, and congenital heart diseases (valvular regurgitation and primary myocardial disease), can alter hemodynamic status and fetal cardiac function. Several ultrasound and Doppler echocardiographic parameters of fetal cardiovascular disease have been shown to correlate with perinatal mortality. However, it is still difficult to identify the signs of fetal heart failure and to determine their relationship with prognosis. The aim of this study was to review the main two-dimensional Doppler ultrasound parameters that can be used in the evaluation of fetal cardiac function, with a focus on how to perform that evaluation and on its clinical applicability.
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Affiliation(s)
- Alberto Borges Peixoto
- Gynecology and Obstetrics Clinic, Hospital Universitário Mário Palmério - Universidade de Uberaba (Uniube), Uberaba, MG, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Division of Pediatrics (Pediatric Cardiology), Department of Internal Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Luciane Alves Rocha
- Graduate Program in Health Sciences, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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40
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Sehgal A, Allison BJ, Miller SL, Polglase GR, McNamara PJ, Hooper SB. Impact of Acute and Chronic Hypoxia-Ischemia on the Transitional Circulation. Pediatrics 2021; 147:peds.2020-016972. [PMID: 33622795 DOI: 10.1542/peds.2020-016972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
The transition from intrauterine life to extrauterine existence encompasses significant cardiorespiratory adaptations. These include rapid lung aeration and increase in pulmonary blood flow (PBF). Perinatal asphyxia and fetal growth restriction can severely hamper this transition. Hypoxia is the common denominator in these 2 disease states, with the former characterized by acute insult and the latter by utero-placental insufficiency and a chronic hypoxemic state. Both may manifest as hemodynamic instability. In this review, we emphasize the role of physiologic-based cord clamping in supplementing PBF during transition. The critical role of lung aeration in initiating pulmonary gas exchange and increasing PBF is discussed. Physiologic studies in animal models have enabled greater understanding of the mechanisms and effects of various therapies on transitional circulation. With data from sheep models, we elaborate instrumentation for monitoring of cardiovascular and pulmonary physiology and discuss the combined effect of chest compressions and adrenaline in improving transition at birth. Lastly, physiologic adaptation influencing management in human neonatal cohorts with respect to cardiac and vascular impairments in hypoxic-ischemic encephalopathy and growth restriction is discussed. Impairments in right ventricular function and vascular mechanics hold the key to prognostication and understanding of therapeutic rationale in these critically ill cohorts. The right ventricle and pulmonary circulation seem to be especially affected and may be explored as therapeutic targets. The role of comprehensive assessments using targeted neonatal echocardiography as a longitudinal, reliable, and easily accessible tool, enabling precision medicine facilitating physiologically appropriate treatment choices, is discussed.
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Affiliation(s)
- Arvind Sehgal
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia; .,Departments of Paediatrics and
| | - Beth J Allison
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Suzanne L Miller
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Graeme R Polglase
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Patrick J McNamara
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa; and.,Internal Medicine, University of Iowa Health Care, Iowa City, Iowa
| | - Stuart B Hooper
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
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41
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Vats K, Choudhary SK, Kumar D, Maria A, Bandopadhyay T. Myocardial performance index in term appropriate and small for gestational age neonates - a cross sectional study. J Neonatal Perinatal Med 2021; 14:485-491. [PMID: 33523027 DOI: 10.3233/npm-200621] [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 It is known that small for gestational age (SGA) babies may be at an increased risk of cardiovascular diseases during adulthood. There is paucity of literature regarding comparative cardiac functions of SGA and appropriate for gestational age (AGA) babies in neonatal period. The present study was conceived to compare the cardiac function of term small and appropriate for gestational age (AGA) babies through a relatively novel echocardiographic index in early neonatal period. OBJECTIVES To compare values of myocardial performance index (MPI) index (MPI = IVCT + IVRT/ET) at 48-72 hours of age among AGA and SGA babies. METHODS Morphological and anthropometric assessment of serially born term babies was done at time of birth to recruit hundred each of AGA and SGA babies. Tissue Doppler Imaging (TDI) was done between 48-72 hours for each enrolled baby to assess both right and left ventricle MPI in each group. RESULTS Mean±SD values for right ventricular MPI in AGA and SGA groups were 0.268 + 0.007 and 0.30 + 0.026 respectively (p < 0.001). Mean±SD values for left ventricular MPI in AGA and SGA groups were 0.25 + 0.012 and 0.30 + 0.017 respectively (p < 0.001). There was significant negative correlation between MPI values for either ventricles and the birth weight (spearmen's rho of -0.66) (p < 0.001). Mean±SD values for LVET in AGA and SGA group were 0.304 + 0.026 and 0.266 + 0.032 respectively (p < 0.001). CONCLUSION MPI had a higher absolute value in the SGA babies as compared to AGA babies. These observations point towards suboptimal cardiac performance among SGA babies as compared to AGA babies on the basis of myocardial performance index.
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Affiliation(s)
- K Vats
- Department of Pediatrics, ABVIMS & RML Hospital, New Delhi, India
| | - S K Choudhary
- Department of Neonatology, ABVIMS & DR. RML Hospital, New Delhi, India
| | - D Kumar
- Division of Pediatric Cardiology, ABVIMS & DR. RML Hospital, New Delhi, India
| | - A Maria
- Department of Neonatology, ABVIMS & DR. RML Hospital, New Delhi, India
| | - T Bandopadhyay
- Department of Neonatology, ABVIMS & DR. RML Hospital, New Delhi, India
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Fratelli N, Prefumo F, Wolf H, Hecher K, Visser GHA, Giussani D, Derks JB, Shaw CJ, Frusca T, Ghi T, Ferrazzi E, Lees CC. Effects of Antenatal Betamethasone on Fetal Doppler Indices and Short Term Fetal Heart Rate Variation in Early Growth Restricted Fetuses. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:56-64. [PMID: 31476786 DOI: 10.1055/a-0972-1098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To investigate the effects of the antenatal administration of betamethasone on fetal Doppler and short term fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses. MATERIALS AND METHODS Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early onset FGR. Repeat Doppler and CTG-STV measurements between the last recording within 48 hours before the first dose of betamethasone (baseline value) and for 10 days after were evaluated. Multilevel analysis was performed to analyze the longitudinal course of the umbilico-cerebral ratio (UC ratio), the ductus venosus pulsatility index (DVPIV) and CTG-STV. RESULTS We included 115 fetuses. A significant increase from baseline in CTG-STV was found on day + 1 (p = 0.019) but no difference thereafter. The DVPIV was not significantly different from baseline in any of the 10 days following the first dose of betamethasone (p = 0.167). Multilevel analysis revealed that, over 10 days, the time elapsed from antenatal administration of betamethasone was significantly associated with a decrease in CTG-STV (p = 0.045) and an increase in the DVPIV (p = 0.001) and UC ratio (p < 0.001). CONCLUSION Although steroid administration in early FGR has a minimal effect on increasing CTG-STV one day afterwards, the effects on Doppler parameters were extremely slight with regression coefficients of small magnitude suggesting no clinical significance, and were most likely related to the deterioration with time in FGR. Hence, arterial and venous Doppler assessment of fetal health remains informative following antenatal steroid administration to accelerate fetal lung maturation.
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Affiliation(s)
- Nicola Fratelli
- Department of Obstetrics and Gynaecology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, Netherlands
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - Gerard H A Visser
- Department of Perinatal Medicine, University of Utrecht, Netherlands
| | - Dino Giussani
- Department of Physiology Development & Neuroscience, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Jan B Derks
- Department of Perinatal Medicine, University of Utrecht, Netherlands
| | - Caroline J Shaw
- Department of Surgery and Cancer, Imperial College London, United Kingdom of Great Britain and Northern Ireland
| | - Tiziana Frusca
- Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Italy
| | - Tullio Ghi
- Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Italy
| | - E Ferrazzi
- Children's Hospital Buzzi, University of Milan, Italy
| | - Christoph C Lees
- Department of Surgery and Cancer, Imperial College London, United Kingdom of Great Britain and Northern Ireland
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Semmler J, Abdel-Azim S, Anzoategui S, Zhang H, Nicolaides KH, Charakida M. Influence of birth weight on fetal cardiac indices at 35-37 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:266-272. [PMID: 33094501 DOI: 10.1002/uog.23522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/10/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Echocardiographic studies have reported that fetuses with low birth weight, compared to those with normal birth weight, have globular hearts and reduced cardiac function. Dichotomizing continuous variables, such as birth weight, may be helpful in describing pathology in small studies but can prevent us from identifying physiological responses in relation to change in size. The aim of this study was to explore associations between fetal cardiac morphology and function and birth weight, as a continuous variable, as well as uterine artery (UtA) pulsatility index (PI), as an indirect measure of placental perfusion, and the cerebroplacental ratio (CPR), as an indirect measure of fetal oxygenation. METHODS This was a prospective study of 1498 women with singleton pregnancy undergoing routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. Pregnancies complicated by pregestational or gestational diabetes mellitus, chronic hypertension, pregnancy-induced hypertension or pre-eclampsia were excluded from the analysis. Conventional and more advanced echocardiographic modalities, such as speckle tracking, were used to assess fetal cardiac function in the right and left ventricles. The morphology of the fetal heart was assessed by calculating the right and left sphericity indices. In addition, the PI of the UtA, umbilical artery (UA) and fetal middle cerebral artery (MCA) was determined and the CPR was calculated by dividing MCA-PI by UA-PI. Multiple linear regression models were used to assess determinants of fetal echocardiographic parameters. RESULTS The study population included 146 (9.7%) small-for-gestational-age (SGA) fetuses with birth weight < 10th percentile and 68 (4.5%) with fetal growth restriction (FGR). In the SGA and FGR groups, compared to the non-SGA and non-FGR fetuses, respectively, there was a more globular right ventricle and reduced left and right ventricular systolic function, and, from the left ventricular diastolic functional indices, the E/A ratio was increased. There was a linear association of right ventricular sphericity index, indices of left and right ventricular systolic function and E/A ratio with birth-weight Z-score. There were no significant associations between cardiac morphological and functional indices and UtA-PI Z-score or CPR Z-score. CONCLUSIONS This screening study at 35-37 weeks' gestation has demonstrated that birth weight is a determinant of fetal cardiac morphology and function but UtA-PI and CPR, as indirect measures of placental perfusion and fetal oxygenation, are not. This suggests that the differences in fetal cardiac indices between small and appropriately grown fetuses may be part of a normal physiological response to change in fetal size rather than part of a pathological adaptation to abnormal placental perfusion and fetal oxygenation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J Semmler
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - S Abdel-Azim
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - S Anzoategui
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - H Zhang
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Echocardiographic assessment of fetal cardiac function in the uterine artery ligation rat model of IUGR. Pediatr Res 2021; 90:801-808. [PMID: 33504964 PMCID: PMC8566221 DOI: 10.1038/s41390-020-01356-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/31/2020] [Accepted: 12/18/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) leads to cardiac dysfunction and adverse remodeling of the fetal heart, as well as a higher risk of postnatal cardiovascular diseases. The rat model of IUGR, via uterine artery ligation, is a popular model but its cardiac sequelae is not well investigated. Here, we performed an echocardiographic evaluation of its cardiac function to determine how well it can represent the disease in humans. METHODS Unilateral uterine artery ligation was performed at embryonic day 17 (E17) and echocardiography was performed at E19 and E20. RESULTS Growth-restricted fetuses were significantly smaller and lighter, and had an higher placenta-to-fetus weight ratio. Growth-restricted fetal hearts had reduced wall thickness-to-diameter ratio, indicating left ventricular (LV) dilatation, and they had elevated trans-mitral and trans-tricuspid E/A ratios and reduced left and right ventricular fractional shortening (FS), suggesting systolic and diastolic dysfunction. These were similar to human IUGR fetuses. However, growth-restricted rat fetuses did not demonstrate head-sparing effect, displayed a lower LV myocardial performance index, and ventricular outflow velocities were not significantly reduced, which were dissimilar to human IUGR fetuses. CONCLUSIONS Despite the differences, our results suggest that this IUGR model has significant cardiac dysfunction, and could be a suitable model for studying IUGR cardiovascular physiology. IMPACT Animal models of IUGR are useful, but their fetal cardiac function is not well studied, and it is unclear if they can represent human IUGR fetuses. We performed an echocardiographic assessment of the heart function of a fetal rat model of IUGR, created via maternal uterine artery ligation. Similar to humans, the model displayed LV dilatation, elevated E/A ratios, and reduced FS. Different from humans, the model displayed reduced MPI, and no significant outflow velocity reduction. Despite differences with humans, this rat model still displayed cardiac dysfunction and is suitable for studying IUGR cardiovascular physiology.
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Li TG, Nie F, Xu XY. Correlation between ductus venosus spectrum and right ventricular diastolic function in isolated single-umbilical-artery foetus and normal foetus in third trimester. World J Clin Cases 2020; 8:5866-5875. [PMID: 33344585 PMCID: PMC7723705 DOI: 10.12998/wjcc.v8.i23.5866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/23/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Single umbilical artery (SUA) is the most common umbilical cord malformation in prenatal diagnosis. The presence of an SUA can cause blood circulation disorder in the foetus and functional changes of the foetal heart, affecting foetal circulation. The right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester were evaluated using the spectral Doppler of blood flow in the foetal ductus venosus (DV).
AIM To evaluate the right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester.
METHODS Colour Doppler was used to measure the spectrum of foetal DV and tricuspid orifice in 34 foetuses with isolated SUA aged 28-39 wk and in age-matched healthy controls. The DV flow velocities and velocity ratios were measured. The early passive/late active (E/A) ratio at the tricuspid orifice and tissue Doppler Tei index of the foetal right ventricular in the two groups were also measured.
RESULTS During the third trimester, the isolated SUA group showed a lower ‘a’-wave peak velocity in the DV than the control group (P < 0.05). The correlations between the velocity ratios and E/A ratio at the tricuspid orifice in the two groups were analysed, and the correlation between the ventricular late diastolic velocity/ventricular diastolic peak flow velocity and E/A ratios was the best (R2 of the isolated SUA group: 0.520; R2 of the control group: 0.358). The correlations between the velocity ratios and tissue Doppler Tei index of foetal right ventricular in the two groups were analysed, and the correlation between the pulsatility index for veins (PIV) and tissue Doppler Tei index ratios was the best (R2 of the isolated SUA group: 0.865; R2 of the control group: 0.627).
CONCLUSION In the isolated SUA group, the atrial systolic peak velocity ‘a’ decreased, and this finding might be related to the changes in foetal cardiac functions. The ratio of ventricular late diastolic velocity to ventricular diastolic peak flow velocity was closely related to the E/A ratio at the tricuspid valve and can be used to identify changes in the right ventricular diastolic functions of isolated SUA and healthy foetuses. PIV was closely related to the tissue Doppler Tei index of the foetal right ventricular and can be used to identify the right ventricular overall functions of isolated SUA and healthy foetuses.
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Affiliation(s)
- Tian-Gang Li
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou 730050, Gansu Province, China
| | - Fang Nie
- Department of Ultrasound Diagnosis, Lanzhou University Second Hospital, Lanzhou 733000, Gansu Province, China
| | - Xiao-Yan Xu
- Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou 730050, Gansu Province, China
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Li TG, Nie F, Xu XY. Correlation between ductus venosus spectrum and right ventricular diastolic function in isolated single-umbilical-artery foetus and normal foetus in third trimester. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.5863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Eraslan Sahin M, Sahin E, Col Madendag I, Madendag Y, Acmaz G, Ozdemir F, Kırlangıç MM, Muderris II. Evaluation of midtrimester ductus venosus diameter and peak systolic velocity to predict late onset small for gestational age fetuses. J Matern Fetal Neonatal Med 2020; 35:3984-3990. [PMID: 33190543 DOI: 10.1080/14767058.2020.1846175] [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: 10/23/2022]
Abstract
OBJECTIVE The ductus venosus, a small blood vessel in the fetal venous system, has extraordinary physiologic significance because it connects the umbilical vein to the inferior vena cava in the fetus circulation system and transports highly oxygenated blood from the placenta to the fetus' heart. Hence, assessment of ductus venosus flows is helpful in evaluating fetal hemodynamics. Considering the critical function of the ductus venosus, we hypothesized that the diameter of the midtrimester ductus venosus and its peak velocity index can be related to adequate fetal growth; therefore, the aim of this study was to evaluate the role of the midtrimester umbilical venous blood flow, ductus venosus diameter, and ductus venosus peak systolic velocity to help predict uncomplicated deliveries of late onset small for gestational age (SGA) fetuses. METHODS In this prospective study we analyzed the pregnancies and deliveries of 398 pregnant women who met the inclusion criteria and divided them into three groups according to fetal birth weight as follows: birth weight <3 percentile SGA group (n = 16), birth weight 3-10 percentile SGA group (n = 42), and appropriate for the gestational age (AGA) group (n = 340). The midtrimester ductus venosus diameter and peak sistolic velocity, umbilical venous blood flow, and umbilical artery pulsatility index (PI) were recorded. In the absence of congenital anomalies, the diagnosis of fetal growth restriction (FGR) is made according to Delphi consensus criteria. In the absence of abnormal Doppler findings, late FGR was defined as occurring ≥32 weeks. RESULTS Maternal age, nulliparity, mean gestational age at ultrasound evaluation, ethnicity, body mass index, and previous cesarean delivery rates were similar among the groups. In addition, mid-trimester fetal biometric measurements and amniotic fluid volume were similar among the groups. The gestational age at delivery, prematurity, fetal birth weight, vaginal delivery rates, and rate of admission to the neonatal intensive care unit were significantly different among the groups. The mean mid-trimester umbilical vein blood flow to abdominal circumference ratio (UVBF/AC) was similar among the groups (p=.740). In the <3 group, the mean peak systolic velocity of the ductus venosus was significantly lower and the mean diameter of the ductus venosus significantly higher than those in the 3-10 and AGA groups (both p<.001). Although the values are below the 95th percentile mid-trimester umbilical artery PI was significantly higher in the <3 percentile SGA group than in the 3-10 percentile SGA and AGA groups. CONCLUSION Our results suggest that the diameter and peak systolic velocity of the mid-trimester ductus venosus are useful noninvasive measurements that provide prediction of late onset SGA fetuses.
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Affiliation(s)
| | - Erdem Sahin
- Department of Obstetrics and Gynecology, Erciyes University Medicine Faculty, Kayseri, Turkey
| | - Ilknur Col Madendag
- Department of Obstetrics and Gynecology, Kayseri City Hospital, Kayseri, Turkey
| | - Yusuf Madendag
- Department of Obstetrics and Gynecology, Erciyes University Medicine Faculty, Kayseri, Turkey
| | - Gokhan Acmaz
- Department of Obstetrics and Gynecology, Erciyes University Medicine Faculty, Kayseri, Turkey
| | - Fatma Ozdemir
- Department of Obstetrics and Gynecology, Erciyes University Medicine Faculty, Kayseri, Turkey
| | - Mehmet Mete Kırlangıç
- Department of Obstetrics and Gynecology, Tuzla Government Hospital, İstanbul, Turkey
| | - Iptisam Ipek Muderris
- Department of Obstetrics and Gynecology, Erciyes University Medicine Faculty, Kayseri, Turkey
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van Oostrum NHM, Derks K, van der Woude DAA, Clur SA, Oei SG, van Laar JOEH. Two-dimensional Speckle tracking echocardiography in Fetal Growth Restriction: a systematic review. Eur J Obstet Gynecol Reprod Biol 2020; 254:87-94. [PMID: 32950891 DOI: 10.1016/j.ejogrb.2020.08.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 12/12/2022]
Abstract
Background Fetal growth restriction (FGR), defined as an estimated fetal weight (EFW)<10th percentile, is associated with an increased risk for adverse fetal and neonatal outcome. Early antenatal diagnosis is important and remains challenging. Deformation changes in the fetal myocardium are early signs of myocardial dysfunction. These changes can be measured using two-dimensional speckle tracking echocardiography (2D-STE) to predict impaired placental function in the growth restricted fetus. Aim To review the literature on fetal heart deformation values measured with 2D-STE, in fetuses with an EFW< 10th centile and appropriate for gestational age (AGA) fetuses, and to compare the results in both groups. Methods The EMBASE, Medline, and Cochrane databases were searched from inception until April 2020. Observational studies on evaluating the cardiac deformation values longitudinal strain, strain rate, and/or global dyssynchrony of both ventricles in FGR, using 2D-STE, were included. Methodological quality was assessed using the Newcastle-Ottowa risk of bias scale. Results Four studies met the inclusion criteria. The mean gestational age (GA) varied from 30 to 38 weeks in the FGR group and 20 to 40 weeks in AGA fetuses. The number of included FGR fetuses (with or without Doppler abnormalities), varied from 30 to 50. Longitudinal strain in FGR fetuses was described as comparable (n = 2), increased (n = 1) and>95th percentile (n = 1) compared to AGA fetuses. Strain rate was measured in two studies. One reported an increased strain rate, another showed comparable strain rate. Two studies addressed global left ventricle (LV) and right ventricle (RV) dyssynchrony. Dyssynchrony was increased in FGR compared to AGA fetuses. Conclusion The currently published data is limited and heterogeneous concerning GA and Doppler profiles. The data presentation and the interpretation thereof make qualitative comparisons impossible. Large prospective longitudinal cohort studies looking at the value of deformation measurements of the fetal heart in FGR and AGA fetuses are needed to assess the clinical significance of deformation values measured with 2D-STE.
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Affiliation(s)
- Noortje H M van Oostrum
- Department of Gynaecology and Obstetrics, Máxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Kris Derks
- Department of Gynaecology and Obstetrics, Máxima Medical Center, Veldhoven, the Netherlands
| | - Daisy A A van der Woude
- Department of Gynaecology and Obstetrics, Máxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - S A Clur
- Department of Paediatric Cardiology, Emma Children's Hospital, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - S Guid Oei
- Department of Gynaecology and Obstetrics, Máxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Judith O E H van Laar
- Department of Gynaecology and Obstetrics, Máxima Medical Center, Veldhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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van Oostrum NHM, van der Woude DAA, Clur SAB, Oei SG, van Laar JOEH. Right ventricular dysfunction identified by abnormal strain values precedes evident growth restriction in small for gestational age fetuses. Prenat Diagn 2020; 40:1525-1531. [PMID: 32735353 DOI: 10.1002/pd.5805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Small for gestational age (SGA) fetuses have an increased risk for adverse outcome. Placental insufficiency leads to changes in the circulation, with secondary adaptation of the fetal heart resulting in changed cardiac deformation. This deformation can be measured with 2D speckle tracking echocardiography (2D-STE). SGA is antenatally often undiagnosed. The measurement of deformation changes in the fetal heart might help in the prediction of SGA and identify fetuses in need of more intensive surveillance. METHODS In this longitudinal prospective cohort study, global longitudinal strain (GLS) and strain rate (GLSR), measured before 23 weeks gestational age were compared between SGA and appropriate for gestational age (AGA) fetuses, based on birthweight corrected for gestational age at birth. RESULTS The fetal heart rate was significantly increased in SGA; 158 beats per minute (146-163) vs 148 (134-156); P = 0.035 in AGA. Right ventricle GLS (RV-GLS) values were significantly increased in SGA; -15.87% (-11.69% to -20.55%) vs -20.24% (-16.29% to -24.28%); p = 0.024, respectively. CONCLUSION RV-GLS values, measured with 2D-STE, were significantly increased in SGA, indicating systolic RV dysfunction before 23 weeks gestational age in fetuses who will become SGA later in pregnancy. A large longitudinal prospective cohort study is needed to confirm these findings.
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Affiliation(s)
- Noortje H M van Oostrum
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Fundamental Perinatology, Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Daisy A A van der Woude
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Fundamental Perinatology, Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| | - Sally-Ann B Clur
- Department of Paediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - S Guid Oei
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Fundamental Perinatology, Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Judith O E H van Laar
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Fundamental Perinatology, Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Clark AR, Lee TC, James JL. Computational modeling of the interactions between the maternal and fetal circulations in human pregnancy. WIREs Mech Dis 2020; 13:e1502. [PMID: 32744412 DOI: 10.1002/wsbm.1502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022]
Abstract
In pregnancy, fetal growth is supported by its placenta. In turn, the placenta is nourished by maternal blood, delivered from the uterus, in which the vasculature is dramatically transformed to deliver this blood an ever increasing volume throughout gestation. A healthy pregnancy is thus dependent on the development of both the placental and maternal circulations, but also the interface where these physically separate circulations come in close proximity to exchange gases and nutrients between mum and baby. As the system continually evolves during pregnancy, our understanding of normal vascular anatomy, and how this impacts placental exchange function is limited. Understanding this is key to improve our ability to understand, predict, and detect pregnancy pathologies, but presents a number of challenges, due to the inaccessibility of the pregnant uterus to invasive measurements, and limitations in the resolution of imaging modalities safe for use in pregnancy. Computational approaches provide an opportunity to gain new insights into normal and abnormal pregnancy, by connecting observed anatomical changes from high-resolution imaging to function, and providing metrics that can be observed by routine clinical ultrasound. Such advanced modeling brings with it challenges to scale detailed anatomical models to reflect organ level function. This suggests pathways for future research to provide models that provide both physiological insights into pregnancy health, but also are simple enough to guide clinical focus. We the review evolution of computational approaches to understanding the physiology and pathophysiology of pregnancy in the uterus, placenta, and beyond focusing on both opportunities and challenges. This article is categorized under: Reproductive System Diseases >Computational Models.
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Affiliation(s)
- Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Tet Chuan Lee
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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