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Swissa SS, Walfisch A, Yaniv-Salem S, Pariente G, Hershkovitz R, Szaingurten-Solodkin I, Shashar S, Beharier O. Maternal Blood Angiogenic Factors and the Prediction of Critical Adverse Perinatal Outcomes Among Small-for-Gestational-Age Pregnancies. Am J Perinatol 2024; 41:1185-1194. [PMID: 35292946 DOI: 10.1055/a-1798-1829] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Our objective was to determine whether maternal blood angiogenic factors in suspected-small-for-gestational-age (sSGA) fetuses can predict critical adverse perinatal outcomes (CAPO) and improve risk assessment. METHODS Women with singleton pregnancies diagnosed with sSGA, between 24 and 356/7 weeks' gestation, were included. Clinical and sonographic comprehensive evaluations were performed at enrolment. Plasma angiogenic factors, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF), were obtained at diagnosis. In parallel, three attending maternal-fetal-medicine specialists predicted the risk (1-5 scale) of these pregnancies to develop CAPO, based on the clinical presentation. CAPOs were defined as prolonged neonatal intensive care unit hospitalization, fetal or neonatal death, and major neonatal morbidity. Statistical analysis included sensitivity, specificity, positive and negative predictive values, and receiver-operating characteristic (ROC) curve analyses. RESULTS Of the 79 cases included, 32 were complicated by CAPO (40.5%). In SGA fetuses with CAPO, the sFlt-1/PlGF ratio was higher (p < 0.001) and PlGF was lower (p < 0.001) as compared with uncomplicated pregnancies. The areas under the ROC curves for specialists were 0.913, 0.824, and 0.811 and for PlGF and sFlt-1/PlGF ratio 0.926 and 0.900, respectively. CAPO was more common in pregnancies with absent end-diastolic flow or reversed end-diastolic flow (AEDF or REDF) in the umbilical artery upon enrolment (91.6%). Yet, 65.6% of cases involving CAPO occurred in patients without AEDF or REDF, and 66.6% of these cases were not identified by one or more of the experts. The sFlt-1/PlGF ratio identified 92.9% of the experts' errors in this group and 100% of the errors in cases with AEDF or REDF. CONCLUSION Among sSGA pregnancies prior to 36 weeks' gestation, angiogenic factors testing can identify most cases later complicated with CAPO. Our data demonstrate for the first time that these markers can reduce clinician judgment errors. Incorporation of these measures into decision-making algorithms could potentially improve management, outcomes, and even health care costs. KEY POINTS · Angiogenic factors at diagnosis of sSGA can be used to predict CAPO.. · The sFlt-1/PlGF ratio can flag sSGA pregnancies at increased risk.. · The sFlt-1/PlGF ratio at admission of sSGA adds to clinical assessment..
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Affiliation(s)
- Shani S Swissa
- Department of Obstetrics and Gynecology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shimrit Yaniv-Salem
- Department of Obstetrics and Gynecology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Reli Hershkovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Irit Szaingurten-Solodkin
- Department of Obstetrics and Gynecology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Sagi Shashar
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ofer Beharier
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Rajiv P, Cade T, Dean J, Jones GD, Brennecke SP. Maternal serum soluble fms-like tyrosine kinase-1-to-placental growth factor ratio distinguishes growth-restricted from non-growth-restricted small-for-gestational-age fetuses. AJOG GLOBAL REPORTS 2024; 4:100302. [PMID: 38318268 PMCID: PMC10839529 DOI: 10.1016/j.xagr.2023.100302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Fetal growth restriction secondary to chronic placental insufficiency is a major cause of perinatal morbidity and mortality. A significant proportion of fetuses with fetal growth restriction are small for gestational age, defined as a birthweight of ≤10th percentile. However, not all small-for-gestational-age fetuses are growth restricted. Some are constitutionally small and otherwise healthy. It is important to distinguish between small-for-gestational-age fetuses with and without fetal growth restriction to ensure appropriate interventions in small-for-gestational-age fetuses with fetal growth restriction and to minimize unnecessary interventions in healthy small-for-gestational-age fetuses. The maternal serum ratio of soluble fms-like tyrosine kinase-1 and placental growth factor is an indicator of placental insufficiency in the latter half of pregnancy. As such, the soluble fms-like tyrosine kinase-1-to-placental growth factor ratio may be a clinically useful tool to distinguish between small-for-gestational-age fetuses with and without fetal growth restriction. OBJECTIVE This study aimed to determine whether the soluble fms-like tyrosine kinase-1-to-placental growth factor ratio can distinguish between small-for-gestational-age fetuses with and without fetal growth restriction with a birthweight of ≤10th percentile. STUDY DESIGN A retrospective audit of 233 singleton pregnancies delivering an infant with a birthweight of ≤10th percentile corrected for gestational age with an antenatal maternal serum soluble fms-like tyrosine kinase-1-to-placental growth factor result was performed. Fetal growth restriction was defined as a birthweight of ≤10th percentile with an umbilical artery pulsatility index of >95th percentile, fetal middle cerebral artery pulsatility index of <5th percentile, amniotic fluid index of <6 cm, and/or cerebroplacental ratio of <1st percentile. The soluble fms-like tyrosine kinase-1-to-placental growth factor ratios before delivery between fetuses with and without fetal growth restriction (121 [fetal growth restriction] vs 112 [no fetal growth restriction]) were compared. The Student t test and Fisher exact test were used to compare cases and controls. The Mann-Whitney U test, linear regression analysis, and Spearman correlation coefficient (Rho) were used to examine associations between the soluble fms-like tyrosine kinase-1-to-placental growth factor ratio and fetal outcomes to determine whether the soluble fms-like tyrosine kinase-1-to-placental growth factor ratio served as a prognostic marker of fetal growth restriction severity. RESULTS The mean soluble fms-like tyrosine kinase-1-to-placental growth factor ratio was increased in fetal growth restriction cases compared with non-fetal growth restriction controls (234.3±25.0 vs 67.4±7.7, respectively; P<.0001). When controlling for preeclampsia, which is associated with placental insufficiency, fetal growth restriction cases still demonstrated an independent increase in the soluble fms-like tyrosine kinase-1-to-placental growth factor ratio (effect size, 0.865; 95% confidence interval, 0.509-1.220; P<.001). The soluble fms-like tyrosine kinase-1-to-placental growth factor ratio was negatively correlated with birthweight percentiles in pregnancies delivering an infant with a birthweight of ≤10th percentile (r=-0.3565; P<.0001). This association was maintained for fetuses with fetal growth restriction (r=-0.2309; P<.05), whereas fetuses without fetal growth restriction had no significant correlation between the soluble fms-like tyrosine kinase-1-to-placental growth factor ratio and neonatal birthweight percentiles. CONCLUSION The soluble fms-like tyrosine kinase-1-to-placental growth factor ratio was significantly higher in small-for-gestational-age fetuses with fetal growth restriction than small-for-gestational-age fetuses without fetal growth restriction, independent of preeclampsia. Furthermore, the soluble fms-like tyrosine kinase-1-to-placental growth factor ratio was negatively correlated with fetal growth restriction birthweight percentiles, suggesting that it may be a clinical measure of fetal growth restriction severity. Therefore, the ratio may usefully delineate fetal growth restriction from constitutionally small but otherwise healthy fetuses antenatally, allowing for timely interventions in small-for-gestational-age cases with fetal growth restriction and unnecessary interventions to be minimized in small-for-gestational-age cases without fetal growth restriction.
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Affiliation(s)
- Prithi Rajiv
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia (Drs Rajiv, Cade, Dean, Davis Jones, and Brennecke)
| | - Thomas Cade
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia (Drs Rajiv, Cade, Dean, Davis Jones, and Brennecke)
| | - Jennifer Dean
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia (Drs Rajiv, Cade, Dean, Davis Jones, and Brennecke)
| | - Gabriel Davis Jones
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia (Drs Rajiv, Cade, Dean, Davis Jones, and Brennecke)
| | - Shaun P. Brennecke
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia (Drs Rajiv, Cade, Dean, Davis Jones, and Brennecke)
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Melbourne, Australia (Dr Brennecke)
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Nel S, Pattinson RC, Vannevel V, Feucht UD, Mulol H, Wenhold FAM. Integrated growth assessment in the first 1000 d of life: an interdisciplinary conceptual framework. Public Health Nutr 2023; 26:1523-1538. [PMID: 37170908 PMCID: PMC10410405 DOI: 10.1017/s1368980023000940] [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: 02/16/2023] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Prenatal growth affects short- and long-term morbidity, mortality and growth, yet communication between prenatal and postnatal healthcare teams is often minimal. This paper aims to develop an integrated, interdisciplinary framework for foetal/infant growth assessment, contributing to the continuity of care across the first 1000 d of life. DESIGN A multidisciplinary think-tank met regularly over many months to share and debate their practice and research experience related to foetal/infant growth assessment. Participants’ personal practice and knowledge were verified against and supplemented by published research. SETTING Online and in-person brainstorming sessions of growth assessment practices that are feasible and valuable in resource-limited, low- and middle-income country (LMIC) settings. PARTICIPANTS A group of obstetricians, paediatricians, dietitians/nutritionists and a statistician. RESULTS Numerous measurements, indices and indicators were identified for growth assessment in the first 1000 d. Relationships between foetal, neonatal and infant measurements were elucidated and integrated into an interdisciplinary framework. Practices relevant to LMIC were then highlighted: antenatal Doppler screening, comprehensive and accurate birth anthropometry (including proportionality of weight, length and head circumference), placenta weighing and incorporation of length-for-age, weight-for-length and mid-upper arm circumference in routine growth monitoring. The need for appropriate, standardised clinical records and corresponding policies to guide clinical practice and facilitate interdisciplinary communication over time became apparent. CONCLUSIONS Clearer communication between prenatal, perinatal and postnatal health care providers, within the framework of a common understanding of growth assessment and a supportive policy environment, is a prerequisite to continuity of care and optimal health and development outcomes.
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Affiliation(s)
- Sanja Nel
- Department of Human Nutrition, University of Pretoria, Pretoria0002, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
| | - Robert C Pattinson
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Valerie Vannevel
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Ute D Feucht
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
- Tshwane District Health Services, Gauteng Department of Health, Pretoria, South Africa
| | - Helen Mulol
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
| | - Friede AM Wenhold
- Department of Human Nutrition, University of Pretoria, Pretoria0002, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
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Cong S, Fan X, Yu P, Zhou C, Wang L, Wang R, Song X, Feng J, Sun X, Sha L, Zhu Z, Zhang A. Spontaneous behaviors during breast crawling and factors influencing self-locating mothers' breasts in newborns: A cross-sectional study. Heliyon 2023; 9:e16440. [PMID: 37260903 PMCID: PMC10227327 DOI: 10.1016/j.heliyon.2023.e16440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/29/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
Breast crawling in newborns to propel themselves to their mothers' breasts normally occurs upon skin-to-skin contact with mothers immediately after birth but is often missed by the neglect of hospital staff and insufficient evidence support. Hence, this study described the behavioral characteristics of 135 newborns from China during breast crawling and further explored the factors influencing newborns' self-locating mothers' breasts (measured by whether fail to experience the familiarization stage, initial time and duration of the familiarization stage) using multivariable analysis. The findings supported and extended previous studies that newborns could emerge in nine instinctive stages and corresponding spontaneous behaviors early in life. Moreover, abnormal fetal heart rate during labor appeared to interfere with newborns experiencing the familiarization stage (aOR = 9.27, 95% CI: 1.41 to 61.07, P = 0.021), while using synthetic oxytocin (β = 5.94, 95% CI: 0.35 to 11.54, P = 0.037), using antibiotics (β = 11.09, 95% CI: 4.11 to 18.07, P = 0.002), and newborns' gender (β = -5.69, 95% CI: 11.26 to -0.12, P = 0.045) would alter the initial time of the familiarization stage. Finally, this study proposes evidence-based strategies to prevent abnormal fetal heart rates and improve medication use.
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Affiliation(s)
- Shengnan Cong
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Xuemei Fan
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Ping Yu
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Chunxiu Zhou
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Lingzhi Wang
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Rui Wang
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Xiaowei Song
- Department of Neurosurgery, Sir Run Run Hospital, Nanjing Medical University, Jiangsu, China
| | - Jingyi Feng
- Faculty of Science, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiaoqing Sun
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Lijuan Sha
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Zhu Zhu
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Aixia Zhang
- Department of Nursing, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
- School of Nursing, Nanjing Medical University, Jiangsu, China
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Nel S, Feucht UD, Mulol H, Wenhold FA. Association of Prenatal Placental Function with Anthropometry and Body Composition through 2 years of Age in South African Infants: The UmbiBaby Study. J Nutr 2023; 153:958-969. [PMID: 36775243 DOI: 10.1016/j.tjnut.2023.02.007] [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: 09/16/2022] [Revised: 01/09/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Placental insufficiency negatively impacts fetal growth and body composition (BC), potentially affecting lifelong health. Placental insufficiency, detectable as an abnormal umbilical artery resistance index (UmA-RI) on Doppler ultrasonography, is highly prevalent in otherwise healthy South African pregnant women. Appropriate intervention reduces stillbirth and perinatal death, but research on long-term outcomes of surviving infants is lacking. OBJECTIVES To describe and compare anthropometry and BC during the first 2 y of life in a cohort of term-born infants with normal and abnormal prenatal UmA-RI. METHODS Term-born infants (n = 81; n = 55 normal, n = 26 abnormal UmA-RI on third trimester Doppler screening) were followed up at 8-time points until age 2 y. Anthropometric measurements were taken, and FFM and FM were assessed by deuterium dilution. Age- and sex-specific z-scores were calculated for anthropometric indices, FM, FFM, FM index (FMI), and FFM index (FFMI) using appropriate reference data. Anthropometry and BC of infants with normal and abnormal UmA-RI were compared using an independent t-test or Mann-Whitney test. RESULTS At most ages, group mean z-scores were <0 for length-for-age and FM and >0 for weight-for-length and FFM. Compared with infants with normal UmA-RI, infants with abnormal UmA-RI had significantly lower weight-for-age z-scores at birth (-0.77 ± 0.75 compared with -0.30 ± 1.10, P = 0.026), ages 10 wk to 9 mo (-0.4 ± 0.87 to -0.2 ± 1.12 compared with 0.3 ± 0.85 to 0.6 ± 1.09; P = 0.007-0.017) and 18 mo (-0.6 ± 0.82 compared with 0.1 ± 1.18; P = 0.037); length-for-age z-scores at ages ≤14 wk (-1.3 ± 1.25 to -0.9 ± 0.87 compared with -0.2 ± 1.04 to -0.1 ± 1.00; P = 0.004-0.021); and FFM-for-age z-scores at ages ≤9 mo (-0.1 ± 0.82 to 0.7 ± 0.71 compared with 0.7 ± 1.00 to 1.3 ± 0.85; P = 0.002-0.028). FFMI, percentage FFM, FM, percentage FM, and FMI showed no consistent significant differences. CONCLUSIONS Infants with abnormal UmA-RI had lower weight-for-age and length-for-age z-scores, particularly at younger ages, with proportionally lower FFM but no consistent differences in percentage FFM and FFMI. These findings merit further investigation in larger cohorts. J Nutr 2023;xx:xx-xx.
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Affiliation(s)
- Sanja Nel
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa; Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa; South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa.
| | - Ute D Feucht
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa; South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa; Department of Paediatrics, University of Pretoria, Pretoria, South Africa; Gauteng Department of Health, Tshwane District Health Services, Pretoria, South Africa
| | - Helen Mulol
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa; South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa; Department of Paediatrics, University of Pretoria, Pretoria, South Africa; Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Friede Am Wenhold
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa; Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa; South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa
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Desplanches T, Bouit C, Cottenet J, Szczepanski E, Quantin C, Fauque P, Sagot P. Combined effects of increasing maternal age and nulliparity on hypertensive disorders of pregnancy and small for gestational age. Pregnancy Hypertens 2019; 18:112-116. [PMID: 31586783 DOI: 10.1016/j.preghy.2019.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The mean age of women delivering for the first time is increasing, and this combination could lead to an increased risk of perinatal complications. OBJECTIVES The objective was to evaluate the potential combined effects of nulliparity and increasing maternal age on small for gestational age (SGA < 10th percentile) and hypertensive disorders of pregnancy (HDP). STUDY DESIGN A population-based cohort study was conducted using data routinely collected on all births in 11 hospitals in the Burgundy perinatal network between 2007 and 2016. Pregnant women with singleton deliveries aged 20 years or older were included at delivery and divided into groups according to maternal age (20 to 24-year-old group as a reference). Multivariate logistic regression models, adjusted on smoking, body mass index, chronic high blood pressure and birth date, were performed. RESULTS A total of 137,791 women were included. Whatever the parity, the risks of SGA and HDP increased with maternal age, but the increase began earlier in nulliparous women. Compared to multiparous women, the risk of SGA in nulliparous women increased with maternal age (aOR = 1.5 95% CI [1.4-1.7] for age 20-24 rising to 2.2 [1.8-2.8] for age 40-49). We found evidence that parity modified the association between maternal age and SGA (test for interaction p < 0.001). The risk of HDP was constantly higher in nulliparous women, whatever the maternal age. CONCLUSION The combination of increasing maternal age and nulliparity has a more negative impact on the occurrence of SGA than either risk factor alone.
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Affiliation(s)
- Thomas Desplanches
- Dijon University Hospital, Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, Dijon F-21000, France.
| | - Camille Bouit
- Dijon University Hospital, Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, Dijon F-21000, France
| | - Jonathan Cottenet
- Dijon University Hospital, Service de Biostatistique et d'Informatique Médicale (DIM), Dijon F-21000, France; Inserm, CIC 1432, Clinical Epidemiology Unit, Dijon, France; Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology Unit, Dijon, France
| | - Emilie Szczepanski
- Dijon University Hospital, Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, Dijon F-21000, France
| | - Catherine Quantin
- Dijon University Hospital, Service de Biostatistique et d'Informatique Médicale (DIM), Dijon F-21000, France; Inserm, CIC 1432, Clinical Epidemiology Unit, Dijon, France; Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology Unit, Dijon, France
| | - Patricia Fauque
- Dijon University Hospital, Laboratoire de Biologie de la Reproduction, Dijon F-21000, France; Inserm 1231, Equipe GAD, Génétique des Anomalies du Développement, Dijon University Hospital, France
| | - Paul Sagot
- Dijon University Hospital, Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, Dijon F-21000, France; University of Burgundy, Dijon, France
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Cahill LS, Hoggarth J, Lerch JP, Seed M, Macgowan CK, Sled JG. Fetal brain sparing in a mouse model of chronic maternal hypoxia. J Cereb Blood Flow Metab 2019; 39:1172-1184. [PMID: 29271304 PMCID: PMC6547196 DOI: 10.1177/0271678x17750324] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hypoxic stress is a common occurrence during human pregnancy, yet little is known about its effects on the fetal brain. This study examined the fetal hemodynamic responses to chronic hypoxia in an experimental mouse model of chronic maternal hypoxia (11% O2 from E14.5 to E17.5). Using high-frequency Doppler ultrasound, we found fetal cerebral and ductus venosus blood flow were both elevated by 69% and pulmonary blood flow was decreased by 62% in the fetuses exposed to chronic hypoxia compared to controls. This demonstrates that brain sparing persists during chronic fetal hypoxia and is mediated by "streaming," where highly oxygenated blood preferentially flows through the ductus venosus towards the cerebral circulation, bypassing the liver and the lungs. Consistent with these changes in blood flow, the fetal brain volume measured by MRI is preserved, while the liver and lung volumes decreased compared to controls. However, hypoxia exposed fetuses were rendered vulnerable to an acute hypoxic challenge (8% O2 for 3 min), demonstrating global blood flow decreases consistent with imminent fetal demise rather than elevated cerebral blood flow. Despite this vulnerability, there were no differences in adult brain morphology in the mice exposed to chronic maternal hypoxia compared to controls.
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Affiliation(s)
- Lindsay S Cahill
- 1 Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Johnathan Hoggarth
- 1 Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jason P Lerch
- 1 Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,2 Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,3 Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Ontario Canada
| | - Mike Seed
- 4 Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,5 Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher K Macgowan
- 2 Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,5 Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John G Sled
- 1 Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.,2 Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,5 Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Fontaine MA, Diane A, Singh VP, Mangat R, Krysa JA, Nelson R, Willing BP, Proctor SD. Low birth weight causes insulin resistance and aberrant intestinal lipid metabolism independent of microbiota abundance in Landrace–Large White pigs. FASEB J 2019; 33:9250-9262. [DOI: 10.1096/fj.201801302rr] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Melanie A. Fontaine
- Metabolic and Cardiovascular Disease Laboratory Group on Molecular and Cell Biology of Lipids Alberta Diabetes and Mazankowski Heart Institutes University of Alberta Edmonton Alberta Canada
| | - Abdoulaye Diane
- Metabolic and Cardiovascular Disease Laboratory Group on Molecular and Cell Biology of Lipids Alberta Diabetes and Mazankowski Heart Institutes University of Alberta Edmonton Alberta Canada
| | - Vijay P. Singh
- Metabolic and Cardiovascular Disease Laboratory Group on Molecular and Cell Biology of Lipids Alberta Diabetes and Mazankowski Heart Institutes University of Alberta Edmonton Alberta Canada
| | - Rabban Mangat
- Metabolic and Cardiovascular Disease Laboratory Group on Molecular and Cell Biology of Lipids Alberta Diabetes and Mazankowski Heart Institutes University of Alberta Edmonton Alberta Canada
| | - Jacqueline A. Krysa
- Metabolic and Cardiovascular Disease Laboratory Group on Molecular and Cell Biology of Lipids Alberta Diabetes and Mazankowski Heart Institutes University of Alberta Edmonton Alberta Canada
| | - Randy Nelson
- Metabolic and Cardiovascular Disease Laboratory Group on Molecular and Cell Biology of Lipids Alberta Diabetes and Mazankowski Heart Institutes University of Alberta Edmonton Alberta Canada
| | - Benjamin P. Willing
- Department of Agricultural Food and Nutritional Science University of Alberta Edmonton Alberta Canada
| | - Spencer D. Proctor
- Metabolic and Cardiovascular Disease Laboratory Group on Molecular and Cell Biology of Lipids Alberta Diabetes and Mazankowski Heart Institutes University of Alberta Edmonton Alberta Canada
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Huang L, Yang S, Yang F, Xiong F. A prospective study about physical growth of children from birth to 2 years old born full-term small-for-gestational-age. J Paediatr Child Health 2019; 55:199-204. [PMID: 30066971 DOI: 10.1111/jpc.14162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 01/12/2023]
Abstract
AIM To evaluate the growth trend of children from birth to 2 years old born full-term small-for-gestational-age (SGA) in Chengdu, China. METHODS Full-term SGA infants were prospectively followed from birth to 2 years of age. The weight, length and head circumference were monitored at 3, 6, 12, 18 and 24 months. Catch-up growth and growth velocity were measured by using standardised z-score and Δz-score. Growth deviation was analysed. RESULTS A total of 850 full-term SGA infants were involved in our study. There were no significant differences in weight or length at birth between male and female infants. Full catch-up growth was seen in 95.85% of SGA infants within 2 years of life, with no gender differences. The z-score and Δz-score for weight at 3 months were less than those at other ages (P < 0.05). The z-score and Δz-score for length at 3 and 6 months were less than those at other ages (P < 0.05). Smaller z-score for head circumference was seen at 3 and 6 months (P < 0.05). The z-score for body mass index at 6 months was the largest over the period of follow-up. The total prevalence of being overweight or obese fluctuated around 10% at different follow-up stages. Males had a faster growth velocity for length at 12 months compared to females (P < 0.05). The proportion of those who were underweight, of short stature or had a head circumference z-score < -2 significantly decreased between 3 and 6 months. At 24 months, there was an increase in z-score of 0.67 standard deviation for both weight and length in most full-term SGA infants, and the proportion of underweight and short stature was 2.97 and 2.67%, respectively. CONCLUSIONS Most full-term SGA infants undergo catch-up growth during the first year of life. Regardless of gender, the catch-up velocity for weight exceeded that for length at each visit. Additional follow-up studies are needed to determine long-term growth outcomes for full-term SGAs.
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Affiliation(s)
- Lili Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, China
| | - Sufei Yang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, China
| | - Fan Yang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, China
| | - Fei Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, China
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10
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Finken MJJ, van der Steen M, Smeets CCJ, Walenkamp MJE, de Bruin C, Hokken-Koelega ACS, Wit JM. Children Born Small for Gestational Age: Differential Diagnosis, Molecular Genetic Evaluation, and Implications. Endocr Rev 2018; 39:851-894. [PMID: 29982551 DOI: 10.1210/er.2018-00083] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/21/2018] [Indexed: 12/25/2022]
Abstract
Children born small for gestational age (SGA), defined as a birth weight and/or length below -2 SD score (SDS), comprise a heterogeneous group. The causes of SGA are multifactorial and include maternal lifestyle and obstetric factors, placental dysfunction, and numerous fetal (epi)genetic abnormalities. Short-term consequences of SGA include increased risks of hypothermia, polycythemia, and hypoglycemia. Although most SGA infants show catch-up growth by 2 years of age, ∼10% remain short. Short children born SGA are amenable to GH treatment, which increases their adult height by on average 1.25 SD. Add-on treatment with a gonadotropin-releasing hormone agonist may be considered in early pubertal children with an expected adult height below -2.5 SDS. A small birth size increases the risk of later neurodevelopmental problems and cardiometabolic diseases. GH treatment does not pose an additional risk.
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Affiliation(s)
- Martijn J J Finken
- Department of Pediatrics, VU University Medical Center, MB Amsterdam, Netherlands
| | - Manouk van der Steen
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Carolina C J Smeets
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Marie J E Walenkamp
- Department of Pediatrics, VU University Medical Center, MB Amsterdam, Netherlands
| | - Christiaan de Bruin
- Department of Pediatrics, Leiden University Medical Center, RC Leiden, Netherlands
| | - Anita C S Hokken-Koelega
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Jan M Wit
- Department of Pediatrics, Leiden University Medical Center, RC Leiden, Netherlands
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11
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Landau-Crangle E, Rochow N, Fenton TR, Liu K, Ali A, So HY, Fusch G, Marrin ML, Fusch C. Individualized Postnatal Growth Trajectories for Preterm Infants. JPEN J Parenter Enteral Nutr 2018; 42:1084-1092. [PMID: 29419902 DOI: 10.1002/jpen.1138] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/27/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Growth of preterm infants is monitored using fetal charts despite individual trajectories being downshifted postnatally by adaptational processes. The study aims to compare different approaches to create individualized postnatal trajectories. METHODS Three approaches to achieve growth similar to healthy term infants at 42+0/7 weeks postmenstrual age (PMA) on World Health Organization growth standards (WHOGS) (target weight) were tested by comparing trajectories obtained by: 1) following birth percentiles (Birth-Weight-Percentile Approach); 2) following percentiles achieved at day of life 21 (Postnatal-Percentile Approach); 3) using day-specific fetal median growth velocities starting at day of life 21 (Fetal-Median-Growth Approach [FMGA]). The primary outcome was delta weight (ΔW), defined as difference between target weight (WHOGS) at 42+0/7 weeks and weight predicted by trajectories. The secondary outcome was ΔW vs %fat mass in a cohort of 20 disease-free surviving very low-birth-weight infants. RESULTS Birth-Weight-Percentile and Postnatal-Percentile Approach showed high ΔW; FMGA alone reduced ΔW. Introducing a factor to FMGA to reflect the transition to extrauterine conditions (Growth-Velocity Approach [GVA]) minimized ΔW. GVA merged with target and best normalized for body composition related to ΔW. CONCLUSIONS GVA provides an evidence-based approach for individualized growth trajectories. GVA is based on physiologic data and that healthy preterm infants adjust their postnatal trajectory below their birth percentile. GVA may reflect a biologic principle because it matches consistently with WHOGS at 42+0/7 weeks for all preterm infants from 24 to 34 weeks. This concept could become a bedside tool to aid clinicians in monitoring growth, guiding nutrition, and minimizing chronic adult disease risks as a consequence of unguided, inappropriate growth.
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Affiliation(s)
| | - Niels Rochow
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Tanis R Fenton
- Alberta Children's Hospital Research Institute, Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Kai Liu
- Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada
| | - Anaam Ali
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Hon Yiu So
- Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada
| | - Gerhard Fusch
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Michael L Marrin
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Christoph Fusch
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, Paracelsus Medical School, General Hospital of Nuremberg, Nuremberg, Germany
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12
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Ahlin K, Jacobsson B, Nilsson S, Himmelmann K. Antecedents and neuroimaging patterns in cerebral palsy with epilepsy and cognitive impairment: a population-based study in children born at term. Acta Obstet Gynecol Scand 2017; 96:828-836. [DOI: 10.1111/aogs.13128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Kristina Ahlin
- Department of Perinatal Center; Department of Obstetrics and Gynecology; Institute for Clinical Sciences; Sahlgrenska Academy; Sahlgrenska University Hospital/Östra; Gothenburg Sweden
| | - Bo Jacobsson
- Department of Perinatal Center; Department of Obstetrics and Gynecology; Institute for Clinical Sciences; Sahlgrenska Academy; Sahlgrenska University Hospital/Östra; Gothenburg Sweden
- Department of Genes and Environment; Division of Epidemiology; Institute of Public Health; Oslo Norway
| | - Staffan Nilsson
- Department of Mathematical Statistics; Institute for Mathematical Sciences; Chalmers University of Technology; Gothenburg Sweden
| | - Kate Himmelmann
- Department of Pediatrics; Institute for Clinical Sciences; Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
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13
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Benton SJ, McCowan LM, Heazell AE, Grynspan D, Hutcheon JA, Senger C, Burke O, Chan Y, Harding JE, Yockell-Lelièvre J, Hu Y, Chappell LC, Griffin MJ, Shennan AH, Magee LA, Gruslin A, von Dadelszen P. Placental growth factor as a marker of fetal growth restriction caused by placental dysfunction. Placenta 2016; 42:1-8. [DOI: 10.1016/j.placenta.2016.03.010] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/14/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
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14
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Carr DJ, Wallace JM, Aitken RP, Milne JS, Martin JF, Zachary IC, Peebles DM, David AL. Peri- and Postnatal Effects of Prenatal Adenoviral VEGF Gene Therapy in Growth-Restricted Sheep. Biol Reprod 2016; 94:142. [PMID: 27103444 DOI: 10.1095/biolreprod.115.133744] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 03/16/2016] [Indexed: 11/01/2022] Open
Abstract
Uterine artery (UtA) adenovirus (Ad) vector-mediated overexpression of vascular endothelial growth factor (VEGF) enhances uterine blood flow in normal sheep pregnancy and increases fetal growth in the overnourished adolescent sheep model of fetal growth restriction (FGR). Herein, we examined its impact on gestation length, neonatal survival, early postnatal growth and metabolism. Singleton-bearing ewes were evenly allocated to receive Ad.VEGF-A165 (5 × 10(10) particles/ml, 10 ml, n = 17) or saline (10 ml, n = 16) injected into each UtA at laparotomy (0.6 gestation). Fetal growth was serially monitored (blind) by ultrasound until delivery. Lambs were weighed and blood was sampled weekly and a glucose tolerance test performed (68-day postnatal age). Hepatic DNA/RNA was extracted at necropsy (83-day postnatal age) to examine methylation status of eight somatotropic axis genes. IGF1 mRNA and protein expression were measured by RT-PCR and radioimmunoassay, respectively. All pregnancies remained viable following Ad.VEGF-A165 treatment. Fetal abdominal circumference and renal volume were greater in the Ad.VEGF-A165 group compared with the saline group at 21/28 days (P ≤ 0.04) postinjection. At delivery, gestation length (P = 0.07), lamb birthweight (P = 0.08), umbilical girth (P = 0.06), and plasma glucose (P = 0.09) tended to be greater in Ad.VEGF-A165-treated lambs. Levels of neonatal intervention required to ensure survival was equivalent between groups. Absolute postnatal growth rate (P = 0.02), insulin area under the curve (P = 0.04) and carcass weight at necropsy (P = 0.04) were increased by Ad.VEGF-A165 treatment. There was no impact on markers of insulin sensitivity or methylation/expression of key genes involved in somatic growth. Ad.VEGF-A165 gene therapy increased fetal growth in a sheep FGR model, and lambs continued to thrive during the neonatal and early postnatal period.
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Affiliation(s)
- David J Carr
- Prenatal Cell and Gene Therapy Group, University College London Institute for Women's Health, University College London, London, United Kingdom Rowett Institute of Nutrition and Health, University of Aberdeen, Bucksburn, Aberdeen, United Kingdom
| | - Jacqueline M Wallace
- Rowett Institute of Nutrition and Health, University of Aberdeen, Bucksburn, Aberdeen, United Kingdom
| | - Raymond P Aitken
- Rowett Institute of Nutrition and Health, University of Aberdeen, Bucksburn, Aberdeen, United Kingdom
| | - John S Milne
- Rowett Institute of Nutrition and Health, University of Aberdeen, Bucksburn, Aberdeen, United Kingdom
| | - John F Martin
- Centre of Cardiovascular Biology and Medicine, University College London, London, United Kingdom
| | - Ian C Zachary
- Centre of Cardiovascular Biology and Medicine, University College London, London, United Kingdom
| | - Donald M Peebles
- Prenatal Cell and Gene Therapy Group, University College London Institute for Women's Health, University College London, London, United Kingdom National Institute for Health Research University College London Hospitals Biomedical Research Centre, Maple House, London, United Kingdom
| | - Anna L David
- Prenatal Cell and Gene Therapy Group, University College London Institute for Women's Health, University College London, London, United Kingdom National Institute for Health Research University College London Hospitals Biomedical Research Centre, Maple House, London, United Kingdom
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15
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Ahlin K, Himmelmann K, Nilsson S, Sengpiel V, Jacobsson B. Antecedents of cerebral palsy according to severity of motor impairment. Acta Obstet Gynecol Scand 2016; 95:793-802. [PMID: 26910364 DOI: 10.1111/aogs.12885] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 02/12/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study was to determine whether antecedents and neuroimaging patterns vary according to the severity of motor impairment in children with cerebral palsy. MATERIAL AND METHODS A population-based study in which all 309 term-born children with spastic and dyskinetic cerebral palsy born between 1983 and 1994 and 618 matched controls were studied. Antecedents were retrieved from obstetric records. Information on neuroimaging was retrieved from the cerebral palsy Register of Western Sweden. Cases were grouped by severity of motor impairment: mild (walks without aids), moderate (walks with aids) or severe (dependent on wheelchair). Binary logistic regression, the Cochran-Armitage test for trends, interaction analyses and interrelationship analyses were performed. RESULTS Antecedents associated with mild motor impairment were antepartum (placental weight, maternal weight and antibiotic therapy) or intrapartum and postpartum adverse events (meconium-stained amniotic fluid, low Apgar score, admission to neonatal intensive care unit and neonatal encephalopathy). Antecedents associated with severe motor impairment were antepartum (congenital infection, small head circumference and brain maldevelopment) or intrapartum and postpartum (emergency cesarean section and maternal antibiotic therapy). Comparisons between mild and severe motor impairment revealed congenital infection, maldevelopment, neonatal encephalopathy and meconium aspiration syndrome significantly more often in the group with severe motor impairment (p < 0.05). White matter injury was the most common neuroimaging pattern in mild motor impairment, whereas maldevelopment and cortical/subcortical lesions were most common in the severe motor impairment group. CONCLUSIONS Our results suggest a variation in antecedents associated with cerebral palsy, related to severity of motor impairment. Timing of antecedents corresponded to neuroimaging patterns.
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Affiliation(s)
- Kristina Ahlin
- Perinatal Center, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Östra, Institute for Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kate Himmelmann
- Department of Pediatrics, Institute for Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Staffan Nilsson
- Department of Mathematical Statistics, Chalmers University of Technology, Gothenburg, Sweden
| | - Verena Sengpiel
- Perinatal Center, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Östra, Institute for Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Bo Jacobsson
- Perinatal Center, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Östra, Institute for Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Genes and Environment, Division of Epidemiology, Institute of Public Health, Oslo, Norway
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16
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Inoue H, Nishio H, Takada H, Sakai Y, Nanishi E, Ochiai M, Onimaru M, Chen SJ, Matsui T, Hara T. Activation of Nod1 Signaling Induces Fetal Growth Restriction and Death through Fetal and Maternal Vasculopathy. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2016; 196:2779-87. [PMID: 26880761 PMCID: PMC4777918 DOI: 10.4049/jimmunol.1500295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 01/05/2016] [Indexed: 01/09/2023]
Abstract
Intrauterine fetal growth restriction (IUGR) and death (IUFD) are both serious problems in the perinatal medicine. Fetal vasculopathy is currently considered to account for a pathogenic mechanism of IUGR and IUFD. We previously demonstrated that an innate immune receptor, the nucleotide-binding oligomerization domain-1 (Nod1), contributed to the development of vascular inflammations in mice at postnatal stages. However, little is known about the deleterious effects of activated Nod1 signaling on embryonic growth and development. We report that administration of FK565, one of the Nod1 ligands, to pregnant C57BL/6 mice induced IUGR and IUFD. Mass spectrometry analysis revealed that maternally injected FK565 was distributed to the fetal tissues across placenta. In addition, maternal injection of FK565 induced robust increases in the amounts of CCL2, IL-6, and TNF proteins as well as NO in maternal, placental and fetal tissues. Nod1 was highly expressed in fetal vascular tissues, where significantly higher levels of CCL2 and IL-6 mRNAs were induced with maternal injection of FK565 than those in other tissues. Using Nod1-knockout mice, we verified that both maternal and fetal tissues were involved in the development of IUGR and IUFD. Furthermore, FK565 induced upregulation of genes associated with immune response, inflammation, and apoptosis in fetal vascular tissues. Our data thus provided new evidence for the pathogenic role of Nod1 in the development of IUGR and IUFD at the maternal-fetal interface.
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Affiliation(s)
- Hirosuke Inoue
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan;
| | - Hisanori Nishio
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hidetoshi Takada
- Perinatal and Pediatric Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Etsuro Nanishi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Mitsuho Onimaru
- Department of Pathophysiological and Experimental Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; and
| | - Si Jing Chen
- Department of Bioscience and Bioenvironmental Sciences, Faculty of Agriculture, Graduate School of Kyushu University, Fukuoka 812-8581, Japan
| | - Toshiro Matsui
- Department of Bioscience and Bioenvironmental Sciences, Faculty of Agriculture, Graduate School of Kyushu University, Fukuoka 812-8581, Japan
| | - Toshiro Hara
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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17
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Herrera EA, Alegría R, Farias M, Díaz-López F, Hernández C, Uauy R, Regnault TRH, Casanello P, Krause BJ. Assessment of in vivo fetal growth and placental vascular function in a novel intrauterine growth restriction model of progressive uterine artery occlusion in guinea pigs. J Physiol 2016; 594:1553-61. [PMID: 26719023 DOI: 10.1113/jp271467] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/21/2015] [Indexed: 01/31/2023] Open
Abstract
Intra-uterine growth restriction (IUGR) is associated with short and long-term metabolic and cardiovascular alterations. Mice and rats have been extensively used to study the effects of IUGR, but there are notable differences in fetal and placental physiology relative to those of humans that argue for alternative animal models. This study proposes that gradual occlusion of uterine arteries from mid-gestation in pregnant guinea pigs produces a novel model to better assess human IUGR. Fetal biometry and in vivo placental vascular function were followed by sonography and Doppler of control pregnant guinea pigs and sows submitted to surgical placement of ameroid constrictors in both uterine arteries (IUGR) at mid-gestation (35 days). The ameroid constrictors induced a reduction in the fetal abdominal circumference growth rate (0.205 cm day(-1) ) compared to control (0.241 cm day(-1) , P < 0.001) without affecting biparietal diameter growth. Umbilical artery pulsatility and resistance indexes at 10 and 20 days after surgery were significantly higher in IUGR animals than controls (P < 0.01). These effects were associated with a decrease in the relative luminal area of placental chorionic arteries (21.3 ± 2.2% vs. 33.2 ± 2.7%, P < 0.01) in IUGR sows at near term. Uterine artery intervention reduced fetal (∼30%), placental (∼20%) and liver (∼50%) weights (P < 0.05), with an increased brain to liver ratio (P < 0.001) relative to the control group. These data demonstrate that the ameroid constrictor implantations in uterine arteries in pregnant guinea pigs lead to placental vascular dysfunction and altered fetal growth that induces asymmetric IUGR.
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Affiliation(s)
- Emilio A Herrera
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Av. Salvador 486, Providencia, 7500922, Santiago, Chile
| | - René Alegría
- Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Av. Salvador 486, Providencia, 7500922, Santiago, Chile
| | - Marcelo Farias
- División de Obstetricia y Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago, 8330024, Chile
| | - Farah Díaz-López
- División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cherie Hernández
- División de Obstetricia y Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago, 8330024, Chile.,División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Uauy
- División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Timothy R H Regnault
- Departments of Obstetrics and Gynaecology and Physiology and Pharmacology, Western University, London, Ontario, Canada.,Lawson Health Research Institute and Children's Health Research Institute, London, Ontario, Canada
| | - Paola Casanello
- División de Obstetricia y Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 391, Santiago, 8330024, Chile.,División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bernardo J Krause
- División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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18
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Giussani DA. The fetal brain sparing response to hypoxia: physiological mechanisms. J Physiol 2016; 594:1215-30. [PMID: 26496004 DOI: 10.1113/jp271099] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/12/2015] [Indexed: 01/13/2023] Open
Abstract
How the fetus withstands an environment of reduced oxygenation during life in the womb has been a vibrant area of research since this field was introduced by Joseph Barcroft, a century ago. Studies spanning five decades have since used the chronically instrumented fetal sheep preparation to investigate the fetal compensatory responses to hypoxia. This defence is contingent on the fetal cardiovascular system, which in late gestation adopts strategies to decrease oxygen consumption and redistribute the cardiac output away from peripheral vascular beds and towards essential circulations, such as those perfusing the brain. The introduction of simultaneous measurement of blood flow in the fetal carotid and femoral circulations by ultrasonic transducers has permitted investigation of the dynamics of the fetal brain sparing response for the first time. Now we know that major components of fetal brain sparing during acute hypoxia are triggered exclusively by a carotid chemoreflex and that they are modified by endocrine agents and the recently discovered vascular oxidant tone. The latter is determined by the interaction between nitric oxide and reactive oxygen species. The fetal brain sparing response matures as the fetus approaches term, in association with the prepartum increase in fetal plasma cortisol, and treatment of the preterm fetus with clinically relevant doses of synthetic steroids mimics this maturation. Despite intense interest into how the fetal brain sparing response may be affected by adverse intrauterine conditions, this area of research has been comparatively scant, but it is likely to take centre stage in the near future.
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Affiliation(s)
- Dino A Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
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19
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Serebrovskaya TV, Xi L. Intermittent hypoxia in childhood: the harmful consequences versus potential benefits of therapeutic uses. Front Pediatr 2015; 3:44. [PMID: 26042211 PMCID: PMC4436817 DOI: 10.3389/fped.2015.00044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/07/2015] [Indexed: 12/04/2022] Open
Abstract
Intermittent hypoxia (IH) often occurs in early infancy in both preterm and term infants and especially at 36-44 weeks postmenstrual age. These episodes of IH could result from sleep-disordered breathing or may be temporally unrelated to apnea or bradycardia events. There are numerous reports indicating adverse effects of IH on development, behavior, academic achievement, and cognition in children with sleep apnea syndrome. It remains uncertain about the exact causative relationship between the neurocognitive and behavioral morbidities and IH and/or its associated sleep fragmentation. On the other hand, well-controlled and moderate IH conditioning/training has been used in sick children for treating their various forms of bronchial asthma, allergic dermatoses, autoimmune thyroiditis, cerebral palsy, and obesity. This review article provides an updated and impartial analysis on the currently available evidence in supporting either side of the seemingly contradictory scenarios. We wish to stimulate a comprehensive understanding of such a complex physiological phenomenon as intermittent hypoxia, which may be accompanied by other confounding factors (e.g., hypercapnia, polycythemia), in order to prevent or reduce its harmful consequences, while maximizing its potential utility as an effective therapeutic tool in pediatric patients.
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Affiliation(s)
| | - Lei Xi
- Department of Internal Medicine, Virginia Commonwealth University , Richmond, VA , USA
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20
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Sullo MG, Perri D, Sibilio M, Rafaniello C, Fucile A, Rossi F, Capuano A. Hypoglycemia, polycythemia and hyponatremia in a newborn exposed to nebivolol during pregnancy. J Pharmacol Pharmacother 2015; 6:45-8. [PMID: 25709355 PMCID: PMC4319251 DOI: 10.4103/0976-500x.149148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/15/2014] [Accepted: 06/28/2014] [Indexed: 11/22/2022] Open
Abstract
Nebivolol is a third-generation beta blocker that exerts selective antagonistic activity on β1 receptors. It has vasodilating properties that result from direct stimulation of endothelial nitric oxide synthase. Nebivolol is indicated for the treatment of hypertension and heart failure, and is generally well tolerated. In this article, we report a case of an infant who was admitted to the Pediatrics and Neonatology Unit of the Moscati Hospital (Aversa, Italy) about 24 hours after birth. The reason for hospitalization was persistent severe hypoglycemia (blood glucose = 30 mg/dL) and jaundice (total bilirubin = 12.5 mg/dL, indirect bilirubin 11.75 mg/dL). He was born by spontaneous delivery after a normal term pregnancy. Birth weight was 3040 g and the Apgar score was 6-9. The mother reported taking nebivolol 5 mg/day for unspecified tachycardia in the last 4 months of pregnancy. Clinical and instrumental investigations carried out during hospitalization did not reveal any congenital or perinatal abnormalities. After treatment for metabolic and electrolyte imbalance, he was discharged on the 10th day of hospitalization, in good clinical condition and with normalization of clinical and laboratory parameters. Currently, there are no specific studies on nebivolol tolerability during pregnancy. Our data suggest that the risk profile of nebivolol during pregnancy is the same as that of other β-blockers. Therefore, further studies are required to determine the safety of β-blockers during pregnancy and the risks to the unborn child.
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Affiliation(s)
- Maria Giuseppa Sullo
- Department of Experimental Medicine, Section of Pharmacology, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Second University of Naples, Naples, Italy
| | - Domenico Perri
- Department of Pediatric, Moscati Hospital, Aversa, Italy
| | | | - Concetta Rafaniello
- Department of Experimental Medicine, Section of Pharmacology, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Second University of Naples, Naples, Italy
| | | | - Francesco Rossi
- Department of Experimental Medicine, Section of Pharmacology, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Second University of Naples, Naples, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, Section of Pharmacology, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Second University of Naples, Naples, Italy
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Carr DJ, Wallace JM, Aitken RP, Milne JS, Mehta V, Martin JF, Zachary IC, Peebles DM, David AL. Uteroplacental adenovirus vascular endothelial growth factor gene therapy increases fetal growth velocity in growth-restricted sheep pregnancies. Hum Gene Ther 2014; 25:375-84. [PMID: 24593228 DOI: 10.1089/hum.2013.214] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Fetal growth restriction (FGR) occurs in ∼8% of pregnancies and is a major cause of perinatal mortality and morbidity. There is no effective treatment. FGR is characterized by reduced uterine blood flow (UBF). In normal sheep pregnancies, local uterine artery (UtA) adenovirus (Ad)-mediated overexpression of vascular endothelial growth factor (VEGF) increases UBF. Herein we evaluated Ad.VEGF therapy in the overnourished adolescent ewe, an experimental paradigm in which reduced UBF from midgestation correlates with reduced lamb birthweight near term. Singleton pregnancies were established using embryo transfer in adolescent ewes subsequently offered a high intake (n=45) or control intake (n=12) of a complete diet to generate FGR or normal fetoplacental growth, respectively. High-intake ewes were randomized midgestation to receive bilateral UtA injections of 5×10¹¹ particles Ad.VEGF-A165 (n=18), control vector Ad.LacZ (n=14), or control saline (n=13). Fetal growth/well-being were evaluated using serial ultrasound. UBF was monitored using indwelling flowprobes until necropsy at 0.9 gestation. Vasorelaxation, neovascularization within the perivascular adventitia, and placental mRNA expression of angiogenic factors/receptors were examined using organ bath analysis, anti-vWF immunohistochemistry, and qRT-PCR, respectively. Ad.VEGF significantly increased ultrasonographic fetal growth velocity at 3-4 weeks postinjection (p=0.016-0.047). At 0.9 gestation fewer fetuses were markedly growth-restricted (birthweight >2SD below contemporaneous control-intake mean) after Ad.VEGF therapy. There was also evidence of mitigated fetal brain sparing (lower biparietal diameter-to-abdominal circumference and brain-to-liver weight ratios). No effects were observed on UBF or neovascularization; however, Ad.VEGF-transduced vessels demonstrated strikingly enhanced vasorelaxation. Placental efficiency (fetal-to-placental weight ratio) and FLT1/KDR mRNA expression were increased in the maternal but not fetal placental compartments, suggesting downstream effects on placental function. Ad.VEGF gene therapy improves fetal growth in a sheep model of FGR, although the precise mechanism of action remains unclear.
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Affiliation(s)
- David J Carr
- 1 UCL Institute for Women's Health, University College London , London WC1E 6HX, United Kingdom
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Wallace JM, Milne JS, Aitken RP, Adam CL. Impact of embryo donor adiposity, birthweight and gender on early postnatal growth, glucose metabolism and body composition in the young lamb. Reprod Fertil Dev 2014; 26:665-81. [DOI: 10.1071/rd13090] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/19/2013] [Indexed: 01/26/2023] Open
Abstract
Intrauterine growth restriction (IUGR) is a risk factor for metabolic syndrome, notably when associated with rapid postnatal catch-up growth. A sheep paradigm was used to assess relationships between prenatal and early postnatal growth trajectories, metabolism and body composition. Singletons (single-sire embryo transfer from obese and control donors) were gestated and suckled by overnourished adolescent dams and categorised by birthweight as IUGR or normal (N). Gestation length was equivalent in both categories and all lambs were delivered spontaneously preterm (PT; mean (± s.e.m.) 139.8 ± 1.7 days; term = 145–147 days). The IUGR lambs were smaller at birth, but fractional growth rates (FGR) for eight anthropometry parameters were higher and independent of gender (except thorax girth; males (M) < females (F)). At Day 48, fasting glucose (IUGR > N; M > F) and first-phase insulin response (to 20 min; IUGR < N; M < F) after glucose were influenced by prenatal growth and gender. Embryo donor adiposity influenced glucose tolerance only. Plasma insulin, insulin-like growth factor-1 (M > F) and leptin (M < F) were influenced by gender but not prenatal growth. At necropsy (Day 77), IUGR plus PT lambs had decreased carcass and visceral organ weights, but carcass composition was not different from N plus PT. In contrast, M were heavier, with lower internal fat mass, carcass fat percentage and perirenal fat leptin mRNA than F. Therefore, IUGR was associated with increased postnatal FGR and altered glucose handling, but, without absolute catch-up growth, gender had the predominant influence on postnatal leptinaemia and adiposity.
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Flamant C, Gascoin G. Devenir précoce et prise en charge néonatale du nouveau-né petit pour l’âge gestationnel. ACTA ACUST UNITED AC 2013; 42:985-95. [DOI: 10.1016/j.jgyn.2013.09.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zana-Taieb E, Butruille L, Franco-Montoya ML, Lopez E, Vernier F, Grandvuillemin I, Evain-Brion D, Deruelle P, Baud O, Delacourt C, Jarreau PH. Effect of two models of intrauterine growth restriction on alveolarization in rat lungs: morphometric and gene expression analysis. PLoS One 2013; 8:e78326. [PMID: 24278109 PMCID: PMC3836790 DOI: 10.1371/journal.pone.0078326] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 09/11/2013] [Indexed: 01/21/2023] Open
Abstract
Intrauterine growth restriction (IUGR) in preterm infants increases the risk of bronchopulmonary dysplasia, characterized by arrested alveolarization. We evaluated the impact of two different rat models (nitric oxide synthase inhibition or protein deprivation) of IUGR on alveolarization, before, during, and at the end of this postnatal process. We studied IUGR rat pups of dams fed either a low protein (LPD) or a normal diet throughout gestation and pups of dams treated by continuous infusion of Nω-nitro-L-arginine methyl ester (L-NAME) or its diluent on the last four days of gestation. Morphometric parameters, alveolar surface (Svap), mean linear intercept (MLI) and radial alveolar count (RAC) and transcriptomic analysis were determined with special focus on genes involved in alveolarization. IUGR pups regained normal weight at day 21 in the two treated groups. In the LPD group, Svap, MLI and RAC were not different from those of controls at day 4, but were significantly decreased at day 21, indicating alveolarization arrest. In the L-NAME group, Svap and RAC were significantly decreased and MLI was increased at day 4 with complete correction at day 21. In the L-NAME model, several factors involved in alveolarization, VEGF, VEGF-R1 and –R2, MMP14, MMP16, FGFR3 and 4, FGF18 and 7, were significantly decreased at day 4 and/or day 10, while the various factors studied were not modified in the LPD group. These results demonstrate that only maternal protein deprivation leads to sustained impairment of alveolarization in rat pups, whereas L-NAME impairs lung development before alveolarization. Known growth factors involved in lung development do not seem to be involved in LPD-induced alveolarization disorders, raising the question of a possible programming of altered alveolarization.
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Affiliation(s)
- Elodie Zana-Taieb
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U767, Paris, France
- PremUp, Paris, France
- Service de Médecine et Réanimation néonatales de Port-Royal, Groupe hospitalier Cochin, Broca, Hôtel-Dieu, Assistance Publique – Hôpitaux de Paris, Paris, France
- Université Paris Descartes, Paris, France
- * E-mail:
| | - Laura Butruille
- Unité environnement périnatal et croissance, EA4489, Faculté de Médecine, Pôle recherche, IFR 114,Université Lille Nord de France, Lille, France
| | | | - Emmanuel Lopez
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U767, Paris, France
- PremUp, Paris, France
- Service de Médecine et Réanimation néonatales de Port-Royal, Groupe hospitalier Cochin, Broca, Hôtel-Dieu, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Flore Vernier
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U767, Paris, France
- PremUp, Paris, France
| | - Isabelle Grandvuillemin
- Institut National de la Santé Et de la Recherche Médicale (INSERM) UMR 1076, Faculté de Pharmacie, Université de la Méditerranée. Marseille, France
| | - Danièle Evain-Brion
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U767, Paris, France
- PremUp, Paris, France
- Université Paris Descartes, Paris, France
| | - Philippe Deruelle
- Unité environnement périnatal et croissance, EA4489, Faculté de Médecine, Pôle recherche, IFR 114,Université Lille Nord de France, Lille, France
| | - Olivier Baud
- PremUp, Paris, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U676, Paris, France
- Service de Réanimation et Pédiatrie néonatales, Hôpital Robert Debré, Assistance Publique – Hôpitaux de Paris, Paris, France
- Université Paris Diderot, Paris, France
| | - Christophe Delacourt
- PremUp, Paris, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U955 IMRB Equipe 04, Créteil, France
- Service de Pneumologie Pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique – Hôpitaux de Paris, Paris, France
- Université Paris Descartes, Paris, France
| | - Pierre-Henri Jarreau
- Institut National de la Santé Et de la Recherche Médicale (INSERM) U767, Paris, France
- PremUp, Paris, France
- Service de Médecine et Réanimation néonatales de Port-Royal, Groupe hospitalier Cochin, Broca, Hôtel-Dieu, Assistance Publique – Hôpitaux de Paris, Paris, France
- Université Paris Descartes, Paris, France
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Antecedents of Cerebral Palsy and Perinatal Death in Term and Late Preterm Singletons. Obstet Gynecol 2013; 122:869-877. [DOI: 10.1097/aog.0b013e3182a265ab] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Deter RL, Lee W, Sangi-Haghpeykar H, Tarca AL, Yeo L, Romero R. Individualized fetal growth assessment: critical evaluation of key concepts in the specification of third trimester size trajectories. J Matern Fetal Neonatal Med 2013; 27:543-51. [PMID: 23962305 DOI: 10.3109/14767058.2013.833904] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To characterize second and third trimester fetal growth using Individualized Growth Assessment methods in a larger cohort of fetuses with normal neonatal growth outcomes. METHODS A prospective longitudinal study of 119 pregnancies was performed from 18 weeks, MA, to delivery. Measurements of several 1D and 3D fetal size parameters were obtained from 3D volume data sets at 3-4 week intervals. Regression analyses were used to determine Start Points (SP) and Rossavik model (P = c {t} (k + st)) coefficients c. k and s for each parameter in each fetus. Second trimester growth velocity reference ranges were determined and size model specification functions re-established, the latter used to generate individual size models. Actual measurements were compared to predicted third trimester size trajectories using Percent Deviations. New age-specific reference ranges for the Percent Deviations of each parameter were defined using 2-level statistical modeling. RESULTS Rossavik models fit the data for all parameters very well (R(2): 99%), with SP's and k values similar to those found in much smaller cohorts. The c* values were strongly related to the second trimester slope (R(2): 97%), as was predicted s* to estimated c* (R(2): 54--95%). Rossavik models predicted third trimester growth with systematic errors close to 0%; random errors (95% range) ranged between 5.7 and 10.9% and 20.0 and 24.3% for 1D and 3D parameters, respectively. CONCLUSIONS IGA procedures for evaluating second and third trimester growth are now established based on a larger cohort (4-6 fold larger). New, more rigorously defined, age-specific standards for the evaluation of third trimester size deviations are now available for nine anatomical parameters and a weight estimation procedure that incorporates a soft tissue parameter (fractional thigh volume). These results provide a means for more reliably assessing fetal growth on an individualized basis, thus minimizing the effect of biological differences in growth.
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Affiliation(s)
- Russell L Deter
- Department of Obstetrics and Gynecology, Baylor College of Medicine , Houston, TX , USA
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Carr DJ, Aitken RP, Milne JS, David AL, Wallace JM. Fetoplacental biometry and umbilical artery Doppler velocimetry in the overnourished adolescent model of fetal growth restriction. Am J Obstet Gynecol 2012; 207:141.e6-15. [PMID: 22840729 DOI: 10.1016/j.ajog.2012.05.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 05/02/2012] [Accepted: 05/09/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate ultrasonographically fetal growth trajectories, placental biometry, and umbilical artery (UA) Doppler indices in growth-restricted pregnancies of overnourished adolescent ewes and normally developing pregnancies of control-fed ewes. STUDY DESIGN Singleton pregnancies were established using embryo transfer in 42 adolescent ewes that were overnourished (n = 27) or control-fed (n = 15) and were scanned at weekly intervals from 83-126 days' gestation and necropsied at 131 days' gestation (term = 145 days). RESULTS Ultrasonographic placental measurements were reduced and UA Doppler indices were increased from 83 days' gestation; measurements of fetal abdominal circumference and femur length, renal volume and tibia length, and biparietal diameter were reduced from 98, 105, and 112 days' gestation, respectively, in overnourished vs control-intake pregnancies. CONCLUSION Overnourishment of adolescent sheep dams produced late-onset asymmetric fetal growth restriction that was commensurate with brain sparing. Ultrasonographic placental biometry was already reduced and UA Doppler indices increased by mid gestation in overnourished pregnancies, preceding reduced fetal growth velocity and indicating an early nutritionally mediated insult on placental development.
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Can placental growth factor in maternal circulation identify fetuses with placental intrauterine growth restriction? Am J Obstet Gynecol 2012; 206:163.e1-7. [PMID: 22055338 DOI: 10.1016/j.ajog.2011.09.019] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 07/27/2011] [Accepted: 09/21/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We investigated whether decreased concentrations of placental growth factor (PlGF) in maternal circulation differentiated placental intrauterine growth restriction (IUGR) from constitutionally small fetuses. Excluding congenital syndromes, infection, and aneuploidy, we assumed IUGR with an abnormal placental pathology to be of placental origin. STUDY DESIGN The study design included a single site, case-control study of 16 cases (9 placental IUGR, 7 constitutionally small) and 79 normal controls with singleton pregnancies. Plasma PlGF was measured by Triage PlGF immunoassay according to the product insert. A positive PlGF test was defined as a concentration less than the fifth percentile for gestational age for normal pregnancy. RESULTS A positive PlGF test was found in 9 of 9 placental IUGR cases, 1 of 7 constitutionally small fetuses, and 4 of 79 controls (P < .0001). PlGF identified placental IUGR from constitutionally small fetuses with 100% sensitivity and 86% specificity (P = .0009). CONCLUSION These preliminary data suggest PlGF may identify placental IUGR antenatally.
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Suter M, Ma J, Harris A, Patterson L, Brown KA, Shope C, Showalter L, Abramovici A, Aagaard-Tillery KM. Maternal tobacco use modestly alters correlated epigenome-wide placental DNA methylation and gene expression. Epigenetics 2011; 6:1284-94. [PMID: 21937876 DOI: 10.4161/epi.6.11.17819] [Citation(s) in RCA: 196] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Several studies linking alterations in differential placental methylation with pregnancy disorders have implicated (de)regulation of the placental epigenome with fetal programming and later-in-life disease. We have previously demonstrated that maternal tobacco use is associated with alterations in promoter methylation of placental CYP1A1 and that these changes are correlated with CYP1A1 gene expression and fetal growth restriction. In this study we sought to expand our analysis of promoter methylation by correlating it to gene expression on a genome-wide scale. Employing side-by-side IlluminaHG-12 gene transcription with Infinium27K methylation arrays, we interrogated correlative changes in placental gene expression and DNA methylation associated with maternal tobacco smoke exposure at an epigenome-wide level and in consideration of signature gene pathways. We observed that the expression of 623 genes and the methylation of 1024 CpG dinucleotides are significantly altered among smokers, with only 38 CpGs showing significant differential methylation (differing by a methylation level of ≥10%). We identified a significant Pearson correlation (≥0.7 or ≤-0.7) between placental transcriptional regulation and differential CpG methylation in only 25 genes among non-smokers but in 438 genes among smokers (18-fold increase, p < 0.0001), with a dominant effect among oxidative stress pathways. Differential methylation at as few as 6 sites was attributed to maternal smoking-mediated birth weight reduction in linear regression models with Bonferroni correction (p < 1.8 × 10(-6)). These studies suggest that a common perinatal exposure (such as maternal smoking) deregulates placental methylation in a CpG site-specific manner that correlates with meaningful alterations in gene expression along signature pathways.
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Affiliation(s)
- Melissa Suter
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX, USA
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Lim K, Armitage JA, Stefanidis A, Oldfield BJ, Black MJ. IUGR in the absence of postnatal "catch-up" growth leads to improved whole body insulin sensitivity in rat offspring. Pediatr Res 2011; 70:339-44. [PMID: 21885936 DOI: 10.1203/pdr.0b013e31822a65a3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A suboptimal in utero environment leads to fetal adaptations to ensure short-term survival but in the long-term may lead to disease when the postnatal growth does not reflect that in utero. This study examined the effect of IUGR on whole body insulin sensitivity and metabolic activity in adult rats. Female Wistar-Kyoto rats were fed either a normal protein diet (NPD 20% casein) or a low protein diet (LPD; 8.7% casein) during pregnancy and 2 wk of lactation. In offspring at 32 wk of age, indirect calorimetry and dual energy x-ray absorptiometry (DEXA) were performed to assess metabolic activity and body composition. Insulin sensitivity was assessed using a euglycemic-hyperinsulinemic clamp. At 3 d of age, male and female LPD offspring were 23 and 27% smaller than controls, respectively. They remained significantly smaller throughout the experimental period (∼10% smaller at 32 wk). Importantly, there was increased insulin sensitivity in LPD offspring (47% increase in males and 38% increase in females); pancreatic insulin content was normal. Body composition, O2 consumption, respiratory exchange ratio (RER), and locomotor activity were not different to controls. These findings suggest that in the absence of "catch-up" growth IUGR programs for improved insulin sensitivity.
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Affiliation(s)
- Kyungjoon Lim
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria 3800, Australia
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Moscuzza F, Belcari F, Nardini V, Bartoli A, Domenici C, Cuttano A, Ghirri P, Boldrini A. Correlation between placental histopathology and fetal/neonatal outcome: chorioamnionitis and funisitis are associated to intraventricular haemorrage and retinopathy of prematurity in preterm newborns. Gynecol Endocrinol 2011; 27:319-23. [PMID: 20528214 DOI: 10.3109/09513590.2010.487619] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Placental anatomopathologic lesions are usually associated with pregnancy complications and neonatal impaired outcome. PATIENTS AND METHODS We included in our study 122 patients with gestational age of 26-35 weeks. From the analysis of three pathological aspects (chorioamnionitis, funisitis and chronic hypoxia), a score was assigned to each lesion depending on the severity of the alteration, to establish a correlation with an impaired neonatal outcome in preterm newborns. RESULTS We found a correlation between chronic hypoxia and preeclampsia, intrauterine growth restriction and/or small-for-gestational age status at birth. Our results also showed the strong association of fetal placental inflammatory status (chorioamnionitis and funisitis) with premature rupture of membranes, very low birth weight, birth at/before 32 gestational weeks, late-onset sepsis, patent duct arteriosus, intraventricular haemorrhage (IVH) and retinopathy of prematurity (ROP). CONCLUSIONS We confirm that placental lesions are associated with impaired pregnancy and neonatal outcome. During pregnancy it may be useful to identify some markers of inflammatory status and chronic hypoxia for an early diagnosis and a detailed monitoring of pregnancy course. Placental pathological analysis is very important to predict the risk of developing serious complications of preterm birth as ROP and IVH.
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Affiliation(s)
- Francesca Moscuzza
- Neonatology and Neonatal Intensive Care Unit, Department of Pediatrics, S. Chiara Hospital/University of Pisa, Italy.
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