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De Vos ES, Mulders AGMGJ, Koning AHJ, Willemsen SP, Rousian M, Van Rijn BB, Steegers EAP, Steegers-Theunissen RPM. Morphologic development of the first-trimester utero-placental vasculature is positively associated with embryonic and fetal growth: the Rotterdam Periconception Cohort. Hum Reprod 2024; 39:923-935. [PMID: 38503486 PMCID: PMC11063559 DOI: 10.1093/humrep/deae056] [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: 06/26/2023] [Revised: 01/31/2024] [Indexed: 03/21/2024] Open
Abstract
STUDY QUESTION Is morphologic development of the first-trimester utero-placental vasculature associated with embryonic growth and development, fetal growth, and birth weight percentiles? SUMMARY ANSWER Using the utero-placental vascular skeleton (uPVS) as a new imaging marker, this study reveals morphologic development of the first-trimester utero-placental vasculature is positively associated with embryonic growth and development, fetal growth, and birth weight percentiles. WHAT IS KNOWN ALREADY First-trimester development of the utero-placental vasculature is associated with placental function, which subsequently impacts embryonic and fetal ability to reach their full growth potential. The attribution of morphologic variations in the utero-placental vascular development, including the vascular structure and branching density, on prenatal growth remains unknown. STUDY DESIGN, SIZE, DURATION This study was conducted in the VIRTUAL Placental study, a subcohort of 214 ongoing pregnancies, embedded in the prospective observational Rotterdam Periconception Cohort (Predict study). Women were included before 10 weeks gestational age (GA) at a tertiary referral hospital in The Netherlands between January 2017 and March 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS We obtained three-dimensional power Doppler volumes of the gestational sac including the embryo and the placenta at 7, 9, and 11 weeks of gestation. Virtual Reality-based segmentation and a recently developed skeletonization algorithm were applied to the power Doppler volumes to generate the uPVS and to measure utero-placental vascular volume (uPVV). Absolute vascular morphology was quantified by assigning a morphologic characteristic to each voxel in the uPVS (i.e. end-, bifurcation-crossing-, or vessel point). Additionally, total vascular length (mm) was calculated. The ratios of the uPVS characteristics to the uPVV were calculated to determine the density of vascular branching. Embryonic growth was estimated by crown-rump length and embryonic volume. Embryonic development was estimated by Carnegie stages. Fetal growth was measured by estimated fetal weight in the second and third trimester and birth weight percentiles. Linear mixed models were used to estimate trajectories of longitudinal measurements. Linear regression analysis with adjustments for confounders was used to evaluate associations between trajectories of the uPVS and prenatal growth. Groups were stratified for conception method (natural/IVF-ICSI conceptions), fetal sex (male/female), and the occurrence of placenta-related complications (yes/no). MAIN RESULTS AND THE ROLE OF CHANCE Increased absolute vascular morphologic development, estimated by positive random intercepts of the uPVS characteristics, is associated with increased embryonic growth, reflected by crown-rump length (endpoints β = 0.017, 95% CI [0.009; 0.025], bifurcation points β = 0.012, 95% CI [0.006; 0.018], crossing points β = 0.017, 95% CI [0.008; 0.025], vessel points β = 0.01, 95% CI [0.002; 0.008], and total vascular length β = 0.007, 95% CI [0.003; 0.010], and similarly with embryonic volume and Carnegie stage, all P-values ≤ 0.01. Density of vascular branching was negatively associated with estimated fetal weight in the third trimester (endpoints: uPVV β = -94.972, 95% CI [-185.245; -3.698], bifurcation points: uPVV β = -192.601 95% CI [-360.532; -24.670]) and birth weight percentiles (endpoints: uPVV β = -20.727, 95% CI [-32.771; -8.683], bifurcation points: uPVV β -51.097 95% CI [-72.257; -29.937], and crossing points: uPVV β = -48.604 95% CI [-74.246; -22.961])), all P-values < 0.05. After stratification, the associations were observed in natural conceptions specifically. LIMITATION, REASONS FOR CAUTION Although the results of this prospective observational study clearly demonstrate associations between first-trimester utero-placental vascular morphologic development and prenatal growth, further research is required before we can draw firm conclusions about a causal relationship. WIDER IMPLICATIONS OF THE FINDINGS Our findings support the hypothesis that morphologic variations in utero-placental vascular development play a role in the vascular mechanisms involved in embryonic and fetal growth and development. Application of the uPVS could benefit our understanding of the pathophysiology underlying placenta-related complications. Future research should focus on the clinical applicability of the uPVS as an imaging marker for the early detection of fetal growth restriction. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Department of Obstetrics and Gynecology of the Erasmus MC, University Medical Centre, Rotterdam, The Netherlands. There are no conflicts of interest. TRIAL REGISTRATION NUMBER Registered at the Dutch Trial Register (NTR6854).
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Affiliation(s)
- E S De Vos
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A G M G J Mulders
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A H J Koning
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - S P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M Rousian
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - B B Van Rijn
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - R P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Lucius C, Koch JBH, Jenssen C, Karlas T, Sänger SL, Dietrich CF. [State of the art: Simulation in US]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:723-736. [PMID: 38417809 DOI: 10.1055/a-2183-1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Technical simulation of diagnostic and therapeutic procedures is of growing relevance for student education and advanced medical training and has already been introduced in the field of ultrasound. This review gives a broad overview on different levels of simulation for ultrasound diagnostics and highlights the technical background of the methodology. A critical review of the literature reveals recommendations for implementing simulation techniques in medical studies and professional ultrasound training. An analysis of strengths and weaknesses shows the advantages of simulation especially in the context of individual learning situations and COVID-19-related restrictions for personal interaction. However, simulation techniques cannot replace the experiences of complex clinical examinations with direct interaction to real patients. Therefore, future applications may focus on repetition and assessment of achieved competencies by using standardized feedback mechanisms in order to preserve the limited resources for practical medical training.
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Affiliation(s)
- Claudia Lucius
- CED-Zentrum Berlin-Nord, Poliklinik Gastroenterologie, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Jonas B H Koch
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christian Jenssen
- Innere Medizin, Krankenhaus Märkisch Oderland GmbH, Strausberg, Germany
- Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Sophie Luise Sänger
- Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christoph F Dietrich
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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Cooke CM, Flaxman TE, La Russa DJ, Duigenan S, Singh SS. Endometriosis Imaging: Enter the Metaverse of Possibilities. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:309-313. [PMID: 36868352 DOI: 10.1016/j.jogc.2023.02.011] [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: 12/21/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 03/05/2023]
Abstract
While laparoscopy has classically been defined as the gold standard for diagnosis of endometriosis, there is now a strong recommendation for the use of advanced imaging in diagnosing the disease. In addition to playing a crucial role in the diagnosis of endometriosis, advanced imaging is also essential for assisting gynaecologic surgeons in planning the surgical management of complex cases of deep endometriosis. This case demonstrates a metaverse of high-level imaging modalities, including advanced ultrasound and magnetic resonance (MRI), which were further enhanced with medical virtual reality, and used for assessment of a patient seen in an outpatient tertiary care gynaecology clinic.
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Affiliation(s)
- Carly M Cooke
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
| | - Teresa E Flaxman
- Department of Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, ON; Department of Radiology, University of Ottawa, Ottawa, ON
| | | | | | - Sukhbir S Singh
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON; Department of Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, ON.
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Dietrich CF, Lucius C, Nielsen MB, Burmester E, Westerway SC, Chu CY, Condous G, Cui XW, Dong Y, Harrison G, Koch J, Kraus B, Nolsøe CP, Nayahangan LJ, Pedersen MRV, Saftoiu A, Savitsky E, Blaivas M. The ultrasound use of simulators, current view, and perspectives: Requirements and technical aspects (WFUMB state of the art paper). Endosc Ultrasound 2023; 12:38-49. [PMID: 36629173 PMCID: PMC10134935 DOI: 10.4103/eus-d-22-00197] [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: 11/16/2022] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
Simulation has been shown to improve clinical learning outcomes, speed up the learning process and improve learner confidence, whilst initially taking pressure off busy clinical lists. The World Federation for Ultrasound in Medicine and Biology (WFUMB) state of the art paper on the use of simulators in ultrasound education introduces ultrasound simulation, its advantages and challenges. It describes different simulator types, including low and high-fidelity simulators, the requirements and technical aspects of simulators, followed by the clinical applications of ultrasound simulation. The paper discusses the role of ultrasound simulation in ultrasound clinical training, referencing established literature. Requirements for successful ultrasound simulation acceptance into educational structures are explored. Despite being in its infancy, ultrasound simulation already offers a wide range of training opportunities and likely holds the key to a broader point of care ultrasound education for medical students, practicing doctors, and other health care professionals. Despite the drawbacks of simulation, there are also many advantages, which are expanding rapidly as the technology evolves.
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Affiliation(s)
- Christoph F. Dietrich
- Department of Internal Medicine (DAIM), Hirslanden Private Hospital Bern, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Claudia Lucius
- Department of Gastroenterology, IBD Centre, Poliklinik Helios Klinikum Buch, Berlin, Germany
| | | | - Eike Burmester
- Department of Internal Medicine (DAIM), Sana Hospital, Luebeck, Germany
| | - Susan Campbell Westerway
- Department of Internal Medicine (DAIM), Faculty of Science and Health, Charles Sturt University, NSW, Australia
| | - Chit Yan Chu
- Department of Internal Medicine (DAIM), Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Sydney, NSW, Australia
| | - George Condous
- Department of Internal Medicine (DAIM), Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Sydney, NSW, Australia
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Jonas Koch
- Department of Internal Medicine (DAIM), Hirslanden Private Hospital Bern, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Barbara Kraus
- Department of Internal Medicine (DAIM), University of Applied Sciences FH Campus Wien, Health Sciences, Radiological Technology, Sonography, Vienna, Austria
| | - Christian Pállson Nolsøe
- Department of Surgery, Centre for Surgical Ultrasound, Zealand University Hospital, Køge, Denmark
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark
| | | | | | - Adrian Saftoiu
- Department of Gastroenterology and Hepatology, Elias Emergency University Hospital, University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania
| | - Eric Savitsky
- Ronald Reagan UCLA Medical Center, UCLA Emergency Medicine Residency Program, Los Angeles, California, USA
| | - Michael Blaivas
- Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
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van Duijn L, Steegers-Theunissen RP, Baart EB, Willemsen S, Laven JS, Rousian M. The impact of culture medium used in IVF-treatment on post-implantation embryonic growth and development with emphasis on sex-specificity: The Rotterdam Periconception Cohort. Reprod Biomed Online 2022; 45:1085-1096. [DOI: 10.1016/j.rbmo.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/08/2022] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
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First Trimester Maternal Homocysteine and Embryonic and Fetal Growth: The Rotterdam Periconception Cohort. Nutrients 2022; 14:nu14061129. [PMID: 35334786 PMCID: PMC8953595 DOI: 10.3390/nu14061129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
Abstract
Homocysteine is a marker for derangements in one-carbon metabolism. Elevated homocysteine may represent a causal link between poor maternal nutrition and impaired embryonic and fetal development. We sought to investigate associations between reference range maternal homocysteine and embryonic and fetal growth. We enrolled 1060 singleton pregnancies (555 natural and 505 in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) pregnancies) from November 2010 to December 2020. Embryonic and fetal body and head growth was assessed throughout pregnancy using three-dimensional ultrasound scans and virtual reality techniques. Homocysteine was negatively associated with first trimester embryonic growth in the included population (crown-rump length B −0.023 mm, 95% CI −0.038,−0.007, p = 0.004, embryonic volume B −0.011 cm3, 95% CI −0.018,−0.004, p = 0.003). After stratification for conception mode, this association remained in IVF/ICSI pregnancies with frozen embryo transfer (crown-rump length B −0.051 mm, 95% CI −0.081,−0.023, p < 0.001, embryonic volume B −0.024 cm3, 95% CI −0.039,−0.009, p = 0.001), but not in IVF/ICSI pregnancies with fresh embryo transfer and natural pregnancies. Homocysteine was not associated with longitudinal measurements of head growth in first trimester, nor with second and third trimester fetal growth. Homocysteine in the highest quartile (7.3−14.9 µmol/L) as opposed to the lowest (2.5−5.2 µmol/L) was associated with reduced birth weight in natural pregnancies only (B −51.98 g, 95% CI −88.13,−15.84, p = 0.005). In conclusion, high maternal homocysteine within the reference range is negatively associated with first trimester embryonic growth and birth weight, and the effects of homocysteine are dependent on conception mode.
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Wiertsema CJ, Sol CM, Mulders AGMGJ, Steegers EAP, Duijts L, Gaillard R, Koning AHJ, Jaddoe VWV. Innovative approach for first‐trimester fetal organ volume measurements using a Virtual Reality system: The Generation R
Next
Study. J Obstet Gynaecol Res 2022; 48:599-609. [PMID: 35092330 PMCID: PMC9306822 DOI: 10.1111/jog.15151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/16/2021] [Accepted: 01/02/2022] [Indexed: 12/03/2022]
Abstract
Introduction To investigate the reproducibility of first‐trimester fetal organ volume measurements using three‐dimensional (3D) ultrasound and a Virtual Reality system. Methods Within a population‐based prospective cohort study, 3D ultrasound datasets of 25 first‐trimester fetuses were collected by three sonographers. We used the V‐scope application to perform Virtual Reality volume assessments of the fetal heart, lungs, and kidneys. All measurements were performed by two independent researchers. Results Intraobserver analyses for volume measurements of the fetal heart, lungs, and kidneys showed intraclass correlation coefficients ≥0.86, mean differences ≤8.3%, and coefficients of variation ≤22.8%. Interobserver analyses showed sufficient agreement for right lung volume measurements, but consistent measurement differences between observers for left lung, heart, and kidney volume measurements (p‐values <0.05). Conclusion We observed sufficient intraobserver reproducibility, but overall suboptimal interobserver reproducibility for first‐trimester fetal heart, lung, and kidney volume measurements using an innovative Virtual Reality approach. In the current stage, these measurements might be promising for the use in research settings. The reproducibility of the measurements might be further improved by novel post‐processing algorithms.
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Affiliation(s)
- Clarissa J. Wiertsema
- The Generation R Study Group Erasmus University Medical Center Rotterdam The Netherlands
- Department of Pediatrics Erasmus University Medical Center Rotterdam The Netherlands
| | - Chalana M. Sol
- The Generation R Study Group Erasmus University Medical Center Rotterdam The Netherlands
- Department of Pediatrics Erasmus University Medical Center Rotterdam The Netherlands
| | | | - Eric A. P. Steegers
- Departments of Obstetrics and Gynecology Erasmus University Medical Center Rotterdam The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology Erasmus University Medical Center Rotterdam The Netherlands
- Department of Pediatrics, Division of Neonatology Erasmus University Medical Center Rotterdam The Netherlands
| | - Romy Gaillard
- The Generation R Study Group Erasmus University Medical Center Rotterdam The Netherlands
- Department of Pediatrics Erasmus University Medical Center Rotterdam The Netherlands
| | - Anton H. J. Koning
- The Generation R Study Group Erasmus University Medical Center Rotterdam The Netherlands
- Department of Pathology, Clinical Bioinformatics Unit Erasmus University Medical Center Rotterdam The Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study Group Erasmus University Medical Center Rotterdam The Netherlands
- Department of Pediatrics Erasmus University Medical Center Rotterdam The Netherlands
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Pietersma CS, Mulders AGMGJ, Sabanovic A, Willemsen SP, Jansen MS, Steegers EAP, Steegers-Theunissen RPM, Rousian M. OUP accepted manuscript. Hum Reprod 2022; 37:696-707. [PMID: 35193145 PMCID: PMC8971648 DOI: 10.1093/humrep/deac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is periconceptional maternal smoking associated with embryonic morphological development in ongoing pregnancies? SUMMARY ANSWER Smoking during the periconceptional period is associated with a delayed embryonic morphological development which is not fully recuperated beyond the first trimester of pregnancy. WHAT IS KNOWN ALREADY Smoking during pregnancy decreases prenatal growth, increasing the risk of preterm birth, small for gestational age (GA) and childhood obesity. STUDY DESIGN, SIZE, DURATION Between 2010 and 2018, 689 women with ongoing singleton pregnancies were periconceptionally enrolled in a prospective cohort study with follow-up until 1 year after delivery. PARTICIPANTS/MATERIALS, SETTING, METHODS Between 7 + 0 and 10 + 3 weeks, GA serial three-dimensional transvaginal ultrasound scans were performed. Embryonic morphological development as assessed by the Carnegie developmental stages was evaluated using Virtual Reality techniques. In the absence of fetal morphology classification methods beyond the embryonic period, fetal ultrasound measurements at around 20 weeks’ GA, and birth weight were used to assess fetal growth. Linear mixed models were used to evaluate the association between smoking and the Carnegie stages. Regarding first-trimester morphological development, we additionally stratified our findings for mode of conception. Multiple linear regression models were used to study the association between smoking, fetal growth and birth weight. To investigate to which extent delayed embryonic morphological development mediated the effect of smoking, contemporary mediation analysis was used. Adjustments were made for potential confounders and other covariates. MAIN RESULTS AND THE ROLE OF CHANCE A total of 689 singleton ongoing pregnancies were included and 1210 Carnegie stages were determined. Maternal periconceptional smoking represented by the number of cigarettes/day was associated with a slight non-significant delay of the Carnegie stages (βcigarettes/day = −0.058, 95% CI −0.122; 0.007, P = 0.080). Smoking of ≥10 cigarettes/day showed the strongest association (β≥10 cigarettes/day = −0.352, 95% CI −0.648; −0.057, P = 0.019), as reflected by a 0.9-day delay in reaching the final Carnegie stage. Stratification for mode of conception showed a stronger negative association between the number of cigarettes/day in the IVF/ICSI group (βcigarettes/day = −0.126, 95% CI −0.200; −0.051, P = 0.001) compared to naturally conceived pregnancies (βcigarettes/day = 0.009, 95% CI −0.093; 0.111, P = 0.867). In the IVF/ICSI group, periconceptional smoking of ≥10 cigarettes/day was associated with in a 1.6 day delay in reaching the final Carnegie stage (β≥10 cigarettes/day = −0.510, 95% CI −0.834; −0.186, P = 0.002). In the second trimester, periconceptional smoking was associated with a smaller femur length (βcigarettes/day = −0.077, 95% CI −0.147; −0.008, P = 0.029) and a larger head circumference (β1–9 cigarettes/day = 0.290, 95% CI 0.065; 0.514, P = 0.012). Smoking was associated with a lower birth weight, with a dose-response effect (βcigarettes/day = −0.150, 95% CI −0.233; −0.068, P < 0.001). Furthermore, using the unadjusted model, 40–60% of the association between smoking and fetal ultrasound parameters and 6.3% of the association between smoking and birth weight can be explained by a delayed embryonic morphology. LIMITATIONS, REASONS FOR CAUTION The study population was recruited from a tertiary referral center. Smoking habits were explored using self-reported questionnaires and checked for consistency by trained researchers. WIDER IMPLICATIONS OF THE FINDINGS This study shows that the association of periconceptional maternal smoking and human morphological development can already be detected early in the first trimester of pregnancy using embryonic morphology as outcome. One of the key messages of this study is that the delay, or dysregulation, in embryonic morphology is associated with allometric growth reflected by smaller fetal measurements at 20 weeks gestation and lower weight at birth. The delay in embryonic morphology, measured in early pregnancy, cannot be recuperated during the pregnancy. The results of this study emphasize the importance of smoking intervention programs prior to conception. More research is warranted to assess the association between periconceptional smoking cessation and embryonic development. STUDY FUNDING/COMPETING INTEREST(S) The work was funded by the Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- C S Pietersma
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - A G M G J Mulders
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - A Sabanovic
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - S P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - M S Jansen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - R P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - M Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Correspondence address. Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre, PO Box 2040, Room Ee2271a, 3000 CA Rotterdam, The Netherlands. Tel: +31-10 7038254; Fax: +31-10-7036815; E-mail: https://orcid.org/0000-0002-3008-2567
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Reijnders IF, Mulders A, Koster M, Kropman A, Koning A, Willemsen SP, Steegers E, Steegers-Theunissen R. First-trimester maternal haemodynamic adaptation to pregnancy and placental, embryonic and fetal development: the prospective observational Rotterdam Periconception cohort. BJOG 2021; 129:785-795. [PMID: 34665928 PMCID: PMC9298112 DOI: 10.1111/1471-0528.16979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/29/2022]
Abstract
Objective To investigate whether first‐trimester maternal haemodynamic adaptation impacts placental, embryonic and fetal development as well as birth outcomes in pregnancies with and without placenta‐related complications. Design Prospective observational cohort. Setting A Dutch tertiary hospital. Population Two hundred and fourteen ongoing pregnancies. Methods At 7, 9 and 11 weeks of gestation, we assessed maternal haemodynamic adaptation (mean arterial blood pressure [MAP], uterine artery [UtA] blood flow) and placental development (placental volume [PV], uteroplacental vascular volume [uPVV]) using three‐dimensional power Doppler ultrasound volumes, and embryonic development (crown–rump length, embryonic volume). At 22 and 32 weeks of gestation, fetal development was assessed by estimated fetal weight. Birth outcomes (birthweight, placental weight) were extracted from medical records. Linear mixed modelling and linear regression analyses were applied. Main outcome measures Birthweight centile and placental weight. Results In placenta‐related complications (n= 55, 25.7%), reduced haemodynamic adaptation, i.e. higher UtA pulsatility index (PI) and resistance index (RI) trajectories, was associated with smaller increase in PV (β = −0.559, 95% CI −0.841 to −0.278, P< 0.001; β = −0.579, 95% CI −0.878 to −0.280, P< 0.001) and uPVV trajectories (UtA PI: β = −0.301, 95% CI −0.578 to −0.023, P= 0.034). At birth, reduced haemodynamic adaptation was associated with lower placental weight (UtA PI: β = −0.502, 95% CI −0.922 to −0.082, P= 0.022; UtA RI: β = −0.435, 95% CI −0.839 to −0.032, P= 0.036). In pregnancies without placenta‐related complications, higher MAP trajectories were positively associated with birthweight centile (β = 0.398, 95% CI 0.049–0.748, P= 0.025). Conclusions Reduced first‐trimester maternal haemodynamic adaptation impacts both placental size and vascularisation and birthweight centile, in particular in pregnancies with placenta‐related complications. Tweetable abstract Reduced first‐trimester maternal haemodynamic adaptation to pregnancy impairs early placental development.
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Affiliation(s)
- I F Reijnders
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Agmgj Mulders
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Mph Koster
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Atm Kropman
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ahj Koning
- Department of Pathology, Clinical Bioinformatics Unit Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - S P Willemsen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eap Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Rpm Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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10
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Rubini E, Baijens IMM, Horánszky A, Schoenmakers S, Sinclair KD, Zana M, Dinnyés A, Steegers-Theunissen RPM, Rousian M. Maternal One-Carbon Metabolism during the Periconceptional Period and Human Foetal Brain Growth: A Systematic Review. Genes (Basel) 2021; 12:1634. [PMID: 34681028 PMCID: PMC8535925 DOI: 10.3390/genes12101634] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/01/2021] [Accepted: 10/12/2021] [Indexed: 01/13/2023] Open
Abstract
The maternal environment during the periconceptional period influences foetal growth and development, in part, via epigenetic mechanisms moderated by one-carbon metabolic pathways. During embryonic development, one-carbon metabolism is involved in brain development and neural programming. Derangements in one-carbon metabolism increase (i) the short-term risk of embryonic neural tube-related defects and (ii) long-term childhood behaviour, cognition, and autism spectrum disorders. Here we investigate the association between maternal one-carbon metabolism and foetal and neonatal brain growth and development. Database searching resulted in 26 articles eligible for inclusion. Maternal vitamin B6, vitamin B12, homocysteine, and choline were not associated with foetal and/or neonatal head growth. First-trimester maternal plasma folate within the normal range (>17 nmol/L) associated with increased foetal head size and head growth, and high erythrocyte folate (1538-1813 nmol/L) with increased cerebellar growth, whereas folate deficiency (<7 nmol/L) associated with a reduced foetal brain volume. Preconceptional folic acid supplement use and specific dietary patterns (associated with increased B vitamins and low homocysteine) increased foetal head size. Although early pregnancy maternal folate appears to be the most independent predictor of foetal brain growth, there is insufficient data to confirm the link between maternal folate and offspring risks for neurodevelopmental diseases.
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Affiliation(s)
- Eleonora Rubini
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (E.R.); (I.M.M.B.); (S.S.); (M.R.)
| | - Inge M. M. Baijens
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (E.R.); (I.M.M.B.); (S.S.); (M.R.)
| | - Alex Horánszky
- Department of Physiology and Animal Health, Institute of Physiology and Animal Health, Hungarian University of Agriculture and Life Sciences, H-2100 Gödöllő, Hungary; (A.H.); (A.D.)
- BioTalentum Ltd., H-2100 Gödöllő, Hungary;
| | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (E.R.); (I.M.M.B.); (S.S.); (M.R.)
| | - Kevin D. Sinclair
- School of Biosciences, University of Nottingham, Nottingham LE12 5RD, UK;
| | | | - András Dinnyés
- Department of Physiology and Animal Health, Institute of Physiology and Animal Health, Hungarian University of Agriculture and Life Sciences, H-2100 Gödöllő, Hungary; (A.H.); (A.D.)
- BioTalentum Ltd., H-2100 Gödöllő, Hungary;
- HCEMM-USZ Stem Cell Research Group, Hungarian Centre of Excellence for Molecular Medicine, H-6723 Szeged, Hungary
- Department of Cell Biology and Molecular Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Régine P. M. Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (E.R.); (I.M.M.B.); (S.S.); (M.R.)
| | - Melek Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (E.R.); (I.M.M.B.); (S.S.); (M.R.)
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11
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Rousian M, Schoenmakers S, Eggink AJ, Gootjes DV, Koning AHJ, Koster MPH, Mulders AGMGJ, Baart EB, Reiss IKM, Laven JSE, Steegers EAP, Steegers-Theunissen RPM. Cohort Profile Update: the Rotterdam Periconceptional Cohort and embryonic and fetal measurements using 3D ultrasound and virtual reality techniques. Int J Epidemiol 2021; 50:1426-1427l. [PMID: 34097026 PMCID: PMC8580268 DOI: 10.1093/ije/dyab030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Melek Rousian
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | - Alex J Eggink
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | - Dionne V Gootjes
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | - Anton H J Koning
- Department of Pathology, University Medical Center, Rotterdam, The Netherlands
| | - Maria P H Koster
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | | | - Esther B Baart
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Joop S E Laven
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
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12
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Wiertsema CJ, Erkamp JS, Mulders AGMGJ, Steegers EAP, Duijts L, Koning AHJ, Gaillard R, Jaddoe VWV. First trimester fetal proportion volumetric measurements using a Virtual Reality approach. Prenat Diagn 2021; 41:868-876. [PMID: 33811672 PMCID: PMC8251560 DOI: 10.1002/pd.5947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/15/2021] [Accepted: 03/27/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To establish feasibility and reproducibility of fetal proportion volumetric measurements, using three-dimensional (3D) ultrasound and a Virtual Reality (VR) system. METHODS Within a population-based prospective birth cohort, 3D ultrasound datasets of 50 fetuses in the late first trimester were collected by three ultrasonographers in a single research center. V-scope software was used for volumetric measurements of total fetus, extremities, head-trunk, head, trunk, thorax, and abdomen. All measurements were performed independently by two researchers. Intraobserver and interobserver reproducibility were analyzed using Bland and Altman methods. RESULTS Intraobserver and interobserver analyses of volumetric measurements of total fetus, head-trunk, head, trunk, thorax and abdomen showed intraclass correlation coefficients above 0.979, coefficients of variation below 7.51% and mean difference below 3.44%. The interobserver limits of agreement were within the ±10% range for volumetric measurements of total fetus, head-trunk, head and trunk. The interobserver limits of agreement for extremities, thorax and abdomen were -26.09% to 4.77%, -14.14% to 10.00% and -14.47% to 8.83%, respectively. CONCLUSION First trimester fetal proportion volumetric measurements using 3D ultrasound and VR are feasible and reproducible, except volumetric measurements of the fetal extremities. These novel volumetric measurements may be used in future research to enable detailed studies on first trimester fetal development and growth.
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Affiliation(s)
- Clarissa J. Wiertsema
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
| | - Jan S. Erkamp
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
| | | | - Eric A. P. Steegers
- Departments of Obstetrics and GynecologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Liesbeth Duijts
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsDivision of Respiratory Medicine and AllergologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Anton H. J. Koning
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Clinical Bioinformatics UnitDepartment of PathologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Romy Gaillard
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study GroupErasmus University Medical CenterRotterdamThe Netherlands
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
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13
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van Duijn L, Hoek J, Rousian M, Baart EB, Willemsen SP, Laven JSE, Steegers-Theunissen RPM, Schoenmakers S. Prenatal growth trajectories and birth outcomes after frozen-thawed extended culture embryo transfer and fresh embryo transfer: the Rotterdam Periconception Cohort. Reprod Biomed Online 2021; 43:279-287. [PMID: 34092521 DOI: 10.1016/j.rbmo.2021.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
RESEARCH QUESTION Are there differences in prenatal growth trajectories and birth outcomes between singleton pregnancies conceived after IVF treatment with frozen-thawed extended culture embryo transfer at day 5, fresh embryo transfer at day 3 or naturally conceived pregnancies? DESIGN From a prospective hospital-based cohort, 859 singleton pregnancies were selected, including 133 conceived after IVF with frozen-thawed embryo transfer, 276 after fresh embryo transfer, and 450 naturally conceived pregnancies. Longitudinal 3D ultrasound scans were performed at 7, 9 and 11 weeks of gestation for offline crown-rump length (CRL) and embryonic volume measurements. Second trimester estimated fetal weight was based on growth parameters obtained during the routine fetal anomaly scan at 20 weeks of gestation. Birth outcome data were collected from medical records. RESULTS No differences regarding embryonic growth trajectories were observed between frozen-thawed and fresh embryo transfer. Birthweight percentiles after fresh embryo transfer were lower than after frozen-thawed embryo transfer (38.0 versus 48.0; P = 0.046, respectively). The prevalence of non-iatrogenic preterm birth (PTB) was significantly lower in pregnancies resulting from fresh embryo transfer compared with frozen-thawed embryo transfer (4.7% versus 10.9%; P = 0.026, respectively). Compared with naturally conceived pregnancies, birthweight percentiles and percentage of non-iatrogenic PTB were significantly lower in pregnancies after fresh embryo transfer and gestational age at birth was significantly higher. CONCLUSIONS This study shows that embryonic growth is comparable between singleton pregnancies conceived after fresh and frozen-thawed embryo transfer. The lower relative birthweight and PTB rate in pregnancies after fresh embryo transfer than after frozen-thawed embryo transfer and naturally conceived pregnancies warrants further investigation.
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Affiliation(s)
- Linette van Duijn
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jeffrey Hoek
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Esther B Baart
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | | | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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14
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Reijnders IF, Mulders AGMGJ, Koster MPH, Kropman ATM, de Vos ES, Koning AHJ, Willemsen SP, Rousian M, Steegers EAP, Steegers-Theunissen RPM. First-trimester utero-placental (vascular) development and embryonic and fetal growth: The Rotterdam periconception cohort. Placenta 2021; 108:81-90. [PMID: 33823358 DOI: 10.1016/j.placenta.2021.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Impaired placental development is a major cause of fetal growth restriction (FGR) and early detection will therefore improve antenatal care and birth outcomes. Here we aim to investigate serial first-trimester ultrasound markers of utero-placental (vascular) development in association with embryonic and fetal growth. METHODS In a prospective cohort, we periconceptionally included 214 pregnant women. Three-dimensional power Doppler ultrasonography at 7, 9 and 11 weeks gestational age (GA) was used to measure placental volumes (PV) and basal plate surface area by Virtual Organ Computer-aided AnaLysis™, and utero-placental vascular volume (uPVV), crown-rump length (CRL) and embryonic volume (EV) by a V-scope volume rendering application. Estimated fetal weight (EFW) was measured by ultrasound at 22 and 32 weeks GA and birth weight percentile (BW) was recorded. Linear mixed models and regression analyses were applied and appropriately adjusted. All analyses were stratified for fetal sex. RESULTS PV trajectories were positively associated with CRL (βadj = 0.416, 95%CI:0.255; 0.576, p < 0.001), EV (βadj = 0.220, 95%CI:0.058; 0.381, p = 0.008) and EFW (βadj = 0.182, 95%CI:0.012; 0.352, p = 0.037). uPVV trajectories were positively associated with CRL (βadj = 0.203, 95%CI 0.021; 0.384, p = 0.029). In girls, PV trajectories were positively associated with CRL (p < 0.001), EV (p = 0.018), EFW (p = 0.026), and uPVV trajectories were positively associated with BW (p = 0.040). In boys, positive associations were shown between PV trajectories and CRL (p = 0.002), and between uPVV trajectories and CRL (p = 0.046). DISCUSSION First-trimester utero-placental (vascular) development is associated with embryonic and fetal growth, with fetal sex specific modifications. This underlines the opportunity to monitor first-trimester placental development and supports the associations with embryonic and fetal growth.
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Affiliation(s)
- I F Reijnders
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - A G M G J Mulders
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - M P H Koster
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - A T M Kropman
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - E S de Vos
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - A H J Koning
- Department of Pathology, Clinical Bioinformatics Unit Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - S P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - M Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - R P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
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15
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Hoek J, Boellaard WPA, van Marion ES, Willemsen SP, Baart EB, Steegers-Theunissen RPM, Schoenmakers S. The impact of the origin of surgical sperm retrieval on placental and embryonic development: The Rotterdam Periconception cohort. Andrology 2020; 9:599-609. [PMID: 33207074 PMCID: PMC7986236 DOI: 10.1111/andr.12943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/17/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND In patients with azoospermia, pregnancy can be achieved after surgical techniques using sperm retrieved from the testis or epididymis, which can impact on DNA integrity and epigenetics. DNA of the fetus and placenta is equally derived from both parents; however, genes important for placental development are expressed from the paternal alleles. Therefore, the origin of sperm may affect fetal and placental development. OBJECTIVES To investigate whether first-trimester trajectories of embryonic and placental development of pregnancies conceived after intracytoplasmic sperm injection (ICSI) with testicular sperm extraction (TESE) or microsurgical epididymal sperm aspiration (MESA), are different from pregnancies after ICSI with ejaculated sperm or natural conceptions. MATERIALS AND METHODS A total of 147 singleton ICSI pregnancies, including pregnancies conceived after TESE (n = 23), MESA (n = 25) and ejaculated sperm (n = 99), and 380 naturally conceived and 140 after IVF treatment without ICSI were selected from the prospective Rotterdam periconception cohort. Crown-rump length (CRL), embryonic volume (EV), Carnegie stages, and placental volume (PV) at 7, 9, and 11 weeks of gestation were measured using 3D ultrasound and virtual reality technology. RESULTS Linear mixed model analysis showed no differences in trajectories of CRL, EV, and Carnegie stages between pregnancies conceived after ICSI with testicular, epididymal, and ejaculated sperm. A significantly positive association was demonstrated for PV between pregnancies conceived after TESE-ICSI (adjusted beta: 0.28(95%CI: 0.05-0.50)) versus ICSI with ejaculated sperm. Retransformation to original values showed that the PV of pregnancies after TESE-ICSI is 14.6% (95%CI: 1.4%-25.5%) larger at 11 weeks of gestation compared to ICSI pregnancies conceived with ejaculated sperm. DISCUSSION AND CONCLUSION Here we demonstrate that the first-trimester growth trajectory of the placenta is increased in pregnancies conceived after TESE-ICSI compared to those conceived after ICSI with ejaculated sperm. Findings are discussed in the light of known differences in sperm DNA integrity, epigenetics, and placental gene expression.
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Affiliation(s)
- Jeffrey Hoek
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem P A Boellaard
- Department of Urology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eva S van Marion
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Esther B Baart
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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16
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Frudiger A, Mulders AGMGJ, Rousian M, Plasschaert SCN, Koning AHJ, Willemsen SP, Steegers-Theunissen RPM, de Vries JIP, Steegers EAP. Evaluation of embryonic posture using four-dimensional ultrasound and virtual reality. J Obstet Gynaecol Res 2020; 47:397-406. [PMID: 33145949 PMCID: PMC7821160 DOI: 10.1111/jog.14554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/21/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
Aim To assess the possibility of embryonic posture evaluation (=feasibility, reproducibility, variation) at rest at 9 weeks' (+0–6 days) gestational age (GA) using four‐dimensional ultrasound and virtual reality (VR) techniques. Moreover, it is hypothesized that embryonic posture shows variation at the same time point in an uneventful pregnancy. Methods In this explorative prospective cohort study, 23 pregnant women were recruited from the Rotterdam periconceptional cohort. A transvaginal four‐dimensional ultrasound examination of 30 min per pregnancy was performed between 9 and 10 weeks' GA. The acquired datasets were offline evaluated longitudinally (i.e. per frame) using VR techniques. Results The ultrasound data of 16 (70%) out of 23 pregnancies were eligible for evaluation. At rest the analysis of the embryonic posture was feasible and showed a strong (>80%) intraobserver and interobserver reproducibility for most body parts. The majority of the body parts were in similar anatomic positions at rest. However, variations in anatomic positions (e.g. 6% rotated head, 9% laterally bent spine), within and between embryos, were seen at 9 weeks' GA. Conclusion In this unique study, we showed for the first time that embryonic posture measurements at rest can be performed in a reliable way using state‐of‐the‐art four‐dimensional ultrasound and VR techniques. Already early in prenatal life there are differences regarding posture within and between embryos.
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Affiliation(s)
- Anne Frudiger
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sophie C N Plasschaert
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Anton H J Koning
- Department of Pathology, Division of Clinical Bioinformatics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Regine P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Johanna I P de Vries
- Department of Obstetrics and Gynecology, Amsterdam Movement Science, Amsterdam UMC-VUmc, Amsterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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17
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Pietersma CS, Mulders AGMGJ, Moolenaar LM, Hunink MGM, Koning AHJ, Willemsen SP, Go ATJI, Steegers EAP, Rousian M. First trimester anomaly scan using virtual reality (VR FETUS study): study protocol for a randomized clinical trial. BMC Pregnancy Childbirth 2020; 20:515. [PMID: 32894073 PMCID: PMC7487721 DOI: 10.1186/s12884-020-03180-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 08/14/2020] [Indexed: 02/08/2023] Open
Abstract
Background In recent years it has become clear that fetal anomalies can already be detected at the end of the first trimester of pregnancy by two-dimensional (2D) ultrasound. This is why increasingly in developed countries the first trimester anomaly scan is being offered as part of standard care. We have developed a Virtual Reality (VR) approach to improve the diagnostic abilities of 2D ultrasound. Three-dimensional (3D) ultrasound datasets are used in VR assessment, enabling real depth perception and unique interaction. The aim of this study is to investigate whether first trimester 3D VR ultrasound is of additional value in terms of diagnostic accuracy for the detection of fetal anomalies. Health-related quality of life, cost-effectiveness and also the perspective of both patient and ultrasonographer on the 3D VR modality will be studied. Methods Women in the first trimester of a high risk pregnancy for a fetus with a congenital anomaly are eligible for inclusion. This is a randomized controlled trial with two intervention arms. The control group receives ‘care as usual’: a second trimester 2D advanced ultrasound examination. The intervention group will undergo an additional first trimester 2D and 3D VR ultrasound examination. Following each examination participants will fill in validated questionnaires evaluating their quality of life and healthcare related expenses. Participants’ and ultrasonographers’ perspectives on the 3D VR ultrasound will be surveyed. The primary outcome will be the detection of fetal anomalies. The additional first trimester 3D VR ultrasound examination will be compared to ‘care as usual’. Neonatal or histopathological examinations are considered the gold standard for the detection of congenital anomalies. To reach statistical significance and 80% power with a detection rate of 65% for second trimester ultrasound examination and 70% for the combined detection of first trimester 3D VR and second trimester ultrasound examination, a sample size of 2800 participants is needed. Discussion First trimester 3D VR detection of fetal anomalies may improve patients’ quality of life through reassurance or earlier identification of malformations. Results of this study will provide policymakers and healthcare professionals with the highest level of evidence for cost-effectiveness of first trimester ultrasound using a 3D VR approach. Trial registration Dutch Trial Registration number NTR6309, date of registration 26 January 2017.
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Affiliation(s)
- C S Pietersma
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - A G M G J Mulders
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - L M Moolenaar
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - M G M Hunink
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, USA
| | - A H J Koning
- Department of Pathology, Clinical Bioinformatics Unit, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - S P Willemsen
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - A T J I Go
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - M Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Reijnders IF, Mulders AGMGJ, van der Windt M, Steegers EAP, Steegers-Theunissen RPM. The impact of periconceptional maternal lifestyle on clinical features and biomarkers of placental development and function: a systematic review. Hum Reprod Update 2020; 25:72-94. [PMID: 30407510 DOI: 10.1093/humupd/dmy037] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/17/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Worldwide, placenta-related complications contribute to adverse pregnancy outcomes, such as pre-eclampsia, fetal growth restriction and preterm birth, with implications for the future health of mothers and offspring. The placenta develops in the periconception period and forms the interface between mother and embryo/fetus. An unhealthy periconceptional maternal lifestyle, such as smoking, alcohol and under- and over-nutrition, can detrimentally influence placental development and function. OBJECTIVE AND RATIONALE The impact of maternal lifestyle on placental health is largely unknown. Therefore, we aim to summarize the evidence of the impact of periconceptional maternal lifestyle on clinical features and biomarkers of placental development and function throughout pregnancy. SEARCH METHODS A comprehensive search in Medline, Embase, Pubmed, The Cochrane Library Web of Science and Google Scholar was conducted. The search strategy included keywords related to the maternal lifestyle, smoking, alcohol, caffeine, nutrition (including folic acid supplement intake) and body weight. For placental markers throughout pregnancy, keywords related to ultrasound imaging, serum biomarkers and histological characteristics were used. We included randomized controlled trials and observational studies published between January 2000 and March 2017 and restricted the analysis to singleton pregnancies and maternal periconceptional lifestyle. Methodological quality was scored using the ErasmusAGE tool. A protocol of this systematic review has been registered in PROSPERO International prospective register of systematic reviews (PROSPERO 2016:CRD42016045596). OUTCOMES Of 2593 unique citations found, 82 studies were included. The median quality score was 5 (range: 0-10). The findings revealed that maternal smoking was associated with lower first-trimester placental vascularization flow indices, higher second- and third-trimester resistance of the uterine and umbilical arteries and lower resistance of the middle cerebral artery. Although a negative impact of smoking on placental weight was expected, this was less clear. Alcohol use was associated with a lower placental weight. One study described higher second- and third-trimester placental growth factor (PlGF) levels after periconceptional alcohol use. None of the studies looked at caffeine intake. Adequate nutrition in the first trimester, periconceptional folic acid supplement intake and strong adherence to a Mediterranean diet, were all associated with a lower resistance of the uterine and umbilical arteries in the second and third trimester. A low caloric intake resulted in a lower placental weight, length, breadth, thickness, area and volume. Higher maternal body weight was associated with a larger placenta measured by ultrasound in the second and third trimester of pregnancy or weighed at birth. In addition, higher maternal body weight was associated with decreased PlGF-levels. WIDER IMPLICATIONS Evidence of the impact of periconceptional maternal lifestyle on placental health was demonstrated. However, due to poorly defined lifestyle exposures and time windows of investigation, unstandardized measurements of placenta-related outcomes and small sample sizes of the included studies, a cautious interpretation of the effect estimates is indicated. We suggest that future research should focus more on physiological consequences of unhealthy lifestyle during the critical periconception window. Moreover, we foresee that new evidence will support the development of lifestyle interventions to improve the health of mothers and their offspring from the earliest moment in life.
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Affiliation(s)
- Ignatia F Reijnders
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
| | - Melissa van der Windt
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, University Medical Centre, Rotterdam, The Netherlands
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Bastiaansen WAP, Rousian M, Steegers-Theunissen RPM, Niessen WJ, Koning A, Klein S. Towards Segmentation and Spatial Alignment of the Human Embryonic Brain Using Deep Learning for Atlas-Based Registration. BIOMEDICAL IMAGE REGISTRATION 2020. [PMCID: PMC7279927 DOI: 10.1007/978-3-030-50120-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bijl RC, Cornette JMJ, van den Bosch AE, Duvekot JJ, Molinger J, Willemsen SP, Koning AHJ, Roos-Hesselink JW, Franx A, Steegers-Theunissen RPM, Koster MPH. Study protocol for a prospective cohort study to investigate Hemodynamic Adaptation to Pregnancy and Placenta-related Outcome: the HAPPO study. BMJ Open 2019; 9:e033083. [PMID: 31712350 PMCID: PMC6858161 DOI: 10.1136/bmjopen-2019-033083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The importance of cardiovascular health in relation to pregnancy outcome is increasingly acknowledged. Women who develop certain pregnancy complications, in particular preeclampsia, are at higher risk for future cardiovascular disease. Independent of its outcome, pregnancy requires a substantial adaptive response of the maternal cardiovascular system. In the Hemodynamic Adaptation to Pregnancy and Placenta-related Outcome (HAPPO) study, we aim to examine longitudinal maternal haemodynamic adaptation to pregnancy from the preconception period onwards. We hypothesise that women who will develop adverse pregnancy outcomes have impaired cardiovascular health before conception, leading to haemodynamic maladaptation to pregnancy and diminished uteroplacental vascular development. METHODS AND ANALYSIS In this prospective cohort study embedded in the Rotterdam periconception cohort, 200 women with a history of placenta-related pregnancy complications (high-risk group) and 100 women with an uncomplicated obstetric history (low-risk group) will be included. At five moments (preconception, first, second and third trimester and postdelivery), women will undergo an extensive examination of the macrocirculatory and microcirculatory system and uteroplacental vascular development. The main outcome measures are differences in maternal haemodynamic adaptation to pregnancy between women with and without placenta-related pregnancy complications. In a multivariate linear mixed model, the relationship between maternal haemodynamic adaptive parameters, (utero)placental vascularisation indices and clinical outcomes (occurrence of pregnancy complications, embryonic and fetal growth trajectories, miscarriage rate, gestational age at delivery, birth weight) will be studied. Subgroup analysis will be performed to study baseline and trajectory differences between high-risk and low-risk women, independent of subsequent pregnancy outcome. ETHICS AND DISSEMINATION This study protocol was approved by the Medical Ethics Committee of the Erasmus MC, Rotterdam, the Netherlands (MEC 2018-150). Results will be disseminated to the medical community by publications in peer-reviewed journals and presentations at scientific congresses. Also, patient associations will be informed and the public will be informed by dissemination through (social) media. TRIAL REGISTRATION NUMBER NL7394 (www.trialregister.nl).
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Affiliation(s)
- Rianne C Bijl
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | - Jérôme M J Cornette
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | - Jeroen Molinger
- Department of Intensive Care Adults, Erasmus MC, Rotterdam, The Netherlands
- Department of Anesthesiology & Intensive Care Medicine, Human Physiology and Pharmacology Lab (HPPL), Duke Medicine, Durham, North Carolina, USA
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Arie Franx
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Maria P H Koster
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
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Steegers EAP. Understanding preconception health for early life course medicine. Paediatr Perinat Epidemiol 2019; 33:503-505. [PMID: 31637731 DOI: 10.1111/ppe.12597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Eric A P Steegers
- Department of Obstetrics and Gynaecology, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
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