1
|
Wu X, He S, Shen Q, Xu S, Guo D, Liang B, Wang X, Cao H, Huang H, Xu L. Etiologic evaluation and pregnancy outcomes of fetal growth restriction (FGR) associated with structural malformations. Sci Rep 2024; 14:9220. [PMID: 38649697 PMCID: PMC11035600 DOI: 10.1038/s41598-024-59422-8] [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: 10/20/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
This study aimed to evaluate the etiology and pregnancy outcomes of fetuses underwent invasive prenatal diagnosis for fetal growth restriction (FGR) accompanied by structural malformations. Data from 130 pregnancies referred for prenatal diagnosis for FGR accompanied by structural malformations were obtained between July 2011 and July 2023. Traditional karyotyping was conducted for all the subjects. A total of 37 (28.5%) cases of chromosomal abnormalities were detected by karyotyping, including 30 cases of numerical anomalies and seven cases of unbalanced structural anomalies. Trisomy 18 was the most common abnormalities, accounting for 51.4%, significantly higher than any other chromosomal abnormality. The cohort was predominantly comprised of early-onset FGR (88.5%) compared to late-onset FGR (11.5%). The incidences of chromosomal abnormalities in this two groups were 29.6% (34/115) and 20.0% (3/15), respectively (p > 0.05). The majority (74.6%, 97/130) of the cohort were affected by a single system malformation, with chromosomal abnormalities found in 19.6% (19/97) of cases. In pregnancies of structural malformations involving two and multiple systems, the frequencies were 56.5% (13/23), and 50.0% (5/10), respectively. Single nucleotide polymorphism array (SNP array) was performed in parallel for 65 cases, revealing additional 7.7% cases of copy number variants (CNVs) compared to karyotyping. Polymerase chain reaction (PCR) was used for detection of cytomegalovirus (CMV) DNA in 92 cases. All fetuses with FGR associated with two or more system malformations were either terminated or stillborn, irrespective of chromosomal aberrations. Conversely, 71.8% of pregnancies with a single-system malformation and normal genetic testing results resulted in live births. Furthermore, two (2.2%) cases tested positive for CMV DNA, leading to one termination and one case of serious developmental disorder after birth. Our study suggests that structural malformations associated with FGR are more likely to affect a single organ system. When multiple systems are involved, the incidence of chromosomal abnormalities and termination rates are notably high. We advocate for the use of CMA and CMV DNA examinations in FGR cases undergo invasive prenatal diagnosis, as these tests can provide valuable insights for etiological exploration and pregnancy management guidance.
Collapse
Affiliation(s)
- Xiaoqing Wu
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
- Department of Laboratory Medicine, Fujian Medical University, Fuzhou, China
- Key Laboratory of Clinical Laboratory Technology for Precision Medicine (Fujian Medical University), Fuzhou, China
| | - Shuqiong He
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Qingmei Shen
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Shiyi Xu
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China
| | - Danhua Guo
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Bin Liang
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Xinrui Wang
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China
| | - Hua Cao
- Fujian Provincial Hospital, Fuzhou, China.
| | - Hailong Huang
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China.
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China.
| | - Liangpu Xu
- Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Fuzhou City, 350001, Fujian Province, China.
- Fujian Provincial Key Laboratory for Prenatal Diagnosis and Birth Defect, Fuzhou, China.
| |
Collapse
|
2
|
Eggenhuizen GM, Go A, Koster MPH, Baart EB, Galjaard RJ. Confined placental mosaicism and the association with pregnancy outcome and fetal growth: a review of the literature. Hum Reprod Update 2021; 27:885-903. [PMID: 33984128 PMCID: PMC8382909 DOI: 10.1093/humupd/dmab009] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/30/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chromosomal mosaicism can be detected in different stages of early life: in cleavage stage embryos, in blastocysts and biopsied cells from blastocysts during preimplantation genetic testing for aneuploidies (PGT-A) and later during prenatal testing, as well as after birth in cord blood. Mosaicism at all different stages can be associated with adverse pregnancy outcomes. There is an onward discussion about whether blastocysts diagnosed as chromosomally mosaic by PGT-A should be considered safe for transfer. An accurate diagnosis of mosaicism remains technically challenging and the fate of abnormal cells within an embryo remains largely unknown. However, if aneuploid cells persist in the extraembryonic tissues, they can give rise to confined placental mosaicism (CPM). Non-invasive prenatal testing (NIPT) uses cell-free (cf) DNA released from the placenta in maternal blood, facilitating the detection of CPM. In literature, conflicting evidence is found about whether CPM is associated with fetal growth restriction (FGR) and/or other pregnancy outcomes. This makes counselling for patients by clinicians challenging and more knowledge is needed for clinical decision and policy making. OBJECTIVE AND RATIONALE The objective of this review is to evaluate the association between CPM and prenatal growth and adverse pregnancy outcomes. All relevant literature has been reviewed in order to achieve an overview on merged results exploring the relation between CPM and FGR and other adverse pregnancy outcomes. SEARCH METHODS The following Medical Subject Headings (MESH) terms and all their synonyms were used: placental, trophoblast, cytotrophoblast, mosaicism, trisomy, fetal growth, birth weight, small for gestational age and fetal development. A search in Embase, PubMed, Medline Ovid, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases was conducted. Relevant articles published until 16 July 2020 were critically analyzed and discussed. OUTCOMES There were 823 articles found and screened based on their title/abstract. From these, 213 articles were selected and full text versions were obtained for a second selection, after which 70 publications were included and 328 cases (fetuses) were analyzed. For CPM in eight different chromosomes (of the total 14 analyzed), there was sufficient evidence that birth weight was often below the 5th percentile of fetal growth standards. FGR was reported in 71.7% of CPM cases and preterm birth (<37 weeks of delivery) was reported in 31.0% of cases. A high rate of structural fetal anomalies, 24.2%, in cases with CPM was also identified. High levels of mosaicism in CVS and presence of uniparental disomy (UPD) were significantly associated with adverse pregnancy outcomes. WIDER IMPLICATIONS Based on the literature, the advice to clinicians is to monitor fetal growth intensively from first trimester onwards in case of CPM, especially when chromosome 2, 3, 7, 13, 15, 16 and 22 are involved. In addition to this, it is advised to examine the fetuses thoroughly for structural fetal anomalies and raise awareness of a higher chance of (possibly extreme) premature birth. Despite prematurity in nearly a fifth of cases, the long-term follow-up of CPM life borns seems to be positive. More understanding of the biological mechanisms behind CPM will help in prioritizing embryos for transfer after the detection of mosaicism in embryos through PGT-A.
Collapse
Affiliation(s)
- Geerke M Eggenhuizen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| | - Attie Go
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| | - Maria P H Koster
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| | - Esther B Baart
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands.,Department of Developmental Biology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| | - Robert Jan Galjaard
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| |
Collapse
|
3
|
Abstract
Intrauterine growth restriction (IUGR) is an important cause of fetal, perinatal and neonatal morbidity and mortality. IUGR occurs because of multiple reasons. Neonates with IUGR experience acute problems in the perinatal and early neonatal period that can be life-threatening. The unfavorable uterine environment causing growth restriction results in programming that predisposes IUGR infants to long-term health issues such as poor physical growth, metabolic syndrome, cardiovascular disease, neurodevelopmental impairment and endocrine abnormalities, warranting careful monitoring. It is imperative to strike the balance between achieving optimal catch-up to promote normal development, while preventing the onset of cardiovascular and metabolic disorders in the long-term.
Collapse
Affiliation(s)
- Kalpashri Kesavan
- Division of Neonatology & Developmental Biology, Department of Pediatrics, David Geffen School of Medicine at UCLA, UCLA Mattel Children's Hospital, 10833 Le Conte Avenue, B2-413 MDCC, Los Angeles, CA 90095, USA.
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine at UCLA, UCLA Mattel Children's Hospital, 10833 Le Conte Avenue, 22-412 MDCC, Los Angeles, CA 90095, USA
| |
Collapse
|
4
|
Zhu L, Baczyk D, Lye SJ, Zhang Z. Preeclampsia is associated with low placental transthyretin levels. Taiwan J Obstet Gynecol 2017; 55:385-9. [PMID: 27343320 DOI: 10.1016/j.tjog.2016.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To investigate the relationship between placental transthyretin (TTR) level and preeclampsia. MATERIALS AND METHODS Placental tissues from uncomplicated and preeclamptic pregnancies were analyzed using immunohistochemistry and image analysis. We measured the mean optical density (OD) of immunohistochemical staining of TTR across multiple sections using Image Pro Plus 6.0. To avoid bias, we used placental tissue array, which contained preeclamptic placentas (n=8) and the control placentas (n=6) on the same slide. RESULTS The mean TTR OD of the syncytiotrophoblast layer of placentas (95% confidence interval) from the first trimester was higher than those from the second/third trimester, and term placentas [0.149 (0.014-0.285) for the 1(st) trimester, 0.037 (0.000-0.073) for the 2(nd)/3(rd) trimester, and 0.011 (0.035-0.056) for term; p<0.01]. Although the OD of the second/third trimester placentas appeared greater than that of term placentas, this was not statistically significant. The mean TTR OD of the syncytiotrophoblast layer of the severe preeclampsia group was lower than that of controls [0.010 (0.005-0.016) vs. 0.027 (0.013-0.041), p<0.05]. CONCLUSION The immunohistochemical expression of TTR in the syncytiotrophoblast layer of the placenta decreased significantly after 12 weeks of gestation, paralleling the changing demands of thyroid hormone uptake into the placenta. The reduced TTR expression in the syncytiotrophoblast layer of the preeclamptic placenta might impair thyroid hormone uptake and contribute to the pathophysiology of the disease.
Collapse
Affiliation(s)
- Lei Zhu
- Beijing Chaoyang Hospital Affiliated Capital Medical University, Beijing, China
| | - Dora Baczyk
- Research Centre for Women's and Infants' Health at the Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephen J Lye
- Research Centre for Women's and Infants' Health at the Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Zhenyu Zhang
- Beijing Chaoyang Hospital Affiliated Capital Medical University, Beijing, China.
| |
Collapse
|
5
|
Sharma D, Shastri S, Farahbakhsh N, Sharma P. Intrauterine growth restriction - part 1. J Matern Fetal Neonatal Med 2016; 29:3977-87. [PMID: 26856409 DOI: 10.3109/14767058.2016.1152249] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Intrauterine growth restriction (IUGR) is a major and silent cause of various morbidity and mortality for the fetal and neonatal population. It is defined as a rate of fetal growth that is less than normal for the growth potential of that specific infant. The terms IUGR and small for gestational age (SGA) are often used interchangeably, although there exists subtle differences between the two. IUGR/SGA is an end result of various etiologies that includes maternal, placental and fetal factors and recently added genetic factors too, also contribute to IUGR. In this review article we will cover the antenatal aspect of IUGR and management with proven preventive intervention.
Collapse
Affiliation(s)
- Deepak Sharma
- a Department of Pediatrics , Pt. B.D. Sharma PGIMS , Rohtak , India
| | - Sweta Shastri
- b Department of Pathology , N.K.P Salve Medical College , Nagpur , India
| | - Nazanin Farahbakhsh
- c Department of Pediatrics , Shiraz University of Medicine , Shiraz , Iran , and
| | | |
Collapse
|
6
|
Soong YK, Huang SY, Yeh CH, Wang TH, Chang KH, Cheng PJ, Shaw SWS. The use of human amniotic fluid mesenchymal stem cells as the feeder layer to establish human embryonic stem cell lines. J Tissue Eng Regen Med 2013; 9:E302-7. [PMID: 23460275 DOI: 10.1002/term.1702] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 12/04/2012] [Accepted: 12/20/2012] [Indexed: 02/06/2023]
Affiliation(s)
- Yung-Kwei Soong
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Lin-Kou Medical Centre; Chang Gung University; Tao-Yuan Taiwan Republic of China
| | - Shang-Yu Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Lin-Kou Medical Centre; Chang Gung University; Tao-Yuan Taiwan Republic of China
| | - Chiu-Hsiang Yeh
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Lin-Kou Medical Centre; Chang Gung University; Tao-Yuan Taiwan Republic of China
| | - Tzu-Hao Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Lin-Kou Medical Centre; Chang Gung University; Tao-Yuan Taiwan Republic of China
| | - Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital, Lin-Kou Medical Centre; Chang Gung University; Tao-Yuan Taiwan Republic of China
| | - Po-Jen Cheng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Lin-Kou Medical Centre; Chang Gung University; Tao-Yuan Taiwan Republic of China
| | - S. W. Steven Shaw
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Lin-Kou Medical Centre; Chang Gung University; Tao-Yuan Taiwan Republic of China
| |
Collapse
|
7
|
Abstract
Fetal imaging technology has been advancing remarkably and prenatal detection and diagnoses have been moved forward from the second and third trimesters to the first trimester. Structural abnormalities detected by fetal imaging often lead to prenatal diagnoses of genetic disorders. However, there are still dilemmas in fetal diagnoses in normal karyotype cases with strong suspicion of congenital genetic disorders from sonographic findings. When fetal sonography reveals multiple minor abnormalities originating from various organs, counseling dilemmas and parental anxieties become greater than before karyotyping. Array-comparative genomic hybridization (aCGH) was developed as a high-resolution analysis of DNA copy number variations (CNVs). In seven cases presenting with abnormal brain structures by fetal imaging, abnormal CNVs were confirmed by aCGH but conventional karyotyping yielded normal results. Although careful patient selection is required in order to deal with microarray results and parental counseling, 'sonogenetics' - incorporating the idea of 'fetuses first' - will play an important role in the era of molecular genetics. Recent advances in non-invasive prenatal testing by using fetal cell-free DNA in maternal plasma has the potential to generate misleading prenatal diagnoses without the observation of fetuses. However, no fetal diagnoses should be made without observing fetuses and we must not forget 'the fetus as a patient'.
Collapse
Affiliation(s)
- Ritsuko K Pooh
- CRIFM Clinical Research Institute of Fetal Medicine PMC, 7-3-7, Uehommachi, Tennoji, Osaka #543-0001, Japan.
| |
Collapse
|
8
|
Chen CP, Su YN, Tsai FJ, Lin HH, Chern SR, Lee MS, Hwang JK, Chen THT, Wang W. Terminal 2q Deletion and Distal 15q Duplication: Prenatal Diagnosis by Array Comparative Genomic Hybridization Using Uncultured Amniocytes. Taiwan J Obstet Gynecol 2009; 48:441-5. [DOI: 10.1016/s1028-4559(09)60343-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|