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Xu E, Jouannic JM, Alison M, Ancel PY, Friszer S, Rousseau J, Guilbaud L, Adamsbaum C, Goffinet F, Blondiaux E. Analysis of MRI brain biometrics in fetuses monitored for intra uterine growth restriction and their prognostic value: Results of a prospective multicenter study. Eur J Obstet Gynecol Reprod Biol 2024; 298:91-97. [PMID: 38735121 DOI: 10.1016/j.ejogrb.2024.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Show a prognostic value of brain changes in fetuses with intra uterine growth restriction (IUGR) on early neonatal outcome. STUDY DESIGN We prospectively recruited pregnant women whose fetuses presented fetal weight < 5th centile. A brain MRI was performed between 28 and 32 weeks of gestation (WG). Several brain biometrics were measured (as fronto-occipital diameter (FOD) and transverse cerebellar diameter (TCD)). Neonatal prognosis was evaluated according to a composite criterion. RESULTS Of the 78 patients included, 62 had a fetal brain MRI. The mean centile value of FOD was lower in the unfavorable outcome group (n = 9) compared to the favorable outcome group (n = 53) (24.5 ± 16.8 vs. 8.6 ± 13.2, p = 0.004). The ROC curve for predicting risk of unfavorable neonatal outcome based on FOD presented an area under the curve of 0.81 (95 % CI, [0.63---0.99]) and a threshold determined at the 3rd centile was associated with sensitivity of 0.78 and a specificity of 0.89. In multivariate analysis, a FOD less than the 3rd centile was significantly associated with an unfavorable neonatal risk. There also was a reduction in TCD (25.5 ± 21.5 vs. 10.4 ± 10.4, p = 0.03) in the unfavorable neonatal outcome group. CONCLUSION We found an association between a reduction in FOD and TCD in fetal MRIs conducted between 28 and 32 WG in fetuses monitored for IUGR with an unfavorable neonatal outcome. Our results suggest that these biometric changes could constitute markers of poor neonatal prognosis.
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Affiliation(s)
- Eric Xu
- Service de Radiologie Pédiatrique, Hôpital Armand Trousseau, GRC IMAGES, Médecine Sorbonne Université, APHP, Paris, France
| | - Jean-Marie Jouannic
- Service de Médecine Fœtale, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France
| | - Marianne Alison
- Service de Radiologie Pédiatrique, Hôpital Robert Debré, APHP, Université Paris Diderot, Paris France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM and Université Paris Descartes, Paris, France; Unité de recherche clinique, CIC-Mère enfant, AP-HP, FHU PREMA, Hôpital Cochin, F-75014 Paris, France
| | - Stéphanie Friszer
- Service de Médecine Fœtale, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France
| | - Jessica Rousseau
- Obstetrical, Perinatal, and Pediatric Epidemiology Team and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM and Université Paris Descartes, Paris, France
| | - Lucie Guilbaud
- Service de Médecine Fœtale, Hôpital Armand Trousseau, Médecine Sorbonne Université, APHP, Paris, France
| | - Catherine Adamsbaum
- Service de Radiopédiatrie, Hôpital Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, France
| | - François Goffinet
- Obstetrical, Perinatal, and Pediatric Epidemiology Team and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM and Université Paris Descartes, Paris, France; Maternité Port Royal, Hôpital Cochin, APHP, DHU Risques et Grossesse, Université Paris Descartes, Paris, France
| | - Eléonore Blondiaux
- Service de Radiologie Pédiatrique, Hôpital Armand Trousseau, GRC IMAGES, Médecine Sorbonne Université, APHP, Paris, France.
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Musco H, Beecher K, Chand KK, Boyd RN, Colditz PB, Wixey JA. The search for blood biomarkers that indicate risk of adverse neurodevelopmental outcomes in fetal growth restriction. Front Pediatr 2024; 12:1396102. [PMID: 38966491 PMCID: PMC11222567 DOI: 10.3389/fped.2024.1396102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024] Open
Abstract
Fetal growth restriction (FGR) impacts 5%-10% of pregnancies and is associated with increased risk of mortality and morbidity. Although adverse neurodevelopmental outcomes are observed in up to 50% of FGR infants, a diagnosis of FGR does not indicate the level of risk for an individual infant and these infants are not routinely followed up to assess neurodevelopmental outcomes. Identifying FGR infants at increased risk of adverse neurodevelopmental outcomes would greatly assist in providing appropriate support and interventions earlier, resulting in improved outcomes. However, current methods to detect brain injury around the time of birth lack the sensitivity required to detect the more subtle alterations associated with FGR. Blood biomarkers have this potential. This systematic review assessed the current literature on blood biomarkers for identifying FGR infants at increased risk of adverse neurodevelopmental outcomes at >12 months after birth. Four databases were searched from inception to 22 February 2024. Articles were assessed for meeting the inclusion criteria by two reviewers. The quality of the included article was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. A summary of findings is presented as insufficient articles were identified for meta-analysis. Excluding duplicates, 1,368 records were screened with only 9 articles considered for full text review. Only one article met all the inclusion criteria. Quality assessment indicated low risk of bias. Both blood biomarkers investigated in this study, neuron specific enolase and S100B, demonstrated inverse relationships with neurodevelopmental assessments at 2 years. Four studies did not meet all the inclusion criteria yet identified promising findings for metabolites and cytokines which are discussed here. These findings support the need for further research and highlight the potential for blood biomarkers to predict adverse outcomes. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=369242, Identifier CRD42022369242.
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Affiliation(s)
- Hannah Musco
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Kate Beecher
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Kirat K. Chand
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Roslyn N. Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Paul B. Colditz
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Perinatal Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Julie A. Wixey
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Abaci Turk E, Yun HJ, Feldman HA, Lee JY, Lee HJ, Bibbo C, Zhou C, Tamen R, Grant PE, Im K. Association between placental oxygen transport and fetal brain cortical development: a study in monochorionic diamniotic twins. Cereb Cortex 2024; 34:bhad383. [PMID: 37885155 PMCID: PMC11032198 DOI: 10.1093/cercor/bhad383] [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: 06/28/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Normal cortical growth and the resulting folding patterns are crucial for normal brain function. Although cortical development is largely influenced by genetic factors, environmental factors in fetal life can modify the gene expression associated with brain development. As the placenta plays a vital role in shaping the fetal environment, affecting fetal growth through the exchange of oxygen and nutrients, placental oxygen transport might be one of the environmental factors that also affect early human cortical growth. In this study, we aimed to assess the placental oxygen transport during maternal hyperoxia and its impact on fetal brain development using MRI in identical twins to control for genetic and maternal factors. We enrolled 9 pregnant subjects with monochorionic diamniotic twins (30.03 ± 2.39 gestational weeks [mean ± SD]). We observed that the fetuses with slower placental oxygen delivery had reduced volumetric and surface growth of the cerebral cortex. Moreover, when the difference between placenta oxygen delivery increased between the twin pairs, sulcal folding patterns were more divergent. Thus, there is a significant relationship between placental oxygen transport and fetal brain cortical growth and folding in monochorionic twins.
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Affiliation(s)
- Esra Abaci Turk
- Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States
- Division of Newborn Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, United States
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, 401 Park Dr, Boston, MA 02115, United States
| | - Hyuk Jin Yun
- Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States
- Division of Newborn Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, United States
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, 401 Park Dr, Boston, MA 02115, United States
| | - Henry A Feldman
- Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States
- Division of Newborn Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, United States
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, United States
| | - Joo Young Lee
- Department of Pediatrics, Hanyang University College of Medicine, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University College of Medicine, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Carolina Bibbo
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United States
| | - Cindy Zhou
- Division of Newborn Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, United States
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, 401 Park Dr, Boston, MA 02115, United States
| | - Rubii Tamen
- Division of Newborn Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, United States
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, 401 Park Dr, Boston, MA 02115, United States
| | - Patricia Ellen Grant
- Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States
- Division of Newborn Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, United States
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, 401 Park Dr, Boston, MA 02115, United States
- Department of Radiology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, United States
| | - Kiho Im
- Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States
- Division of Newborn Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, United States
- Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, 401 Park Dr, Boston, MA 02115, United States
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Laureano B, Irzan H, O'Reilly H, Ourselin S, Marlow N, Melbourne A. Myelination of preterm brain networks at adolescence. Magn Reson Imaging 2024; 105:114-124. [PMID: 37984490 DOI: 10.1016/j.mri.2023.11.001] [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: 06/09/2022] [Revised: 10/31/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023]
Abstract
Prematurity and preterm stressors severely affect the development of infants born before 37 weeks of gestation, with increasing effects seen at earlier gestations. Although preterm mortality rates have declined due to the advances in neonatal care, disability rates, especially in middle-income settings, continue to grow. With the advances in MR imaging technology, there has been a focus on safely imaging the preterm brain to better understand its development and discover the brain regions and networks affected by prematurity. Such studies aim to support interventions and improve the neurodevelopment of preterm infants and deliver accurate prognoses. Few studies, however, have focused on the fully developed brain of preterm born infants, especially in extremely preterm subjects. To assess the long-term effect of prematurity on the adult brain, myelin related biomarkers such as myelin water fraction and g-ratio are measured for a cohort of 19-year-old extremely preterm born subjects. Using multi-modal imaging techniques that combine T2 relaxometry and neurite density information, the results show that specific brain regions associated with white matter injuries due to preterm birth, such as the posterior limb of the internal capsule and corpus callosum, are still less myelinated in adulthood. Furthermore, a weak positive relationship between myelin water fraction values and Full-Scale Intelligence Quotient (FSIQ) scores was found in multiple brain regions previously defined as less myelinated in the Extremely Preterm (EPT) cohort. These findings might suggest altered connectivity in the adult preterm brain and explain differences in cognitive outcomes.
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Affiliation(s)
- Beatriz Laureano
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK.
| | - Hassna Irzan
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Dept. of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Helen O'Reilly
- Children's Disability Network Team, St. Michael's House, Dublin, Ireland
| | - Sebastian Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Dept. of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Neil Marlow
- Institute for Women's Health, University College London, London, UK
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Dept. of Medical Physics and Biomedical Engineering, University College London, London, UK
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Alda MG, Holberton J, MacDonald TM, Charlton JK. Small for gestational age at preterm birth identifies adverse neonatal outcomes more reliably than antenatal suspicion of fetal growth restriction. J Matern Fetal Neonatal Med 2023; 36:2279017. [PMID: 37981759 DOI: 10.1080/14767058.2023.2279017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/30/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Fetal growth restriction (FGR) is an important reason for premature delivery and a leading cause of perinatal morbidity and mortality. We aimed to evaluate whether classification as small for gestational age (SGA; <10th centile) at birth or antenatal suspicion of FGR was more strongly associated with neonatal morbidity and mortality in preterm infants. METHODS A retrospective audit of infants born between 24 + 0 and 32 + 6 weeks of gestation from 2012-2019 and admitted to the Neonatal Unit at Mercy Hospital for Women (MHW). Infants were categorized according to whether FGR was listed as an antenatal complication in the medical records and whether they were SGA (<10th centile on Fenton chart) or appropriate for gestational age (AGA) at birth, and comparisons for neonatal outcomes were made. RESULTS 371/2126 preterm infants (17.5%) had antenatal suspicion of FGR, and 166 (7.8%) were SGA at birth. No differences in any neonatal outcomes were found between infants with or without suspected FGR, except decreased intraventricular hemorrhage (IVH) in the FGR group. SGA classification was associated with increased rates of all morbidities other than IVH, including bronchopulmonary dysplasia, retinopathy of prematurity, and necrotizing enterocolitis, compared with the AGA group. Death was significantly higher in the SGA group (7.2%) compared with the AGA group (3.5%). CONCLUSION SGA by Fenton chart more reliably identified neonates at risk of adverse neonatal outcomes than antenatal suspicion of FGR, suggesting it is a reasonable clinical proxy. This most likely reflects the much lower tenth centile weight cutoffs on the Fenton charts compared to in-utero charts used antenatally to diagnose FGR based on ultrasound estimated fetal weight. SGA classification by Fenton approximately equates to <3rd centile on in-utero charts at our institution, therefore identifying the most severe FGR cases.
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Affiliation(s)
- Maria G Alda
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Department of Paediatrics, Mercy Hospital for Women, Melbourne, Australia
| | - James Holberton
- Department of Paediatrics, Mercy Hospital for Women, Melbourne, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Teresa M MacDonald
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia
| | - Julia K Charlton
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Division of Neonatology, BC Women's Hospital, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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6
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Huang N, Chen W, Jiang H, Yang J, Zhang Y, Shi H, Wang Y, Yuan P, Qiao J, Wei Y, Zhao Y. Metabolic dynamics and prediction of sFGR and adverse fetal outcomes: a prospective longitudinal cohort study. BMC Med 2023; 21:455. [PMID: 37996847 PMCID: PMC10666385 DOI: 10.1186/s12916-023-03134-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Selective fetal growth restriction (sFGR) is an extreme complication that significantly increases the risk of perinatal mortality and long-term adverse neurological outcomes in offspring, affecting approximately 15% of monochorionic diamniotic (MCDA) twin pregnancies. The lack of longitudinal cohort studies hinders the early prediction and intervention of sFGR. METHODS We constructed a prospective longitudinal cohort study of sFGR, and quantified 25 key metabolites in 337 samples from maternal plasma in the first, second, and third trimester and from cord plasma. In particular, our study examined fetal growth and brain injury data from ultrasonography and used the Ages and Stages Questionnaire-third edition subscale (ASQ-3) to evaluate the long-term neurocognitive behavioral development of infants aged 2-3 years. Furthermore, we correlated metabolite levels with ultrasound data, including physical development and brain injury indicators, and ASQ-3 data using Spearman's-based correlation tests. In addition, special combinations of differential metabolites were used to construct predictive models for the occurrence of sFGR and fetal brain injury. RESULTS Our findings revealed various dynamic patterns for these metabolites during pregnancy and a maximum of differential metabolites between sFGR and MCDA in the second trimester (n = 8). The combination of L-phenylalanine, L-leucine, and L-isoleucine in the second trimester, which were closely related to fetal growth indicators, was highly predictive of sFGR occurrence (area under the curve [AUC]: 0.878). The combination of L-serine, L-histidine, and L-arginine in the first trimester and creatinine in the second trimester was correlated with long-term neurocognitive behavioral development and showed the capacity to identify fetal brain injury with high accuracy (AUC: 0.94). CONCLUSIONS The performance of maternal plasma metabolites from the first and second trimester is superior to those from the third trimester and cord plasma in discerning sFGR and fetal brain injury. These metabolites may serve as useful biomarkers for early prediction and promising targets for early intervention in clinical settings.
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Affiliation(s)
- Nana Huang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Wei Chen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, 100191, China
| | - Hai Jiang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Jing Yang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Youzhen Zhang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Huifeng Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Ying Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Pengbo Yuan
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Jie Qiao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China.
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China.
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, 100191, China.
- Beijing Advanced Innovation Center for Genomics, Beijing, China.
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China.
| | - Yuan Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China.
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China.
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China.
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China.
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Wu ZH, Li FF, Ruan LL, Feng Q, Zhang S, Li ZH, Otoo A, Tang J, Fu LJ, Liu TH, Ding YB. miR-181d-5p, which is upregulated in fetal growth restriction placentas, inhibits trophoblast fusion via CREBRF. J Assist Reprod Genet 2023; 40:2725-2737. [PMID: 37610607 PMCID: PMC10643557 DOI: 10.1007/s10815-023-02917-6] [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: 03/27/2023] [Accepted: 08/15/2023] [Indexed: 08/24/2023] Open
Abstract
PURPOSE Fetal growth restriction (FGR) is a common complication characterized by impaired placental function and unfavorable pregnancy outcomes. This study aims to elucidate the expression pattern of miR-181d-5p in FGR placentas and explore its effects on trophoblast fusion. METHODS The expression pattern of miR-181d-5p in human FGR placentas were evaluated using qRT-PCR. Western blot, qRT-PCR, and Immunofluorescence analysis were performed in a Forskolin (FSK)-induced BeWo cell fusion model following the transfection of miR-181d-5p mimic or inhibitor. Potential target genes for miR-181d-5p were identified by screening miRNA databases. The interaction between miR-181d-5p and Luman/CREB3 Recruitment Factor (CREBRF) was determined through a luciferase assay. Moreover, the effect of CREBRF on BeWo cell fusion was examined under hypoxic conditions. RESULTS Aberrant up-regulation of miR-181d-5p and altered expression of trophoblast fusion makers, including glial cell missing 1 (GCM1), Syncytin1 (Syn1), and E-cadherin (ECAD), were found in human FGR placentas. A down-regulation of miR-181d-5p expression was observed in the FSK-induced BeWo cell fusion model. Transfection of the miR-181d-5p mimic resulted in the inhibition of BeWo cell fusion, characterized by a down-regulation of GCM1 and Syn1, accompanied by an up-regulation of ECAD. Conversely, the miR-181d-5p inhibitor promoted BeWo cell fusion. Furthermore, miR-181d-5p exhibited negative regulation of CREBRF, which was significantly down-regulated in the hypoxia-induced BeWo cell model. The overexpression of CREBRF was effectively ameliorated the impaired BeWo cell fusion induced by hypoxia. CONCLUSIONS Our study demonstrated that miR-181d-5p, which is elevated in FGR placenta, inhibited the BeWo cell fusion through negatively regulating the expression of CREBRF.
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Affiliation(s)
- Zhi-Hong Wu
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Chongqing Medical University, Chongqing, China
| | - Fang-Fang Li
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Chongqing Medical University, Chongqing, China
| | - Ling-Ling Ruan
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Chongqing Medical University, Chongqing, China
| | - Qian Feng
- Chongqing Key Laboratory of Traditional Chinese Medicine for Prevention and Cure of Metabolic Diseases, Chongqing Medical University, Chongqing, China
| | - Shuang Zhang
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Chongqing Medical University, Chongqing, China
| | - Zhuo-Hang Li
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Chongqing Medical University, Chongqing, China
| | - Antonia Otoo
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Chongqing Medical University, Chongqing, China
| | - Jing Tang
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Chongqing Medical University, Chongqing, China
| | - Li-Juan Fu
- Department of Pharmacology, the School of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China.
- Academician Workstation, Changsha Medical University, Changsha, China.
| | - Tai-Hang Liu
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Chongqing Medical University, Chongqing, China.
| | - Yu-Bin Ding
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chongqing, 401147, China.
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, Chongqing Medical University, Chongqing, China.
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Luo M, Yi Y, Huang S, Dai S, Xie L, Liu K, Zhang S, Jiang T, Wang T, Yao B, Wang H, Xu D. Gestational dexamethasone exposure impacts hippocampal excitatory synaptic transmission and learning and memory function with transgenerational effects. Acta Pharm Sin B 2023; 13:3708-3727. [PMID: 37719378 PMCID: PMC10501875 DOI: 10.1016/j.apsb.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/20/2023] [Accepted: 05/06/2023] [Indexed: 09/19/2023] Open
Abstract
The formation of learning and memory is regulated by synaptic plasticity in hippocampal neurons. Here we explored how gestational exposure to dexamethasone, a synthetic glucocorticoid commonly used in clinical practice, has lasting effects on offspring's learning and memory. Adult offspring rats of prenatal dexamethasone exposure (PDE) displayed significant impairments in novelty recognition and spatial learning memory, with some phenotypes maintained transgenerationally. PDE impaired synaptic transmission of hippocampal excitatory neurons in offspring of F1 to F3 generations, and abnormalities of neurotransmitters and receptors would impair synaptic plasticity and lead to impaired learning and memory, but these changes failed to carry over to offspring of F5 and F7 generations. Mechanistically, altered hippocampal miR-133a-3p-SIRT1-CDK5-NR2B signaling axis in PDE multigeneration caused inhibition of excitatory synaptic transmission, which might be related to oocyte-specific high expression and transmission of miR-133a-3p. Together, PDE affects hippocampal excitatory synaptic transmission, with lasting consequences across generations, and CDK5 in offspring's peripheral blood might be used as an early-warning marker for fetal-originated learning and memory impairment.
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Affiliation(s)
- Mingcui Luo
- Department of Obstetrics, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
| | - Yiwen Yi
- Department of Pharmacology, Taikang Medical School (School of Basic Medical Sciences), Wuhan University, Wuhan 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
| | - Songqiang Huang
- Department of Pharmacology, Taikang Medical School (School of Basic Medical Sciences), Wuhan University, Wuhan 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
| | - Shiyun Dai
- Department of Pharmacology, Taikang Medical School (School of Basic Medical Sciences), Wuhan University, Wuhan 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
| | - Lulu Xie
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan 430071, China
| | - Kexin Liu
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Shuai Zhang
- Department of Obstetrics, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
| | - Tao Jiang
- Department of Pharmacology, Taikang Medical School (School of Basic Medical Sciences), Wuhan University, Wuhan 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
| | - Tingting Wang
- Department of Obstetrics, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
| | - Baozhen Yao
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan 430071, China
| | - Hui Wang
- Department of Pharmacology, Taikang Medical School (School of Basic Medical Sciences), Wuhan University, Wuhan 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
| | - Dan Xu
- Department of Obstetrics, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan 430071, China
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
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9
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Bendall A, Schreiber V, Crawford K, Kumar S. Predictive utility of the fetal cerebroplacental ratio for hypoxic ischaemic encephalopathy, severe neonatal morbidity and perinatal mortality in late-preterm and term infants. Aust N Z J Obstet Gynaecol 2023; 63:491-498. [PMID: 37029609 DOI: 10.1111/ajo.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/17/2023] [Indexed: 04/09/2023]
Abstract
AIMS The aim of this study was to evaluate the association of a low cerebroplacental ratio (CPR) with hypoxic ischaemic encephalopathy (HIE), severe neonatal morbidity (SNM) and perinatal mortality (PNM). METHODS This was a retrospective cohort study of late-preterm and term births at Mater Mothers' Hospital, Brisbane, between 2016 and 2020. Study outcomes were HIE, PNM and SNM (a composite of severe acidosis, Apgar score less than four at 5 min, severe respiratory distress or need for significant cardiopulmonary resuscitation at birth). Univariate and multivariable logistic regressions were used to determine if a low CPR was associated with HIE, SNM or PNM. RESULTS A total of 51 870 births met the inclusion criteria. Of these, 216 (0.42%) were complicated by HIE, 10 224 (19.7%) had SNM and 251 (0.48%) had PNM. Rates of low CPR (<10th and <5th centile) were significantly higher in the SNM cohort (20.1 and 13.2%, respectively) and PNM cohort (21.1 and 15.1%, respectively) compared to the overall cohort. A low CPR was associated with significantly increased adjusted odds for SNM but not for HIE or PNM. The area under the receiver operating characteristic curve for CPR <10th centile was greatest for SNM (0.768) and lowest for HIE (0.595). Predictive margins of a low CPR for HIE, SNM and PNM were significant only for SNM at late-preterm gestations. CONCLUSIONS A low CPR is associated with increased odds of SNM in infants born >34 weeks' gestation but not for HIE or PNM.
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Affiliation(s)
- Alexa Bendall
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Veronika Schreiber
- Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Kylie Crawford
- Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
- NHMRC Centre for Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
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10
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Musco H, Beecher K, Chand KK, Colditz PB, Wixey JA. Blood Biomarkers in the Fetally Growth Restricted and Small for Gestational Age Neonate: Associations with Brain Injury. Dev Neurosci 2023; 46:84-97. [PMID: 37231871 DOI: 10.1159/000530492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/29/2023] [Indexed: 05/27/2023] Open
Abstract
Fetal growth restriction (FGR) and small for gestational age (SGA) infants have increased risk of mortality and morbidity. Although both FGR and SGA infants have low birthweights for gestational age, a diagnosis of FGR also requires assessments of umbilical artery Doppler, physiological determinants, neonatal features of malnutrition, and in utero growth retardation. Both FGR and SGA are associated with adverse neurodevelopmental outcomes ranging from learning and behavioral difficulties to cerebral palsy. Up to 50% of FGR, newborns are not diagnosed until around the time of birth, yet this diagnosis lacks further indication of the risk of brain injury or adverse neurodevelopmental outcomes. Blood biomarkers may be a promising tool. Defining blood biomarkers indicating an infant's risk of brain injury would provide the opportunity for early detection and therefore earlier support. The aim of this review was to summarize the current literature to assist in guiding the future direction for the early detection of adverse brain outcomes in FGR and SGA neonates. The studies investigated potential diagnostic blood biomarkers from cord and neonatal blood or serum from FGR and SGA human neonates. Results were often conflicting with heterogeneity common in the biomarkers examined, timepoints, gestational age, and definitions of FGR and SGA used. Due to these variations, it was difficult to draw strong conclusions from the results. The search for blood biomarkers of brain injury in FGR and SGA neonates should continue as early detection and intervention is critical to improve outcomes for these neonates.
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Affiliation(s)
- Hannah Musco
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Kate Beecher
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Kirat K Chand
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Paul B Colditz
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Julie A Wixey
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
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11
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Misan N, Michalak S, Kapska K, Osztynowicz K, Ropacka-Lesiak M, Kawka-Paciorkowska K. Does the Blood-Brain Barrier Integrity Change in Regard to the Onset of Fetal Growth Restriction? Int J Mol Sci 2023; 24:ijms24031965. [PMID: 36768287 PMCID: PMC9916066 DOI: 10.3390/ijms24031965] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/18/2022] [Accepted: 01/06/2023] [Indexed: 01/21/2023] Open
Abstract
The aim of the study was to determine whether early-onset and late-onset fetal growth restriction (FGR) differentially affects the blood-brain barrier integrity. Furthermore, the purpose of the study was to investigate the relationship between the blood-brain barrier breakdown and neurological disorders in FGR newborns. To evaluate the serum tight junction (TJ) proteins and the placental TJ proteins expression, an ELISA method was used. A significant difference in serum OCLN concentrations was noticed in pregnancies complicated by the early-onset FGR, in relation to the intraventricular hemorrhage (IVH) occurrence in newborns. No significant differences in concentrations of the NR1 subunit of the N-methyl-d-aspartate receptor (NR1), nucleoside diphosphate kinase A (NME1), S100 calcium-binding protein B (S100B), occludin (OCLN), claudin-5 (CLN5), zonula occludens-1 (zo-1), the CLN5/zo-1 ratio, and the placental expression of OCLN, CLN5, claudin-4 (CLN4), zo-1 were noticed between groups. The early-onset FGR was associated with a higher release of NME1 into the maternal circulation in relation to the brain-sparing effect and premature delivery. Additionally, in late-onset FGR, the higher release of the S100B into the maternal serum in regard to fetal distress was observed. Furthermore, there was a higher release of zo-1 into the maternal circulation in relation to newborns' moderate acidosis in late-onset FGR. Blood-brain barrier disintegration is not dependent on pregnancy advancement at the time of FGR diagnosis. NME1 may serve as a biomarker useful in the prediction of fetal circulatory centralization and extremely low birth weight in pregnancies complicated by the early-onset FGR. Moreover, the serum zo-1 concentration may have prognostic value for moderate neonatal acidosis in late-onset FGR pregnancies.
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Affiliation(s)
- Natalia Misan
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
- Correspondence:
| | - Sławomir Michalak
- Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 60-355 Poznan, Poland
- Department of Neurosurgery and Neurotraumatology, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Katarzyna Kapska
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
| | - Krystyna Osztynowicz
- Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Mariola Ropacka-Lesiak
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
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12
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Roufaeil C, Razak A, Malhotra A. Cranial Ultrasound Abnormalities in Small for Gestational Age or Growth-Restricted Infants Born over 32 Weeks Gestation: A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:brainsci12121713. [PMID: 36552172 PMCID: PMC9776358 DOI: 10.3390/brainsci12121713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
AIM To perform a systematic review and meta-analysis of existing literature to evaluate the incidence of cranial ultrasound abnormalities (CUAs) amongst moderate to late preterm (MLPT) and term infants, affected by fetal growth restriction (FGR) or those classified as small for gestational age (SGA). METHODS A systematic review methodology was performed, and Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement was utilised. Descriptive and observational studies reporting cranial ultrasound outcomes on FGR/SGA MLPT and term infants were included. Primary outcomes reported was incidence of CUAs in MLPT and term infants affected by FGR or SGA, with secondary outcomes including brain structure development and growth, and cerebral artery Dopplers. A random-effects model meta-analysis was performed. Risk of Bias was assessed using the Newcastle-Ottawa scale for case-control and cohort studies, and Joanna Briggs Institute Critical Appraisal Checklist for studies reporting prevalence data. GRADE was used to assess for certainty of evidence. RESULTS Out of a total of 2085 studies identified through the search, seventeen were deemed to be relevant and included. Nine studies assessed CUAs in MLPT FGR/SGA infants, seven studies assessed CUAs in late preterm and term FGR/SGA infants, and one study assessed CUAs in both MLPT and term FGR/SGA infants. The incidence of CUAs in MLPT, and late preterm to term FGR/SGA infants ranged from 0.4 to 33% and 0 to 70%, respectively. A meta-analysis of 7 studies involving 168,136 infants showed an increased risk of any CUA in FGR infants compared to appropriate for gestational age (AGA) infants (RR 1.96, [95% CI 1.26-3.04], I2 = 68%). The certainty of evidence was very low due to non-randomised studies, methodological limitations, and heterogeneity. Another meta-analysis looking at 4 studies with 167,060 infants showed an increased risk of intraventricular haemorrhage in FGR/SGA infants compared to AGA infants (RR 2.40, [95% CI 2.03-2.84], I2 = 0%). This was also of low certainty. CONCLUSIONS The incidence of CUAs in MLPT and term growth-restricted infants varied widely between studies. Findings from the meta-analyses suggest the risk of CUAs and IVH may indeed be increased in these FGR/SGA infants when compared with infants not affected by FGR, however the evidence is of low to very low certainty. Further specific cohort studies are needed to fully evaluate the benefits and prognostic value of cranial ultrasonography to ascertain the need for, and timing of a cranial ultrasound screening protocol in this infant population, along with follow-up studies to ascertain the significance of CUAs identified.
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Affiliation(s)
- Charlene Roufaeil
- Monash Newborn, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
| | - Abdul Razak
- Monash Newborn, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
| | - Atul Malhotra
- Monash Newborn, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC 3168, Australia
- Correspondence:
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13
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Misan N, Michalak S, Rzymski P, Poniedziałek B, Kapska K, Osztynowicz K, Ropacka-Lesiak M. Molecular Indicators of Blood-Brain Barrier Breakdown and Neuronal Injury in Pregnancy Complicated by Fetal Growth Restriction. Int J Mol Sci 2022; 23:ijms232213798. [PMID: 36430274 PMCID: PMC9695431 DOI: 10.3390/ijms232213798] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022] Open
Abstract
This study evaluated the damage to the endothelial tight junctions (TJs) in pregnancies complicated by fetal growth restriction (FGR) and investigated whether FGR is related to blood-brain barrier disintegration and, subsequently, to the appearance of proteins indicative of neuronal injury in maternal blood. The studied group included 90 pregnant women diagnosed with FGR. The control group consisted of 70 women with an uncomplicated pregnancy. The biochemical measurements included serum neuronal proteins (subunit of the N-methyl-D-aspartate receptor-NR1, nucleoside diphosphate kinase A-NME1, and S100 calcium-binding protein B-S100B), serum TJ proteins (occludin-OCLN, claudin-5-CLN5, zonula occludens-zo-1, and OCLN/zo-1 and CLN5/zo-1 ratios), and placental expression of TJ proteins (OCLN, claudin-4 CLN4, CLN5, zo-1). The significantly higher serum S100B and CLN5 levels and serum CLN5/zo-1 ratio were observed in FGR compared to healthy pregnancies. Moreover, FGR was characterized by increased placental CLN5 expression. Both serum NME1 levels and placental CLN4 expression in FGR pregnancies were significantly related to the incidence of neurological disorders in newborns. Mothers of FGR neonates who developed neurological complications and intraventricular hemorrhage (IVH) had statistically higher NME1 concentrations during pregnancy and significantly lower placental CLN4 expression than mothers of FGR neonates without neurological abnormalities. The serum NME1 levels and placental CLN4 expression were predictive markers of IVH in the FGR group. The blood-brain barrier is destabilized in pregnancies complicated by FGR. Neurological disorders, including IVH, are associated with higher serum concentrations of NME1 and the decreased placental expression of CLN4. The serum NME1 levels and placental CLN4 expression may serve as biomarkers, helpful in predicting IVH in FGR. It may allow for more precise monitoring and influence decision-making on the optimal delivery time to avoid developing neurological complications.
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Affiliation(s)
- Natalia Misan
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
- Correspondence:
| | - Sławomir Michalak
- Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806 Poznań, Poland
| | - Barbara Poniedziałek
- Department of Environmental Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
| | - Katarzyna Kapska
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
| | - Krystyna Osztynowicz
- Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Mariola Ropacka-Lesiak
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
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14
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Misan N, Michalak S, Kapska K, Osztynowicz K, Ropacka-Lesiak M. Blood-Brain Barrier Disintegration in Growth-Restricted Fetuses with Brain Sparing Effect. Int J Mol Sci 2022; 23:ijms232012349. [PMID: 36293204 PMCID: PMC9604432 DOI: 10.3390/ijms232012349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
The endothelial cells of the blood-brain barrier adhere closely, which is provided by tight junctions (TJs). The aim of the study was to assess the damage to the endothelial TJs in pregnancy, complicated by fetal growth restriction (FGR) and circulatory centralization (brain-sparing effect, BS). The serum concentrations of NR1 subunit of the N-methyl-D-aspartate receptor (NR1), nucleoside diphosphate kinase A (NME1), S100 calcium-binding protein B (S100B), occludin (OCLN), claudin-5 (CLN5), and zonula occludens protein – 1 (zo-1), and the placental expressions of OCLN, claudin-4 (CLN4), CLN5, and zo-1 were assessed with ELISA. The significantly higher serum NME1 concentrations and the serum CLN5/zo-1 index were observed in FGR pregnancy with BS, as compared to the FGR group without BS. The FGR newborns with BS were about 20 times more likely to develop an intraventricular hemorrhage (IVH) than the FGR infants without BS. The cerebroplacental ratio (CPR) allowed to predict the IVH in growth-restricted fetuses. The significantly lower placental CLN4 expression was observed in the FGR group with BS and who postnatally developed an IVH, as compared to the growth-restricted infants with BS without IVH signs. Pregnancy complicated by FGR and BS is associated with the destabilization of the fetal blood-brain barrier. The IVH in newborns is reflected in the inhibition of the placental CLN4 expression, which may be a useful marker in the prediction of an IVH among growth-restricted fetuses.
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Affiliation(s)
- Natalia Misan
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Poznan, Poland
- Correspondence:
| | - Sławomir Michalak
- Department of Neurochemistry and Neuropathology, Chair of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355 Poznan, Poland
| | - Katarzyna Kapska
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Poznan, Poland
| | - Krystyna Osztynowicz
- Department of Neurochemistry and Neuropathology, Chair of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355 Poznan, Poland
| | - Mariola Ropacka-Lesiak
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Poznan, Poland
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15
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Mylrea-Foley B, Thornton JG, Mullins E, Marlow N, Hecher K, Ammari C, Arabin B, Berger A, Bergman E, Bhide A, Bilardo C, Binder J, Breeze A, Brodszki J, Calda P, Cannings-John R, Černý A, Cesari E, Cetin I, Dall'Asta A, Diemert A, Ebbing C, Eggebø T, Fantasia I, Ferrazzi E, Frusca T, Ghi T, Goodier J, Greimel P, Gyselaers W, Hassan W, Von Kaisenberg C, Kholin A, Klaritsch P, Krofta L, Lindgren P, Lobmaier S, Marsal K, Maruotti GM, Mecacci F, Myklestad K, Napolitano R, Ostermayer E, Papageorghiou A, Potter C, Prefumo F, Raio L, Richter J, Sande RK, Schlembach D, Schleußner E, Stampalija T, Thilaganathan B, Townson J, Valensise H, Visser GHA, Wee L, Wolf H, Lees CC. Perinatal and 2-year neurodevelopmental outcome in late preterm fetal compromise: the TRUFFLE 2 randomised trial protocol. BMJ Open 2022; 12:e055543. [PMID: 35428631 PMCID: PMC9014041 DOI: 10.1136/bmjopen-2021-055543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Following the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years. METHODS AND ANALYSIS Women with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the estimated fetal weight or abdominal circumference is <10th percentile or has decreased by 50 percentiles since 18-32 weeks will be included for observational data collection. Participants will be randomised if cerebral blood flow redistribution is identified, based on umbilical to middle cerebral artery pulsatility index ratio values. Computerised cardiotocography (cCTG) must show normal fetal heart rate short term variation (≥4.5 msec) and absence of decelerations at randomisation. Randomisation will be 1:1 to immediate delivery or delayed delivery (based on cCTG abnormalities or other worsening fetal condition). The primary outcome is poor condition at birth and/or fetal or neonatal death and/or major neonatal morbidity, the secondary non-inferiority outcome is 2-year infant general health and neurodevelopmental outcome based on the Parent Report of Children's Abilities-Revised questionnaire. ETHICS AND DISSEMINATION The Study Coordination Centre has obtained approval from London-Riverside Research Ethics Committee (REC) and Health Regulatory Authority (HRA). Publication will be in line with NIHR Open Access policy. TRIAL REGISTRATION NUMBER Main sponsor: Imperial College London, Reference: 19QC5491. Funders: NIHR HTA, Reference: 127 976. Study coordination centre: Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS with Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University. IRAS Project ID: 266 400. REC reference: 20/LO/0031. ISRCTN registry: 76 016 200.
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Affiliation(s)
- Bronacha Mylrea-Foley
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Jim G Thornton
- Department of Obstetrics and Gynaecology, University of Nottingham, City hospital, Nottingham, UK
| | - Edward Mullins
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Neil Marlow
- Elizabeth Garrett Anderson Institute for Women's Health University College London, London, UK
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Ammari
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Birgit Arabin
- Department of Obstetrics Charite, Humboldt University of Berlin, Berlin, Germany
| | - Astrid Berger
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Bergman
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Amarnath Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Caterina Bilardo
- Department of Obstetrics Amsterdam, Vrije Universiteit Amsterdam, Noord-Holland, The Netherlands
| | - Julia Binder
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Andrew Breeze
- Fetal medicine Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jana Brodszki
- Department of Obstetrics and Gynecology, Lund Skanes universitetssjukhus Lund, Skåne, Sweden
| | - Pavel Calda
- Department of Obstetrics and Gynaecology, Charles University, Praha, Czech Republic
| | | | - Andrej Černý
- Department of Obstetrics & Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Elena Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Hospital, University of Milan, Milan, Italy
| | - Irene Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Hospital, University of Milan, Milan, Italy
| | | | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Ilaria Fantasia
- Unit of Fetal Medicine and Prenatal Diagnosis, RCCS materno infantile Burlo Garofolo Dipartimento di Pediatria, Trieste, Italy
| | - Enrico Ferrazzi
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, ltaly
| | | | - Tullio Ghi
- Department of Obstetrics & Gynecology, University of Parma, Parma, Italy
| | - Jenny Goodier
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Patrick Greimel
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Wilfried Gyselaers
- Department of Obstetrics and Gynecology, Hospital Oost-Limburg, Genk, Belgium
| | - Wassim Hassan
- Obstetrics & Gynaecology, East Suffolk and North Essex NHS Foundation Trust, Colchester Hospital, Colchester, UK
| | | | - Alexey Kholin
- National Medical Research Center for Obstetrics, Gynecology & Perinatology, Moscow, Russia
| | - Philipp Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Medical University of Graz, Graz, Austria
| | - Ladislav Krofta
- Institute for Care of Mother and Child, Prague, Czech Republic
| | - Peter Lindgren
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention & Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Silvia Lobmaier
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karel Marsal
- Obstetrics and Gynaecology, Faculty of Medicine, Lunds Universitet, Lund, Sweden
| | - Giuseppe M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, Federico II University Hospital, Napoli, Italy
| | - Federico Mecacci
- High Risk Pregnancy Unit, University Hospital Careggi, Firenze, Italy
| | - Kirsti Myklestad
- Department of Obstetrics, Children's and Women's Health, St Olavs Hospital University Hospital, Trondheim, Norway
| | - Raffaele Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health University College London, London, UK
| | - Eva Ostermayer
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Aris Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK,Molecular & Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Claire Potter
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, Università degli Studi di Brescia, Brescia, Italy
| | - Luigi Raio
- Department of Obstetrics and Gynaecology, University of Bern, Bern, Switzerland
| | - Jute Richter
- Department of Gynecology and Obstetrics, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ragnar Kvie Sande
- Department of Obstetrics and Gynaecology, Stavanger University Hospital, Stavanger, Norway
| | - Dietmar Schlembach
- Vivantes Network for Health, Clinicum Neukoelln, Clinic for Obstetric Medicine, Berlin, Germany
| | | | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, RCCS materno infantile Burlo Garofolo Dipartimento di Pediatria, Trieste, Italy
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK,Molecular & Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Herbert Valensise
- Division of Obstetrics and Gynaecology Policlinico Casilino, Roma, Italy
| | - Gerard HA Visser
- Department of Obstetrics, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Ling Wee
- Obstetrics And Gynaecology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Hans Wolf
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Christoph C Lees
- Imperial College London, Obstetrics and Gynaecology, Queen Charlotte's & Chelsea Hospital London, London, UK
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16
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Stevenson NJ, Lai MM, Starkman HE, Colditz PB, Wixey JA. Electroencephalographic studies in growth-restricted and small-for-gestational-age neonates. Pediatr Res 2022; 92:1527-1534. [PMID: 35197567 PMCID: PMC9771813 DOI: 10.1038/s41390-022-01992-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 12/30/2022]
Abstract
Foetal growth restriction (FGR) and being born small for gestational age (SGA) are associated with neurodevelopmental delay. Early diagnosis of neurological damage is difficult in FGR and SGA neonates. Electroencephalography (EEG) has the potential as a tool for the assessment of brain development in FGR/SGA neonates. In this review, we analyse the evidence base on the use of EEG for the assessment of neonates with FGR or SGA. We found consistent findings that FGR/SGA is associated with measurable changes in the EEG that present immediately after birth and persist into childhood. Early manifestations of FGR/SGA in the EEG include changes in spectral power, symmetry/synchrony, sleep-wake cycling, and the continuity of EEG amplitude. Later manifestations of FGR/SGA into infancy and early childhood include changes in spectral power, sleep architecture, and EEG amplitude. FGR/SGA infants had poorer neurodevelopmental outcomes than appropriate for gestational age controls. The EEG has the potential to identify FGR/SGA infants and assess the functional correlates of neurological damage. IMPACT: FGR/SGA neonates have significantly different EEG activity compared to AGA neonates. EEG differences persist into childhood and are associated with adverse neurodevelopmental outcomes. EEG has the potential for early identification of brain impairment in FGR/SGA neonates.
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Affiliation(s)
- Nathan J. Stevenson
- grid.1049.c0000 0001 2294 1395Brain Modelling Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia
| | - Melissa M. Lai
- grid.1003.20000 0000 9320 7537UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia ,grid.416100.20000 0001 0688 4634Perinatal Research Centre, Royal Brisbane and Women’s Hospital, Herston, QLD 4029 Australia
| | - Hava E. Starkman
- grid.1003.20000 0000 9320 7537UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia ,grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynaecology, University of Toronto, King’s College Circle, Toronto, ON M5S Canada
| | - Paul B. Colditz
- grid.1003.20000 0000 9320 7537UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia ,grid.416100.20000 0001 0688 4634Perinatal Research Centre, Royal Brisbane and Women’s Hospital, Herston, QLD 4029 Australia
| | - Julie A. Wixey
- grid.1003.20000 0000 9320 7537UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
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17
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Kang J, Koehler RC, Graham EM, Boctor EM. Photoacoustic assessment of the fetal brain and placenta as a method of non-invasive antepartum and intrapartum monitoring. Exp Neurol 2022; 347:113898. [PMID: 34662542 PMCID: PMC8756814 DOI: 10.1016/j.expneurol.2021.113898] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/21/2022]
Abstract
A noninvasive monitor for concurrent evaluation of placental and fetal sagittal sinus sO 2 for both antepartum surveillance at the late 2nd and 3rd trimesters and intrapartum monitoring would be a great advantage over current methods. A PA fetal brain and placental monitor has potential value to rapidly identify the fetus at risk for developing hypoxia and ischemia of a sufficient degree that brain injury or death may develop, which may be prevented by intervention with delivery and other follow-up treatments.
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Affiliation(s)
- Jeeun Kang
- Laboratory for Computational Sensing and Robotics, Whiting School of Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Raymond C Koehler
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Ernest M Graham
- Department of Gyn-Ob, Division of Maternal-Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Neuroscience Intensive Care Nursery Program, Johns Hopkins University School of Medicine; Baltimore, MD, United States of America.
| | - Emad M Boctor
- Laboratory for Computational Sensing and Robotics, Whiting School of Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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18
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Dulay S, Rivas L, Pla L, Berdún S, Eixarch E, Gratacós E, Illa M, Mir M, Samitier J. Fetal ischemia monitoring with in vivo implanted electrochemical multiparametric microsensors. J Biol Eng 2021; 15:28. [PMID: 34930385 PMCID: PMC8691007 DOI: 10.1186/s13036-021-00280-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/30/2021] [Indexed: 12/15/2022] Open
Abstract
Under intrauterine growth restriction (IUGR), abnormal attainment of the nutrients and oxygen by the fetus restricts the normal evolution of the prenatal causing in many cases high morbidity being one of the top-ten causes of neonatal death. The current gold standards in hospitals to detect this relevant problem is the clinical observation by echography, cardiotocography and Doppler. These qualitative techniques are not conclusive and requires risky invasive fetal scalp blood testing and/or amniocentesis. We developed micro-implantable multiparametric electrochemical sensors for measuring ischemia in real time in fetal tissue and vascular. This implantable technology is designed to continuous monitoring for an early detection of ischemia to avoid potential fetal injury. Two miniaturized electrochemical sensors were developed based on oxygen and pH detection. The sensors were optimized in vitro under controlled concentration, to assess the selectivity and sensitivity required. The sensors were then validated in vivo in the ewe fetus model, by means of their insertion in the muscle leg and inside the iliac artery of the fetus. Ischemia was achieved by gradually obstructing the umbilical cord to regulate the amount of blood reaching the fetus. An important challenge in fetal monitoring is the detection of low levels of oxygen and pH changes under ischemic conditions, requiring high sensitivity sensors. Significant differences were observed in both; pH and pO2 sensors under changes from normoxia to hypoxia states in the fetus tissue and vascular with both sensors. Herein, we demonstrate the feasibility of the developed sensors for future fetal monitoring in medical applications.
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Affiliation(s)
- Samuel Dulay
- Nanobioengineering group, Institute for Bioengineering of Catalonia (IBEC) Barcelona Institute of Science and Technology (BIST), 12 Baldiri Reixac 15-21, 08028, Barcelona, Spain
| | - Lourdes Rivas
- Nanobioengineering group, Institute for Bioengineering of Catalonia (IBEC) Barcelona Institute of Science and Technology (BIST), 12 Baldiri Reixac 15-21, 08028, Barcelona, Spain
| | - Laura Pla
- Fetal Medicine Research Center, BCNatal. Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Building Helios 2, Sabino Arana Street 1, 08028, Barcelona, Spain
| | - Sergio Berdún
- Fetal Medicine Research Center, BCNatal. Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Building Helios 2, Sabino Arana Street 1, 08028, Barcelona, Spain
| | - Elisenda Eixarch
- Fetal Medicine Research Center, BCNatal. Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Building Helios 2, Sabino Arana Street 1, 08028, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eduard Gratacós
- Fetal Medicine Research Center, BCNatal. Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Building Helios 2, Sabino Arana Street 1, 08028, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Miriam Illa
- Fetal Medicine Research Center, BCNatal. Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Building Helios 2, Sabino Arana Street 1, 08028, Barcelona, Spain
| | - Mònica Mir
- Nanobioengineering group, Institute for Bioengineering of Catalonia (IBEC) Barcelona Institute of Science and Technology (BIST), 12 Baldiri Reixac 15-21, 08028, Barcelona, Spain. .,Biomedical Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain. .,Department of Electronics and Biomedical Engineering, University of Barcelona, Martí i Franquès 1, 08028, Barcelona, Spain.
| | - Josep Samitier
- Nanobioengineering group, Institute for Bioengineering of Catalonia (IBEC) Barcelona Institute of Science and Technology (BIST), 12 Baldiri Reixac 15-21, 08028, Barcelona, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Monforte de Lemos 3-5, Pabellón 11, 28029, Madrid, Spain.,Department of Electronics and Biomedical Engineering, University of Barcelona, Martí i Franquès 1, 08028, Barcelona, Spain
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19
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Neuroimaging and neurodevelopmental outcome after early fetal growth restriction: NEUROPROJECT-FGR. Pediatr Res 2021; 90:869-875. [PMID: 33469173 DOI: 10.1038/s41390-020-01333-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/24/2020] [Accepted: 12/09/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adverse neurodevelopmental outcomes and MRI alterations are reported in infants born after fetal growth restriction (FGR). This study evaluates the additional role of FGR over prematurity in determining brain impairment. METHODS Retrospective observational study comparing 48 FGR and 36 appropriate for gestational age infants born between 26 and 32 weeks' gestation who underwent a cerebral MRI at term equivalent age. Exclusion criteria were twins, congenital anomalies, and findings of overt brain lesions. Main outcomes were total maturation score (TMS) and cerebral areas independently measured by two neuro-radiologists and Griffiths or Bayley scale III scores at median age of 2 years. RESULTS TMS was not significantly different between the groups. Inner calvarium and parenchyma's areas were significantly smaller in FGR cases. There were no significant differences in the average quotient scores. A positive correlation between parenchyma area and cognitive score was found (r = 0.372, p = 0.0078) and confirmed after adjusting for sex, gestational age, and birth weight (p = 0.0014). Among FGR, the subgroup with umbilical arterial Doppler velocimetry alterations had significantly worse gross motor scores (p = 0.005). CONCLUSIONS FGR plays additional role over prematurity in determining brain impairment. An early structural dimensional MRI evaluation may identify infants who are at higher risk. IMPACT Fetal growth-restricted infants showed smaller cerebral parenchymal areas than preterm controls. There is a positive correlation between the parenchyma area and the cognitive score. These results highlight the already known link between structure and function and add importance to the role of a structural dimensional MRI evaluation even in the absence of overt brain lesions.
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20
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Perinatal blood biomarkers for the identification of brain injury in very low birth weight growth-restricted infants. J Perinatol 2021; 41:2252-2260. [PMID: 34083761 PMCID: PMC8496988 DOI: 10.1038/s41372-021-01112-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/29/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine if blood biomarkers measured at delivery and shortly after birth can identify growth-restricted infants at risk for developing severe brain injury. STUDY DESIGN In a cohort of very low birth weight neonates, fetal growth restricted (FGR) (birth weight <10%) were compared to non-FGR neonates, and within the FGR group those with brain injury were compared to those without. Biomarkers were measured in cord blood at delivery, and daily for the 1st 5 days of life. RESULT FGR was associated with significantly higher levels of interleukin (IL)-6, IL-8, IL-10, and lower levels of vascular endothelial growth factor (VEGF). FGR and brain injury were associated with significantly higher levels of IL-6, IL-8, IL-10, and glial fibrillary acidic protein (GFAP). CONCLUSION Interleukins may be involved in a common pathway contributing to both the development of growth restriction and brain injury, and GFAP may help identify brain injury within this growth-restricted group.
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21
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Silva PIP, Perez M. Prenatal Ultrasound Diagnosis of Biometric changes in the Brain of Growth Restricted Fetuses. A Systematic Review of Literature. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:545-559. [PMID: 34461665 PMCID: PMC10302626 DOI: 10.1055/s-0041-1730290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Fetal growth restriction (FGR) occurs when the fetus does not reach its intrauterine potential for growth and development as a result of compromise in placental function. It is a condition that affects 5 to 10% of pregnancies and is the second most common cause of perinatal morbidity and mortality. Children born with FGR are at risk of impaired neurological and cognitive development and cardiovascular or endocrine diseases in adulthood. The purpose of the present revision is to perform a literature search for evidence on the detection and assessment by ultrasound of brain injury linked to FGR during fetal life. Using a systematic approach and quantitative evaluation as study methodology, we reviewed ultrasound studies of the fetal brain structure of growth-restricted fetuses with objective quality measures. A total of eight studies were identified. High quality studies were identified for measurement of brain volumes; corpus callosum; brain fissure depth measurements, and cavum septi pellucidi width measurement. A low-quality study was available for transverse cerebellar diameter measurement in FGR. Further prospective randomized studies are needed to understand the changes that occur in the brain of fetuses with restricted growth, as well as their correlation with the changes in cognitive development observed.
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22
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Rock CR, White TA, Piscopo BR, Sutherland AE, Miller SL, Camm EJ, Allison BJ. Cardiovascular and Cerebrovascular Implications of Growth Restriction: Mechanisms and Potential Treatments. Int J Mol Sci 2021; 22:ijms22147555. [PMID: 34299174 PMCID: PMC8303639 DOI: 10.3390/ijms22147555] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 01/25/2023] Open
Abstract
Fetal growth restriction (FGR) is a common complication of pregnancy, resulting in a fetus that fails to reach its genetically determined growth potential. Whilst the fetal cardiovascular response to acute hypoxia is well established, the fetal defence to chronic hypoxia is not well understood due to experiment constraints. Growth restriction results primarily from reduced oxygen and nutrient supply to the developing fetus, resulting in chronic hypoxia. The fetus adapts to chronic hypoxia by redistributing cardiac output via brain sparing in an attempt to preserve function in the developing brain. This review highlights the impact of brain sparing on the developing fetal cardiovascular and cerebrovascular systems, as well as emerging long-term effects in offspring that were growth restricted at birth. Here, we explore the pathogenesis associated with brain sparing within the cerebrovascular system. An increased understanding of the mechanistic pathways will be critical to preventing neuropathological outcomes, including motor dysfunction such as cerebral palsy, or behaviour dysfunctions including autism and attention-deficit/hyperactivity disorder (ADHD).
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Affiliation(s)
- Charmaine R. Rock
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Tegan A. White
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Beth R. Piscopo
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Amy E. Sutherland
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
| | - Suzanne L. Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Emily J. Camm
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Beth J. Allison
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (C.R.R.); (T.A.W.); (B.R.P.); (A.E.S.); (S.L.M.); (E.J.C.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
- Correspondence:
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23
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McLean G, Malhotra A, Lombardo P, Schneider M. Cranial Ultrasound Screening Protocols for Very Preterm Infants. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1645-1656. [PMID: 33895036 DOI: 10.1016/j.ultrasmedbio.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
Cranial ultrasound examinations are routinely performed in very preterm neonates. There is no widespread agreement on the optimal timing of these examinations. This review examines screening protocols and recommendations available for the timing of cranial ultrasound examinations in preterm neonates born before 32 wk of gestation. A systematic search was performed to find published screening protocols, and 18 articles were included in the final review. The protocols varied in their recommendations on timing, although at least one examination in the first week of life was universally recommended. The recommended timing for a "late" or final ultrasound examination was variable, and included at 6 wks of postnatal age, term-equivalent age or hospital discharge. There was no agreement as to whether weekly or fortnightly sequential ultrasound imaging should be performed after the first week of life. Further studies are required to establish an optimal protocol for these very preterm neonates to improve detection and monitoring of brain injuries.
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Affiliation(s)
- Glenda McLean
- Diagnostic Imaging Department, Monash Health, Melbourne, Australia; Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Australia.
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Clayton, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
| | - Paul Lombardo
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Australia
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24
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Morrison JL, Ayonrinde OT, Care AS, Clarke GD, Darby JRT, David AL, Dean JM, Hooper SB, Kitchen MJ, Macgowan CK, Melbourne A, McGillick EV, McKenzie CA, Michael N, Mohammed N, Sadananthan SA, Schrauben E, Regnault TRH, Velan SS. Seeing the fetus from a DOHaD perspective: discussion paper from the advanced imaging techniques of DOHaD applications workshop held at the 2019 DOHaD World Congress. J Dev Orig Health Dis 2021; 12:153-167. [PMID: 32955011 DOI: 10.1017/s2040174420000884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Advanced imaging techniques are enhancing research capacity focussed on the developmental origins of adult health and disease (DOHaD) hypothesis, and consequently increasing awareness of future health risks across various subareas of DOHaD research themes. Understanding how these advanced imaging techniques in animal models and human population studies can be both additively and synergistically used alongside traditional techniques in DOHaD-focussed laboratories is therefore of great interest. Global experts in advanced imaging techniques congregated at the advanced imaging workshop at the 2019 DOHaD World Congress in Melbourne, Australia. This review summarizes the presentations of new imaging modalities and novel applications to DOHaD research and discussions had by DOHaD researchers that are currently utilizing advanced imaging techniques including MRI, hyperpolarized MRI, ultrasound, and synchrotron-based techniques to aid their DOHaD research focus.
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Affiliation(s)
- Janna L Morrison
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Oyekoya T Ayonrinde
- Fiona Stanley Hospital, Murdoch, WA, Australia
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Alison S Care
- The Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Geoffrey D Clarke
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Jack R T Darby
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Justin M Dean
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- The Department of Obstetrics and Gynecology, Monash University, Melbourne, Victoria, Australia
| | - Marcus J Kitchen
- School of Physics and Astronomy, Monash University, Melbourne, Victoria, Australia
| | | | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
| | - Erin V McGillick
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- The Department of Obstetrics and Gynecology, Monash University, Melbourne, Victoria, Australia
| | - Charles A McKenzie
- Department of Medical Biophysics, Western University, London, ON, Canada
- Lawson Health Research Institute and Children's Health Research Institute, London, ON, Canada
| | - Navin Michael
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
| | - Nuruddin Mohammed
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Suresh Anand Sadananthan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
| | - Eric Schrauben
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Timothy R H Regnault
- Lawson Health Research Institute and Children's Health Research Institute, London, ON, Canada
- Department of Obstetrics and Gynecology, Western University, London, ON, Canada
- Department of Physiology and Pharmacology, Western University, London, ON, Canada
| | - S Sendhil Velan
- Singapore Bioimaging Consortium, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
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25
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Apparent diffusion coefficient of different areas of brain in foetuses with intrauterine growth restriction. Pol J Radiol 2020; 85:e301-e308. [PMID: 32685065 PMCID: PMC7361370 DOI: 10.5114/pjr.2020.96950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/28/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose This study aimed to compare the apparent diffusion coefficient (ADC) values of different brain areas between two groups of intrauterine growth restricted (IUGR) foetuses and control cases. Material and methods A total of 38 foetuses with IUGR and 18 normal control foetuses with similar gestational age were compared using a 3T magnetic resonance scanner. IUGR cases included 23 foetuses with clinical severity signs (group A) and 15 foetuses without clinical severity signs (group B). ADC values were measured in different brain regions and compared among groups. Foetuses with structural brain abnormalities were excluded from the study. Results All foetuses had normal foetal structural brain anatomy. Head circumference (HC) < 5% was more common in IUGR group A compared to IUGR group B (56.5% vs. 13.3%, p < 0.0001). In comparison to the normal group, the ADC values in IUGR foetuses were significantly lower in cerebellar hemispheres (CH) (1.239 vs. 1.280.5 × 10-3 mm2/s, p = 0.045), thalami (1.205 vs. 1.285 × 10-3 mm2/s, p = 0.031) and caudate nucleus (CN) (1.319 vs. 1.394 × 10-3 mm2/s, p = 0.04). However, there were no significant differences in ADC values between IUGR subtypes. Among all brain regions, pons had the lowest ADC values. Conclusions ADC values of thalami, CN, and CH were significantly lower in IUGR than control foetuses, while there was no significant difference among IUGR groups. Further studies are needed to evaluate the prognostic value of ADC changes in IUGR foetuses.
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Maki Y, Nygard K, Hammond RR, Regnault TRH, Richardson BS. Maternal Undernourishment in Guinea Pigs Leads to Fetal Growth Restriction with Increased Hypoxic Cells and Oxidative Stress in the Brain. Dev Neurosci 2020; 41:290-299. [PMID: 32316015 DOI: 10.1159/000506939] [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: 11/01/2019] [Accepted: 02/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We determined whether maternal nutrient restriction (MNR) in guinea pigs leading to fetal growth restriction (FGR) impacts markers for brain hypoxia and oxidative stress. METHODS Guinea pigs were fed ad libitum (control) or 70% of the control diet before pregnancy, switching to 90% at mid-pregnancy (MNR). Near term, hypoxyprobe-1 (HP-1) was injected into pregnant sows. Fetuses were then necropsied and brain tissues were processed for HP-1 (hypoxia marker) and 4HNE, 8-OHdG, and 3-nitrotyrosine (oxidative stress markers) immunoreactivity (IR). RESULTS FGR-MNR fetal and brain weights were decreased 38 and 12%, respectively, with brain/fetal weights thereby increased 45% as a measure of brain sparing, and more so in males than females. FGR-MNR HP-1 IR was increased in most of the brain regions studied, and more so in males than females, while 4HNE and 8-OHdG IR were increased in select brain regions, but with no sex differences. CONCLUSIONS Chronic hypoxia is likely to be an important signaling mechanism in the FGR brain, but with males showing more hypoxia than females. This may involve sex differences in adaptive decreases in growth and normalizing of oxygen, with implications for sex-specific alterations in brain development and risk for later neuropsychiatric disorder.
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Affiliation(s)
- Yohei Maki
- Department of Obstetrics and Gynecology, University of Western Ontario, London, Ontario, Canada.,Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Karen Nygard
- Biotron Integrated Microscopy Facility, University of Western Ontario, London, Ontario, Canada
| | - Robert R Hammond
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada.,Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Timothy R H Regnault
- Department of Obstetrics and Gynecology, University of Western Ontario, London, Ontario, Canada.,Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada.,The Children's Health Research Institute, London, Ontario, Canada
| | - Bryan S Richardson
- Department of Obstetrics and Gynecology, University of Western Ontario, London, Ontario, Canada, .,Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada, .,The Children's Health Research Institute, London, Ontario, Canada,
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Caputo MP, Williams JN, Drnevich J, Radlowski EC, Larsen RJ, Sutton BP, Leyshon BJ, Hussain J, Nakamura MT, Kuchan MJ, Das T, Johnson RW. Hydrolyzed Fat Formula Increases Brain White Matter in Small for Gestational Age and Appropriate for Gestational Age Neonatal Piglets. Front Pediatr 2020; 8:32. [PMID: 32117837 PMCID: PMC7029735 DOI: 10.3389/fped.2020.00032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/22/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Intrauterine growth restriction is a common cause of small for gestational age (SGA) infants worldwide. SGA infants are deficient in digestive enzymes required for fat digestion and absorption compared to appropriate for gestational age (AGA) infants, putting them at risk for impaired neurocognitive development. Objective: The objective was to determine if a hydrolyzed fat (HF) infant formula containing soy free fatty acids, 2-monoacylglycerolpalmitate, cholesterol, and soy lecithin could increase brain tissue incorporation of essential fatty acids or white matter to enhance brain development in SGA and AGA neonatal piglet models. Methods: Sex-matched, littermate pairs of SGA (0.5-0.9 kg) and AGA (1.2-1.8 kg) 2 days old piglets (N = 60) were randomly assigned to control (CON) or HF formula diets in a 2 × 2 factorial design. On day 14, 24 piglets were used for hippocampal RNA-sequencing; the rest began a spatial learning task. On days 26-29, brain structure was assessed by magnetic resonance imaging (MRI). Cerebellum and hippocampus were analyzed for fatty acid content. Results: SGA piglets grew more slowly than AGA piglets, with no effect of diet on daily weight gain or weight at MRI. HF diet did not affect brain weight. HF diet increased relative volumes of 7 brain regions and white matter (WM) volume in both SGA and AGA piglets. However, HF did not ameliorate SGA total WM integrity deficits. RNA sequencing revealed SGA piglets had increased gene expression of synapse and cell signaling pathways and decreased expression of ribosome pathways in the hippocampus compared to AGA. HF decreased expression of immune response related genes in the hippocampus of AGA and SGA piglets, but did not correct gene expression patterns in SGA piglets. Piglets learned the T-maze task at the same rate, but SGA HF, SGA CON, and AGA HF piglets had more accurate performance than AGA CON piglets on reversal day 2. HF increased arachidonic acid (ARA) percentage in the cerebellum and total ARA in the hippocampus. Conclusions: HF enhanced brain development in the neonatal piglet measured by brain volume and WM volume in specific brain regions; however, more studies are needed to assess long-term outcomes.
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Affiliation(s)
- Megan P Caputo
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States.,Department of Animal Sciences, University of Illinois, Urbana, IL, United States
| | - Jennifer N Williams
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States.,Department of Animal Sciences, University of Illinois, Urbana, IL, United States
| | - Jenny Drnevich
- High Performance Biological Computing Group and the Carver Biotechnology Center, University of Illinois, Urbana, IL, United States
| | - Emily C Radlowski
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States.,Department of Animal Sciences, University of Illinois, Urbana, IL, United States
| | - Ryan J Larsen
- Beckman Institute, University of Illinois, Urbana, IL, United States
| | - Bradley P Sutton
- Beckman Institute, University of Illinois, Urbana, IL, United States.,Department of Bioengineering, University of Illinois, Urbana, IL, United States
| | - Brian J Leyshon
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States.,Department of Animal Sciences, University of Illinois, Urbana, IL, United States
| | - Jamal Hussain
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL, United States
| | - Manabu T Nakamura
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States.,Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL, United States
| | - Matthew J Kuchan
- Abbott Nutrition, Discovery Research, Columbus, OH, United States
| | - Tapas Das
- Abbott Nutrition, Discovery Research, Columbus, OH, United States
| | - Rodney W Johnson
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States.,Department of Animal Sciences, University of Illinois, Urbana, IL, United States.,Neuroscience Program, University of Illinois, Urbana, IL, United States
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Cardiovascular effects of prenatal stress-Are there implications for cerebrovascular, cognitive and mental health outcome? Neurosci Biobehav Rev 2019; 117:78-97. [PMID: 31708264 DOI: 10.1016/j.neubiorev.2018.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/17/2023]
Abstract
Prenatal stress programs offspring cognitive and mental health outcome. We reviewed whether prenatal stress also programs cardiovascular dysfunction which potentially modulates cerebrovascular, cognitive and mental health disorders. We focused on maternal stress and prenatal glucocorticoid (GC) exposure which have different programming effects. While maternal stress induced cortisol is mostly inactivated by the placenta, synthetic GCs freely cross the placenta and have different receptor-binding characteristics. Maternal stress, particularly anxiety, but not GC exposure, has adverse effects on maternal-fetal circulation throughout pregnancy, probably by co-activation of the maternal sympathetic nervous system, and by raising fetal catecholamines. Both effects may impair neurodevelopment. Experimental data also suggest that severe maternal stress and GC exposure during early and mid-gestation may increase the risk for cardiovascular disorders. Human data are scarce and especially lacking for older age. Programming mechanisms include aberrations in cardiac and kidney development, and functional changes in the renin-angiotensin-aldosterone-system, stress axis and peripheral and coronary vasculature. Adequate experimental or human studies examining the consequences for cerebrovascular, cognitive and mental disorders are unavailable.
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29
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Turk EA, Stout JN, Ha C, Luo J, Gagoski B, Yetisir F, Golland P, Wald LL, Adalsteinsson E, Robinson JN, Roberts DJ, Barth WH, Grant PE. Placental MRI: Developing Accurate Quantitative Measures of Oxygenation. Top Magn Reson Imaging 2019; 28:285-297. [PMID: 31592995 PMCID: PMC7323862 DOI: 10.1097/rmr.0000000000000221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The Human Placenta Project has focused attention on the need for noninvasive magnetic resonance imaging (MRI)-based techniques to diagnose and monitor placental function throughout pregnancy. The hope is that the management of placenta-related pathologies would be improved if physicians had more direct, real-time measures of placental health to guide clinical decision making. As oxygen alters signal intensity on MRI and oxygen transport is a key function of the placenta, many of the MRI methods under development are focused on quantifying oxygen transport or oxygen content of the placenta. For example, measurements from blood oxygen level-dependent imaging of the placenta during maternal hyperoxia correspond to outcomes in twin pregnancies, suggesting that some aspects of placental oxygen transport can be monitored by MRI. Additional methods are being developed to accurately quantify baseline placental oxygenation by MRI relaxometry. However, direct validation of placental MRI methods is challenging and therefore animal studies and ex vivo studies of human placentas are needed. Here we provide an overview of the current state of the art of oxygen transport and quantification with MRI. We suggest that as these techniques are being developed, increased focus be placed on ensuring they are robust and reliable across individuals and standardized to enable predictive diagnostic models to be generated from the data. The field is still several years away from establishing the clinical benefit of monitoring placental function in real time with MRI, but the promise of individual personalized diagnosis and monitoring of placental disease in real time continues to motivate this effort.
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Affiliation(s)
- Esra Abaci Turk
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, MA, USA
| | - Jeffrey N. Stout
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, MA, USA
| | - Christopher Ha
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, MA, USA
| | - Jie Luo
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Borjan Gagoski
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, MA, USA
| | - Filiz Yetisir
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, MA, USA
| | - Polina Golland
- Computer Science and Artificial Intelligence Laboratory (CSAIL), Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Electrical Engineering and Computer Science Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Lawrence L. Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Elfar Adalsteinsson
- Department of Electrical Engineering and Computer Science Massachusetts Institute of Technology, Cambridge, MA, United States
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Julian N. Robinson
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA
| | | | - William H. Barth
- Maternal-Fetal Medicine, Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - P. Ellen Grant
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children’s Hospital, MA, USA
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30
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Malhotra A, Sepehrizadeh T, Dhollander T, Wright D, Castillo-Melendez M, Sutherland AE, Pham Y, Ditchfield M, Polglase GR, de Veer M, Jenkin G, Pannek K, Shishegar R, Miller SL. Advanced MRI analysis to detect white matter brain injury in growth restricted newborn lambs. NEUROIMAGE-CLINICAL 2019; 24:101991. [PMID: 31473545 PMCID: PMC6728876 DOI: 10.1016/j.nicl.2019.101991] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/06/2019] [Accepted: 08/21/2019] [Indexed: 12/13/2022]
Abstract
Background Fetal growth restriction (FGR) is a serious pregnancy complication associated with increased risk of adverse neurodevelopment and neuromorbidity. Current imaging techniques, including conventional magnetic resonance imaging (MRI), are not sensitive enough to detect subtle structural abnormalities in the FGR brain. We examined whether advanced MRI analysis techniques have the capacity to detect brain injury (particularly white matter injury) caused by chronic hypoxia-induced fetal growth restriction in newborn preterm lambs. Methods Surgery was undertaken in twin bearing pregnant ewes at 88–90 days gestation (term = 150 days) to induce FGR in one fetus. At 127 days gestation (~32 weeks human brain development), FGR and control (appropriate for gestational age, AGA) lambs were delivered by caesarean section, intubated and ventilated. Conventional and advanced brain imaging was conducted within the first two hours of life using a 3T MRI scanner. T1-weighted (T1w) and T2-weighted (T2w) structural imaging, magnetic resonance spectroscopy (MRS), and diffusion MRI (dMRI) data were acquired. Diffusion tensor imaging (DTI) modelling and analysis of dMRI data included the following regions of interest (ROIs): subcortical white matter, periventricular white matter, cerebellum, hippocampus, corpus callosum and thalamus. Fixel-based analysis of 3-tissue constrained spherical deconvolution (CSD) of the dMRI data was performed and compared between FGR and AGA lambs. Lambs were euthanised immediately after the scans and brain histology performed in the regions of interest to correlate with imaging. Results FGR and AGA lamb (body weight, mean (SD): 2.2(0.5) vs. 3.3(0.3) kg, p = .002) MRI brain scans were analysed. There were no statistically significant differences observed between the groups in conventional T1w, T2w or MRS brain data. Mean, axial and radial diffusivity, and fractional anisotropy indices obtained from DTI modelling also did not show any statistically significant differences between groups in the ROIs. Fixel-based analysis of 3-tissue CSD, however, did reveal a decrease in fibre cross-section (FC, p < .05) but not in fibre density (FD) or combined fibre density and cross-section (FDC) in FGR vs. AGA lamb brains. The specific tracts that showed a decrease in FC were in the regions of the periventricular white matter, hippocampus and cerebellar white matter, and were supported by histological evidence of white matter hypomyelination and disorganisation in corresponding FGR lamb brain regions. Conclusions The neuropathology associated with FGR in neonatal preterm lambs is subtle and imaging detection may require advanced MRI and tract-based analysis techniques. Fixel-based analysis of 3-tissue CSD demonstrates that the preterm neonatal FGR brain shows evidence of macrostructural (cross-sectional) deficits in white matter subsequent to altered antenatal development. These findings can inform analysis of similar brain pathology in neonatal infants. FGR brain injury can be subtle, and not easily detected on conventional imaging. Fixel-based analysis showed differences in fibre content of FGR lamb brain tracts. Histological stain confirmed myelination deficits in corresponding brain regions.
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Affiliation(s)
- Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia.
| | | | - Thijs Dhollander
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; The Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - David Wright
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia
| | - Margie Castillo-Melendez
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Amy E Sutherland
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | - Yen Pham
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | | | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Michael de Veer
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Graham Jenkin
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Kerstin Pannek
- Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Rosita Shishegar
- Monash Biomedical Imaging, Monash University, Melbourne, Australia; The Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia; CSIRO Health and Biosecurity, Parkville, Victoria, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
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31
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Ding YX, Cui H. The brain development of infants with intrauterine growth restriction: role of glucocorticoids. Horm Mol Biol Clin Investig 2019; 39:hmbci-2019-0016. [PMID: 31348758 DOI: 10.1515/hmbci-2019-0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/20/2019] [Indexed: 12/14/2022]
Abstract
Brain injury is a serious complication of intrauterine growth restriction (IUGR), but the exact mechanism remains unclear. While glucocorticoids (GCs) play an important role in intrauterine growth and development, GCs also have a damaging effect on microvascular endothelial cells. Moreover, intrauterine adverse environments lead to fetal growth restriction and the hypothalamus-pituitary-adrenal (HPA) axis resetting. In addition, chronic stress can cause a decrease in the number and volume of astrocytes in the hippocampus and glial cells play an important role in neuronal differentiation. Therefore, it is speculated that the effect of GCs on cerebral neurovascular units under chronic intrauterine stimulation is an important mechanism leading to brain injury in infants with growth restrictions.
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Affiliation(s)
- Ying-Xue Ding
- Department of Pediatric, Beijing Friendship Hospital, Capital Medical University, Beijing, China, Phone: +86-10-13146645219
| | - Hong Cui
- Department of Pediatric, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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32
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Caravale B, Herich L, Zoia S, Capone L, Voller F, Carrozzi M, Chiandotto V, Balottin U, Lacchei M, Croci I, Cuttini M. Risk of Developmental Coordination Disorder in Italian very preterm children at school age compared to general population controls. Eur J Paediatr Neurol 2019; 23:296-303. [PMID: 30711366 DOI: 10.1016/j.ejpn.2019.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/21/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder that involves difficulties in goal-directed motor coordination, with ineffective control of fine and gross motor movements in the absence of sensory impairment or neurological condition. DCD is frequently reported in children born very preterm (VP) who survive without CP. AIMS To measure the risk of DCD at school age in a large area-based cohort of VP children and general population controls, adjusting for gender, birth weight by gestational age and age at assessment. METHODS VP children (N = 608) were part of a prospective cohort study in Italy. Controls (N = 370) were participants in the DCDQ-Italian validation study in the same age range. The Italian version of Developmental Coordination Disorder Questionnaire (DCDQ-Italian) was used to measure the performances in motor coordination during ordinary activities from the parental point of view. Multivariable regression analysis was used to obtain adjusted risk ratios of screening positive for DCD. RESULTS VP children had scores significantly lower than peers, and about 30% of them appeared at risk of DCD using the 15th percentile cut-off of the Italian validation study. Birth-weight <10th percentile for gestational age and male gender were significant predictors. A slight trend effect was present, with extremely preterm children (<28 weeks gestation) showing the highest risk. CONCLUSIONS Our study confirmed the higher DCD risk in VP children, particularly when males and SGA.
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Affiliation(s)
- Barbara Caravale
- Department of Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
| | - Lena Herich
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146, Rome, Italy.
| | - Stefania Zoia
- Struttura Complessa Tutela Salute Bambini Adolescenti Donne Famiglia, Azienda Sanitaria Universitaria Integrata di Trieste, Via Giovanni Sai 7, 34128, Trieste, Italy.
| | - Luca Capone
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Fabio Voller
- Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, 50141, Florence, Italy.
| | - Marco Carrozzi
- Department of Neuroscience, Burlo Garofolo Hospital, IRCCS, Via dell'Istria 65/1, 34127, Trieste, Italy.
| | - Valeria Chiandotto
- Neonatal Intensive Care Unit, S. Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy.
| | - Umberto Balottin
- Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100, Pavia, Italy; Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Maria Lacchei
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146, Rome, Italy.
| | - Ileana Croci
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146, Rome, Italy.
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146, Rome, Italy.
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Vasung L, Abaci Turk E, Ferradal SL, Sutin J, Stout JN, Ahtam B, Lin PY, Grant PE. Exploring early human brain development with structural and physiological neuroimaging. Neuroimage 2019; 187:226-254. [PMID: 30041061 PMCID: PMC6537870 DOI: 10.1016/j.neuroimage.2018.07.041] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022] Open
Abstract
Early brain development, from the embryonic period to infancy, is characterized by rapid structural and functional changes. These changes can be studied using structural and physiological neuroimaging methods. In order to optimally acquire and accurately interpret this data, concepts from adult neuroimaging cannot be directly transferred. Instead, one must have a basic understanding of fetal and neonatal structural and physiological brain development, and the important modulators of this process. Here, we first review the major developmental milestones of transient cerebral structures and structural connectivity (axonal connectivity) followed by a summary of the contributions from ex vivo and in vivo MRI. Next, we discuss the basic biology of neuronal circuitry development (synaptic connectivity, i.e. ensemble of direct chemical and electrical connections between neurons), physiology of neurovascular coupling, baseline metabolic needs of the fetus and the infant, and functional connectivity (defined as statistical dependence of low-frequency spontaneous fluctuations seen with functional magnetic resonance imaging (fMRI)). The complementary roles of magnetic resonance imaging (MRI), electroencephalography (EEG), magnetoencephalography (MEG), and near-infrared spectroscopy (NIRS) are discussed. We include a section on modulators of brain development where we focus on the placenta and emerging placental MRI approaches. In each section we discuss key technical limitations of the imaging modalities and some of the limitations arising due to the biology of the system. Although neuroimaging approaches have contributed significantly to our understanding of early brain development, there is much yet to be done and a dire need for technical innovations and scientific discoveries to realize the future potential of early fetal and infant interventions to avert long term disease.
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Affiliation(s)
- Lana Vasung
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Esra Abaci Turk
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Silvina L Ferradal
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Jason Sutin
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Jeffrey N Stout
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Banu Ahtam
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Pei-Yi Lin
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Malhotra A, Allison BJ, Castillo-Melendez M, Jenkin G, Polglase GR, Miller SL. Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact. Front Endocrinol (Lausanne) 2019; 10:55. [PMID: 30792696 PMCID: PMC6374308 DOI: 10.3389/fendo.2019.00055] [Citation(s) in RCA: 203] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022] Open
Abstract
Being born small lays the foundation for short-term and long-term implications for life. Intrauterine or fetal growth restriction describes the pregnancy complication of pathological reduced fetal growth, leading to significant perinatal mortality and morbidity, and subsequent long-term deficits. Placental insufficiency is the principal cause of FGR, which in turn underlies a chronic undersupply of oxygen and nutrients to the fetus. The neonatal morbidities associated with FGR depend on the timing of onset of placental dysfunction and growth restriction, its severity, and the gestation at birth of the infant. In this review, we explore the pathophysiological mechanisms involved in the development of major neonatal morbidities in FGR, and their impact on the health of the infant. Fetal cardiovascular adaptation and altered organ development during gestation are principal contributors to postnatal consequences of FGR. Clinical presentation, diagnostic tools and management strategies of neonatal morbidities are presented. We also present information on the current status of targeted therapies. A better understanding of neonatal morbidities associated with FGR will enable early neonatal detection, monitoring and management of potential adverse outcomes in the newborn period and beyond.
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Affiliation(s)
- Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- *Correspondence: Atul Malhotra
| | - Beth J. Allison
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Margie Castillo-Melendez
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Graham Jenkin
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Graeme R. Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Suzanne L. Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
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Maternal nutrient restriction in guinea pigs leads to fetal growth restriction with increased brain apoptosis. Pediatr Res 2019; 85:105-112. [PMID: 30420709 DOI: 10.1038/s41390-018-0230-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/10/2018] [Accepted: 10/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND We determined whether maternal nutrient restriction (MNR) in guinea pigs leading to fetal growth restriction (FGR) impacts cell death in the brain with implications for neurodevelopmental adversity. METHODS Guinea pigs were fed ad libitum (Control) or 70% of the control diet before pregnancy, switching to 90% at mid-pregnancy (MNR). Fetuses were necropsied near term and brain tissues processed for necrosis (H&E), apoptosis (TUNEL), and pro- (Bax) and anti- (Bcl-2 and Grp78) apoptotic protein immunoreactivity. RESULTS FGR-MNR fetal and brain weights were decreased 38% and 12%, respectively, indicating brain sparing but with brains still smaller. While necrosis remained unchanged, apoptosis was increased in the white matter and hippocampus in the FGR brains, and control and FGR-related apoptosis were increased in males for most brain areas. Bax was increased in the CA4 and Bcl-2 was decreased in the dentate gyrus in the FGR brains supporting a role in the increased apoptosis, while Grp78 was increased in the FGR females, possibly contributing to the sex-related differences. CONCLUSIONS MNR-induced FGR results in increased brain apoptosis with regional and sex-related differences that may contribute to the reduction in brain area size reported clinically and increased risk in FGR males for later neurodevelopmental adversity.
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Gestational age-specific risk of stillbirth during term pregnancy according to maternal age. Arch Gynecol Obstet 2018; 299:681-688. [PMID: 30578438 DOI: 10.1007/s00404-018-5022-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 12/14/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the gestational age-specific risk of stillbirth according to the maternal age group particularly regarding stillbirth risk at the end of pregnancy. METHODS This study was a retrospective national cohort study of all singleton term pregnancy using the Korean Vital Statistics database (n = 2,798,542). We evaluated the risk of stillbirth by gestational week in mothers aged 20-49 years according to maternal age group and neonatal birth weight. RESULTS The risk of stillbirth in women aged 41 years and older was significantly higher than in women aged 20-29 years between 37 and 40 weeks' gestation. The stillbirth rate per 10,000 ongoing pregnancy in women aged 37-38 years at 39 weeks' gestation (4.22, 95% confidence intervals [CI] 3.01-5.90) and that in women aged 39-40 years at 40 weeks' gestation (8.15, 95% CI 4.83-13.77) were significantly higher in comparison with in those aged 20-29 years at 39 weeks' gestation (1.95, 95% CI 1.64-2.33) and at 40 weeks' gestation (2.59, 95% CI 2.1-3,18). The risk of stillbirth showed an increasing pattern at 40 gestational weeks, in women aged 39 years and older. CONCLUSIONS Delivery plan need to be set up and supported to decrease rates of stillbirth at term in women aged 35 years and older with other risk factors and in women aged 37 years and older regardless of risk factors, and especially in women older than 40 years of age.
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Malhotra A, Castillo-Melendez M, Allison BJ, Sutherland AE, Nitsos I, Pham Y, Alves de Alencar Rocha AK, Fahey MC, Polglase GR, Jenkin G, Miller SL. Neuropathology as a consequence of neonatal ventilation in premature growth-restricted lambs. Am J Physiol Regul Integr Comp Physiol 2018; 315:R1183-R1194. [PMID: 30230932 DOI: 10.1152/ajpregu.00171.2018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fetal growth restriction (FGR) and prematurity are associated with high risk of brain injury and long-term neurological deficits. FGR infants born preterm are commonly exposed to mechanical ventilation, but it is not known whether ventilation differentially induces brain pathology in FGR infants compared with appropriate for gestational age (AGA) infants. We investigated markers of neuropathology in moderate- to late-preterm FGR lambs, compared with AGA lambs, delivered by caesarean birth and ventilated under standard neonatal conditions for 24 h. FGR was induced by single umbilical artery ligation in fetal sheep at 88-day gestation (term, 150 days). At 125-day gestation, FGR and AGA lambs were delivered, dried, intubated, and commenced on noninjurious ventilation, with surfactant administration at 10 min. A group of unventilated FGR and AGA lambs at the same gestation was also examined. Over 24 h, circulating pH, Po2, and lactate levels were similar between groups. Ventilated FGR lambs had lower cerebral blood flow compared with AGA lambs ( P = 0.01). The brain of ventilated FGR lambs showed neuropathology compared with unventilated FGR, and unventilated and ventilated AGA lambs, with increased apoptosis (caspase-3), blood-brain barrier dysfunction (albumin extravasation), activated microglia (Iba-1), and increased expression of cellular oxidative stress (4-hydroxynonenal). The neuropathologies seen in the ventilated FGR brain were most pronounced in the periventricular and subcortical white matter but also evident in the subventricular zone, cortical gray matter, and hippocampus. Ventilation of preterm FGR lambs increased brain injury compared with AGA preterm lambs and unventilated FGR lambs, mediated via increased vascular permeability, neuroinflammation and oxidative stress.
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Affiliation(s)
- Atul Malhotra
- Monash Newborn, Monash Children's Hospital , Melbourne , Australia.,Department of Paediatrics, Monash University , Melbourne , Australia.,The Ritchie Centre, Hudson Institute of Medical Research , Melbourne , Australia
| | - Margie Castillo-Melendez
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne , Australia.,Department of Obstetrics and Gynaecology, Monash University , Melbourne , Australia
| | - Beth J Allison
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne , Australia.,Department of Obstetrics and Gynaecology, Monash University , Melbourne , Australia
| | - Amy E Sutherland
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne , Australia
| | - Ilias Nitsos
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne , Australia
| | - Yen Pham
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne , Australia
| | | | - Michael C Fahey
- Department of Paediatrics, Monash University , Melbourne , Australia.,The Ritchie Centre, Hudson Institute of Medical Research , Melbourne , Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne , Australia.,Department of Obstetrics and Gynaecology, Monash University , Melbourne , Australia
| | - Graham Jenkin
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne , Australia.,Department of Obstetrics and Gynaecology, Monash University , Melbourne , Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research , Melbourne , Australia.,Department of Obstetrics and Gynaecology, Monash University , Melbourne , Australia
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Zhang Y, Zhang M, Li L, Wei B, He A, Lu L, Li X, Zhang L, Xu Z, Sun M. Methylation-reprogrammed Wnt/β-catenin signalling mediated prenatal hypoxia-induced brain injury in foetal and offspring rats. J Cell Mol Med 2018; 22:3866-3874. [PMID: 29808608 PMCID: PMC6050486 DOI: 10.1111/jcmm.13660] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/27/2018] [Indexed: 12/13/2022] Open
Abstract
Prenatal hypoxia (PH) is a common pregnancy complication, harmful to brain development. This study investigated whether and how PH affected Wnt pathway in the brain. Pregnant rats were exposed to hypoxia (10.5% O2) or normoxia (21% O2; Control). Foetal brain weight and body weight were decreased in the PH group, the ratio of brain weight to body weight was increased significantly. Prenatal hypoxia increased mRNA expression of Wnt3a, Wnt7a, Wnt7b and Fzd4, but not Lrp6. Activated β‐catenin protein and Fosl1 expression were also significantly up‐regulated. Increased Hif1a expression was found in the PH group associated with the higher Wnt signalling. Among 5 members of the Sfrp family, Sfrp4 was down‐regulated. In the methylation‐regulating genes, higher mRNA expressions of Dnmt1 and Dnmt3b were found in the PH group. Sodium bisulphite and sequencing revealed hyper‐methylation in the promoter region of Sfrp4 gene in the foetal brain, accounting for its decreased expression and contributing to the activation of the Wnt‐Catenin signalling. The study of PC12 cells treated with 5‐aza further approved that decreased methylation could result in the higher Sfrp4 expression. In the offspring hippocampus, protein levels of Hif1a and mRNA expression of Sfrp4 were unchanged, whereas Wnt signal pathway was inhibited. The data demonstrated that PH activated the Wnt pathway in the foetal brain, related to the hyper‐methylation of Sfrp4 as well as Hif1a signalling. Activated Wnt signalling might play acute protective roles to the foetal brain in response to hypoxia, also would result in disadvantageous influence on the offspring in long‐term.
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Affiliation(s)
- Yingying Zhang
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Mengshu Zhang
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Lingjun Li
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Bin Wei
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Axin He
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Likui Lu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Xiang Li
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Lubo Zhang
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China.,Center for Perinatal Biology, Loma Linda University, Loma Linda, CA, USA
| | - Zhice Xu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China.,Center for Perinatal Biology, Loma Linda University, Loma Linda, CA, USA
| | - Miao Sun
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
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Wixey JA, Chand KK, Pham L, Colditz PB, Bjorkman ST. Therapeutic potential to reduce brain injury in growth restricted newborns. J Physiol 2018; 596:5675-5686. [PMID: 29700828 DOI: 10.1113/jp275428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/28/2018] [Indexed: 12/27/2022] Open
Abstract
Brain injury in intrauterine growth restricted (IUGR) infants is a major contributing factor to morbidity and mortality worldwide. Adverse outcomes range from mild learning difficulties, to attention difficulties, neurobehavioral issues, cerebral palsy, epilepsy, and other cognitive and psychiatric disorders. While the use of medication to ameliorate neurological deficits in IUGR neonates has been identified as warranting urgent research for several years, few trials have been reported. This review summarises clinical trials focusing on brain protection in the IUGR newborn as well as therapeutic interventions trialled in animal models of IUGR. Therapeutically targeting mechanisms of brain injury in the IUGR neonate is fundamental to improving long-term neurodevelopmental outcomes. Inflammation is a key mechanism in neonatal brain injury; and therefore an appealing target. Ibuprofen, an anti-inflammatory drug currently used in the preterm neonate, may be a potential therapeutic candidate to treat brain injury in the IUGR neonate. To better understand the potential of ibuprofen and other therapeutic agents to be neuroprotective in the IUGR neonate, long-term follow-up information of neurodevelopmental outcomes must be studied. Where agents such as ibuprofen are shown to be effective, have a good safety profile and are relatively inexpensive, they can be widely adopted and lead to improved outcomes.
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Affiliation(s)
- Julie A Wixey
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, 4029, Australia
| | - Kirat K Chand
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, 4029, Australia
| | - Lily Pham
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, 4029, Australia
| | - Paul B Colditz
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, 4029, Australia
| | - S Tracey Bjorkman
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, 4029, Australia
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