1
|
Choi ES, Lee H, Lee SJ, Jung YM, Kim HY, Lee SM, Lee KA, Seol HJ, Ko HS, Na SH, Kwak DW, Hwang HS, Choi S, Hong SC, Won HS, Kim SY, Kim HJ, Ahn KH. Ultrasonographic assessment of abnormal fetal growth related to uteroplacental-fetal biometrics and Doppler (U-AID) indices: Protocol for multicenter retrospective cohort study trial. PLoS One 2024; 19:e0298060. [PMID: 38359058 PMCID: PMC10868764 DOI: 10.1371/journal.pone.0298060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Fetal growth restriction (FGR) is one of the leading causes of perinatal morbidity and mortality. Many studies have reported an association between FGR and fetal Doppler indices focusing on umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV). The uteroplacental-fetal circulation which affects the fetal growth consists of not only UA, MCA, and DV, but also umbilical vein (UV), placenta and uterus itself. Nevertheless, there is a paucity of large-scale cohort studies that have assessed the association between UV, uterine wall, and placental thickness with perinatal outcomes in FGR, in conjunction with all components of the uteroplacental-fetal circulation. Therefore, this multicenter study will evaluate the association among UV absolute flow, placental thickness, and uterine wall thickness and adverse perinatal outcome in FGR fetuses. This multicenter retrospective cohort study will include singleton pregnant women who undergo at least one routine fetal ultrasound scan during routine antepartum care. Pregnant women with fetuses having structural or chromosomal abnormalities will be excluded. The U-AID indices (UtA, UA, MCA, and UV flow, placental and uterine wall thickness, and estimated fetal body weight) will be measured during each trimester of pregnancy. The study population will be divided into two groups: (1) FGR group (pregnant women with FGR fetuses) and (2) control group (those with normal growth fetus). We will assess the association between U-AID indices and adverse perinatal outcomes in the FGR group and the difference in U-AID indices between the two groups.
Collapse
Affiliation(s)
- Eun-Saem Choi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Hwasun Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Se Jin Lee
- Department of Obstetrics and Gynecology, School of Medicine Kangwon National University, Chuncheon-si, Gangwon-Do, Korea
| | - Young Mi Jung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung A. Lee
- Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyun-Joo Seol
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hun Na
- Department of Obstetrics and Gynecology, School of Medicine Kangwon National University, Chuncheon-si, Gangwon-Do, Korea
| | - Dong Wook Kwak
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Han-Sung Hwang
- Department of Obstetrics and Gynecology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sooran Choi
- Department of Obstetrics and Gynecology, College of Medicine, Inha University, Incheon, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Young Kim
- Department of Obstetrics and Gynecology, Gachon University Gil Hospital, Incheon, South Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| |
Collapse
|
2
|
Estrella CAS, Gatford KL, Xiang R, Javadmanesh A, Ghanipoor-Samami M, Nattrass GS, Shuaib E, McAllister MM, Beckman I, Thomsen DA, Clifton VL, Owens JA, Roberts CT, Hiendleder S, Kind KL. Asymmetric growth-limiting development of the female conceptus. Front Endocrinol (Lausanne) 2024; 14:1306513. [PMID: 38362586 PMCID: PMC10867182 DOI: 10.3389/fendo.2023.1306513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/08/2023] [Indexed: 02/17/2024] Open
Abstract
Introduction Sex differences in prenatal growth may contribute to sex-dependent programming effects on postnatal phenotype. Methods We integrated for the first time phenotypic, histomorphological, clinico-chemical, endocrine and gene expression analyses in a single species, the bovine conceptus at mid-gestation. Results We demonstrate that by mid-gestation, before the onset of accelerated growth, the female conceptus displays asymmetric lower growth compared to males. Female fetuses were smaller with lower ponderal index and organ weights than males. However, their brain:body weight, brain:liver weight and heart:body weight ratios were higher than in males, indicating brain and heart 'sparing'. The female placenta weighed less and had lower volumes of trophoblast and fetal connective tissue than the male placenta. Female umbilical cord vessel diameters were smaller, and female-specific relationships of body weight and brain:liver weight ratios with cord vessel diameters indicated that the umbilico-placental vascular system creates a growth-limiting environment where blood flow is redistributed to protect brain and heart growth. Clinico-chemical indicators of liver perfusion support this female-specific growth-limiting phenotype, while lower insulin-like growth factor 2 (IGF2) gene expression in brain and heart, and lower circulating IGF2, implicate female-specific modulation of key endocrine mediators by nutrient supply. Conclusion This mode of female development may increase resilience to environmental perturbations in utero and contribute to sex-bias in programming outcomes including susceptibility to non-communicable diseases.
Collapse
Affiliation(s)
- Consuelo Amor S. Estrella
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Epigenetics and Genetics Group and Davies Research Centre, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Kathryn L. Gatford
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
| | - Ruidong Xiang
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Epigenetics and Genetics Group and Davies Research Centre, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Ali Javadmanesh
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Epigenetics and Genetics Group and Davies Research Centre, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Mani Ghanipoor-Samami
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Epigenetics and Genetics Group and Davies Research Centre, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Greg S. Nattrass
- South Australian Research and Development Institute, Livestock Systems, Roseworthy, SA, Australia
| | - Entesar Shuaib
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Epigenetics and Genetics Group and Davies Research Centre, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Milton M. McAllister
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Ian Beckman
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Dana A. Thomsen
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Epigenetics and Genetics Group and Davies Research Centre, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Vicki L. Clifton
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Julie A. Owens
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Deakin University, Geelong, VIC, Australia
| | - Claire T. Roberts
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Flinders University, College of Medicine and Public Health, Adelaide, SA, Australia
| | - Stefan Hiendleder
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Epigenetics and Genetics Group and Davies Research Centre, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Karen L. Kind
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
- Epigenetics and Genetics Group and Davies Research Centre, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| |
Collapse
|
3
|
Kivilevitch Z, Gilboa Y, Gilad N, Kassif E, Achiron R. Afferent venous perfusion of fetal liver: umbilical and portal blood-flow volumes in fetuses born small-for-gestational age. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:813-820. [PMID: 37128168 DOI: 10.1002/uog.26237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/25/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To quantify the dynamic changes in the afferent venous flow volume of the liver in low-risk pregnancies with fetuses born small-for-gestational age. METHODS This was a prospective study of low-risk singleton pregnancies with estimated fetal weight (EFW) and birth weight ≤ 10th centile attending for a routine second- or third-trimester ultrasound examination. Their umbilical and portal blood-flow volumes were compared with those of a control group of fetuses born appropriate-for-gestational age from which normal reference ranges were constructed. Absolute and Z-score differences between the groups were assessed. RESULTS In total, 133 fetuses were included in the study group and 362 in the control group. The mean umbilical blood-flow volume in the study group, both absolute and normalized per kg of EFW, was below that of the appropriate-for-gestational-age fetuses for most of the period of pregnancy studied (overall mean Z-score, -0.82 and -0.84, respectively). In contrast, the mean portal blood-flow volume, per kg of EFW, showed the opposite trend (overall mean Z-score, +0.86), reaching its maximum level (+1.43) in the late third trimester. This resulted in a steep decrease in the mean placental-to-portal-blood-flow volume ratio, from 14.4 at 24 weeks of gestation (above the 60th centile) to 4.7 at 38 weeks of gestation (15th centile), corresponding to Z-scores of +0.4 and -1.02, respectively. CONCLUSION In fetuses born small-for-gestational age, the ratio of blood-flow volume in the umbilical vein to that in the portal vein decreases consistently during pregnancy, and to a greater extent compared with those born appropriate-for-gestational age, reaching a lower nadir in the third trimester. This additional redistribution of liver perfusion affects negatively fetal growth even in low-risk pregnancy, and should be taken into account when planning delivery. We suggest considering liver venous perfusion as an ancillary tool for monitoring small-for-gestational-age pregnancies. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- Z Kivilevitch
- Maccabi Health Services, Ultrasound Unit, The Negev Medical Center, Beer Sheva, Israel
| | - Y Gilboa
- Department of Obstetrics and Gynecology, Ultrasound Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Gilad
- Department of Obstetrics and Gynecology, Ultrasound Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Kassif
- Department of Obstetrics and Gynecology, Ultrasound Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Achiron
- Department of Obstetrics and Gynecology, Ultrasound Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Rubin JM, Pinter SZ, Halloran KM, Pallas BD, Fowlkes JB, Vyas AK, Padmanabhan V, Kripfgans OD. Placental assessment using spectral analysis of the envelope of umbilical venous waveforms in sheep. Placenta 2023; 142:119-127. [PMID: 37699274 PMCID: PMC10954287 DOI: 10.1016/j.placenta.2023.08.072] [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: 06/16/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION This study was designed to test the efficacy of an ultrasound flow measurement method to evaluate placental function in a hyperandrogenic sheep model that produces placental morphologic changes and an intrauterine growth restriction (IUGR) phenotype. MATERIALS AND METHODS Pregnant ewes were assigned randomly between control (n = 12) and testosterone-treatment (T-treated, n = 22) groups. The T-treated group was injected twice weekly intramuscularly (IM) with 100 mg testosterone propionate. Control sheep were injected with corn oil vehicle. Lambs were delivered at 119.5 ± 0.48 days gestation. At the time of delivery of each lamb, flow spectra were generated from one fetal artery and two fetal veins, and the spectral envelopes examined using fast Fourier transform analysis. Base 10 logarithms of the ratio of the amplitudes of the maternal and fetal spectral peaks (LRSP) in the venous power spectrum were compared in the T-treated and control populations. In addition, we calculated the resistive index (RI) for the artery defined as ((peak systole - min diastole)/peak systole). Two-tailed T-tests were used for comparisons. RESULTS LRSPs, after removal of significant outliers, were -0.158 ± 0.238 for T-treated and 0.057 ± 0.213 for control (p = 0.015) animals. RIs for the T-treated sheep fetuses were 0.506 ± 0.137 and 0.497 ± 0.086 for controls (p = 0.792) DISCUSSION: LRSP analysis distinguishes between T-treated and control sheep, whereas RIs do not. LRSP has the potential to identify compromised pregnancies.
Collapse
Affiliation(s)
- Jonathan M Rubin
- University of Michigan Department of Radiology, Medical Sciences Building 1, 1301 Catherine St, Ann Arbor, MI, 48109-2026, USA.
| | - Stephen Z Pinter
- University of Michigan Department of Radiology, Medical Sciences Building 1, 1301 Catherine St, Ann Arbor, MI, 48109-2026, USA.
| | - Katherine M Halloran
- University of Michigan Department of Pediatrics, 7510 MSRB1, 1150 W. Medical Center Dr, Ann Arbor, MI, 48109-5718, USA.
| | - Brooke D Pallas
- University of Michigan Address Unit Lab Animal Medicine, 2800 Plymouth Rd. NCRC-G090, Ann Arbor, MI, 48109-2800, USA.
| | - J Brian Fowlkes
- University of Michigan Department of Radiology, Medical Sciences Building 1, 1301 Catherine St, Ann Arbor, MI, 48109-2026, USA.
| | - Arpita K Vyas
- Washington University in St. Louis Department of Pediatrics, St. Louis Children's Hospital, 1 Children's Place, St. Louis, MO, 63110, USA.
| | - Vasantha Padmanabhan
- University of Michigan Department of Pediatrics, 7510 MSRB1, 1150 W. Medical Center Dr, Ann Arbor, MI, 48109-5718, USA.
| | - Oliver D Kripfgans
- University of Michigan Department of Radiology, Medical Sciences Building 1, 1301 Catherine St, Ann Arbor, MI, 48109-2026, USA.
| |
Collapse
|
5
|
Kivilevitch Z, Gilboa Y, Kassif E, Achiron R. The Fetal Liver Afferent Venous Flow Volumes in Fetuses With Appropriate for Gestational Age Birth Weight. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2377-2390. [PMID: 37269243 DOI: 10.1002/jum.16265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/15/2023] [Accepted: 05/03/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The present study aimed: 1) to simultaneously investigate the relationship between blood flow volumes of the two fetal liver afferent venous systems of normally appropriate for gestational age newborns. 2) to establish the normal reference range centiles values that will serve as a basis for future investigations. METHODS A cross-sectional, prospective study of singleton low obstetric risk pregnancies. Doppler examination included the measurement of the umbilical and the main portal vein vessels' diameters and time-averaged maximum velocity. The absolute and per kilogram of estimated fetal weight flow volumes and the ratio between the placental and portal blood volume flow were calculated from these data. RESULTS Three hundred and sixty-three pregnant women were included in the study. The umbilical and portal flow volumes' capacity to provide blood flow per kilogram of fetal weight, in the period of maximum fetal growth, was diverse. The placental flow decreased continuously from a mean of 121.2 mL/min/kg at the 20th week of gestation to 64.1 mL/min/kg at the 38th week of gestation. Meanwhile, the portal flow volume per kilogram of fetal weight increased from 9.6 mL/min/kg at 32 weeks of gestation to 10.3 at the 38th week of gestation. This resulted in a decrease in the umbilical to portal flow volume ratio from 13.3 to 9.6 during this period. CONCLUSION Our results indicate that in the period of maximum fetal growth, the placental/portal ratio diminishes emphasizing the portal flow's predominance with low oxygen and nutrient supply to the liver.
Collapse
Affiliation(s)
- Zvi Kivilevitch
- Maccabi Health Services, Ultrasound Unit, The Negev Medical Center, Beer-Sheva, Israel
| | - Yinon Gilboa
- Department of Obstetrics and Gynecology, Ultrasound Unit, The Chaim Sheba Medical Center Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, Ultrasound Unit, The Chaim Sheba Medical Center Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, Ultrasound Unit, The Chaim Sheba Medical Center Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
6
|
Gowtham M, Gugapriya TS, Umredkar AA, Deulkar S. The Impact of COVID-19-Related Psychological Stress on Fetoplacental Circulation: A Doppler Scan of Umbilical Vessels in Third-Trimester Antenatal Women. Cureus 2023; 15:e41517. [PMID: 37551208 PMCID: PMC10404444 DOI: 10.7759/cureus.41517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION The placenta is an important organ of pregnancy. A multitude of physiological and pathological factors influence blood flow in the placenta during pregnancy. However, the fetal effects of maternal psychological stress were inconclusive. The recent COVID-19 pandemic had unprecedented economic, social, and psychological effects. The effect of COVID-19-induced psychological stress in antenatal women and its resultant fetal impact were studied by observing the Doppler waveforms of the uterine and umbilical arteries. METHODS The cross-sectional study was conducted on 26 healthy third-trimester antenatal women who satisfied pre-set inclusion and exclusion criteria. A pandemic-related pregnancy stress scale (PREPS) was used to evaluate the stress in pregnant women and categorize it into mild, moderate, and severe levels. The Doppler ultrasound of the uterine and umbilical vessels was done along with a routine growth scan in the third trimester of pregnancy. The arterial waveforms, Pulsatility index (PI) of uterine and umbilical arteries, umbilical vein blood flow, and biometric parameters of the fetus were recorded and analyzed. RESULTS Seventeen of the 26 participants were found to be moderately stressed. Among the three dimensions of the PREPS tool, the perinatal infection stress dimension was expressed predominantly. A strong expression of the positive affirmation dimension was seen in antenatal women. The mean Pulsatility index in the mild, moderate, and severe groups was 0.74, 0.93, and 0.63, respectively. The association between the PREPS score and the Pulsatility index of the umbilical artery alone was found to be significant at p=0.02. CONCLUSION The COVID-19 pandemic caused moderate to severe levels of psychological stress in pregnant women. The statistically significant association between the PREPS score and the umbilical artery PI indicates possible fetoplacental compromise, suggesting the need for cognitive therapy to manage psychological stress in antenatal women.
Collapse
Affiliation(s)
- M Gowtham
- Anatomy, All India Institute of Medical Sciences Nagpur, Nagpur, IND
| | - T S Gugapriya
- Anatomy, All India Institute of Medical Sciences Nagpur, Nagpur, IND
| | - Ashwini A Umredkar
- Radio-diagnosis, All India Institute of Medical Sciences Nagpur, Nagpur, IND
| | - Snehal Deulkar
- Anatomy, All India Institute of Medical Sciences Nagpur, Nagpur, IND
| |
Collapse
|
7
|
Ozawa K, Kanazawa S, Mikami M, Muromoto J, Sugibayashi R, Wada S, Sago H. Ultrasound measurement of umbilical venous flow volume at the intra-abdominal portion in normal fetuses. J Med Ultrason (2001) 2023; 50:427-432. [PMID: 37171782 PMCID: PMC10353956 DOI: 10.1007/s10396-023-01315-w] [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: 01/31/2023] [Accepted: 04/04/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Umbilical venous flow volume (UVFV) measured using ultrasound can be used to assess placental circulation in a fetus. UVFV measured at the intra-abdominal portion using half the maximum flow velocity of the umbilical vein (UV) has good reproducibility with low variance. However, reference values in previous reports were based on a small number of cases with a wide reference range. In the present study, we evaluated UVFV standard values measured at the intra-abdominal portion in normal Japanese fetuses. METHODS Measurements were performed on normal pregnant women during routine ultrasound screening at around 20 or 30 weeks of gestation. The diameter and flow velocity of the UV were measured at the fetal abdomen point between the insertion of the UV and branches of the portal vein. UVFV (ml/min) was calculated as follows: (UV diameter [cm]/2)2 × maximum velocity [cm/s] × 0.5 × 3.14 × 60). RESULTS A total of 278 pregnant women were included in the study. UVFV increased with gestational weeks, and UVFV per estimated fetal weight (EFW) slightly decreased with increasing gestational weeks. The 50th (10th-90th) percentiles of UVFV per EFW at 20, 25, and 30 weeks of gestation were 130 (105-165), 123 (94-147), and 104 (80-131) ml/min/kg, respectively. CONCLUSION New UVFV reference values measured at the intra-abdominal portion of fetuses using large-scale samples were established. Future studies should assess fetuses under pathologic conditions using UVFV reference values.
Collapse
Affiliation(s)
- Katsusuke Ozawa
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura Setagaya-Ku, Tokyo, 157-8535, Japan.
| | - Seiji Kanazawa
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Masashi Mikami
- Division of Biostatistics, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Jin Muromoto
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Rika Sugibayashi
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Seiji Wada
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Haruhiko Sago
- Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura Setagaya-Ku, Tokyo, 157-8535, Japan
| |
Collapse
|
8
|
Barbieri M, Zamagni G, Fantasia I, Monasta L, Lo Bello L, Quadrifoglio M, Ricci G, Maso G, Piccoli M, Di Martino DD, Ferrazzi EM, Stampalija T. Umbilical Vein Blood Flow in Uncomplicated Pregnancies: Systematic Review of Available Reference Charts and Comparison with a New Cohort. J Clin Med 2023; 12:jcm12093132. [PMID: 37176573 PMCID: PMC10179232 DOI: 10.3390/jcm12093132] [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: 03/22/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
The objectives of the study were (1) to perform a systematic review of the available umbilical vein blood flow volume (UV-Q) reference ranges in uncomplicated pregnancies; and (2) to compare the findings of the systematic review with UV-Q values obtained from a local cohort. Available literature in the English language on this topic was identified following the PRISMA guidelines. Selected original articles were further grouped based on the UV sampling sites and the formulae used to compute UV-Q. The 50th percentiles, the means, or the best-fitting curves were derived from the formulae or the reported tables presented by authors. A prospective observational study of uncomplicated singleton pregnancies from 20+0 to 40+6 weeks of gestation was conducted to compare UV-Q with the results of this systematic review. Fifteen sets of data (fourteen sets belonging to manuscripts identified by the research strategy and one obtained from our cohort) were compared. Overall, there was a substantial heterogeneity among the reported UV-Q central values, although when using the same sampling methodology and formulae, the values overlap. Our data suggest that when adhering to the same methodology, the UV-Q assessment is accurate and reproducible, thus encouraging further investigation on the possible clinical applications of this measurement in clinical practice.
Collapse
Affiliation(s)
- Moira Barbieri
- Department of Mother and Neonate, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
| | - Giulia Zamagni
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
| | - Ilaria Fantasia
- Department of Mother and Neonate, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
| | - Leila Lo Bello
- Department of Mother and Neonate, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
| | - Mariachiara Quadrifoglio
- Department of Mother and Neonate, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
| | - Giuseppe Ricci
- Department of Mother and Neonate, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | - Gianpaolo Maso
- Department of Mother and Neonate, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
| | - Monica Piccoli
- Department of Mother and Neonate, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
| | - Daniela Denis Di Martino
- Department of Mother, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Policlinico di Milano, 20100 Milan, Italy
| | - Enrico Mario Ferrazzi
- Department of Mother, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Policlinico di Milano, 20100 Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, 20100 Milan, Italy
| | - Tamara Stampalija
- Department of Mother and Neonate, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| |
Collapse
|
9
|
Casati D, Lanna M, Mando' C, Zavatta A, Nelva Stellio L, Faiola S, Laoreti A, Anelli GM, Cetin I. Fetal oxygen and glucose utilization of uncomplicated monochorionic twins: Adapting to the intrauterine environment. Placenta 2023; 132:7-14. [PMID: 36603352 DOI: 10.1016/j.placenta.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/16/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Monochorionic twins (MC) develop under unique intrauterine conditions and show a high risk of compromise during fetal life. Here we describe umbilical vein blood flow (UVBF) and fetal oxygen and glucose utilization in uncomplicated MC twins and investigate possible differences within twin-pairs according to birth-order. METHODS Prospective single-center study on 48 uncomplicated MC twins enrolled at the time of elective cesarean delivery. Ultrasound measurements of UVBF for Twin 1 and Twin 2 labelled according to birth-order were performed before spinal anesthesia. Umbilical arterial and venous blood samples were collected for each twin after fetal delivery, and fetal oxygen and glucose deliveries and uptakes were computed. RESULTS All twins were delivered within 2 min from one-another under steady-state conditions at 36.4 weeks of median gestational age (IQR 36.0-37.0). Birthweight and umbilical cord gas analyses were within physiological ranges for all twins. Second-born twins showed significantly lower UVBF, measured before delivery, and lower median birthweight compared to first-borns. Moreover, median values of estimated fetal oxygen and glucose consumption were lower in second compared to first MC twins. DISCUSSION Uncomplicated MC twins show different birthweight, oxygenation and metabolic rates based on their position in utero, hinting at pre-existing conditions possibly deriving by uneven vascular and metabolic distribution of the two placental territories. The innovative findings of this study emphasize the biological uniqueness of these pregnancies and prompt further physiological studies on MC twins and placenta metabolism.
Collapse
Affiliation(s)
- Daniela Casati
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Mariano Lanna
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Chiara Mando'
- University of Milan, Department of Biomedical and Clinical Sciences, Milan, Italy
| | - Alice Zavatta
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Leonardo Nelva Stellio
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Stefano Faiola
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Arianna Laoreti
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Gaia Maria Anelli
- University of Milan, Department of Biomedical and Clinical Sciences, Milan, Italy
| | - Irene Cetin
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, Milan, Italy; University of Milan, Department of Biomedical and Clinical Sciences, Milan, Italy
| |
Collapse
|
10
|
Wang L, Zhou D, Long B, Wang J, Li L, Peng Y, Zhou Q, Zeng S. The abnormal umbilical venous-arterial index in the second half of pregnancy is associated with fetal outcome: A retrospective cross-sectional study. Front Pediatr 2023; 11:1036359. [PMID: 36969267 PMCID: PMC10036777 DOI: 10.3389/fped.2023.1036359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023] Open
Abstract
Objective This study aims to observe the changes of the umbilical venous-arterial index (VAI) and investigate its predictive power for fetal outcome during the second half of pregnancy. Methods Fetuses with gestational age (GA) at 24-39 weeks were collected. According to the outcome score, neonates with outcome scores of 0, 1, or 2 were assigned to the control group, whereas those with scores of 3-12 were assigned to the compromised group. VAI was calculated as the ratio of normalized umbilical vein blood flow volume and umbilical artery pulsatility index. Regression analysis was performed to obtain the best-fitting curves between VAI and GA in the controls. Doppler parameters and perinatal outcomes were compared in both groups. Receiver operating characteristic analysis was used to assess the diagnostic performance of the VAI. Results A total of 833 (95%) fetuses had Doppler parameters and pregnancy outcomes documented. Compared with the controls, the VAI was significantly lower in the compromised group (83.2 vs. 184.8 ml/min/kg, p < 0.001). The sensitivity and specificity of VAI to predict compromised neonates were 95.15% (95% Cl, 89.14 to 97.91%) and 99.04% (95% CI: 98.03 to 99.53%), respectively at a cutoff value of 120 ml/min/kg. Conclusions VAI presents better diagnostic performance than umbilical vein blood flow volume and umbilical artery pulsatility index. A cutoff value of 120 ml/min/kg might be used as the warning value for predicting the fetal outcome.
Collapse
Affiliation(s)
- Ling Wang
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Dan Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, China
- Correspondence: Dan Zhou
| | - Baiguo Long
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Jiqing Wang
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Lingling Li
- Department of Ultrasound, Women and Children Healthcare Hospital of Changsha, Changsha, China
| | - Yang Peng
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Qichang Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Zeng
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, China
| |
Collapse
|
11
|
Hamidi OP, Driver C, Steller JG, Peek EE, Monasta L, Stampalija T, Gumina DL, DeVore GR, Hobbins JC, Galan HL. Umbilical Venous Volume Flow in Late-Onset Fetal Growth Restriction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:173-183. [PMID: 35451119 DOI: 10.1002/jum.15993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Umbilical vein flow (UVF) is reduced in fetal growth restriction (FGR). We compared absolute and size-adjusted UVF (estimated fetal weight [EFW] and abdominal circumference [AC]) and rates of abnormal UVF parameters (<10th percentile) among FGR fetuses meeting Delphi criteria (FGR-D) against small for gestational age (SGA) fetuses and appropriate for gestational age (AGA) controls. METHODS Absolute UVF, UVF/EFW, and UVF/AC were compared between 73 FGR pregnancies (35 FGR-D, 38 SGA) and 108 AGA controls. Rates of abnormal UVF were compared to abnormal umbilical artery pulsatility index (UAPI). Independent samples t-tests, Mann-Whitney U, odds ratio (OR), chi-squared, and Fisher's exact tests were used as appropriate. RESULTS Mean absolute UVF was significantly decreased in FGR-D compared to AGA (P = .0147), but not between SGA and AGA fetuses. The incidence of both abnormal absolute UVF and UVF/AC values (<10th centile) was higher among late-onset FGR fetuses versus AGA fetuses (UVF: OR 2.7, confidence interval [CI] 1.37-5.4; UVF/AC: OR 2.73, CI 1.37-5.4). UVF was more frequently abnormal than UAPI and in only two fetuses were both Doppler values abnormal. CONCLUSION Absolute UVF is altered in late-onset FGR, and most pronounced among FGR-D. UVF may provide additional insight into fetal compromise in those affected by growth restriction.
Collapse
Affiliation(s)
- Odessa P Hamidi
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Camille Driver
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jon G Steller
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Emma E Peek
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Diane L Gumina
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Greggory R DeVore
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - John C Hobbins
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Henry L Galan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
- Colorado Fetal Care Center, Children's Hospital of Colorado, Aurora, CO, USA
| |
Collapse
|
12
|
DeVore GR, Epstein A. Computing Z-Score Equations for Clinical Use to Measure Fetal Umbilical Vein Size and Flow Using Six Independent Variables of Age and Size. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1949-1960. [PMID: 34792203 DOI: 10.1002/jum.15872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Measurements of the umbilical vein diameter (UVD) and blood flow (mL/min) (UVF) have been demonstrated to be decreased in fetuses with growth restriction (FGR) using gestational age (GA) as the independent variable. However, no previous studies have used the biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and the estimated fetal weight (EFW) to create equations to be used for z-score computations when evaluating fetuses at risk foran abnormal UVD and UVF. METHODS Two hundred and forty normal fetuses between 20 and 40 weeks of gestation were examined in which the UVD and time averaged maximal velocity (TAMX) were measured from which the UVF, UVF/HC, UVF/AC, and UVF/kg were computed. Fractional polynomial regression analysis was used to compute z-score equations using the above independent variables. Thirty-six fetuses with abnormal growth of the AC were examined to test the validity of the equations. RESULTS The UVD, TAMX, UVF, UVF/HC, and UVF/AC all increased with gestatonal age and fetal growth except for the UVF/kg, which decreased with age and growth. From the regression equations, two z-score calculators were created using an Excel spreadsheet that can be used in clinical practice. Abnormal measurements of the UVD, UVF, UVF/HC, UVF/AC, and UVF/kg were observed in the 36 study fetuses, 21 with an AC < 10th centile and 15 with an AC > 90th centile. CONCLUSION Using the equations generated from this study and the z-score calculators provides a clinical tool to measure the size and flow of the umbilical vein that may have clinical implications.
Collapse
Affiliation(s)
- Greggory R DeVore
- Fetal Diagnostic Center, Pasadena, California, USA
- Fetal Diagnostic Center, Tarzana, California, USA
- Fetal Diagnostic Centers, Lancaster, California, USA
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, CA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Aaron Epstein
- Fetal Diagnostic Center, Pasadena, California, USA
- Fetal Diagnostic Center, Tarzana, California, USA
- Fetal Diagnostic Centers, Lancaster, California, USA
| |
Collapse
|
13
|
Wang L, Zhou Q, Zhou C, Wang J, Shi C, Long B, Hu L, Peng Y, Liu Y, Xu G. Z-Score Reference Ranges for Umbilical Vein Diameter and Blood Flow Volume in Normal Fetuses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:907-916. [PMID: 34219256 DOI: 10.1002/jum.15774] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To establish Z-scores for the diameter and blood flow volume of the umbilical vein (UV) in normal fetuses. METHODS This was a prospective study involving 907 normal fetuses. We measured the diameter (Duv) of two different segments of the UV (FUV: the free loop of the UV; FIUV: the fetal intra-abdominal UV). Next, we calculated the blood flow volume (Quv). Z-scores were created for both Duv and Quv using gestational age, femur length, and biparietal diameter as independent variables. RESULTS We successfully acquired 858 (94.6%) normal fetal measurements. Between 20 and 39 weeks, the Duv of the FUV and FIUV increased from 0.38 to 0.80 cm and from 0.33 to 0.70 cm, respectively. The Quv of the FUV and FIUV increased from 32.66 to 381.88 ml/min and from 31.50 to 360.15 ml/min, respectively. Linear or quadratic regression models were best fitted between the parameters of UV and the independent variables. Z-scores were successfully determined for both the Duv and Quv. CONCLUSIONS The calculation of Z-scores for the Duv and Quv is simple by applying standard statistical methods. These Z-scores may be useful to evaluate placental circulation and provide a rationale for monitoring and evaluating the prognosis of fetuses.
Collapse
Affiliation(s)
- Ling Wang
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Qichang Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chunhui Zhou
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Jiqing Wang
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Chunlan Shi
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Baiguo Long
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Li Hu
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Yang Peng
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Yuchan Liu
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Ganqiong Xu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
14
|
Saw SN, Dai Y, Yap CH. A Review of Biomechanics Analysis of the Umbilical-Placenta System With Regards to Diseases. Front Physiol 2021; 12:587635. [PMID: 34475826 PMCID: PMC8406807 DOI: 10.3389/fphys.2021.587635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Placenta is an important organ that is crucial for both fetal and maternal health. Abnormalities of the placenta, such as during intrauterine growth restriction (IUGR) and pre-eclampsia (PE) are common, and an improved understanding of these diseases is needed to improve medical care. Biomechanics analysis of the placenta is an under-explored area of investigation, which has demonstrated usefulness in contributing to our understanding of the placenta physiology. In this review, we introduce fundamental biomechanics concepts and discuss the findings of biomechanical analysis of the placenta and umbilical cord, including both tissue biomechanics and biofluid mechanics. The biomechanics of placenta ultrasound elastography and its potential in improving clinical detection of placenta diseases are also discussed. Finally, potential future work is listed.
Collapse
Affiliation(s)
- Shier Nee Saw
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Yichen Dai
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Choon Hwai Yap
- Department of Bioengineering, Imperial College London, London, United Kingdom
| |
Collapse
|
15
|
Ozawa K, Davey MG, Tian Z, Hornick MA, Mejaddam AY, McGovern PE, Flake AW, Rychik J. Evaluation of umbilical venous flow volume measured using ultrasound compared to circuit flow volume in the EXTra-uterine Environment for Neonatal Development (EXTEND) system in fetal sheep. Prenat Diagn 2021; 41:1668-1674. [PMID: 34480376 DOI: 10.1002/pd.6041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/16/2021] [Accepted: 09/01/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare and validate umbilical venous flow volume (UVFV) measured at the intra-abdominal portion using ultrasound with actual flow volume of umbilical vein (UV) in fetal sheep sustained on the EXTrauterine Environment for Neonatal Development (EXTEND) system. METHODS Circuit flow volume through the oxygenator was obtained using sensors. Ultrasound derived UVFV (ml/min) was calculated as (UV diameter [cm]/2)2 × 3.14 × maximum velocity (cm/s) × 0.5 × 60, measured at approximately the mid portion between its abdominal insertion and the origin of the ductus venosus. UVFV was measured by ultrasound once daily and was compared to the average of daily circuit flow volume directly measured. RESULTS UVFV was measured 168 times in 15 fetal sheep. The ratio of circuit flow volume to combined cardiac output remained stable within the anticipated physiological range throughout. UVFV measured by ultrasound showed good correlation to directly measured circuit flow (r = 0.72). Interclass correlation coefficients for intra-observer variability was 0.991 (95% confidence interval [CI], 0.979-0.996). CONCLUSION UVFV measured at the intra-abdominal portion using ultrasound shows a good correlation with directly measured circuit flow volume in UV of fetal sheep on the EXTEND system. Regular incorporation of such validated UVFV measures into clinical use may offer opportunities to better understand conditions of placental dysfunction.
Collapse
Affiliation(s)
- Katsusuke Ozawa
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Fetal Heart Program, Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Marcus G Davey
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Zhiyun Tian
- Fetal Heart Program, Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Matthew A Hornick
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ali Y Mejaddam
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Patrick E McGovern
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alan W Flake
- Center for Fetal Research, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jack Rychik
- Fetal Heart Program, Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
16
|
Dall'asta A, Ghi T, Mappa I, Maqina P, Frusca T, Rizzo G. Intrapartum Doppler ultrasound: where are we now? Minerva Obstet Gynecol 2021; 73:94-102. [PMID: 33215908 DOI: 10.23736/s2724-606x.20.04698-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intrapartum hypoxic events most commonly occur in low-risk pregnancies with appropriately grown fetuses. Continuous intrapartum monitoring by means of cardiotocography has not demonstrated a reduction in the frequency of adverse perinatal outcome but has been linked with an increase in the caesarean section rate, particularly among women considered at low risk. Available data from the literature suggests that abnormalities in the uterine artery Doppler and in the ratio between fetal cerebral and umbilical Doppler (i.e. cerebroplacental ratio [CPR]) are associated with conditions of subclinical placental function occurring in fetuses who have failed to achieve their growth potential regardless of their actual size. In this review we summarize the available evidence on the use of intrapartum Doppler ultrasound for the fetal surveillance during labor and the identification of the fetuses at risk of intrapartum distress.
Collapse
Affiliation(s)
- Andrea Dall'asta
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy -
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK -
| | - Tullio Ghi
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ilenia Mappa
- Division of Maternal and Fetal Medicine, Cristo Re Hospital, Tor Vergata University, Rome, Italy
| | - Pavjola Maqina
- Division of Maternal and Fetal Medicine, Cristo Re Hospital, Tor Vergata University, Rome, Italy
| | - Tiziana Frusca
- Unit of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Cristo Re Hospital, Tor Vergata University, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| |
Collapse
|
17
|
Rubin JM, Li S, Fowlkes JB, Sethuraman S, Kripfgans OD, Shi W, Treadwell MC, Jago JR, Leichner RD, Pinter SZ. Comparison of Variations Between Spectral Doppler and Gaussian Surface Integration Methods for Umbilical Vein Blood Volume Flow. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:369-376. [PMID: 32770569 PMCID: PMC7924168 DOI: 10.1002/jum.15411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/10/2020] [Accepted: 06/21/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVES We are studying a new method for estimating blood volume flow that uses 3-dimensional ultrasound to measure the total integrated flux through an ultrasound-generated Gaussian surface that intersects the umbilical cord. This method makes none of the assumptions typically required with standard 1-dimensional spectral Doppler volume flow estimates. We compared the variations in volume flow estimates between techniques in the umbilical vein. METHODS The study was Institutional Review Board approved, and all 12 patients gave informed consent. Because we had no reference standard for the true umbilical vein volume flow, we compared the variations of the measurements for the flow measurement techniques. At least 3 separate spectral Doppler and 3 separate Gaussian surface measurements were made along the umbilical vein. Means, standard deviations, and coefficients of variation (standard deviation/mean) for the flow estimation techniques were calculated for each patient. P < .05 was considered significant. RESULTS The ranges of the mean volume flow estimates were 174 to 577 mL/min for the spectral Doppler method and 100 to 341 mL/min for the Gaussian surface integration (GSI) method. The mean standard deviations (mean ± SD) were 161 ± 95 and 45 ± 48 mL/min for the spectral Doppler and GSI methods, respectively (P < .003). The mean coefficients of variation were 0.46 ± 0.17 and 0.18 ± 0.14 for the spectral Doppler and GSI methods respectively (P < 0.002). CONCLUSIONS The new volume flow estimation method using 3-dimensional ultrasound appears to have significantly less variation in estimates than the standard 1-dimensional spectral Doppler method.
Collapse
Affiliation(s)
- Jonathan M Rubin
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sibo Li
- Philips Research North America, Cambridge, Massachusetts, USA
| | - J Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Oliver D Kripfgans
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - William Shi
- Philips Research North America, Cambridge, Massachusetts, USA
| | - Marjorie C Treadwell
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - James R Jago
- Philips Research North America, Cambridge, Massachusetts, USA
| | | | - Stephen Z Pinter
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
18
|
Abduljalil K, Pan X, Clayton R, Johnson TN, Jamei M. Fetal Physiologically Based Pharmacokinetic Models: Systems Information on Fetal Cardiac Output and Its Distribution to Different Organs during Development. Clin Pharmacokinet 2021; 60:741-757. [PMID: 33486719 DOI: 10.1007/s40262-020-00973-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Fetal circulation is unique and the parameters describing hemodynamic status during development are critical for constructing a fetal physiologically based pharmacokinetic model. To date, a comprehensive review of circulatory changes during fetal development, with a specific focus on developing these models, has not been reported. The objective of this work was to collate, analyze, and mathematically describe physiological information on fetal cardiac output and tissue blood flows during development. METHODS A comprehensive literature search was carried out to collate and evaluate the changes to fetal cardiac output and fetal tissue blood flows during growth. The collated data were assessed, integrated, and analyzed to establish continuous mathematical functions describing the average parameter changes and variability during development. RESULTS Data were available for fetal cardiac output (14 Doppler studies), blood flow through the fetal umbilical vein (15 studies), ductus venosus (6 studies), liver veins (5 studies), brain (4 studies), lungs (5 studies), and kidneys (2 studies). Fetal cardiac output is described as either an age- or weight-dependent function. The latter is preferred as it generates an individualized cardiac output that is correlated to the fetal body weight. Blood flow as a proportion of fetal cardiac output to the liver, placenta, brain, kidneys, and lungs was age varying, whilst for the adipose, bone, heart, muscle, and skin the blood flow proportions were fixed. The pattern of change (with respect to direction and pace) for each of these parameters was different. CONCLUSIONS Despite limitations in the availability of some values, the collected data provide a useful resource for fetal physiologically based pharmacokinetic modeling. Potential applications of these data include predicting xenobiotic exposure and risk assessment in the fetus following the administration of maternally dosed drugs or unintended exposure to environmental toxicants.
Collapse
Affiliation(s)
- Khaled Abduljalil
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK.
| | - Xian Pan
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Ruth Clayton
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Trevor N Johnson
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
| | - Masoud Jamei
- Certara UK Limited (Simcyp Division), Level 2-Acero, 1 Concourse Way, Sheffield, S1 2BJ, UK
| |
Collapse
|
19
|
Liu HL, Huang S, Wang X, Qi HB, Li JN, Zhang L. The role of umbilical artery velocities in the clinical assessment of twin-twin transfusion syndrome at stage. Int J Gynaecol Obstet 2021; 155:518-523. [PMID: 33423303 DOI: 10.1002/ijgo.13590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/17/2020] [Accepted: 01/07/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To analyze the discordances of the umbilical artery velocities between pregnancies with twin-twin transfusion syndrome (TTTS) at stage I and those with normal monochorionic-diamniotic (MCDA) twins, and investigate the value of their discordances in predicting TTTS at stage I. METHODS We recruited 58 twin pregnancies with TTTS at stage I and 60 normal MCDA twin pregnancies in a tertiary referral center retrospectively. The umbilical artery velocities and their discordances were compared between the normal and TTTS twins. RESULTS The discordances of umbilical artery mean diastolic velocity (UA-MDV), umbilical artery time-averaged maximum velocity (UA-TAmax), umbilical artery peak systolic velocity (UA-PSV), and umbilical artery end-diastolic velocity (UA-EDV) were higher in the TTTS group than in the normal group. In TTTS co-twins, the UA-MDV, UA-TAmax, UA-PSV, and UA-EDV in recipients were higher than those in donors. The discordances of UA-TAmax and UA-PSV were found to be independent predicting factors for TTTS at stage I. CONCLUSION Co-twin umbilical artery velocity discordances were significantly associated with stage I TTTS. The results suggest that UA-TAmax and UA-PSV might be new parameters for predicting TTTS at stage I.
Collapse
Affiliation(s)
- Hong-Li Liu
- Department of Obstetrics and Fetal Medicine Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China
| | - Shuai Huang
- Department of Obstetrics and Fetal Medicine Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China
| | - Xing Wang
- Department of Obstetrics and Fetal Medicine Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China
| | - Hong-Bo Qi
- Department of Obstetrics and Fetal Medicine Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China
| | - Jun-Nan Li
- Department of Obstetrics and Fetal Medicine Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China
| | - Lan Zhang
- Department of Obstetrics and Fetal Medicine Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China
| |
Collapse
|
20
|
Ho DY, Josowitz R, Katcoff H, Griffis HM, Tian Z, Gaynor JW, Rychik J. Mid-gestational fetal placental blood flow is diminished in the fetus with congenital heart disease. Prenat Diagn 2020; 40:1432-1438. [PMID: 32673414 DOI: 10.1002/pd.5791] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/29/2020] [Accepted: 07/08/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Data suggest fetuses with congenital heart disease (CHD) have placental abnormalities. Their abnormal placental vasculature may affect fetal placental blood flow, which has not previously been explored. METHOD We performed a retrospective cross-sectional study comparing umbilical venous volume flow (UVVF) of single ventricle, D-transposition of the great arteries, and tetralogy of Fallot fetuses with fetuses without CHD. UVVF and combined cardiac output (CCO) were calculated from fetal echocardiography and compared using t tests, χ2 and Fisher's exact tests. RESULTS Mean gestational age and fetal weight were greater in CHD fetuses (26.5 weeks, 1119.4 g; n = 81, P < .001) compared to controls (23.1 weeks, 675 g; n = 170, P < .001). UVVF/fetal weight was nevertheless decreased among cases (99.8 vs 115.3 mL/min/kg, P < .001). Subgroup analysis of 20- to 25-week fetuses demonstrated no significant differences in case and control baseline characteristics. In CHD fetuses (n = 31) compared to controls (n = 144), absolute UVVF (50.8 vs 62.1 mL/min, P = .006), and UVVF/fetal weight (98.8 vs 118.5 mL/min/kg, P < .001) were decreased. Findings were similar in single ventricle (n = 24) and hypoplastic left heart syndrome (n = 14). CONCLUSION Mid-gestational placental blood flow in CHD fetuses is decreased compared to controls. Further study is needed to explore the relationship between UVVF and placental pathology, and impact on outcomes.
Collapse
Affiliation(s)
- Deborah Y Ho
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Rebecca Josowitz
- Fetal Heart Program, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hannah Katcoff
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heather M Griffis
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Zhiyun Tian
- Fetal Heart Program, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - J William Gaynor
- Department of Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jack Rychik
- Fetal Heart Program, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
21
|
Sheng X, Sheng Y, Gao S, Fan F, Wang J. Low fluid shear stress promoted ciliogenesis via Dvl2 in hUVECs. Histochem Cell Biol 2020; 154:639-654. [PMID: 32776193 DOI: 10.1007/s00418-020-01908-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 01/30/2023]
Abstract
This study aims to explore the mechanism of fluid shear stress in regulating the primary cilia assembly or disassembly in human umbilical vein endothelial cells (hUVECs) using microfluidic chamber experiments. Immunofluorescence analysis showed that primary cilia assembled under disturbed fluid shear stress (DF) of 1 dyne/cm2, while disassembled under unidirectional shear stress (USS) of 15 dynes/cm2. Disheveled (Dvl2) in Wnt signaling pathway was effectively co-immunoprecipitated with Bardet-Biedl syndrome proteins 8 (Bbs8) and γ-tubulin. Compared with those in the control group, the percentages of ciliated cells with Dvl2 overexpression were found to be 67% and 59.667%, respectively, under USS and DF (an increment of 21-38.7%); while, those with Dvl2 silencing were 16% and 32.667%, respectively, under USS and DF (a decrement of 23-30%). Further, the expression of Bbs8 and γ-tubulin was decreased by RNA interference of Dvl2 but increased with Dvl2 overexpression. The results indicated that Dvl2 played a pivotal role during DF-induced primary cilia assembly, and was important for apical docking of basal bodies through Bbs8 and γ-tubulin.
Collapse
Affiliation(s)
- Xin Sheng
- Department of Biochemistry, Zunyi Medical University, Zunyi, 563000, People's Republic of China.
| | - Yan Sheng
- Laboratory of Basic Medical Morphology, Zunyi Medical University, Zunyi, 563000, People's Republic of China
| | - Shuanglin Gao
- Department of Biochemistry, Zunyi Medical University, Zunyi, 563000, People's Republic of China
| | - Fang Fan
- Department of Biochemistry, Zunyi Medical University, Zunyi, 563000, People's Republic of China
| | - Junhua Wang
- Department of Biochemistry, Zunyi Medical University, Zunyi, 563000, People's Republic of China
| |
Collapse
|
22
|
Stefopoulou M, Johnson J, Wilsgaard T, Lindgren P, Herling L, Kiserud T, Acharya G. Volume blood flow-based indices of fetal brain sparing in the second half of pregnancy: A longitudinal study. Acta Obstet Gynecol Scand 2020; 99:1717-1727. [PMID: 32776322 DOI: 10.1111/aogs.13950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cerebroplacental ratio (CPR) and umbilicocerebral ratio (UCR) are clinically used as a measure of fetal brain sparing. These are calculated as the ratios between the pulsatility indices (PIs) of middle cerebral (MCA) and umbilical (UA) arteries, and are an indirect representation of the balance between cerebral and placental perfusion. Volume blood flow (Q)-based ratios, ie Q-CPR or Q-UCR, would directly reflect the distribution of fetal cardiac output to the placenta and brain. Thus, we aimed to determine the development pattern of Q-CPR and Q-UCR during the second half of pregnancy, construct reference intervals, and evaluate their association with CPR and UCR. MATERIAL AND METHODS In a longitudinal cohort study of low-risk pregnancies, the inner diameter of the fetal superior vena cava (SVC) and umbilical vein (UV) was measured and velocity waveforms were obtained from the MCA, UA, UV and SVC using ultrasound at approximately 4-weekly intervals from 20 to 41 weeks. The CPR was calculated as PIMCA /PIUA and the inverse ratio was the UCR. Cerebral and placental blood flows were estimated as the product of mean velocity and cross-sectional area of the SVC and UV, respectively. Q-CPR was calculated as QSVC /QUV and the inverse as the Q-UCR. Gestational age-specific reference intervals were calculated and associations between variables were tested using multilevel regression modeling. RESULTS Longitudinal reference intervals of Q-CPR and Q-UCR were established based on 471 paired measurements of QSVC and QUV obtained serially from 134 singleton pregnancies. The mean Q-CPR increased from 0.4 to 0.8 during the second half of pregnancy and Q-UCR declined from 2.5 to 1.3, while the CPR and UCR had U-shaped curves but in opposite directions. No significant correlation was found between CPR and Q-CPR (R = 0.10; P = .051), or UCR and Q-UCR (R = 0.09; P = .11), and the agreement between PI-based and Q-based indices of fetal brain sparing was poor. CONCLUSIONS Indices of fetal brain sparing based on placental and cerebral volume blood flow differ from those calculated from UA and MCA PIs. They correlated poorly with conventional CPR and UCR, indicating that they may provide additional/different physiological information. Reference values of Q-CPR and Q-UCR established here can be useful to investigate their clinical value further.
Collapse
Affiliation(s)
- Maria Stefopoulou
- Department of Clinical Science, Division of Obstetrics and Gynecology, Intervention & Technology, Karolinska Institutet and Center for Fetal Medicine Karolinska, University Hospital, Stockholm, Sweden.,Department of Clinical Medicine, Faculty of Health Sciences, Women's Health and Perinatology Research Group, UiT-The Arctic University of Norway, Tromsø, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Jonas Johnson
- Department of Clinical Science, Division of Obstetrics and Gynecology, Intervention & Technology, Karolinska Institutet and Center for Fetal Medicine Karolinska, University Hospital, Stockholm, Sweden
| | - Tom Wilsgaard
- Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Peter Lindgren
- Department of Clinical Science, Division of Obstetrics and Gynecology, Intervention & Technology, Karolinska Institutet and Center for Fetal Medicine Karolinska, University Hospital, Stockholm, Sweden
| | - Lotta Herling
- Department of Clinical Science, Division of Obstetrics and Gynecology, Intervention & Technology, Karolinska Institutet and Center for Fetal Medicine Karolinska, University Hospital, Stockholm, Sweden.,Department of Clinical Medicine, Faculty of Health Sciences, Women's Health and Perinatology Research Group, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Torvid Kiserud
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ganesh Acharya
- Department of Clinical Science, Division of Obstetrics and Gynecology, Intervention & Technology, Karolinska Institutet and Center for Fetal Medicine Karolinska, University Hospital, Stockholm, Sweden.,Department of Clinical Medicine, Faculty of Health Sciences, Women's Health and Perinatology Research Group, UiT-The Arctic University of Norway, Tromsø, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
23
|
Cetin I, Taricco E, Mandò C, Radaelli T, Boito S, Nuzzo AM, Giussani DA. Fetal Oxygen and Glucose Consumption in Human Pregnancy Complicated by Fetal Growth Restriction. Hypertension 2020; 75:748-754. [PMID: 31884857 DOI: 10.1161/hypertensionaha.119.13727] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In healthy pregnancy, glucose and oxygen availability are essential for fetal growth and well being. However, how substrate delivery and fetal uptake are affected in human pregnancy complicated by fetal growth restriction (FGR) is still unknown. Here, we show that the human FGR fetus has a strikingly reduced umbilical uptake of both oxygen and glucose. In 30 healthy term and 32 FGR human pregnancies, umbilical volume flow (Qumb) and parallel umbilical vein (uv) and artery (ua) blood samples were obtained at elective Cesarean section to calculate fetal glucose and oxygen uptake as Qumb · Δ (uv-ua) differences. Umbilical blood flow was significantly lower in FGR pregnancy (-63%; P<0.001) but not when normalized for fetal body weight. FGR pregnancy had significantly lower umbilical oxygen delivery and uptake, both as absolute values (delivery: -78%; uptake: -78%) and normalized (delivery: -50%; uptake: -48%) for fetal body weight (all P<0.001). Umbilical glucose absolute delivery and uptake were significantly reduced (delivery: -68%; uptake: -72%) but only glucose uptake was decreased when normalized for fetal body weight (-30%; P<0.05). The glucose/oxygen quotient was significantly increased (+100%; P<0.05) while glucose clearance was significantly decreased (71%; P<0.001) in FGR pregnancy (both P<0.05). The human fetus in FGR pregnancy triggers compensatory mechanisms to reduce its metabolic rate, matching the proportion of substrate consumption relative to oxygen delivery as a survival strategy during complicated pregnancy.
Collapse
Affiliation(s)
- Irene Cetin
- From the Department of Biomedical and Clinical Sciences Luigi Sacco, Università degli Studi di Milano, Italy (I.C., E.T., C.M.)
| | - Emanuela Taricco
- From the Department of Biomedical and Clinical Sciences Luigi Sacco, Università degli Studi di Milano, Italy (I.C., E.T., C.M.)
| | - Chiara Mandò
- From the Department of Biomedical and Clinical Sciences Luigi Sacco, Università degli Studi di Milano, Italy (I.C., E.T., C.M.)
| | - Tatjana Radaelli
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy (T.R., S.B.)
| | - Simona Boito
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy (T.R., S.B.)
| | - Anna Maria Nuzzo
- Department of Surgical Sciences, University of Turin, Italy (A.M.N.)
| | - Dino A Giussani
- Department of Physiology Development and Neuroscience, University of Cambridge, United Kingdom (D.A.G.)
| |
Collapse
|
24
|
Kanazawa S, Muromoto J, Ozawa K, Mikami M, Ogawa K, Wada S, Sago H. Reliability and characteristics of ultrasound measurement of fetal umbilical venous blood flow volume according to the site of measurement. J Med Ultrason (2001) 2020; 47:305-312. [PMID: 31912321 DOI: 10.1007/s10396-019-00999-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aimed at assessing the reliability and characteristics of fetal umbilical venous blood flow volume (UVFV) measurement using ultrasound. METHODS We conducted a prospective study at our center from November 2017 to July 2019. We performed transabdominal ultrasound examinations at 18-34 weeks' gestation in uncomplicated singleton pregnancies. UVFV was calculated using vessel diameter (D) and maximum flow velocity (V) as follows: (D/2)2 × π × V × 0.5 × 60 (Q, mL/min). Two examiners measured each value three times in the free-loop (FL) and intra-abdominal (IA) portions of the umbilical vein. Intra-rater and inter-rater reliability was evaluated by intraclass correlation coefficient (ICC) and a Bland-Altman plot. RESULTS Two hundred and eight cases were measured by two examiners. The rate of complete measurement at FL and IA was not significantly different (88.5% vs. 79.3%, respectively; p = 0.113). The intra-rater reliability of D and V was high at FL and IA. Regarding inter-rater reliability, the ICC of D, V, and Q was 0.973, 0.582, and 0.963 at FL, and 0.994, 0.912, and 0.989 at IA, respectively. A Bland-Altman plot showed that D and V had greater standard deviation at FL than IA. Regarding Q, the standard deviation at FL was also larger than at IA, and measurement variance at FL increased as the measured value increased, but that at IA did not. CONCLUSION UVFV measurement showed high intra-rater and inter-rater reliability at FL and IA, but the variance of measurements at FL became large as the measured value increased. Properties of different measurement sites should be considered when evaluating UVFV.
Collapse
Affiliation(s)
- Seiji Kanazawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Advanced Pediatric Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Jin Muromoto
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Katsusuke Ozawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masashi Mikami
- Division of Biostatistics, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kohei Ogawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Seiji Wada
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan. .,Advanced Pediatric Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.
| |
Collapse
|
25
|
Ryd D, Sun L, Steding-Ehrenborg K, Bidhult S, Kording F, Ruprecht C, Macgowan CK, Seed M, Aletras AH, Arheden H, Hedström E. Quantification of blood flow in the fetus with cardiovascular magnetic resonance imaging using Doppler ultrasound gating: validation against metric optimized gating. J Cardiovasc Magn Reson 2019; 21:74. [PMID: 31783877 PMCID: PMC6883707 DOI: 10.1186/s12968-019-0586-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/25/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Fetal cardiovascular magnetic resonance (CMR) imaging is used clinically and for research, but has been previously limited due to lack of direct gating methods. A CMR-compatible Doppler ultrasound (DUS) gating device has resolved this. However, the DUS-gating method is not validated against the current reference method for fetal phase-contrast blood flow measurements, metric optimized gating (MOG). Further, we investigated how different methods for vessel delineation affect flow volumes and observer variability in fetal flow acquisitions. AIMS To 1) validate DUS gating versus MOG for quantifying fetal blood flow; 2) assess repeatability of DUS gating; 3) assess impact of region of interest (ROI) size on flow volume; and 4) compare time-resolved and static delineations for flow volume and observer variability. METHODS Phase-contrast CMR was acquired in the fetal descending aorta (DAo) and umbilical vein by DUS gating and MOG in 22 women with singleton pregnancy in gestational week 360 (265-400) with repeated scans in six fetuses. Impact of ROI size on measured flow was assessed for ROI:s 50-150% of the vessel diameter. Four observers from two centers provided time-resolved and static delineations. Bland-Altman analysis was used to determine agreement between both observers and methods. RESULTS DAo flow was 726 (348-1130) ml/min and umbilical vein flow 366 (150-782) ml/min by DUS gating. Bias±SD for DUS-gating versus MOG were - 45 ± 122 ml/min (-6 ± 15%) for DAo and 19 ± 136 ml/min (2 ± 24%) for umbilical vein flow. Repeated flow measurements in the same fetus showed similar volumes (median CoV = 11% (DAo) and 23% (umbilical vein)). Region of interest 50-150% of vessel diameter yielded flow 35-120%. Bias±SD for time-resolved versus static DUS-gated flow was 33 ± 39 ml/min (4 ± 6%) for DAo and 11 ± 84 ml/min (2 ± 15%) for umbilical vein flow. CONCLUSIONS Quantification of blood flow in the fetal DAo and umbilical vein using DUS-gated phase-contrast CMR is feasible and agrees with the current reference method. Repeatability was generally high for CMR fetal blood flow assessment. An ROI similar to the vessel area or slightly larger is recommended. A static ROI is sufficient for fetal flow quantification using currently available CMR sequences.
Collapse
Affiliation(s)
- Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Liqun Sun
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Sebastian Bidhult
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Fabian Kording
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Ruprecht
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher K. Macgowan
- Department of Medical Biophysics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Michael Seed
- Department of Pediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
- Department of Diagnostic Imaging, University of Toronto and Hospital for Sick Children, Toronto, ON Canada
| | - Anthony H. Aletras
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- School of Medicine, Laboratory of Computing, Medical Informatics and Biomedical, Imaging Technologies, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| |
Collapse
|
26
|
Wai SG, Rozance PJ, Wesolowski SR, Hay WW, Brown LD. Prolonged amino acid infusion into intrauterine growth-restricted fetal sheep increases leucine oxidation rates. Am J Physiol Endocrinol Metab 2018; 315:E1143-E1153. [PMID: 30205012 PMCID: PMC6336957 DOI: 10.1152/ajpendo.00128.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Overcoming impaired growth in an intrauterine growth-restricted (IUGR) fetus has potential to improve neonatal morbidity, long-term growth, and metabolic health outcomes. The extent to which fetal anabolic capacity persists as the IUGR condition progresses is not known. We subjected fetal sheep to chronic placental insufficiency and tested whether prolonged amino acid infusion would increase protein accretion in these IUGR fetuses. IUGR fetal sheep were infused for 10 days with either mixed amino acids providing ~2 g·kg-1·day-1 (IUGR-AA) or saline (IUGR-Sal) during late gestation. At the end of the infusion, fetal plasma leucine, isoleucine, lysine, methionine, and arginine concentrations were higher in the IUGR-AA than IUGR-Sal group ( P < 0.05). Fetal plasma glucose, oxygen, insulin, IGF-1, cortisol, and norepinephrine concentrations were similar between IUGR groups, but glucagon concentrations were fourfold higher in the IUGR-AA group ( P < 0.05). Net umbilical amino acid uptake rate did not differ between IUGR groups; thus the total amino acid delivery rate (net umbilical amino acid uptake + infusion rate) was higher in the IUGR-AA than IUGR-Sal group (30 ± 4 vs. 19 ± 1 μmol·kg-1·min-1, P < 0.05). Net umbilical glucose, lactate, and oxygen uptake rates were similar between IUGR groups. Fetal leucine oxidation rate, measured using a leucine tracer, was higher in the IUGR-AA than IUGR-Sal group (2.5 ± 0.3 vs. 1.7 ± 0.3 μmol·kg-1·min-1, P < 0.05). Fetal protein accretion rate was not statistically different between the IUGR groups (1.6 ± 0.4 and 0.8 ± 0.3 μmol·kg-1·min-1 in IUGR-AA and IUGR-Sal, respectively) due to variability in response to amino acids. Prolonged amino acid infusion into IUGR fetal sheep increased leucine oxidation rates with variable anabolic response.
Collapse
Affiliation(s)
- Sandra G Wai
- Perinatal Research Center, Department of Pediatrics, University of Colorado School of Medicine , Aurora, Colorado
| | - Paul J Rozance
- Perinatal Research Center, Department of Pediatrics, University of Colorado School of Medicine , Aurora, Colorado
| | - Stephanie R Wesolowski
- Perinatal Research Center, Department of Pediatrics, University of Colorado School of Medicine , Aurora, Colorado
| | - William W Hay
- Perinatal Research Center, Department of Pediatrics, University of Colorado School of Medicine , Aurora, Colorado
| | - Laura D Brown
- Perinatal Research Center, Department of Pediatrics, University of Colorado School of Medicine , Aurora, Colorado
| |
Collapse
|
27
|
Pinter SZ, Kripfgans OD, Treadwell MC, Kneitel AW, Fowlkes JB, Rubin JM. Evaluation of Umbilical Vein Blood Volume Flow in Preeclampsia by Angle-Independent 3D Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1633-1640. [PMID: 29243838 DOI: 10.1002/jum.14507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/15/2017] [Accepted: 09/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To investigate the association between umbilical vein blood volume flow and the condition of preeclampsia in an at-risk maternal patient cohort. Umbilical vein volume flow was quantified by a 3-dimensional (3D) sonographic technique that overcomes several limitations of standard sonographic flow measurement methods. METHODS A total of 35 patients, each with a singleton pregnancy, were recruited to provide 5 patients with preeclampsia, derived as a subset from a 26-patient at-risk group, and 9 patients with normal pregnancies. An ultrasound system equipped with a 2.0-8.0-MHz transducer was used to acquire multivolume 3D color flow and power mode data sets to compute the mean umbilical vein volume flow in patients with normal pregnancies and preeclampsia. RESULTS The gestational ages of the pregnancies ranged from 29.7 to 34.3 weeks in the patients with preeclampsia and from 25.9 to 34.7 weeks in the patients with normal pregnancies. Comparisons between patients with normal pregnancies and those with preeclampsia showed weight-normalized flow with a moderately high separation between groups (P = .11) and depth-corrected, weight-normalized flow with a statistically significant difference between groups (P = .035). Umbilical vein volume flow measurements were highly reproducible in the mean estimate, with an intrapatient relative SE of 12.1% ± 5.9% and an intrameasurement relative SE of 5.6% ± 1.9 %. In patients who developed pregnancy-induced hypertension or severe pregnancy-induced hypertension, umbilical vein volume flow suggested gestational hypertensive disorder before clinical diagnosis. CONCLUSIONS Results indicate that mean depth-corrected, weight-normalized umbilical vein volume flow is reduced in pregnancies complicated by preeclampsia and that volume flow may indicate hypertensive disorder earlier in gestation. Volume flow measurements are highly reproducible, and further study in a larger clinical population is encouraged to determine whether 3D volume flow can complement the management of preeclampsia and, in general, at-risk pregnancy.
Collapse
Affiliation(s)
- Stephen Z Pinter
- Departments of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver D Kripfgans
- Departments of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Marjorie C Treadwell
- Departments of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anna W Kneitel
- Departments of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - J Brian Fowlkes
- Departments of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan M Rubin
- Departments of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
28
|
Dallmann A, Ince I, Meyer M, Willmann S, Eissing T, Hempel G. Gestation-Specific Changes in the Anatomy and Physiology of Healthy Pregnant Women: An Extended Repository of Model Parameters for Physiologically Based Pharmacokinetic Modeling in Pregnancy. Clin Pharmacokinet 2018; 56:1303-1330. [PMID: 28401479 DOI: 10.1007/s40262-017-0539-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the past years, several repositories for anatomical and physiological parameters required for physiologically based pharmacokinetic modeling in pregnant women have been published. While providing a good basis, some important aspects can be further detailed. For example, they did not account for the variability associated with parameters or were lacking key parameters necessary for developing more detailed mechanistic pregnancy physiologically based pharmacokinetic models, such as the composition of pregnancy-specific tissues. OBJECTIVES The aim of this meta-analysis was to provide an updated and extended database of anatomical and physiological parameters in healthy pregnant women that also accounts for changes in the variability of a parameter throughout gestation and for the composition of pregnancy-specific tissues. METHODS A systematic literature search was carried out to collect study data on pregnancy-related changes of anatomical and physiological parameters. For each parameter, a set of mathematical functions was fitted to the data and to the standard deviation observed among the data. The best performing functions were selected based on numerical and visual diagnostics as well as based on physiological plausibility. RESULTS The literature search yielded 473 studies, 302 of which met the criteria to be further analyzed and compiled in a database. In total, the database encompassed 7729 data. Although the availability of quantitative data for some parameters remained limited, mathematical functions could be generated for many important parameters. Gaps were filled based on qualitative knowledge and based on physiologically plausible assumptions. CONCLUSION The presented results facilitate the integration of pregnancy-dependent changes in anatomy and physiology into mechanistic population physiologically based pharmacokinetic models. Such models can ultimately provide a valuable tool to investigate the pharmacokinetics during pregnancy in silico and support informed decision making regarding optimal dosing regimens in this vulnerable special population.
Collapse
Affiliation(s)
- André Dallmann
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, Westfälische Wilhelm-University Münster, Münster, Germany
| | - Ibrahim Ince
- ET-TD-ET Systems Pharmacology CV, Bayer AG, Leverkusen, Germany.
| | - Michaela Meyer
- DD-CS Clinical Pharmacometrics, Bayer AG, Wuppertal, Germany
| | - Stefan Willmann
- DD-CS Clinical Pharmacometrics, Bayer AG, Wuppertal, Germany
| | - Thomas Eissing
- ET-TD-ET Systems Pharmacology CV, Bayer AG, Leverkusen, Germany
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, Westfälische Wilhelm-University Münster, Münster, Germany
| |
Collapse
|
29
|
Saw SN, Poh YW, Chia D, Biswas A, Mattar CNZ, Yap CH. Characterization of the hemodynamic wall shear stresses in human umbilical vessels from normal and intrauterine growth restricted pregnancies. Biomech Model Mechanobiol 2018; 17:1107-1117. [PMID: 29691766 DOI: 10.1007/s10237-018-1017-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/13/2018] [Indexed: 12/13/2022]
Abstract
Significant reductions in blood flow and umbilical diameters were reported in pregnancies affected by intrauterine growth restriction (IUGR) from placental insufficiency. However, it is not known if IUGR umbilical blood vessels experience different hemodynamic wall shear stresses (WSS) compared to normal umbilical vessels. As WSS is known to influence vasoactivity and vascular growth and remodeling, which can regulate flow rates, it is important to study this parameter. In this study, we aim to characterize umbilical vascular WSS environment in normal and IUGR pregnancies, and evaluate correlation between WSS and vascular diameter, and gestational age. Twenty-two normal and 21 IUGR pregnancies were assessed via ultrasound between the 27th and 39th gestational week. IUGR was defined as estimated fetal weight and/or abdominal circumference below the 10th centile, with no improvement during the remainder of the pregnancy. Vascular diameter was determined by 3D ultrasound scans and image segmentation. Umbilical artery (UA) WSS was computed via computational flow simulations, while umbilical vein (UV) WSS was computed via the Poiseuille equation. Univariate multiple regression analysis was used to test for the differences between normal and IUGR cohort. UV volumetric flow rate, UA and UV diameters were significantly lower in IUGR fetuses, but flow velocities and WSS trends in UA and UV were very similar between normal and IUGR groups. In both groups, UV WSS showed a significant negative correlation with diameter, but UA WSS had no correlation with diameter, suggesting a constancy of WSS environment and the existence of WSS homeostasis in UA, but not in UV. Despite having reduced flow rate and vascular sizes, IUGR UAs had hemodynamic mechanical stress environments and trends that were similar to those in normal pregnancies. This suggested that endothelial dysfunction or abnormal mechanosensing was unlikely to be the cause of small vessels in IUGR umbilical cords.
Collapse
Affiliation(s)
- Shier Nee Saw
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, #02-04, Singapore, 117575, Singapore
| | - Yu Wei Poh
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, #02-04, Singapore, 117575, Singapore
| | - Dawn Chia
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore, Singapore
| | - Arijit Biswas
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore, Singapore
| | - Citra Nurfarah Zaini Mattar
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore, Singapore
| | - Choon Hwai Yap
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, #02-04, Singapore, 117575, Singapore.
| |
Collapse
|
30
|
Rodríguez-Soto AE, Langham MC, Abdulmalik O, Englund EK, Schwartz N, Wehrli FW. MRI quantification of human fetal O 2 delivery rate in the second and third trimesters of pregnancy. Magn Reson Med 2018; 80:1148-1157. [PMID: 29359353 DOI: 10.1002/mrm.27094] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/21/2017] [Accepted: 12/28/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Ana E Rodríguez-Soto
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael C Langham
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Osheiza Abdulmalik
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Erin K Englund
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nadav Schwartz
- Maternal and Child Health Research Program, Department of OBGYN, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Felix W Wehrli
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
31
|
Spurway J, Logan P, Pak SC, Nielsen S. Reference ranges for the intra-amniotic umbilical cord vein diameter, peak velocity and blood flow in a regional NSW population. Australas J Ultrasound Med 2017; 20:155-162. [PMID: 34760489 PMCID: PMC8409896 DOI: 10.1002/ajum.12060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM To construct gestational age (GA)-related reference ranges of the intra-amniotic umbilical cord vein (UCV) diameter, peak velocity (PV) and blood flow (Qucv) using a Central West New South Wales population. MATERIALS AND METHODS This was a prospective, quasi-experimental study of low risk, singleton pregnancies (n = 321) between 16 and 42 weeks of gestation. Participation was voluntary following informed consent. The UCV diameter and PV were measured using B mode and duplex Doppler respectively, and Qucv calculated. Percentile values and reference range graphs were established using quantile regression modelling in R statistical software. Intraclass correlation coefficients (ICCs) were calculated to assess the intra and intersonographer reliability. RESULTS Reference ranges for the UCV diameter, PV and Qucv were established and graphed. All three UCV measurements increased with advancing GA, with both diameter and Qucv exhibiting a decline in the late third trimester. The intrasonographer and intersonographer ICCs for the UCV diameter and PV showed almost perfect agreement within and between sonographers. CONCLUSION Gestational age-related reference ranges for the UCV diameter, PV and Qucv were developed using quantile regression from a cohort of low risk, singleton pregnancies in Central West NSW. These reference ranges have the potential to assist in the diagnosis and monitoring of fetal growth restriction.
Collapse
Affiliation(s)
- Jacqueline Spurway
- Medical Imaging DepartmentOrange Health ServicePO Box 319OrangeNew South Wales2800Australia
| | - Patricia Logan
- School of Biomedical SciencesCharles Sturt UniversityLocked Bag 49DubboNew South Wales2830Australia
| | - Sok Cheon Pak
- School of Biomedical SciencesCharles Sturt UniversityPanorama AvenueBathurstNew South Wales2795Australia
| | - Sharon Nielsen
- Quantitative Consulting UnitCharles Sturt UniversityLocked Bag 588Wagga WaggaNew South Wales2678Australia
| |
Collapse
|
32
|
Zhang Z, Imperial MZ, Patilea-Vrana GI, Wedagedera J, Gaohua L, Unadkat JD. Development of a Novel Maternal-Fetal Physiologically Based Pharmacokinetic Model I: Insights into Factors that Determine Fetal Drug Exposure through Simulations and Sensitivity Analyses. Drug Metab Dispos 2017; 45:920-938. [PMID: 28588050 PMCID: PMC5506457 DOI: 10.1124/dmd.117.075192] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/25/2017] [Indexed: 12/21/2022] Open
Abstract
Determining fetal drug exposure (except at the time of birth) is not possible for both logistical and ethical reasons. Therefore, we developed a novel maternal-fetal physiologically based pharmacokinetic (m-f-PBPK) model to predict fetal exposure to drugs and populated this model with gestational age-dependent changes in maternal-fetal physiology. Then, we used this m-f-PBPK to: 1) perform a series of sensitivity analyses to quantitatively demonstrate the impact of fetoplacental metabolism and placental transport on fetal drug exposure for various drug-dosing regimens administered to the mother; 2) predict the impact of gestational age on fetal drug exposure; and 3) demonstrate that a single umbilical venous (UV)/maternal plasma (MP) ratio (even after multiple-dose oral administration to steady state) does not necessarily reflect fetal drug exposure. In addition, we verified the implementation of this m-f-PBPK model by comparing the predicted UV/MP and fetal/MP AUC ratios with those predicted at steady state after an intravenous infusion. Our simulations yielded novel insights into the quantitative contribution of fetoplacental metabolism and/or placental transport on gestational age-dependent fetal drug exposure. Through sensitivity analyses, we demonstrated that the UV/MP ratio does not measure the extent of fetal drug exposure unless obtained at steady state after an intravenous infusion or when there is little or no fluctuation in MP drug concentrations after multiple-dose oral administration. The proposed m-f-PBPK model can be used to predict fetal exposure to drugs across gestational ages and therefore provide the necessary information to assess the risk of drug toxicity to the fetus.
Collapse
Affiliation(s)
- Zufei Zhang
- Department of Pharmaceutics, University of Washington, Seattle, Washington (Z.Z., M.Z.I., G.I.P.-V, J.D.U.); and Simcyp Limited (a Certara company), Sheffield, United Kingdom (J.W., L.G.)
| | - Marjorie Z Imperial
- Department of Pharmaceutics, University of Washington, Seattle, Washington (Z.Z., M.Z.I., G.I.P.-V, J.D.U.); and Simcyp Limited (a Certara company), Sheffield, United Kingdom (J.W., L.G.)
| | - Gabriela I Patilea-Vrana
- Department of Pharmaceutics, University of Washington, Seattle, Washington (Z.Z., M.Z.I., G.I.P.-V, J.D.U.); and Simcyp Limited (a Certara company), Sheffield, United Kingdom (J.W., L.G.)
| | - Janak Wedagedera
- Department of Pharmaceutics, University of Washington, Seattle, Washington (Z.Z., M.Z.I., G.I.P.-V, J.D.U.); and Simcyp Limited (a Certara company), Sheffield, United Kingdom (J.W., L.G.)
| | - Lu Gaohua
- Department of Pharmaceutics, University of Washington, Seattle, Washington (Z.Z., M.Z.I., G.I.P.-V, J.D.U.); and Simcyp Limited (a Certara company), Sheffield, United Kingdom (J.W., L.G.)
| | - Jashvant D Unadkat
- Department of Pharmaceutics, University of Washington, Seattle, Washington (Z.Z., M.Z.I., G.I.P.-V, J.D.U.); and Simcyp Limited (a Certara company), Sheffield, United Kingdom (J.W., L.G.)
| |
Collapse
|
33
|
Andersen CC, Hodyl NA, Kirpalani HM, Stark MJ. A Theoretical and Practical Approach to Defining "Adequate Oxygenation" in the Preterm Newborn. Pediatrics 2017; 139:peds.2016-1117. [PMID: 28325811 DOI: 10.1542/peds.2016-1117] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2016] [Indexed: 11/24/2022] Open
Abstract
John Scott Haldane recognized that the administration of supplemental oxygen required titration in the individual. Although he made this observation in adults, it is equally applicable to the preterm newborn. But how, in practice, can the oxygen requirements in the preterm newborn be determined to avoid the consequences of too little and too much oxygen? Unfortunately, the current generation of oxygen saturation trials in preterm newborns guides saturation thresholds rather than individual oxygen requirements. For this reason, we propose an alternate model for the description of oxygen sufficiency. This model considers the adequacy of oxygen delivery relative to simultaneous consumption. We describe how measuring oxygen extraction or the venous oxygen reservoir could define a physiologically based definition of adequate oxygen. This definition would provide a clinically useful reference value while making irrelevant the absolute values of both oxygen delivery and consumption. Additional trials to test adjunctive, noninvasive measurements of oxygen status in high-risk preterm newborns are needed to minimize the effects of both insufficient and excessive oxygen exposure.
Collapse
Affiliation(s)
- Chad C Andersen
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia; .,Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; and
| | - Nicolette A Hodyl
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia.,Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; and
| | - Haresh M Kirpalani
- Neonatal Division, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael J Stark
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia.,Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; and
| |
Collapse
|
34
|
Najafzadeh A, Jacoby P, Mattes E, Dickinson JE. The umbilical vein in the human fetus has a non‐linear growth pattern across gestation. Australas J Ultrasound Med 2016; 19:99-104. [DOI: 10.1002/ajum.12018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Afrooz Najafzadeh
- School of Women's and Infants' Health The University of Western Australia King Edward Memorial Hospital Perth Western Australia Australia
- School of Paediatrics and Child Health The University of Western Australia Perth Western Australia Australia
- School of Health Professions Murdoch University Perth Western Australia Australia
- Telethon Kids Institute 100 Roberts Road, Subiaco Perth Western Australia Australia
| | - Peter Jacoby
- Telethon Kids Institute 100 Roberts Road, Subiaco Perth Western Australia Australia
| | - Eugen Mattes
- Telethon Kids Institute 100 Roberts Road, Subiaco Perth Western Australia Australia
- School of Medicine and Pharmacology The University of Western Australia Crawley Western Australia Australia
| | - Jan E Dickinson
- School of Women's and Infants' Health The University of Western Australia King Edward Memorial Hospital Perth Western Australia Australia
| |
Collapse
|
35
|
Saw SN, Dawn C, Biswas A, Mattar CNZ, Yap CH. Characterization of the in vivo wall shear stress environment of human fetus umbilical arteries and veins. Biomech Model Mechanobiol 2016; 16:197-211. [DOI: 10.1007/s10237-016-0810-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
|
36
|
Acharya G, Sonesson SE, Flo K, Räsänen J, Odibo A. Hemodynamic aspects of normal human feto-placental (umbilical) circulation. Acta Obstet Gynecol Scand 2016; 95:672-82. [DOI: 10.1111/aogs.12919] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/26/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Ganesh Acharya
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; UiT - The Arctic University of Norway; Tromsø Norway
- Department of Clinical Sciences, Intervention and Technology; Karolinska Institute; Stockholm Sweden
- Department of Women′s and Children's Health; Karolinska Institute; Stockholm Sweden
| | - Sven-Erik Sonesson
- Department of Women′s and Children's Health; Karolinska Institute; Stockholm Sweden
| | - Kari Flo
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; UiT - The Arctic University of Norway; Tromsø Norway
| | - Juha Räsänen
- Department of Obstetrics and Gynecology; Kuopio University Hospital and University of Eastern Finland; Kuopio Finland
| | - Anthony Odibo
- Division of Maternal Fetal Medicine; Department of Obstetrics and Gynecology; University of South Florida; Tampa FL USA
| |
Collapse
|
37
|
Rizzo G, Rizzo L, Aiello E, Allegra E, Arduini D. Modelling umbilical vein blood flow normograms at 14-40 weeks of gestation by quantile regression analysis. J Matern Fetal Neonatal Med 2016; 29:701-6. [PMID: 25758625 DOI: 10.3109/14767058.2015.1019855] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To construct reference limits for gestation of umbilical vein blood flow (UVBF) in normal singleton pregnancies between 14 and 40 weeks of gestation using quantile regression. METHODS We ultrasonographycally examined 852 fetuses from low-risk pregnancies between 16 and 40 weeks of gestation in a prospective cross-sectional study. UV diameter and time-averaged maximum velocity (TAMXV) were measured in UV intra-abdominal portion by real time and Doppler ultrasonography. A semi-automatic measurement software was used to obtain UV diameter values. UVBF was then calculated from UV diameter and TAMXV measurements and expressed both as absolute value and as value normalized for fetal abdominal circumference (UVBF/AC). Individual centile values of the variables investigated were established by quantile regression in the gestational interval considered. In 50 cases UVBF was measured twice by the same investigator or by a second investigator and the intra- and inter-observer agreement were calculated. RESULTS A significant increase in UV diameter, TAMXV, UVBF absolute value and UVBF/AC was evidenced in the gestational period considered. Growth charts were established based on these measurements. The intra- and inter-observer intraclass correlation coefficients resulted as 0.92 (0.87-0.96) and 0.89 (0.84-0.97), respectively, for UBVF. CONCLUSIONS In this study we constructed UVBF charts using quantile regression in a large cohort of low-risk pregnancies. These charts offer the advantage of specific estimated regression parameters for each percentile, better defining the normal range of UVBF. This promises to be useful in the diagnosis and management of fetuses with abnormal fetal growth.
Collapse
Affiliation(s)
- Giuseppe Rizzo
- a Department of Obstetrics and Gynecology , Università di Roma "Tor Vergata" , Roma , Italy and
| | - Ludovica Rizzo
- b Operations Research Center, Massachusetts Institute of Technology , Cambridge , MA , USA
| | - Elisa Aiello
- a Department of Obstetrics and Gynecology , Università di Roma "Tor Vergata" , Roma , Italy and
| | - Eugenio Allegra
- a Department of Obstetrics and Gynecology , Università di Roma "Tor Vergata" , Roma , Italy and
| | - Domenico Arduini
- a Department of Obstetrics and Gynecology , Università di Roma "Tor Vergata" , Roma , Italy and
| |
Collapse
|
38
|
Volumetric Growth of the Liver in the Human Fetus: An Anatomical, Hydrostatic, and Statistical Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:858162. [PMID: 26413551 PMCID: PMC4564626 DOI: 10.1155/2015/858162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/30/2015] [Accepted: 04/06/2015] [Indexed: 02/03/2023]
Abstract
Using anatomical, hydrostatic, and statistical methods, liver volumes were assessed in 69 human fetuses of both sexes aged 18-30 weeks. No sex differences were found. The median of liver volume achieved by hydrostatic measurements increased from 6.57 cm(3) at 18-21 weeks through 14.36 cm(3) at 22-25 weeks to 20.77 cm(3) at 26-30 weeks, according to the following regression: y = -26.95 + 1.74 × age ± Z × (-3.15 + 0.27 × age). The median of liver volume calculated indirectly according to the formula liver volume = 0.55 × liver length × liver transverse diameter × liver sagittal diameter increased from 12.41 cm(3) at 18-21 weeks through 28.21 cm(3) at 22-25 weeks to 49.69 cm(3) at 26-30 weeks. There was a strong relationship (r = 0.91, p < 0.001) between the liver volumes achieved by hydrostatic (x) and indirect (y) methods, expressed by y = -0.05 + 2.16x ± 7.26. The liver volume should be calculated as follows liver volume = 0.26 × liver length × liver transverse diameter × liver sagittal diameter. The age-specific liver volumes are of great relevance in the evaluation of the normal hepatic growth and the early diagnosis of fetal micro- and macrosomias.
Collapse
|
39
|
Prior T, Kumar S. Expert review--identification of intra-partum fetal compromise. Eur J Obstet Gynecol Reprod Biol 2015; 190:1-6. [PMID: 25917435 DOI: 10.1016/j.ejogrb.2015.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/31/2015] [Accepted: 04/07/2015] [Indexed: 09/30/2022]
Abstract
Whilst most cases of cerebral palsy occur as a consequence of an ante-natal insult, a significant proportion, particularly in the term fetus, are attributable to intra-partum hypoxia. Intra-partum monitoring using continuous fetal heart rate assessment has led to an increased incidence of operative delivery without a concurrent reduction in the incidence of cerebral palsy. Despite this, birth asphyxia remains the strongest and most consistent risk factor for cerebral palsy in term infants. This review evaluates current intra-partum monitoring techniques as well as alternative approaches aimed at better identification of the fetus at risk of compromise in labour.
Collapse
Affiliation(s)
- Tomas Prior
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London W12 0HS, UK; Institute for Reproductive and Developmental Biology, Imperial College London, London W12 0HS, UK
| | - Sailesh Kumar
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London W12 0HS, UK; Institute for Reproductive and Developmental Biology, Imperial College London, London W12 0HS, UK; Mater Research Institute/University of Queensland, Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia.
| |
Collapse
|
40
|
Baeyens N, Nicoli S, Coon BG, Ross TD, Van den Dries K, Han J, Lauridsen HM, Mejean CO, Eichmann A, Thomas JL, Humphrey JD, Schwartz MA. Vascular remodeling is governed by a VEGFR3-dependent fluid shear stress set point. eLife 2015; 4. [PMID: 25643397 PMCID: PMC4337723 DOI: 10.7554/elife.04645] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 02/01/2015] [Indexed: 12/23/2022] Open
Abstract
Vascular remodeling under conditions of growth or exercise, or during recovery from arterial restriction or blockage is essential for health, but mechanisms are poorly understood. It has been proposed that endothelial cells have a preferred level of fluid shear stress, or ‘set point’, that determines remodeling. We show that human umbilical vein endothelial cells respond optimally within a range of fluid shear stress that approximate physiological shear. Lymphatic endothelial cells, which experience much lower flow in vivo, show similar effects but at lower value of shear stress. VEGFR3 levels, a component of a junctional mechanosensory complex, mediate these differences. Experiments in mice and zebrafish demonstrate that changing levels of VEGFR3/Flt4 modulates aortic lumen diameter consistent with flow-dependent remodeling. These data provide direct evidence for a fluid shear stress set point, identify a mechanism for varying the set point, and demonstrate its relevance to vessel remodeling in vivo. DOI:http://dx.doi.org/10.7554/eLife.04645.001 Blood and lymphatic vessels remodel their shape, diameter and connections during development, and throughout life in response to growth, exercise and disease. This process is called vascular remodeling. The endothelial cells that line the inside of blood and lymphatic vessels are constantly exposed to the frictional force from flowing blood, termed fluid shear stress. Changes in shear stress are sensed by the endothelial cells, which trigger vascular remodeling to return the stress to the original level. It has been proposed that remodeling is governed by a preferred level of fluid shear stress, or set point, against which deviations in the shear stress are compared. Thus, changing the fluid flow through a blood vessel increases or decreases shear stress, which results in the vessel remodeling to restore the original level of shear stress. Like all remodeling, this process involves inflammation to recruit white blood cells, which assist with the process. Baeyens et al. investigated whether such a shear stress set point exists and what its biological basis might be using cultured endothelial cells from human umbilical veins. These cells remained stable and in a resting state when a particular level of shear stress was applied to them; above or below this shear stress level, the cells produced an inflammatory response like that seen during vascular remodeling. This suggests that these cells do indeed have a set point for shear stress. The same response occurred in human lymphatic endothelial cells, although in these cells the shear stress set point was much lower, correlating with the low flow in lymphatic vessels. Baeyens et al. then discovered that the shear stress set point is related to the level of a protein called VEGFR3 in the cells, which was recently found to participate in shear stress sensing. Endothelial cells from lymphatic vessels normally produce much greater quantities of VEGFR3 than those from blood vessels. Reducing the amount of VEGFR3 in lymphatic endothelial cells increased the set point shear stress, while increasing the levels in blood vessel cells decreased the set point. This suggests that the levels of this protein account for the difference in the response of these two cell types. Baeyens et al. then tested this pathway by reducing the levels of VEGFR3 in zebrafish embryos and in adult mice. In both animals, this caused arteries to narrow, showing that VEGFR3 levels also control sensitivity to shear stress—and hence vascular remodeling—inside living creatures. Understanding in detail how vascular remodeling is regulated could help improve treatments for a wide range of cardiovascular conditions. To do so, further work will be needed to develop methods to control the sensitivity of endothelial cells to shear stress and to identify other proteins that might specifically control the narrowing or the expansion of vessels in human patients. DOI:http://dx.doi.org/10.7554/eLife.04645.002
Collapse
Affiliation(s)
- Nicolas Baeyens
- Department of Internal Medicine, Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, United States
| | - Stefania Nicoli
- Department of Internal Medicine, Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, United States
| | - Brian G Coon
- Department of Internal Medicine, Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, United States
| | - Tyler D Ross
- Department of Internal Medicine, Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, United States
| | - Koen Van den Dries
- Department of Internal Medicine, Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, United States
| | - Jinah Han
- Department of Internal Medicine, Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, United States
| | - Holly M Lauridsen
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, United States
| | - Cecile O Mejean
- Department of Internal Medicine, Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, United States
| | - Anne Eichmann
- Department of Internal Medicine, Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, United States
| | - Jean-Leon Thomas
- Department of Neurology, Yale University School of Medicine, New Haven, United States
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, United States
| | - Martin A Schwartz
- Department of Internal Medicine, Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, United States
| |
Collapse
|
41
|
Warner TD, Roussos-Ross D, Behnke M. It's not your mother's marijuana: effects on maternal-fetal health and the developing child. Clin Perinatol 2014; 41:877-94. [PMID: 25459779 PMCID: PMC4254522 DOI: 10.1016/j.clp.2014.08.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pro-marijuana advocacy efforts exemplified by the "medical" marijuana movement, coupled with the absence of conspicuous public health messages about the potential dangers of marijuana use during pregnancy, could lead to greater use of today's more potent marijuana, which could have significant short- and long-term consequences. This article reviews the current literature regarding the effects of prenatal marijuana use on the pregnant woman and her offspring.
Collapse
Affiliation(s)
- Tamara D. Warner
- University of Florida, Department of Pediatrics, P.O. Box 100296, Gainesville, FL 32610-0296, (352) 273-8985
| | - Dikea Roussos-Ross
- University of Florida, Department of Obstetrics and Gynecology, P.O. Box 100294, Gainesville, FL 32610-0294, (352) 273-7660
| | - Marylou Behnke
- University of Florida, Department of Pediatrics, P.O. Box 100296, Gainesville, FL 32610-0296, (352) 273-8985
| |
Collapse
|
42
|
Calvigioni D, Hurd YL, Harkany T, Keimpema E. Neuronal substrates and functional consequences of prenatal cannabis exposure. Eur Child Adolesc Psychiatry 2014; 23:931-41. [PMID: 24793873 PMCID: PMC4459494 DOI: 10.1007/s00787-014-0550-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/15/2014] [Indexed: 02/01/2023]
Abstract
Cannabis remains one of the world's most widely used substance of abuse amongst pregnant women. Trends of the last 50 years show an increase in popularity in child-bearing women together with a constant increase in cannabis potency. In addition, potent herbal "legal" highs containing synthetic cannabinoids that mimic the effects of cannabis with unknown pharmacological and toxicological effects have gained rapid popularity amongst young adults. Despite the surge in cannabis use during pregnancy, little is known about the neurobiological and psychological consequences in the exposed offspring. In this review, we emphasize the importance of maternal programming, defined as the intrauterine presentation of maternal stimuli to the foetus, in neurodevelopment. In particular, we focus on cannabis-mediated maternal adverse effects, resulting in direct central nervous system alteration or sensitization to late-onset chronic and neuropsychiatric disorders. We compare clinical and preclinical experimental studies on the effects of foetal cannabis exposure until early adulthood, to stress the importance of animal models that permit the fine control of environmental variables and allow the dissection of cannabis-mediated molecular cascades in the developing central nervous system. In sum, we conclude that preclinical experimental models confirm clinical studies and that cannabis exposure evokes significant molecular modifications to neurodevelopmental programs leading to neurophysiological and behavioural abnormalities.
Collapse
Affiliation(s)
- Daniela Calvigioni
- Division of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 17177 Stockholm, Sweden. Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Yasmin L. Hurd
- Department of Psychiatry and Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | - Tibor Harkany
- Division of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 17177 Stockholm, Sweden. Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Erik Keimpema
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, 1090 Vienna, Austria
| |
Collapse
|
43
|
Huizink AC. Prenatal cannabis exposure and infant outcomes: overview of studies. Prog Neuropsychopharmacol Biol Psychiatry 2014; 52:45-52. [PMID: 24075896 DOI: 10.1016/j.pnpbp.2013.09.014] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/07/2013] [Accepted: 09/19/2013] [Indexed: 12/20/2022]
Abstract
Accumulating evidence from both human and preclinical studies indicates maternal substance use during pregnancy can affect fetal development, birth weight and infant outcomes. Thus, the prenatal period can be regarded as an important and potentially sensitive period of development. In this manuscript, an updated overview of studies on prenatal cannabis exposure in humans is presented, including recent studies conducted within the Generation R study. Findings on fetal growth, birth outcomes, early neonatal behavior and infant behavior and cognitive development are discussed in detail. Preclinical evidence and potential mechanisms are described as well, and recommendations for future studies are provided. It is concluded that evidence seems to suggest that fetal development is affected by prenatal maternal cannabis use, while findings on effects on infant behavior or cognition are inconsistent. Beyond infancy, subtle differences may be found in specific cognitive or behavioral outcomes, although replication studies in which pregnant women and their fetuses are exposed to current and probably higher levels of Δ9-tetrahydrocannabinol and novel designs are needed to come to firm conclusions.
Collapse
Affiliation(s)
- A C Huizink
- Department of Developmental Psychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Clinical Child and Family Studies, VU University Amsterdam, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|
44
|
Prior T, Mullins E, Bennett P, Kumar S. Are 1st-trimester β-human chorionic gonadotrophin and pregnancy-associated plasma protein A levels predictive of intrapartum fetal compromise in a selected normal population? Aust N Z J Obstet Gynaecol 2014; 54:418-23. [DOI: 10.1111/ajo.12216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 04/06/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Tomas Prior
- Centre for Fetal Care; Queen Charlotte's and Chelsea Hospital; London UK
- Institute for Reproductive and Developmental Biology; Imperial College London; London UK
- Mater Research Institute; South Brisbane Queensland Australia
| | - Edward Mullins
- Centre for Fetal Care; Queen Charlotte's and Chelsea Hospital; London UK
- Institute for Reproductive and Developmental Biology; Imperial College London; London UK
| | - Phillip Bennett
- Centre for Fetal Care; Queen Charlotte's and Chelsea Hospital; London UK
- Institute for Reproductive and Developmental Biology; Imperial College London; London UK
| | - Sailesh Kumar
- Centre for Fetal Care; Queen Charlotte's and Chelsea Hospital; London UK
- Institute for Reproductive and Developmental Biology; Imperial College London; London UK
- Mater Research Institute; South Brisbane Queensland Australia
| |
Collapse
|
45
|
Prior T, Mullins E, Bennett P, Kumar S. Umbilical venous flow rate in term fetuses: can variations in flow predict intrapartum compromise? Am J Obstet Gynecol 2014; 210:61.e1-8. [PMID: 23999417 DOI: 10.1016/j.ajog.2013.08.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/05/2013] [Accepted: 08/28/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of the study was to investigate the distribution of umbilical venous flow rates, measured in early labor, in a cohort of normal term pregnancies and to establish the relationship between umbilical venous flow and subsequent intrapartum outcome. STUDY DESIGN Five hundred eighty-nine women with uncomplicated, term, singleton pregnancies were recruited to this prospective observational study prior to active labor (dilation of 4 cm or less) at Queen Charlotte's and Chelsea Hospital (London, UK). All participants underwent an ultrasound examination, during which fetal biometry, umbilical venous flow velocity, and umbilical vein diameter were recorded. Umbilical venous flow rate was then calculated. Following delivery, intrapartum and neonatal outcomes were correlated with the ultrasound findings. Cases were subdivided according to mode of delivery, and mean umbilical venous flow rates were compared between the groups. Cases were also subdivided according to umbilical venous flow rate (less than the 20th centile, 20th-80th centile, and greater than the 80th centile), and the incidence of diagnoses of fetal compromise was compared. RESULTS Fetuses delivered by emergency cesarean for presumed fetal compromise had the lowest umbilical venous flow rates (both corrected for and uncorrected for birthweight) (P = .02 and P = .001, respectively). Fetuses with the lowest umbilical venous flow rates were significantly more likely to require emergency cesarean for presumed fetal compromise than those with the highest flow rates (15.7% vs 5.6%, relative risk, 2.83; 95% confidence interval, 1.16-6.91). CONCLUSION Fetuses with the lowest umbilical venous flow rates are at increased risk of a subsequent diagnosis of intrapartum fetal compromise. Measurement of umbilical venous flow could contribute to the risk stratification of pregnancies prior to labor.
Collapse
Affiliation(s)
- Tomas Prior
- Center for Fetal Care, Queen Charlotte's and Chelsea Hospital, and the Institute for Reproductive and Developmental Biology, Imperial College London, London, England, UK
| | - Edward Mullins
- Center for Fetal Care, Queen Charlotte's and Chelsea Hospital, and the Institute for Reproductive and Developmental Biology, Imperial College London, London, England, UK
| | - Phillip Bennett
- Center for Fetal Care, Queen Charlotte's and Chelsea Hospital, and the Institute for Reproductive and Developmental Biology, Imperial College London, London, England, UK
| | - Sailesh Kumar
- Center for Fetal Care, Queen Charlotte's and Chelsea Hospital, and the Institute for Reproductive and Developmental Biology, Imperial College London, London, England, UK; Mater Research Institute/University of Queensland, South Brisbane, QLD, Australia.
| |
Collapse
|
46
|
Pinter SZ, Rubin JM, Kripfgans OD, Treadwell MC, Romero VC, Richards MS, Zhang M, Hall AL, Fowlkes JB. Three-dimensional sonographic measurement of blood volume flow in the umbilical cord. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1927-34. [PMID: 23197545 PMCID: PMC3654397 DOI: 10.7863/jum.2012.31.12.1927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Three-dimensional (3D) umbilical cord blood volume flow measurement with the intention of providing a straightforward, consistent, and accurate method that overcomes the limitations associated with traditional pulsed wave Doppler flow measurement and provides a means by which to recognize and manage at-risk pregnancies. METHODS The first study involved 3D sonographic volume flow measurements in 7 healthy ewes whose pregnancies ranged from 18 to 19 weeks' gestation (7 singletons). Sonographic umbilical arterial and venous flow measurements from each fetus were compared to the corresponding average measured arterial/venous flow to assess the feasibility of measurement in a static vessel. A second complementary study involved 3D sonographic volume flow measurements in 7 healthy women whose pregnancies ranged from 17.9 to 36.3 weeks' gestation (6 singletons and 1 twin). Umbilical venous flow measurements were compared to similar flow measurements reported in the literature. Pregnancy outcomes were abstracted from the medical records of the recruited patients. RESULTS In the fetal sheep model, arterial/venous flow comparisons yielded errors of 10% or less for 8 of the 9 measurements. In the clinical study, venous flow measurements showed agreement with the literature over a range of gestational ages. Two of the 7 patients in the clinical study had lower flow than anticipated for gestational age; one had a subsequent diagnosis of intrauterine growth restriction, and the other had preeclampsia. CONCLUSIONS Accurate measurement of umbilical blood volume flow can be performed with relative ease in both the sheep model and in humans using the proposed 3D sonographic flow measurement technique. Results encourage further development of the method as a means for diagnosis and identification of at-risk pregnancies.
Collapse
Affiliation(s)
| | | | | | | | - Vivian C. Romero
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI USA
| | | | - Man Zhang
- Department of Radiology, University of Michigan, Ann Arbor, MI USA
| | | | - J. Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, MI USA
| |
Collapse
|
47
|
Najafzadeh A, Dickinson JE. Umbilical venous blood flow and its measurement in the human fetus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:502-11. [PMID: 22855424 DOI: 10.1002/jcu.21970] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 06/11/2012] [Indexed: 05/26/2023]
Abstract
In this review, we evaluate the published methodologies to describe a noninvasive technique for the quantitative assessment of umbilical venous blood flow in the human fetus. We identify a number of variations in the reported methodologies and address some of the common errors associated with Doppler assessment of umbilical venous flow volume. The potential role of umbilical venous flow volumetry in the management of intrauterine growth restriction is briefly evaluated including its utility and reliability in everyday clinical practice.
Collapse
Affiliation(s)
- Afrooz Najafzadeh
- School of Women's and Infants' Health, The University of Western Australia, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Western Australia 6008, Australia
| | | |
Collapse
|
48
|
Chang YL, Chang SD, Chao AS, Wang CN, Wang TH, Cheng PJ. The Relationships of Umbilical Venous Volume Flow, Birthweight and Placental Share in Monochorionic Twin Pregnancies With and Without Selective Intrauterine Growth Restriction. Twin Res Hum Genet 2012; 14:192-7. [DOI: 10.1375/twin.14.2.192] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study was conducted to investigate the relationship among umbilical venous volume flow, birthweight and placental share in monochorionic twins with or without selective growth restriction. Having excluded cases complicated with twin-to-twin transfusion syndrome and one co-twin suffering intrauterine fetal death, a total of 51 monochorionic twin pregnancies were divided into two groups as with (group 1) and without (group 2) selective intrauterine growth restriction. Umbilical venous volume flow was calculated by multiplying the umbilical vein cross-sectional area by half of the maximal velocity around mid-trimester. The placentas were cut along the vascular equator into two individual placental masses. The discordance of birthweight was calculated as [(birthweight of larger twin—birthweight of smaller twin)/birthweight of larger twin 100%]. The discordances of umbilical venous volume flow and placental share were calculated in a similar fashion. The median umbilical venous volume flow discordances (68.4% and 15.3% in groups 1 and 2 monochorionic twins, respectively) were similar and correlated well with the placental share discordances (66.6% and 18.5% in groups 1 and 2 monochorionic twins, respectively) but not with the birthweight discordance (28.6% and 6.4% in groups 1 and 2 monochorionic twins, respectively) in both groups. We concluded that the umbilical venous volume flow discordance reflects the placental share discordance rather than the birthweight discordance in monochorionic twin pregnancies.
Collapse
|
49
|
van den Akker CHP, Schierbeek H, Minderman G, Vermes A, Schoonderwaldt EM, Duvekot JJ, Steegers EAP, van Goudoever JB. Amino acid metabolism in the human fetus at term: leucine, valine, and methionine kinetics. Pediatr Res 2011; 70:566-71. [PMID: 21857387 DOI: 10.1203/pdr.0b013e31823214d1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Human fetal metabolism is largely unexplored. Understanding how a healthy fetus achieves its fast growth rates could eventually play a pivotal role in improving future nutritional strategies for premature infants. To quantify specific fetal amino acid kinetics, eight healthy pregnant women received before elective cesarean section at term, continuous stable isotope infusions of the essential amino acids [1-13C,15N]leucine, [U-13C5]valine, and [1-13C]methionine. Umbilical blood was collected after birth and analyzed for enrichments and concentrations using mass spectrometry techniques. Fetuses showed considerable leucine, valine, and methionine uptake and high turnover rates. α-Ketoisocaproate, but not α-ketoisovalerate (the leucine and valine ketoacids, respectively), was transported at net rate from the fetus to the placenta. Especially, leucine and valine data suggested high oxidation rates, up to half of net uptake. This was supported by relatively low α-ketoisocaproate reamination rates to leucine. Our data suggest high protein breakdown and synthesis rates, comparable with, or even slightly higher than in premature infants. The relatively large uptakes of total leucine and valine carbon also suggest high fetal oxidation rates of these essential branched chain amino acids.
Collapse
Affiliation(s)
- Chris H P van den Akker
- Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, 3000 CB Rotterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Effects of dietary L-arginine or N-carbamylglutamate supplementation during late gestation of sows on the miR-15b/16, miR-221/222, VEGFA and eNOS expression in umbilical vein. Amino Acids 2011; 42:2111-9. [PMID: 21638020 PMCID: PMC3351605 DOI: 10.1007/s00726-011-0948-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 05/04/2011] [Indexed: 11/08/2022]
Abstract
Placental vascular formation and blood flow are crucial for fetal survival, growth and development, and arginine regulates vascular development and function. This study determined the effects of dietary arginine or N-carbamylglutamate (NCG) supplementation during late gestation of sows on the microRNAs, vascular endothelial growth factor A (VEGFA) and endothelial nitric oxide synthase (eNOS) expression in umbilical vein. Twenty-seven landrace × large white sows at day (d) 90 of gestation were assigned randomly to three groups and fed the following diets: a control diet and the control diet supplemented with 1.0% l-arginine or 0.10% NCG. Umbilical vein of fetuses with body weight around 2.0 kg (oversized), 1.5 kg (normal) and 0.6 kg (intrauterine growth restriction, IUGR) were obtained immediately after farrowing for miR-15b, miR-16, miR-221, miR-222, VEGFA and eNOS real-time PCR analysis. Compared with the control diets, dietary Arg or NCG supplementation enhanced the reproductive performance of sows, significantly increased (P < 0.05) plasma arginine and decreased plasma VEGF and eNOS (P < 0.05). The miR-15b expression in the umbilical vein was higher (P < 0.05) in the NCG-supplemented group than in the control group. There was a trend in that the miR-222 expression in the umbilical vein of the oversized fetuses was higher (0.05 < P < 0.1) than in the normal and IUGR fetuses. The expression of eNOS in both Arg-supplemented and NCG-supplemented group were lower (P < 0.05) than in the control group. The expression of VEGFA was higher (P < 0.05) in the NCG-supplemented group than in the Arg-supplemented and the control group. Meanwhile, the expression of VEGFA of the oversized fetuses was higher (P < 0.05) than the normal and IUGR fetuses. In conclusion, this study demonstrated that dietary Arg or NCG supplementation may affect microRNAs (miR-15b, miR-222) targeting VEGFA and eNOS gene expressions in umbilical vein, so as to regulate the function and volume of the umbilical vein, provide more nutrients and oxygen from the maternal to the fetus tissue for fetal development and survival, and enhance the reproductive performance of sows.
Collapse
|