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Jasper EA, Oltman SP, Rogers EE, Dagle JM, Murray JC, Kamya M, Kakuru A, Kajubi R, Ochieng T, Adrama H, Okitwi M, Olwoch P, Jagannathan P, Clark TD, Dorsey G, Ruel T, Jelliffe-Pawlowski LL, Ryckman KK. Targeted newborn metabolomics: prediction of gestational age from cord blood. J Perinatol 2022; 42:181-186. [PMID: 35067676 PMCID: PMC8830770 DOI: 10.1038/s41372-021-01253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our study sought to determine whether metabolites from a retrospective collection of banked cord blood specimens could accurately estimate gestational age and to validate these findings in cord blood samples from Busia, Uganda. STUDY DESIGN Forty-seven metabolites were measured by tandem mass spectrometry or enzymatic assays from 942 banked cord blood samples. Multiple linear regression was performed, and the best model was used to predict gestational age, in weeks, for 150 newborns from Busia, Uganda. RESULTS The model including metabolites and birthweight, predicted the gestational ages within 2 weeks for 76.7% of the Ugandan cohort. Importantly, this model estimated the prevalence of preterm birth <34 weeks closer to the actual prevalence (4.67% and 4.00%, respectively) than a model with only birthweight which overestimates the prevalence by 283%. CONCLUSION Models that include cord blood metabolites and birth weight appear to offer improvement in gestational age estimation over birth weight alone.
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Affiliation(s)
| | - Scott P Oltman
- University of California, San Francisco, Department of Epidemiology & Biostatistics, Kampala, Uganda.,UCSF California Preterm Birth Initiative, Kampala, Uganda
| | - Elizabeth E Rogers
- University of California San Francisco, Department of Pediatrics, Kampala, Uganda
| | - John M Dagle
- University of Iowa, Department of Pediatrics, Kampala, Uganda
| | | | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Teddy Ochieng
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Harriet Adrama
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Martin Okitwi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Peter Olwoch
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Tamara D. Clark
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Theodore Ruel
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Laura L Jelliffe-Pawlowski
- University of California, San Francisco, Department of Epidemiology & Biostatistics, Kampala, Uganda.,UCSF California Preterm Birth Initiative, Kampala, Uganda
| | - Kelli K Ryckman
- Department of Epidemiology, University of Iowa, Iowa, IA, USA.
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Debbink MP, Son SL, Woodward PJ, Kennedy AM. Sonographic Assessment of Fetal Growth Abnormalities. Radiographics 2020; 41:268-288. [PMID: 33337968 DOI: 10.1148/rg.2021200081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fetal growth abnormalities have significant consequences for pregnancy management and maternal and fetal well-being. The accurate diagnosis of fetal growth abnormalities contributes to optimal antenatal management, which may minimize the sequelae of inadequate or excessive fetal growth. An accurate diagnosis of abnormal fetal growth depends on accurate pregnancy dating and serial growth measurements. The fetal size at any given stage of pregnancy is either appropriate or inappropriate for the given gestational age (GA). Pregnancy dating is most accurate in the first trimester, as biologic variability does not come into play until the second and third trimesters. The authors describe the determination of GA with use of standard US measurements and how additional parameters can be used to confirm dating. Once dates are established, serial measurements are used to identity abnormal growth patterns. The sometimes confusing definitions of abnormal growth are clarified, the differentiation of a constitutionally small but healthy fetus from a growth-restricted at-risk fetus is described, and the roles of Doppler US and other adjunctive examinations in the management of growth restriction are discussed. In addition, the definition of selective growth restriction in twin pregnancy is briefly discussed, as is the role of Doppler US in the classification of subtypes of selective growth restriction in monochorionic twinning. The criteria for diagnosing macrosomia and the management of affected pregnancies also are reviewed. The importance of correct pregnancy dating in the detection and surveillance of abnormal fetal growth and for prevention of perinatal maternal and fetal morbidity and mortality cannot be overstated. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Michelle P Debbink
- From the Departments of Obstetrics and Gynecology (M.P.D., S.L.S.) and Radiology and Imaging Sciences (P.J.W., A.M.K.), University of Utah, 50 N Medical Dr, Salt Lake City, UT 84132
| | - Shannon L Son
- From the Departments of Obstetrics and Gynecology (M.P.D., S.L.S.) and Radiology and Imaging Sciences (P.J.W., A.M.K.), University of Utah, 50 N Medical Dr, Salt Lake City, UT 84132
| | - Paula J Woodward
- From the Departments of Obstetrics and Gynecology (M.P.D., S.L.S.) and Radiology and Imaging Sciences (P.J.W., A.M.K.), University of Utah, 50 N Medical Dr, Salt Lake City, UT 84132
| | - Anne M Kennedy
- From the Departments of Obstetrics and Gynecology (M.P.D., S.L.S.) and Radiology and Imaging Sciences (P.J.W., A.M.K.), University of Utah, 50 N Medical Dr, Salt Lake City, UT 84132
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Butt K, Lim KI. Guideline No. 388-Determination of Gestational Age by Ultrasound. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:1497-1507. [PMID: 31548039 DOI: 10.1016/j.jogc.2019.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To assist clinicians in assigning gestational age based on ultrasound biometry. OUTCOMES To determine whether ultrasound dating provides more accurate gestational age assessment than menstrual dating with or without the use of ultrasound. To provide maternity health care providers and researchers with evidence-based guidelines for the assignment of gestational age. To determine which ultrasound biometric parameters are superior when gestational age is uncertain. To determine whether ultrasound gestational age assessment is cost effective. EVIDENCE Published literature was retrieved through searches of PubMed or MEDLINE and The Cochrane Library in 2013 using appropriate controlled vocabulary and key words (gestational age, ultrasound biometry, ultrasound dating). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English. There were no date restrictions. Searches were updated on a regular basis and incorporated in the guideline to July 31, 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS Accurate assignment of gestational age may reduce post-dates labour induction and may improve obstetric care through allowing the optimal timing of necessary interventions and the avoidance of unnecessary ones. More accurate dating allows for optimal performance of prenatal screening tests for aneuploidy. A national algorithm for the assignment of gestational age may reduce practice variations across Canada for clinicians and researchers. Potential harms include the possible reassignment of dates when significant fetal pathology (such as fetal growth restriction or macrosomia) result in a discrepancy between ultrasound biometric and clinical gestational age. Such reassignment may lead to the omission of appropriate-or the performance of inappropriate-fetal interventions. SUMMARY STATEMENTS RECOMMENDATIONS.
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Butt K, Lim KI. Directive clinique N o 388 - Détermination de l'âge gestationnel par échographie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1508-1520. [PMID: 31548040 DOI: 10.1016/j.jogc.2019.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Sonographic estimation of gestational age from 20 to 40 weeks by fetal kidney lengths' measurements among pregnant women in Portharcourt, Nigeria. BMC Med Imaging 2019; 19:72. [PMID: 31438870 PMCID: PMC6704576 DOI: 10.1186/s12880-019-0371-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 08/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Ultrasonography has become an indispensible tool in the management of obstetric patients. Accurate determination of fetal gestational age (FGA) has posed great challenge to patient management as the accuracy of traditional biometric parameters decreases with advance in gestation age. Accuracy of fetal kidney length (FKL) in the determination of FGA at third trimester has been documented in other population. This study is aimed to create baseline reference values of fetal kidney lengths in a Nigerian population as previous studies show population specific variations. Methods This prospective cross sectional study was carried out on 534 pregnant women between 20 and 40 weeks of gestation who met the inclusion criteria at Diamond Biomedical Services Ltd. A pilot study was conducted on 20 patients to determine the reproducibility and reliability of ultrasound measurement of FKL. Fetal kidney lengths were calculated as mean of three separate measurements. The 5th, 50th and 95th percentiles were calculated using least squared regression analysis. Third polynomial regression models were used to establish the relationship between right and left FKL and FGA. Results Both FKL measurements are highly reproducible with excellent correlation and agreement within and between sonographers. It correlates strongly with gestational age while the relationships between right and left kidney lengths with gestational age were established using the following regression equations: RKL = − 11.18 + 1.193 × FGA − 0.0350 × FGA2 + 0.00037 × FGA3 and LKL = − 12.57 + 1.332 × FGA − 0.0390 × FGA2 + 0.00040 × FGA3 for right and left kidneys respectively. Conclusion Nigerian population specific baseline reference values of FKLs for the estimation of FGA should be adopted rather than relying on the Caucasians values as universal patterns.
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Abonyi OE, Eze CU, Onwuzu SWI. Sonographic correlation of foetal neck circumference and area with gestational age among pregnant women in Port Harcourt, Nigeria. J OBSTET GYNAECOL 2017; 37:1025-1031. [PMID: 28764584 DOI: 10.1080/01443615.2017.1318267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to create a reference range nomogram of foetal neck circumference (FNC) and foetal neck area (FNA) in a Nigerian population using polynomial regression models. This cross-sectional study involved 723 pregnant women between 14 and 40 weeks of gestation. Axial measurements of the FNC and FNA were obtained in three measurements and the mean taken as the final value and the 5th, 50th and 95th percentiles for each foetal gestational age (FGA) were calculated. FNC and FNA correlated strongly with FGA, biparietal diameter, abdominal circumference, head circumference, and femoral length. Cubic models fitted the FNC vs FGA, and FNA vs. FGA values, and the mathematical relationships are given as: [Formula: see text] [Formula: see text] [Formula: see text]. Nomograms of FNC and FNA are thus generated. Impact statement The foetal neck circumference (FNC) and foetal neck area (FNA) can serve as predictors of foetal gestational age (FGA) since they correlate strongly and positively with FGA and known biometric parameters. The measurements obtained vary with the population studied. This study provides a nomogram of the FNA and FNC for an African population. The values correlate with that of the Caucasian population up to 32 weeks FGA. Interestingly, FNA and FNC measurements demonstrate high correlation but poor agreement in measurements between sonographers. Even though FNA and FNC could be used as predictors of foetal gestational age, the measurements vary significantly between sonographers. This is attributable to the difficulty in obtaining a satisfactory axial view of foetal neck, which is dependent on foetal presentation.
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Affiliation(s)
- Obinna Everistus Abonyi
- a Department of Medical Radiography and Radiological Sciences , University of Nigerian, Enugu Campus , Enugu State , Nigeria
| | - Charles Ugwoke Eze
- a Department of Medical Radiography and Radiological Sciences , University of Nigerian, Enugu Campus , Enugu State , Nigeria
| | - Sobechukwu W I Onwuzu
- a Department of Medical Radiography and Radiological Sciences , University of Nigerian, Enugu Campus , Enugu State , Nigeria
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Butt K, Lim K. Détermination de l'âge gestationnel par échographie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S391-S403. [PMID: 28063550 DOI: 10.1016/j.jogc.2016.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIF Aider les cliniciens à attribuer un âge gestationnel en fonction des résultats de la biométrie échographique. ISSUES Déterminer si la datation par échographie offre une évaluation plus précise de l'âge gestationnel que la datation en fonction des dernières règles avec ou sans recours à l'échographie. Offrir, aux praticiens et aux chercheurs du domaine des soins de maternité, des lignes directrices factuelles en matière d'attribution de l'âge gestationnel. Identifier les paramètres biométriques échographiques qui sont de fiabilité supérieure lorsque l'âge gestationnel est incertain. Déterminer la rentabilité de l'évaluation de l'âge gestationnel par échographie. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans PubMed ou MEDLINE et The Cochrane Library en 2013 au moyen d'un vocabulaire contrôlé et de mots clés appropriés (p. ex. « gestational age », « ultrasound biometry » et « ultrasound dating »). Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles rédigés en anglais. Aucune restriction n'a été appliquée en matière de dates. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'au 31 juillet 2013. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. VALEURS La qualité des résultats est évaluée au moyen des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (Tableau 1). AVANTAGES, DéSAVANTAGES ET COûTS: L'attribution précise d'un âge gestationnel pourrait réduire l'incidence du déclenchement mené en raison d'une grossesse prolongée et améliorer les soins obstétricaux en nous permettant de planifier la chronologie des interventions nécessaires de façon optimale et d'éviter les interventions inutiles. Une datation plus précise permet l'optimisation de la tenue de tests prénataux de dépistage de l'aneuploïdie. Un algorithme national d'attribution de l'âge gestationnel pourrait atténuer les variations pancanadiennes en matière de pratique pour les cliniciens et les chercheurs. Parmi les désavantages potentiels, on trouve la réattribution possible des dates lorsqu'une pathologie fœtale importante (comme le retard de croissance intra-utérin ou la macrosomie) donne lieu à une divergence entre les résultats de la biométrie échographique et l'âge gestationnel clinique. Une telle réattribution pourrait mener à l'omission d'interventions fœtales justifiées ou à la tenue d'interventions fœtales injustifiées. DéCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Koning IV, Tielemans MJ, Hoebeek FE, Ecury-Goossen GM, Reiss IKM, Steegers-Theunissen RPM, Dudink J. Impacts on prenatal development of the human cerebellum: a systematic review. J Matern Fetal Neonatal Med 2016; 30:2461-2468. [PMID: 27806674 DOI: 10.1080/14767058.2016.1253060] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The cerebellum is essential for normal neurodevelopment and is particularly susceptible for intra-uterine disruptions. Although some causal prenatal exposures have been identified, the origin of neurodevelopmental disorders remains mostly unclear. Therefore, a systematic literature search was conducted to provide an overview of parental environmental exposures and intrinsic factors influencing prenatal cerebellar growth and development in humans. MATERIALS AND METHODS The literature search was limited to human studies in the English language and was conducted in Embase, Medline, Cochrane, Web of Science, Pubmed and GoogleScholar. Eligible studies were selected by three independent reviewers and study quality was scored by two independent reviewers. RESULTS The search yielded 3872 articles. We found 15 eligible studies reporting associations between cerebellar development and maternal smoking (4), use of alcohol (3), in vitro fertilization mediums (1), mercury (1), mifepristone (2), aminopropionitriles (1), ethnicity (2) and cortisol levels (1). No studies reported on paternal factors. CONCLUSIONS Current literature on associations between parental environmental exposures, intrinsic factors and human cerebellar development is scarce. Yet, this systematic review provided an essential overview of human studies demonstrating the vulnerability of the cerebellum to the intra-uterine environment.
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Affiliation(s)
- Irene V Koning
- a Department of Obstetrics and Gynecology , Erasmus MC University Medical Center , Rotterdam , The Netherlands.,b Department of Pediatrics , Subdivision of Neonatology, Sophia Children's Hospital , Rotterdam , The Netherlands
| | | | - Freek E Hoebeek
- d Department of Neuroscience , Erasmus MC University Medical Center , Rotterdam , The Netherlands , and
| | - Ginette M Ecury-Goossen
- b Department of Pediatrics , Subdivision of Neonatology, Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Irwin K M Reiss
- b Department of Pediatrics , Subdivision of Neonatology, Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Regine P M Steegers-Theunissen
- a Department of Obstetrics and Gynecology , Erasmus MC University Medical Center , Rotterdam , The Netherlands.,b Department of Pediatrics , Subdivision of Neonatology, Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Jeroen Dudink
- b Department of Pediatrics , Subdivision of Neonatology, Sophia Children's Hospital , Rotterdam , The Netherlands.,e Department of Neonatology , Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht , The Netherlands
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Butt K, Lim K, Lim K, Bly S, Butt K, Cargill Y, Davies G, Denis N, Hazlitt G, Morin L, Ouellet A, Salem S. Determination of Gestational Age by Ultrasound. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:171-181. [DOI: 10.1016/s1701-2163(15)30664-2] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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de Carvalho AAV, Marchiori E, Carvalho JA, Figueiredo I, Velarde LGC. Use of fetal colon thickness for auxiliary term dating of pregnancy. Int J Gynaecol Obstet 2011; 112:216-9. [PMID: 21269627 DOI: 10.1016/j.ijgo.2010.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 09/11/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To verify whether fetal colon thickness can be used as a marker for estimating, independent of biometrics and fetal weight percentile, the gestational age (GA) of fetuses between 37 and 40 weeks. METHODS The study group was 1296 fetuses aged between 33 and 40 weeks. The correlation between GA and colon thickness was assessed by the Pearson correlation test. For term fetuses (≥ 37 weeks), comparisons among the mean colon thickness for different weight percentiles at each GA (in weeks) were made with an analysis of variance test. RESULTS A significant relationship was observed between GA and colon thickness (P < 0.001, r(2) = 0.6). For term fetuses, significant differences were observed among the mean colon thickness values for different weight percentiles at 38 and 39 weeks. Of the 157 term fetuses for which biometrics would have underestimated GA by 2 weeks or more, 126 (80.3%) had a colon thickness equal to, or greater than, 14 mm. This colon thickness was also observed in 52 (70.3%) of term fetuses weighing less than the 10th percentile (n = 74). CONCLUSION The present study suggested that colon thickness might be a good marker for 37 weeks of gestation, and might identify term fetuses for which biometrics has underestimated the GA.
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Ozat M, Kanat-Pektas M, Gungor T, Gurlek B, Caglar M. The significance of fetal sacral length in the ultrasonographic assessment of gestational age. Arch Gynecol Obstet 2010; 283:999-1004. [DOI: 10.1007/s00404-010-1510-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
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