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Daida T, Shin BC, Cepeda C, Devaskar SU. Neurodevelopment Is Dependent on Maternal Diet: Placenta and Brain Glucose Transporters GLUT1 and GLUT3. Nutrients 2024; 16:2363. [PMID: 39064806 PMCID: PMC11279700 DOI: 10.3390/nu16142363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/09/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
Glucose is the primary energy source for most mammalian cells and its transport is affected by a family of facilitative glucose transporters (GLUTs) encoded by the SLC2 gene. GLUT1 and GLUT3, highly expressed isoforms in the blood-brain barrier and neuronal membranes, respectively, are associated with multiple neurodevelopmental disorders including epilepsy, dyslexia, ADHD, and autism spectrum disorder (ASD). Dietary therapies, such as the ketogenic diet, are widely accepted treatments for patients with the GLUT1 deficiency syndrome, while ameliorating certain symptoms associated with GLUT3 deficiency in animal models. A ketogenic diet, high-fat diet, and calorie/energy restriction during prenatal and postnatal stages can also alter the placental and brain GLUTs expression with long-term consequences on neurobehavior. This review focuses primarily on the role of diet/energy perturbations upon GLUT isoform-mediated emergence of neurodevelopmental and neurodegenerative disorders.
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Affiliation(s)
- Tomoko Daida
- Department of Pediatrics, Division of Neonatology and Developmental Biology and Neonatal Research Center, at the UCLA Children’s Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (T.D.); (B.-C.S.)
| | - Bo-Chul Shin
- Department of Pediatrics, Division of Neonatology and Developmental Biology and Neonatal Research Center, at the UCLA Children’s Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (T.D.); (B.-C.S.)
| | - Carlos Cepeda
- Intellectual and Developmental Disabilities Research Center and Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Sherin U. Devaskar
- Department of Pediatrics, Division of Neonatology and Developmental Biology and Neonatal Research Center, at the UCLA Children’s Discovery and Innovation Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (T.D.); (B.-C.S.)
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Mayer-Pickel K, Nanda M, Gajic M, Cervar-Zivkovic M. Preeclampsia and the Antiphospholipid Syndrome. Biomedicines 2023; 11:2298. [PMID: 37626793 PMCID: PMC10452741 DOI: 10.3390/biomedicines11082298] [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: 06/24/2023] [Revised: 08/06/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Antiphospholipid syndrome (APS) is characterized by venous or arterial thrombosis and/or adverse pregnancy outcome in the presence of persistent laboratory evidence of antiphospholipid antibodies (aPLs). Preeclampsia complicates about 10-17% of pregnancies with APS. However, only early onset preeclampsia (<34 weeks of gestation) belongs to the clinical criteria of APS. The similarities in the pathophysiology of early onset preeclampsia and APS emphasize an association of these two syndromes. Overall, both are the result of a defective trophoblast invasion and decidual transformation at early gestation. Women with APS are at increased risk for prematurity; the reasons are mostly iatrogenic due to placental dysfunction, such as preeclampsia or FGR. Interestingly, women with APS have also an increased risk for preterm delivery, even in the absence of FGR and preeclampsia, and therefore it is not indicated but spontaneous. The basic treatment of APS in pregnancy is low-dose aspirin and low-molecular-weight heparin. Nevertheless, up to 20-30% of women develop complications at early and late gestation, despite basic treatment. Several additional treatment options have been proposed, with hydroxychloroquine (HCQ) being one of the most efficient. Additionally, nutritional interventions, such as intake of vitamin D, have shown promising beneficial effects. Curcumin, due to its antioxidant and anti-inflammatory properties, might be considered as an additional intervention as well.
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Affiliation(s)
- Karoline Mayer-Pickel
- Department of Obstetrics, Medical University Graz, 8036 Graz, Austria; (M.N.); (M.G.); (M.C.-Z.)
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Molad M, Gover A, Marai Z, Lavie-Nevo K, Kessel I, Shemer-Meiri L, Soloveichik M. Neurodevelopmental Outcome of Very Low Birth Weight Infants in the Northern District of Israel: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1320. [PMID: 37628319 PMCID: PMC10453082 DOI: 10.3390/children10081320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Currently, no local database in Israel collects neurodevelopmental outcomes of very low birth weight (VLBW) preterm infants. We investigated neurodevelopmental outcomes in one district of the largest healthcare organization in Israel. METHODS A cross-sectional study including all VLBW (<1500 g) preterm infants born between 1 January 2006 and 31 December 2016 who were followed in any of seven child development centers in Israel's Northern District. Data were retrospectively collected from the computerized medical record database. RESULTS Out of 436 participants, 55.1% had normal developmental outcomes. A total of 8.9% had cerebral palsy (CP), 12.2% had a global developmental delay (GDD), and 33.4% had a language delay. Out of the extremely preterm infants (n = 109), 20.2% had CP, 22.0% had GDD, and 44.9% had language delay. We found a statistically significant higher rate of abnormal neurodevelopment outcomes in non-Jews compared to Jews (57% vs. 37.8%, respectively, p < 0.0001). CONCLUSIONS We found a relatively high overall rate of CP in our local population and a significant difference in neurodevelopmental outcomes between Jews and non-Jews. This study emphasizes the need for an expanded and detailed national database collecting post-discharge outcomes, as well as an assessment of national healthcare resource allocation and inequalities in preterm infants' post-discharge care.
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Affiliation(s)
- Michal Molad
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa 3436212, Israel; (M.M.); (K.L.-N.); (I.K.); (M.S.)
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa 3525433, Israel;
| | - Ayala Gover
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa 3525433, Israel;
- Neonatal Intensive Care Unit, Bnai Zion Medical Center, Haifa 31048, Israel
| | - Zaki Marai
- Pediatrics Department, Carmel Medical Center, Haifa, 3436212, Israel;
| | - Karen Lavie-Nevo
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa 3436212, Israel; (M.M.); (K.L.-N.); (I.K.); (M.S.)
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa 3525433, Israel;
| | - Irina Kessel
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa 3436212, Israel; (M.M.); (K.L.-N.); (I.K.); (M.S.)
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa 3525433, Israel;
| | - Lilach Shemer-Meiri
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa 3525433, Israel;
- Pediatrics Department, Carmel Medical Center, Haifa, 3436212, Israel;
| | - Marina Soloveichik
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa 3436212, Israel; (M.M.); (K.L.-N.); (I.K.); (M.S.)
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa 3525433, Israel;
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Hugh O, Gardosi J. Fetal weight projection model to define growth velocity and validation against pregnancy outcome in a cohort of serially scanned pregnancies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:86-95. [PMID: 35041244 PMCID: PMC9328382 DOI: 10.1002/uog.24860] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/24/2021] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Fetal growth assessment is central to good antenatal care, yet there is a lack of definition of normal and abnormal fetal growth rate which can identify pregnancies at risk of adverse outcome. The aim of this study was to develop and test a model for defining normal limits of growth velocity which are specific to the fetal weight measurement interval. METHODS The cohort consisted of 102 138 singleton pregnancies which underwent at least two third-trimester measurements of ultrasound estimated fetal weight (EFW), usually carried out because routine early-pregnancy risk assessment had indicated an increased risk of fetal growth restriction. We projected the EFW from the first of each consecutive measurement pair along its own centile rank to the gestational age of the second scan. Normal growth was defined as the second EFW being within a weight range based on limits derived by partial receiver-operating-characteristics-curve (pROC) analyses for small-for-gestational-age (SGA; < 10th centile) and large-for-gestational-age (LGA; > 90th centile) birth weight. The limits were measurement-interval specific and calculated for a fixed false-positive rate (FPR) of 10%. The resultant normal, slow and accelerated growth rates calculated from consecutive EFW pairs were evaluated against the following predefined perinatal outcome measures: stillbirth, neonatal death, SGA and LGA at birth, 5-min Apgar score < 7 and admission to the neonatal intensive care unit. Slow growth based on the last two scans was compared with SGA fetal weight (EFW < 10th centile) at the last scan and association with stillbirth risk was assessed, expressed as relative risk (RR) with 95% CI. RESULTS The optimal cut-off limits for normal growth rate between consecutive scans varied according to the length of the measurement interval, with an average of -8.0% for slow growth and + 9.3% for accelerated growth at a fixed FPR of 10%. Slow growth between random consecutive scan pairs was associated significantly with all predefined outcome measures including stillbirth (RR, 2.19; 95% CI, 1.84-2.53) and neonatal death (RR, 2.28; 95% CI, 1.60-3.13). Accelerated growth was associated with LGA at birth (RR, 2.15; 95% CI, 2.10-2.20), while normal growth was protective of all adverse outcome measures. Slow growth between the last two scans (which were performed at a median gestational age of 33 + 1 to 36 + 4 weeks) and SGA at the last scan were each predictors of stillbirth, and stillbirth risk was highest when both were present (RR, 2.65; 95% CI, 1.67-4.20). However, 66.2% of pregnancies with slow growth were not SGA at the last scan and these cases also had an increased risk of stillbirth (RR, 2.07; 95% CI, 1.40-3.05). CONCLUSION Fetal growth velocity defined by projected, measurement-interval specific fetal weight limits is associated independently with perinatal outcome and should be used for antenatal surveillance in addition to assessment by fetal size. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- O. Hugh
- Perinatal InstituteBirminghamUK
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Chand KK, Pannek K, Colditz PB, Wixey JA. Brain outcomes in runted piglets: a translational model of fetal growth restriction. Dev Neurosci 2022; 44:194-204. [PMID: 35263744 DOI: 10.1159/000523995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
etal growth restriction (FGR) is associated with long-term neurodevelopmental disabilities including learning and behavioural disorders, autism, and cerebral palsy. Persistent changes in brain structure and function that are associated with developmental disabilities are demonstrated in FGR neonates. However, the mechanisms underlying these changes remain to be determined. There are currently no therapeutic interventions available to protect the FGR newborn brain. With the wide range of long-term neurodevelopmental disorders associated with FGR, the use of an animal model appropriate to investigating mechanisms of injury in the FGR newborn is crucial for the development of effective and targeted therapies for babies. Piglets are ideal animals to explore how perinatal insults affect brain structure and function. FGR occurs spontaneously in the piglet, unlike other animal models that require surgical or chemical intervention, allowing brain outcomes to be studied without the confounding impacts of experimental interventions. The FGR piglet mimics many of the human pathophysiological outcomes associated with FGR including asymmetrical growth restriction with brain sparing. This review will discuss the similarities observed in brain outcomes between the human FGR and FGR piglet from a magnetic resonance imaging in the living and a histological perspective. FGR piglet studies provide the opportunity to determine and track mechanisms of brain injury in a clinically relevant animal model of FGR. Findings from these FGR piglet studies may provide critical information to rapidly translate neuroprotective interventions to clinic to improve outcomes for newborn babies.
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Affiliation(s)
- Kirat K Chand
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kerstin Pannek
- The Australian E-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Paul B Colditz
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Julie A Wixey
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Stevenson NJ, Lai MM, Starkman HE, Colditz PB, Wixey JA. Electroencephalographic studies in growth-restricted and small-for-gestational-age neonates. Pediatr Res 2022; 92:1527-1534. [PMID: 35197567 PMCID: PMC9771813 DOI: 10.1038/s41390-022-01992-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 12/30/2022]
Abstract
Foetal growth restriction (FGR) and being born small for gestational age (SGA) are associated with neurodevelopmental delay. Early diagnosis of neurological damage is difficult in FGR and SGA neonates. Electroencephalography (EEG) has the potential as a tool for the assessment of brain development in FGR/SGA neonates. In this review, we analyse the evidence base on the use of EEG for the assessment of neonates with FGR or SGA. We found consistent findings that FGR/SGA is associated with measurable changes in the EEG that present immediately after birth and persist into childhood. Early manifestations of FGR/SGA in the EEG include changes in spectral power, symmetry/synchrony, sleep-wake cycling, and the continuity of EEG amplitude. Later manifestations of FGR/SGA into infancy and early childhood include changes in spectral power, sleep architecture, and EEG amplitude. FGR/SGA infants had poorer neurodevelopmental outcomes than appropriate for gestational age controls. The EEG has the potential to identify FGR/SGA infants and assess the functional correlates of neurological damage. IMPACT: FGR/SGA neonates have significantly different EEG activity compared to AGA neonates. EEG differences persist into childhood and are associated with adverse neurodevelopmental outcomes. EEG has the potential for early identification of brain impairment in FGR/SGA neonates.
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Affiliation(s)
- Nathan J. Stevenson
- grid.1049.c0000 0001 2294 1395Brain Modelling Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia
| | - Melissa M. Lai
- grid.1003.20000 0000 9320 7537UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia ,grid.416100.20000 0001 0688 4634Perinatal Research Centre, Royal Brisbane and Women’s Hospital, Herston, QLD 4029 Australia
| | - Hava E. Starkman
- grid.1003.20000 0000 9320 7537UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia ,grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynaecology, University of Toronto, King’s College Circle, Toronto, ON M5S Canada
| | - Paul B. Colditz
- grid.1003.20000 0000 9320 7537UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia ,grid.416100.20000 0001 0688 4634Perinatal Research Centre, Royal Brisbane and Women’s Hospital, Herston, QLD 4029 Australia
| | - Julie A. Wixey
- grid.1003.20000 0000 9320 7537UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029 Australia
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Idowu B, Adedo A, Arogundade R, Okunowo A, Oduola-Owoo L. Comparative study of the umbilical artery Doppler indices of healthy and growth-restricted foetuses in Lagos. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:63-69. [PMID: 36213799 PMCID: PMC9536402 DOI: 10.4103/jwas.jwas_63_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022]
Abstract
Aim of the Study: This study compared the umbilical artery Doppler indices (UADI) in normal and foetal growth-restricted (FGR) foetuses to determine the relationship between the UADI and pregnancy outcomes. Materials and Methods: This was a case-control study that recruited one hundred and eighty pregnant women comprising 90 with FGR pregnancies and 90 with normal pregnancies. Foetal biometric parameters and UADI were measured in all the participants. The UADI and clinical outcomes (preterm delivery, birth weight, perinatal death, etc.) of the normal and FGR foetuses were compared. Results: The mean estimated foetal weights of the FGR pregnancies (subjects) and normal pregnancies (controls) were 2.76 ± 0.66 kg and 3.62 ± 0.37 kg, respectively (P < 0.0001). The mean APGAR score at 5 min was 6.93 ± 1.72 for subjects and 8.03 ± 0.94 for controls (P < 0.0001). Abnormal umbilical artery Doppler waveforms were detected: decreased end-diastolic flow in 25 (27.8%), absent end-diastolic in 7 (7.8%) and reversed end-diastolic flow in 4 (4.4%) of the FGR pregnancies. There were 74 (82.2%) preterm deliveries among the subjects, while only 7 (7.8%) of the controls had preterm deliveries. Six deaths (two perinatal and four neonatal deaths) were recorded among the subjects, while no death occurred among the controls. Conclusion: Foetuses with FGR showed significantly higher quantitative Doppler indices (increased RI, PI, SD ratio), and a higher prevalence of abnormal umbilical artery waveform pattern (qualitative) than the healthy foetuses (controls).
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Sugihara M, Unno N, Suzuki H, Sekizawa A, Tanaka H, Fujimori K, Ikeda T, Shimoya K. Examination of fetal well-being evaluation metrics for fetal growth restriction as seen from Japan Obstetric Compensation Cause Analysis Report data. J Obstet Gynaecol Res 2021; 48:15-19. [PMID: 34664338 DOI: 10.1111/jog.15067] [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: 09/17/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
Advances in perinatal care have improved the prognoses of both mothers and neonates; however, cerebral palsy continues to occur. In this study, we examined methods for the intragestational evaluation of the health of infants who later developed cerebral palsy. A retrospective review was conducted on light-for-dates cases among the 2113 cause analysis reports issued by the Japan Obstetric Compensation System between January 2009 and September 2018. In our examination, we determined that non-stress tests and ultrasonic Doppler tests were used to evaluate fetal well-being. Moreover, we observed cases in which additional testing was not performed even when fetal growth restriction (FGR) was identified. Appropriate management of FGR may help reduce the incidence of cerebral palsy.
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Affiliation(s)
- Mika Sugihara
- Department of Obstetrics and Gynecology 1, Kawasaki Medical School, Kurashiki, Japan
| | - Nobuya Unno
- Department of Obstetrics and Gynecology, Kitasato University, Tokyo, Japan
| | - Hideaki Suzuki
- Public Interest Incorporated Foundation, Japan Council for Quality Health Care, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mie University, Tsu, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mie University, Tsu, Japan
| | - Koichiro Shimoya
- Department of Obstetrics and Gynecology 1, Kawasaki Medical School, Kurashiki, Japan
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Abstract
BACKGROUND Preterm birth is an important risk factor for neurodevelopmental disabilities. The vast majority of these disabilities occur, however, among term births. The role of fetal growth restriction specifically among term babies has been incompletely described. METHODS We conducted a population-based study of term birth weight and its link to a range of neurodevelopmental outcomes using Norwegian health registries. To remove the influence of preterm birth, we restricted our analyses to 1.8 million singleton babies born during a narrow range of term gestational age (39-41 weeks). Babies with malformations were excluded. We adjusted analyses simply for year of birth, as further adjustments for sex, parity, maternal age, smoking, marital status, immigrant status, and parental education had trivial influence. An additional sibling analysis controlled for unmeasured family-based confounding. RESULTS The risk of neurodevelopmental disabilities at term steadily increased at birth weights lower than 3.5 kg. Using the category of 3.5-3.9 kg as the reference, the odds reached 25-fold for cerebral palsy at the smallest weights (95% confidence interval 8.0, 79), 16-fold for vision/hearing disability (4.0, 65), 11-fold for intellectual impairment (6.9, 17), 7-fold for schizophrenia (1.0, 50), 5.4-fold for epilepsy (2.6, 12), and 3.5-fold for autism spectrum (1.3, 9.4) and behavioral disorders including attention-deficit hyperactivity disorder (2.1, 5.4). Associations remained robust with sibling controls. CONCLUSIONS Reduced fetal growth is a powerful predictor of a wide variety of neurodevelopmental disabilities independent of preterm delivery.
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Association between moderated level of air pollution and fetal growth: the potential role of noise exposure. Sci Rep 2021; 11:11238. [PMID: 34045628 PMCID: PMC8160128 DOI: 10.1038/s41598-021-90788-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/17/2021] [Indexed: 02/07/2023] Open
Abstract
This study aims to analyze, in a population of singletons, the potential confounding or modifying effect of noise on the relationship between fetal growth restriction (FGR) or small for gestational age (SGA) and environmental exposure to air pollution. All women with single pregnancies living in one of two medium-sized cities (Besançon, Dijon) and who delivered at a university hospital between 2005 and 2009 were included. FGR and SGA were obtained from medical records. Outdoor residential exposure to nitrogen dioxide (NO2) and particulate matter (PM10) was quantified at the mother’s address at delivery over defined pregnancy periods; outdoor noise exposure was considered to be the annual average daily noise levels in the façade of building (LAeq,24 h). Adjusted odds ratios (ORa) were estimated by multivariable logistic regressions. Among the 8994 included pregnancies, 587 presented FGR and 918 presented SGA. In the two-exposure models, for SGA, the ORa for a 10-µg/m3 increase of PM10 during the two last months before delivery was 1.18, 95%CI 1.00–1.41 and for FGR, these ORa were for the first and the third trimesters, and the two last months before delivery: 0.77 (0.61–0.97), 1.38 (1.12–1.70), and 1.35 (1.11–1.66), respectively. Noise was not associated with SGA or FGR and did not confound the relationship between air pollution and SGA or FGR. These results are in favor of an association between PM10 exposure and fetal growth, independent of noise, particularly towards the end of pregnancy, and of a lack of association between noise and fetal growth.
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Gómez-Vilarrubla A, Mas-Parés B, Díaz M, Xargay-Torrent S, Carreras-Badosa G, Jové M, Martin-Gari M, Bonmatí-Santané A, de Zegher F, Ibañez L, López-Bermejo A, Bassols J. Fatty acids in the placenta of appropiate- versus small-for-gestational-age infants at term birth. Placenta 2021; 109:4-10. [PMID: 33895685 DOI: 10.1016/j.placenta.2021.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/24/2021] [Accepted: 04/15/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Fatty acids are essential nutrients for the fetus and are supplied by the mother through the placenta. Desaturase and elongase enzymes play an important role in modulating the fatty acid composition of body tissues. We aimed to compare the fatty acid profile and the estimated desaturase and elongase activities in the placenta of appropriate (AGA) versus small-for-gestational-age (SGA), and to determine their relationship with the offspring size at birth. METHODS The placental fatty acid profile was analyzed by gas chromatography in 84 infants (45 AGA and 30 SGA) from a prenatal cohort study. The estimated desaturase and elongase activities were calculated from product-precursor fatty acid ratios. Results were associated with maternal (age, body mass index and weight gain during gestation) and neonatal (gestational age, sex, birth weight and birth length) parameters. RESULTS Differences in placental fatty acid composition between AGA and SGA infants rather than correlations thereof with neonatal parameters were observed. Placentas from SGA infants contained lower levels of omega-3 (ALA, EPA, DPA, and DHA) and high omega-6/omega-3 ratios (AA/DHA and LA/ALA), as well as low elongase (Elovl5) and high desaturase (D9Dn7 and D5Dn6) activity as compared to AGA infants (all p < 0.0001). DISCUSSION Placentas of AGA and SGA infants differed in fatty acids profile as well as in estimated desaturase and elongase activities. A striking feature of SGA placentas was the low availability of omega-3. Hence, omega-3 fatty acid status deserves further attention, as a potential target of prenatal interventions.
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Affiliation(s)
- Ariadna Gómez-Vilarrubla
- Maternal-Fetal Metabolic Research Group, Girona Institute for Biomedical Research (IDIBGI), 17190, Salt, Spain
| | - Berta Mas-Parés
- Pediatric Endocrinology Research Group, Girona Institute for Biomedical Research (IDIBGI), 17190, Salt, Spain
| | - Marta Díaz
- Endocrinology, Pediatric Research Institute, Sant Joan de Déu Children's Hospital, 08950, Esplugues, Barcelona, Spain; CIBERDEM (Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders), ISCIII, 28029, Madrid, Spain
| | - Sílvia Xargay-Torrent
- Pediatric Endocrinology Research Group, Girona Institute for Biomedical Research (IDIBGI), 17190, Salt, Spain
| | - Gemma Carreras-Badosa
- Pediatric Endocrinology Research Group, Girona Institute for Biomedical Research (IDIBGI), 17190, Salt, Spain
| | - Mariona Jové
- Department of Experimental Medicine, University of Lleida-Biomedical Research Institute of Lleida, Lleida, Spain
| | - Meritxell Martin-Gari
- Department of Experimental Medicine, University of Lleida-Biomedical Research Institute of Lleida, Lleida, Spain
| | | | - Francis de Zegher
- Department of Development & Regeneration, University of Leuven, 3000, Leuven, Belgium
| | - Lourdes Ibañez
- Endocrinology, Pediatric Research Institute, Sant Joan de Déu Children's Hospital, 08950, Esplugues, Barcelona, Spain; CIBERDEM (Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders), ISCIII, 28029, Madrid, Spain
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Institute for Biomedical Research (IDIBGI), 17190, Salt, Spain; Department of Pediatrics, Dr. Josep Trueta Hospital, 17007, Girona, Spain.
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Institute for Biomedical Research (IDIBGI), 17190, Salt, Spain.
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Melamed N, Hiersch L, Aviram A, Keating S, Kingdom JC. Customized birth-weight centiles and placenta-related fetal growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:409-416. [PMID: 33073889 DOI: 10.1002/uog.23516] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/20/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The value of using customized birth-weight centiles to improve the diagnostic accuracy for fetal growth restriction (FGR), in comparison with using population-based charts, remains a matter of debate. One potential explanation for the conflicting data is that most studies used measures of perinatal mortality and morbidity as proxies for placenta-mediated FGR, many of which are not specific and may be confounded by other factors such as prematurity. The aim of this study was to compare the diagnostic accuracy of small-for-gestational age (SGA) at birth, defined according to customized vs population-based charts, for associated abnormal placental pathology. METHODS This was a secondary analysis of data from a prospective cohort study on risk factors for placenta-mediated complications and abnormal placental pathology in low-risk nulliparous women. All placentae were sent for detailed histopathological examination by two perinatal pathologists. The primary exposure was SGA, defined as birth weight < 10th centile for gestational age using either a customized (SGAcust ) or a population-based (SGApop ) birth-weight reference. The outcomes of interest were one of three types of abnormal placental pathology associated with FGR: maternal vascular malperfusion (MVM), chronic villitis and fetal vascular malperfusion (FVM). Adjusted relative risks (aRR) with 95% CIs were estimated using modified Poisson regression analysis, with adjustment for smoking, body mass index and aspirin treatment. RESULTS A total of 857 nulliparous women met the study criteria. The proportions of infants identified as SGA based on the customized and population-based charts were 12.6% (108/857) and 11.4% (98/857), respectively. A diagnosis of SGA using either customized or population-based charts was associated with an increased risk of any placental pathology (aRR, 3.04 (95% CI, 2.29-4.04) and 1.60 (95% CI, 1.10-2.31), respectively) and MVM pathology (aRR, 12.33 (95% CI, 6.60-23.03) and 5.29 (95% CI, 2.87-9.76), respectively). SGAcust , but not SGApop , was also associated with an increased risk for chronic villitis (aRR, 1.85 (95% CI, 1.07-3.18)) and FVM pathology (aRR, 2.48 (95% CI, 1.25-4.93)). SGAcust had a higher detection rate for any placental pathology (30.3% vs 17.1%; P < 0.001), MVM pathology (63.2% vs 39.5%; P = 0.003) and chronic villitis (20.8% vs 8.3%; P = 0.007) than did SGApop , for a similar false-positive rate. This was mainly the result of a higher detection rate for abnormal pathology in the white and East-Asian subgroups and a lower false-positive rate for abnormal pathology in the South-Asian subgroup by SGAcust than by SGApop . In addition, pregnancies in the SGAcust group, but not those in the SGApop group, were more likely to be complicated by preterm birth and a low 5-min Apgar score than were the corresponding non-SGA group. CONCLUSION These findings suggest that customized birth-weight centiles may be superior to population-based birth-weight centiles in detecting FGR that is due to underlying placental disease. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N Melamed
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - L Hiersch
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - A Aviram
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - S Keating
- Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - J C Kingdom
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
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Ankert J, Groten T, Pletz MW, Mishra S, Seliger G, Lobmaier SM, da Costa CP, Seidel V, von Weizsäcker K, Jablonka A, Dopfer C, Schleenvoigt BT. Fetal growth restriction in a cohort of migrants in Germany. BMC Pregnancy Childbirth 2021; 21:145. [PMID: 33596847 PMCID: PMC7890902 DOI: 10.1186/s12884-021-03620-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Migrant women may have an increased risk of adverse birth outcomes. This study analyses the occurrence of low birth weight, preterm birth and intrauterine growth restriction / fetal growth restriction (IUGR/FGR) in pregnant migrants. Method Cross-sectional study of 82 mother-child pairs of pregnant migrants attending medical care in Germany. Results The Median age was 27 years, 49% of patients were of oriental-asian ethnicity and median year of migration was 2015. At least one previous pregnancy was reported in 76% of patients, in 40% the delivery mode was caesarian section. Median gestational age was 39.7 weeks. Preterm birth occurred in 6.1% of pregnancies. Median gestational age for preterm birth was 32.3 weeks. Low birth weight (< 2500 g) occurred in 6.1%. Birth weights below the 10th percentile of birth weight for gestational age were observed in 8.5% of the total cohort. Conclusions Compared to German data no increased occurrence of low birth weight, preterm birth or IUGR/FGR was found. We note that the rate of caesarian section births was higher than in the general population for reasons yet to be identified. The authors propose stratification according to migration status for the national documentation of birth outcomes in Germany. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03620-z.
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Affiliation(s)
- Juliane Ankert
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Sasmita Mishra
- Department of Obstetrics and Gynaecology, Heidekreis Klinikum, Walsrode, Germany
| | - Gregor Seliger
- Polyclinic of Obstetrics and Prenatal Medicine, Halle University Hospital, Halle (Saale), Germany
| | - Silvia M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Clarissa Prazeres da Costa
- Institute for Medical Microbiology, Immunology and Hygiene, Center for Global Health, Technical University of Munich, Munich, Germany
| | - Vera Seidel
- Clinic for Obstetrics, Charité, University Hospital, Berlin, Germany
| | | | - Alexandra Jablonka
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research, Site Hannover-Brunswick, Hannover, Germany
| | - Christian Dopfer
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Benjamin T Schleenvoigt
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
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Melamed N, Hiersch L, Aviram A, Mei-Dan E, Keating S, Kingdom JC. Diagnostic accuracy of fetal growth charts for placenta-related fetal growth restriction. Placenta 2021; 105:70-77. [PMID: 33556716 DOI: 10.1016/j.placenta.2021.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/09/2021] [Accepted: 01/27/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The choice of fetal growth chart to be used in antenatal screening for fetal growth restriction (FGR) has an important impact on the proportion of fetuses diagnosed as small for gestational age (SGA), and on the detection rate for FGR. We aimed to compare diagnostic accuracy of SGA diagnosed using four different common fetal growth charts [Hadlock, Intergrowth-21st (IG21), World Health Organization (WHO), and National Institute of Child Health and Human Development (NICHD)], for abnormal placental pathology. METHODS A secondary analysis of data from a prospective cohort study in low-risk nulliparous women. The exposure was SGA (birthweight <10th centile for gestational age) using each of the four charts. The outcomes were one of three types of abnormal placental pathology associated with fetal growth restriction: maternal vascular malperfusion (MVM), chronic villitis, and fetal vascular malperfusion. RESULTS A total of 742 nulliparous women met the study criteria. The proportion of SGA was closest to the expected rate of 10% using the Hadlock chart (12.7%). The detection rates (DR) and false positive rates (FPR) for MVM pathology were similar for the Hadlock (DR = 53.1%, FPR = 10.8%), WHO (DR = 59.4%, FPR = 14.2%), and NICHD (DR = 53.1%, FPR = 12.3%) charts, and each was superior when compared to the IG21 chart (DR = 34.4%, FPR = 3.8%, p < 0.001). The diagnosis of SGA was associated with increased risks of preeclampsia and preterm birth for all four charts. DISCUSSION The selection of fetal growth chart to be used in screening programs for FGR has important implications with regard to the false positive and detection rate for FGR.
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Affiliation(s)
- Nir Melamed
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, M5G 1X8, Canada; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada
| | - Liran Hiersch
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, M5G 1X8, Canada; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada
| | - Amir Aviram
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, M5G 1X8, Canada; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada
| | - Elad Mei-Dan
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, M5G 1X8, Canada; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, 4001 Leslie St, Toronto, Ontario, M2K 1E1, Canada
| | - Sarah Keating
- Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
| | - John C Kingdom
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, M5G 1X8, Canada; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
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Solé-Navais P, Brantsæter AL, Caspersen IH, Lundh T, Muglia LJ, Meltzer HM, Zhang G, Jacobsson B, Sengpiel V, Barman M. Maternal Dietary Selenium Intake during Pregnancy Is Associated with Higher Birth Weight and Lower Risk of Small for Gestational Age Births in the Norwegian Mother, Father and Child Cohort Study. Nutrients 2020; 13:nu13010023. [PMID: 33374667 PMCID: PMC7822440 DOI: 10.3390/nu13010023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 12/20/2022] Open
Abstract
Selenium is an essential trace element involved in the body’s redox reactions. Low selenium intake during pregnancy has been associated with low birth weight and an increased risk of children being born small for gestational age (SGA). Based on data from the Norwegian Mother, Father and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN), we studied the association of maternal selenium intake from diet and supplements during the first half of pregnancy (n = 71,728 women) and selenium status in mid-pregnancy (n = 2628 women) with birth weight and SGA status, according to population-based, ultrasound-based and customized growth standards. An increase of one standard deviation of maternal dietary selenium intake was associated with increased birth weight z-scores (ß = 0.027, 95% CI: 0.007, 0.041) and lower SGA risk (OR = 0.91, 95% CI 0.86, 0.97) after adjusting for confounders. Maternal organic and inorganic selenium intake from supplements as well as whole blood selenium concentration were not associated with birth weight or SGA. Our results suggest that a maternal diet rich in selenium during pregnancy may be beneficial for foetal growth. However, the effect estimates were small and further studies are needed to elucidate the potential impact of selenium on foetal growth.
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Affiliation(s)
- Pol Solé-Navais
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (P.S.-N.); (B.J.); (V.S.)
| | - Anne Lise Brantsæter
- Division of Infection Control, Environment and Health, Norwegian Institute of Public Health, 0213 Oslo, Norway; (A.L.B.); (H.M.M.)
| | | | - Thomas Lundh
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, 221 85 Lund, Sweden;
| | - Louis J. Muglia
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics and Perinatal Institute, Cincinnati, OH 45229, USA; (L.J.M.); (G.Z.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Office of the President, Burroughs Wellcome Fund, Research Triangle Park, Durham, NC 27709, USA
| | - Helle Margrete Meltzer
- Division of Infection Control, Environment and Health, Norwegian Institute of Public Health, 0213 Oslo, Norway; (A.L.B.); (H.M.M.)
| | - Ge Zhang
- Cincinnati Children’s Hospital Medical Center, Division of Human Genetics and Perinatal Institute, Cincinnati, OH 45229, USA; (L.J.M.); (G.Z.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Bo Jacobsson
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (P.S.-N.); (B.J.); (V.S.)
- Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, 0456 Oslo, Norway
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital/Östra, 405 30 Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (P.S.-N.); (B.J.); (V.S.)
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital/Östra, 405 30 Gothenburg, Sweden
| | - Malin Barman
- Department of Biology and Biological Engineering, Chalmers University of Technology, 412 96 Gothenburg, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
- Correspondence:
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16
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Gent J, Bullough S, Harrold J, Jackson R, Woolfall K, Andronis L, Kenny L, Cornforth C, Heazell AEP, Benbow E, Alfirevic Z, Sharp A. The PLANES study: a protocol for a randomised controlled feasibility study of the placental growth factor (PlGF) blood test-informed care versus standard care alone for women with a small for gestational age fetus at or after 32 + 0 weeks' gestation. Pilot Feasibility Stud 2020; 6:179. [PMID: 33292754 PMCID: PMC7677818 DOI: 10.1186/s40814-020-00722-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Stillbirth remains a major concern across the globe and in some high-resource countries, such as the UK; efforts to reduce the rate have achieved only modest reductions. One third of stillborn babies are small for gestational age (SGA), and these pregnancies are also at risk of neonatal adverse outcomes and lifelong health problems, especially when delivered preterm. Current UK clinical guidance advocates regular monitoring and early term delivery of the SGA fetus; however, the most appropriate regimen for surveillance of these babies remains unclear and often leads to increased intervention for a large number of these women. This pilot trial will determine the feasibility of a large-scale trial refining the risk of adverse pregnancy outcome in SGA pregnancies using biomarkers of placental function sFlt-1/PlGF, identifying and intervening in only those deemed at highest risk of stillbirth. Methods PLANES is a randomised controlled feasibility study of women with an SGA fetus that will be conducted at two tertiary care hospitals in the UK. Once identified on ultrasound, women will be randomised into two groups in a 3:1 ratio in favour of sFlt-1/PlGF ratio led management vs standard care. Women with an SGA fetus and a normal sFlt-1/PlGF ratio will have a repeat ultrasound and sFlt-1/PlGF ratio every 2 weeks with planned birth delayed until 40 weeks. In those women with an SGA fetus and an abnormal sFlt-1/PlGF ratio, we will offer birth from 37 weeks or sooner if there are other concerning features on ultrasound. Women assigned to standard care will have an sFlt-1/PlGF ratio taken, but the results will be concealed from the clinical team, and the woman’s pregnancy will be managed as per the local NHS hospital policy. This integrated mixed method study will also involve a health economic analysis and a perspective work package exploring trial feasibility through interviews and questionnaires with participants, their partners, and clinicians. Discussion Our aim is to determine feasibility through the assessment of our ability to recruit and retain participants to the study. Results from this pilot study will inform the design of a future large randomised controlled trial that will be adequately powered for adverse pregnancy outcome. Such a study would provide the evidence needed to guide future management of the SGA fetus. Trial registration ISRCTN58254381. Registered on 4 July 2019
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Affiliation(s)
- Joanna Gent
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Sian Bullough
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Jane Harrold
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Richard Jackson
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - Kerry Woolfall
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Lazaros Andronis
- Division of Health Sciences and Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Louise Kenny
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Alexander E P Heazell
- Maternal and Fetal Research Centre, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, 5th Floor (Research), St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Emily Benbow
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Zarko Alfirevic
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - Andrew Sharp
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK.
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Patel V, Resnick K, Liang C, Smith M, Haghpeykar HS, Mastrobattista JM, Gandhi M. Midtrimester Ultrasound Predictors of Small-for-Gestational-Age Neonates. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2027-2031. [PMID: 32420664 DOI: 10.1002/jum.15310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/01/2020] [Accepted: 04/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To determine whether a specific estimated fetal weight (EFW) or abdominal circumference (AC) measurement percentile at the 18-to 24-week ultrasound (US) examination is associated with a small-for-gestational-age (SGA) neonate. METHODS A retrospective case-control study was conducted including women with uncomplicated singleton gestations who delivered a term SGA neonate identified as having a birth weight (BW) below the 10th percentile on the Olsen growth curve and had an 18- to 24-week US examination in our database. The study period was October 2011 to January 2018. A similar number of control charts were requested randomly over the same time with BW in the 10th to 90th percentiles, all which had an 18-to 24-week US examination in our database. After all neonates meeting BW criteria were identified, a chart review was performed to specifically evaluate biometric parameters from the US at 18 to 24 weeks to determine a potential correlation with the EFW percentile and AC percentile. Pregnancy, neonatal outcomes, and maternal demographic characteristics were collected. RESULTS A total of 549 term neonates with a BW below the 10th percentile, and 593 control term neonates with BW in the of 10th to 90th percentiles were reviewed. Our analyses revealed that the AC and EFW percentiles were poor predictors of BW (<10th percentile; areas under the receiver operating characteristic curves, 0.68 and 0.69, respectively). A similar low ability of AC and EFW to predict BW below the 5th percentile was noted. CONCLUSIONS (1) No tipping point or cutoff for the EFW or AC percentile at the 18- to 24-week US examination was identified to predict a term SGA neonate. (2) These data are helpful when counseling women in midgestation about specific parameters, their importance, and the potential need for follow up imaging.
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Yang KT, Yin CH, Hung YM, Huang SJ, Lee CC, Kuo TJ. Continuity of Care Is Associated with Medical Costs and Inpatient Days in Children with Cerebral Palsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082913. [PMID: 32340141 PMCID: PMC7215569 DOI: 10.3390/ijerph17082913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/05/2023]
Abstract
Background: Children with cerebral palsy (CP) place a considerable burden on medical costs and add to an increased number of inpatient days in Taiwan. Continuity of care (COC) has not been investigated in this population thus far. Materials and Methods: We designed a retrospective population-based cohort study using Taiwan’s National Health Insurance Research Database. Patients aged 0 to 18 years with CP catastrophic illness certificates were enrolled. We investigated the association of COC index (COCI) with medical costs and inpatient days. We also investigated the possible clinical characteristics affecting the outcome. Results: Over five years, children with CP with low COCI levels had higher medical costs and more inpatient days than did those with high COCI levels. Younger age at CP diagnosis, more inpatient visits one year before obtaining a catastrophic illness certificate, pneumonia, and nasogastric tube use increased medical expenses and length of hospital stay. Conclusions: Improving COC reduces medical costs and the number of inpatient days in children with CP. Certain characteristics also influence these outcomes.
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Affiliation(s)
- Kuang-Tsu Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Chun-Hao Yin
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
- Yuh-Ing Junior College of Health Care and Management, Kaohsiung 80776, Taiwan
| | - Shih-Ju Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 11221, Taiwan
| | - Tsu-Jen Kuo
- Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Department of Dental Technology, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan
- Correspondence: ; Tel.: +886-7-346-8214; Fax: +886-7-346-8392
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Mayer-Pickel K, Stern C, Cervar-Zivkovic M, Schöll W, Moertl M. Preeclampsia before fetal viability in women with primary antiphospholipid syndrome- materno-fetal outcomes in a series of 7 cases. J Reprod Immunol 2020; 138:103101. [PMID: 32114217 DOI: 10.1016/j.jri.2020.103101] [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: 09/12/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Preeclampsia complicates about 10-17 % of pregnancies with antiphospholipid syndrome (APS). It is often severe and might occur sometimes at early gestation. The development of preeclampsia before fetal viability is a huge challenge for obstetricians and demands an intensive discussion regarding the therapeutical options. PATIENTS AND METHODS We retrospectively reviewed the data of 7 women with primary APS who developed preeclampsia before 24 weeks of gestation. Plasma exchange had been performed in four of the cases and two women received corticosteroids. One of the women had received 20 mg of pravastatin daily, starting at 18 weeks of gestation. Neonatal outcome was: live birth in four cases and IUFD in three cases. The main pediatric complications were noted in a 28-week-old premature born boy, who developed severe IRDS and thrombocytopenia. At the present time, the boy continues to have a retarded status. DISCUSSION This retrospective analysis revealed that women with APS can develop severe preeclampsia even before 20 weeks of gestation. Several management options for prolongation of pregnancy such as plasma exchange, pravastatin, LMHW, hydroxychloroquine/HCQ, or TNF-alpha blocker should be discussed with the patients. Optimal management of preeclampsia before 24 weeks of gestation usually depends on weighing the maternal and fetal complications from expectant management with prolongation of pregnancy versus the predominant fetal and neonatal risks of extreme prematurity from "aggressive" management with immediate delivery.
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Zanno AE, Romer MA, Fox L, Golden T, Jaeckle-Santos L, Simmons RA, Grinspan JB. Reducing Th2 inflammation through neutralizing IL-4 antibody rescues myelination in IUGR rat brain. J Neurodev Disord 2019; 11:34. [PMID: 31839002 PMCID: PMC6913005 DOI: 10.1186/s11689-019-9297-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 11/11/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) is a common complication of pregnancy and is associated with significant neurological deficits in infants, including white matter damage. Previous work using an animal model of IUGR has demonstrated that IUGR rats exhibit neurobehavioral deficits and developmental delays in oligodendrocyte maturation and myelination, but the mechanisms which cause this delay are unknown. Inflammation may be an important etiological factor in IUGR and has been recognized as playing a fundamental role in the pathogenesis of myelin disorders, including cerebral palsy. METHODS To create the model, the uterine arteries of pregnant rats were ligated at embryonic day 15. Rats delivered spontaneously. Cytokine and chemokine expression was evaluated at one prenatal and three postnatal time points, and myelin protein expression and oligodendrocyte cell numbers were evaluated by several methods at postnatal day 14. IL-4 was identified as a potential inhibitor of myelination, and rat pups were injected with IL-4 function blocking antibody from postnatal days 1-5 and myelination was assessed. RESULTS Here, we show a novel mechanism of white matter injury. IUGR induces an exaggerated Th2 response in the developing rat brain, including upregulation of several Th2 cytokines. Of these, IL-4 is significantly increased during the period corresponding to robust developmental myelination. We show that neutralizing IL-4 antibody therapy given in the newborn period ameliorates inflammation and restores myelin protein expression and oligodendrocyte cell number in the IUGR brain to control levels, demonstrating a novel role for Th2 responses and IL-4 in IUGR and white matter injury. In addition, IL-4 directly affects oligodendrocytes in vitro decreasing differentiation. CONCLUSIONS In this study, we have identified inflammation as a factor in the decrease in myelin seen in an animal model of IUGR. IL-4, an inflammatory protein often thought to be protective in the adult, is specifically increased, and treatment of these animals to prevent this increase ameliorates white matter damage. Our results suggest that the immune system plays a role in IUGR that is different in the perinatal period than in the adult and preventing this exaggerated Th2 response may be a potential therapeutic target.
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Affiliation(s)
- Allison E. Zanno
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Micah A. Romer
- Department of Neurology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 516D Abramson Center, 3615 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Lauren Fox
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Thea Golden
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Lane Jaeckle-Santos
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Rebecca A. Simmons
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Judith B. Grinspan
- Department of Neurology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 516D Abramson Center, 3615 Civic Center Blvd, Philadelphia, PA 19104 USA
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21
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Baldauf C, Sondhi M, Shin BC, Ko YE, Ye X, Lee KW, Devaskar SU. Murine maternal dietary restriction affects neural Humanin expression and cellular profile. J Neurosci Res 2019; 98:902-920. [PMID: 31840315 DOI: 10.1002/jnr.24568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/06/2019] [Accepted: 11/15/2019] [Indexed: 11/10/2022]
Abstract
To understand the cellular basis for the neurodevelopmental effects of intrauterine growth restriction (IUGR), we examined the global and regional expression of various cell types within murine (Mus musculus) fetal brain. Our model employed maternal calorie restriction to 50% daily food intake from gestation day 10-19, producing IUGR offspring. Offspring had smaller head sizes with larger head:body ratios indicating a head sparing IUGR effect. IUGR fetuses at embryonic day 19 (E19) had reduced nestin (progenitors), β-III tubulin (immature neurons), Glial fibrillary acidic protein (astrocytes), and O4 (oligodendrocytes) cell lineages via immunofluorescence quantification and a 30% reduction in cortical thickness. No difference was found in Bcl-2 or Bax (apoptosis) between controls and IUGR, though qualitatively, immunoreactivity of doublecortin (migration) and Ki67 (proliferation) was decreased. In the interest of examining a potential therapeutic peptide, we next investigated a novel pro-survival peptide, mouse Humanin (mHN). Ontogeny examination revealed highest mHN expression at E19, diminishing by postnatal day 15 (P15), and nearly absent in adult (3 months). Subanalysis by sex at E19 yielded higher mHN expression among males during fetal life, without significant difference between sexes postnatally. Furthermore, female IUGR mice at E19 had a greater increase in cortical mHN versus the male fetus over their respective controls. We conclude that maternal dietary restriction-associated IUGR interferes with neural progenitors differentiating into the various cellular components populating the cerebral cortex, and reduces cerebral cortical size. mHN expression is developmental stage and sex specific, with IUGR, particularly in the females, adaptively increasing its expression toward mediating a pro-survival approach against nutritional adversity.
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Affiliation(s)
- Claire Baldauf
- Department of Pediatrics, Division of Neonatology & Developmental Biology, UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Monica Sondhi
- Department of Pediatrics, Division of Neonatology & Developmental Biology, UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Bo-Chul Shin
- Department of Pediatrics, Division of Neonatology & Developmental Biology, UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Young Eun Ko
- Department of Pediatrics, Division of Neonatology & Developmental Biology, UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Xin Ye
- Department of Pediatrics, Division of Neonatology & Developmental Biology, UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Kuk-Wha Lee
- Department of Pediatrics, Division of Endocrinology, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Sherin U Devaskar
- Department of Pediatrics, Division of Neonatology & Developmental Biology, UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
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22
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Neurodevelopmental outcome of late-preterm infants: Literature review. Arch Pediatr 2019; 26:492-496. [PMID: 31704103 DOI: 10.1016/j.arcped.2019.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/09/2019] [Indexed: 12/28/2022]
Abstract
Late-preterm infants are characterized by a birth term from 340/7 to 366/7 weeks of gestation. A foetal brain at 340/7 weeks of gestation weighs only 65% of the full-term newborn brain, which suggests a particular cerebral vulnerability to injury during this 6-week period. Epidemiological studies reporting the neurological outcomes of late-preterm infants exhibit large methodological heterogeneity that inhibits clarity on this issue. However, contradictory results and odds ratio values near neutral reveal probable moderate neurodevelopmental delay in late-preterm infants. This observation reflects the variable neurological outcomes of this population according to multiple perinatal factors. Therefore, the current challenge is to define efficient screening strategies to determine infants requiring specific follow-up.
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23
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Wixey JA, Sukumar KR, Pretorius R, Lee KM, Colditz PB, Bjorkman ST, Chand KK. Ibuprofen Treatment Reduces the Neuroinflammatory Response and Associated Neuronal and White Matter Impairment in the Growth Restricted Newborn. Front Physiol 2019; 10:541. [PMID: 31133875 PMCID: PMC6523042 DOI: 10.3389/fphys.2019.00541] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/17/2019] [Indexed: 12/31/2022] Open
Abstract
Intrauterine growth restriction (IUGR) is a condition where the fetus does not achieve optimal growth, commonly caused by placental insufficiency. The chronic decrease in blood flow restricts oxygen and nutrient supply to the fetus, which can damage numerous organ systems, with the fetal brain being particularly vulnerable. Although white matter and neuronal injury are evident in IUGR infants, the specific mechanisms underlying these changes are poorly understood. Inflammation is considered to be a main driver in exacerbating brain injury. Using a spontaneous piglet model of IUGR, we aim to determine whether administration of the anti-inflammatory drug ibuprofen will decrease inflammation at postnatal day 4 (P4). The treatment group received ibuprofen (20 mg/kg/day on day 1 and 10 mg/kg/day on days 2 and 3) in piglet formula during the morning feed each day and brains examined on P4. Markers of inflammation, apoptosis, cell proliferation, neuronal injury, and white matter injury were examined. Ibuprofen treatment ameliorated the increase in numbers of microglia and astrocytes in the parietal cortex and white matter tracts of the IUGR piglet brain on P4 as well as decreasing proinflammatory cytokines. Ibuprofen treatment prevented the reduction in apoptosis, neuronal cell counts, and myelin index in the IUGR piglets. Our findings demonstrate ibuprofen reduces the inflammatory response in the IUGR neonatal brain and concurrently reduces neuronal and white matter impairment.
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Affiliation(s)
- Julie A Wixey
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Kishen R Sukumar
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Rinaldi Pretorius
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Kah Meng Lee
- Institute of Health Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Paul B Colditz
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - S Tracey Bjorkman
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Kirat K Chand
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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24
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Kim MA, Han GH, Kim YH. Prediction of small-for-gestational age by fetal growth rate according to gestational age. PLoS One 2019; 14:e0215737. [PMID: 31026299 PMCID: PMC6485641 DOI: 10.1371/journal.pone.0215737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Small-for-gestational age (SGA) infants should be identified before birth because of an increased risk of adverse perinatal outcomes. The objective of this study was to assess the impact of fetal growth rate by gestational age on the prediction of SGA and to identify the optimal time to initiate intensive fetal monitoring to detect SGA in low-risk women. We also sought to determine which the ultrasonographic parameters that contribute substantially to the birthweight determination. METHODS This was a retrospective study of 442 healthy pregnant women with singleton pregnancies. There were 328 adequate-for-gestational age (AGA) neonates and 114 SGA infants delivered between 37+0 and 41+6 weeks of gestation. We compared the biparietal diameters (BPD), head circumferences (HC), abdominal circumferences (AC), femur lengths (FL), and estimated fetal weights (EFW) obtained on each ultrasound to determine which of these parameters was the best indicator of SGA. We created receiver operating characteristic curves, calculated the areas under the curves (AUCs), and analyzed the data using multivariable logistic regressions to assess the ultrasound screening performances and identify the best predictive factor. RESULTS Among the four ultrasonographic parameters, the AC measurement between 24+0~28+6 weeks achieved a sensitivity of 79.5% and a specificity of 71.7%, with an AUC of 0.806 in the prediction of SGA. AC showed consistently higher AUCs above 0.8 with 64~80% sensitivities as gestational age progressed. EFW measurements from 33+0~35+6 gestational weeks achieved a sensitivity of 60.6% and a specificity of 87.6%, with an AUC of 0.826. In a conditional growth model developed from the linear mixed regression, the value differences between AC and EFW in the SGA and AGA groups became even more pronounced after 33+0~35+6 weeks. CONCLUSION Healthy low-risk women with a low fetal AC after 24 weeks' gestation need to be monitored carefully for fetal growth to identify SGA infants with a risk for adverse perinatal outcomes.
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Affiliation(s)
- Min-A Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Gwan Hee Han
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Han Kim
- Department of Obstetrics and Gynecology, Severance Hospital, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
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25
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Haseler E, Melhem N, Sinha MD. Renal disease in pregnancy: Fetal, neonatal and long-term outcomes. Best Pract Res Clin Obstet Gynaecol 2019; 57:60-76. [PMID: 30930143 DOI: 10.1016/j.bpobgyn.2019.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/19/2018] [Accepted: 01/21/2019] [Indexed: 12/17/2022]
Abstract
Renal disease in women of childbearing age is estimated to be approximately 3%; consequently, renal disease is not an uncommon comorbidity in pregnancy. There has been considerable evidence published over the last 20 years to suggest that renal disease in pregnancy is associated with higher maternal, fetal, and offspring morbidity. Studies published are largely heterogeneous; include unmatched cohort studies; and focus on early neonatal outcomes such as prematurity, small for gestational age, and neonatal unit admission. There appears to be an inverse relationship between maternal renal function and likelihood of neonatal morbidity using these outcome measures. Overall though, data regarding medium-to long-term outcomes for children born to mothers with renal disease are scarce. However, in view of emerging epidemiological evidence regarding cardiovascular programming in intrauterine life in those born premature or small for gestational age, it is likely that this population of children remain at high risk of cardiovascular disease as adults. The scope of this review is to amalgamate and summarize existing evidence regarding the outcomes of infants born to mothers with renal disease. Focus will be given to pregnancy-related acute kidney injury, chronic kidney disease, dialysis, and transplantation.
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Affiliation(s)
- Emily Haseler
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Nabil Melhem
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Manish D Sinha
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK; Kings College London, UK.
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26
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Vollmer B, Edmonds CJ. School Age Neurological and Cognitive Outcomes of Fetal Growth Retardation or Small for Gestational Age Birth Weight. Front Endocrinol (Lausanne) 2019; 10:186. [PMID: 30984109 PMCID: PMC6447606 DOI: 10.3389/fendo.2019.00186] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/06/2019] [Indexed: 01/30/2023] Open
Abstract
Children who were growth restricted in utero (FGR) and are born small for gestational age (SGA) may experience poorer long term neurological and cognitive outcomes. Those also born preterm may have particular difficulties. The objective of this paper was to review the literature on school age neurocognitive outcome for term and preterm children that was published in the last 15 years. Considering term born children first, there is evidence that these children are at higher risk for Cerebral Palsy (CP) than those born appropriate for gestational age (AGA); information on neuromotor function in the absence of CP is somewhat contradictory. With regards to cognitive outcome, the most common finding was that being born SGA and/or FGR at term does not impact negatively on general intellectual functioning, commonly assessed by IQ scores. There was some indication that they may experience particular problems with attention. With regards to children born preterm, the risk of CP appears not to be increased compared to those preterms born AGA. For preterm children who do not develop CP, motor outcome is more affected by post-natal and post-neonatal brain growth than intrauterine growth. In contrast to term born children, preterm SGA and/or FGR children are at increased risk of cognitive and behavioral difficulties, and in common with term born children, are at higher risk than their AGA counterparts of difficulties with attentional control. In conclusion, preterm born SGA and/or FGR children are at higher risk of neurodevelopmental problems in the school years. It is important to continue to follow up children into the school age years because these difficulties may take time to emerge, and may be more visible in the more demanding school environment.
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Affiliation(s)
- Brigitte Vollmer
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Paediatric and Neonatal Neurology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- *Correspondence: Brigitte Vollmer
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27
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da Silva PDA, Uscategui RAR, Santos VJC, Taira AR, Mariano RSG, Rodrigues MGK, Simões APR, Maronezi MC, Avante ML, Monteiro FOB, Vicente WRR, Feliciano MAR. Acoustic radiation force impulse (ARFI) elastography to asses maternal and foetal structures in pregnant ewes. Reprod Domest Anim 2018; 54:498-505. [PMID: 30489657 DOI: 10.1111/rda.13384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/18/2018] [Indexed: 12/15/2022]
Abstract
The aim of this study was to evaluate the stiffness of foetal lungs, liver, kidneys and placentomes by acoustic radiation force impulse (ARFI) elastography in ovine and to correlate obtained findings with foetal development. Twenty-four ewes were included, and tissue stiffness of foetal lung, liver, kidney and placentome was measured beginning with 10th gestational week by qualitative-quantitative ARFI elastography. A total of 33 healthy lambs were born. Qualitative elastographic analysis permitted to classify maternal and foetal tissues elasticity in decreasing order as follows: placentome, kidney, liver and lung. Regarding quantitative ARFI elastography data, shear wave velocity (SWV) of foetal lung and liver varied. The lung SWV decreased gradually from the 16th to the 21st gestational week (R2 = 0.80; p < 0.001), while liver SWV increased gradually from the 14th to 21st gestational week (R2 = 0.80; p < 0.001). In contrast, the kidneys and placentomes SWV's remained constant through gestation (p = 0.076; and 0.34). ARFI elastography was shown feasible for evaluation of maternal and foetal tissues stiffness in the ovine model. It can be used to demonstrate pulmonary and hepatic stiffness modifications during foetal development.
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Affiliation(s)
- Priscila D A da Silva
- Faculda de Ciências Agrárias e Veterinárias, Department of Animal Reproduction, Universidade Estadual Paulista, Jaboticabal, Brazil
| | - Ricardo Andrés R Uscategui
- Faculda de Ciências Agrárias e Veterinárias, Department of Animal Reproduction, Universidade Estadual Paulista, Jaboticabal, Brazil
| | - Victor J C Santos
- Faculda de Ciências Agrárias e Veterinárias, Department of Animal Reproduction, Universidade Estadual Paulista, Jaboticabal, Brazil
| | - Augusto R Taira
- Faculda de Ciências Agrárias e Veterinárias, Department of Animal Reproduction, Universidade Estadual Paulista, Jaboticabal, Brazil
| | - Renata S G Mariano
- Faculda de Ciências Agrárias e Veterinárias, Department of Animal Reproduction, Universidade Estadual Paulista, Jaboticabal, Brazil
| | - Mariana G K Rodrigues
- Faculda de Ciências Agrárias e Veterinárias, Department of Animal Reproduction, Universidade Estadual Paulista, Jaboticabal, Brazil
| | - Ana Paula R Simões
- Faculda de Ciências Agrárias e Veterinárias, Department of Animal Reproduction, Universidade Estadual Paulista, Jaboticabal, Brazil
| | - Marjury C Maronezi
- Faculda de Ciências Agrárias e Veterinárias, Department of Animal Reproduction, Universidade Estadual Paulista, Jaboticabal, Brazil
| | - Michelle L Avante
- Faculda de Ciências Agrárias e Veterinárias, Department of Animal Reproduction, Universidade Estadual Paulista, Jaboticabal, Brazil
| | - Frederico O B Monteiro
- Instituto da Saúde e Produção Animal, Universidade Federal Rural da Amazônia, Belem, Brazil
| | - Wilter R R Vicente
- Faculda de Ciências Agrárias e Veterinárias, Department of Animal Reproduction, Universidade Estadual Paulista, Jaboticabal, Brazil
| | - Marcus A R Feliciano
- Faculda de Ciências Agrárias e Veterinárias, Department of Animal Reproduction, Universidade Estadual Paulista, Jaboticabal, Brazil.,Sector of Diagnostic Imaging, Universidade Federal do Recôncavo da Bahia, Jaboticabal, Brazil
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28
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Mariet AS, Mauny F, Pujol S, Thiriez G, Sagot P, Riethmuller D, Boilleaut M, Defrance J, Houot H, Parmentier AL, Vasseur-Barba M, Benzenine E, Quantin C, Bernard N. Multiple pregnancies and air pollution in moderately polluted cities: Is there an association between air pollution and fetal growth? ENVIRONMENT INTERNATIONAL 2018; 121:890-897. [PMID: 30347371 DOI: 10.1016/j.envint.2018.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Multiple pregnancies (where more than one fetus develops simultaneously in the womb) are systematically excluded from studies of the impact of air pollution on pregnancy outcomes. This study aims to analyze, in a population of multiple pregnancies, the relationship between fetal growth restriction (FGR), small for gestational age (SGA) and exposure to air pollution in moderately polluted cities. METHODS All women with multiple pregnancies living in the city of Besançon or in the urban area of Dijon and who delivered at a university hospital between 2005 and 2009 were included. FGR and SGA were obtained from medical records. Outdoor residential nitrogen dioxide (NO2) exposure was assessed using the mother's address, considering a 50 m radius buffer over the following defined pregnancy periods: each trimester, entire pregnancy and two months before delivery. Logistic regression analyses were performed. RESULTS This study included 249 multiple pregnancies with 506 newborns. The median of NO2 concentration considering a 50 m radius buffer during entire pregnancy was 23.1 μg/m3 (minimum at 10.1 μg/m3 and maximum at 46.7 μg/m3). No association was observed between NO2 and SGA whatever the pregnancy period (the odds ratio (OR) range 0.78 to 0.88). Regarding FGR, the OR associated with an increase of 10 μg/m3 of NO2 exposure during entire pregnancy was 1.52 (95% Confidence Interval (CI): 1.02-2.26). Similar results were observed for NO2 exposure during the various pregnancy periods. CONCLUSIONS These results are in line with an association between NO2 and fetal growth in multiple pregnancies for an exposure mostly below the threshold set out in European legislation.
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Affiliation(s)
- Anne-Sophie Mariet
- CHU Dijon Bourgogne, Service de Biostatistiques et d'Information Médicale, F-21000 Dijon, France; CHU Dijon Bourgogne, Inserm, Clinical Investigation Center of Dijon (Inserm CIC 1432), F-21000 Dijon, France; Université Bourgogne Franche-Comté, Inserm, Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses (B2PHI), UMR 1181, F-21000 Dijon, France
| | - Frédéric Mauny
- CHU de Besançon, Unité de Méthodologie en Recherche Clinique, Épidémiologie et Santé Publique, INSERM CIC 1431, F-25000 Besançon, France; Université de Bourgogne Franche-Comté, CNRS, Laboratoire Chrono-Environnement UMR 6249, F-25000 Besançon, France.
| | - Sophie Pujol
- CHU de Besançon, Unité de Méthodologie en Recherche Clinique, Épidémiologie et Santé Publique, INSERM CIC 1431, F-25000 Besançon, France; Université de Bourgogne Franche-Comté, CNRS, Laboratoire Chrono-Environnement UMR 6249, F-25000 Besançon, France
| | - Gérard Thiriez
- CHU de Besançon, Service de Réanimation Pédiatrique, Néonatalogie et Urgences Pédiatriques, F-25000 Besançon, France
| | - Paul Sagot
- CHU Dijon Bourgogne, Service de Gynécologie-Obstétrique, F-21000 Dijon, France
| | - Didier Riethmuller
- CHU de Besançon, Service de Gynécologie-Obstétrique, F-25000 Besançon, France
| | | | - Jérôme Defrance
- Centre Scientifique et Technique du Bâtiment, Pôle Acoustique et Eclairage, F-38400 Saint Martin d'Hères, France
| | - Hélène Houot
- Université de Bourgogne Franche-Comté, CNRS, Laboratoire ThéMA UMR 6049, F-25000 Besançon, France
| | - Anne-Laure Parmentier
- CHU de Besançon, Unité de Méthodologie en Recherche Clinique, Épidémiologie et Santé Publique, INSERM CIC 1431, F-25000 Besançon, France; Université de Bourgogne Franche-Comté, CNRS, Laboratoire Chrono-Environnement UMR 6249, F-25000 Besançon, France
| | - Marie Vasseur-Barba
- CHU de Besançon, Unité de Méthodologie en Recherche Clinique, Épidémiologie et Santé Publique, INSERM CIC 1431, F-25000 Besançon, France; Université de Bourgogne Franche-Comté, CNRS, Laboratoire Chrono-Environnement UMR 6249, F-25000 Besançon, France
| | - Eric Benzenine
- CHU Dijon Bourgogne, Service de Biostatistiques et d'Information Médicale, F-21000 Dijon, France; CHU Dijon Bourgogne, Inserm, Clinical Investigation Center of Dijon (Inserm CIC 1432), F-21000 Dijon, France
| | - Catherine Quantin
- CHU Dijon Bourgogne, Service de Biostatistiques et d'Information Médicale, F-21000 Dijon, France; CHU Dijon Bourgogne, Inserm, Clinical Investigation Center of Dijon (Inserm CIC 1432), F-21000 Dijon, France; Université Bourgogne Franche-Comté, Inserm, Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses (B2PHI), UMR 1181, F-21000 Dijon, France
| | - Nadine Bernard
- Université de Bourgogne Franche-Comté, CNRS, Laboratoire Chrono-Environnement UMR 6249, F-25000 Besançon, France; Université de Bourgogne Franche-Comté, CNRS, Laboratoire ThéMA UMR 6049, F-25000 Besançon, France
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29
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Aviram A, Sherman C, Kingdom J, Zaltz A, Barrett J, Melamed N. Defining early vs late fetal growth restriction by placental pathology. Acta Obstet Gynecol Scand 2018; 98:365-373. [PMID: 30372519 DOI: 10.1111/aogs.13499] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/21/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although early and late fetal growth restriction have been suggested to be distinct entities, the optimal gestational age cut-off that differentiates the two conditions is currently unclear and has been arbitrarily set in previous studies between 32 and 37 weeks. We aimed to use placental pathology findings to determine that optimal gestational age cut-off between early and late fetal growth restriction. MATERIAL AND METHODS A retrospective cohort study of all women with singleton gestation who gave birth to a neonate diagnosed as small-for-gestational age (small-for-gestational age, defined as birthweight <10th percentile for gestational age) at a tertiary referral center between January 2001 and December 2015, and for whom placental pathology was available. Placental abnormalities were classified into lesions associated with maternal vascular malperfusion (MVM), fetal vascular malperfusion, placental hemorrhage and chronic villitis. Placental findings were analyzed as a function of gestational age at birth. The analysis was repeated in the subgroups of women without hypertensive complications of pregnancy (to reflect changes associated with isolated small-for-gestational age) and of neonates with severe small-for-gestational age (defined as birthweight <5th percentile), which are more likely to represent true fetal growth restriction. RESULTS A total of 895 women met the inclusion criteria. The only histological finding that changed with gestational age was MVM pathology, which decreased in frequency with increasing gestational age. We identified a considerable drop in the rate of MVM lesions at 33 weeks of gestation. The rate of MVM pathology in placentas of infants born before 330/7 weeks was significantly higher than that observed in placentas of infants born at 330/7 weeks or longer: 71.6% vs 27.4%, P < 0.001 for ≥2 MVM lesions, and 35.5% vs 3.5%, P < 0.001 for ≥3 MVM lesions. These findings persisted in the subgroups of women without hypertensive complications of pregnancy (n = 662) and of neonates with severe small-for-gestational age (n = 464). CONCLUSIONS Using placental pathology as a direct measure of the mechanisms underlying fetal growth restriction, the optimal gestational age at birth cut-off which differentiates early from late fetal growth restriction appears to be 330/7 weeks.
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Affiliation(s)
- Amir Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Christopher Sherman
- Division of Anatomic Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Center , University of Toronto, Toronto, Ontario, Canada
| | - John Kingdom
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Arthur Zaltz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Jon Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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Chang JL, Bashir M, Santiago C, Farrow K, Fung C, Brown AS, Dettman RW, Dizon MLV. Intrauterine Growth Restriction and Hyperoxia as a Cause of White Matter Injury. Dev Neurosci 2018; 40:344-357. [PMID: 30428455 DOI: 10.1159/000494273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/03/2018] [Indexed: 01/17/2023] Open
Abstract
Intrauterine growth restriction (IUGR) is estimated to occur in 5% of pregnancies, with placental insufficiency being the most common cause in developed countries. While it is known that white matter injury occurs in premature infants, the extent of IUGR on white matter injury is less defined in term infants. We used a novel murine model that utilizes a thromboxane A2 (TXA2) analog (U46619), a potent vasoconstrictor, to induce maternal hypertension and mimic human placental insufficiency-induced IUGR to study the white matter. We also investigated the role of hyperoxia as an additional risk factor for white matter injury, as IUGR infants are at increased risk of respiratory comorbidities leading to increased oxygen exposure. We found that TXA2 analog-induced IUGR results in white matter injury as demonstrated by altered myelin structure and changes in the oligodendroglial cell/oligodendrocyte population. In addition, our study demonstrates that hyperoxia exposure independently results in white matter perturbation. To our knowledge, this is the first study to report single and combined effects of IUGR with hyperoxia impacting the white matter and motor function. These results draw attention to the need for close monitoring of motor development in IUGR babies following hospital discharge as well as highlighting the importance of limiting, as clinically feasible, the degree of oxygen overexposure to potentially improve motor outcomes in this population of infants.
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Affiliation(s)
- Jill L Chang
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,
| | - Mirrah Bashir
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Kathryn Farrow
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Camille Fung
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ashley S Brown
- Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Robert W Dettman
- Stanley Manne Children's Research Institute, Chicago, Illinois, USA
| | - Maria L V Dizon
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Sharp A, Duong C, Agarwal U, Alfirevic Z. Screening and management of the small for gestational age fetus in the UK: A survey of practice. Eur J Obstet Gynecol Reprod Biol 2018; 231:220-224. [PMID: 30415129 DOI: 10.1016/j.ejogrb.2018.10.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Antenatal detection of the small for gestational (SGA) fetus has become an important indicator of quality of antenatal care in the UK. This has been driven by a desire to reduce stillbirth in this at risk group. METHODS We conducted a postal survey of 187 NHS consultant units within the UK to determine what the current practice for the detection and subsequent management of the suspected SGA fetus was following the guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) in 2013. RESULTS The survey was performed in 3 rounds between 2016 and 2017 with a response rate of 65%. 85% of units assessed risk factors for SGA at booking. 81% of units used a customized symphysis fundal height (SFH) chart to screen for SGA with 95% of them using a cut off of <10th centile to refer for ultrasound assessment. When ultrasound is used to detect SGA, 80% of units used estimated fetal weight (EFW), with 89% of these using a cut off of <10th centile to diagnose SGA. Umbilical artery (UA) Doppler monitoring was undertaken in 97% of management and 94% delivered after 37 weeks. Only 24% of units had a dedicated fetal growth clinic, whilst 48% of units were able to offer computerised CTG to monitor the SGA fetus. CONCLUSIONS Overall there is consistency in the screening methods for SGA (customised SFH charts) and identification of suspected SGA (SFH <10th centile, EFW <10th centile, UA monitoring and induction of labour at term). There was a low uptake of computerized CTG to monitor SGA babies and a low number of specialised fetal growth clinics.
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Affiliation(s)
- A Sharp
- Department of Women's and Children's Health, University of Liverpool, United Kingdom; Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, United Kingdom.
| | - C Duong
- Department of Women's and Children's Health, University of Liverpool, United Kingdom
| | - U Agarwal
- Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, United Kingdom
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, United Kingdom; Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, United Kingdom
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Jayawardena L, Sheehan P. Introduction of a customised growth chart protocol increased detection of small for gestational age pregnancies in a tertiary Melbourne hospital. Aust N Z J Obstet Gynaecol 2018; 59:493-500. [PMID: 30302752 DOI: 10.1111/ajo.12902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Growth charts customised for maternal height, weight, ethnicity and parity have been proposed as more effective at detecting infants who are small for gestational age (SGA) than routine screening with symphysio-fundal height measurement alone. Our non-randomised, prospective cohort study assessed antenatal SGA detection rates in a general maternity cohort following the introduction of the Perinatal Institute's Growth Assessment Protocol (GAP) program (consisting of customised growth chart software for plotting symphysio-fundal height, staff training and serial auditing). METHODS The GAP program was implemented into the routine antenatal schedule of 882 women who delivered at The Royal Women's Hospital, Melbourne, during our study period. SGA detection was compared to 936 women from the same team who delivered prior to the intervention. Secondary outcomes assessed were infant gestation at birth and method of delivery, neonatal Apgar scores and admission to the Neonatal Intensive and Special Care nursery (NISC). RESULTS Identification of SGA infants increased from 21% to 41% with the introduction of the GAP program (OR 2.6, 95% CI 1.3-4.9, P < 0.05). This was not associated with an increase in false-positive rates. Following the introduction of the GAP Program, SGA babies were more likely to be born by vaginal delivery (OR 2.7; 95% CI 1.4-5.1, P < 0.005). There was no overall increase in the induction of labour or caesarean delivery rates. Overall rates of admission to NISC were reduced. CONCLUSIONS In our increasingly culturally heterogenous society, the use of the GAP program is a safe and potentially more sensitive tool for detecting in utero growth restriction.
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Affiliation(s)
- Lulusha Jayawardena
- Maternity Services, The Royal Women's Hospital Parkville, Melbourne, Australia
| | - Penelope Sheehan
- Maternity Services, The Royal Women's Hospital Parkville, Melbourne, Australia.,Pregnancy Research Centre, The University of Melbourne, Melbourne, Australia
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Zhang-Rutledge K, Mack LM, Mastrobattista JM, Gandhi M. Significance and Outcomes of Fetal Growth Restriction Below the 5th Percentile Compared to the 5th to 10th Percentiles on Midgestation Growth Ultrasonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2243-2249. [PMID: 29476559 DOI: 10.1002/jum.14577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/15/2017] [Accepted: 12/04/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine whether there are differences in neonatal and pregnancy outcomes in pregnancies complicated by severe fetal growth restriction, defined as estimated fetal weight below the 5th percentile, compared with estimated fetal weight in the 5th to 10th percentiles at midgestation. METHODS We conducted a retrospective review of singleton nonanomalous gestations with estimated fetal weight at or below the 10th percentile (Hadlock et al. Radiology 1991; 181:129-133) at 18 to 24 weeks' gestation. The cohort was divided into fetuses with estimated fetal weight below the 5th percentile and estimated fetal weight in the 5th to 10th percentiles. Antenatal and neonatal outcomes were compared across the groups. RESULTS Of the 254 growth-restricted fetuses, 91 had estimated fetal weight below the 5th percentile, and 163 were in the 5th to 10th percentiles. Fetuses below the 5th percentile were 2.82 times more likely to be born small for gestational age compared to fetuses at the 5th to 10th percentiles (P = .001). Fetuses with estimated fetal weight below the 5th percentile had higher rates of hypertensive disorders of pregnancy (relative risk [RR], 1.79; P = .04), abnormal umbilical artery Doppler waveforms (RR, 6.27; P = .01), labor induction (RR, 1.45; P = .002), neonatal intensive care unit admission (RR, 1.73; P = .02), and Apgar scores of less than 7 at 1 minute (RR, 2.05; P = .04). CONCLUSIONS Severely growth-restricted fetuses with an estimated fetal weight below the 5th percentile at 18 to 24 weeks are born smaller and have worse antepartum and neonatal outcomes than those with an estimated fetal weight in the 5th to 10th percentiles. These findings suggest that severely growth-restricted fetuses at midgestation should be treated and counseled differently than those in the 5th to 10th percentiles.
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Affiliation(s)
- Kathy Zhang-Rutledge
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Lauren M Mack
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Joan M Mastrobattista
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Manisha Gandhi
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
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Veglia M, Cavallaro A, Papageorghiou A, Black R, Impey L. Small-for-gestational-age babies after 37 weeks: impact study of risk-stratification protocol. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:66-71. [PMID: 28600829 DOI: 10.1002/uog.17544] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/30/2017] [Accepted: 06/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Although no clear evidence exists, many international guidelines advocate early-term delivery of small-for-gestational-age (SGA) fetuses. The aim of this study was to determine whether a risk-stratification protocol in which low-risk SGA fetuses are managed expectantly beyond 37 weeks affects perinatal and maternal outcomes. METHODS This was an impact study examining data collected over a 39-month period (1 January 2013 to 30 April 2016) at a tertiary referral unit. The study included women who were referred to the fetal medicine unit with a singleton non-anomalous fetus diagnosed antenatally as SGA (estimated fetal weight < 10th centile) from 36 + 0 weeks' gestation. In 2014, a protocol for management of SGA was introduced, which included risk stratification with surveillance and expectant management after 37 weeks for lower-risk babies (protocol group). This was compared with the previous strategy, which recommended delivery at around 37 weeks (pre-protocol group). Primary outcome was neonatal composite adverse outcome. RESULTS In the pre-protocol group, there were 138 SGA babies; in the protocol group there were 143. Mean gestational ages at delivery were 37.4 weeks in the pre-protocol group and 38.2 weeks in the protocol group (P = 0.04). The incidence of neonatal composite adverse outcome was lower in the protocol group (9% vs 22%; P < 0.01), as was neonatal unit admission (13% vs 39%; P < 0.01). Induction of labor and Cesarean section rates were lower, and vaginal delivery rate (83% vs 60%; P < 0.01) was higher, in the protocol group. Most of the differences were as a result of delayed delivery of SGA babies that were stratified as low risk. CONCLUSIONS The findings of this study suggest that protocol-based management of SGA babies may improve outcome, and that identification of moderate SGA should not in isolation prompt delivery. Larger numbers are required to assess any impact on perinatal mortality. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Veglia
- Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Department of Obstetrics and Gynaecology, Ospedale Cristo Re, Rome, Italy
| | - A Cavallaro
- Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Oxford Fetal Medicine Unit, Department of Maternal and Fetal Medicine, The Women's Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Papageorghiou
- Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - R Black
- Oxford Fetal Medicine Unit, Department of Maternal and Fetal Medicine, The Women's Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - L Impey
- Oxford Fetal Medicine Unit, Department of Maternal and Fetal Medicine, The Women's Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Ultrasound Elastography can Detect Placental Tissue Abnormalities. Radiol Oncol 2018; 52:129-135. [PMID: 30018515 PMCID: PMC6043885 DOI: 10.2478/raon-2018-0024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/23/2018] [Indexed: 12/21/2022] Open
Abstract
Background In this prospective cohort study, we examined the utility of elastography to evaluate the fetus and placenta. Patients and methods Pregnant women in their third trimester of pregnancy, by which time the placenta has formed, were included in this study. A total of 111 women underwent ultrasound examinations, including elastography. Elastographic evaluation was performed using two protocols. First, the placental index (PI) was measured, which quantitatively assesses the hardness of tissue. Second, regions of interest (ROI) were categorized into 3-step scores according to the frequency of the blue area (hardness of placental tissue score [HT score]), which is a qualitative method. After delivery, 40 of the 111 placentas were pathologically examined. Results The average PI was 44.3 (± 29.4) in the in utero SGA group, which was significantly higher than that in the normal group (8.8 (± 10.0); p < 0.01) during pregnancy. There was a significant correlation between the PI and z score for estimated fetal weight (EFW) (r = -0.55; p < 0.01). Moreover, a significant positive correlation was observed between the PI and the z score of birth weight (r = -0.39; p < 0.01). Pathological ischemia findings of the placenta were identified in 67% of the HT score 3 group, representing 6 of the 9 patients, and in 20% of the HT score 1 group, representing only 3 of the 15 patients. Conclusions Placental hardness, as determined by elastography, correlates with both lower estimated fetal body weight and birth weight. These results suggest that ultrasound elastography in the placenta may be an additional marker of intrauterine fetal well-being.
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Zhu H, Huang L, He Z, Zou Z, Luo Y. Estrogen-related receptor γ regulates expression of 17β-hydroxysteroid dehydrogenase type 1 in fetal growth restriction. Placenta 2018; 67:38-44. [PMID: 29941172 DOI: 10.1016/j.placenta.2018.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Estrogen-related receptor γ (ERRγ) and 17β-hydroxysteroid dehydrogenase type 1 (HSD17B1) have important roles in cell invasion and in the proliferation of many types of cancer cells. However, it remains unknown whether ERRγ and HSD17B1 contribute to abnormal placental structure and dysfunction which characterize fetal growth restriction (FGR). Therefore, the aim of this study was to investigate the expression profiles of ERRγ and HSD17B1 in placenta tissues affected by FGR and to examine a possible molecular mechanism by which ERRγ is able to regulate HSD17B1 during development of FGR. METHODS Placenta tissues were collected from women affected by FGR (n = 28) and from women with appropriately gestational age (AGA) (n = 30). Relative mRNA and protein levels of ERRγ and HSD17B1 in both groups were assessed by quantitative real-time PCR, immunohistochemistry, and Western blot analyses. The effect of ERRγ on trophoblast function and its associated mechanistic details were studied in the trophoblast cell line, HTR-8/SVneo, which was transfected with small interfering RNA (siRNA) targeting ERRγ. RESULTS Both mRNA and protein levels of ERRγ and HSD17B1 were significantly lower in FGR placentae (P < 0.05). When ERRγ expression was knocked down in HTR-8/SVneo cells with siRNA, invasion and proliferation were inhibited. In addition, HSD17B1 expression was significantly decreased. In dual luciferase reporter assays, ERRγ stimulated transcription of HSD17B1 by targeting the ERRγ response element within its 5'-flanking promoter region. DISCUSSION Aberrant ERRγ expression may contribute to the pathogenesis of FGR by regulating the transcriptional activity of HSD17B1.
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Affiliation(s)
- Hui Zhu
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Linhuan Huang
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhiming He
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhiyong Zou
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanmin Luo
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Zinni M, Colella M, Batista Novais AR, Baud O, Mairesse J. Modulating the Oxytocin System During the Perinatal Period: A New Strategy for Neuroprotection of the Immature Brain? Front Neurol 2018; 9:229. [PMID: 29706926 PMCID: PMC5908892 DOI: 10.3389/fneur.2018.00229] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/23/2018] [Indexed: 11/13/2022] Open
Abstract
Oxytocin is a neurohypophysal hormone known for its activity during labor and its role in lactation. However, the function of oxytocin (OTX) goes far beyond the peripheral regulation of reproduction, and the central effects of OTX have been extensively investigated, since it has been recognized to influence the learning and memory processes. OTX has also prominent effects on social behavior, anxiety, and autism. Interaction between glucocorticoids, OTX, and maternal behavior may have long-term effects on the developmental program of the developing brain subjected to adverse events during pre and perinatal periods. OTX treatment in humans improves many aspects of social cognition and behavior. Its effects on the hypothalamic–pituitary–adrenal axis and inflammation appear to be of interest in neonates because these properties may confer benefits when the perinatal brain has been subjected to injury. Indeed, early life inflammation and abnormal adrenal response to stress have been associated with an abnormal white matter development. Recent investigations demonstrated that OTX is involved in the modulation of microglial reactivity in the developing brain. This review recapitulates state-of-the art data supporting the hypothesis that the OTX system could be considered as an innovative candidate for neuroprotection, especially in the immature brain.
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Affiliation(s)
- Manuela Zinni
- INSERM U1141 Protect, Paris-Diderot University, Paris, France
| | - Marina Colella
- INSERM U1141 Protect, Paris-Diderot University, Paris, France
| | - Aline Rideau Batista Novais
- INSERM U1141 Protect, Paris-Diderot University, Paris, France.,Neonatal Intensive Care Unit, Robert Debré Children's Hospital, Paris, France
| | - Olivier Baud
- INSERM U1141 Protect, Paris-Diderot University, Paris, France.,University of Geneva, Geneva, Switzerland.,Division of Neonatology, Geneva Children's Hospital, Geneva, Switzerland
| | - Jérôme Mairesse
- INSERM U1141 Protect, Paris-Diderot University, Paris, France.,University of Geneva, Geneva, Switzerland
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Colella M, Frérot A, Novais ARB, Baud O. Neonatal and Long-Term Consequences of Fetal Growth Restriction. Curr Pediatr Rev 2018; 14:212-218. [PMID: 29998808 PMCID: PMC6416241 DOI: 10.2174/1573396314666180712114531] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Fetal Growth Restriction (FGR) is one of the most common noxious antenatal conditions in humans, inducing a substantial proportion of preterm delivery and leading to a significant increase in perinatal mortality, neurological handicaps and chronic diseases in adulthood. This review summarizes the current knowledge about the postnatal consequences of FGR, with a particular emphasis on the long-term consequences on respiratory, cardiovascular and neurological structures and functions. RESULT AND CONCLUSION FGR represents a global health challenge, and efforts are urgently needed to improve our understanding of the critical factors leading to FGR and subsequent insults to the developing organs.
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Affiliation(s)
- Marina Colella
- University Paris Diderot, Sorbone Paris-Cité, Inserm U1141, Neonatal intensive care unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children’s hospital, Paris, France
| | - Alice Frérot
- University Paris Diderot, Sorbone Paris-Cité, Inserm U1141, Neonatal intensive care unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children’s hospital, Paris, France
| | - Aline Rideau Batista Novais
- University Paris Diderot, Sorbone Paris-Cité, Inserm U1141, Neonatal intensive care unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children’s hospital, Paris, France
| | - Olivier Baud
- University Paris Diderot, Sorbone Paris-Cité, Inserm U1141, Neonatal intensive care unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children’s hospital, Paris, France
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Barthold JS, Wintner A, Hagerty JA, Rogers KJ, Hossain MJ. Cryptorchidism in Boys With Cerebral Palsy Is Associated With the Severity of Disease and With Co-Occurrence of Other Congenital Anomalies. Front Endocrinol (Lausanne) 2018; 9:151. [PMID: 29713311 PMCID: PMC5911456 DOI: 10.3389/fendo.2018.00151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/20/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cryptorchidism is reported in 40-50% of small case series of cerebral palsy (CP) and attributed to hypothalamic-pituitary-gonadal axis abnormalities, intellectual disability (ID), or cremaster spasticity. We collected demographic and clinical data to define the frequency of cryptorchidism and clinical comorbidities in a large CP population. METHODS Electronic health record data were collected for all male patients ≥7 years of age seen in a large, multidisciplinary CP clinic between 2000 and 2016. Variables including age, testicular position, surgical findings, CP severity, birth history, and comorbidities were tested for association using univariable and stepwise backward logistic regression analyses. RESULTS Of 839 established patients, testis position was scrotal in 553, undescended in 185 (24%), retractile in 38 (5%), and undocumented in 63 cases. Cryptorchidism were diagnosed at a mean age of 5.8 years, with 20% documented as acquired, and testes were most commonly in the superficial inguinal pouch (41%) and associated with an inguinal hernia (56%). Severity was bilateral in 114/166 (69%) undescended and 24/36 (66%) retractile cases, respectively. Mean birth weight and the frequency of prematurity (55, 58, and 54%) and multiple birth (14, 13, and 9%) were not significantly different among the three groups. We observed a strong ordinal trend in the frequency of comorbidities, including quadriplegia, syndromic features/known genetic disease, intrauterine growth restriction (IUGR), death, brain malformations, seizures, gastrostomy, absent continence, ID and hearing, speech or visual impairment, with the retractile group holding the intermediate position for the majority. The stepwise multivariable analysis showed independent positive associations of cryptorchidism with quadriplegia, syndromic features/known genetic disease, hearing loss, and absent continence, and inverse associations with gestational age and multiple birth. CONCLUSION These data suggest that cryptorchidism is less common than previously reported in CP cases, but most strongly associated with quadriplegia. Delayed diagnosis may be related to an acquired condition or to the multiple additional functional deficits that occur in this population. Our data suggest that UDT and CP may both be components of malformation syndromes occurring in singleton births whose clinical features are more likely to include earlier delivery, IUGR, hearing loss, and/or global spasticity.
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Goodin A, Delcher C, Valenzuela C, Wang X, Zhu Y, Roussos-Ross D, Brown JD. The Power and Pitfalls of Big Data Research in Obstetrics and Gynecology: A Consumer's Guide. Obstet Gynecol Surv 2017; 72:669-682. [PMID: 29164265 PMCID: PMC5704657 DOI: 10.1097/ogx.0000000000000504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Research in obstetrics and gynecology (OB/GYN) increasingly relies on "big data" and observational study designs. There is a gap in practitioner-relevant guides to interpret and critique such research. OBJECTIVE This guide is an introduction to interpreting research using observational data and provides explanations and context for related terminology. In addition, it serves as a guide for critiquing OB/GYN studies that use observational data by outlining how to assess common pitfalls of experimental and observational study designs. Lastly, the piece provides a compendium of observational data resources commonly used within OB/GYN research. EVIDENCE ACQUISITION Review of literature was conducted for the collection of definitions and examples of terminology related to observational data research. Data resources were collected via Web search and researcher recommendations. Next, each data resource was reviewed and analyzed for content and accessibility. Contents of data resources were organized into summary tables and matched to relevant literature examples. RESULTS We identified 26 observational data resources frequently used in secondary analysis for OB/GYN research. Cost, accessibility considerations for software/hardware capabilities, and contents of each data resource varied substantially. CONCLUSIONS AND RELEVANCE Observational data sources can provide researchers with a variety of options in tackling their research questions related to OB/GYN practice, patient health outcomes, trends in utilization of medications/procedures, or prevalence estimates of disease states. Insurance claims data resources are useful for population-level prevalence estimates and utilization trends, whereas electronic health record-derived data and patient survey data may be more useful for exploring patient behaviors and trends in practice.
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Affiliation(s)
- Amie Goodin
- *Postdoctoral Associate, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; †Assistant Professor and ‡Student, Department of Health Outcomes & Policy, University of Florida College of Medicine; §Graduate Student, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; ¶Assistant Professor, Departments of Obstetrics & Gynecology and Psychiatry, University of Florida College of Medicine; and ∥Assistant Professor, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Chris Delcher
- *Postdoctoral Associate, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; †Assistant Professor and ‡Student, Department of Health Outcomes & Policy, University of Florida College of Medicine; §Graduate Student, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; ¶Assistant Professor, Departments of Obstetrics & Gynecology and Psychiatry, University of Florida College of Medicine; and ∥Assistant Professor, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Chelsea Valenzuela
- *Postdoctoral Associate, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; †Assistant Professor and ‡Student, Department of Health Outcomes & Policy, University of Florida College of Medicine; §Graduate Student, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; ¶Assistant Professor, Departments of Obstetrics & Gynecology and Psychiatry, University of Florida College of Medicine; and ∥Assistant Professor, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Xi Wang
- *Postdoctoral Associate, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; †Assistant Professor and ‡Student, Department of Health Outcomes & Policy, University of Florida College of Medicine; §Graduate Student, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; ¶Assistant Professor, Departments of Obstetrics & Gynecology and Psychiatry, University of Florida College of Medicine; and ∥Assistant Professor, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Yanmin Zhu
- *Postdoctoral Associate, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; †Assistant Professor and ‡Student, Department of Health Outcomes & Policy, University of Florida College of Medicine; §Graduate Student, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; ¶Assistant Professor, Departments of Obstetrics & Gynecology and Psychiatry, University of Florida College of Medicine; and ∥Assistant Professor, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Dikea Roussos-Ross
- *Postdoctoral Associate, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; †Assistant Professor and ‡Student, Department of Health Outcomes & Policy, University of Florida College of Medicine; §Graduate Student, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; ¶Assistant Professor, Departments of Obstetrics & Gynecology and Psychiatry, University of Florida College of Medicine; and ∥Assistant Professor, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Joshua D. Brown
- *Postdoctoral Associate, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; †Assistant Professor and ‡Student, Department of Health Outcomes & Policy, University of Florida College of Medicine; §Graduate Student, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy; ¶Assistant Professor, Departments of Obstetrics & Gynecology and Psychiatry, University of Florida College of Medicine; and ∥Assistant Professor, Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL
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Assumpção RP, Mucci DB, Fonseca FCP, Marcondes H, Sardinha FLC, Citelli M, Tavares do Carmo MG. Fatty acid profile of maternal and fetal erythrocytes and placental expression of fatty acid transport proteins in normal and intrauterine growth restriction pregnancies. Prostaglandins Leukot Essent Fatty Acids 2017; 125:24-31. [PMID: 28987718 DOI: 10.1016/j.plefa.2017.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/19/2017] [Accepted: 08/21/2017] [Indexed: 02/02/2023]
Abstract
Long-chain polyunsaturated fatty acids (LC-PUFA), mainly docosahexaenoic (DHA) and arachidonic acids (AA), are critical for adequate fetal growth and development. We investigated mRNA expression of proteins involved in hydrolysis, uptake and/or transport of fatty acids in placenta of fifteen full term normal pregnancies and eleven pregnancies complicated by intrauterine growth restriction (IUGR) with normal umbilical blood flows. The mRNA expression of LPL, FATPs (-1, -2 and -4) and FABPs (-1 and -3) was increased in IUGR placentas, however, tissue profile of LC-PUFA was not different between groups. Erythrocytes from both mothers and fetuses of the IUGR group showed lower concentrations of AA and DHA and inferior DHA/ALA ratio compared to normal pregnancies (P < 0.05). We hypothesize that reduced circulating levels of AA and DHA could up-regulate mRNA expression of placental fatty acids transporters, as a compensatory mechanism, however this failed to sustain normal LC-PUFA supply to the fetus in IUGR.
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Affiliation(s)
- Renata P Assumpção
- Laboratório de Bioquímica Nutricional, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Daniela B Mucci
- Laboratório de Bioquímica Nutricional, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fernanda C P Fonseca
- Laboratório de Bioquímica Nutricional, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Henrique Marcondes
- Laboratório de Bioquímica Nutricional, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fátima L C Sardinha
- Laboratório de Bioquímica Nutricional, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marta Citelli
- Departamento de Nutrição Básica e Experimental, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria G Tavares do Carmo
- Laboratório de Bioquímica Nutricional, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Ruff CA, Faulkner SD, Rumajogee P, Beldick S, Foltz W, Corrigan J, Basilious A, Jiang S, Thiyagalingam S, Yager JY, Fehlings MG. The extent of intrauterine growth restriction determines the severity of cerebral injury and neurobehavioural deficits in rodents. PLoS One 2017; 12:e0184653. [PMID: 28934247 PMCID: PMC5608203 DOI: 10.1371/journal.pone.0184653] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/28/2017] [Indexed: 12/16/2022] Open
Abstract
Background Cerebral Palsy (CP) is the most common physical pediatric neurodevelopmental disorder and spastic diplegic injury is its most frequent subtype. CP results in substantial neuromotor and cognitive impairments that have significant socioeconomic impact. Despite this, its underlying pathophysiological mechanisms and etiology remain incompletely understood. Furthermore, there is a need for clinically relevant injury models, which a) reflect the heterogeneity of the condition and b) can be used to evaluate new translational therapies. To address these key knowledge gaps, we characterized a chronic placental insufficiency (PI) model, using bilateral uterine artery ligation (BUAL) of dams. This injury model results in intrauterine growth restriction (IUGR) in pups, and animals recapitulate the human phenotype both in terms of neurobehavioural and anatomical deficits. Methods Effects of BUAL were studied using luxol fast blue (LFB)/hematoxylin & eosin (H&E) staining, immunohistochemistry, quantitative Magnetic Resonance Imaging (MRI), and Catwalk neurobehavioural tests. Results Neuroanatomical analysis revealed regional ventricular enlargement and corpus callosum thinning in IUGR animals, which was correlated with the extent of growth restriction. Olig2 staining revealed reductions in oligodendrocyte density in white and grey matter structures, including the corpus callosum, optic chiasm, and nucleus accumbens. The caudate nucleus, along with other brain structures such as the optic chiasm, internal capsule, septofimbrial and lateral septal nuclei, exhibited reduced size in animals with IUGR. The size of the pretectal nucleus was reduced only in moderately injured animals. MAG/NF200 staining demonstrated reduced myelination and axonal counts in the corpus callosum of IUGR animals. NeuN staining revealed changes in neuronal density in the hippocampus and in the thickness of hippocampal CA2 and CA3 regions. Diffusion weighted imaging (DWI) revealed regional white and grey matter changes at 3 weeks of age. Furthermore, neurobehavioural testing demonstrated neuromotor impairments in animals with IUGR in paw intensities, swing speed, relative print positions, and phase dispersions. Conclusions We have characterized a rodent model of IUGR and have demonstrated that the neuroanatomical and neurobehavioural deficits mirror the severity of the IUGR injury. This model has the potential to be applied to examine the pathobiology of and potential therapeutic strategies for IUGR-related brain injury. Thus, this work has potential translational relevance for the study of CP.
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Affiliation(s)
- Crystal A. Ruff
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stuart D. Faulkner
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Prakasham Rumajogee
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Beldick
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Warren Foltz
- STARR facility, Toronto Medical Discovery Tower, Toronto, Ontario, Canada
| | - Jennifer Corrigan
- Section of Pediatric Neurosciences, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Alfred Basilious
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shangjun Jiang
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shanojan Thiyagalingam
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jerome Y. Yager
- Section of Pediatric Neurosciences, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michael G. Fehlings
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Gao J, Zhao B, He L, Sun M, Yu X, Wang L. Risk of cerebral palsy in Chinese children: A N:M matched case control study. J Paediatr Child Health 2017; 53:464-469. [PMID: 28134474 DOI: 10.1111/jpc.13479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 11/01/2016] [Accepted: 11/10/2016] [Indexed: 11/28/2022]
Abstract
AIM To estimate epidemiological risk factors for cerebral palsy (CP) in children. METHODS A N:M matched case control study was conducted in 114 persons with CP and 1286 controls. Relevant data were collected using a maternal self-design questionnaire. Univariate logistic regression and multivariate conditional logistic regression analyses were performed using SPSS. RESULTS Univariate analysis has yielded 20 significant risk factors for CP. Advanced maternal age (30 years or older) at childbirth (adjusted odds ratio (OR) 1.63, 95% confidence interval (CI) 0.98-2.72), alcohol consumption during pregnancy (adjusted OR 4.17, 95% CI 1.23-14.08), living in the countryside (adjusted OR 1.71, 95% CI 1.18-2.48), father's occupational exposure to harmful substances (adjusted OR 3.34, 95% CI 1.61-6.93) and multiple births (adjusted OR 3.10, 95% CI 1.65-5.84) were found to be risk factors for CP by multivariate analysis. On the other side, high mother's education level (adjusted OR 0.60, 95% CI 0.46-0.76), folic acid supplements (adjusted OR 0.50, 95% CI 0.30-0.82), and high birth hospital level (adjusted OR 0.68, 95% CI 0.52-0.90) were found to be protective factors. CONCLUSION Although the important risk factors of CP focus on gestation at birth and perinatal events, the incidence could probably be further lowered, if potential risk factors identified in this study are considered.
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Affiliation(s)
- Jing Gao
- Children Rehabilitation Center of Huaian Maternity and Child Care Hospital, Huaian, China
| | - Bin Zhao
- Children Rehabilitation Center of Huaian Maternity and Child Care Hospital, Huaian, China
| | - Luna He
- Children Rehabilitation Center of Huaian Maternity and Child Care Hospital, Huaian, China
| | - Meiling Sun
- Children Rehabilitation Center of Huaian Maternity and Child Care Hospital, Huaian, China
| | - Xuefeng Yu
- The Fourth Affiliated Hospital of Nanchang University, Nanjing, China
| | - Lina Wang
- Key Laboratory of Environmental Medicine Engineering, Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, China
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Tolcos M, Petratos S, Hirst JJ, Wong F, Spencer SJ, Azhan A, Emery B, Walker DW. Blocked, delayed, or obstructed: What causes poor white matter development in intrauterine growth restricted infants? Prog Neurobiol 2017; 154:62-77. [PMID: 28392287 DOI: 10.1016/j.pneurobio.2017.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 03/17/2017] [Accepted: 03/29/2017] [Indexed: 12/22/2022]
Abstract
Poor white matter development in intrauterine growth restricted (IUGR) babies remains a major, untreated problem in neonatology. New therapies, guided by an understanding of the mechanisms that underlie normal and abnormal oligodendrocyte development and myelin formation, are required. Much of our knowledge of the mechanisms that underlie impaired myelination come from studies in adult demyelinating disease, preterm brain injury, or experimental models of hypoxia-ischemia. However, relatively less is known for IUGR which is surprising because IUGR is a leading cause of perinatal mortality and morbidity, second only to premature birth. IUGR is also a significant risk factor for the later development of cerebral palsy, and is a greater risk compared to some of the more traditionally researched antecedents - asphyxia and inflammation. Recent evidence suggests that the white matter injury and reduced myelination in the brains of some preterm babies is due to impaired maturation of oligodendrocytes thereby resulting in the reduced capacity to synthesize myelin. Therefore, it is not surprising that the hypomyelination observable in the central nervous system of IUGR infants has similarly lead to investigations identifying a delay or blockade in the progress of maturation of oligodendrocytes in these infants. This review will discuss current ideas thought to account for the poor myelination often present in the neonate's brain following IUGR, and discuss novel interventions that are promising as treatments that promote oligodendrocyte maturation, and thereby repair the myelination deficits that otherwise persist into infancy and childhood and lead to neurodevelopmental abnormalities.
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Affiliation(s)
- Mary Tolcos
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia.
| | - Steven Petratos
- Department of Medicine, Central Clinical School, Monash University, Prahran, Victoria, 3004, Australia
| | - Jonathan J Hirst
- School of Biomedical Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Flora Wong
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia; Monash Newborn and Monash University, Clayton, Victoria, 3168, Australia
| | - Sarah J Spencer
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Aminath Azhan
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, 3168, Australia
| | - Ben Emery
- Oregon Health and Science University, Portland, OR, 97239-3098, USA
| | - David W Walker
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
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Biro MA, East C. Poorer detection rates of severe fetal growth restriction in women of likely refugee background: A case for re-focusing pregnancy care. Aust N Z J Obstet Gynaecol 2017; 57:186-192. [DOI: 10.1111/ajo.12593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Mary Anne Biro
- School of Nursing and Midwifery; Clayton Campus, Monash University; Clayton Victoria Australia
| | - Christine East
- School of Nursing and Midwifery; Clayton Campus, Monash University; Clayton Victoria Australia
- Monash Health; Monash Medical Centre; Clayton Victoria Australia
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Monier I, Ancel PY, Ego A, Guellec I, Jarreau PH, Kaminski M, Goffinet F, Zeitlin J. Gestational age at diagnosis of early-onset fetal growth restriction and impact on management and survival: a population-based cohort study. BJOG 2017; 124:1899-1906. [DOI: 10.1111/1471-0528.14555] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 12/01/2022]
Affiliation(s)
- I Monier
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
- Antoine Beclere Maternity Unit; Department of Obstetrics and Gynaecology; South Paris University Hospitals; AP-HP; Paris France
| | - P-Y Ancel
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
| | - A Ego
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
- Clinical Research Centre (CICO3); Grenoble University Hospital; Grenoble France
| | - I Guellec
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
- Paediatric and Neonatal Intensive Care Unit; Armand-Trousseau Hospital; AP-HP; Paris France
| | - P-H Jarreau
- Department of Neonatal Medicine and Intensive Care Unit of Port-Royal; Cochin University Hospital; AP-HP; DHU Risks in Pregnancy; Paris France
| | - M Kaminski
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
| | - F Goffinet
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
- Port-Royal Maternity Unit; Department of Obstetrics and Gynaecology; Cochin University Hospital; AP-HP; Paris France
| | - J Zeitlin
- Inserm UMR 1153; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy; Paris Descartes University; Paris France
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Evaluation of the effectiveness of low-dose aspirin and omega 3 in treatment of asymmetrically intrauterine growth restriction: A randomized clinical trial. Eur J Obstet Gynecol Reprod Biol 2017; 210:231-235. [PMID: 28068596 DOI: 10.1016/j.ejogrb.2017.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/28/2016] [Accepted: 01/02/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To test the effect of aspirin and omega 3 on fetal weight as well as feto-maternal blood flow in asymmetrical intrauterine growth restriction (IUGR). STUDY DESIGN This study is a clinically registered (NCT02696577), open, parallel, randomized controlled trial, conducted at Assiut Woman's Health Hospital, Egypt including 80 pregnant women (28-30 weeks) with IUGR. They were randomized either to group I: aspirin or group II: aspirin plus omega 3. The primary outcome was the fetal weight after 6 weeks of treatment. Secondary outcomes included Doppler blood flow changes in both uterine and umbilical arteries, birth weight, time and method of delivery and admission to NICU. The outcome variables were analyzed using paired and unpaired t-test. RESULTS The estimated fetal weight increased significant in group II more than group I (p=0.00). The uterine and umbilical arteries blood flow increased significantly in group II (p<0.05). The birth weight in group II was higher than that observed in group I (p<0.05). CONCLUSION The using of aspirin with omega 3 is more effective than using aspirin only in increasing fetal weight and improving utero-placental blood flow in IUGR.
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Zhao M, Dai H, Deng Y, Zhao L. SGA as a Risk Factor for Cerebral Palsy in Moderate to Late Preterm Infants: a System Review and Meta-analysis. Sci Rep 2016; 6:38853. [PMID: 27958310 PMCID: PMC5153647 DOI: 10.1038/srep38853] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/11/2016] [Indexed: 11/09/2022] Open
Abstract
Small for gestational age (SGA) is an established risk factor for cerebral palsy (CP) in term infants. However, there is conflicting data on the association between SGA and CP in moderate to late preterm infants. The aim of the article was to explore the relationship between SGA and CP in the moderate to late preterm infants and its strength by meta-analysis. We performed a system search in OVID (EMBASE and MEDLINE) and WANFANG from inception to May 2016. The study-specific risk estimates were pooled using the random-effect model. A total of seven studies were included in the meta-analysis, consisting of three cohort and four case-control studies. A statistically significant association was found between SGA and CP in moderate to late premature infants (OR: 2.34; 95% CI: 1.43-3.82). The association were higher in the several subgroups: 34-36 week gestational age (OR: 3.47; 95% CI: 1.29-9.31), SGA < 2SDs (OR: 3.48; 95% CI: 1.86-6.49), and malformation included in CP (OR: 3.00; 95% CI: 1.71-5.26). In moderate to late premature infants, SGA is a convenient and reliable predictor for CP. More studies are needed to explore the underlying mechanisms between SGA and CP association.
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Affiliation(s)
- Mengwen Zhao
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hongmei Dai
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yuanying Deng
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lingling Zhao
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
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Redelmeier DA, Naqib F, Thiruchelvam D, R Barrett JF. Motor vehicle crashes during pregnancy and cerebral palsy during infancy: a longitudinal cohort analysis. BMJ Open 2016; 6:e011972. [PMID: 27650764 PMCID: PMC5051428 DOI: 10.1136/bmjopen-2016-011972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To assess the incidence of cerebral palsy among children born to mothers who had their pregnancy complicated by a motor vehicle crash. DESIGN Retrospective longitudinal cohort analysis of children born from 1 April 2002 to 31 March 2012 in Ontario, Canada. PARTICIPANTS Cases defined as pregnancies complicated by a motor vehicle crash and controls as remaining pregnancies with no crash. MAIN OUTCOME Subsequent diagnosis of cerebral palsy by age 3 years. RESULTS A total of 1 325 660 newborns were analysed, of whom 7933 were involved in a motor vehicle crash during pregnancy. A total of 2328 were subsequently diagnosed with cerebral palsy, equal to an absolute risk of 1.8 per 1000 newborns. For the entire cohort, motor vehicle crashes correlated with a 29% increased risk of subsequent cerebral palsy that was not statistically significant (95% CI -16 to +110, p=0.274). The increased risk was only significant for those with preterm birth who showed an 89% increased risk of subsequent cerebral palsy associated with a motor vehicle crash (95% CI +7 to +266, p=0.037). No significant increase was apparent for those with a term delivery (95% CI -62 to +79, p=0.510). A propensity score-matched analysis of preterm births (n=4384) yielded a 138% increased relative risk of cerebral palsy associated with a motor vehicle crash (95% CI +27 to +349, p=0.007), equal to an absolute increase of about 10.9 additional cases per 1000 newborns (18.2 vs 7.3, p=0.010). CONCLUSIONS Motor vehicle crashes during pregnancy may be associated with an increased risk of cerebral palsy among the subgroup of cases with preterm birth. The increase highlights a specific role for traffic safety advice in prenatal care.
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Affiliation(s)
- Donald A Redelmeier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Faisal Naqib
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Toronto, Ontario, Canada
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Toronto, Ontario, Canada
| | - Jon F R Barrett
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
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Nawathe A, Lees C. Early onset fetal growth restriction. Best Pract Res Clin Obstet Gynaecol 2016; 38:24-37. [PMID: 27693119 DOI: 10.1016/j.bpobgyn.2016.08.005] [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] [Received: 05/30/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 12/13/2022]
Abstract
Fetal growth restriction remains a challenging entity with significant variations in clinical practice around the world. The different etiopathogenesis of early and late fetal growth restriction with their distinct progression of fetal severity and outcomes, compounded by doctors and patient anxiety adds to the quandary involving its management. This review summarises the literature around diagnosing and monitoring early onset fetal growth restriction (early onset FGR) with special emphasis on optimal timing of delivery as guided by recent research advances.
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Affiliation(s)
- Aamod Nawathe
- Queen Charlotte's and Chelsea Hospital, London, W120HS, UK.
| | - Christoph Lees
- Queen Charlotte's and Chelsea Hospital, London, W120HS, UK.
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