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Mecacci F, Romani E, Clemenza S, Zullino S, Avagliano L, Petraglia F. Early Fetal Growth Restriction with or Without Hypertensive Disorders: a Clinical Overview. Reprod Sci 2024; 31:591-602. [PMID: 37684516 DOI: 10.1007/s43032-023-01330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023]
Abstract
Early onset fetal growth restriction (FGR) is one of the main adverse pregnancy conditions, often associated with poor neonatal outcomes. Frequently, early onset FGR is associated with early onset hypertensive disorders of pregnancy (HDP), and in particular preeclampsia (PE). However, to date, it is still an open question whether pregnancies complicated by early FGR plus HDP (FGR-HDP) and those complicated by early onset FGR without HDP (normotensive-FGR (n-FGR)) show different prenatal and postnatal outcomes and, consequently, should benefit from different management and long-term follow-up. Recent data support the hypothesis that the presence of PE may have an additional impact on maternal hemodynamic impairment and placental lesions, increasing the risk of poor neonatal outcomes in pregnancy affected by early onset FGR-HDP compared to pregnancy affected by early onset n-FGR. This review aims to elucidate this poor studied topic, comparing the clinical characteristics, perinatal outcomes, and potential long-term sequelae of early onset FGR-HDP and early onset n-FGR.
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Affiliation(s)
- Federico Mecacci
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Eleonora Romani
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Sara Clemenza
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Sara Zullino
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | | | - Felice Petraglia
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
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2
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Abella L, D'Adamo E, Strozzi M, Botondi V, Abella E, Cassinari M, Mazzucco L, Maconi A, Testa M, Zanelli C, Patacchiola R, Librandi M, Osmelli J, Carabotta M, Chiarelli F, Gazzolo D. Early changes in S100B maternal blood levels can predict fetal intrauterine growth restriction. Clin Chem Lab Med 2023; 61:2205-2211. [PMID: 37366015 DOI: 10.1515/cclm-2023-0294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Intrauterine growth restriction (IUGR) represents one of the main causes of perinatal mortality and morbidity. Nowadays, IUGR early diagnosis is mandatory in order to limit the occurrence of multiorgan failure, especially the brain. Therefore, we investigated whether longitudinal S100B assessment in maternal blood could be a trustable predictor of IUGR. METHODS We conducted a prospective study in 480 pregnancies (IUGR: n=40; small for gestational age, SGA: n=40; controls: n=400) in whom S100B was measured at three predetermined monitoring time-points (T1: 8-18 GA; T2: 19-23 GA; T3: 24-28 GA). RESULTS Lower S100B in IUGR fetuses than SGA and controls (p<0.05, for all) at T1-T3. Receiver operating characteristic curve showed that S100B at T1 was the best predictor of IUGR (sensitivity: 100 %; specificity: 81.4 %) than T2, T3. CONCLUSIONS The early lower S100B concentration in pregnant women lately complicated by IUGR support the notion that non-invasive early IUGR diagnosis and monitoring is becoming feasible. Results open the way to further studies aimed at diagnosing and monitoring fetal/maternal diseases at earliest time.
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Affiliation(s)
| | - Ebe D'Adamo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | - Mariachiara Strozzi
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Valentina Botondi
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | | | - Maurizio Cassinari
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Laura Mazzucco
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Antonio Maconi
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Michela Testa
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | - Cristian Zanelli
- Neonatal Intensive Care Unit, ASO SS Antonio, Biagio, C. Arrigo, Alessandria, Italy
| | | | | | - Jacopo Osmelli
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Maura Carabotta
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | | | - Diego Gazzolo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
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3
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Sayres L, Flockton AR, Ji S, Rey Diaz C, Gumina DL, Su EJ. Angiogenic Function of Human Placental Endothelial Cells in Severe Fetal Growth Restriction Is Not Rescued by Individual Extracellular Matrix Proteins. Cells 2023; 12:2339. [PMID: 37830553 PMCID: PMC10572031 DOI: 10.3390/cells12192339] [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: 07/21/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023] Open
Abstract
Severe fetal growth restriction (FGR) is characterized by increased placental vascular resistance resulting from aberrant angiogenesis. Interactions between endothelial cells (ECs) and the extracellular matrix (ECM) are critical to the complex process of angiogenesis. We have previously found that placental stromal abnormalities contribute to impaired angiogenesis in severe FGR. The objective of this research is to better characterize the effect of individual ECM proteins on placental angiogenic properties in the setting of severe FGR. ECs were isolated from human placentae, either control or affected by severe FGR, and subjected to a series of experiments to interrogate the role of ECM proteins on adhesion, proliferation, migration, and apoptosis. We found impaired proliferation and migration of growth-restricted ECs. Although individual substrates did not substantially impact migratory capacity, collagens I, III, and IV partially mitigated proliferative defects seen in FGR ECs. Differences in adhesion and apoptosis between control and FGR ECs were not evident. Our findings demonstrate that placental angiogenic defects that characterize severe FGR cannot be explained by a singular ECM protein, but rather, the placental stroma as a whole. Further investigation of the effects of stromal composition, architecture, stiffness, growth factor sequestration, and capacity for remodeling is essential to better understand the role of ECM in impaired angiogenesis in severe FGR.
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Affiliation(s)
- Lauren Sayres
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Amanda R. Flockton
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Shuhan Ji
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Carla Rey Diaz
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Diane L. Gumina
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Emily J. Su
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
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4
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Kosmeri C, Giapros V, Rallis D, Balomenou F, Serbis A, Baltogianni M. Classification and Special Nutritional Needs of SGA Infants and Neonates of Multiple Pregnancies. Nutrients 2023; 15:2736. [PMID: 37375640 DOI: 10.3390/nu15122736] [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: 05/15/2023] [Revised: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Data regarding the nutritional management of preterm small for gestational age (SGA) infants are scarce. In the recent report of ESPGHAN, the recommended energy for very preterm infants during hospitalization has been increased, yet this may not fit the needs of all preterm infants. It is important to distinguish fetal growth-restricted (FGR) infants from constitutional SGA infants, as well as preterm SGA from preterm AGA infants, since they may have different nutritional needs. Preterm FGR infants, and specifically infants < 29 weeks' gestation, accumulate nutrient deficits due to intrauterine malnutrition, prematurity, morbidities, delayed initiation of feeding, and feeding intolerance. Therefore, these infants may need more aggressive nutrition for optimal catch-up growth and neurologic development. However, a balance should be kept between optimal and excessive catch-up growth, since the combination of intrauterine malnutrition and excessive postnatal growth has been linked with later adverse metabolic consequences. Furthermore, multiple gestation is often complicated by FGR and prematurity. There is controversy in the definition of FGR in multiple gestations, and it should be noted that FGR in multiple gestation usually differs etiologically from FGR in singletons. The aim of this review is to summarize existing knowledge regarding the nutritional needs of preterm FGR and FGR infants of multiple gestation.
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Affiliation(s)
- Chrysoula Kosmeri
- Department of Pediatrics, University Hospital of Ioannina, 455 00 Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Dimitrios Rallis
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Foteini Balomenou
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Anastasios Serbis
- Department of Pediatrics, University Hospital of Ioannina, 455 00 Ioannina, Greece
| | - Maria Baltogianni
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
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5
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Weigelt A, Bleck S, Huebner MJ, Rottermann K, Waellisch W, Morhart P, Abu-Tair T, Dittrich S, Schoeffl I. Impact of premature birth on cardiopulmonary function in later life. Eur J Pediatr 2023:10.1007/s00431-023-04952-y. [PMID: 37147470 DOI: 10.1007/s00431-023-04952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 05/07/2023]
Abstract
Pulmonary function is reduced in children after preterm birth. The variety of subgroups ranges from early to late preterm births. Limitations in pulmonary function can be observed even after late preterm birth without signs of bronchopulmonary dysplasia and/or history of mechanical ventilation. Whether this reduction in lung function is reflected in the cardiopulmonary capacity of these children is unclear. This study aims to investigate the impact of moderate to late premature birth on cardiopulmonary function. Cardiopulmonary exercise testing on a treadmill was performed by 33 former preterm infants between 8 and 10 years of age who were born between 32 + 0 and 36 + 6 weeks of gestation and compared with a control group of 19 children born in term of comparable age and sex. The former preterm children achieved comparable results to the term-born controls with respect to most of the cardiopulmonary exercise parameters [Formula: see text]. The only differences were in a slightly higher oxygen uptake efficiency slope [Formula: see text] and higher peak minute ventilation [Formula: see text] in the group of children born preterm. With respect to heart rate recovery [Formula: see text] and breathing efficiency [Formula: see text], there were no significant differences. CONCLUSION Children born preterm did not show limitations in cardiopulmonary function in comparison with matched controls. WHAT IS KNOWN • Preterm birth is associated with reduced pulmonary function in later life, this is also true for former late preterms. • As a consequence of being born premature, the lungs have not finished their important embryological development. Cardiopulmonary fitness is an important parameter for overall mortality and morbidity in children and adults and a good pulmonary function is therefore paramount. WHAT IS NEW • Children born prematurely were comparable to an age- and sex-matched control group with regards to almost all cardiopulmonary exercise variables. • A significantly higher OUES, a surrogate parameter for VO2peak was found for the group of former preterm children, most likely reflecting on more physical exercise in this group. Importantly, there were no signs of impaired cardiopulmonary function in the group of former preterm children.
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Affiliation(s)
- Annika Weigelt
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany.
| | - Steffen Bleck
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Matthias Jens Huebner
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Kathrin Rottermann
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Wolfgang Waellisch
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Patrick Morhart
- Department of Neonatology and Intensive Medical Care, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Tariq Abu-Tair
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
| | - Isabelle Schoeffl
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, LS13HE, UK
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D'Agostin M, Di Sipio Morgia C, Vento G, Nobile S. Long-term implications of fetal growth restriction. World J Clin Cases 2023; 11:2855-2863. [PMID: 37215406 PMCID: PMC10198075 DOI: 10.12998/wjcc.v11.i13.2855] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/08/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
Fetal growth restriction (FGR), or intrauterine growth restriction (IUGR), is a complication of pregnancy where the fetus does not achieve its genetic growth potential. FGR is characterized by a pathological retardation of intrauterine growth velocity in the curve of intrauterine growth. However, the FGR definition is still debated, and there is a lack of a uniform definition in the literature. True IUGR, compared to constitutional smallness, is a pathological condition in which the placenta fails to deliver an adequate supply of oxygen and nutrients to the developing fetus. Infants with IUGR, compared to appropriately grown gestational age infants, have a significantly higher risk of mortality and neonatal complications with long-term consequences. Several studies have demonstrated how suboptimal fetal growth leads to long-lasting physiological alterations for the developing fetus as well as for the newborn and adult in the future. The long-term effects of fetal growth retardation may be adaptations to poor oxygen and nutrient supply that are effective in the fetal period but deleterious in the long term through structural or functional alterations. Epidemiologic studies showed that FGR could be a contributing factor for adult chronic diseases including cardiovascular disease, metabolic syndrome, diabetes, respiratory diseases and impaired lung function, and chronic kidney disease. In this review we discussed pathophysiologic mechanisms of FGR-related complications and potential preventive measures for FGR.
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Affiliation(s)
- Martina D'Agostin
- Department of Pediatrics, University of Trieste, Trieste 34100, Italy
| | - Chiara Di Sipio Morgia
- Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 000168, Italy
| | - Stefano Nobile
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 000168, Italy
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7
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Sixtus RP, Berry MJ, Gray CL, Dyson RM. A novel whole-body thermal stress test for monitoring cardiovascular responses in Guinea pigs. J Therm Biol 2023; 113:103500. [PMID: 37055107 DOI: 10.1016/j.jtherbio.2023.103500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/27/2023] [Accepted: 02/04/2023] [Indexed: 03/12/2023]
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality worldwide. Stress tests are frequently employed to expose early signs of cardiovascular dysfunction or disease and can be employed, for example, in the context of preterm birth. We aimed to establish a safe and effective thermal stress test to examine cardiovascular function. Guinea pigs were anaesthetized using a 0.8% isoflurane, 70% N2O mix. ECG, non-invasive blood pressure, laser Doppler flowmetry, respiratory rate, and an array of skin and rectal thermistors were applied. A physiologically relevant heating and a cooling thermal stress test was developed. Upper and lower thermal limits for core body temperature were set at 41.5 OC and 34 OC, for the safe recovery of animals. This protocol therefore presents a viable thermal stress test for use in guinea pig models of health and disease that facilitates exploration of whole-system cardiovascular function.
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Affiliation(s)
- Ryan P Sixtus
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.
| | - Mary J Berry
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Clint L Gray
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Rebecca M Dyson
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
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8
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Fenton TR, Elmrayed S, Scime NV, Tough SC, Pinto J, Sabet F, Wollny K, Lee Y, Harrison TG, Alladin-Karan B, Kramer MS, Ospina MB, Lorenzetti DL, Madubueze A, Leung AA, Kumar M. Small for date preterm infants and risk of higher blood pressure in later life: A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2023. [PMID: 36688258 DOI: 10.1111/ppe.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Historical reports suggest that infants born small for gestational age (SGA) are at increased risk for high blood pressure (BP) at older ages after adjustment for later age body size. Such adjustment may be inappropriate since adiposity is a known cause of cardiovascular and metabolic disease. OBJECTIVES To assess the association between SGA births and later BP among preterm births, considering potential background confounders and over-adjustment for later body size. METHODS A database search of studies up to October 2022 included MEDLINE, EMBASE and CINAHL. Studies were included if they reported BP (systolic [SBP] or diastolic [DBP]) (outcomes) for participants born preterm with SGA (exposure) or non-SGA births. All screening, extraction steps, and risk of bias (using the Risk of Bias In Non-randomised Studies of Interventions [ROBINS-I] tool) were conducted in duplicate by two reviewers. Data were pooled in meta-analysis using random-effects models. We explored potential sources of heterogeneity. RESULTS We found no meaningful difference in later BP between preterm infants with and without SGA status at birth. Meta-analysis of 25 studies showed that preterm SGA, compared to preterm non-SGA, was not associated with higher BP at age 2 and older with mean differences for SBP 0.01 mmHg (95% CI -0.10, 0.12, I2 = 59.8%, n = 20,462) and DBP 0.01 mm Hg (95% CI -0.10, 0.12), 22 studies, (I2 = 53.0%, n = 20,182). Adjustment for current weight did not alter the results, which could be due to the lack of differences in later weight status in most of the included studies. The included studies were rated to be at risk of bias due to potential residual confounding, with a low risk of bias in other domains. CONCLUSIONS Evidence indicates that preterm infants born SGA are not at increased risk of developing higher BP as children or as adults as compared to non-SGA preterm infants.
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Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Seham Elmrayed
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Global Health and Human Ecology Institute, American University in Cairo, Cairo, Egypt
| | - Natalie V Scime
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jahaira Pinto
- Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Fatemeh Sabet
- Interior Health Authority, Kelowna, British Columbia, Canada
| | - Krista Wollny
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Yoonshin Lee
- Senior Persons Living Connected, Hong Fook Mental Health Association, Toronto, Ontario, Canada
| | - Tyrone G Harrison
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bibi Alladin-Karan
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Maria B Ospina
- Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Diane L Lorenzetti
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Health Sciences Library and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ada Madubueze
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A Leung
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Manoj Kumar
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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9
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Sanderson K, O'Shea TM, Kistler CE. An Individualized Approach to Kidney Disease Screening in Children With a History of Preterm Birth. Clin Pediatr (Phila) 2022; 62:385-388. [PMID: 36271655 PMCID: PMC10119330 DOI: 10.1177/00099228221132126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Keia Sanderson
- Division of Nephrology and Hypertension, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T Michael O'Shea
- Department of Pediatrics, Division of Neonatology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christine E Kistler
- Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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10
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Course CW, Kotecha SJ, Cousins M, Hart K, Lowe J, Watkins WJ, Kotecha S. Association of Gestation and Fetal Growth Restriction on Cardiovascular Health in Preterm-Born Children. J Pediatr 2022; 255:42-49.e4. [PMID: 36241052 PMCID: PMC7614853 DOI: 10.1016/j.jpeds.2022.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To prospectively evaluate the associations of early and current life factors, including gestational age and fetal growth restriction in preterm-born subjects, on cardiovascular health including measures of central and peripheral blood pressure and arterial stiffness and assess cardiovascular changes before and after acute exercise in preterm- and term-born school-aged children. STUDY DESIGN From 240 children, aged 7-12 years, 204 (141 preterm-born and 63 term-born) had satisfactory data. An oscillometric device recorded cardiovascular measures before and after cycle ergometer exercise testing. Data were analyzed with multivariable linear regression and mediation. RESULTS Central systolic blood pressure (SBP) was 6.4 mmHg (95% CI, 1.2, 11.6) higher in preterm-born children with fetal growth restriction and 3.4 mmHg (0.02, 6.8) higher in those without fetal growth restriction when compared with term controls. Augmentation index was 4.1% (0.7, 7.4) higher in the preterm fetal growth restriction group when compared with those without fetal growth restriction but was similar between the latter group and term controls. Regression modelling showed gestational age, female sex, and antenatal smoking, but not fetal growth restriction, were significantly associated with SBP. In contrast, fetal growth restriction and fat mass index, but not gestation, were significantly associated with augmentation index. Cardiovascular exercise responses were similar between all 3 groups studied. CONCLUSIONS Our data show the differential associations of prematurity and fetal growth restriction on central SBP and augmentation index. Cardiovascular responses to exercise were similar in all 3 groups. Preterm-born children with and without fetal growth restriction are at an increased risk of cardiovascular disease in adult life. TRIAL REGISTRATION URL: https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-003712-20/GB: RHiNO, EudraCT: 2015-003712-20.
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Affiliation(s)
- Christopher W Course
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sarah J Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Michael Cousins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom; Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Kylie Hart
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - John Lowe
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - W John Watkins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom.
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Adjusting growth standards for fetal sex improves correlation of small babies with stillbirth and adverse perinatal outcomes: A state-wide population study. PLoS One 2022; 17:e0274521. [PMID: 36215239 PMCID: PMC9551630 DOI: 10.1371/journal.pone.0274521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/28/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Sex impacts birthweight, with male babies heavier on average. Birthweight charts are thus sex specific, but ultrasound fetal weights are often reported by sex neutral standards. We aimed to identify what proportion of infants would be re-classified as SGA if sex-specific charts were used, and if this had a measurable impact on perinatal outcomes. METHODS Retrospective cohort study including all infants born in Victoria, Australia, from 2005-2015 (529,261 cases). We applied GROW centiles, either adjusted or not adjusted for fetal sex. We compared overall SGA populations, and the populations of males considered small by sex-specific charts only (SGAsex-only), and females considered small by sex-neutral charts only (SGAunadjust-only). RESULTS Of those <10th centile by sex-neutral charts, 39.6% were male and 60.5% female, but using sex-specific charts, 50.3% were male and 49.7% female. 19.2% of SGA females were reclassified as average for gestational age (AGA) using sex-specific charts. These female newborns were not at increased risk of stillbirth, combined perinatal mortality, NICU admissions, low Apgars or emergency CS compared with an AGA infant, but were at greater risk of being iatrogenically delivered on suspicion of growth restriction. 25.0% male infants were reclassified as SGA by sex-specific charts. These male newborns, compared to the AGAall infant, were at greater risk of stillbirth (RR 1.94, 95%CI 1.30-2.90), combined perinatal mortality (RR 1.80, 95%CI 1.26-2.57), NICU admissions (RR 1.38, 95%CI 1.12-1.71), Apgars <7 at 5 minutes (RR 1.40, 95%CI 1.25-1.56) and emergency CS (RR 1.12, 95%CI 1.06-1.18). CONCLUSIONS Use of growth centiles not adjusted for fetal sex disproportionately classifies female infants as SGA, increasing their risk of unnecessary intervention, and fails to identify a cohort of male infants at increased risk of adverse outcomes, including stillbirth. Sex-specific charts may help inform decisions and improve outcomes.
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12
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Skogastierna C, Elfvin A, Hansson S, Magnusson P, Swolin‐Eide D. Impaired renal clearance among Swedish adolescents born preterm. Acta Paediatr 2022; 111:1722-1728. [PMID: 35490381 PMCID: PMC9545013 DOI: 10.1111/apa.16379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 12/24/2022]
Abstract
AIM To determine whether adolescents born before 28 gestational weeks have an increased risk for renal impairment. METHODS Swedish infants, born before 28 gestational weeks in 2001 and 2002, were identified from a local register. A total of 16 children, 12 females and 4 males, were examined at 16-17 years of age with 51 Cr-EDTA clearance. A comparison group (n = 26) was used. RESULTS Most study participants (n = 13) had normal blood pressure; one individual had hypertension stage 1. All study participants had results within the reference interval for ionised calcium, parathyroid hormone, intact fibroblast growth factor-23 and for urinary albumin-to-creatinine ratio. Four out of 16 participants (25%) had a 51 Cr-EDTA clearance less than 90 ml/min/1.73 m2 , indicating a reduced kidney function. Measured 51 Cr-EDTA clearance values were significantly lower in the study group than in the comparison group (p = 0.0012). Five study participants (31%) were referred for further investigations. CONCLUSION Swedish children born before 28 gestational weeks have an increased risk of renal impairment later in life, suggesting that the kidney function in these individuals should be assessed, at least once, during adolescence.
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Affiliation(s)
- Carin Skogastierna
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Anders Elfvin
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Pediatrics Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | - Sverker Hansson
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Per Magnusson
- Department of Clinical Chemistry Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Diana Swolin‐Eide
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Pediatrics Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
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13
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Nutritional support and prophylaxis of azithromycin for pregnant women to improve birth outcomes in peri-urban slums of Karachi, Pakistan-a protocol of multi-arm assessor-blinded randomized controlled trial (Mumta PW trial). Trials 2022; 23:2. [PMID: 34980232 PMCID: PMC8721479 DOI: 10.1186/s13063-021-05960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal undernutrition is critical in the etiology of poor perinatal outcomes and accounts for 20% of small-for-gestational-age (SGA) births. High levels of food insecurity, antenatal undernourishment, and childhood undernutrition necessitate the supplementation of fortified balanced energy protein (BEP) during pregnancy in low-income settings especially with scarce literature available in this subject. Hence, this paper extensively covers the protocol of such a trial conducted in an urban slum of Karachi, Pakistan. METHODS The trial is community-based, open-labelled, four-arm, and randomized controlled that will include parallel group assignments with a 1:1:1:1 allocation ratio in low-income squatter settlements in urban Karachi, Pakistan. All pregnant women (PW), if identified between > 8 and < 19 weeks of gestation based on ultrasound, will be offered routine antenatal care (ANC) counseling and voluntary participation in the trial after written informed consent. A total number of 1836 PW will be enrolled with informed consent and randomly allocated to one of the four arms receiving: (1) ANC counseling only (control group), (2) ANC counseling plus BEP supplement (intervention arm 1), (3) ANC counseling plus BEP supplement plus 2 doses azithromycin (intervention arm 2), or (4) ANC counseling plus BEP supplement plus daily single dose of nicotinamide and choline (intervention arm 3). TRIAL REGISTRATION ClinicalTrials.gov NCT04012177 . Registered on July 9, 2019.
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14
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Meakin C, Barrett ES, Aleksunes LM. Extravillous trophoblast migration and invasion: Impact of environmental chemicals and pharmaceuticals. Reprod Toxicol 2022; 107:60-68. [PMID: 34838982 PMCID: PMC8760155 DOI: 10.1016/j.reprotox.2021.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 01/03/2023]
Abstract
During pregnancy, the migration and invasion of extravillous trophoblasts (EVTs) into the maternal uterus is essential for proper development of the placenta and fetus. During the first trimester, EVTs engraft and remodel maternal spiral arteries allowing for efficient blood flow and the transfer of essential nutrients and oxygen to the fetus. Aberrant migration of EVTs leading to either shallow or deep invasion into the uterus has been implicated in a number of gestational pathologies including preeclampsia, fetal growth restriction, and placenta accreta spectrum. The migration and invasion of EVTs is well-coordinated to ensure proper placentation. However, recent data point to the ability of xenobiotics to disrupt EVT migration. These xenobiotics include heavy metals, endocrine disrupting chemicals, and organic contaminants and have often been associated with adverse pregnancy outcomes. In most instances, xenobiotics appear to reduce EVT migration; however, there are select examples of enhanced motility after chemical exposure. In this review, we provide an overview of the 1) current experimental approaches used to evaluate EVT migration and invasion in vitro, 2) ability of environmental chemicals and pharmaceuticals to enhance or retard EVT motility, and 3) signaling pathways responsible for altered EVT migration that are sensitive to disruption by xenobiotics.
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Affiliation(s)
- Cassandra Meakin
- Department of Pharmacology and Toxicology, Rutgers University, Piscataway, NJ
| | - Emily S. Barrett
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Lauren M. Aleksunes
- Department of Pharmacology and Toxicology, Rutgers University, Piscataway, NJ,Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ,Center for Lipid Research, New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ
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15
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Huang L, Li P, Feng T, Xiong F. Changes of dendritic cell and natural killer cell on the cord blood with idiopathic fetal growth restriction. J Matern Fetal Neonatal Med 2021; 35:7526-7531. [PMID: 34380371 DOI: 10.1080/14767058.2021.1951214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the characteristics of dendritic cells (DC) and natural killer cells (NK) in umbilical cord blood of pregnant patients diagnosed with idiopathic fetal growth restriction (IFGR). METHODS A prospective study cohort of IFGR patients was established who were in the third trimester (28-36 weeks), with a healthy, pregnant woman cohort selected as controls. Umbilical cord blood was collected. RESULTS The study included 50 pregnant women in the IFGR group and 50 pregnant women in the healthy, control group. The incidence of SGA in the IFGR group was 52.0%, and the incidence of preterm birth was 18.0%. The incidence of neonatal complications in neonates with live birth in the IFGR group was 12.0%. The birth weight, body length and placental weight of the newborns in the IFGR group were significantly lower than those in the control group (p < .05). Flow cytometry revealed no significant difference in the proportion or maturity of DC in umbilical cord blood between IFGR group and control group (p > .05). The proportion of NK cells in umbilical cord blood of IFGR group was significantly higher than that of normal control group. The proportion of CD56dimCD16+ NK cells was also significantly higher than that of the normal control group (p < .05), but the expression of NK cell surface killing activator receptor NKG2D and inhibitory receptor NKG2A was not statistically significant (p > .05). CONCLUSION The number and proportion of DC cells in cord blood may not be the key factors affecting the outcomes observed during FGR pregnancies. However, we found the proportion of NK cells in cord blood to be significantly increased, as well as the ratio of CD56dimCD16 + NK to CD56highCD16-NK to be imbalanced, which may be one of the pathogenesis of the pathological pregnancy leading to IFGR.
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Affiliation(s)
- Lili Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, PR China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, PR China
| | - Ping Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, PR China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, PR China
| | - Ting Feng
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, PR China
| | - Fei Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, PR China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, PR China
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16
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Abstract
OBJECTIVE To investigate the literature and determine if prematurity has an impact on long-term adverse kidney outcomes. DESIGN Systematic review. DATA SOURCES OVID Medline, PubMed, SCOPUS, CINAHL and EMBASE databases were searched for studies relating to the adverse outcomes of prematurity from 1990 to April 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES All articles published between January 1990 and April 2021 that investigated whether premature infants developed long-term adverse renal outcomes were included in this review. Articles must have been human studies and written in English. Case series with less than 20 participants and case studies were excluded. DATA EXTRACTION AND SYNTHESIS One reviewer completed the database searches. Article selection was performed independently and in a non-blinded manner by both reviewers. Initial screening was by title and abstract. Full texts of remaining articles were reviewed. Articles for which inclusion was unclear were re-reviewed by both reviewers, and a unanimous decision was taken as to whether they should be included. The Newcastle-Ottawa Scale was used for quality assessment of the included articles. RESULTS The literature search yielded 31 human studies, which investigated the short-term and long-term kidney outcomes of prematurity. These studies were conducted in 17 different countries. The most common outcomes measured were blood pressure (BP) and glomerular filtration rate. Other common outcomes measured included kidney size and mass, proteinuria, albuminuria, chronic kidney disease (CKD) and physical parameters such as height, weight and body mass index. CONCLUSION Prematurity is likely linked to increased risk of kidney dysfunction and high BP in childhood and into early adulthood. Premature birth conferred a twofold increased risk of CKD and extremely premature birth conferred a threefold increased risk of CKD. However, further larger multicentre studies are needed to draw definitive conclusions on the long-term kidney outcomes of prematurity.
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Affiliation(s)
- Ananya Sangla
- Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Yogavijayan Kandasamy
- Department of Neonatology, Townsville Hospital and Health Service, Townsville, Queensland, Australia
- The University of Newcastle, Callaghan, New South Wales, Australia
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17
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Postnatal Expression Profile of MicroRNAs Associated with Cardiovascular Diseases in 3- to 11-Year-Old Preterm-Born Children. Biomedicines 2021; 9:biomedicines9070727. [PMID: 34202871 PMCID: PMC8301298 DOI: 10.3390/biomedicines9070727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/11/2021] [Accepted: 06/22/2021] [Indexed: 01/07/2023] Open
Abstract
(1) Background: Preterm-born children have an increased cardiovascular risk with the first clinical manifestation during childhood and/or adolescence. (2) Methods: The occurrence of overweight/obesity, prehypertension/hypertension, valve problems or heart defects, and postnatal microRNA expression profiles were examined in preterm-born children at the age of 3 to 11 years descending from preterm prelabor rupture of membranes (PPROM) and spontaneous preterm birth (PTB) pregnancies. The whole peripheral blood gene expression of 29 selected microRNAs associated with cardiovascular diseases was the subject of our interest. (3) Results: Nearly one-third of preterm-born children (32.43%) had valve problems and/or heart defects. The occurrence of systolic and diastolic prehypertension/hypertension was also inconsiderable in a group of preterm-born children (27.03% and 18.92%). The vast majority of children descending from either PPROM (85.45%) or PTB pregnancies (85.71%) had also significantly altered microRNA expression profiles at 90.0% specificity. (4) Conclusions: Postnatal microRNA expression profiles were significantly influenced by antenatal and early postnatal factors (gestational age at delivery, birth weight of newborns, and condition of newborns at the moment of birth). These findings may contribute to the explanation of increased cardiovascular risk in preterm-born children. These findings strongly support the belief that preterm-born children should be dispensarized for a long time to have access to specialized medical care.
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18
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Supraphysiological estradiol levels on the hCG trigger day are associated with SGA for singletons born from fresh embryo transfer. J Dev Orig Health Dis 2021; 13:244-251. [PMID: 33971999 DOI: 10.1017/s2040174421000234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The effects of supraphysiological estradiol (E2) on neonatal outcomes and the significance of specific E2 concentrations remain unclear. The purpose of this study was to investigate whether supraphysiological E2 levels on the human chorionic gonadotropin (hCG) trigger day are associated with small size for gestational age (SGA) in singletons born from fresh embryo transfer (ET) cycles. Patients with singleton pregnancies who delivered after the transfer of fresh embryos, during the period from July 2012 to December 2017, at our center were included. We excluded cycles involving a vanishing twin, maternal age >35 years, basal follicle-stimulating hormone ≥10 mIU/ml, or anti-Müllerian hormone ≤1 ng/ml. We then divided all cycles into five groups by E2 level on trigger day: group A, <2000 pg/ml (reference group); group B, 2000 pg/ml≤E2<2999 pg/ml; group C, 3000 pg/ml≤E2<3999 pg/ml; group D, 4000 pg/ml≤E2<4999 pg/ml; and group E, ≥5000 pg/ml. The prevalence of SGA among singletons from fresh ET was the primary outcome. The SGA rate significantly increased when the E2 level was ≥4000 pg/ml, as observed by comparing groups D (odds ratio [OR]: 1·79, 95% confidence interval [CI]: 1·16-2·76, P = 0·01) and E (OR: 1·68, 95% CI: 1·10-2·56, P = 0·02) with the reference group. Multivariate logistic regression indicated that a serum E2 level of at least 4000 pg/ml on the hCG trigger day was associated with increased SGA and with significant differences for groups D (adjusted OR [AOR]: 1·65, 95% CI: 1·05-2·59, P = 0·03) and E (AOR: 1·60, 95% CI: 1·03-2·53, P = 0·04) relative to the reference group. In conclusion, in fresh ET cycles, the supraphysiological E2 ≥4000 pg/ml on the hCG trigger day increases the risk of SGA.
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19
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Heo JS, Lee JM. The Long-Term Effect of Preterm Birth on Renal Function: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062951. [PMID: 33805740 PMCID: PMC8001027 DOI: 10.3390/ijerph18062951] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/29/2022]
Abstract
The preterm-born adult population is ever increasing following improved survival rates of premature births. We conducted a meta-analysis to investigate long-term effects of preterm birth on renal function in preterm-born survivors. We searched PubMed and EMBASE to identify studies that compared renal function in preterm-born survivors and full-term-born controls, published until 2 February 2019. A random effects model with standardized mean difference (SMD) was used for meta-analyses. Heterogeneity of the studies was evaluated using Higgin’s I2 statistics. Risk of bias was assessed using the Newcastle–Ottawa quality assessment scale. Of a total of 24,388 articles screened, 27 articles were finally included. Compared to full-term-born controls, glomerular filtration rate and effective renal plasma flow were significantly decreased in preterm survivors (SMD −0.54, 95% confidence interval (CI), −0.85 to −0.22, p = 0.0008; SMD −0.39, 95% CI, −0.74 to −0.04, p = 0.03, respectively). Length and volume of the kidneys were significantly decreased in the preterm group compared to the full-term controls (SMD −0.73, 95% CI, −1.04 to −0.41, p < 0.001; SMD −0.82, 95% CI, −1.05 to −0.60, p < 0.001, respectively). However, serum levels of blood urea nitrogen, creatinine, and cystatin C showed no significant difference. The urine microalbumin to creatinine ratio was significantly increased in the preterm group. Both systolic and diastolic blood pressures were also significantly elevated in the preterm group, although the plasma renin level did not differ. This meta-analysis demonstrates that preterm-born survivors may be subject to decreased glomerular filtration, increased albuminuria, decreased kidney size and volume, and hypertension even though their laboratory results may not yet deteriorate.
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Affiliation(s)
- Ju Sun Heo
- Department of Pediatrics, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea;
| | - Jiwon M. Lee
- Department of Pediatrics, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon 35015, Korea
- Correspondence: ; Tel.: +82-42-280-7152
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20
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Chiavaroli V, Derraik JGB, Jayasinghe TN, Rodrigues RO, Biggs JB, Battin M, Hofman PL, O'Sullivan JM, Cutfield WS. Lower insulin sensitivity remains a feature of children born very preterm. Pediatr Diabetes 2021; 22:161-167. [PMID: 33084185 DOI: 10.1111/pedi.13140] [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: 06/19/2020] [Revised: 09/24/2020] [Accepted: 10/15/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The first report of children born very preterm (<32 weeks of gestation) having insulin resistance was made 16 years ago. However, neonatal care has improved since. Thus, we aimed to assess whether children born very preterm still have lower insulin sensitivity than term controls. METHODS Participants were prepubertal children aged 5 to 11 years born very preterm (<32 weeks of gestation; n = 51; 61% boys) or at term (37-41 weeks; n = 50; 62% boys). Frequently sampled intravenous glucose tolerance tests were performed, and insulin sensitivity was calculated using Bergman's minimal model. Additional clinical assessments included anthropometry, body composition using whole-body dual-energy X-ray absorptiometry scans, clinic blood pressure, and 24-hour ambulatory blood pressure monitoring. RESULTS Children born very preterm were 0.69 standard deviation score (SDS) lighter (P < .001), 0.53 SDS shorter (P = .003), and had body mass index 0.57 SDS lower (P = .003) than children born at term. Notably, children born very preterm had insulin sensitivity that was 25% lower than term controls (9.4 vs 12.6 × 10-4 minutes-1 ·[mU/L]; P = .001). Other parameters of glucose metabolism, including fasting insulin levels, were similar in the two groups. The awake systolic blood pressure (from 24-hour monitoring) tended to be 3.1 mm Hg higher on average in children born very preterm (P = .054), while the clinic systolic blood pressure was 5.4 mm Hg higher (P = .002). CONCLUSIONS Lower insulin sensitivity remains a feature of children born very preterm, despite improvements in neonatal intensive care. As reported in our original study, our findings suggest the defect in insulin action in prepubertal children born very pretermis primarily peripheral and not hepatic.
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Affiliation(s)
- Valentina Chiavaroli
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Neonatal Intensive Care Unit, Pescara Public Hospital, Pescara, Italy
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Endocrinology Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | | | | | - Janene B Biggs
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Malcolm Battin
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
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21
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Biagioni EM, May LE, Broskey NT. The impact of advanced maternal age on pregnancy and offspring health: A mechanistic role for placental angiogenic growth mediators. Placenta 2021; 106:15-21. [PMID: 33601220 DOI: 10.1016/j.placenta.2021.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 01/01/2023]
Abstract
The birth rates among women of advanced maternal age (AMA) have risen over the last two decades; yet, pregnancies with AMA are considered high-risk and are associated with a significant increase in pregnancy complications. Although the mechanisms leading to pregnancy complications in women with AMA are not fully understood, it has been well established in the literature that offspring exposed to unfavorable environmental conditions in utero, such as gestational diabetes, preeclampsia, and/or intrauterine growth restriction during the early stages of development are subject to long-term health consequences. Additionally, angiogenic growth mediators, which drive vascular development of the placenta, are imbalanced in pregnancies with AMA. These same imbalances also occur in pregnancies complicated by preeclampsia, gestational diabetes, and obesity. This review discusses the impact of AMA on pregnancy and offspring health, and the potential mechanistic role of placental angiogenic growth mediators in the development of pregnancy complications at AMA.
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Affiliation(s)
- Ericka M Biagioni
- College of Health and Human Performance, Department of Kinesiology, East Carolina University, Greenville, NC, USA; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA
| | - Linda E May
- College of Health and Human Performance, Department of Kinesiology, East Carolina University, Greenville, NC, USA; School of Dental Medicine, Department of Foundational Sciences and Research, East Carolina University, Greenville, NC, USA
| | - Nicholas T Broskey
- College of Health and Human Performance, Department of Kinesiology, East Carolina University, Greenville, NC, USA; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, USA.
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22
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Pritchard N, Kaitu'u-Lino T, Harris L, Tong S, Hannan N. Nanoparticles in pregnancy: the next frontier in reproductive therapeutics. Hum Reprod Update 2020; 27:280-304. [PMID: 33279994 DOI: 10.1093/humupd/dmaa049] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Nanotechnology involves the engineering of structures on a molecular level. Nanomedicine and nano-delivery systems have been designed to deliver therapeutic agents to a target site or organ in a controlled manner, maximizing efficacy while minimizing off-target effects of the therapeutic agent administered. In both reproductive medicine and obstetrics, developing innovative therapeutics is often tempered by fears of damage to the gamete, embryo or developing foetus or of negatively impacting a woman's reproductive potential. Thus, nanomedicine delivery systems may provide alternative targeted intervention strategies, treating the source of the disease and minimizing long-term consequences for the mother and/or her foetus. OBJECTIVE AND RATIONALE This review summarizes the current state of nanomedicine technology in reproductive medicine and obstetrics, including safety, potential applications, future directions and the hurdles for translation. SEARCH METHODS A comprehensive electronic literature search of PubMed and Web of Science databases was performed to identify studies published in English up until February 2020. Relevant keywords were used to obtain information regarding use of nanoparticle technology in fertility and gene therapy, early pregnancy complications (ectopic pregnancy and gestational trophoblastic disease) and obstetric complications (preeclampsia, foetal growth restriction, preterm birth and gestational diabetes) and for selective treatment of the mother or foetus. Safety of specific nanoparticles to the gamete, embryo and foetus was also investigated. OUTCOMES Pre-clinical research in the development of nanoparticle therapeutic delivery is being undertaken in many fields of reproductive medicine. Non-hormonal-targeted nanoparticle therapy for fibroids and endometriosis may provide fertility-sparing medical management. Delivery of interventions via nanotechnology provides opportunities for gene manipulation and delivery in mammalian gametes. Targeting cytotoxic treatments to early pregnancy tissue provides an alternative approach to manage ectopic pregnancies and gestational trophoblastic disease. In pregnancy, nanotherapeutic delivery offers options to stably deliver silencing RNA and microRNA inhibitors to the placenta to regulate gene expression, opening doors to novel genetic treatments for preeclampsia and foetal growth restriction. Restricting delivery of teratogenic drugs to the maternal compartment (such as warfarin) may reduce risks to the foetus. Alternatively, targeted delivery of drugs to the foetus (such as those to treat foetal arrythmias) may minimize side effects for the mother. WIDER IMPLICATIONS We expect that further development of targeted therapies using nanoparticles in a reproductive setting has promise to eventually allow safe and directed treatments for conditions impacting the health and reproductive capacity of women and for the management of pregnancy and serious pregnancy complications.
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Affiliation(s)
- Natasha Pritchard
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Tu'uhevaha Kaitu'u-Lino
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, Diagnostics Discovery and Reverse Translation, University of Melbourne, Heidelberg, Victoria, Australia
| | - Lynda Harris
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
- Maternal and Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Maternal and Fetal Health Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester, UK
| | - Stephen Tong
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Natalie Hannan
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia
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23
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Cardiovascular risk factors in those born preterm - systematic review and meta-analysis. J Dev Orig Health Dis 2020; 12:539-554. [PMID: 33028453 DOI: 10.1017/s2040174420000914] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Emerging evidence demonstrates a link between preterm birth (PTB) and later life cardiovascular disease (CVD). We conducted a systematic review and meta-analysis to compare conventional CVD risk factors between those born preterm and at term. PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. The review protocol is registered in PROSPERO (CRD42018095005). CVD risk factors including systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index, lipid profile, blood glucose, and fasting insulin among those born preterm (<37 weeks' gestation) were compared with those born at term (≥37 weeks' gestation). Subgroup analyses based on gender, age, gestational at birth (<32 weeks' gestation and <28 weeks' gestation), and PTB associated with small for gestational age or average for gestational age were also performed. Fifty-six studies provided data on 308,987 individuals. Being born preterm was associated with 3.26 mmHg (95% confidence interval [CI] 2.08 to 4.44) higher mean SBP and 1.32 mmHg (95% CI: 0.61 to 2.04) higher mean DBP compared to being born at term. Subgroup analyses demonstrated that SBP was higher among (a) preterm compared to term groups from early adolescence until adulthood; (b) females born preterm but not among males born preterm compared to term controls; and (c) those born at <32 weeks or <28 weeks compared to term. Our meta-analyses demonstrate higher SBP and DBP among those born preterm compared to term. The difference in SBP is evident from early adolescence until adulthood.
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Senra JC, Yoshizaki CT, Doro GF, Ruano R, Gibelli MABC, Rodrigues AS, Koch VHK, Krebs VLJ, Zugaib M, Francisco RPV, Bernardes LS. Kidney impairment in fetal growth restriction: three-dimensional evaluation of volume and vascularization. Prenat Diagn 2020; 40:1408-1417. [PMID: 32583885 DOI: 10.1002/pd.5778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/28/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Renal development is impaired in fetal growth restriction (FGR). Renal size can be considered a surrogate of renal function in childhood, and could be impaired in that condition. Our aim was to evaluate the ratio of total renal volume, measured by three-dimensional ultrasound, to estimated fetal weight (TRV/EFW) among fetuses with and without growth restriction. Furthermore, we correlated TRV/EFW with fetal Doppler velocimetry and renal vascularization indexes and evaluated the association of renal volume and vascular parameters with adverse neonatal events in growth-restricted fetuses. METHODS In a retrospective cohort, TRV and renal vascularization of growth-restricted and normal fetuses were evaluated by three-dimensional ultrasonography and VOCAL technique. Independent samples t-tests and Mann-Whitney test were used for comparisons between groups. Logistic regression model was applied to evaluate the association between renal characteristics and adverse neonatal events. RESULTS Seventy-one growth-restricted fetuses were compared to 194 controls. The TRV/EFW was lower in the growth-restricted group (P < .001). In our sample, this ratio did not correlate with Doppler velocimetry parameters, renal vascular indexes or any adverse neonatal events. CONCLUSION The TRV/EFW ratio is decreased in FGR. Further studies are needed to investigate the association of this ratio with long-term renal outcomes.
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Affiliation(s)
- Janaína Campos Senra
- Department of Obstetrics and Gynecology, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Carlos Tadashi Yoshizaki
- Department of Obstetrics and Gynecology, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Giovana Farina Doro
- Department of Obstetrics and Gynecology, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Rodrigo Ruano
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | | | - Agatha Sacramento Rodrigues
- Statistician, Department of Obstetrics and Gynecology, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Vera Hermina Kalika Koch
- Pediatric Nephrology Unit, Department of Pediatrics, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Vera Lúcia Jornada Krebs
- Neonatal Unit, Department of Pediatrics, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Marcelo Zugaib
- Department of Obstetrics and Gynecology, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | | | - Lisandra Stein Bernardes
- Department of Obstetrics and Gynecology, Clinics Hospital, University of São Paulo, São Paulo, Brazil
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25
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Lin F, Yang C, Feng T, Yang S, Zhou R, Li H. The Maternal-Fetal Interface in Small-for-Gestational-Age Pregnancies Is Associated With a Reduced Quantity of Human Decidual NK Cells With Weaker Functional Ability. Front Cell Dev Biol 2020; 8:633. [PMID: 33015028 PMCID: PMC7509437 DOI: 10.3389/fcell.2020.00633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 06/24/2020] [Indexed: 12/17/2022] Open
Abstract
Small for gestational age (SGA) refers to a birth weight that is less than the 10th percentile of the mean weight of infants at the same gestational age. This condition is associated with a variety of complications, and a high risk of cardiovascular and cerebrovascular diseases in adulthood. Decidual natural killer (dNK) cells at the maternal–fetal interface have received significant research attention in terms of normal pregnancy or miscarriage; however, data relating to SGA are limited. In this study, we aimed to investigate the characteristics and regulatory role of dNK cells at the maternal–fetal interface in SGA. Using immunofluorescence assays, we found that dNK cells maintained close contact with extra-villous trophoblasts, and the proportion of dNK cells in SGA decreased more than in appropriate for gestational age (AGA). Flow cytometry also showed that there was a significantly lower percentage of dNK cells in SGA (25.01 ± 2.43%) than in AGA (34.25 ± 2.30%) (p = 0.0103). The expression of the inhibitory receptor NKG2A on dNK cells and the secretion levels of both perforin and TGF-β1 from dNK cells were significantly higher in SGA than in AGA, while the cytotoxicity of dNK cells in SGA against K562 cells was attenuated. Compared to AGA, the functional ability of dNK cells in SGA showed significant functional impairment in promoting proliferation, migration, invasion, and tube formation in trophoblast cells or vascular endothelial cells. The abnormal function of dNK cells may affect fetal growth and development, and could therefore participate in the pathogenesis of SGA.
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Affiliation(s)
- Fang Lin
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chuan Yang
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ting Feng
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shuo Yang
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Rong Zhou
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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26
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Color of Colon Content of Normal and Intrauterine Growth-Restricted Weaned Piglets is Associated with Specific Microbial Taxa and Physiological Parameters. Animals (Basel) 2020; 10:ani10061073. [PMID: 32580422 PMCID: PMC7341333 DOI: 10.3390/ani10061073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/09/2020] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Selection for hyperprolific sows has increased litter sizes but has also increased the number of small piglets per litter. A large percentage of these piglets have been exposed to intrauterine growth restriction (IUGR) during gestation, and this is accompanied by higher mortality and reduced growth in pig production. In humans, IUGR is associated with long-term health consequences such as cardiovascular disease, as well as metabolic diseases such as type 2 diabetes. It is therefore of interest to study the gut microbiota (GM) of IUGR compared to normal piglets, as a well-balanced GM is associated with improved health outcomes. Differences in feces color was associated with different metabolite signatures and specific GM signatures. Understanding these differences in the composition of the microbial community and its functional capacity during weaning is important for pig production, as the GM play important roles in pig health and growth performance. Abstract A well-balanced gut microbiome is associated with improved health outcomes, but to date, the GM of IUGR piglets have only been sparsely investigated. Here, we investigated GM composition, color of colon content, and blood parameters of 20 IUGR and 20 normal 24-day-old piglets. No significant differences were detected in colon microbiota composition between IUGR and the normal piglets with respect to alpha and beta diversity measures. The colon content of these piglets displayed three colors: brown, black, and yellow. Interestingly, the color of the colon content varied with microbial community composition, with significant differences in the relative abundance of taxa belonging to Fusobacteria and Treponema. Fusobacteria were most abundant in yellow fecal samples, with a mean relative abundance around 5.6%, whereas this was 0.51% within brown and 0.02% for the black fecal samples. Fusobacteria positively correlated with total blood protein, albumin, and triglycerides. Contrarily, Treponema was at 0.9% the most abundant in black fecal samples, while present at 0.1% of relative abundance in brown fecal samples and 0.01% in yellow samples, correlating positively with blood iron content. This study indicates that colon/fecal content color can be used as indicator for specific GM and metabolite signatures.
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27
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Chalouhi GE, Millischer AÉ, Mahallati H, Siauve N, Melbourne A, Grevent D, Vinit N, Heidet L, Aigrain Y, Ville Y, Blanc T, Salomon LJ. The use of fetal MRI for renal and urogenital tract anomalies. Prenat Diagn 2019; 40:100-109. [PMID: 31736096 DOI: 10.1002/pd.5610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/20/2022]
Abstract
Fetal anomalies are detected in approximately 2% of all fetuses and, among these, genitourinary tract abnormalities account for 30% to 50% of all structural anomalies present at birth. Although ultrasound remains the first line diagnostic modality, fetal MRI provides important additional structural and functional information, especially with the development of faster sequences and the use of functional sequences. The added value of MRI-based imaging is three-fold: (a) improvement of diagnostic accuracy by adequate morphological examination, (b) detection of additional anomalies, and (c) in addition, MRI has the potential to provide information regarding renal function. In this review, we describe the role of fetal MRI in the anatomical evaluation of renal and urogenital tract anomalies, and we also touch upon the contribution of functional MRI to the diagnostic workup of these conditions.
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Affiliation(s)
- Gihad E Chalouhi
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Division of Fetal Medicine, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon.,Université de Paris, Paris, France
| | - Anne-Élodie Millischer
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Houman Mahallati
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Nathalie Siauve
- Imagerie Médicale, Hôpital Louis Mourier APHP, Colombes, France
| | - Andrew Melbourne
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - David Grevent
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Nicolas Vinit
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France
| | - Laurence Heidet
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Pediatric Nephrology Department, Hôpital Universitaire Necker-Enfants Malades, Sorbonne Paris Cité University, Paris, France
| | - Yves Aigrain
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France
| | - Yves Ville
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Thomas Blanc
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,INSERM U1151-CNRS UMR 8253, Université de Paris, Institut Necker-Enfants Malades, Paris, France.,Université de Paris, Paris, France
| | - Laurent J Salomon
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Université de Paris, Paris, France
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28
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Pritchard NL, Hiscock RJ, Lockie E, Permezel M, McGauren MFG, Kennedy AL, Green B, Walker SP, Lindquist AC. Identification of the optimal growth charts for use in a preterm population: An Australian state-wide retrospective cohort study. PLoS Med 2019; 16:e1002923. [PMID: 31584941 PMCID: PMC6777749 DOI: 10.1371/journal.pmed.1002923] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/09/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Preterm infants are a group at high risk of having experienced placental insufficiency. It is unclear which growth charts perform best in identifying infants at increased risk of stillbirth and other adverse perinatal outcomes. We compared 2 birthweight charts (population centiles and INTERGROWTH-21st birthweight centiles) and 3 fetal growth charts (INTERGROWTH-21st fetal growth charts, World Health Organization fetal growth charts, and Gestation Related Optimal Weight [GROW] customised growth charts) to identify which chart performed best in identifying infants at increased risk of adverse perinatal outcome in a preterm population. METHODS AND FINDINGS We conducted a retrospective cohort study of all preterm infants born at 24.0 to 36.9 weeks gestation in Victoria, Australia, from 2005 to 2015 (28,968 records available for analysis). All above growth charts were applied to the population. Proportions classified as <5th centile and <10th centile by each chart were compared, as were proportions of stillborn infants considered small for gestational age (SGA, <10th centile) by each chart. We then compared the relative performance of non-overlapping SGA cohorts by each chart to our low-risk reference population (infants born appropriate size for gestational age [>10th and <90th centile] by all intrauterine charts [AGAall]) for the following perinatal outcomes: stillbirth, perinatal mortality (stillbirth or neonatal death), Apgar <4 or <7 at 5 minutes, neonatal intensive care unit admissions, suspicion of poor fetal growth leading to expedited delivery, and cesarean section. All intrauterine charts classified a greater proportion of infants as <5th or <10th centile than birthweight charts. The magnitude of the difference between birthweight and fetal charts was greater at more preterm gestations. Of the fetal charts, GROW customised charts classified the greatest number of infants as SGA (22.3%) and the greatest number of stillborn infants as SGA (57%). INTERGROWTH classified almost no additional infants as SGA that were not already considered SGA on GROW or WHO charts; however, those infants classified as SGA by INTERGROWTH had the greatest risk of both stillbirth and total perinatal mortality. GROW customised charts classified a larger proportion of infants as SGA, and these infants were still at increased risk of mortality and adverse perinatal outcomes compared to the AGAall population. Consistent with similar studies in this field, our study was limited in comparing growth charts by the degree of overlap, with many infants classified as SGA by multiple charts. We attempted to overcome this by examining and comparing sub-populations classified as SGA by only 1 growth chart. CONCLUSIONS In this study, fetal charts classified greater proportions of preterm and stillborn infants as SGA, which more accurately reflected true fetal growth restriction. Of the intrauterine charts, INTERGROWTH classified the smallest number of preterm infants as SGA, although it identified a particularly high-risk cohort, and GROW customised charts classified the greatest number at increased risk of perinatal mortality.
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Affiliation(s)
- Natasha L. Pritchard
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Richard J. Hiscock
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Elizabeth Lockie
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Permezel
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Monica F. G. McGauren
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Amber L. Kennedy
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Brittany Green
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan P. Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anthea C. Lindquist
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- * E-mail:
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Cauldwell M, Steer PJ, von Klemperer K, Kaler M, Grixti S, Hale J, O'Heney J, Warriner D, Curtis S, Mohan AR, Dockree S, Mackillop L, Head CEG, Sterrenberg M, Wallace S, Freeman LJ, Patridge G, Baalman JH, McAuliffe FM, Simpson M, Walker N, Girling J, Siddiqui F, Bolger AP, Bredaki F, Walker F, Vause S, Gatzoulis MA, Johnson MR, Roberts A. Maternal and neonatal outcomes in women with history of coronary artery disease. Heart 2019; 106:380-386. [DOI: 10.1136/heartjnl-2019-315325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/25/2019] [Accepted: 08/05/2019] [Indexed: 01/12/2023] Open
Abstract
BackgroundPregnancy outcomes in women with pre-existing coronary artery disease (CAD) are poorly described. There is a paucity of data therefore on which to base clinical management to counsel women, with regard to both maternal and neonatal outcomes.MethodWe conducted a retrospective multicentre study of women with established CAD delivering at 16 UK specialised cardiac obstetric clinics. We included pregnancies of 24 weeks’ gestation or more, delivered between January 1998 and October 2018. Data were collected on maternal cardiovascular, obstetric and neonatal events.Results79 women who had 92 pregnancies (94 babies including two sets of twins) were identified. 35.9% had body mass index >30% and 24.3% were current smokers. 18/79 (22.8%) had prior diabetes, 27/79 (34.2%) had dyslipidaemia and 21/79 (26.2%) had hypertension. The underlying CAD was due to atherosclerosis in 52/79 (65.8%), spontaneous coronary artery dissection (SCAD) in 11/79 (13.9%), coronary artery spasm in 7/79 (8.9%) and thrombus in 9/79 (11.4%).There were six adverse cardiac events (6.6% event rate), one non-ST elevation myocardial infarction at 23 weeks’ gestation, two SCAD recurrences (one at 26 weeks’ gestation and one at 9 weeks’ postpartum), one symptomatic deterioration in left ventricular function and two women with worsening angina. 14% of women developed pre-eclampsia, 25% delivered preterm and 25% of infants were born small for gestational age.ConclusionWomen with established CAD have relatively low rates of adverse cardiac events in pregnancy. Rates of adverse obstetric and neonatal events are greater, highlighting the importance of multidisciplinary care.
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30
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Increased aortic wave reflection contributes to higher systolic blood pressure in adolescents born preterm. J Hypertens 2019; 36:1514-1523. [PMID: 29601410 DOI: 10.1097/hjh.0000000000001719] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the wave reflection characteristics in the aortic arch and common carotid artery of ex-preterm adolescents and assess their relationship to central blood pressure in a cohort followed prospectively since birth. METHODS Central blood pressures, pulse wave velocity, augmentation index, microvascular reactive hyperemia, arterial distensibility, compliance and stiffness index, and also aortic and carotid wave intensity were measured in 18-year-olds born extremely preterm at below 28 weeks' gestation (n = 76) and term-born controls (n = 42). RESULTS Compared with controls, ex-preterm adolescents had higher central systolic (111 ± 11 vs. 105 ± 10 mmHg; P < 0.001) and diastolic blood pressures (73 ± 7 vs. 67 ± 7 mmHg; P < 0.001). Although conventional measures of arterial function and biomechanics such as pulse wave velocity and augmentation index were no different between groups, wave intensity analysis revealed elevated backward compression wave area (-0.39 ± 0.21 vs. -0.29 ± 0.17 W/m/s × 10; P = 0.03), backward compression wave pressure change (9.0 ± 3.5 vs. 6.6 ± 2.5 mmHg; P = 0.001) and reflection index (0.44 ± 0.15 vs. 0.32 ± 0.08; P < 0.001) in the aorta of ex-preterm adolescents compared with controls. These changes were less pronounced in the carotid artery. On multivariable analysis, forward and backward compression wave areas were the only biomechanical variables associated with central systolic pressure. CONCLUSIONS Ex-preterm adolescents demonstrate elevated wave reflection indices in the aortic arch, which correlate with central systolic pressure. Wave intensity analysis may provide a sensitive novel marker of evolving vascular dysfunction in ex-preterm survivors.
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Abstract
Intrauterine growth restriction (IUGR) is an important cause of fetal, perinatal and neonatal morbidity and mortality. IUGR occurs because of multiple reasons. Neonates with IUGR experience acute problems in the perinatal and early neonatal period that can be life-threatening. The unfavorable uterine environment causing growth restriction results in programming that predisposes IUGR infants to long-term health issues such as poor physical growth, metabolic syndrome, cardiovascular disease, neurodevelopmental impairment and endocrine abnormalities, warranting careful monitoring. It is imperative to strike the balance between achieving optimal catch-up to promote normal development, while preventing the onset of cardiovascular and metabolic disorders in the long-term.
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Affiliation(s)
- Kalpashri Kesavan
- Division of Neonatology & Developmental Biology, Department of Pediatrics, David Geffen School of Medicine at UCLA, UCLA Mattel Children's Hospital, 10833 Le Conte Avenue, B2-413 MDCC, Los Angeles, CA 90095, USA.
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine at UCLA, UCLA Mattel Children's Hospital, 10833 Le Conte Avenue, 22-412 MDCC, Los Angeles, CA 90095, USA
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32
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Kuo AH, Li C, Huber HF, Clarke GD, Nathanielsz PW. Intrauterine growth restriction results in persistent vascular mismatch in adulthood. J Physiol 2018; 596:5777-5790. [PMID: 29098705 PMCID: PMC6265527 DOI: 10.1113/jp275139] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/31/2017] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Intrauterine growth restriction (IUGR) increases offspring risk of chronic diseases later in life, including cardiovascular dysfunction. Our prior studies suggest biventricular cardiac dysfunction and vascular impairment in baboons who were IUGR at birth because of moderate maternal nutrient reduction. The current study reveals changes in artery sizes, distensibility, and blood flow pattern in young adult IUGR baboons, which may contribute to cardiac stress. The pattern of abnormality observed suggests that vascular redistribution seen with IUGR in fetal life may continue into adulthood. ABSTRACT Maternal nutrient reduction induces intrauterine growth restriction (IUGR), increasing risks of chronic diseases later in life, including cardiovascular dysfunction. Using ultrasound, we determined regional blood flow, blood vessel sizes, and distensibility in IUGR baboons (8 males, 8 females, 8.8 years, similar to 35 human years) and controls (12 males, 12 females, 9.5 years). The measured blood vessels were larger in size in the males compared to females before but not after normalization to body surface area. Smaller IUGR normalized blood vessel sizes were observed in the femoral and external iliac arteries but not the brachial or common carotid arteries and not correlated significantly with birth weight. Mild decrease in distensibility in the IUGR group was seen in the iliac but not the carotid arteries without between-sex differences. In IUGR baboons there was increased carotid arterial blood flow velocity during late systole and diastole. Overall, our findings support the conclusion that region specific vascular and haemodynamic changes occur with IUGR, which may contribute to the occurrence of later life cardiac dysfunction. The pattern of alteration observed suggests vascular redistribution efforts in response to challenges in the perinatal period may persist into adulthood. Further studies are needed to determine the life course progression of these changes.
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Affiliation(s)
- Anderson H. Kuo
- Department of Radiology and Research Imaging InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Cun Li
- Department of Animal ScienceUniversity of WyomingLaramieWYUSA
- Southwest National Primate Research CenterSan AntonioTXUSA
| | | | - Geoffrey D. Clarke
- Department of Radiology and Research Imaging InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
- Southwest National Primate Research CenterSan AntonioTXUSA
| | - Peter W. Nathanielsz
- Department of Animal ScienceUniversity of WyomingLaramieWYUSA
- Southwest National Primate Research CenterSan AntonioTXUSA
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Hoyt AT, Canfield MA, Romitti PA, Botto LD, Anderka MT, Krikov SV, Feldkamp ML. Does Maternal Exposure to Secondhand Tobacco Smoke During Pregnancy Increase the Risk for Preterm or Small-for-Gestational Age Birth? Matern Child Health J 2018; 22:1418-1429. [PMID: 29574536 DOI: 10.1007/s10995-018-2522-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction While associations between active smoking and various adverse birth outcomes (ABOs) have been reported in the literature, less is known about the impact of secondhand smoke (SHS) on many pregnancy outcomes. Methods We examined the relationship between maternal exposure to SHS during pregnancy and preterm (< 37 weeks gestation) and small-for-gestational age (SGA; assessed using sex-, race/ethnic-, and parity-specific growth curves) singleton births using non-smoking controls from the National Birth Defects Prevention Study (1997-2011). Multivariable logistic regression models for household, workplace/school, and combined SHS exposure-controlled for maternal education, race/ethnicity, pre-pregnancy body mass index, and high blood pressure-were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Interaction was assessed for maternal folic acid supplementation, alcohol use, age at delivery, and infant sex. Results Infants of 8855 mothers were examined in the preterm birth analysis with 666 (7.5%) categorized as preterm, 574 moderately preterm (32-36 weeks), and 92 very preterm (< 32 weeks). For the SGA analysis, infants of 8684 mothers were examined with 670 (7.7%) categorized as SGA. The aORs for mothers reporting both household and workplace/school SHS were elevated for preterm (aOR 1.99; 95% CI 1.13-3.50) and moderately preterm birth (32-36 weeks) (aOR 2.17; 95% CI 1.22-3.88). No results for the SGA analysis achieved significance, nor was evidence of interaction evident. Conclusion The findings suggest an association between SHS from multiple exposure sources and preterm birth, but no evidence for association with SGA births. Continued study of SHS and ABOs is needed to best inform public health prevention programs.
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Affiliation(s)
- Adrienne T Hoyt
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 W. 49th St., Austin, TX, 78714-9347, USA.
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 W. 49th St., Austin, TX, 78714-9347, USA
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marlene T Anderka
- Massachusetts Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, MA, USA
| | - Sergey V Krikov
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Abstract
Under physiological conditions, the arterial endothelium exerts a powerful protective influence to maintain vascular homeostasis. However, during the development of vascular disease, these protective activities are lost, and dysfunctional endothelial cells actually promote disease pathogenesis. Numerous investigations have analyzed the characteristics of dysfunctional endothelium with a view to understanding the processes responsible for the dysfunction and to determining their role in vascular pathology. This review adopts an alternate approach: reviewing the mechanisms that contribute to the initial formation of a healthy protective endothelium and on how those mechanisms may be disrupted, precipitating the appearance of dysfunctional endothelial cells and the progression of vascular disease. This approach, which highlights the role of endothelial adherens junctions and vascular endothelial-cadherin in endothelial maturation and endothelial dysfunction, provides new insight into the remarkable biology of this important cell layer and its role in vascular protection and vascular disease.
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Luu TM, Rehman Mian MO, Nuyt AM. Long-Term Impact of Preterm Birth: Neurodevelopmental and Physical Health Outcomes. Clin Perinatol 2017; 44:305-314. [PMID: 28477662 DOI: 10.1016/j.clp.2017.01.003] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Preterm birth severely disrupts the normal developmental maturation of organ systems, resulting in lasting adverse effects. High blood pressure, cardiac dysfunction, obstructive lung disease, elevated blood glucose, and mental health problems occur earlier and at higher rates in the preterm-born than in the term populations. Disadvantageous health conditions may have a significant impact on the well-being of preterm-born individuals from childhood through adulthood. This review summarizes the impact of preterm birth on neurodevelopment and on cardiovascular, renal, metabolic, and pulmonary health.
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Affiliation(s)
- Thuy Mai Luu
- Department of Pediatrics, Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.
| | - Muhammad Oneeb Rehman Mian
- Department of Biomedical Sciences, Fetomaternal and Neonatal Pathologies Axis, Research Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, 3175 Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Anne Monique Nuyt
- Department of Pediatrics, Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
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Joo Turoni C, Chaila Z, Chahla R, Bazán de Casella MC, Peral de Bruno M. Vascular Function in Children with Low Birthweight and Its Relationship with Early Markers of Cardiovascular Risk. Horm Res Paediatr 2017; 85:396-405. [PMID: 27173666 DOI: 10.1159/000445949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/05/2016] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Low birthweight (LBW) increases the risk of developing cardiovascular diseases (CVD). Few studies have established its impact at early ages. AIMS To study endothelial function (EF) and arterial stiffness (AS) and their relationship to early markers of CVD risk in children with LBW. METHODS In children with LBW (4-6 years; n = 53), anthropometric, haemodynamic and laboratory parameters, including HOMA-IR, hs-CRP, adiponectin and leptin, were determined. EF and AS were evaluated by digital pulse plethysmography. Data were compared with a control group (n = 33). RESULTS In both groups, anthropometric parameters remained within normal limits. Insulin and HOMA-IR had normal values, but they were significantly augmented in LBW children. LBW children showed higher leptin and hs-CRP levels than the control group. The LBW group had decreased EF (37.5 ± 5.6%) compared with the control group (75.0 ± 11.9%; p < 0.01), however without differences in AS. In LBW children, EF was negatively correlated with waist circumference, leptin, hs-CRP and with a cumulative score of risk factors. CONCLUSIONS LBW children display altered EF that is related to early changes in CVD risk factors. The differences found in the metabolic parameters might indicate a pro-inflammatory state. This hypothesis is also supported by the laboratory findings and the correlation between EF and the number of CVD risk factors, suggesting that very early lifestyle interventions may be needed.
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Affiliation(s)
- Claudio Joo Turoni
- Departamento Biomx00E9;dico-Fisiologx00ED;a, Facultad de Medicina, UNT, INSIBO-CONICET, Tucumx00E1;n, Argentina
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Sultana Z, Maiti K, Aitken J, Morris J, Dedman L, Smith R. Oxidative stress, placental ageing-related pathologies and adverse pregnancy outcomes. Am J Reprod Immunol 2017; 77. [PMID: 28240397 DOI: 10.1111/aji.12653] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/20/2017] [Indexed: 12/22/2022] Open
Abstract
Oxidative stress (OS), an imbalance between free radical generation and antioxidant defence, is recognized as a key factor in the pathogenesis of adverse pregnancy outcomes. Although OS is a common future of normal pregnancy, persistent, overwhelming OS leads to consumption and decline of antioxidants, affecting placental antioxidant capacity and reducing systems. The accumulation of OS causes damage to lipids, proteins and DNA in the placental tissue that induces a form of accelerated ageing. Premature ageing of the placenta is associated with placental insufficiency that prevents the organ meeting the needs of the foetus, and as a consequence, the viability of the foetus is compromised. This review summarizes the literature regarding the role of OS and premature placental ageing in the pathophysiology of pregnancy complications.
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Affiliation(s)
- Zakia Sultana
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, NSW, Australia.,Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Reproductive Science, University of Newcastle, Newcastle, NSW, Australia
| | - Kaushik Maiti
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, NSW, Australia.,Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Reproductive Science, University of Newcastle, Newcastle, NSW, Australia
| | - John Aitken
- Priority Research Centre for Reproductive Science, University of Newcastle, Newcastle, NSW, Australia
| | - Jonathan Morris
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia
| | - Lee Dedman
- Faculty of Science and Information Technology, School of Design, Communication and Information Technology, University of Newcastle, Newcastle, NSW, Australia
| | - Roger Smith
- Mothers and Babies Research Centre, Hunter Medical Research Institute, Newcastle, NSW, Australia.,Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Reproductive Science, University of Newcastle, Newcastle, NSW, Australia
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Bruel A, Rozé JC, Quere MP, Flamant C, Boivin M, Roussey-Kesler G, Allain-Launay E. Renal outcome in children born preterm with neonatal acute renal failure: IRENEO-a prospective controlled study. Pediatr Nephrol 2016; 31:2365-2373. [PMID: 27335060 DOI: 10.1007/s00467-016-3444-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/21/2016] [Accepted: 06/03/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Acute kidney injury (AKI) is a severe complication of prematurity, with currently unknown consequences for renal function in childhood. The objective of this study was to search for signs of reduced nephron number in children aged 3-10 years who had been born preterm with neonatal AKI and compare this group to control children. METHODS IRENEO was a prospective, controlled study conducted in 2013 in Nantes University Hospital. Children who were born at less than 33 weeks gestational age (GA) and included in the LIFT cohort were eligible for entry. Twenty-five children with AKI (AKI-C) and 49 no-AKI children were matched on a propensity score of neonatal AKI and age. AKI was defined as a serum creatinine level higher than critical values: 1.6 mg/dl (GA 24-27 weeks), 1.1 mg/dl (28-29) and 1 mg/dl (GA 30-32). Renal function was evaluated during childhood. RESULTS Mean age of the children at the time of the study was 6.6 years. No difference in microalbuminuria, estimated glomerular filtration rate (GFR) or pulse wave velocity was observed between the two groups. Renal volume was lower in the AKI-C group (57 vs. 68; p = 0.04). In the entire cohort, 10.8 % had a microalbuminuria, and 23 % had a diminished GFR (median 79 ml/min/1.73 m2). The GFR was lower in children with very low birth weight of <1000 g (99 vs. 107 ml/min/1.73 m2; p = 0.04). CONCLUSION In children born preterm, neonatal AKI does not seem to influence renal function. However, independent ofAKI, a large proportion of very preterm infants, especially those with very low birth weight, presented with signs of nephron reduction, thus requiring follow-up with a nephrologist.
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Affiliation(s)
- Alexandra Bruel
- Department of Pediatrics, Nantes University Hospital, Nantes, France.
- CIC 004, INSERM-Nantes University Hospital, Nantes, France.
| | - Jean-Christophe Rozé
- Neonatal Intensive Care Unit, Nantes University Hospital, Nantes, France
- CIC 004, INSERM-Nantes University Hospital, Nantes, France
| | - Marie-Pierre Quere
- Department of Pediatric Radiology, Nantes University Hospital, Nantes, France
| | - Cyril Flamant
- Neonatal Intensive Care Unit, Nantes University Hospital, Nantes, France
- CIC 004, INSERM-Nantes University Hospital, Nantes, France
| | - Marion Boivin
- CIC 004, INSERM-Nantes University Hospital, Nantes, France
| | - Gwenaëlle Roussey-Kesler
- Department of Pediatrics, Nantes University Hospital, Nantes, France
- CIC 004, INSERM-Nantes University Hospital, Nantes, France
| | - Emma Allain-Launay
- Department of Pediatrics, Nantes University Hospital, Nantes, France
- CIC 004, INSERM-Nantes University Hospital, Nantes, France
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Odri Komazec I, Posod A, Schwienbacher M, Resch M, Pupp Peglow U, Kiechl S, Baumgartner D, Kiechl-Kohlendorfer U. Aortic Elastic Properties in Preschool Children Born Preterm. Arterioscler Thromb Vasc Biol 2016; 36:2268-2274. [PMID: 27659099 DOI: 10.1161/atvbaha.116.308144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/09/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Preterm birth predisposes children to the development of cardiovascular diseases in adulthood. The aim of this study was to characterize elastic properties of the aorta at preschool age and test the hypothesis that prematurity is associated with decreased aortic distensibility and increased stiffness, both of which are predictors of increased cardiovascular risk. APPROACH AND RESULTS In an observational study of 76 five- to seven-year-old children born at a gestational age <32 weeks and 79 term-born controls, elastic parameters of the ascending and descending abdominal aorta were determined noninvasively by means of M mode echocardiographic tracings and calculated using computerized wall contour analysis. Compared with children born at term, the preterm group showed significantly reduced distensibility and increased stiffness of the descending abdominal aorta. These results remained significant under multivariable adjustment for birth weight z score, maternal smoking in pregnancy, maternal education, family history of cardiovascular disease, breastfeeding, childhood nutrition, and current body mass index z score (multivariable odds ratios and 95% confidence intervals 5.1, 1.7-15.9; P=0.005 and 2.8, 1.0-7.9; P=0.046, respectively). Further adjustment for intravenous lipid therapy attenuated the strength of association. Elastic properties of the ascending aorta did not differ between the 2 study groups. CONCLUSIONS Children born preterm are characterized by decreased elastic properties of the descending abdominal aorta potentially attributable to impaired viscoelastic properties of and lipid damage to the aorta. Clinical follow-up of preterm infants with a focus on aortic elastic properties may be useful for tailoring early prevention programs and counteracting cardiovascular risk in adulthood.
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Affiliation(s)
- Irena Odri Komazec
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Anna Posod
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Martin Schwienbacher
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Maria Resch
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Ulrike Pupp Peglow
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Stefan Kiechl
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Daniela Baumgartner
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.)
| | - Ursula Kiechl-Kohlendorfer
- From the Department of Pediatrics II (Neonatology) (I.O.K., A.P., M.R., U.P.P., U.K.-K.), Department of Pediatrics III (Cardiology, Pulmonology, Allergology, and Cystic Fibrosis) (I.O.K., M.S., D.B.), and Department of Neurology (S.K.), Medical University of Innsbruck, Austria; and Department of Pediatrics, Clinical Division for Cardiology, Medical University of Graz, Austria (D.B.).
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Powell KL, Stevens V, Upton DH, McCracken SA, Simpson AM, Cheng Y, Tasevski V, Morris JM, Ashton AW. Role for the thromboxane A2 receptor β-isoform in the pathogenesis of intrauterine growth restriction. Sci Rep 2016; 6:28811. [PMID: 27363493 PMCID: PMC4929481 DOI: 10.1038/srep28811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/08/2016] [Indexed: 12/25/2022] Open
Abstract
Intrauterine growth restriction (IUGR) is a pathology of pregnancy that results in failure of the fetus to reach its genetically determined growth potential. In developed nations the most common cause of IUGR is impaired placentation resulting from poor trophoblast function, which reduces blood flow to the fetoplacental unit, promotes hypoxia and enhances production of bioactive lipids (TXA2 and isoprostanes) which act through the thromboxane receptor (TP). TP activation has been implicated as a pathogenic factor in pregnancy complications, including IUGR; however, the role of TP isoforms during pregnancy is poorly defined. We have determined that expression of the human-specific isoform of TP (TPβ) is increased in placentae from IUGR pregnancies, compared to healthy pregnancies. Overexpression of TPα enhanced trophoblast proliferation and syncytialisation. Conversely, TPβ attenuated these functions and inhibited migration. Expression of the TPβ transgene in mice resulted in growth restricted pups and placentae with poor syncytialisation and diminished growth characteristics. Together our data indicate that expression of TPα mediates normal placentation; however, TPβ impairs placentation, and promotes the development of IUGR, and represents an underappreciated pathogenic factor in humans.
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Affiliation(s)
- Katie L Powell
- Division of Perinatal Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia.,Sydney Medical School Northern, University of Sydney, NSW, 2006, Australia.,Pathology North, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Veronica Stevens
- Division of Perinatal Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia.,Sydney Medical School Northern, University of Sydney, NSW, 2006, Australia
| | - Dannielle H Upton
- Division of Perinatal Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia.,School of Life Sciences, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Sharon A McCracken
- Division of Perinatal Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia.,Sydney Medical School Northern, University of Sydney, NSW, 2006, Australia
| | - Ann M Simpson
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW, 2007, Australia.,Centre for Health Technologies, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Yan Cheng
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, 19104, USA
| | - Vitomir Tasevski
- Division of Perinatal Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia.,Pathology North, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.,School of Life Sciences, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Jonathan M Morris
- Division of Perinatal Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia.,Sydney Medical School Northern, University of Sydney, NSW, 2006, Australia
| | - Anthony W Ashton
- Division of Perinatal Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia.,Sydney Medical School Northern, University of Sydney, NSW, 2006, Australia
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Payal V, Jora R, Sharma P, Gupta PK, Gupta M. Premature birth and insulin resistance in infancy: A prospective cohort study. Indian J Endocrinol Metab 2016; 20:497-505. [PMID: 27366716 PMCID: PMC4911839 DOI: 10.4103/2230-8210.183470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This study was done to determine the role of prematurity and other variables to predict insulin sensitivity in infancy. SUBJECTS AND METHODS In this prospective study, 36 preterm appropriate for gestational age (AGA), 11 preterm small for gestational age (SGA), and 17 term SGA included as study cohort and 36 term AGA as control cohort. Detailed anthropometry assessment was performed at birth, 3, 6, and 9 months and at 9 months, fasting plasma glucose and serum insulin was done. Insulin resistance was determined by using homeostasis model assessment version 2. RESULTS It is found that preterm AGA (mean difference 0.617, 95% confidence interval [CI]; 0.43-0.80, P = 0.0001), preterm SGA (mean difference 0.764, 95% CI; 0.44-1.09, P = 0.0001), and term AGA (mean difference 0.725, 95% CI; 0.49-0.96, P = 0.0001) group had significantly higher insulin resistance than control. There was no significant difference in between preterm SGA and preterm AGA (mean difference 0.147 95% CI; -0.13-0.42, P = 0.927). In multiple regression models, SGA status (β =0.505) was more significant predictor of insulin resistance index than gestational age (β = -0.481), weight-for-length (β =0.315), and ponderal index (β = -0.194). CONCLUSION Preterm birth is a risk factor for the future development of insulin resistance which may develop as early as infancy.
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Affiliation(s)
- Vikas Payal
- Department of Pediatrics, Dr. S.N. Medical College, Umaid Hospital, Jodhpur, Rajasthan, India
| | - Rakesh Jora
- Department of Pediatrics, Dr. S.N. Medical College, Umaid Hospital, Jodhpur, Rajasthan, India
| | - Pramod Sharma
- Department of Pediatrics, Dr. S.N. Medical College, Umaid Hospital, Jodhpur, Rajasthan, India
| | - Pradeep Kumar Gupta
- Department of Pediatrics, Dr. S.N. Medical College, Umaid Hospital, Jodhpur, Rajasthan, India
| | - Mukesh Gupta
- Department of Pediatrics, Dr. S.N. Medical College, Umaid Hospital, Jodhpur, Rajasthan, India
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Nakashima T, Inoue H, Fujiyoshi J, Matsumoto N. Longitudinal analysis of serum cystatin C for estimating the glomerular filtration rate in preterm infants. Pediatr Nephrol 2016; 31:983-9. [PMID: 26809806 DOI: 10.1007/s00467-015-3309-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/28/2015] [Accepted: 12/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cystatin C (Cys-C) is a more sensitive marker of renal function than creatinine (Cre) in pediatric and adult populations. However, the reference values of serum Cys-C for estimating glomerular filtration rates (eGFRs) in premature infants during the first year of life have not been sufficiently studied. METHODS In this prospective study, 481 blood samples were collected from 261 preterm infants with uncomplicated clinical courses during their first year of life. Infants were divided into three groups according to gestational age at birth: 27-30 weeks, 31-33 weeks, and 34-36 weeks. Serum Cys-C and Cre levels were measured at 6-30 days, 3-5 months, 7-9 months, and 12-14 months after birth and the eGFR was calculated using two previously published equations. RESULTS The median serum Cys-C levels were 1.776, 1.248, 1.037, and 0.960 mg/L at the first, second, third, and fourth measurement time-point, respectively, with the value significantly decreasing with age up to 12-14 months. Cys-C levels were independent of gestational age and gender. In contrast to Cys-C, serum Cre values declined rapidly up to 3-5 months, then remained constant up to 12-14 months. Using the Cys-C-based equation, the eGFR significantly increased with increasing age until approximately 1 year after birth; however, no such trend was noted using the equation based on Cys-C + Cre. CONCLUSIONS Reference ranges for Cys-C in premature infants decline gradually over the first year after birth. Cys-C appears to be a more reliable marker than Cre for estimating GFR in preterm infants.
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Affiliation(s)
- Toshinori Nakashima
- Department of Pediatrics, Kitakyushu Municipal Medical Center, Fukuoka, Japan. .,Department of Pediatrics, National Hospital Organization Kokura Medical Center, 10-1 Harugaoka, Kokuraminami-ku, Kiakyushu-shi, Fukuoka, Japan.
| | - Hirosuke Inoue
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junko Fujiyoshi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoko Matsumoto
- Department of Pediatrics, Kitakyushu Municipal Medical Center, Fukuoka, Japan
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Kowalski RR, Beare R, Doyle LW, Smolich JJ, Cheung MMH. Elevated Blood Pressure with Reduced Left Ventricular and Aortic Dimensions in Adolescents Born Extremely Preterm. J Pediatr 2016; 172:75-80.e2. [PMID: 26873655 DOI: 10.1016/j.jpeds.2016.01.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/15/2015] [Accepted: 01/06/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the long-term cardiovascular effects of extremely preterm birth in a cohort of adolescents followed prospectively, who were largely free from intrauterine growth restriction. STUDY DESIGN Central blood pressures, aortic and cardiac dimensions, left ventricle (LV) function, pulse wave velocity, augmentation index, and microvascular reactive hyperemia were measured in 18-year-old subjects born extremely preterm at <28 weeks' gestation (n = 109) and term-born controls (n = 81). RESULTS Compared with controls, preterm adolescents had higher systolic (124 ± 13 vs 118 ± 10 mm Hg, P = .002) and diastolic (72 ± 8 vs 67 ± 7 mm Hg, P < .001) blood pressures, but lower ascending aortic z-scores (0.13 ± 0.89 vs 0.42 ± 0.78, P = .02), LV diastolic (48.5 ± 4 vs 50.3 ± 4.5 mm, P = .007) and systolic (30.2 ± 3.5 vs 31.9 ± 4.0 mm, P = .003) diameters, and a reduced LV mass (130 ± 34 vs 145 ± 41 g, P = .01) and mass index (75 ± 14 vs 81 ± 16 g/m(2), P = .02). However, LV relative wall thickness, LV function, pulse wave velocity, augmentation index, and microvascular reactive hyperemia were similar. Within the ex-preterm group, there were no significant relationships between birthweight z-scores and any cardiovascular measures, once the latter were adjusted for current body size. CONCLUSIONS Extremely preterm birth had relatively minor cardiovascular effects in late-adolescence, with increased blood pressures, decreased LV, and aortic size, but preserved LV function, macrovascular properties, and microvascular function. In utero growth was not independently related to cardiovascular function within the ex-preterm cohort.
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Affiliation(s)
- Remi R Kowalski
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Cardiology, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.
| | - Richard Beare
- Developmental Imaging, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Lex W Doyle
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia; Research Office, Royal Women's Hospital, Parkville, Victoria, Australia; Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Victoria, Australia
| | - Joseph J Smolich
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Michael M H Cheung
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Cardiology, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
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Alves PJS, Araujo Júnior E, Henriques ACPT, Carvalho FHC. Preterm at birth is not associated with greater cardiovascular risk in adolescence. J Matern Fetal Neonatal Med 2016; 29:3351-7. [PMID: 26625307 DOI: 10.3109/14767058.2015.1126577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the effects of preterm birth and gender on subsequent cardiovascular risk factors among urban adolescents in a capital in the Brazilian northeast and to compare them with a group of adolescents term at birth. METHODS In a retrospective double cohort, data of birth weight were extracted from hospital registers of children born in a same day of birth, between 1992 and 2002. We classified the preterm as a unique group born before 37 weeks of gestation. A total of 134 adolescents, aged 10-20 years were found and investigated. We measured anthropometric and clinical data, blood lipid profile and glucose after overnight fasting. RESULTS Preterm subjects had less years of scholar education, especially between females (p = 0.01). Preterm females also had lower height (p = 0.00) and waist-hip circumference ratio (p = 0.01). Preterm males had lower cesarean delivery (p = 0.05) and greater family history of cardiovascular disease (p = 0.05). Although the differences on clinical or laboratorial measurements were small and non-significant for cardiovascular risk factors, systolic blood pressure (SBP) and diastolic blood pressure (DBP) tended to be higher in preterm groups, especially for females (SBP = 4.1 mmHg and DBP = 1.6 mmHg, p = 0.12 and p = 0.38, respectively). CONCLUSION Premature did not increase cardiovascular risk adolescents in this sample. The lower association between premature and poor health outcomes among adolescents in a low average socioeconomic status population from a capital in the Brazilian northeast corroborates previous findings in other countries.
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Affiliation(s)
- Priscila Jesus Santos Alves
- a Department of Community Health, School of Medicine , Federal University of Ceará (UFC) , Fortaleza - CE , Brazil
| | - Edward Araujo Júnior
- b Department of Obstetrics, Paulista School of Medicine , Federal University of São Paulo (EPM-UNIFESP) , São Paulo - SP , Brazil , and
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El Rafei R, Abbas HA, Charafeddine L, Nakad P, Al Bizri A, Hamod D, Yunis KA. Association of Pre-Pregnancy Body Mass Index and Gestational Weight Gain with Preterm Births and Fetal Size: an Observational Study from Lebanon. Paediatr Perinat Epidemiol 2016; 30:38-45. [PMID: 26469281 DOI: 10.1111/ppe.12249] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are reported to impact the preterm birth (PTB) rate and newborn size. Most studies have been conducted in developed countries, although PTB and adverse pregnancy outcomes are more frequent in the developing world. The aim of this study is to elucidate the association of pre-pregnancy BMI and GWG on the occurrence of PTB and sub-optimal fetal size in Lebanon. METHODS This is a retrospective cohort study using a hospital-based register covering 35% of births in Lebanon between 2001 and 2012. Data were collected on 170 428 pregnancies from 32 hospitals using medical records and interviews. RESULTS After adjusting for confounders, underweight women had increased odds of having very preterm [odds ratio (OR) 1.58, 95% confidence interval (CI) 1.16, 2.14], preterm (OR 1.42, 95% CI 1.28, 1.58), and small for gestational age (SGA) (OR 1.50, 95% CI 1.37, 1.63) neonates. When BMI was analysed with GWG, only SGA remained significant in underweight women with low GWG. For all BMI groups, low GWG was protective against large for gestational age (LGA) and high GWG increased the odds of LGA. GWG, both low (OR 1.25, 95% CI 1.15, 1.35) and high (OR 1.43, 95% CI 1.32, 1.55) increased the risk of PTB in normal weight women. The same result was obtained for overweight women. CONCLUSIONS High GWG increased the risk of LGA for all groups and PTB in normal weight and overweight women, whereas low GWG increased the risk of SGA and PTB. Given that there are not many studies from middle income/developing countries on patterns of weight gain during pregnancy, findings from this study may help with pre-conception counselling with emphasis on the importance of an optimal pre-pregnancy BMI and appropriate weight gain during pregnancy.
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Affiliation(s)
- Rym El Rafei
- Pediatrics and Adolescent Medicine, Neonatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein A Abbas
- Pediatrics and Adolescent Medicine, Neonatology, American University of Beirut Medical Center, Beirut, Lebanon.,University of Texas MD Anderson Center, Houston, Texas, USA
| | - Lama Charafeddine
- Pediatrics and Adolescent Medicine, Neonatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Pascale Nakad
- Pediatrics and Adolescent Medicine, Neonatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ayah Al Bizri
- Pediatrics and Adolescent Medicine, Neonatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dany Hamod
- Pediatrics and Adolescent Medicine, Neonatology, Saint Georges Hospital-University of Balamand, Beirut, Lebanon
| | - Khalid A Yunis
- Pediatrics and Adolescent Medicine, Neonatology, American University of Beirut Medical Center, Beirut, Lebanon
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Su EJ. Role of the fetoplacental endothelium in fetal growth restriction with abnormal umbilical artery Doppler velocimetry. Am J Obstet Gynecol 2015; 213:S123-30. [PMID: 26428491 DOI: 10.1016/j.ajog.2015.06.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/12/2015] [Accepted: 06/16/2015] [Indexed: 01/30/2023]
Abstract
Growth-restricted fetuses with absent or reversed end-diastolic velocities in the umbilical artery are at substantially increased risk for adverse perinatal and long-term outcome, even in comparison to growth-restricted fetuses with preserved end-diastolic velocities. Translational studies show that this Doppler velocimetry correlates with fetoplacental blood flow, with absent or reversed end-diastolic velocities signifying abnormally elevated resistance within the placental vasculature. The fetoplacental vasculature is unique in that it is not subject to autonomic regulation, unlike other vascular beds. Instead, humoral mediators, many of which are synthesized by local endothelial cells, regulate placental vascular resistance. Existing data demonstrate that in growth-restricted pregnancies complicated by absent or reversed umbilical artery end-diastolic velocities, an imbalance in production of these vasoactive substances occurs, favoring vasoconstriction. Morphologically, placentas from these pregnancies also demonstrate impaired angiogenesis, whereby vessels within the terminal villi are sparsely branched, abnormally thin, and elongated. This structural deviation from normal placental angiogenesis restricts blood flow and further contributes to elevated fetoplacental vascular resistance. Although considerable work has been done in the field of fetoplacental vascular development and function, much remains unknown about the mechanisms underlying impaired development and function of the human fetoplacental vasculature, especially in the context of severe fetal growth restriction with absent or reversed umbilical artery end-diastolic velocities. Fetoplacental endothelial cells are key regulators of angiogenesis and vasomotor tone. A thorough understanding of their role in placental vascular biology carries the significant potential of discovering clinically relevant and innovative approaches to prevention and treatment of fetal growth restriction with compromised umbilical artery end-diastolic velocities.
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Barrett HL, Kubala MH, Scholz Romero K, Denny KJ, Woodruff TM, McIntyre HD, Callaway LK, Dekker Nitert M. Placental lipase expression in pregnancies complicated by preeclampsia: a case-control study. Reprod Biol Endocrinol 2015; 13:100. [PMID: 26336959 PMCID: PMC4558775 DOI: 10.1186/s12958-015-0098-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/20/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preeclampsia (PE) is associated with maternal and neonatal morbidity and mortality. In PE, the physiological hyperlipidaemia of pregnancy is exaggerated. The purpose of this study was to examine the expression of adipose triglyceride lipase (ATGL), hormone sensitive lipase (HSL), lipoprotein lipase (LPL) and endothelial lipase (EL) in pregnancies complicated by PE. METHODS Placentae were collected from 16 women with PE and 20 women with uncomplicated pregnancies matched for maternal prepregnancy BMI and gestational age of delivery. Gene and protein expression of the placental lipases were measured by Q-PCR and Western blot. DNA methylation of the promoter of LPL was assessed by bisulfite sequencing. Lipase localisation and activity were analysed. RESULTS Gene expression of all lipases was significantly reduced, as was HSL protein level in women with PE. All lipases were localised to trophoblasts and endothelial cells in PE and control placentae. There was no difference in methylation of the LPL promoter between PE and control placentae. Lipase activity was not altered in placentae from women with PE. CONCLUSION These results suggest that the decreased placental lipase gene but not protein expression or lipase activity, which is associated with late-onset PE is not a major contributor to the abnormal lipids seen in PE.
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Affiliation(s)
- Helen L Barrett
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
- Obstetric Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
- School of Medicine, The University of Queensland, Herston, QLD, Australia.
| | - Marta H Kubala
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
| | | | - Kerina J Denny
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia.
| | - Trent M Woodruff
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia.
| | - H David McIntyre
- School of Medicine, The University of Queensland, Herston, QLD, Australia.
- Mater Research Institute, The University of Queensland Brisbane, Brisbane, QLD, Australia.
| | - Leonie K Callaway
- Obstetric Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
- School of Medicine, The University of Queensland, Herston, QLD, Australia.
| | - Marloes Dekker Nitert
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
- School of Medicine, The University of Queensland, Herston, QLD, Australia.
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Yoon SH, Hur M, Hwang HS, Kwon HS, Sohn IS. The difference of lymphocyte subsets including regulatory T-cells in umbilical cord blood between AGA neonates and SGA neonates. Yonsei Med J 2015; 56:798-804. [PMID: 25837188 PMCID: PMC4397452 DOI: 10.3349/ymj.2015.56.3.798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE This study aimed to compare the regulatory T cells in cord blood of appropriate for gestational age (AGA) neonates with those of small for gestational age (SGA) neonates. MATERIALS AND METHODS Umbilical cord blood was collected upon labor in 108 healthy full-term (between 37 and 41 gestational weeks) neonates, who were born between November 2010 and April 2012. Among them, 77 samples were obtained from AGA neonates, and 31 samples were obtained from SGA neonates. Regulatory T cells and lymphocyte subsets were determined using a flow cytometer. Student's t-test for independent samples was used to compare differences between AGA and SGA neonates. RESULTS Regulatory T cells in cord blood were increased in the SGA group compared with normal controls (p=0.041). However, cytotoxic T cells in cord blood were significantly decreased in the SGA group compared with normal controls (p=0.007). CONCLUSION This is the first study to compare the distribution of lymphocyte subsets including regulatory T cells in cord blood between AGA neonates and SGA neonates.
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Affiliation(s)
- Sang Hee Yoon
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Han Sung Hwang
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Han Sung Kwon
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - In Sook Sohn
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.
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Idiopathic Fetal Growth Restriction: Repercussion of Modulation in Oxidative Stress. Indian J Clin Biochem 2015; 31:30-7. [PMID: 26855485 DOI: 10.1007/s12291-015-0487-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
Abstract
Oxidative stress has been proposed as one of the causes involved in idiopathic fetal growth restriction (IFGR). However, the exact relationship between oxidative stress and IFGR is not understood. This study aimed at understanding the role of oxidative stress and antioxidant status in IFGR materno-fetal dyads and matched controls. 75 materno-fetal dyads with IFGR were enrolled with equal number of normal low risk controls. Malondialdehyde (MDA) levels were measured as marker of oxidative stress, while paraoxonase-1 (PON1) activity and total antioxidant capacity (TAC) of serum were measured as markers of antioxidant status. MDA levels were increased in both maternal and cord blood of IFGR neonates as compared to controls (p < 0.001). TAC of serum were found to be decreased in IFGR (both maternal and cord blood) as compared to controls (p < 0.001; p < 0.05, respectively). PON1 activity was found to be decreased in the IFGR mothers while it was found increased in IFGR cord blood (p < 0.01; p < 0.001)). IFGR is a state of increased oxidative stress. Decreased PON1 enzymatic activity in mothers is also associated with IFGR.
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Edwards MO, Kotecha SJ, Lowe J, Watkins WJ, Henderson AJ, Kotecha S. Effect of preterm birth on exercise capacity: A systematic review and meta-analysis. Pediatr Pulmonol 2015; 50:293-301. [PMID: 29889363 DOI: 10.1002/ppul.23117] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 09/10/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Survivors of preterm-birth have increased prevalence of respiratory, cardiovascular, and neurological diseases in later life however, the overall impact of prematurity on cardiorespiratory exercise capacity is unclear. OBJECTIVE We, therefore, systematically reviewed the literature on cardiorespiratory exercise capacity in survivors of preterm birth. METHODOLOGY Relevant studies up to March 2013 were searched using eight electronic health databases. Studies reporting exercise capacity in participants born preterm (<37 weeks) were included. The main outcome of interest was oxygen uptake (V˙O2max) at maximal exercise. Data were categorized into four groups: (i) preterm-born subjects including those with or without bronchopulmonary dysplasia (BPD) but excluding study groups biased towards BPD; (ii) preterm-born subjects (BPD excluded); (iii) preterm-born subjects who had BPD28 (defined as oxygen dependency at 28 days of life) in infancy; (iv) preterm born subjects with BPD36 (oxygen dependency at 36 weeks post menstrual age) in infancy. RESULTS From 9,341 abstracts, 22 included publications reported V˙O2max in ml/kg/min from 685 preterm and 680 term-born subjects. Overall 20 studies reported results for preterm-born subjects including BPD; 14 studies for the preterm group excluding BPD; 10 studies for the BPD28 group; and 8 studies for BPD36 group. The mean differences (95% CI) for the four groups were -2.20 (-3.70, -0.70) ml/kg/min; -2.26 (-4.44, -0.07 ml/kg/min; -3.04 (-5.48, -0.61) ml/kg/min, and -3.05 (-5.93, -0.18) ml/kg/min, respectively. CONCLUSION Despite marked deficits in spirometry, preterm-born children have a marginally decreased V˙O2max, which is unlikely to be of great clinical significance. Pediatr Pulmonol. 2015; 50:293-301. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Martin O Edwards
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Sarah J Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - John Lowe
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - W John Watkins
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - A John Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
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