1
|
Chen JY, Yu BL, Wu XJ, Li YF, Zhong LY, Chen M. A longitudinal and cross-sectional study of placental circulation between normal and placental insufficiency pregnancies. Placenta 2024; 149:29-36. [PMID: 38490095 DOI: 10.1016/j.placenta.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/11/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION To longitudinally and cross-sectionally study the differences in the uterine artery pulsatility index (UTPI), umbilical artery pulsatility index (UAPI) and placental vascularization indices (PVIs, derived from 3-dimensional power Doppler) between normal and placental insufficiency pregnancies throughout gestation. METHODS UTPI, UAPI and PVI were measured 6 times at 4- to 5- week intervals from 11 to 13+6 weeks-36 weeks. Preeclampsia (PE) and fetal growth restriction (FGR) were defined as placental insufficiency. Comparisons of UTPI, UAPI and PVI between normal and insufficiency groups were performed by one-way repeated measures analysis of variance. RESULTS A total of 125 women were included: monitored regularly from the first trimester to 36 weeks of gestation: 109 with normal pregnancies and 16 with placental insufficiency. Longitudinal study of the normal pregnancy group showed that UTPI and UAPI decreased significantly every 4 weeks, while PVIs increased significantly every 8 weeks until term. In the placental insufficiency group however, this decrease occurred slower at 8 weeks intervals and UTPI stabilized after 24 weeks. No significant difference was noted in PVIs throughout pregnancy. Cross-sectional study from different stages of gestation showed that UTPI was higher in the insufficiency group from 15 weeks onward and PVIs were lower after 32 weeks. DISCUSSION Compared to high-risk pregnancies with normal outcome, UTPI and UAPI needed a longer time to reach a significant change in those with clinical confirmation of placental insufficiency pregnancies and no significant change was found in PVI throughout gestation. UTPI was the earliest factor in detecting adverse outcome pregnancies.
Collapse
Affiliation(s)
- J Y Chen
- Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangzhou, China; Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, Guangzhou, China; The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - B L Yu
- Department of Bio Resource Research Center, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - X J Wu
- Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangzhou, China; Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, Guangzhou, China; The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Y F Li
- Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangzhou, China; Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, Guangzhou, China; The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - L Y Zhong
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - M Chen
- Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangzhou, China; Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangzhou, China; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, Guangzhou, China; The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
2
|
Espinoza J. Evolutionary perspective of uteroplacental malperfusion: subjacent insult common to most pregnancy complications. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:7-13. [PMID: 37391928 DOI: 10.1002/uog.26218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 07/02/2023]
Abstract
Linked article: There is a comment on this article by Yagel et al. Click here to view the Correspondence.
Collapse
Affiliation(s)
- J Espinoza
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Fetal Intervention, UTHealth, McGovern Medical School, University of Texas, Houston, TX, USA
| |
Collapse
|
3
|
Qiao P, Zhao Y, Jiang X, Xu C, Yang Y, Bao Y, Xie H, Ying H. Impact of growth discordance in twins on preeclampsia based on chorionicity. Am J Obstet Gynecol 2020; 223:572.e1-572.e8. [PMID: 32247845 DOI: 10.1016/j.ajog.2020.03.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite extensive investigations over the last decade, preeclampsia remains an unpredictable pregnancy complication causing perinatal morbidity and mortality worldwide, particularly in twin pregnancies. OBJECTIVE This study aimed to determine the relationship between growth discordance in twin pregnancies and the risk for preeclampsia based on chorionicity. STUDY DESIGN This was a retrospective single-center study that included 2122 women with twin pregnancies who were admitted to a tertiary hospital between January 2013 and June 2016. Growth discordance was defined as twin birthweight difference ≥20%. Logistic regression models were used to analyze the association between growth discordance and risk for gestational hypertension-preeclampsia in all subjects. Stratified sampling by twin chorionicity (dichorionic and monochorionic) was also conducted. Further analysis was performed to estimate the association between the degree of growth discordance and gestational hypertension-preeclampsia risk in monochorionic and dichorionic twin pregnancies. RESULTS The prevalence of growth discordance was 17.6%. In all subjects, growth discordance was associated with increased risk for gestational hypertension-preeclampsia. After stratification by twin chorionicity, growth discordance was associated with an increased risk for gestational hypertension preeclampsia (adjusted odds ratio [AOR], 1.84; 95% confidence interval [CI], 1.26-2.67) and preeclampsia (AOR, 1.82; 95% CI, 1.21-2.73), including mild preeclampsia (AOR, 1.86; 95% CI, 1.02-3.37), severe preeclampsia (AOR, 1.78; 95% CI, 1.06-2.97; P<.05), and early-onset preeclampsia (AOR, 2.98; 95% CI, 1.40-6.32), in the dichorionic twin pregnancy group; however, no significant association was found in the monochorionic twin pregnancy group. A 10% increment of growth discordance in the dichorionic twin pregnancy group was associated with an elevated risk for gestational hypertension preeclampsia (AOR, 1.20; 95% CI, 1.02-1.41) and preeclampsia (AOR, 1.24; 95% CI, 1.04-1.48), including severe preeclampsia (AOR, 1.28; 95% CI, 1.04-1.59) and early-onset preeclampsia (AOR, 1.47; 95% CI, 1.08-2.00), but no significant association was found in the monochorionic twin pregnancy group. CONCLUSION Growth discordance is associated with an increased risk for preeclampsia in dichorionic but not in monochorionic twin pregnancy. In addition, the prevalence of preeclampsia increases significantly with increasing degree of growth discordance, reflecting a dose-response relationship in dichorionic twin pregnancy.
Collapse
Affiliation(s)
- Ping Qiao
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yan Zhao
- Department of Women & Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xiang Jiang
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chuanlu Xu
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yingying Yang
- Department of Women & Children's Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yirong Bao
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Han Xie
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Hao Ying
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
| |
Collapse
|
4
|
Nagar T, Sharma D, Choudhary M, Khoiwal S, Nagar RP, Pandita A. The Role of Uterine and Umbilical Arterial Doppler in High-risk Pregnancy: A Prospective Observational Study from India. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2015; 9:1-5. [PMID: 25922590 PMCID: PMC4401238 DOI: 10.4137/cmrh.s24048] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 11/18/2022]
Abstract
AIM To study the role of Doppler imaging in prediction of high-risk pregnancies and their outcomes. METHODS AND MATERIAL This prospective study in a setup of tertiary-level care center includes 500 high-risk pregnant women from rural and urban sectors and evaluates the predictive values of various Doppler indices. RESULTS Out of 500 patients, 110 patients had abnormal Doppler among them, 70 patients had abnormal uterine artery Doppler, and 50 patients had abnormal umbilical artery Doppler flow indices. In all, 10 patients had both umbilical artery and uterine artery abnormal Doppler indices. When uterine artery was abnormal (70 patients), 20 patients had preeclampsia, 10 patients had pregnancy-induced hypertension (PIH), and 25 patients had intrauterine growth restriction (IUGR). Systolic/diastolic (S/D) ratio and notch had sensitivity of 60% and positive predictive value of 33.3% and 37.5%, respectively. When umbilical artery was abnormal (50 patients), 10 had preeclampsia, 15 had PIH, and 15 had IUGR. S/D ratio had the highest positive predictive value of 40%; sensitivity is same for all. In uterine artery, combination of parameters had the best sensitivity of 80%, followed by notch and S/D ratio. In umbilical artery, combination of parameters, S/D ratio, and RI (resistance index) had sensitivity of 40%; specificity of all the indices was 91–96%. In all, 20 patients had bilateral notch, and among them 15 developed preeclampsia and 15 developed IUGR. When both uterine and umbilical artery Doppler were abnormal (10 patients), all patients had preeclampsia and IUGR. CONCLUSION Therefore, Doppler study may be used for the prediction of preeclampsia and IUGR to reduce the maternal and perinatal morbidity and mortality.
Collapse
Affiliation(s)
| | - Deepak Sharma
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | - Mukesh Choudhary
- Department of Medical and Pediatric Oncology, GCRI, Ahmedabad, Gujarat, India
| | - Shusheela Khoiwal
- Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India
| | | | - Aakash Pandita
- Department of Medical and Pediatric Oncology, GCRI, Ahmedabad, Gujarat, India
| |
Collapse
|
5
|
The relationship between preeclampsia and intrauterine growth restriction in twin pregnancies. Am J Obstet Gynecol 2014; 211:422.e1-5. [PMID: 24881822 DOI: 10.1016/j.ajog.2014.05.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/24/2014] [Accepted: 05/24/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Preeclampsia and intrauterine growth restriction (IUGR) are correlated in singleton pregnancies. The objective of this study was to estimate their relationship in twin pregnancies. STUDY DESIGN Cohort of 578 patients with twin pregnancies delivered by 1 maternal fetal medicine practice from 2005-2013. Patients with chronic hypertension, monochorionic-monoamniotic placentation, twin-twin transfusion, and major congenital anomalies were excluded. Standard definitions were used for gestational hypertension and preeclampsia. We defined IUGR as any twin birthweight less than the 5th percentile for gestational age, as well as any twin birthweight less than the 10th percentile for gestational age. RESULTS The incidence of preeclampsia was 14.9%, the incidence of birthweight <10% was 50.0%, and the incidence of birthweight <5% was 27.5%. Comparing patients with and without preeclampsia, the rate of birthweight <5th percentile did not differ (27.9% vs 27.4%, P = .929), nor did the rate of birthweight <10th percentile (48.8% vs 50.2%, P = .815). We had 80% power with an alpha error of 5% to show a difference in the likelihood of IUGR <10th percentile from 50% to 66% and a difference in the likelihood of IUGR <5th percentile from 27% to 42% in patients without and with preeclampsia. CONCLUSION In patients with twin pregnancy, there is no correlation between preeclampsia and IUGR. This suggests that in twin pregnancies, as opposed to singleton pregnancies, the pathophysiology may differ between these 2 common conditions.
Collapse
|
6
|
Rasmussen S, Irgens LM, Espinoza J. Maternal obesity and excess of fetal growth in pre-eclampsia. BJOG 2014; 121:1351-7. [DOI: 10.1111/1471-0528.12677] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 12/01/2022]
Affiliation(s)
- S Rasmussen
- Department of Clinical Science; University of Bergen; Bergen Norway
- Department of Obstetrics and Gynaecology; Haukeland University Hospital; Bergen Norway
| | - LM Irgens
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
| | - J Espinoza
- Department of Obstetrics and Gynecology; Baylor College of Medicine and Texas Children's Hospital Pavilion for Women; Houston TX USA
| |
Collapse
|
7
|
Miranda J, Romero R, Korzeniewski SJ, Schwartz AG, Chaemsaithong P, Stampalija T, Yeo L, Dong Z, Hassan SS, Chrousos GP, Gold P, Chaiworapongsa T. The anti-aging factor α-klotho during human pregnancy and its expression in pregnancies complicated by small-for-gestational-age neonates and/or preeclampsia. J Matern Fetal Neonatal Med 2013; 27:449-57. [PMID: 23808483 DOI: 10.3109/14767058.2013.818652] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE α-klotho, a protein with anti-aging properties, has been involved in important biological processes, such as calcium/phosphate metabolism, resistance to oxidative stress, and nitric oxide production in the endothelium. Recent studies have suggested a role of α-klotho in endocrine regulation of mineral metabolism and postnatal growth in infants. Yet, the role of α-klotho during pregnancy remains largely unknown. The aim of this study was to determine whether maternal plasma concentration of α-klotho changes during pregnancy and evaluate its expression in pregnancies complicated by small for gestational age (SGA) and/or preeclampsia (PE). STUDY DESIGN This cross-sectional study included patients in the following groups: (1) non pregnant women (n = 37); (2) uncomplicated pregnancy (n = 130); (3) PE without an SGA neonate (PE; n = 58); (4) PE with an SGA neonate (PE and SGA; n = 52); and (5) SGA neonate without PE (SGA; n = 52). Plasma concentrations of α-klotho were determined by ELISA. RESULTS The median plasma α-klotho concentration was higher in pregnant than in non-pregnant women. Among women with an uncomplicated pregnancy, the median plasma concentration of α-klotho increased as a function of gestational age (Spearman Rho = 0.2; p = 0.006). The median (interquartile range) plasma concentration of α-klotho in women with PE and SGA [947.6 (762-2013) pg/mL] and SGA without PE [1000 (585-1567) pg/mL] were 21% and 17% lower than that observed in women with an uncomplicated pregnancy [1206.6 (894-2012) pg/mL], (p = 0.005 and p = 0.02), respectively. Additionally, there were no significant differences in the median plasma concentration of α-klotho between uncomplicated pregnancies and women with PE without an SGA neonate (p = 0.5). CONCLUSION Maternal plasma concentration of α-klotho was higher during pregnancy than in a non-pregnant state. Moreover, the median maternal plasma concentration of α-klotho was lower in mothers who delivered an SGA neonate than in those with an uncomplicated pregnancy regardless of the presence or absence of PE.
Collapse
Affiliation(s)
- Jezid Miranda
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda , MD and Detroit, MI , USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|