Isolated oligohydramnios in previous pregnancy is a risk factor for a placental related disorder in subsequent delivery

BACKGROUND

We aimed to assess the association between isolated oligohydramnios in previous pregnancy and the incidence of placental related complications in subsequent pregnancy.

METHODS

This was a retrospective cohort study of live singleton births from a single university affiliated medical center during an eleven-year period of women with two subsequent deliveries at our center. An analysis of outcomes was performed for all second deliveries, comparing women for whom their first delivery was complicated by isolated oligohydramnios (previous oligohydramnios group), and women without isolated oligohydramnios in their first delivery (control group). Patients for whom their first delivery was complicated by small for gestational age, pregnancy induced hypertension and preterm birth were excluded. The study groups were compared for obstetric and early neonatal outcomes, recurrence of oligohydramnios and a composite of placental related pregnancy complications.

RESULTS

A total of 213 in the previous oligohydramnios group and 5348 in the control group were compared. No differences were found between the groups in maternal age, body mass index, smoking and comorbidities. Gestational age at delivery was, 39.6 ± 1.3 vs. 39.3 ± 1.4 weeks, p = 0.006, in the previous oligohydramnios and controls respectively, although preterm birth rate was similar between the groups. The previous oligohydramnios group had a significantly higher incidence of oligohydramnios in second delivery, aOR 3.37, 95%CI 1.89-6.00, small for gestational age neonates, aOR 1.94, 95% CI 1.16-3.25, and overall placental related disorders of pregnancy, aOR 2.13, 95%CI 1.35-3.35.

CONCLUSION

Pregnancies complicated by isolated oligohydramnios are associated with an increased risk of placental related disorders in subsequent pregnancy. Isolated oligohydramnios may be the first sign of placental insufficiency and an independent manifestation of the placental related complications spectrum.

Developmental Differences in Left Ventricular Strain in IUGR vs. Control Children the First Three Months of Life

BACKGROUND

Intrauterine growth restriction (IUGR) may directly affect cardiovascular function in early life. Longitudinal data on left ventricular longitudinal strain (LVLS), a key measure of cardiac function independent of body size, is not available. We hypothesize impaired cardiac function among IUGR newborns and persistence of the impairment until age 3 months.

METHOD

This is a prospective cohort study of consecutive pregnancies where IUGR was identified at 18-38 weeks gestational age (GA) with healthy controls randomly selected at 18-20 weeks GA. Echocardiograms were performed at birth and at age 3-4 months, and then compared.

RESULTS

At birth, mean (SD) LVLS did not differ between the IUGR group [N = 19; - 15.76 (3.12) %] and controls [N = 35; - 15.53 (3.56) %]. The IUGR group demonstrated no significant change in LVLS at age 3-4 months [- 17.80 (3.82) %], while the control group [- 20.91 (3.31) %] showed a significant increase (P < 0.001). Thus, LVLS was lower in the IUGR group at age 3-4 months (P = 0.003).

CONCLUSION

The lack of increase in LVLS may suggest that IUGR has a direct impact on cardiac function as early as during the first months of life. Trial registration Clinical trials.gov Identifier: NCT02583763, registration October 22, 2015. Retrospectively registered September 2014-October 2015, thereafter, registered prospectively.

Down-regulation of DKK1 and Wnt1/β-catenin pathway by increased homeobox B7 resulted in cell differentiation suppression of intrauterine fetal growth retardation in human placenta

OBJECTIVE

This study aimed to test the influence of homeobox B7 (HoxB7) on the proliferation, invasion, and migration of human trophoblast cells and to reveal the down-regulation of HoxB7 on the transcriptional suppression of Dick Kopf-related protein1 (DKK1) and of Cysteine-rich glycosylated wingless protein 1 (Wnt1)/β-catenin in intrauterine fetal growth retardation (FGR).

METHODS

Quantitative measurement of HoxB7, DKK1, Wnt1, and β-catenin was performed in human placentas collected from normal pregnancies and from FGR with quantitative real time PCR (qRT-PCR). Cultured HTR-8/SVneo cells, transfected with a lentiviral plasmid that in-frame expresses human HoxB7 gene, were applied to functional assessment to study the biological impact of HoxB7 gene on DKK1, Wnt1, and β-catenin. Counting Kit-8, Transwell invasion assays, and flow cytometry were applied for the functional measurements.

RESULTS

The expression of HoxB7 was significantly increased, and of DKK1, Wnt1, and β-catenin was decreased, in FGR placenta tissues and in HTR-8/SVneo cells. Function studies revealed that overexpression of HoxB7 inhibited proliferation, migration, and invasion in HTR-8/SVneo cells. DKK1, Wnt1, and β-catenin were down-regulated in HTR-8/SVneo cells, inversely correlated with HoxB7 expression. Overexpression of HoxB7 showed a suppressive effect on proliferation, migration, and invasion in the HTR-8/SVneo cells.

CONCLUSIONS

Our results indicate that HoxB7 inhibited human trophoblast cell differentiation by down-regulating DKK1 expression and that it may affect transcription of Wnt1/β-catenin. The activation of HoxB7 might suppress the cell differentiation in HTR-8/SVneo cell cultures. The Wnt/β-catenin signaling pathway may play a significant role in the pathogenesis of FGR by regulating the invasion and proliferation of trophoblasts.