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Mercado L, Escalona-Vargas D, Siegel ER, Preissl H, Bolin EH, Eswaran H. Exploring the Influence of Fetal Sex on Heart Rate Dynamics Using Fetal Magnetocardiographic Recordings. Reprod Sci 2024; 31:823-831. [PMID: 37884730 DOI: 10.1007/s43032-023-01384-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Abstract
Fetal sex has been associated with different development trajectories that cause structural and functional differences between the sexes throughout gestation. Fetal magnetocardiography (fMCG) recordings from 123 participants (64 females and 59 males; one recording/participant) from a database consisting of low-risk pregnant women were analyzed to explore and compare fetal development trajectories of both sexes. The gestational age of the recordings ranged from 28 to 38 weeks. Linear metrics in both the time and frequency domains were applied to study fetal heart rate variability (fHRV) measures that reveal the dynamics of short- and long-term variability. Rates of linear change with GA in these metrics were analyzed using general linear model regressions with assessments for significantly different variances and GA regression slopes between the sexes. The fetal sexes were well balanced for GA and sleep state. None of the fHRV measures analyzed exhibited significant variance heterogeneity between the sexes, and none of them exhibited a significant sex-by-GA interaction. The absence of a statistically significant sex-by-GA interaction on all parameters resulted in none of the regression slope estimates being significantly different between the sexes. With high-precision fMCG recordings, we were able to explore the variation in fHRV parameters as it relates to fetal sex. The fMCG-based fHRV parameters did not show any significant difference in rates of change with gestational age between sexes. This study provides a framework for understanding normal development of the fetal autonomic nervous system, especially in the context of fetal sex.
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Affiliation(s)
- Luis Mercado
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Diana Escalona-Vargas
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the Eberhard Karls University of Tübingen, fMEG Center, Tübingen, Germany
| | - Elijah H Bolin
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Hari Eswaran
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.
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Briceño-Pérez C, Briceño-Sanabria L, Briceño-Sanabria C, Reyna-Villasmil E. Early life corticosteroid overexposure: Epigenetic and fetal origins of adult diseases. Int J Gynaecol Obstet 2024; 164:40-46. [PMID: 37318113 DOI: 10.1002/ijgo.14914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/30/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
The relationship between events occurring during intrauterine development and later-life predisposition to long-term disease, has been described. The fetus responds to excess intrauterine exposure to high levels of corticosteroids, modifying their physiological development and stopping their growth. Fetal exposure to elevated levels of either endogenous (alterations in fetal hypothalamic-pituitary-adrenal axis) or synthetic corticosteroids, is one model of early-life adversity; to developing adult disease. At the molecular level, there are transcriptional changes in metabolic and growth pathways. Epigenetic mechanisms participate in transgenerational inheritance, not genomic. Exposures that change 11β-hydroxysteroid dehydrogenase type 2 enzyme methylation status in the placenta can result in transcriptional repression of the gene, causing the fetus to be exposed to higher levels of cortisol. More precise diagnosis and management of antenatal corticosteroids for preterm birth, would potentially decrease the risk of long-term adverse outcomes. More studies are needed to understand the potential roles of factors to alter fetal corticosteroid exposure. Long-term infant follow-up is required to determine whether methylation changes in placenta may represent useful biomarkers of later disease risk. This review, summarize recent advances in the programming of fetal effects of corticosteroid exposure, the role of corticosteroids in epigenetic gene regulation of placental 11β-hydroxysteroid dehydrogenase type 2 enzyme expression and transgenerational effects.
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Affiliation(s)
- Carlos Briceño-Pérez
- Department of Obstetrics and Gynecology, University of Zulia, Maracaibo, Venezuela
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Gong XL, Du YF, Zhao YY, Wu TC, Shi HF, Wang XL, Wei Y. [Association between maternal plasma one-carbon biomarkers during pregnancy and fetal growth in twin pregnancies]. Zhonghua Fu Chan Ke Za Zhi 2023; 58:774-782. [PMID: 37849258 DOI: 10.3760/cma.j.cn112141-20230418-00175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Objective: To characterize the relationship between the levels of plasma methyl donor and related metabolites (including choline, betaine, methionine, dimethylglycine and homocysteine) and fetal growth in twin pregnancies. Methods: A hospital-based cohort study was used to collect clinical data of 92 pregnant women with twin pregnancies and their fetuses who were admitted to Peking University Third Hospital from March 2017 to January 2018. Fasting blood was collected from the pregnant women with twin pregnancies (median gestational age: 18.9 weeks). The levels of methyl donors and related metabolites in plasma were quantitatively analyzed by high-performance liquid chromatography combined with mass spectrometry. The generalized estimation equation was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and neonatal outcomes of twins, and the generalized additive mixed model was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and fetal growth ultrasound indicators. Results: (1) General clinical data: of the 92 women with twin pregnancies, 66 cases (72%) were dichorionic diamniotic (DCDA) twin pregnancies, and 26 cases (28%) were monochorionic diamniotic (MCDA) twin pregnancies. The comparison of the levels of five plasma methyl donors and related metabolites in twin pregnancies with different basic characteristics showed that the median levels of plasma choline and betaine in pregnant women ≥35 years old were higher than those in pregnant women <35 years old, and the differences were statistically significant (all P<0.05). (2) Correlation between plasma methyl donor and related metabolites levels and neonatal growth indicators: after adjusting for confounding factors, plasma homocysteine level in pregnant women with twins was significantly negatively correlated with neonatal birth weight (β=-47.9, 95%CI:-94.3- -1.6; P=0.043). Elevated methionine level was significantly associated with decreased risks of small for gestational age infants (SGA; OR=0.5, 95%CI: 0.3-0.9; P=0.021) and low birth weight infants (OR=0.6, 95%CI: 0.4-0.9; P=0.020). Increased homocysteine level was associated with increased risks of SGA (OR=1.5, 95%CI: 1.0-2.2; P=0.029) and inconsistent growth in twin fetuses (OR=1.9, 95%CI: 1.0-3.7; P=0.049). (3) Correlation between the levels of plasma methyl donors and related metabolites and intrauterine growth indicators of twins pregnancies: for every 1 standard deviation increase in plasma choline level in pregnant women with twin pregnancies, fetal head circumference, abdominal circumference, femoral length and estimated fetal weight in the second trimester increased by 1.9 mm, 2.6 mm, 0.5 mm and 20.1 g, respectively, and biparietal diameter, abdominal circumference and estimated fetal weight increased by 0.7 mm, 3.0 mm and 38.4 g in the third trimester, respectively, and the differences were statistically significant (all P<0.05). (4) Relationship between plasma methyl donor and related metabolites levels in pregnant women with different chorionicity and neonatal birth weight and length: the negative correlation between plasma homocysteine level and neonatal birth weight was mainly found in DCDA twin pregnancy (β=-65.9, 95%CI:-110.6- -21.1; P=0.004). The levels of choline, betaine and dimethylglycine in plasma of MCDA twin pregnancy were significantly correlated with the birth weight and length of newborns (all P<0.05). Conclusion: Homocysteine level is associated with low birth weight in twins, methionine is associated with decreased risk of SGA, and choline is associated with fetal growth in the second and third trimesters of pregnancy.
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Affiliation(s)
- X L Gong
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, National center for Healthcare Quality Management in Obstetrics, Peking University Third Hospital, Beijing 100191, China
| | - Y F Du
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Y Y Zhao
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, National center for Healthcare Quality Management in Obstetrics, Peking University Third Hospital, Beijing 100191, China
| | - T C Wu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, National center for Healthcare Quality Management in Obstetrics, Peking University Third Hospital, Beijing 100191, China
| | - H F Shi
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, National center for Healthcare Quality Management in Obstetrics, Peking University Third Hospital, Beijing 100191, China
| | - X L Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
| | - Y Wei
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, National center for Healthcare Quality Management in Obstetrics, Peking University Third Hospital, Beijing 100191, China
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Mahadevan A, Tipler A, Jones H. Shared developmental pathways of the placenta and fetal heart. Placenta 2023; 141:35-42. [PMID: 36604258 DOI: 10.1016/j.placenta.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Congenital heart defects (CHD) remain the most common class of birth defect worldwide, affecting 1 in every 110 live births. A host of clinical and morphological indicators of placental dysfunction are observed in pregnancies complicated by fetal CHD and, with the recent emergence of single-cell sequencing capabilities, the molecular and physiological associations between the embryonic heart and developing placenta are increasingly evident. In CHD pregnancies, a hostile intrauterine environment may negatively influence and alter fetal development. Placental maldevelopment and dysfunction creates this hostile in-utero environment and may manifest in the development of various subtypes of CHD, with downstream perfusion and flow-related alterations leading to yet further disruption in placental structure and function. The adverse in-utero environment of CHD-complicated pregnancies is well studied, however the specific etiological role that the placenta plays in CHD development remains unclear. Many mouse and rat models have been used to characterize the relationship between CHD and placental dysfunction, but these paradigms present substantial limitations in the assessment of both the heart and placenta. Improvements in non-invasive placental assessment can mitigate these limitations and drive human-specific investigation in relation to fetal and placental development. Here, we review the clinical, structural, and molecular relationships between CHD and placental dysfunction, the CHD subtype-dependence of these changes, and the future of Placenta-Heart axis modeling and investigation.
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Affiliation(s)
- Aditya Mahadevan
- Physiology and Aging, University of Florida College of Medicine, USA; Center for Research in Perinatal Outcomes, University of Florida, USA
| | - Alyssa Tipler
- Physiology and Aging, University of Florida College of Medicine, USA; Center for Research in Perinatal Outcomes, University of Florida, USA
| | - Helen Jones
- Physiology and Aging, University of Florida College of Medicine, USA; Center for Research in Perinatal Outcomes, University of Florida, USA.
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Widatalla N, Yoshida C, Koide K, Kasahara Y, Saito M, Kimura Y, Khandoker A. Investigating the association of maternal heart rate variability with fetal birth weight. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38082611 DOI: 10.1109/embc40787.2023.10340182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Maternal heart rate (HR) was reported to affect birth weight and birth outcomes. Low birth weight constitutes a major health problem, and it is estimated that around 15% to 20% of births worldwide are low weight. In our previous study, we discussed the presence of similarities between maternal and fetal HRs, therefore, here, we propose to develop a parameter based on maternal and fetal HR variability (HRV) to divide data into two patterns to investigate the association of fetal birth weight with maternal HR and HRV. The parameter was derived from non-invasive records of maternal and fetal electrocardiograms (ECGs) that were collected from 78 subjects (age: 22 - 44 years old, gestational age (GA): 19 - 40 weeks). The HRV parameter was calculated by first evaluating the standard deviation (SD) of the number of R peaks occurring per 2 seconds (snRpp2s). Then, the difference between maternal and fetal snRpp2s (dmf) was calculated. The correlation between our derived parameter [dmf] with GA revealed a significant correlation that suggested the dmf's association with fetal development. The association analysis results between birthweight with maternal HR and HRV per pattern showed that significant negative correlations exist between them in one pattern. Still, the same correlations were not observed in the other pattern. This study's findings emphasise maternal health's role in fetal development assessment. In addition, this study highlights the importance of developing novel factors for properly assessing fetal development and birth outcomes.
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Stenhouse C, Bazer FW, Ashworth CJ. Sexual dimorphism in placental development and function: Comparative physiology with an emphasis on the pig. Mol Reprod Dev 2023; 90:684-696. [PMID: 35466463 DOI: 10.1002/mrd.23573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 11/10/2022]
Abstract
Across mammalian species, it has been demonstrated that sex influences birth weight, with males being heavier than females; a characteristic that can be observed from early gestation. Male piglets are more likely to be stillborn and have greater preweaning mortality than their female littermates, despite the additional maternal investment into male fetal growth. Given the conserved nature of the genome between the sexes, it is hypothesized that these developmental differences between males and females are most likely orchestrated by differential placental adaptation. This review summarizes the current understanding of fetal sex-specific differences in placental and endometrial structure and function, with an emphasis on pathways found to be differentially regulated in the pig including angiogenesis, apoptosis, and proliferation. Given the importance of piglet sex in agricultural enterprises, and the potential for skewed litter sex ratios, it is imperative to improve understanding of the relationship between fetal sex and molecular signaling in both the placenta and endometria across gestation.
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Affiliation(s)
- Claire Stenhouse
- Department of Animal Science, Texas A&M University, College Station, Texas, USA
- Functional Genetics and Development Division, The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
| | - Fuller W Bazer
- Department of Animal Science, Texas A&M University, College Station, Texas, USA
| | - Cheryl J Ashworth
- Functional Genetics and Development Division, The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
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Miles JR, Walsh SC, Rempel LA, Pannier AK. Mechanisms regulating the initiation of porcine conceptus elongation. Mol Reprod Dev 2023; 90:646-657. [PMID: 35719060 DOI: 10.1002/mrd.23623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/10/2022] [Accepted: 06/01/2022] [Indexed: 11/12/2022]
Abstract
Significant increases in litter size within commercial swine production over the past decades have led to increases in preweaning piglet mortality due to increase within-litter birthweight variation, typically due to mortality of the smallest littermate piglets. Therefore, identifying mechanisms to reduce variation in placental development and subsequent fetal growth are critical to normalizing birthweight variation and improving piglet survivability in high-producing commercial pigs. A major contributing factor to induction of within-litter variation occurs during the peri-implantation period as the pig blastocyst elongates from spherical to filamentous morphology in a short period of time and rapidly begins superficial implantation. During this period, there is significant within-litter variation in the timing and extent of elongation among littermates. As a result, delays and deficiencies in conceptus elongation not only contribute directly to early embryonic mortality, but also influence subsequent within-litter birthweight variation. This study will highlight key aspects of conceptus elongation and provide some recent evidence pertaining to specific mechanisms from -omics studies (i.e., metabolomics of the uterine environment and transcriptomics of the conceptus) that may specifically regulate the initiation of conceptus elongation to identify potential factors to reduce within-litter variation and improve piglet survivability.
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Affiliation(s)
- Jeremy R Miles
- USDA, U.S. Meat Animal Research Center (USMARC), Clay Center, Nebraska, USA
| | - Sophie C Walsh
- Department of Biological Systems Engineering, University of Nebraska-Lincoln (UNL), Lincoln, Nebraska, USA
| | - Lea A Rempel
- USDA, U.S. Meat Animal Research Center (USMARC), Clay Center, Nebraska, USA
| | - Angela K Pannier
- Department of Biological Systems Engineering, University of Nebraska-Lincoln (UNL), Lincoln, Nebraska, USA
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8
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Pino O, Di Pietro S, Poli D. Effect of Musical Stimulation on Placental Programming and Neurodevelopment Outcome of Preterm Infants: A Systematic Review. Int J Environ Res Public Health 2023; 20:2718. [PMID: 36768104 PMCID: PMC9915377 DOI: 10.3390/ijerph20032718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The fetal environment is modulated by the placenta, which integrates and transduces information from the maternal environment to the fetal developmental program and adapts rapidly to changes through epigenetic mechanisms that respond to internal (hereditary) and external (environmental and social) signals. Consequently, the fetus corrects the trajectory of own development. During the last trimester of gestation, plasticity shapes the fetal brain, and prematurity can alter the typical developmental trajectories. In this period, prevention through activity-inducing (e.g., music stimulation) interventions are currently tested. The purpose of this review is to describe the potentialities of music exposure on fetus, and on preterm newborns in the Neonatal Intensive Care Unit evaluating its influence on neurobehavioral development. METHODS Databases were searched from 2010 to 2022 for studies investigating mechanisms of placental epigenetic regulation and effects of music exposure on the fetus and pre-term neonates. RESULTS In this case, 28 selected papers were distributed into three research lines: studies on placental epigenetic regulation (13 papers), experimental studies of music stimulation on fetus or newborns (6 papers), and clinical studies on premature babies (9 papers). Placental epigenetic changes of the genes involved in the cortisol and serotonin response resulted associated with different neurobehavioral phenotypes in newborns. Prenatal music stimulation had positive effects on fetus, newborn, and pregnant mother while post-natal exposure affected the neurodevelopment of the preterm infants and parental interaction. CONCLUSIONS The results testify the relevance of environmental stimuli for brain development during the pre- and perinatal periods and the beneficial effects of musical stimulation that can handle the fetal programming and the main neurobehavioral disorders.
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Affiliation(s)
- Olimpia Pino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Sofia Di Pietro
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Diana Poli
- INAIL Research, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene Via Fontana Candida 1, 00078 Monte Porzio Catone, Italy
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Abruzzese GA, Arbocco FCV, Ferrer MJ, Silva AF, Motta AB. Role of Hormones During Gestation and Early Development: Pathways Involved in Developmental Programming. Adv Exp Med Biol 2023; 1428:31-70. [PMID: 37466768 DOI: 10.1007/978-3-031-32554-0_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Accumulating evidence suggests that an altered maternal milieu and environmental insults during the intrauterine and perinatal periods of life affect the developing organism, leading to detrimental long-term outcomes and often to adult pathologies through programming effects. Hormones, together with growth factors, play critical roles in the regulation of maternal-fetal and maternal-neonate interfaces, and alterations in any of them may lead to programming effects on the developing organism. In this chapter, we will review the role of sex steroids, thyroid hormones, and insulin-like growth factors, as crucial factors involved in physiological processes during pregnancy and lactation, and their role in developmental programming effects during fetal and early neonatal life. Also, we will consider epidemiological evidence and data from animal models of altered maternal hormonal environments and focus on the role of different tissues in the establishment of maternal and fetus/infant interaction. Finally, we will identify unresolved questions and discuss potential future research directions.
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Affiliation(s)
- Giselle Adriana Abruzzese
- Laboratorio de Fisio-patología ovárica, Centro de Estudios Farmacológicos y Botánicos (CEFYBO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Fiorella Campo Verde Arbocco
- Laboratorio de Hormonas y Biología del Cáncer, Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), CONICET, Mendoza, Argentina
- Laboratorio de Reproducción y Lactancia, IMBECU, CONICET, Mendoza, Argentina
- Facultad de Ciencias Médicas, Universidad de Mendoza, Mendoza, Argentina
| | - María José Ferrer
- Laboratorio de Fisio-patología ovárica, Centro de Estudios Farmacológicos y Botánicos (CEFYBO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Aimé Florencia Silva
- Laboratorio de Fisio-patología ovárica, Centro de Estudios Farmacológicos y Botánicos (CEFYBO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Alicia Beatriz Motta
- Laboratorio de Fisio-patología ovárica, Centro de Estudios Farmacológicos y Botánicos (CEFYBO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
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Salmeri N, Carbone IF, Cavoretto PI, Farina A, Morano D. Epigenetics Beyond Fetal Growth Restriction: A Comprehensive Overview. Mol Diagn Ther 2022; 26:607-626. [PMID: 36028645 DOI: 10.1007/s40291-022-00611-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 12/30/2022]
Abstract
Fetal growth restriction is a pathological condition occurring when the fetus does not reach the genetically determined growth potential. The etiology of fetal growth restriction is expected to be multifactorial and include fetal, maternal, and placental factors, the latter being the most frequent cause of isolated fetal growth restriction. Severe fetal growth restriction has been related to both an increased risk of perinatal morbidity and mortality, and also a greater susceptibility to developing diseases (especially cardio-metabolic and neurological disorders) later in life. In the last decade, emerging evidence has supported the hypothesis of the Developmental Origin of Health and Disease, which states that individual developmental 'programming' takes place via a delicate fine tuning of fetal genetic and epigenetic marks in response to a large variety of 'stressor' exposures during pregnancy. As the placenta is the maternal-fetal interface, it has a crucial role in fetal programming, such that any perturbation altering placental function interferes with both in-utero fetal growth and also with the adult life phenotype. Several epigenetic mechanisms have been highlighted in modulating the dynamic placental epigenome, including alterations in DNA methylation status, post-translational modification of histones, and non-coding RNAs. This review aims to provide a comprehensive and critical overview of the available literature on the epigenetic background of fetal growth restriction. A targeted research strategy was performed using PubMed, MEDLINE, Embase, and The Cochrane Library up to January 2022. A detailed and fully referenced synthesis of available literature following the Scale for the Assessment of Narrative Review Articles guidelines is provided. A variety of epigenetic marks predominantly interfering with placental development, function, and metabolism were found to be potentially associated with fetal growth restriction. Available evidence on the role of environmental exposures in shaping the placental epigenome and the fetal phenotype were also critically discussed. Because of the highly dynamic crosstalk between epigenetic mechanisms and the extra level of complexity in interpreting the final placental transcriptome, a full comprehension of these phenomenon is still lacking and advances in multi-omics approaches are urgently needed. Elucidating the role of epigenetics in the developmental origins of health and disease represents a new challenge for the coming years, with the goal of providing early interventions and prevention strategies and, hopefully, new treatment opportunities.
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Affiliation(s)
- Noemi Salmeri
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Ilma Floriana Carbone
- Unit of Obstetrics, Department of Woman, Child and Neonate, Mangiagalli Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Ivo Cavoretto
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, 40138, Bologna, Italy.
| | - Danila Morano
- Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria S. Anna, University of Ferrara, Cona, Ferrara, Italy
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Moore LG, Wesolowski SR, Lorca RA, Murray AJ, Julian CG. Why is human uterine artery blood flow during pregnancy so high? Am J Physiol Regul Integr Comp Physiol 2022; 323:R694-R699. [PMID: 36094446 PMCID: PMC9602899 DOI: 10.1152/ajpregu.00167.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/12/2022] [Accepted: 09/07/2022] [Indexed: 11/22/2022]
Abstract
In healthy near-term women, blood flow to the uteroplacental circulation is estimated as 841 mL/min, which is greater than in other mammalian species. We argue that as uterine venous Po2 sets the upper limit for O2 diffusion to the fetus, high uterine artery blood flow serves to narrow the maternal arterial-to-uterine venous Po2 gradient and thereby raise uterine vein Po2. In support, we show that the reported levels for uterine artery blood flow agree with what is required to maintain normal fetal growth. Although residence at high altitudes (>2,500 m) depresses fetal growth, not all populations are equally affected; Tibetans and Andeans have higher levels of uterine artery blood flow than newcomers and exhibit normal fetal growth. Estimates of uterine venous Po2 from the umbilical blood-gas data available from healthy Andean pregnancies indicate that their high levels of uterine artery blood flow are consistent with their reported, normal birth weights. Unknown, however, are the effects on placental gas exchange of the lower levels of uterine artery blood flow seen in high-altitude newcomers or hypoxia-associated pregnancy complications. We speculate that, by widening the maternal artery to uterine vein Po2 gradient, lower levels of uterine artery blood flow prompt metabolic changes that slow fetal growth to match O2 supply.
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Affiliation(s)
- Lorna G Moore
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado
| | | | - Ramón A Lorca
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado
| | - Andrew J Murray
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Colleen G Julian
- Department of Biomedical Informatics, University of Colorado Denver, Aurora, Colorado
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Villar J, Ochieng R, Gunier RB, Papageorghiou AT, Rauch S, McGready R, Gauglitz JM, Barros FC, Vatish M, Fernandes M, Zammit V, Carrara VI, Munim S, Craik R, Barsosio HC, Carvalho M, Berkley JA, Ismail LIC, Norris SA, Tshivuila-Matala COO, Nosten F, Ohuma EO, Stein A, Lambert A, Winsey A, Uauy R, Eskenazi B, Bhutta ZA, Kennedy SH. Association between fetal abdominal growth trajectories, maternal metabolite signatures early in pregnancy, and childhood growth and adiposity: prospective observational multinational INTERBIO-21st fetal study. Lancet Diabetes Endocrinol 2022; 10:710-719. [PMID: 36030799 PMCID: PMC9622423 DOI: 10.1016/s2213-8587(22)00215-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Obesity predominantly affects populations in high-income countries and those countries facing epidemiological transition. The risk of childhood obesity is increased among infants who had overweight or obesity at birth, but in low-resource settings one in five infants are born small for gestational age. We aimed to study the relationships between: (1) maternal metabolite signatures; (2) fetal abdominal growth; and (3) postnatal growth, adiposity, and neurodevelopment. METHODS In the prospective, multinational, observational INTERBIO-21st fetal study, conducted in maternity units in Pelotas (Brazil), Nairobi (Kenya), Karachi (Pakistan), Soweto (South Africa), Mae Sot (Thailand), and Oxford (UK), we enrolled women (≥18 years, with a BMI of less than 35 kg/m2, natural conception, and a singleton pregnancy) who initiated antenatal care before 14 weeks' gestation. Ultrasound scans were performed every 5±1 weeks until delivery to measure fetal growth and feto-placental blood flow, and we used finite mixture models to derive growth trajectories of abdominal circumference. The infants' health, growth, and development were monitored from birth to age 2 years. Early pregnancy maternal blood and umbilical cord venous blood samples were collected for untargeted metabolomic analysis. FINDINGS From Feb 8, 2012, to Nov 30, 2019, we enrolled 3598 pregnant women and followed up their infants to 2 years of age. We identified four ultrasound-derived trajectories of fetal abdominal circumference growth that accelerated or decelerated within a crucial 20-25 week gestational age window: faltering growth, early accelerating growth, late accelerating growth, and median growth tracking. These distinct phenotypes had matching feto-placental blood flow patterns throughout pregnancy, and different growth, adiposity, vision, and neurodevelopment outcomes in early childhood. There were 709 maternal metabolites with positive effect for the faltering growth phenotype and 54 for the early accelerating growth phenotype; 31 maternal metabolites had a negative effect for the faltering growth phenotype and 76 for the early accelerating growth phenotype. Metabolites associated with the faltering growth phenotype had statistically significant odds ratios close to 1·5 (ie, suggesting upregulation of metabolic pathways of impaired fetal growth). The metabolites had a reciprocal relationship with the early accelerating growth phenotype, with statistically significant odds ratios close to 0.6 (ie, suggesting downregulation of fetal growth acceleration). The maternal metabolite signatures included 5-hydroxy-eicosatetraenoic acid, and 11 phosphatidylcholines linked to oxylipin or saturated fatty acid sidechains. The fungicide, chlorothalonil, was highly abundant in the early accelerating growth phenotype group. INTERPRETATION Early pregnancy lipid biology associated with fetal abdominal growth trajectories is an indicator of patterns of growth, adiposity, vision, and neurodevelopment up to the age of 2 years. Our findings could contribute to the earlier identification of infants at risk of obesity. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Jose Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.
| | | | - Robert B Gunier
- Center for Environmental Research and Community Health, School of Public Health, University of California, Berkeley, CA, USA
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Stephen Rauch
- Center for Environmental Research and Community Health, School of Public Health, University of California, Berkeley, CA, USA
| | - Rose McGready
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Fernando C Barros
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Manu Vatish
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michelle Fernandes
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Medical Research Council Lifecourse Epidemiology Centre & Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Victor Zammit
- Biomedical Sciences, Translational & Experimental Medicine, Warwick Medical School, University of Warwick, Coventry, UK
| | - Verena I Carrara
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Shama Munim
- Department of Obstetrics and Gynaecology, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rachel Craik
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Hellen C Barsosio
- Kenya Medical Research Institute-Coast Centre for Geographical Medicine and Research, University of Oxford, Kilifi, Kenya
| | - Maria Carvalho
- Department of Obstetrics & Gynaecology, Faculty of Health Sciences, Aga Khan University Hospital, Nairobi, Kenya
| | - James A Berkley
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Kenya Medical Research Institute-Coast Centre for Geographical Medicine and Research, University of Oxford, Kilifi, Kenya
| | - Leila I Cheikh Ismail
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Clinical Nutrition and Dietetics Department, University of Sharjah, Sharjah, United Arab Emirates
| | - Shane A Norris
- South African Medical Research Institute Developmental Pathways For Health Research Unit, Department of Paediatrics & Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Chrystelle O O Tshivuila-Matala
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; South African Medical Research Institute Developmental Pathways For Health Research Unit, Department of Paediatrics & Child Health, University of the Witwatersrand, Johannesburg, South Africa; Health, Nutrition & Population Global Practice, World Bank Group, Washington, DC, USA
| | - Francois Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Eric O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK; Medical Research Council and Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; African Health Research Institute, KwaZulu-Natal, South Africa
| | - Ann Lambert
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Adele Winsey
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Ricardo Uauy
- Department of Nutrition and Public Health Interventions Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health, School of Public Health, University of California, Berkeley, CA, USA
| | - Zulfiqar A Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya; Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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Salazar-Petres E, Pereira-Carvalho D, Lopez-Tello J, Sferruzzi-Perri AN. Placental structure, function, and mitochondrial phenotype relate to fetal size in each fetal sex in mice†. Biol Reprod 2022; 106:1292-1311. [PMID: 35293971 PMCID: PMC9327737 DOI: 10.1093/biolre/ioac056] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/28/2022] [Accepted: 03/08/2022] [Indexed: 11/25/2022] Open
Abstract
Fetal growth depends on placental function, which requires energy from mitochondria. Here we investigated whether mitochondrial function in the placenta relates to the growth of the lightest and heaviest fetuses of each sex within the litter of mice. Placentas from the lightest and heaviest fetuses were taken to evaluate placenta morphology (stereology), mitochondrial energetics (high-resolution respirometry), mitochondrial regulators, nutrient transporters, hormone handling, and signaling pathways (qPCR and Western blotting). We found that mitochondrial complex I and II oxygen consumption rate was greater for placentas supporting the lightest female fetuses, although placental complex I abundance of the lightest females and complexes III and V of the lightest males were decreased compared to their heaviest counterparts. Expression of mitochondrial biogenesis (Nrf1) and fission (Drp1 and Fis1) genes was lower in the placenta from the lightest females, whilst biogenesis-related gene Tfam was greater in the placenta of the lightest male fetuses. In addition, placental morphology and steroidogenic gene (Cyp17a1 and Cyp11a1) expression were aberrant for the lightest females, but glucose transporter (Slc2a1) expression was lower in only the lightest males versus their heaviest counterparts. Differences in intra-litter placental phenotype were related to changes in the expression of hormone-responsive (androgen receptor) and metabolic signaling (AMPK, AKT, and PPARγ) pathways. Thus, in normal mouse pregnancy, placental structure, function, and mitochondrial phenotype are differentially responsive to the growth of the female and male fetus. This study may inform the design of sex-specific therapies for placental insufficiency and fetal growth abnormalities with life-long benefits for the offspring.
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Affiliation(s)
- Esteban Salazar-Petres
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
| | - Daniela Pereira-Carvalho
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
| | - Jorge Lopez-Tello
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
| | - Amanda Nancy Sferruzzi-Perri
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
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Nagaraj C, Li Y, Tang B, Bordag N, Guntur D, Enyedi P, Olschewski H, Olschewski A. Potassium Channels in the Transition from Fetal to the Neonatal Pulmonary Circulation. Int J Mol Sci 2022; 23:ijms23094681. [PMID: 35563072 PMCID: PMC9106051 DOI: 10.3390/ijms23094681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 12/10/2022] Open
Abstract
The transition from the fetal to the neonatal circulation includes dilatation of the pulmonary arteries (PA) and closure of the Ductus Arteriosus Botalli (DAB). The resting membrane potential and various potassium channel activities in smooth muscle cells (SMC) from fetal and neonatal PA and DAB obtained from the same species has not been systematically analyzed. The key issue addressed in this paper is how the resting membrane potential and the whole-cell potassium current (IK) change when PASMC or DABSMC are transitioned from hypoxia, reflecting the fetal state, to normoxia, reflecting the post-partal state. Patch-clamp measurements were employed to characterize whole-cell K+ channel activity in fetal and post-partal (newborn) PASMC and DABSMC. The main finding of this paper is that the SMC from both tissues use a similar set of K+ channels (voltage-dependent (Kv), calcium-sensitive (KCa), TASK-1 and probably also TASK-2 channels); however, their activity level depends on the cell type and the oxygen level. Furthermore, we provide the first evidence for pH-sensitive non-inactivating K+ current in newborn DABSMC and PASMC, suggesting physiologically relevant TASK-1 and TASK-2 channel activity, the latter particularly in the Ductus Arteriosus Botalli.
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Affiliation(s)
- Chandran Nagaraj
- Ludwig Boltzmann Institute for Lung Vascular Research, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (C.N.); (N.B.)
| | - Yingji Li
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (Y.L.); (B.T.); (D.G.)
| | - Bi Tang
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (Y.L.); (B.T.); (D.G.)
| | - Natalie Bordag
- Ludwig Boltzmann Institute for Lung Vascular Research, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (C.N.); (N.B.)
- Department of Dermatology and Venereology, Medical University of Graz, Auenbruggerplatz 8, 8036 Graz, Austria
| | - Divya Guntur
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (Y.L.); (B.T.); (D.G.)
| | - Péter Enyedi
- Department of Physiology, Faculty of Medicine, Semmelweis University, Tűzoltó utca 37-47, 1094 Budapest, Hungary;
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria;
| | - Andrea Olschewski
- Experimental Anaesthesiology, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (Y.L.); (B.T.); (D.G.)
- Correspondence:
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15
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Hufnagel A, Dearden L, Fernandez-Twinn DS, Ozanne SE. Programming of cardiometabolic health: the role of maternal and fetal hyperinsulinaemia. J Endocrinol 2022; 253:R47-R63. [PMID: 35258482 PMCID: PMC9066586 DOI: 10.1530/joe-21-0332] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022]
Abstract
Obesity and gestational diabetes during pregnancy have multiple short- and long-term consequences for both mother and child. One common feature of pregnancies complicated by maternal obesity and gestational diabetes is maternal hyperinsulinaemia, which has effects on the mother and her adaptation to pregnancy. Even though insulin does not cross the placenta insulin can act on the placenta as well affecting placental growth, angiogenesis and lipid metabolism. Obese and gestational diabetic pregnancies are often characterised by maternal hyperglycaemia resulting in exposure of the fetus to high levels of glucose, which freely crosses the placenta. This leads to stimulation of fetal ß-cells and insulin secretion in the fetus. Fetal hyperglycaemia/hyperinsulinaemia has been shown to cause multiple complications in fetal development, such as altered growth trajectories, impaired neuronal and cardiac development and early exhaustion of the pancreas. These changes could increase the susceptibility of the offspring to develop cardiometabolic diseases later in life. In this review, we aim to summarize and review the mechanisms by which maternal and fetal hyperinsulinaemia impact on (i) maternal health during pregnancy; (ii) placental and fetal development; (iii) offspring energy homeostasis and long-term cardiometabolic health; (iv) how interventions can alleviate these effects.
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Affiliation(s)
- Antonia Hufnagel
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Level 4, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, UK
| | - Laura Dearden
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Level 4, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, UK
| | - Denise S Fernandez-Twinn
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Level 4, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, UK
| | - Susan E Ozanne
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Level 4, Addenbrooke’s Hospital, Cambridge, Cambridgeshire, UK
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Yadav A, Beilin LJ, Huang RC, Vlaskovsky P, Newnham JP, White SW, Mori TA. The relationship between intrauterine foetal growth trajectories and blood pressure in young adults. J Hypertens 2022; 40:478-489. [PMID: 34751171 DOI: 10.1097/hjh.0000000000003035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have reported an association between low birthweight and elevated blood pressure (BP) in adulthood, but few have examined the relationship between foetal growth and adult BP. METHOD The study examined the association between intrauterine growth trajectories determined by serial ultrasound and BP of the adult offspring in the Raine Study. Foetal growth trajectories for abdominal circumference, femur length and head circumference z-scores were developed using group-based trajectory modelling from 1440 women with serial ultrasounds from 15-weeks pregnancy to birth. Seven abdominal circumference, five femur length and five head circumference trajectory groups were identified. Longitudinal linear mixed modelling examined the association between trajectory groups and offspring BP at 20 (n = 487), 22 (n = 419) and 27 (n = 436) years. RESULTS Higher SBP in adulthood significantly associated with two abdominal circumference trajectories, one with the most restricted foetal growth [3.52 mmHg, 95% confidence interval (95% CI) = 1.20-5.83] and the other with sustained low-growth (1.92 mmHg, 95% CI = 0.11-3.73) compared with an average growth trajectory, after adjusting for sex, age, alcohol consumption and BMI. Foetal head circumference trajectories with sustained low-growth or average-to-falling growth significantly associated with higher adult systolic (3.45 mmHg, 95% CI = 1.77-5.14 and 1.54 mmHg, 95% CI = 0.30-2.78, respectively) and diastolic (2.28 mmHg, 95% CI = 0.77-3.78 and 1.47 mmHg, 95% CI = 0.54-2.39, respectively) BP compared with average growth. Low femur length growth associated with higher adult DBP after adjusting for sex, but not after accounting for adult BMI. CONCLUSION Our results show that restricted foetal head and abdominal circumference associated with higher adult SBP over two decades later, reinforcing the importance of the early intrauterine environment and its influence on adult BP.
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Affiliation(s)
| | | | | | | | - John P Newnham
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia
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Pérez-Cruz M, Gómez O, Gibert M, Masoller N, Marimon E, Lip-Sosa D, Bennasar M, Bonet-Carne E, Gómez-Roig MD, Martínez-Crespo JM, Gratacós E, Eixarch E. Corpus callosum size by neurosonography in fetuses with congenital heart defect and relationship with expected pattern of brain oxygen supply. Ultrasound Obstet Gynecol 2022; 59:220-225. [PMID: 33998077 DOI: 10.1002/uog.23684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/22/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate corpus callosum (CC) size by neurosonography (NSG) in fetuses with an isolated major congenital heart defect (CHD) and explore the association of CC size with the expected pattern of in-utero oxygen supply to the brain. METHODS A total of 56 fetuses with postnatally confirmed isolated major CHD and 56 gestational-age-matched controls were included. Fetuses with CHD were stratified into two categories according to the main expected pattern of cerebral arterial oxygen supply: Class A, moderately to severely reduced oxygen supply (left outflow tract obstruction and transposition of the great arteries) and Class B, near normal or mildly impaired oxygenated blood supply to the brain (other CHD). Transvaginal NSG was performed at 32-36 weeks in all fetuses to evaluate CC length, CC total area and areas of CC subdivisions in the midsagittal plane. RESULTS CHD fetuses had a significantly smaller CC area as compared to controls (7.91 ± 1.30 vs 9.01 ± 1.44 mm2 ; P < 0.001), which was more pronounced in the most posterior part of the CC. There was a significant linear trend for reduced CC total area across the three clinical groups, with CHD Class-A cases showing more prominent changes (controls, 9.01 ± 1.44 vs CHD Class B, 8.18 ± 1.21 vs CHD Class A, 7.53 ± 1.33 mm2 ; P < 0.05). CONCLUSIONS Fetuses with major CHD had a smaller CC compared with controls, and the difference was more marked in the CHD subgroup with expected poorer brain oxygenation. Sonographic CC size could be a clinically feasible marker of abnormal white matter development in CHD. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Pérez-Cruz
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Maternal and Child Health and Development Network II (SAMID II), funded by Instituto de Salud Carlos III (ISCIII), Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), Madrid, Spain
| | - O Gómez
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - M Gibert
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - N Masoller
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - E Marimon
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - D Lip-Sosa
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - M Bennasar
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - E Bonet-Carne
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Universitat Politècnica de Catalunya, BarcelonaTech, Barcelona, Spain
| | - M D Gómez-Roig
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Maternal and Child Health and Development Network II (SAMID II), funded by Instituto de Salud Carlos III (ISCIII), Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), Madrid, Spain
| | - J M Martínez-Crespo
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - E Gratacós
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - E Eixarch
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
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Allotey J, Whittle R, Snell KIE, Smuk M, Townsend R, von Dadelszen P, Heazell AEP, Magee L, Smith GCS, Sandall J, Thilaganathan B, Zamora J, Riley RD, Khalil A, Thangaratinam S. External validation of prognostic models to predict stillbirth using International Prediction of Pregnancy Complications (IPPIC) Network database: individual participant data meta-analysis. Ultrasound Obstet Gynecol 2022; 59:209-219. [PMID: 34405928 DOI: 10.1002/uog.23757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/30/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. METHODS MEDLINE, EMBASE, DH-DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose individual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C-statistic, and calibration was assessed using calibration plots, calibration slope and calibration-in-the-large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random-effects meta-analysis. Clinical utility was assessed using net benefit. RESULTS Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one-fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overall high risk of bias, according to PROBAST. In the IPD meta-analysis, the models had summary C-statistics ranging from 0.53 to 0.65 and summary calibration slopes ranging from 0.40 to 0.88, with risk predictions that were generally too extreme compared with the observed risks. The models had little to no clinical utility, as assessed by net benefit. However, there remained uncertainty in the performance of some models due to small available sample sizes. CONCLUSIONS The three validated stillbirth prediction models showed generally poor and uncertain predictive performance in new data, with limited evidence to support their clinical application. The findings suggest methodological shortcomings in their development, including overfitting. Further research is needed to further validate these and other models, identify stronger prognostic factors and develop more robust prediction models. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J Allotey
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R Whittle
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - K I E Snell
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - M Smuk
- Medical Statistics Department, London School of Hygiene and Tropical Medicine, London, UK
| | - R Townsend
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - P von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - A E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - L Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - G C S Smith
- Department of Obstetrics and Gynaecology, NIHR Biomedical Research Centre, Cambridge University, Cambridge, UK
| | - J Sandall
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Health Service and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - J Zamora
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - R D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - S Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Chuaiphichai S, Yu GZ, Tan CM, Whiteman C, Douglas G, Dickinson Y, Drydale EN, Appari M, Zhang W, Crabtree MJ, McNeill E, Hale AB, Lewandowski AJ, Alp NJ, Vatish M, Leeson P, Channon KM. Endothelial GTPCH (GTP Cyclohydrolase 1) and Tetrahydrobiopterin Regulate Gestational Blood Pressure, Uteroplacental Remodeling, and Fetal Growth. Hypertension 2021; 78:1871-1884. [PMID: 34689592 PMCID: PMC8577301 DOI: 10.1161/hypertensionaha.120.17646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/07/2021] [Indexed: 01/01/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Surawee Chuaiphichai
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.C., C.W., G.D., Y.D., E.N.D., M.A., M.J.C., E.M., A.B.H., N.J.A., K.M.C.)
| | - Grace Z. Yu
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.M.J.T., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Cheryl M.J. Tan
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.M.J.T., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Christopher Whiteman
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.C., C.W., G.D., Y.D., E.N.D., M.A., M.J.C., E.M., A.B.H., N.J.A., K.M.C.)
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.M.J.T., A.J.L., P.L.), University of Oxford, United Kingdom
- Nuffield Department of Women’s and Reproductive Health (W.Z., M.V.), University of Oxford, United Kingdom
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, United Kingdom (M.V., K.M.C.)
| | - Gillian Douglas
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.C., C.W., G.D., Y.D., E.N.D., M.A., M.J.C., E.M., A.B.H., N.J.A., K.M.C.)
| | - Yasmin Dickinson
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.C., C.W., G.D., Y.D., E.N.D., M.A., M.J.C., E.M., A.B.H., N.J.A., K.M.C.)
| | - Edward N. Drydale
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.C., C.W., G.D., Y.D., E.N.D., M.A., M.J.C., E.M., A.B.H., N.J.A., K.M.C.)
| | - Mahesh Appari
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.C., C.W., G.D., Y.D., E.N.D., M.A., M.J.C., E.M., A.B.H., N.J.A., K.M.C.)
| | - Wei Zhang
- Nuffield Department of Women’s and Reproductive Health (W.Z., M.V.), University of Oxford, United Kingdom
| | - Mark J. Crabtree
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.C., C.W., G.D., Y.D., E.N.D., M.A., M.J.C., E.M., A.B.H., N.J.A., K.M.C.)
| | - Eileen McNeill
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.C., C.W., G.D., Y.D., E.N.D., M.A., M.J.C., E.M., A.B.H., N.J.A., K.M.C.)
| | - Ashley B. Hale
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.C., C.W., G.D., Y.D., E.N.D., M.A., M.J.C., E.M., A.B.H., N.J.A., K.M.C.)
| | - Adam J. Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.M.J.T., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Nicholas J. Alp
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.C., C.W., G.D., Y.D., E.N.D., M.A., M.J.C., E.M., A.B.H., N.J.A., K.M.C.)
| | - Manu Vatish
- Nuffield Department of Women’s and Reproductive Health (W.Z., M.V.), University of Oxford, United Kingdom
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, United Kingdom (M.V., K.M.C.)
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (G.Z.Y., C.M.J.T., A.J.L., P.L.), University of Oxford, United Kingdom
| | - Keith M. Channon
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.C., C.W., G.D., Y.D., E.N.D., M.A., M.J.C., E.M., A.B.H., N.J.A., K.M.C.)
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, United Kingdom (M.V., K.M.C.)
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20
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Deter RL, Lee W, Dicker P, Tully EC, Cody F, Malone FD, Flood KM. Third-trimester growth diversity in small fetuses classified as appropriate-for-gestational age or small-for-gestational age at birth. Ultrasound Obstet Gynecol 2021; 58:882-891. [PMID: 33998089 DOI: 10.1002/uog.23688] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/01/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE We have shown previously that third-trimester growth in small fetuses (estimated fetal weight (EFW) < 10th percentile) with birth weight (BW) < 10th percentile is heterogeneous using individualized growth assessment (IGA). We aimed to test our hypothesis that individual growth patterns in small fetuses with BW > 10th percentile are also variable but in different ways. METHODS This was a study of 191 cases with EFW < 10th percentile and BW > 10th percentile (appropriate-for-gestational-age (AGA) cohort), derived from the PORTO study. Composite size parameters were used to quantify growth pathology at individual third-trimester timepoints (individual composite prenatal growth assessment score (-icPGAS)). The fetal growth pathology score 1 (-FGPS1), calculated cumulatively from serial -icPGAS values, was used to characterize third-trimester growth patterns. Vascular-system evaluation included umbilical artery (UA) and middle cerebral artery (MCA) Doppler velocimetry. Outcome variables were birth age (preterm/term delivery) and BW (expressed as growth potential realization index for weight (GPRIWT ) and percentile). The findings from the AGA cohort were compared with those from small fetuses (EFW < 10th percentile) with BW < 10th percentile (small-for-gestational-age (SGA) cohort). RESULTS The AGA cohort was found to have 134 fetuses (70%) with normal growth pattern and 57 (30%) with growth restriction based on IGA criteria. Seven growth-restriction -FGPS1 patterns were observed, including the previously defined progressive, late, adaptive and recovering types. The recovering type was the most common growth pattern in the AGA cohort (50.9%). About one-third of fetuses without any evidence of growth restriction had significant unexplained abnormalities in the UA (34%) and MCA (31%) and elevated mean GPRIWT values (113 ± 12.5%). Comparison of the AGA and SGA cohorts indicated a significant difference in the distribution of -FGPS1 growth patterns (P = 0.0001). Compared with the SGA cohort, the AGA cohort had more fetuses with a normal growth pattern (70% vs 38%) and fewer cases with growth restriction (30% vs 62%). While the recovering type was the most common growth-restriction pattern in the AGA cohort (51%), the progressive type was the primary growth-restriction pattern in the SGA cohort (44%). No difference in the incidence of MCA or UA abnormality was found between the SGA and AGA cohorts when comparing subgroups of more than 10 fetuses. CONCLUSIONS Both normal-growth and growth-restriction patterns were observed in the AGA cohort using IGA, as seen previously in the SGA cohort. The seven types of growth restriction defined in the SGA cohort were also identified in AGA cases, but their distribution was significantly different. In one-third of cases without evidence of growth pathology in the AGA cohort, Doppler abnormalities in the UA and MCA were seen. This heterogeneity underscores the difficulty of accurate classification of fetal and neonatal growth status using conventional population-based methods. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R L Deter
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - P Dicker
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - E C Tully
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - F Cody
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - F D Malone
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - K M Flood
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
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21
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Abstract
Hormones have an important role in the regulation of fetal growth and development, especially in response to nutrient availability in utero. Using micro-CT and an electromagnetic three-point bend test, this study examined the effect of pancreas removal at 0.8 fraction of gestation on the developing bone structure and mechanical strength in fetal sheep. When fetuses were studied at 10 and 25 days after surgery, pancreatectomy caused hypoinsulinaemia, hyperglycaemia and growth retardation which was associated with low plasma concentrations of leptin and a marker of osteoclast activity and collagen degradation. In pancreatectomized fetuses compared to control fetuses, limb lengths were shorter, and trabecular (Tb) bone in the metatarsi showed greater bone volume fraction, Tb thickness, degree of anisotropy and porosity, and lower fractional bone surface area and Tb spacing. Mechanical strength testing showed that pancreas deficiency was associated with increased stiffness and a greater maximal weight load at fracture in a subset of fetuses studied near term. Overall, pancreas deficiency in utero slowed the growth of the fetal skeleton and adapted the developing bone to generate a more compact and connected structure. Maintenance of bone strength in growth-retarded limbs is especially important in a precocial species in preparation for skeletal loading and locomotion at birth.
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Affiliation(s)
- Stuart A Lanham
- Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, School of Medicine, University of Southampton, Southampton, UK
| | - Dominique Blache
- School of Agriculture and Environment, University of Western Australia, Crawley, Australia
| | - Richard O C Oreffo
- Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, School of Medicine, University of Southampton, Southampton, UK
| | - Abigail L Fowden
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Alison J Forhead
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
- Department of Biological and Medical Sciences, Oxford Brookes University, Oxford, UK
- Correspondence should be addressed to A J Forhead:
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22
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Allen MC, Moog NK, Buss C, Yen E, Gustafsson HC, Sullivan EL, Graham AM. Co-occurrence of preconception maternal childhood adversity and opioid use during pregnancy: Implications for offspring brain development. Neurotoxicol Teratol 2021; 88:107033. [PMID: 34601061 PMCID: PMC8578395 DOI: 10.1016/j.ntt.2021.107033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 12/11/2022]
Abstract
Understanding of the effects of in utero opioid exposure on neurodevelopment is a priority given the recent dramatic increase in opioid use among pregnant individuals. However, opioid abuse does not occur in isolation-pregnant individuals abusing opioids often have a significant history of adverse experiences in childhood, among other co-occurring factors. Understanding the specific pathways in which these frequently co-occurring factors may interact and cumulatively influence offspring brain development in utero represents a priority for future research in this area. We highlight maternal history of childhood adversity (CA) as one such co-occurring factor that is more prevalent among individuals using opioids during pregnancy and which is increasingly shown to affect offspring neurodevelopment through mechanisms beginning in utero. Despite the high incidence of CA history in pregnant individuals using opioids, we understand very little about the effects of comorbid prenatal opioid exposure and maternal CA history on fetal brain development. Here, we first provide an overview of current knowledge regarding effects of opioid exposure and maternal CA on offspring neurodevelopment that may occur during gestation. We then outline potential mechanistic pathways through which these factors might have interactive and cumulative influences on offspring neurodevelopment as a foundation for future research in this area.
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Affiliation(s)
- Madeleine C Allen
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States
| | - Nora K Moog
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Luisenstrasse 57, 10117 Berlin, Germany
| | - Claudia Buss
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Luisenstrasse 57, 10117 Berlin, Germany; Development, Health and Disease Research Program, University of California, Irvine, 837 Health Sciences Drive, Irvine, California 92697, United States
| | - Elizabeth Yen
- Department of Pediatrics, Tufts Medical Center, Boston, MA 02111, United States
| | - Hanna C Gustafsson
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States
| | - Elinor L Sullivan
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States; Division of Neuroscience, Oregon National Primate Research Center, 505 NW 185(th) Ave., Beaverton, OR 97006, United States; Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States
| | - Alice M Graham
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States.
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23
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Rubini E, Baijens IMM, Horánszky A, Schoenmakers S, Sinclair KD, Zana M, Dinnyés A, Steegers-Theunissen RPM, Rousian M. Maternal One-Carbon Metabolism during the Periconceptional Period and Human Foetal Brain Growth: A Systematic Review. Genes (Basel) 2021; 12:1634. [PMID: 34681028 PMCID: PMC8535925 DOI: 10.3390/genes12101634] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/01/2021] [Accepted: 10/12/2021] [Indexed: 01/13/2023] Open
Abstract
The maternal environment during the periconceptional period influences foetal growth and development, in part, via epigenetic mechanisms moderated by one-carbon metabolic pathways. During embryonic development, one-carbon metabolism is involved in brain development and neural programming. Derangements in one-carbon metabolism increase (i) the short-term risk of embryonic neural tube-related defects and (ii) long-term childhood behaviour, cognition, and autism spectrum disorders. Here we investigate the association between maternal one-carbon metabolism and foetal and neonatal brain growth and development. Database searching resulted in 26 articles eligible for inclusion. Maternal vitamin B6, vitamin B12, homocysteine, and choline were not associated with foetal and/or neonatal head growth. First-trimester maternal plasma folate within the normal range (>17 nmol/L) associated with increased foetal head size and head growth, and high erythrocyte folate (1538-1813 nmol/L) with increased cerebellar growth, whereas folate deficiency (<7 nmol/L) associated with a reduced foetal brain volume. Preconceptional folic acid supplement use and specific dietary patterns (associated with increased B vitamins and low homocysteine) increased foetal head size. Although early pregnancy maternal folate appears to be the most independent predictor of foetal brain growth, there is insufficient data to confirm the link between maternal folate and offspring risks for neurodevelopmental diseases.
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Affiliation(s)
- Eleonora Rubini
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (E.R.); (I.M.M.B.); (S.S.); (M.R.)
| | - Inge M. M. Baijens
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (E.R.); (I.M.M.B.); (S.S.); (M.R.)
| | - Alex Horánszky
- Department of Physiology and Animal Health, Institute of Physiology and Animal Health, Hungarian University of Agriculture and Life Sciences, H-2100 Gödöllő, Hungary; (A.H.); (A.D.)
- BioTalentum Ltd., H-2100 Gödöllő, Hungary;
| | - Sam Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (E.R.); (I.M.M.B.); (S.S.); (M.R.)
| | - Kevin D. Sinclair
- School of Biosciences, University of Nottingham, Nottingham LE12 5RD, UK;
| | | | - András Dinnyés
- Department of Physiology and Animal Health, Institute of Physiology and Animal Health, Hungarian University of Agriculture and Life Sciences, H-2100 Gödöllő, Hungary; (A.H.); (A.D.)
- BioTalentum Ltd., H-2100 Gödöllő, Hungary;
- HCEMM-USZ Stem Cell Research Group, Hungarian Centre of Excellence for Molecular Medicine, H-6723 Szeged, Hungary
- Department of Cell Biology and Molecular Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Régine P. M. Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (E.R.); (I.M.M.B.); (S.S.); (M.R.)
| | - Melek Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands; (E.R.); (I.M.M.B.); (S.S.); (M.R.)
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24
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White M, Grynspan D, Van Mieghem T, Connor KL. Isolated fetal neural tube defects associate with increased risk of placental pathology: Evidence from the Collaborative Perinatal Project. Placenta 2021; 114:56-67. [PMID: 34479062 DOI: 10.1016/j.placenta.2021.08.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Neural tube defects (NTDs) are amongst the most common congenital anomalies and are associated with significant postnatal morbidity, but also with a higher incidence of low birthweight and fetal growth restriction. Despite the placenta being a critical determinant of fetal growth, placental development has not been extensively studied in fetuses with NTDs. METHODS We performed a matched case-cohort study using data from the Collaborative Perinatal Project to assess the risk of placental pathology in pregnancies with an isolated fetal NTD (cases; n = 74) compared to those without any congenital anomalies (controls; n = 148). We hypothesised that cases would be at an increased risk of placental pathology compared to controls. Data were analysed using adjusted generalized linear and nominal logistic regression models. Results are presented as adjusted β or adjusted odds ratio (aOR; 95% confidence interval). RESULTS Cases had lower placental weight (β = -22.2 g [-37.8 to -6.6]), surface area (β = -9.6 cm2 [-18.3 to -1.0]) and birth length z-scores (β = -0.4 [-0.7 to -0.001]) compared to controls. Cases were more likely to have a single umbilical artery (vs. two; 6 [8.1%] vs. 1 [0.7%]; aOR = 301 [52.6-1726]), placental hypermaturity (9 [12.2%] vs. 5 [3.4%]; aOR = 6.8 [3.1-14.7]), many (vs. few) Hofbauer cells (9 [12.2%] vs. 7 [4.7%]; aOR = 3.02 [1.2-7.3]), and stromal fibrosis (9 [12.2%] vs. 10 [6.8%]; aOR = 3.0 [1.4-6.3]) in placental terminal villi compared to controls. CONCLUSIONS Fetuses with isolated NTDs may be at increased risk of placental pathology, which could be contributing to poor fetal growth in these pregnancies and subsequent postnatal morbidities.
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Affiliation(s)
- Marina White
- Health Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - David Grynspan
- Vernon Jubilee Hospital, Vernon, BC, V1T 5L2, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, V6T 1Z7, Canada
| | - Tim Van Mieghem
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada
| | - Kristin L Connor
- Health Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada.
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25
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Martin WN, Wang CA, Lye SJ, Matthews SG, Reynolds RM, McLaughlin CE, Smith R, Pennell CE. A Life Course Approach to the Relationship Between Fetal Growth and Hypothalamic-Pituitary-Adrenal Axis Function. J Clin Endocrinol Metab 2021; 106:2646-2659. [PMID: 33999183 PMCID: PMC8372661 DOI: 10.1210/clinem/dgab341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Human and animal studies suggest that hypothalamic-pituitary-adrenal axis (HPA-A) function may be programmed in utero; however, these findings are inconsistent. Given the powerful metabolic actions of cortisol, it is important to clarify the influence of early life on adult HPA-A function. OBJECTIVE To determine the relationship between fetal growth and HPA-A stress response to a psychosocial stressor in young adults. DESIGN Multigenerational, prospective cohort study (the Raine Study) conducted between 1989 and 1991. SETTING King Edward Memorial Hospital, Perth, Western Australia, Australia. PARTICIPANTS A total of 917 participants aged 18 years from Gen2 of the Raine Study. MAIN OUTCOME MEASURES Measures of hypothalamic-pituitary-adrenal axis function before and after exposure to the Trier Social Stress Test. RESULTS In fully adjusted models, an inverse linear relationship was observed between birthweight and plasma measures of (1) baseline cortisol (β = -0.90%, 95% CI: -1.73 to -0.07; P = 0.03); (2) peak cortisol (β = -0.78%, 95% CI -1.51 to -0.06; P = 0.03); (3) area under the curve with respect to ground (β = -0.89%, 95% CI -1.60 to -0.18; P = 0.01); and (4) adrenal sensitivity (β = -1.02, 95% CI: -1.85 to -0.18; P = 0.02). Similar results were demonstrated for percent optimal birthweight. No consistent quadratic relationships were identified. No associations were found between measures of fetal adiposity and HPA-A function at age 18 years, or fetal growth and HPA-A response pattern. Removal of anticipatory responders from the models substantially attenuated the observed relationships. CONCLUSION We observed an inverse linear relationship between fetal growth and HPA-A function at age 18 years. This differs from the inverse parabolic relationship (inverted U curve) reported in adults of advanced age. Altered adrenal sensitivity may underlie this relationship.
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Affiliation(s)
- Wrivu N Martin
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales 2308, Australia
| | - Carol A Wang
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales 2308, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, New South Wales 2305, Australia
| | - Stephen J Lye
- Program in Development and Fetal Health, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Ontario M5T 3H7, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada
- Department of Obstetrics and Gynaecology (Maternal Fetal Medicine), University of Toronto, Toronto, Ontario M5G 1E2, Canada
| | - Stephen G Matthews
- Program in Development and Fetal Health, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Ontario M5T 3H7, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada
- Department of Obstetrics and Gynaecology (Maternal Fetal Medicine), University of Toronto, Toronto, Ontario M5G 1E2, Canada
| | - Rebecca M Reynolds
- British Heart Foundation Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Carly E McLaughlin
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Bentley 6102, Australia
| | - Roger Smith
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales 2308, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, New South Wales 2305, Australia
| | - Craig E Pennell
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales 2308, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, New South Wales 2305, Australia
- Correspondence: Craig Pennell, School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, NSW, 2287, Australia.
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Lund A, Ebbing C, Rasmussen S, Qvigstad E, Kiserud T, Kessler J. Pre-gestational diabetes: Maternal body mass index and gestational weight gain are associated with augmented umbilical venous flow, fetal liver perfusion, and thus birthweight. PLoS One 2021; 16:e0256171. [PMID: 34398922 PMCID: PMC8367003 DOI: 10.1371/journal.pone.0256171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/30/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To assess how maternal body mass index and gestational weight gain are related to on fetal venous liver flow and birthweight in pregnancies with pre-gestational diabetes mellitus. METHODS In a longitudinal observational study, 49 women with pre-gestational diabetes mellitus were included for monthly assessments (gestational weeks 24-36). According to the Institute Of Medicine criteria, body mass index was categorized to underweight, normal, overweight, and obese, while gestational weight gain was classified as insufficient, appropriate or excessive. Fetal size, portal flow, umbilical venous flow and distribution to the fetal liver or ductus venosus were determined using ultrasound techniques. The impact of fetal venous liver perfusion on birthweight and how body mass index and gestational weight gain modified this effect, was compared with a reference population (n = 160). RESULTS The positive association between umbilical flow to liver and birthweight was more pronounced in pregnancies with pre-gestational diabetes mellitus than in the reference population. Overweight and excessive gestational weight gain were associated with higher birthweights in women with pre-gestational diabetes mellitus, but not in the reference population. Fetuses of overweight women with pre-gestational diabetes mellitus had higher umbilical (p = 0.02) and total venous liver flows (p = 0.02), and a lower portal flow fraction (p = 0.04) than in the reference population. In pre-gestational diabetes mellitus pregnancies with excessive gestational weight gain, the umbilical flow to liver was higher than in those with appropriate weight gain (p = 0.02). CONCLUSIONS The results support the hypothesis that umbilical flow to the fetal liver is a key determinant for fetal growth and birthweight modifiable by maternal factors. Maternal pre-gestational diabetes mellitus seems to augment this influence as shown with body mass index and gestational weight gain.
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Affiliation(s)
- Agnethe Lund
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Research Group for Pregnancy, Fetal Development and Birth, University of Bergen, Bergen, Norway
| | - Cathrine Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Research Group for Pregnancy, Fetal Development and Birth, University of Bergen, Bergen, Norway
- * E-mail:
| | - Svein Rasmussen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Research Group for Pregnancy, Fetal Development and Birth, University of Bergen, Bergen, Norway
| | - Elisabeth Qvigstad
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torvid Kiserud
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Research Group for Pregnancy, Fetal Development and Birth, University of Bergen, Bergen, Norway
| | - Jörg Kessler
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Research Group for Pregnancy, Fetal Development and Birth, University of Bergen, Bergen, Norway
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Oken E, Thompson JW, Rifas-Shiman SL, Vilchuk K, Bogdanovich N, Hameza M, Yang S, Patel R, Kramer MS, Martin RM. Analysis of Maternal Prenatal Weight and Offspring Cognition and Behavior: Results From the Promotion of Breastfeeding Intervention Trial (PROBIT) Cohort. JAMA Netw Open 2021; 4:e2121429. [PMID: 34410396 PMCID: PMC8377565 DOI: 10.1001/jamanetworkopen.2021.21429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Prenatal experiences can influence fetal brain development. OBJECTIVE To examine associations of maternal prenatal body mass index (BMI) with cognition and behavior of offspring born full-term. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined follow-up data from a breastfeeding promotion intervention at 31 hospitals and affiliated polyclinics in the Republic of Belarus. Participants included 11 276 children who were evaluated from birth (1996-1997) to adolescence (2017-2019), with maternal BMI information available in prenatal medical records. EXPOSURES Maternal BMI, calculated as weight in kilograms divided by height in meters squared, after 35 weeks gestation; secondary analyses examined maternal BMI at other time points and paternal BMI. MAIN OUTCOMES AND MEASURES Trained pediatricians assessed child cognition with the Wechsler Abbreviated Scales of Intelligence (WASI) at 6.5 years and the computerized self-administered NeuroTrax battery at 16 years, both with an approximate mean (SD) of 100 (15). Parents and teachers rated behaviors at 6.5 years using the Strengths and Difficulties Questionnaire (SDQ, range 0-40). Mixed-effects linear regression analyses corrected for clustering, adjusted for the randomized intervention group and baseline parental sociodemographic characteristics, and were considered mediation by child BMI. RESULTS Among 11 276 participants, 9355 women (83%) were aged 20 to 34 years, 10 128 (89.8%) were married, and 11 050 (98.0%) did not smoke during pregnancy. Each 5-unit increase in of maternal late-pregnancy BMI (mean [SD], 27.2 [3.8]) was associated with lower offspring WASI performance intelligence quotient (IQ) (-0.52 points; 95% CI, -0.87 to -0.17 points) at 6.5 years and lower scores on 5 of 7 NeuroTrax subscales and the global cognitive score at 16 years (-0.67 points; 95% CI, -1.06 to -0.29 points). Results were similar after adjustment for sociodemographic characteristics, pregnancy complications, and paternal BMI and were not mediated by child weight. Higher late pregnancy maternal BMI was also associated with more behavioral problems reported on the SDQ by teachers but not associated with parent-reported behaviors (externalizing behaviors: 0.13 points; 95% CI, 0.02 to 0.24 points; and total difficulties: 0.14 points, 95% CI, -0.02 to 0.30 points). Results were similar for maternal BMI measured in the first trimester or postpartum. In contrast, higher 6.5-year paternal BMI was associated with slightly better child cognition (WASI verbal IQ: 0.42 points; 95% CI, 0.02 to 0.82 points; NeuroTrax executive function score: 0.68 points; 95% CI, 0.24 to 1.12 points) and fewer teacher-reported behavioral problems (total difficulties: -0.29 points; 95% CI, -0.46 to -0.11 points). CONCLUSIONS AND RELEVANCE This cohort study supports findings from animal experiments and human observational studies in settings with higher maternal BMI and obesity rates. Higher maternal prenatal BMI may be associated with poorer offspring brain development, although residual confounding cannot be excluded.
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Affiliation(s)
- Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jennifer W. Thompson
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Konstantin Vilchuk
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Natalia Bogdanovich
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Mikhail Hameza
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rita Patel
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael S. Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Richard M. Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service Foundation Trust, University of Bristol, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
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Wu J, Sun T, Yu B, Li Z, Wu Q, Wang Y, Qian Z, Zhang Y, Jiang L, Wei H. Age-specific structural fetal brain atlases construction and cortical development quantification for chinese population. Neuroimage 2021; 241:118412. [PMID: 34298085 DOI: 10.1016/j.neuroimage.2021.118412] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/16/2021] [Accepted: 07/19/2021] [Indexed: 01/14/2023] Open
Abstract
In magnetic resonance imaging (MRI) studies of fetal brain development, structural brain atlases usually serve as essential references for the fetal population. Individual images are usually normalized into a common or standard space for analysis. However, the existing fetal brain atlases are mostly based on MR images obtained from Caucasian populations and thus are not ideal for the characterization of the fetal Chinese population due to neuroanatomical differences related to genetic factors. In this paper, we use an unbiased template construction algorithm to create a set of age-specific Chinese fetal atlases between 21-35 weeks of gestation from 115 normal fetal brains. Based on the 4D spatiotemporal atlas, the morphological development patterns, e.g., cortical thickness, cortical surface area, sulcal and gyral patterns, were quantified. The fetal brain abnormalities were detected when referencing the age-specific template. Additionally, a direct comparison of the Chinese fetal atlases and Caucasian fetal atlases reveals dramatic anatomical differences, mainly in the medial frontal and temporal regions. After applying the Chinese and Caucasian fetal atlases separately to an independent Chinese fetal brain dataset, we find that the Chinese fetal atlases result in significantly higher accuracy than the Caucasian fetal atlases in guiding brain tissue segmentation. These results suggest that the Chinese fetal brain atlases are necessary for quantitative analysis of the typical and atypical development of the Chinese fetal population in the future. The atlases with their parcellations are now publicly available at https://github.com/DeepBMI/FBA-Chinese.
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Affiliation(s)
- Jiangjie Wu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Taotao Sun
- Department of Radiology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Boliang Yu
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Zhenghao Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Wu
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Yutong Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaoxia Qian
- Department of Radiology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yuyao Zhang
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Ling Jiang
- Department of Radiology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
| | - Hongjiang Wei
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China.
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Steinhauser CB, Lambo CA, Askelson K, Burns GW, Behura SK, Spencer TE, Bazer FW, Satterfield MC. Placental Transcriptome Adaptations to Maternal Nutrient Restriction in Sheep. Int J Mol Sci 2021; 22:ijms22147654. [PMID: 34299281 PMCID: PMC8306922 DOI: 10.3390/ijms22147654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/15/2021] [Indexed: 12/13/2022] Open
Abstract
Placental development is modified in response to maternal nutrient restriction (NR), resulting in a spectrum of fetal growth rates. Pregnant sheep carrying singleton fetuses and fed either 100% (n = 8) or 50% (NR; n = 28) of their National Research Council (NRC) recommended intake from days 35–135 of pregnancy were used to elucidate placentome transcriptome alterations at both day 70 and day 135. NR fetuses were further designated into upper (NR NonSGA; n = 7) and lower quartiles (NR SGA; n = 7) based on day 135 fetal weight. At day 70 of pregnancy, there were 22 genes dysregulated between NR SGA and 100% NRC placentomes, 27 genes between NR NonSGA and 100% NRC placentomes, and 22 genes between NR SGA and NR NonSGA placentomes. These genes mediated molecular functions such as MHC class II protein binding, signaling receptor binding, and cytokine activity. Gene set enrichment analysis (GSEA) revealed significant overrepresentation of genes for natural-killer-cell-mediated cytotoxicity in NR SGA compared to 100% NRC placentomes, and alterations in nutrient utilization pathways between NR SGA and NR NonSGA placentomes at day 70. Results identify novel factors associated with impaired function in SGA placentomes and potential for placentomes from NR NonSGA pregnancies to adapt to nutritional hardship.
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Affiliation(s)
- Chelsie B. Steinhauser
- Department of Animal Science, Texas A & M University, College Station, TX 77843, USA; (C.B.S.); (K.A.); (F.W.B.)
| | - Colleen A. Lambo
- Department of Veterinary Physiology and Pharmacology, Texas A & M University, College Station, TX 77843, USA;
| | - Katharine Askelson
- Department of Animal Science, Texas A & M University, College Station, TX 77843, USA; (C.B.S.); (K.A.); (F.W.B.)
| | - Gregory W. Burns
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI 49503, USA;
| | - Susanta K. Behura
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, USA; (S.K.B.); (T.E.S.)
- Institute for Data Science and Informatics, University of Missouri, Columbia, MO 65211, USA
| | - Thomas E. Spencer
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, USA; (S.K.B.); (T.E.S.)
| | - Fuller W. Bazer
- Department of Animal Science, Texas A & M University, College Station, TX 77843, USA; (C.B.S.); (K.A.); (F.W.B.)
| | - Michael Carey Satterfield
- Department of Animal Science, Texas A & M University, College Station, TX 77843, USA; (C.B.S.); (K.A.); (F.W.B.)
- Correspondence: ; Tel.: +1-979-845-6448
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Mazurkiewicz D, Bronkowska M. Circulating Insulin and IGF-1 and Frequency of Food Consumption during Pregnancy as Predictors of Birth Weight and Length. Nutrients 2021; 13:nu13072344. [PMID: 34371854 PMCID: PMC8308892 DOI: 10.3390/nu13072344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
The aim of the study was to assess the relationships between maternal insulin and insulin-like growth factor-1 (IGF-1) concentration and food consumption frequency and the birth parameters of the newborn. A total of 157 mother-newborn pairs participated in the study. The study showed that more frequent consumption of sweet and salty snacks as well as fruit and fruit or vegetable juices may promote greater weight gain in pregnancy and higher newborn birth weight. A significantly higher insulin concentration was found among overweight women according to body mass index (BMI), and a significantly lower concentration of IGF-1 was demonstrated among women ≥35 years of age. There was no significant correlation between the concentration of insulin and IGF-1 in the mother’s blood plasma and the birth weight and length of the newborn. A significant relationship was only found between the concentration of IGF-1 in the mother’s blood and the Ponderal index of the newborn. A woman’s eating habits during pregnancy have a significant impact on the mother’s health and on the proper growth and development of the foetus.
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Kothandapani A, Jefcoate CR, Jorgensen JS. Cholesterol Contributes to Male Sex Differentiation Through Its Developmental Role in Androgen Synthesis and Hedgehog Signaling. Endocrinology 2021; 162:6204698. [PMID: 33784378 PMCID: PMC8168945 DOI: 10.1210/endocr/bqab066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Indexed: 12/17/2022]
Abstract
Two specialized functions of cholesterol during fetal development include serving as a precursor to androgen synthesis and supporting hedgehog (HH) signaling activity. Androgens are produced by the testes to facilitate masculinization of the fetus. Recent evidence shows that intricate interactions between the HH and androgen signaling pathways are required for optimal male sex differentiation and defects of either can cause birth anomalies indicative of 46,XY male variations of sex development (VSD). Further, perturbations in cholesterol synthesis can cause developmental defects, including VSD, that phenocopy those caused by disrupted androgen or HH signaling, highlighting the functional role of cholesterol in promoting male sex differentiation. In this review, we focus on the role of cholesterol in systemic androgen and local HH signaling events during fetal masculinization and their collective contributions to pediatric VSD.
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Affiliation(s)
- Anbarasi Kothandapani
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin 53705, USA
- Correspondence: Anbarasi Kothandapani, PhD, Department of Comparative Biosciences, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53705, USA. E-mail:
| | - Colin R Jefcoate
- Department of Cell and Regenerative Biology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705, USA
| | - Joan S Jorgensen
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin 53705, USA
- Correspondence: Joan S. Jorgensen, DVM, PhD, Department of Comparative Biosciences, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53705, USA. E-mail:
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Sano M, Nagura H, Ueno S, Nakashima A. Amino Acid Composition of Amniotic Fluid during the Perinatal Period Reflects Mother's Fat and Carbohydrate Intake. Nutrients 2021; 13:nu13072136. [PMID: 34206490 PMCID: PMC8308307 DOI: 10.3390/nu13072136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 12/31/2022] Open
Abstract
Dietary content during pregnancy is important because it is necessary for the growth of the fetus. With the assumption that the nutritional status of the fetus can be monitored by measuring amino acid concentrations in the amniotic fluid, we investigated whether the habitual dietary intake of pregnant women affected the composition of the amniotic fluid and the significance of performing amniotic fluid analysis. The subjects were 34 mothers who delivered full-term babies by cesarean section. Three biological samples were collected from the mothers: blood, cord blood, and amniotic fluid. At the same time, the mothers' prenatal nutritional intake information was also recorded. When the amino acid contents of the samples were compared with the mothers' nutrient intake, many amino acids in the amniotic fluid were positively correlated with lipid intake, but not with protein intake. There was a negative correlation between lipid intake and carbohydrate intake, and the amino acid contents of the amniotic fluid were also negatively correlated with carbohydrate intake. The results of this study were consistent with those found in animal models, suggesting that the analysis of amniotic fluid may be a useful method to investigate the effects of habitual diet during human pregnancy on the fetus.
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Affiliation(s)
- Mitsue Sano
- Department of Nutrition, School of Human Cultures, The University of Shiga Prefecture, Hikone 522-8533, Shiga, Japan; (H.N.); (S.U.)
- Correspondence: ; Tel.: +81-749-28-8454
| | - Haruna Nagura
- Department of Nutrition, School of Human Cultures, The University of Shiga Prefecture, Hikone 522-8533, Shiga, Japan; (H.N.); (S.U.)
| | - Sayako Ueno
- Department of Nutrition, School of Human Cultures, The University of Shiga Prefecture, Hikone 522-8533, Shiga, Japan; (H.N.); (S.U.)
| | - Akira Nakashima
- Jinno Ladies Clinic-Branch Hospital “Alice”, Hikone 522-0057, Shiga, Japan;
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Abstract
The uterus is the organ for embryo implantation and fetal development. Most current models of the uterus are centred around capturing its function during later stages of pregnancy to increase the survival in pre-term births. However, in vitro models focusing on the uterine tissue itself would allow modelling of pathologies including endometriosis and uterine cancers, and open new avenues to investigate embryo implantation and human development. Motivated by these key questions, we discuss how stem cell-based uteri may be engineered from constituent cell parts, either as advanced self-organising cultures, or by controlled assembly through microfluidic and print-based technologies.
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Affiliation(s)
- Sophie Bergmann
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
- Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
- Wellcome Trust - Medical Research Council Stem Cell Institute, University of Cambridge, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - Magdalena Schindler
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
- Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
- Wellcome Trust - Medical Research Council Stem Cell Institute, University of Cambridge, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - Clara Munger
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
- Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
- Wellcome Trust - Medical Research Council Stem Cell Institute, University of Cambridge, Jeffrey Cheah Biomedical Centre, Cambridge, UK
| | - Christopher A Penfold
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
- Centre for Trophoblast Research, University of Cambridge, Cambridge, UK.
- Wellcome Trust - Medical Research Council Stem Cell Institute, University of Cambridge, Jeffrey Cheah Biomedical Centre, Cambridge, UK.
- Wellcome Trust - Cancer Research UK Gurdon Institute, Henry Wellcome Building of Cancer and Developmental Biology, University of Cambridge, Cambridge, UK.
| | - Thorsten E Boroviak
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
- Centre for Trophoblast Research, University of Cambridge, Cambridge, UK.
- Wellcome Trust - Medical Research Council Stem Cell Institute, University of Cambridge, Jeffrey Cheah Biomedical Centre, Cambridge, UK.
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Kristiansen O, Zucknick M, Reine TM, Kolset SO, Jansson T, Powell TL, Haugen G, Henriksen T, Michelsen TM. Mediators Linking Maternal Weight to Birthweight and Neonatal Fat Mass in Healthy Pregnancies. J Clin Endocrinol Metab 2021; 106:1977-1993. [PMID: 33713406 PMCID: PMC8692236 DOI: 10.1210/clinem/dgab166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT Lifestyle interventions have not efficaciously reduced complications caused by maternal weight on fetal growth, requiring insight into explanatory mediators. OBJECTIVE We hypothesized that maternal mediators, including adiponectin, leptin, insulin, and glucose, mediate effects of pregestational BMI (pBMI) and gestational weight gain (GWG) on birthweight and neonatal fat mass percentage (FM%) through placental weight and fetal mediators, including insulin levels (Ifv) and venous-arterial glucose difference (ΔGfva). Hypothesized confounders were maternal age, gestational age, and parity. METHODS A cross-sectional study of healthy mother-offspring-pairs (n = 165) applying the 4-vessel in vivo sampling method at Oslo University Hospital, Norway. We obtained pBMI, GWG, birthweight, and placental weight. FM% was available and calculated for a subcohort (n = 84). We measured circulating levels of adiponectin, leptin, glucose, and insulin and performed path analysis and traditional mediation analyses based on linear regression models. RESULTS The total effect of pBMI and GWG on newborn size was estimated to be 30 g (range, 16-45 g) birthweight and 0.17 FM% (range, 0.04-0.29 FM%) per kg∙m-2 pBMI and 31 g (range, 18-44 g) and 0.24 FM% (range, 0.10-0.37 FM%) per kg GWG. The placental weight was the main mediator, mediating 25-g birthweight and 0.11 FM% per kg∙m-2 pBMI and 25-g birthweight and 0.13 FM% per kg GWG. The maternal mediators mediated a smaller part of the effect of pBMI (3.8-g birthweight and 0.023 FM% per kg∙m-2 pBMI) but not GWG. CONCLUSION Placental weight was the main mediator linking pBMI and GWG to birthweight and FM%. The effect of pBMI, but not GWG, on birthweight and FM%, was also mediated via the maternal and fetal mediators.
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Affiliation(s)
- Oddrun Kristiansen
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, 0424Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, 0372Norway
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, 0372Norway
- Correspondence: Oddrun Kristiansen, PhD, Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Postboks 4956 Nydalen, Oslo, 0424 Norway. ;
| | - Manuela Zucknick
- Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, 0372Norway
| | - Trine M Reine
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, 0372Norway
- Institute of Cancer Genetics and Informatics, Oslo University Hospital, Oslo, 0379Norway
| | - Svein O Kolset
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, 0372Norway
| | - Thomas Jansson
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Colorado 80045, USA
| | - Theresa L Powell
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Colorado 80045, USA
- Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Colorado 80045, USA
| | - Guttorm Haugen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, 0372Norway
- Department of Fetal Medicine, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, 0424Norway
| | - Tore Henriksen
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, 0424Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, 0372Norway
| | - Trond M Michelsen
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, 0424Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, 0372Norway
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Meakin AS, Cuffe JSM, Darby JRT, Morrison JL, Clifton VL. Let's Talk about Placental Sex, Baby: Understanding Mechanisms That Drive Female- and Male-Specific Fetal Growth and Developmental Outcomes. Int J Mol Sci 2021; 22:ijms22126386. [PMID: 34203717 PMCID: PMC8232290 DOI: 10.3390/ijms22126386] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/09/2021] [Accepted: 06/12/2021] [Indexed: 02/06/2023] Open
Abstract
It is well understood that sex differences exist between females and males even before they are born. These sex-dependent differences may contribute to altered growth and developmental outcomes for the fetus. Based on our initial observations in the human placenta, we hypothesised that the male prioritises growth pathways in order to maximise growth through to adulthood, thereby ensuring the greatest chance of reproductive success. However, this male-specific “evolutionary advantage” likely contributes to males being less adaptable to shifts in the in-utero environment, which then places them at a greater risk for intrauterine morbidities or mortality. Comparatively, females are more adaptable to changes in the in-utero environment at the cost of growth, which may reduce their risk of poor perinatal outcomes. The mechanisms that drive these sex-specific adaptations to a change in the in-utero environment remain unclear, but an increasing body of evidence within the field of developmental biology would suggest that alterations to placental function, as well as the feto-placental hormonal milieu, is an important contributing factor. Herein, we have addressed the current knowledge regarding sex-specific intrauterine growth differences and have examined how certain pregnancy complications may alter these female- and male-specific adaptations.
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Affiliation(s)
- Ashley S. Meakin
- Early Origins of Adult Health Research Group, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (A.S.M.); (J.R.T.D.); (J.L.M.)
| | - James S. M. Cuffe
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4072, Australia;
| | - Jack R. T. Darby
- Early Origins of Adult Health Research Group, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (A.S.M.); (J.R.T.D.); (J.L.M.)
| | - Janna L. Morrison
- Early Origins of Adult Health Research Group, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (A.S.M.); (J.R.T.D.); (J.L.M.)
| | - Vicki L. Clifton
- Mater Medical Research Institute, The University of Queensland, Brisbane, QLD 4000, Australia
- Correspondence:
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Alkhalefah A, Dunn WB, Allwood JW, Parry KL, Houghton FD, Ashton N, Glazier JD. Maternal intermittent fasting during pregnancy induces fetal growth restriction and down-regulated placental system A amino acid transport in the rat. Clin Sci (Lond) 2021; 135:1445-1466. [PMID: 34008846 DOI: 10.1042/cs20210137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/11/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022]
Abstract
During Ramadan, many pregnant Muslim women fast between dawn and sunset. Although the impacts of prolonged maternal intermittent fasting (IF) on fetal growth and placental function are under-researched, reported effects include reduced placental weight and birth weight. In the present study, pregnant Wistar rats were used to model repeated cycles of IF on fetal development and placental function and to examine sex-specific effects. In the IF group, food was withdrawn daily from 17:00 to 09:00 over 21 days of gestation, while the control group received food ad libitum. Both groups had free water access. IF dams consumed less food, had significantly reduced weight compared with controls, with reduced plasma glucose and amino acids. Both fetal sexes were significantly lighter in the IF group with reduced fetal plasma amino acids. Placental weights and morphology were unchanged. The profile of placental metabolites was altered in the IF group with sex-specific responses evident. Transplacental flux of 14C-methylaminoisobutyric acid (14C-MeAIB), a system A amino acid transporter substrate, was significantly reduced in both fetal sexes in the IF group. Sodium-dependent 14C-MeAIB uptake into isolated placental plasma membrane vesicles was unchanged. The gene expression of system A transporter Slc38a1, Slc38a2 and Slc38a4 was up-regulated in IF male placentas only. No changes were observed in placental SNAT1 and SNAT2 protein expression. Maternal IF results in detrimental impacts on maternal physiology and fetal development with changes in the placental and fetal metabolite profiles. Reduced placental system A transporter activity may be responsible for fetal growth restriction in both sexes.
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Affiliation(s)
- Alaa Alkhalefah
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, St. Mary's Hospital, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester M13 9WL, U.K
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9NT, U.K
| | - Warwick B Dunn
- School of Biosciences, University of Birmingham, Birmingham B15 2TT, U.K
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, U.K
| | - James W Allwood
- School of Biosciences, University of Birmingham, Birmingham B15 2TT, U.K
| | - Kate L Parry
- Centre for Human Development, Stem Cells and Regeneration, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, U.K
| | - Franchesca D Houghton
- Centre for Human Development, Stem Cells and Regeneration, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, U.K
| | - Nick Ashton
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9NT, U.K
| | - Jocelyn D Glazier
- Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PT, U.K
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Camm EJ, Inzani I, De Blasio MJ, Davies KL, Lloyd IR, Wooding FBP, Blache D, Fowden AL, Forhead AJ. Thyroid Hormone Deficiency Suppresses Fetal Pituitary-Adrenal Function Near Term: Implications for the Control of Fetal Maturation and Parturition. Thyroid 2021; 31:861-869. [PMID: 33126831 DOI: 10.1089/thy.2020.0534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: The fetal hypothalamic-pituitary-adrenal (HPA) axis plays a key role in the control of parturition and maturation of organ systems in preparation for birth. In hypothyroid fetuses, gestational length may be prolonged and maturational processes delayed. The extent to which the effects of thyroid hormone deficiency in utero on the timing of fetal maturation and parturition are mediated by changes to the structure and function of the fetal HPA axis is unknown. Methods: In twin sheep pregnancies where one fetus was thyroidectomized and the other sham-operated, this study investigated the effect of hypothyroidism on circulating concentrations of adrenocorticotrophic hormone (ACTH) and cortisol, and the structure and secretory capacity of the anterior pituitary and adrenal glands. The relative population of pituitary corticotrophs and the masses of the adrenal zones were assessed by immunohistochemical and stereological techniques. Adrenal mRNA abundances of key steroidogenic enzymes and growth factors were examined by quantitative polymerase chain reaction. Results: Hypothyroidism in utero reduced plasma concentrations of ACTH and cortisol. In thyroid-deficient fetuses, the mass of corticotrophs in the anterior pituitary gland was unexpectedly increased, while the mass of the zona fasciculata and its proportion of the adrenal gland were decreased. These structural changes were associated with lower adrenocortical mRNA abundances of insulin-like growth factor (IGF)-I and its receptor, and key steroidogenic enzymes responsible for glucocorticoid synthesis. The relative mass of the adrenal medulla and its proportion of the adrenal gland were increased by thyroid hormone deficiency in utero, without any change in expression of phenylethanolamine N-methyltransferase or the IGF system. Conclusions: Thyroid hormones are important regulators of the structure and secretory capacity of the pituitary-adrenal axis before birth. In hypothyroid fetuses, low plasma cortisol may be due to impaired adrenocortical growth and steroidogenic enzyme expression, secondary to low circulating ACTH concentration. Greater corticotroph population in the anterior pituitary gland of the hypothyroid fetus indicates compensatory cell proliferation and that there may be abnormal corticotroph capacity for ACTH synthesis and/or impaired hypothalamic input. Suppression of the development of the fetal HPA axis by thyroid hormone deficiency may contribute to the delay in fetal maturation and delivery observed in hypothyroid offspring.
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Affiliation(s)
- Emily J Camm
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Isabella Inzani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Miles J De Blasio
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Katie L Davies
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - India R Lloyd
- Department of Biological and Medical Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - F B Peter Wooding
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Dominique Blache
- School of Agriculture and Environment, University of Western Australia, Crawley, Australia
| | - Abigail L Fowden
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Alison J Forhead
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
- Department of Biological and Medical Sciences, Oxford Brookes University, Oxford, United Kingdom
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Sanli S, Bulbul A, Ucar A. The effect of umbilical cord blood spexin, free 25(OH) vitamin D3 and adipocytokine levels on intrauterine growth and anthropometric measurements in newborns. Cytokine 2021; 144:155578. [PMID: 34010726 DOI: 10.1016/j.cyto.2021.155578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/18/2022]
Abstract
Spexin is a newly described peptide and is known to reduce the uptake of long-chain fatty acids into adipocytes. The serum spexin levels of obese children between the ages of 12-18 are lower. The effect of serum spexin and free 25(OH) vitamin D3 levels on intrauterine development in newborns is unknown. Our aims is to evaluate the effects of spexin and adipocytokin levels in the cord blood of term newborn babies on the weight of the baby according to the gestation age (GA) and anthropometric measurement results. Babies who were born in our hospital and whose GA was ≥37 weeks were evaluated in three groups as appropriate for GA (AGA), small for GA (SGA) and large for GA (LGA). A total of 84 babies, including an equal number of infants in AGA, SGA and LGA groups, were included in the study. Spexin, leptin, active ghrelin, free 25(OH) vitamin D3, glucose, and insulin levels in the cord blood of infants were examined at birth. The results were compared according to GA and birth weight (BW). There was no statistically significant difference between groups in terms of mean spexin, active ghrelin, free 25(OH) vitamin D3, and insulin levels. The mean leptin level was significantly higher in LGA group than SGA and AGA groups (p 0.004). The mean spexin and leptin levels were higher in girls than in boys (respectively p value 0.029, 0.003). Although there is a significant positive correlation between BW, head circumference, height, umbilical circumference, umbilical circumference/height ratio and the mean leptin levels (p < 0.001), there was no significant correlation between mean spexin, active ghrelin, free 25 (OH) vitamin D3, insulin, and glucose levels. This study suggests that spexin may not have an effect on intrauterine development.
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Affiliation(s)
- Senanur Sanli
- University of Health Science, Sisli Hamidiye Etfal Education and Research Hospital, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey
| | - Ali Bulbul
- University of Health Science, Sisli Hamidiye Etfal Education and Research Hospital, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey.
| | - Ahmet Ucar
- University of Health Science, Sisli Hamidiye Etfal Education and Research Hospital, Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul, Turkey
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Paladini D, Finarelli A, Donarini G, Parodi S, Lombardo V, Tuo G, Birnbaum R. Frontal lobe growth is impaired in fetuses with congenital heart disease. Ultrasound Obstet Gynecol 2021; 57:776-782. [PMID: 32573836 DOI: 10.1002/uog.22127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/18/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The primary objective of this study was to assess whether fetuses with congenital heart disease (CHD) have smaller frontal brain areas compared with normal controls. The secondary objective was to evaluate whether there are any differences in frontal brain area between cases with different types of CHD, grouped according to their impact on hemodynamics. METHODS This was a retrospective cross-sectional study, including 421 normal fetuses and 101 fetuses with isolated CHD evaluated between 20 and 39 gestational weeks at our fetal medicine and surgery unit in the period January 2016-December 2019. The study group was subdivided, according to the CHD hemodynamics, as follows: (1) hypoplastic left heart syndrome and other forms of functionally univentricular heart defect; (2) transposition of the great arteries; (3) conotruncal defects and other CHDs with large shunts; (4) right ventricular outflow tract obstruction, without a hypoplastic right ventricle; (5) left outflow tract obstruction; (6) others. The transventricular axial view of the fetal head was used as the reference view, on which the frontal lobe anteroposterior diameter (FAPD) and the occipitofrontal diameter (OFD) were measured, assuming the former to be representative of the area of the frontal lobes. The FAPD/OFD ratio was then calculated as FAPD/OFD × 100. These two variables (FAPD and FAPD/OFD ratio) were then evaluated and compared between the study and control groups. Adjustment for gestational age, both via multiple linear regression and by using a-posteriori matching based on the propensity score, was employed. RESULTS In normal fetuses, FAPD showed a linear positive correlation with gestational age. In fetuses with CHD, the FAPD was shorter than in normal fetuses from the 20th gestational week onwards, with the difference increasing after 30 gestational weeks. FAPD/OFD ratio was significantly smaller in fetuses with CHD than in normal fetuses (P < 0.0001) at all gestational ages, with no apparent differences among the various CHD categories, all of which had smaller FAPD/OFD ratio compared with controls. CONCLUSIONS Fetuses with CHD have a shorter FAPD and a smaller FAPD/OFD ratio compared with normal fetuses. This impaired growth of the frontal area of the brain seems to occur in all types of CHD, regardless of their impact on hemodynamics. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - A Finarelli
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - G Donarini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - S Parodi
- Unit of Epidemiology and Biostatistics, Istituto G. Gaslini, Genoa, Italy
| | - V Lombardo
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - G Tuo
- Pediatric Cardiology, Istituto G. Gaslini, Genoa, Italy
| | - R Birnbaum
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
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Lindell N, Bladh M, Carlsson A, Josefsson A, Aakesson K, Samuelsson U. Size for gestational age affects the risk for type 1 diabetes in children and adolescents: a Swedish national case-control study. Diabetologia 2021; 64:1113-1120. [PMID: 33544169 PMCID: PMC8012313 DOI: 10.1007/s00125-021-05381-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/11/2020] [Indexed: 10/26/2022]
Abstract
AIM/HYPOTHESIS Environmental factors are believed to contribute to the risk of developing type 1 diabetes. The aim of this study was to investigate how size for gestational age affects the risk of developing childhood type 1 diabetes. METHODS Using the Swedish paediatric diabetes quality register and the Swedish medical birth register, children with type 1 diabetes diagnosed between 2000 and 2012 (n = 9376) were matched with four control children (n = 37,504). Small for gestational age (SGA) and large for gestational age (LGA) were defined according to Swedish national standards. Data were initially analysed using Pearson's χ2 and thereafter by single and multiple logistic regression models. RESULTS An equal proportion of children were born appropriate for gestational age, but children with type 1 diabetes were more often born LGA and less often born SGA than control children (4.7% vs 3.5% and 2.0% vs 2.6%, respectively, p < 0.001). In the multiple logistic regression analysis, being born LGA increased (adjusted OR 1.16 [95% CI 1.02, 1.32]) and SGA decreased (adjusted OR 0.76 [95% CI 0.63, 0.92]) the risk for type 1 diabetes, regardless of maternal BMI and diabetes. CONCLUSIONS/INTERPRETATION Size for gestational age of Swedish children affects the risk of type 1 diabetes, with increased risk if the child is born LGA and decreased risk if the child is born SGA. Being born LGA is an independent risk factor for type 1 diabetes irrespective of maternal BMI and diabetes. Thus, reducing the risk for a child being born LGA might to some extent reduce the risk for type 1 diabetes.
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Affiliation(s)
- Nina Lindell
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Marie Bladh
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Annelie Carlsson
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Karin Aakesson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
| | - Ulf Samuelsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Pediatrics, Linköping University, Linköping, Sweden
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Mitku AA, Zewotir T, North D, Jeena P, Naidoo RN. Effects of prenatal exposure factors on birth outcomes through mediation of favorable fetal growth conditions using structural equation modeling. PLoS One 2021; 16:e0249664. [PMID: 33905420 PMCID: PMC8078817 DOI: 10.1371/journal.pone.0249664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background Birth weight, birth length, and gestational age are major indicators of newborn health. Several prenatal exposure factors influence the fetal environment. The aim of the study was to investigate the effect of prenatal exposure factors, including socio-demographic, behavioural, dietary, physical activity, clinical and environmental on birth outcomes through the mediation of Favourable Fetal Growth Conditions (FFGC). Methods Data was obtained from six hundred and fifty-six Mother and Child in the Environment birth cohort study in Durban, South Africa from 2013 to 2017. We adopted structural equation models which evaluate the direct and indirect effects by allowing multiple simultaneous equations to incorporate confounding and mediation. Results A significant direct and indirect effect of FFGC on newborn weight, length, and gestational age was seen. Gestational weight gain and maternal body mass index in the first trimester exerted a mediation effect between maternal behavioural risk factors and FFGC. Similarly, the level of physical activity during pregnancy was associated with decreased gestational weight gain. The effects of maternal characteristics on newborn weight, length, and gestational age were largely indirect, operating through FFGC as a latent variable. Conclusions Gestational weight gain and maternal pre-gestational BMI were observed to mediate the association between prenatal behavioural risk factors and favourable fetal growth conditions. Trial registration Retrospectively registered from 01 March 2013.
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Affiliation(s)
- Aweke A. Mitku
- School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
- Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Delia North
- School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Prakash Jeena
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N. Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Kawakami H, Nishizawa S, Hikita A, Hoshi K. Histochemical and Morphometrical Analyses of Scarless Wound Healing in Mouse Fetal Model. Tokai J Exp Clin Med 2021; 46:33-43. [PMID: 33835474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Scar formation is an inevitable outcome after craniofacial surgery in the congenital facial anomaly. Scarless healing is the ultimate treatment after the surgery. Therefore, we elucidate the mechanism underlying scarless healing during fetal development. METHODS A full-thickness back skin excision (1 × 0.5 mm) was made at embryonic day 16.5 (E16.5) and 18.5 (E18.5) in fetal C57BL/6J mice and examined the histochemical and morphometrical findings of wound healing after 48 hours. RESULTS The wound made at E16.5 showed almost complete re-epithelialization with fine reticular dermal collagen fibers, but not at E18.5. The ratio of CK5 positive area was significantly higher in the wound of E16.5 operation than in the E18.5. The wounds made at E18.5 showed granulation tissue formation which will lead to subsequent scar formation. The collagen fibers tended to be thinner in wound than in normal skin, while the decrease in the number of fibers but the increase in the straightness of fibers were evident in the wound at E18.5. CONCLUSION Transition point of scarless healing seemed between E16.5 and E18.5 in mice, which may imply that the potential of epithelial regeneration and matrix formation was changed, possibly due to alteration of cell constitution and decrease in stemness, at that time.
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Affiliation(s)
- Hiroshi Kawakami
- Department of Sensory and Motor System Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-Ku, Tokyo 113-0033, Japan.
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Torres PJ, Luque EM, Di Giorgio NP, Ramírez ND, Ponzio MF, Cantarelli V, Carlini VP, Lux-Lantos V, Martini AC. Fetal Programming Effects of a Mild Food Restriction During Pregnancy in Mice: How Does It Compare to Intragestational Ghrelin Administration? Reprod Sci 2021; 28:3547-3561. [PMID: 33856666 DOI: 10.1007/s43032-021-00574-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/02/2021] [Indexed: 12/19/2022]
Abstract
To explore in mice if a 15% food restriction protocol during pregnancy programs the offspring postnatal development, with emphasis on reproductive function, and to assess if ghrelin (Ghrl) administration to mouse dams exerts effects that mimic those obtained under mild caloric restriction. Mice were 15% food-restricted, injected with 4 nmol/animal/day of Ghrl, or injected with the vehicle (control) thorough pregnancy. After birth, the pups did not receive further treatment. Pups born from food-restricted dams (FR pups) were lighter than Ghrl pups at birth, but reached normal weight at adulthood. Ghrl pups were heavier at birth and gained more weight than control pups (C pups). This effect was not associated with plasma IGF-1. FR pups showed a delay in pinna detachment and eye opening, while an advance was observed in Ghrl pups. FR pups showed also impairment in the surface-righting reflex. In both female FR and Ghrl pups, there was an advance in vaginal opening and, in adulthood, FR pups showed a significant decrease in their own litter size and plasma progesterone, and an increase in embryo loss. A delay in testicular descent was evident in male Ghrl pups. Changes in puberty onset were not associated with differences in the expression of Kiss1 in hypothalamic nuclei. Finally, in adulthood, FR pups showed a significant decrease in sperm quality. In conclusion, a mild food restriction thorough gestation exerted programming effects on the offspring, affecting also their reproductive function in adulthood. These effects were not similar to those of intragestational Ghrl administration.
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Affiliation(s)
- Pedro Javier Torres
- Instituto de Fisiología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, e Instituto de Investigaciones en Ciencias de la Salud (INICSA; CONICET-UNC), Santa Rosa 1085, X5000ESU, Córdoba, Argentina
| | - Eugenia Mercedes Luque
- Instituto de Fisiología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, e Instituto de Investigaciones en Ciencias de la Salud (INICSA; CONICET-UNC), Santa Rosa 1085, X5000ESU, Córdoba, Argentina
| | - Noelia Paula Di Giorgio
- Laboratorio de Neuroendocrinología, Instituto de Biología y Medicina Experimental, (IBYME; CONICET), Vuelta de Obligado 2490, Buenos Aires, C1428ADN, Argentina
| | - Nicolás David Ramírez
- Instituto de Fisiología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, e Instituto de Investigaciones en Ciencias de la Salud (INICSA; CONICET-UNC), Santa Rosa 1085, X5000ESU, Córdoba, Argentina
| | - Marina Flavia Ponzio
- Instituto de Fisiología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, e Instituto de Investigaciones en Ciencias de la Salud (INICSA; CONICET-UNC), Santa Rosa 1085, X5000ESU, Córdoba, Argentina
| | - Verónica Cantarelli
- Instituto de Fisiología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, e Instituto de Investigaciones en Ciencias de la Salud (INICSA; CONICET-UNC), Santa Rosa 1085, X5000ESU, Córdoba, Argentina
| | - Valeria Paola Carlini
- Instituto de Fisiología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, e Instituto de Investigaciones en Ciencias de la Salud (INICSA; CONICET-UNC), Santa Rosa 1085, X5000ESU, Córdoba, Argentina
| | - Victoria Lux-Lantos
- Laboratorio de Neuroendocrinología, Instituto de Biología y Medicina Experimental, (IBYME; CONICET), Vuelta de Obligado 2490, Buenos Aires, C1428ADN, Argentina
| | - Ana Carolina Martini
- Instituto de Fisiología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, e Instituto de Investigaciones en Ciencias de la Salud (INICSA; CONICET-UNC), Santa Rosa 1085, X5000ESU, Córdoba, Argentina.
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Green LJ, Kennedy SH, Mackillop L, Gerry S, Purwar M, Staines Urias E, Cheikh Ismail L, Barros F, Victora C, Carvalho M, Ohuma E, Jaffer Y, Noble JA, Gravett M, Pang R, Lambert A, Bertino E, Papageorghiou AT, Garza C, Bhutta Z, Villar J, Watkinson P. International gestational age-specific centiles for blood pressure in pregnancy from the INTERGROWTH-21st Project in 8 countries: A longitudinal cohort study. PLoS Med 2021; 18:e1003611. [PMID: 33905424 PMCID: PMC8112691 DOI: 10.1371/journal.pmed.1003611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 05/11/2021] [Accepted: 04/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Gestational hypertensive and acute hypotensive disorders are associated with maternal morbidity and mortality worldwide. However, physiological blood pressure changes in pregnancy are insufficiently defined. We describe blood pressure changes across healthy pregnancies from the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Fetal Growth Longitudinal Study (FGLS) to produce international, gestational age-specific, smoothed centiles (third, 10th, 50th, 90th, and 97th) for blood pressure. METHODS AND FINDINGS Secondary analysis of a prospective, longitudinal, observational cohort study (2009 to 2016) was conducted across 8 diverse urban areas in Brazil, China, India, Italy, Kenya, Oman, the United Kingdom, and the United States of America. We enrolled healthy women at low risk of pregnancy complications. We measured blood pressure using standardised methodology and validated equipment at enrolment at <14 weeks, then every 5 ± 1 weeks until delivery. We enrolled 4,607 (35%) women of 13,108 screened. The mean maternal age was 28·4 (standard deviation [SD] 3.9) years; 97% (4,204/4,321) of women were married or living with a partner, and 68% (2,955/4,321) were nulliparous. Their mean body mass index (BMI) was 23.3 (SD 3.0) kg/m2. Systolic blood pressure was lowest at 12 weeks: Median was 111.5 (95% CI 111.3 to 111.8) mmHg, rising to a median maximum of 119.6 (95% CI 118.9 to 120.3) mmHg at 40 weeks' gestation, a difference of 8.1 (95% CI 7.4 to 8.8) mmHg. Median diastolic blood pressure decreased from 12 weeks: 69.1 (95% CI 68.9 to 69.3) mmHg to a minimum of 68.5 (95% CI 68.3 to 68.7) mmHg at 19+5 weeks' gestation, a change of -0·6 (95% CI -0.8 to -0.4) mmHg. Diastolic blood pressure subsequently increased to a maximum of 76.3 (95% CI 75.9 to 76.8) mmHg at 40 weeks' gestation. Systolic blood pressure fell by >14 mmHg or diastolic blood pressure by >11 mmHg in fewer than 10% of women at any gestational age. Fewer than 10% of women increased their systolic blood pressure by >24 mmHg or diastolic blood pressure by >18 mmHg at any gestational age. The study's main limitations were the unavailability of prepregnancy blood pressure values and inability to explore circadian effects because time of day was not recorded for the blood pressure measurements. CONCLUSIONS Our findings provide international, gestational age-specific centiles and limits of acceptable change to facilitate earlier recognition of deteriorating health in pregnant women. These centiles challenge the idea of a clinically significant midpregnancy drop in blood pressure.
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Affiliation(s)
- Lauren J. Green
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford University Hospitals NHS Trust, NIHR Biomedical Research Centre, Oxford, United Kingdom
- * E-mail:
| | - Stephen H. Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Lucy Mackillop
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Manorama Purwar
- Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India
| | - Eleonora Staines Urias
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Leila Cheikh Ismail
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- College of Health Sciences, University of Sharjah, United Arab Emirates
| | - Fernando Barros
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Cesar Victora
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Maria Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Eric Ohuma
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Yasmin Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman
| | - J. Alison Noble
- Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Michael Gravett
- Departments of Obstetrics and Gynecology and of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Ruyan Pang
- School of Public Health, Peking University, Beijing, China
| | - Ann Lambert
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Enrico Bertino
- Dipartimento di Scienze Pediatriche e dell’ Adolescenza, SCDU Neonatologia, Universita di Torino, Torino, Italy
| | - Aris T. Papageorghiou
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Cutberto Garza
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Zulfiqar Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - José Villar
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Peter Watkinson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford University Hospitals NHS Trust, NIHR Biomedical Research Centre, Oxford, United Kingdom
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Abstract
Excess nutritional supply to the growing fetus, resulting from maternal diabetes and obesity, is associated with increased risks of fetal maldevelopment and adverse metabolic conditions in postnatal life. The placenta, interposed between mother and fetus, serves as the gateway between the two circulations and is usually considered to mediate maternal exposures to the fetus through a direct supply line. In this Perspective, however, we argue that the placenta is not an innocent bystander and mounts responses to fetal "signals of distress" to sustain its own adequate function and protect the fetus. We describe several types of protection that the placenta can offer the fetus against maternal metabolic perturbations and offer a theoretical model of how the placenta responds to the intrauterine environment in maternal diabetes and obesity to stabilize the fetal environment. Our approach supports growing calls for early screening and control of pregnancy metabolism to minimize harmful fetal outcomes.
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Tarantal AF, Hartigan-O’Connor DJ, Penna E, Kreutz A, Martinez ML, Noctor SC. Fetal Rhesus Monkey First Trimester Zika Virus Infection Impacts Cortical Development in the Second and Third Trimesters. Cereb Cortex 2021; 31:2309-2321. [PMID: 33341889 PMCID: PMC8023859 DOI: 10.1093/cercor/bhaa336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/18/2020] [Accepted: 10/18/2020] [Indexed: 12/28/2022] Open
Abstract
Zika virus is a teratogen similar to other neurotropic viruses, notably cytomegalovirus and rubella. The goal of these studies was to address the direct impact of Zika virus on fetal development by inoculating early gestation fetal rhesus monkeys using an ultrasound-guided approach (intraperitoneal vs. intraventricular). Growth and development were monitored across gestation, maternal samples collected, and fetal tissues obtained in the second trimester or near term. Although normal growth and anatomical development were observed, significant morphologic changes were noted in the cerebral cortex at 3-weeks post-Zika virus inoculation including massive alterations in the distribution, density, number, and morphology of microglial cells in proliferative regions of the fetal cerebral cortex; an altered distribution of Tbr2+ neural precursor cells; increased diameter and volume of blood vessels in the cortical proliferative zones; and a thinner cortical plate. At 3-months postinoculation, alterations in morphology, distribution, and density of microglial cells were also observed with an increase in blood vessel volume; and a thinner cortical plate. Only transient maternal viremia was observed but sustained maternal immune activation was detected. Overall, these studies suggest persistent changes in cortical structure result from early gestation Zika virus exposure with durable effects on microglial cells.
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Affiliation(s)
- Alice F Tarantal
- Department of Pediatrics, School of Medicine, University of California, Davis, Davis, CA 95616, USA
- Department of Cell Biology and Human Anatomy, School of Medicine, University of California, Davis, Davis, CA 95616, USA
- California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA
| | - Dennis J Hartigan-O’Connor
- California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, Davis, CA 95616, USA
| | - Elisa Penna
- Department of Psychiatry and Behavioral Science, School of Medicine, University of California, Davis, Davis, CA 95817, USA
| | - Anna Kreutz
- Department of Psychiatry and Behavioral Science, School of Medicine, University of California, Davis, Davis, CA 95817, USA
| | - Michele L Martinez
- California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA
| | - Stephen C Noctor
- Department of Psychiatry and Behavioral Science, School of Medicine, University of California, Davis, Davis, CA 95817, USA
- MIND Institute, School of Medicine, University of California, Davis, Davis, CA 95817, USA
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Fan HM, Mitchell AL, Williamson C. ENDOCRINOLOGY IN PREGNANCY: Metabolic impact of bile acids in gestation. Eur J Endocrinol 2021; 184:R69-R83. [PMID: 33434155 DOI: 10.1530/eje-20-1101] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/09/2020] [Indexed: 11/08/2022]
Abstract
Bile acids are lipid-solubilising molecules that also regulate metabolic processes. Farnesoid X receptor (FXR) and Takeda G-protein coupled receptor 5 (TGR5) are two bile acid receptors with key metabolic roles. FXR regulates bile acid synthesis in the liver and influences bile acid uptake in the intestine. TGR5 is mainly involved in regulation of signalling pathways in response to bile acid uptake in the gut and therefore prandial response. Both FXR and TGR5 have potential as therapeutic targets for disorders of glucose and/or lipid homeostasis. Gestation is also known to cause small increases in bile acid concentrations, but physiological hypercholanaemia of pregnancy is usually not sufficient to cause any clinically relevant effects. This review focuses on how gestation alters bile acid homeostasis, which can become pathological if the elevation of maternal serum bile acids is more marked than physiological hypercholanaemia, and on the influence of FXR and TGR5 function in pregnancy on glucose and lipid metabolism. This will be discussed with reference to two gestational disorders: intrahepatic cholestasis of pregnancy (ICP), a disease where bile acids are pathologically elevated, and gestational diabetes mellitus (GDM), characterised by hyperglycaemia during pregnancy.
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Affiliation(s)
- Hei Man Fan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Alice L Mitchell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Catherine Williamson
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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Kosiv KA, Moon-Grady A, Hogan W, Keller R, Rapoport R, Rogers E, Feldstein VA, Lee H, Peyvandi S. Fetal cerebrovascular impedance is reduced in left congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2021; 57:386-391. [PMID: 32068925 PMCID: PMC7431368 DOI: 10.1002/uog.21992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/31/2020] [Accepted: 02/09/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Congenital diaphragmatic hernia (CDH) can cause a significant mass effect in the fetal thorax, displacing the heart into the opposite hemithorax. In left-sided CDH (L-CDH), this is associated with smaller left-sided cardiac structures and reduced left-ventricular cardiac output (LVCO). The effect of these physiologic changes on cerebral blood flow is not well understood. We sought to describe the middle cerebral artery (MCA) pulsatility index (PI), a measure of cerebrovascular impedance, in fetuses with L-CDH and those with right-sided CDH (R-CDH) compared with unaffected fetuses, and the relationship between MCA-PI and LVCO. We hypothesized that MCA-PI would be lower in fetuses with L-CDH and similar in those with R-CDH compared to controls, and that MCA-PI would be correlated with LVCO. METHODS We identified all fetuses with CDH evaluated at The University of California San Francisco, San Francisco, CA, USA from 2011 to 2018. Fetal echocardiograms and ultrasound scans were reviewed. Umbilical artery and MCA Doppler examinations were assessed to calculate pulsatility indices. Ventricular outputs were calculated using Doppler-derived stroke volume and fetal heart rate. Lung-to-head ratio (LHR), estimated fetal weight, biparietal diameter (BPD) and head circumference (HC) were obtained from fetal sonograms. Measurements in fetuses with CDH, according to the side of the defect, were compared with those in unaffected, gestational age-matched controls. A subset of CDH survivors had available data on neurodevelopmental outcome, as assessed using the Bayley Scales of Infant Development, 3rd edition. RESULTS A total of 64 fetuses with CDH (L-CDH, n = 53; R-CDH, n = 11) comprised the study groups, with 27 unaffected fetuses serving as controls. Mean gestational age at evaluation was similar between the three groups. Compared to controls, fetuses with L-CDH had significantly lower LVCO expressed as a percentage of combined cardiac output (CCO) (32%; 95% CI, 29-35% vs 38%; 95% CI, 33-42%; P = 0.04) and lower MCA-PI Z-score (-1.3; 95% CI, -1.7 to -1.0 vs 0.08; 95% CI, -0.5 to 0.6; P < 0.001), while they did not differ between the R-CDH group and controls. There was a strong positive association between LVCO as a percentage of CCO and MCA-PI Z-score in the overall cohort of CDH and control fetuses (P = 0.01). BPD and HC were similar between the three groups. At neurodevelopmental follow-up, mean cognitive, motor and language scores in the CDH group were within 1 SD of those in the general population. CONCLUSION MCA-PI values are significantly lower in fetuses with L-CDH as compared to controls, and lower LVCO was correlated with lower MCA vascular impedance. The neurodevelopmental effect of changes in MCA-PI in response to decreased LVCO is unknown, although, on average, CDH survivors had neurodevelopmental scores in the normal range. This may reflect a fetal compensatory mechanism in response to diminished antegrade cerebral blood flow. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- Katherine A. Kosiv
- The University of California, San Francisco Department of Pediatrics, Division of Pediatric Cardiology, San Francisco, CA
| | - Anita Moon-Grady
- The University of California, San Francisco Department of Pediatrics, Division of Pediatric Cardiology, San Francisco, CA
| | - Whitnee Hogan
- The University of California, San Francisco Department of Pediatrics, Division of Pediatric Cardiology, San Francisco, CA
| | - Roberta Keller
- The University of California, San Francisco Department of Pediatrics, Division of Neonatology, San Francisco, CA
| | - Rebecca Rapoport
- The University of California, San Francisco Department of Pediatrics, Division of Neonatology, San Francisco, CA
| | - Elizabeth Rogers
- The University of California, San Francisco Department of Pediatrics, Division of Neonatology, San Francisco, CA
| | - Vickie A. Feldstein
- The University of California, San Francisco Department of Pediatrics, Department of Radiology & Biomedical Imaging, San Francisco, CA
| | - Hanmin Lee
- The University of California, San Francisco Department of Pediatrics, Department of Surgery, San Francisco, CA
| | - Shabnam Peyvandi
- The University of California, San Francisco Department of Pediatrics, Division of Pediatric Cardiology, San Francisco, CA
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Fries N, Dhombres F, Massoud M, Stirnemann JJ, Bessis R, Haddad G, Salomon LJ. The impact of optimal dating on the assessment of fetal growth. BMC Pregnancy Childbirth 2021; 21:167. [PMID: 33639870 PMCID: PMC7912534 DOI: 10.1186/s12884-021-03640-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/08/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The impact of using the Intergrowth (IG) dating formulae in comparison to the commonly used Robinson dating on the evaluation of biometrics and estimated fetal weight (EFW) has not been evaluated. METHODS Nationwide cross-sectional study of routine fetal ultrasound biometry in low-risk pregnant women whose gestational age (GA) had been previously assessed by a first trimester CRL measurement. We compared the CRL-based GA according to the Robinson formula and the IG formula. We evaluated the fetal biometric measurements as well as the EFW taken later in pregnancy depending on the dating formula used. Mean and standard deviation of the Z scores as well as the number and percentage of cases classified as <3rd, < 10th, >90th and > 97th percentile were compared. RESULTS Three thousand five hundred twenty-two low-risk women with scans carried out after 18 weeks were included. There were differences of zero, one and 2 days in 642 (18.2%), 2700 (76.7%) and 180 (5%) when GA was estimated based on the Robinson or the IG formula, respectively. The biometry Z scores assessed later in pregnancy were all statistically significantly lower when the Intergrowth-based dating formula was used (p < 10- 4). Likewise, the number and percentage of foetuses classified as <3rd, < 10th, >90th and > 97th percentile demonstrated significant differences. As an example, the proportion of SGA foetuses varied from 3.46 to 4.57% (p = 0.02) and that of LGA foetuses from 17.86 to 13.4% (p < 10- 4). CONCLUSION The dating formula used has a quite significant impact on the subsequent evaluation of biometry and EFW. We suggest that the combined and homogeneous use of a recent dating standard, together with prescriptive growth standards established on the same low-risk pregnancies, allows an optimal assessment of fetal growth.
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Affiliation(s)
- N Fries
- Collége Français d'Echographie Foetale, CFEF, 34820, Teyran, France
| | - F Dhombres
- Collége Français d'Echographie Foetale, CFEF, 34820, Teyran, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Sorbonne Université, Paris, France
| | - M Massoud
- Collége Français d'Echographie Foetale, CFEF, 34820, Teyran, France
- Hôpital Femme Mère Enfant et Université Claude Bernard Lyon 1, 69500, Bron, France
| | - J J Stirnemann
- EA FETUS, 7328, Université Paris-Descartes, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Université de Paris, 149, Rue de Sèvres, Cedex 15, 75743, Paris, France
| | - R Bessis
- Collége Français d'Echographie Foetale, CFEF, 34820, Teyran, France
| | - G Haddad
- Collége Français d'Echographie Foetale, CFEF, 34820, Teyran, France
| | - L J Salomon
- Collége Français d'Echographie Foetale, CFEF, 34820, Teyran, France.
- EA FETUS, 7328, Université Paris-Descartes, Paris, France.
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Université de Paris, 149, Rue de Sèvres, Cedex 15, 75743, Paris, France.
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Melamed N, Hiersch L, Aviram A, Mei-Dan E, Keating S, Kingdom JC. Diagnostic accuracy of fetal growth charts for placenta-related fetal growth restriction. Placenta 2021; 105:70-77. [PMID: 33556716 DOI: 10.1016/j.placenta.2021.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/09/2021] [Accepted: 01/27/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The choice of fetal growth chart to be used in antenatal screening for fetal growth restriction (FGR) has an important impact on the proportion of fetuses diagnosed as small for gestational age (SGA), and on the detection rate for FGR. We aimed to compare diagnostic accuracy of SGA diagnosed using four different common fetal growth charts [Hadlock, Intergrowth-21st (IG21), World Health Organization (WHO), and National Institute of Child Health and Human Development (NICHD)], for abnormal placental pathology. METHODS A secondary analysis of data from a prospective cohort study in low-risk nulliparous women. The exposure was SGA (birthweight <10th centile for gestational age) using each of the four charts. The outcomes were one of three types of abnormal placental pathology associated with fetal growth restriction: maternal vascular malperfusion (MVM), chronic villitis, and fetal vascular malperfusion. RESULTS A total of 742 nulliparous women met the study criteria. The proportion of SGA was closest to the expected rate of 10% using the Hadlock chart (12.7%). The detection rates (DR) and false positive rates (FPR) for MVM pathology were similar for the Hadlock (DR = 53.1%, FPR = 10.8%), WHO (DR = 59.4%, FPR = 14.2%), and NICHD (DR = 53.1%, FPR = 12.3%) charts, and each was superior when compared to the IG21 chart (DR = 34.4%, FPR = 3.8%, p < 0.001). The diagnosis of SGA was associated with increased risks of preeclampsia and preterm birth for all four charts. DISCUSSION The selection of fetal growth chart to be used in screening programs for FGR has important implications with regard to the false positive and detection rate for FGR.
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Affiliation(s)
- Nir Melamed
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, M5G 1X8, Canada; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada
| | - Liran Hiersch
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, M5G 1X8, Canada; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada
| | - Amir Aviram
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, M5G 1X8, Canada; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada
| | - Elad Mei-Dan
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, M5G 1X8, Canada; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, 4001 Leslie St, Toronto, Ontario, M2K 1E1, Canada
| | - Sarah Keating
- Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
| | - John C Kingdom
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, M5G 1X8, Canada; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
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