Abstract
ABSTRACTFetal activity in utero is a normal part of pregnancy and reduced or absent movement can lead to long-term skeletal defects, such as Fetal Akinesia Deformation Sequence, joint dysplasia and arthrogryposis. A variety of animal models with decreased or absent embryonic movements show a consistent set of developmental defects, providing insight into the aetiology of congenital skeletal abnormalities. At developing joints, defects include reduced joint interzones with frequent fusion of cartilaginous skeletal rudiments across the joint. At the spine, defects include shortening and a spectrum of curvature deformations. An important question, with relevance to possible therapeutic interventions for human conditions, is the capacity for recovery with resumption of movement following short-term immobilisation. Here, we use the well-established chick model to compare the effects of sustained immobilisation from embryonic day (E)4-10 to two different recovery scenarios: (1) natural recovery from E6 until E10 and (2) the addition of hyperactive movement stimulation during the recovery period. We demonstrate partial recovery of movement and partial recovery of joint development under both recovery conditions, but no improvement in spine defects. The joints examined (elbow, hip and knee) showed better recovery in hindlimb than forelimb, with hyperactive mobility leading to greater recovery in the knee and hip. The hip joint showed the best recovery with improved rudiment separation, tissue organisation and commencement of cavitation. This work demonstrates that movement post paralysis can partially recover specific aspects of joint development, which could inform therapeutic approaches to ameliorate the effects of human fetal immobility.This article has an associated First Person interview with the first author of the paper.
Highlights
IntroductionReduced Fetal Movement (RFM) is a common clinical presentation in obstetric practice, with22-25% of women perceiving decreased fetal movement resulting in poor perinatal outcomes (reviewed in Lai et al, 2016; Dutton et al, 2012)
Reduced Fetal Movement (RFM) is a common clinical presentation in obstetric practice, with22-25% of women perceiving decreased fetal movement resulting in poor perinatal outcomes
The study reveals that embryonic movement post paralysis can partially-recover specific aspects of joint development, which could inform therapeutic approaches to ameliorate the effects of restricted fetal movement in utero
Summary
Reduced Fetal Movement (RFM) is a common clinical presentation in obstetric practice, with22-25% of women perceiving decreased fetal movement resulting in poor perinatal outcomes (reviewed in Lai et al, 2016; Dutton et al, 2012). Reduced Fetal Movement (RFM) is a common clinical presentation in obstetric practice, with. RFM in utero is associated with a number of conditions and syndromes including Fetal Akinesia Deformation Sequence (FADS) which represents a spectrum of defects in bone and joint formation including hypomineralised, brittle bones prone to fracture (Temporary Brittle Bone Disease), and contracture of joints (reviewed in Shea et al, 2015); joint dysplasia, of the hip (reviewed in Nowlan, 2015); and arthrogryposis, defined as multiple joint contractures, affecting approximately 1 in 3000 live births (Skaria et al, 2019; Hall, 2014). Short term absence of fetal movements at approximately 8 weeks of gestation, lasting over 3 weeks, has been theorised to be sufficient to result in the clinical features of arthrogryposis (Kowalczyk and Felus, 2016). In most cases the reasons behind reduced fetal movement are unknown but the use of patient specific case studies of rare movement disorders (e.g. Prader-Willi syndrome), in combination with retrospective studies, further highlight the causative relationship between diminished fetal movements and skeletal anomalies (Donker et al, 2009; Bigi et al, 2008; Fong and De Vries, 2003; Moessinger, 1983)
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