Fetal Gender Research Articles

A-339 Utomated Flow of a Non-invasive Fetal Gender Determination Lab-developed Molecular Test

Abstract Background The discovery of cell-free fetal DNA in maternal circulation during pregnancy fostered the introduction of non-invasive tests. Fetal gender determination may be determined at early pregnancy by real-time PCR, identifying the presence or absence of Y chromosome markers in maternal plasma. Dasa has been offering this test for more than 10 years. In 2022, the assay was adapted to an automated flow. Methods The Flow Solution platform, powered by Roche®, was adapted to the in-house test, allowing the processing of 94 samples. Whole blood is obtained from pregnant women from the 8th week of pregnancy onwards. Each maternal plasma sample is extracted once and the DNA eluate submitted to real-time amplification targeting the DYS14 gene from the Y chromosome, in triplicate. The human RNAseP gene is co-amplified as an internal control. Full process takes 5 hours, with the possibility of overlapping a new routine every 2 hours, with a daily capacity of 12 routines (1128 samples/day). Results In 2022, 129 849 fetal gender determination results were released. Of these, 49% of the results indicated male and 51% female fetuses.A few samples displayed indeterminate results, showing amplification curves but with cycle threshold values that are above the cutoff. Other samples do not reach internal quality metrics and the analysis is repeated from the plasma or a new collection is requested. Results that, after the second collection, remain indeterminate, are forwarded with the patient's clinical history to the medical board. In contact with the patient, possible causes for inconclusive results are explained. In 2022, for every 10 000 tests there were 8 were medical contacts.The automated methodology developed and implemented, allowed a high processing volume, with 129 849 tests released in 2022, an increase of 33% compared to 2021 when the method had manual steps. The Total Service Time (TST) from collection to results release in 2022 was approximately 5 days, a 20% reduction compared to 2021, and the repetition rate of 2.43% in 2022 was 0.9% lower than 2021. Recollections also diminished from 1% in 2021 falling to 0.8% in 2022. Conclusion A new automated flow was successfully implemented in 2022 improving the productivity and quality of the service, achieving a high accuracy and leading to a significant reduction in errors and repetitions while reducing the turnaround time and recollections.

Cell-free fetal DNA (cffDNA) extraction from whole blood by using a fully automatic centrifugal microfluidic device based on displacement of magnetic silica beads

The purpose of this research was to design a fully automated centrifugal microfluidic system (Lab-on-a-Disk) for isolating cell free fetal DNAs (cffDNAs) from whole blood. To achieve this goal, magnetic silica beads were used, such that after attaching cffDNA to them, they were transferred between chambers by using external fixed magnets. All the standards and required steps for cffDNA extraction including plasma separation, adding proteinase K, lysis buffer, binding buffer, washing buffer, and elution buffer were considered in this designed disk. To evaluate the function of the disk, the collected samples were tested from several aspects. First, the purity of extracted plasma from whole blood was investigated which included hemoglobin test, hemocytometer, etc. This disk could extract 1.3 mL pure plasma from 3 mL blood with 45% hematocrit. The results of the extracted plasma showed 99% purity. Finally, the cffDNAs were examined by using a male fetal gender identification kit and real-time PCR machine. The results indicated the correct function of the disk in extracting cffDNAs in samples of 10 Landa from cycle 34 onwards. Compared to the clinical method, the disk not only was able to extract cffDNA in 20 min but also it led to less buffer consumption since the disk only required 1 mL plasma for extraction of cffDNAs.

Association between anogenital distance as a noninvasive index in the diagnosis and prognosis of reproductive disorder: A systematic review.

There are 2 measures of anogenital distance (AGD) in men and women. AGD has been used as an indicator of fetal androgen dysfunction and an adverse outcome in adulthood. Some studies have shown the association of AGD as a predictor in the diagnosis and prognosis of diseases and disorders. To systematically summarize the latest evidence for presenting AGD as a new approach for prognosis and early diagnosis of diseases. A systematic review of the available literature was performed using Medline via PubMed, Scopus, and ISI Web of Knowledge up to July 2021, using search terms "anogenital distance" OR "anogenital index" OR "ano genital distance" OR "ano genital index". Language restrictions were not imposed. After reviewing the retrieved articles, 47 unique studies were included in this systematic review. Different outcomes, including endometriosis, prostate cancer, polycystic ovary syndrome, pelvic organ prolapse, hypospadias, cryptorchidism, fertility and semen parameters, maternal and birth development, and ovarian and gynecological-related disorders, have been studied in the included evidence. A negative association was observed between AGD and endometriosis and hypospadias and a positive association between AGD and prostate cancer, polycystic ovary syndrome, male fetal gender, and fertility parameters. Using quantitative indicators such as AGD may be a useful clinical tool for the diagnosis of diseases. Although many studies have shown an association between AGD and diseases, some factors, including different measurement methods, different measurement tools, age, and different definitions of AGD, can be involved in the variation of AGD.

Effects of In Utero EtOH Exposure on 18S Ribosomal RNA Processing: Contribution to Fetal Alcohol Spectrum Disorder.

Fetal alcohol spectrum disorders (FASD) are leading causes of neurodevelopmental disability. The mechanisms by which alcohol (EtOH) disrupts fetal brain development are incompletely understood, as are the genetic factors that modify individual vulnerability. Because the phenotype abnormalities of FASD are so varied and widespread, we investigated whether fetal exposure to EtOH disrupts ribosome biogenesis and the processing of pre-ribosomal RNAs and ribosome assembly, by determining the effect of exposure to EtOH on the developmental expression of 18S rRNA and its cleaved forms, members of a novel class of short non-coding RNAs (srRNAs). In vitro neuronal cultures and fetal brains (11-22 weeks) were collected according to an IRB-approved protocol. Twenty EtOH-exposed brains from the first and second trimester were compared with ten unexposed controls matched for gestational age and fetal gender. Twenty fetal-brain-derived exosomes (FB-Es) were isolated from matching maternal blood. RNA was isolated using Qiagen RNA isolation kits. Fetal brain srRNA expression was quantified by ddPCR. srRNAs were expressed in the human brain and FB-Es during fetal development. EtOH exposure slightly decreased srRNA expression (1.1-fold; p = 0.03). Addition of srRNAs to in vitro neuronal cultures inhibited EtOH-induced caspase-3 activation (1.6-fold, p = 0.002) and increased cell survival (4.7%, p = 0.034). The addition of exogenous srRNAs reversed the EtOH-mediated downregulation of srRNAs (2-fold, p = 0.002). EtOH exposure suppressed expression of srRNAs in the developing brain, increased activity of caspase-3, and inhibited neuronal survival. Exogenous srRNAs reversed this effect, possibly by stabilizing endogenous srRNAs, or by increasing the association of cellular proteins with srRNAs, modifying gene transcription. Finally, the reduction in 18S rRNA levels correlated closely with the reduction in fetal eye diameter, an anatomical hallmark of FASD. The findings suggest a potential mechanism for EtOH-mediated neurotoxicity via alterations in 18S rRNA processing and the use of FB-Es for early diagnosis of FASD. Ribosome biogenesis may be a novel target to ameliorate FASD in utero or after birth. These findings are consistent with observations that gene-environment interactions contribute to FASD vulnerability.

Ultrasonography for the evaluation of pregnancy in the female canine.

Ultrasonography can be used for canine pregnancy diagnosis, determination of gestational age, assessing foetal maturation and readiness for birth, monitoring high-risk pregnancies, assessing foetal distress, evaluating bitches in dystocia and foetal gender determination. As the quality and resolution of ultrasound machines have improved, the clinician's abilities to utilize ultrasound as an integral part of reproductive evaluation of all aspects of pregnancy have exponentially increased. This paper reviews the use of ultrasonography throughout pregnancy and the advances made in the interpretation of captured images.

Modeling fetal cavum septum pellucidi width by quantile regression at 18-34 weeks of gestation: A prospective cross-sectional study.

Develop charts for cavum septum pellucidi (CSP) following a standardized methodology and using quantile regression. The secondary objective was to assess the influence of fetal gender on the generated reference curves. In a cross-sectional prospective study 453 low-risk singleton pregnancies were evaluated at a gestational age interval between 18 and 34 weeks. The width of CSP were measured on ultrasound images using a standardized technique and their changes were evaluated by quantile regression as a function of gestational age (GA) interval or head circumference (HC). Differences between sex were evaluated. The measurement of CSP significantly increased with gestation and HC. Linear models better described the changes of CSP with GA and HC. The fits of CSP width with GA and HC were not significantly different. Male fetuses showed significantly higher CSP width when compared to female fetuses (u = 2.973; p = 0.005). We generated prospective nomograms of fetal CSP development using quantile regression and following a strict standardized methodology. These new charts may be useful to better identify abnormal cases at higher risk of associated anomalies. Further our findings underline the potential effect of gender in developing fetal brain.

Determination of Rh type and gender using circulating cell-free fetal DNA in early pregnancy of Rh negative women in turkey.

Choosing the right clinical approach for early and reliable diagnosis/screening is becoming more important day by day. The aim of the study was to determine the early RhD type with cff-DNA obtained from maternal plasma, especially in the light of recent developments. In this way, it is aimed to apply Rh Ig only to mothers who are determined to have RhD (+) fetuses and to prevent unnecessary further tests that may possess a risk for RhD (-) fetuses. Prediction of fetal gender and RH genotype was performed by using RT-qPCR method. With simultaneous amplification of sequences of SRY, DYS14 and RH genes (exon 7 and exon 10). Fetal gender and RhD were determined in 30 RHD (-) pregnant women with cfDNA. As a result of genotyping, the gender of 67% (20/30) fetuses was determined as male; the gender of 33% (10/30) fetuses was determined as female in a sample group of 30 pregnancies. It was determined that the DYS14 100% (20/20) gene was more sensitive than the SRY 97% (18/20) gene in gender determination after examining prenatal and postnatal results. As a result of the analysis, the presence of 17% (5/30) RhD (-) fetuses and 83% (25/30) RhD (+) fetuses were determined which is 100% compatible with postnatal results. Detecting fetal RhD gene in maternal plasma made an important contribution to its use in non-invasive prenatal screening. This study shows that unnecessary intervention and cost can be avoided with successful genotyping analysis performed with RT-qPCR.

Evaluation of Satisfaction Level of Pregnant Women Presented for Obstetrics Ultrasound Scan in Gombe State Specialist Hospital in North Eastern Nigeria

Obstetrics ultrasound plays an important role in patients care through foetal and maternal management serving as an indispensable tool in routine antenatal care due to its sensitivity in detecting foetal anomaly, failed pregnancy, pregnancy dating as well as multiple gestation. The study aimed at evaluating the level of satisfaction in pregnant women presenting for obstetrics scan at Gombe State Specialist Hospital where a convenient sampling technique was used to draw one hundred and sixty (160) pregnant women coming for obstetric scan at Gombe State Specialist Hospital from February, 2020 to June 2020. Data was collected using a well-structured questionnaire designed based on the parasuraman service quality model and analyzed using statistical package for social sciences (SPSS) version 20.0 where descriptive statistics were generated and presented in Tables and Charts. The participants were aged between 16 and 40 years with a mean age of 24.64. The results showed total patient’s satisfaction with regards to waiting area and waiting time, however highest level of unsatisfaction is recorded in the patient’s perception of the accuracy of the ultrasound scan. The study also found majority of the respondents believed that the main purpose of obstetric scan is to check for fetal wellbeing while 19.4% of the respondents had obstetric scan for gender determination. Obstetrics scan is considered to be a major examination among pregnant women for confirmation of fetal wellbeing and gender. The level of education and exposure by pregnant women serve as a key factor in expecting more from obstetric scan.

Correlation of Placental Weight with Neonatal Weight and HbA1c in Normal Sudanese Pregnant Ladies in Alban-Jaded Teaching Hospital

Background: The placenta is a life-supporting organ for the growing fetus. Several studies have highlighted the relationship between placental weight and neonatal birth weight; however, the role of glycosylated hemoglobin (HbA1c) has not been addressed. Aim: The study aimed to determine the relationship between the placental weight, neonatal birth weight, and HbA1c at term pregnancy in a Sudanese hospital. Methods: This was a cross-sectional hospital-based study conducted at Al Ban-Jaded Hospital between November and December 2022. Data, including the gestational age at delivery (in weeks), parity, mode of delivery, fetal birth weight, placental weight, fetal gender, and presence or absence of maternal medical diseases, was obtained from 60 singleton term deliveries who met the inclusion criteria for the study. The tested data was analyzed using SPSS version 25, and t-test was used to compare the statistical significance (P value ≤ 0.05 was considered statistically significant). Results: The mean age was 27.02 ± 6.8 years. The mean HbA1C was 5.98% ± 0.39% (5.2%–6.9%). Glycated hemoglobin was elevated (≥5.7%) in the majority (46, 76.7%) of pregnancies. The mean placental weight was 290 ± 106 g (100 g–700 g), while the mean birth weight was 3.00 kg ± 0.36 kg (2.3 kg–3.8 kg), and the placental/birth weight ratio was 9.6%. There was a significant positive correlation between neonatal weight and placental weight (r=0.514, P value=0.000). Also, neonatal weight and placental weight had a significant positive correlation with HbA1C (r=0.657, P value=0.000). Placental weight and neonatal birth weight significantly increased with the gestational age of neonates (P value <0.05), with a slight drop noted in term gestation. Conclusions: There is a positive correlation between placental weight and birth weight of the neonate in pregnancies with high maternal HbA1C, and placental weight and birth weight were higher than in pregnancies with normal maternal HbA1C.

Correlation of Placental Weight with Neonatal Weight and HbA1c in Normal Sudanese Pregnant Ladies in Alban-Jaded Teaching Hospital

Background: The placenta is a life-supporting organ for the growing fetus. Several studies have highlighted the relationship between placental weight and neonatal birth weight; however, the role of glycosylated hemoglobin (HbA1c) has not been addressed. Aim: The study aimed to determine the relationship between the placental weight, neonatal birth weight, and HbA1c at term pregnancy in a Sudanese hospital. Methods: This was a cross-sectional hospital-based study conducted at Al Ban-Jaded Hospital between November and December 2022. Data, including the gestational age at delivery (in weeks), parity, mode of delivery, fetal birth weight, placental weight, fetal gender, and presence or absence of maternal medical diseases, was obtained from 60 singleton term deliveries who met the inclusion criteria for the study. The tested data was analyzed using SPSS version 25, and t-test was used to compare the statistical significance (P value ≤ 0.05 was considered statistically significant). Results: The mean age was 27.02 ± 6.8 years. The mean HbA1C was 5.98% ± 0.39% (5.2%–6.9%). Glycated hemoglobin was elevated (≥5.7%) in the majority (46, 76.7%) of pregnancies. The mean placental weight was 290 ± 106 g (100 g–700 g), while the mean birth weight was 3.00 kg ± 0.36 kg (2.3 kg–3.8 kg), and the placental/birth weight ratio was 9.6%. There was a significant positive correlation between neonatal weight and placental weight (r=0.514, P value=0.000). Also, neonatal weight and placental weight had a significant positive correlation with HbA1C (r=0.657, P value=0.000). Placental weight and neonatal birth weight significantly increased with the gestational age of neonates (P value <0.05), with a slight drop noted in term gestation. Conclusions: There is a positive correlation between placental weight and birth weight of the neonate in pregnancies with high maternal HbA1C, and placental weight and birth weight were higher than in pregnancies with normal maternal HbA1C.

The interaction of maternal obesity and administered betamethasone in the development of fetal respiratory distress syndrome

IntroductionThe current study evaluated the effect of obesity on neonatal respiratory distress syndrome (RDS) in pregnant women who were administered ACSs due to the risk of preterm birth and delivered before 34 weeks of gestation.Material and methodsIn this retrospective study, 414 pregnant women who had a singleton pregnancy, were aged 18–40 years, and received two doses of ACS 24 h apart administered between 23+0/7 and 33+5/7 gestation weeks due to the risk of a preterm birth were included. For maximum fetal effect, those who completed the 48-hour steroid treatment and delivered before 34 weeks of gestation were divided into three groups according to BMI at ACS administration.ResultsGestational age at ACS administration and gestational age at delivery were similar among groups.. Neonatal RDS occurred in 17 (18.6%) newborns in the normal weight group, 40 (17.1%) newborns in the overweight group, and 23 (25.5%) newborns in the obese group. After adjusting for independent effects from maternal age, gestational age at ACS administration, gestational age at delivery, emergency cesarean delivery, fetal birth weight, and fetal gender, we found that RDS rates were significantly higher in the obese group.ConclusionsOur results suggest that maternal obesity reduces the effects of ACS and that RDS rates are higher in neonates born before 34 weeks of gestation to obese mothers to whom ACS has been administered.Therefore, pregnant women who have a high BMI and who are at risk of preterm birth are more likely to require an adjustment in ACS dosing.

Prenatal Diagnosis of Pierre Robin Sequence and Its Prognosis: A Retrospective Cohort Study.

This study aimed to explore the efficiency of ultrasound (US) in prenatal diagnosis and prognosis of Pierre Robin sequence (PRS) of 18 cases. A total of 79,305 women admitted for prenatal US examinations were recruited from January 2017 to December 2020. Eighteen cases of PRS fetuses were selected form the cohort and 40 cases of isolated micrognathia were recruited randomly as control group. All the clinical and imaging results were retrospectively reviewed. General condition, US measurements, and prognosis of fetuses were compared between groups. Cleft palate, glossoptosis, and micrognathia were found in all 18 fetuses with PRS by prenatal US. Compared with the isolated micrognathia group, there were no significant differences in the PRS group in examination of maternal age, gestational weeks at assessment, and gender of fetuses, but significant lower measures in inferior facial angle, jaw index, and frontal nasal-mental angle (each p < 0.05). Twelve fetuses were defined to have other associated malformations. Ear malformations were the most common associated malformations with a prevalence of 44.4% (8/18). All of the18 cases were confirmed with PRS after delivery or autopsy. Two delivered infants were found bucking easily, one baby was spitting up frequently but growth showed normal. Prenatal detection of PRS with US examination is highly efficient. Even with the triad of malformations, isolated PRS had good outcomes following initial stabilization and management in the neonatal period. Prenatal detection of Pierre Robin syndrome with targeted US examination is efficient in discerning characteristics of this rare syndrome. Even with the triad of malformations, isolated PRS had good outcomes following initial stabilization and management in the neonatal period. · Prenatal diagnosis of fetal PRS is of great clinical importance.. · Micrognathia has been identified as the primary feature of PRS.. · Posterior displacement of the tongue may cause acute neonatal respiratory distress.. · Even with triad malformation, isolated PRS seemed to have good outcomes..

Brain cortical maturation assessed by magnetic resonance imaging in unaffected or mildly affected fetuses with cytomegalovirus infection.

To assess by magnetic resonance imaging (MRI) the cortical maturation pattern in fetuses with cytomegalovirus (CMV) infection with mild or no abnormalities on ultrasound (US) and MRI, and to establish possible differences compared with healthy controls. This was a retrospective case-control study of consecutive pregnancies with a CMV-infected fetus undergoing prenatal MRI as a complementary diagnostic tool in two centers, and a control group of singleton low-risk pregnancies without fetal structural abnormalities, with normal fetal growth and with healthy newborns. CMV infection was confirmed by extraction of CMV-DNA from fetal and neonatal samples. Only fetuses with mild (mildly affected) or no (unaffected) neuroimaging abnormalities on US and MRI were included. MRI measurements of fetal parieto-occipital sulcus, cingulate sulcus and calcarine sulcus depth, Sylvian fissure depth and Sylvian fissure angles were performed and cortical development grading of specific cortical areas and sulci were assessed by one operator who was blinded to CMV infection status. Data were compared between controls and fetuses with CMV infection, using linear regression and non-parametric trend analysis. Twenty-four CMV-infected fetuses (seven unaffected and 17 mildly affected) and 24 healthy controls that underwent fetal MRI between 27 and 36 weeks' gestation were included. Compared with controls, CMV-infected fetuses showed significantly larger median lateral ventricular width (right side, 7.8 (interquartile range (IQR), 5.9-9.9) mm vs 3.9 (IQR, 2.6-5.3) mm; left side, 7.5 (IQR, 6.0-10.9) mm vs 4.2 (IQR, 3.2-5.3) mm), significantly decreased parieto-occipital sulcus depth (right side, 12.6 (IQR, 11.3-13.5) mm vs 15.9 (IQR, 13.5-17.3) mm; left side, 12.3 (IQR, 10.6-13.5) mm vs 16.0 (IQR, 13.3-17.5) mm) and calcarine sulcus depth (right side, 15.4 (IQR, 14.4-16.3) mm vs 17.5 (IQR, 16.1-18.7) mm; left side, 14.6 (IQR, 14.1-15.6) mm vs 16.7 (IQR, 15.6-18.9) mm) (P < 0.001 for all). Compared with controls, CMV-infected fetuses also had significantly smaller upper (right side, 42.8° (IQR, 35.8-45.8°) vs 48.9° (IQR, 38.4-64.7°); left side, 40.9° (IQR, 34.2-45.8°) vs 48.2° (IQR, 41.9-60.7°)) and lower (right side, 41.6° (IQR, 34.4-49.2°) vs 48.9° (IQR, 40.6-60.9°); left side, 42.2° (IQR, 38.8-46.9°) vs 48.9° (IQR, 39.5-57.5°)) Sylvian fissure angles (P < 0.05 for all). In addition, the mildly affected CMV-infected fetuses had a significantly lower cortical development grading in the temporal and parietal areas, and the parieto-occipital and calcarine sulci compared with healthy fetuses (P < 0.05). These differences persisted when adjusting for gestational age, ipsilateral atrium width, fetal gender and when considering small-for-gestational age as a confounding factor. Unaffected and mildly affected CMV-infected fetuses showed delayed cortical maturation compared with healthy controls. These results suggest that congenital CMV infection, even in non-severely affected fetuses that are typically considered of good prognosis, could be associated with altered brain cortical structure. Further research is warranted to better elucidate the correlation of these findings with neurodevelopmental outcomes. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Evolution of fetal ventriculomegaly diagnosed in the second trimester of pregnancy: A retrospective study in Northern Greece

Introduction: The present retrospective study aims to examine the course of ventriculomegaly (VM) during gestation, the association between the degree of VM and the presence of additional sonographic fetal malformations, as well as to inspect the prevalence of VM with reference to fetal gender. Materials and Methods: The databases of two maternal-fetal ultrasound units were reviewed from 2010 to 2021. All cases were classified as either mild (10 to &lt;12mm), moderate (12 to &lt;15mm), or severe (≥15mm) according to the fetal posterior ventricle width measurement upon VM diagnosis, at 20-24 weeks of gestation. Furthermore, cases with additional fetal sonographic abnormalities were registered as cases of non-isolated VM, whereas those cases without further fetal malformations on ultrasound (US) scan were documented as cases of isolated VM. The final sonographic record of every participant, following VM diagnosis, was registered so that the evolution of VM during gestation could be monitored. Results: The sonographic and medical records of 81 women diagnosed with fetal VM were studied. The prevalence of VM is about 0.24% and the male/female ratio was 2; 88.9% of the cases were mild, 9.9% moderate, while only 1 (1.2%) was severe at diagnosis. Among the initial 62 cases of mild VM, 24 (38.7%) regressed, 16 (25.8%) remained unchanged and 22 (35.5%) progressed. There was an association between a higher degree of VM and the presence of additional fetal abnormalities. Conclusions: The majority of VM cases are mild at diagnosis and in isolated about one third resolves in the third trimester and about one third progresses but not to severe. Therefore, a follow up scan is useful to reassure most parents and identify those cases that may progress to moderate.

Fetal left-atrial posterior-space-to-diagonal ratio at 17-37 weeks' gestation for prediction of total anomalous pulmonary venous connection.

To develop normative data for the left-atrial posterior-space-to-diagonal (LAPSD) ratio and post-left atrium space (PLAS) index in fetuses from 17 to 37 weeks' gestation, and determine the optimal cut-offs of the LAPSD ratio and PLAS index to discriminate between normal fetuses and those with total anomalous pulmonary venous connection (TAPVC). This was a prospective cross-sectional assessment of 428 structurally normal fetuses between 17 and 37 weeks' gestation and a retrospective study of 27 TAPVC fetuses. The fetal LAPSD ratio was calculated by dividing the left atrium-descending aorta distance (LDD) by the left atrial diagonal diameter (LA). The PLAS index was calculated as the ratio of the LDD to the descending aorta diameter (DA). Pearson's correlation analysis was used to examine the correlation of cardiac parameters with gestational age (GA) and fetal somatic growth. The PLAS index and LAPSD ratio were compared between the normal and TAPVC groups to assess their usefulness in the prenatal diagnosis of TAPVC. LDD, LA and DA measures showed moderate to strong positive correlation, whereas both the LAPSD ratio and PLAS index showed a slight decrease with increasing GA and biometric variables. The fetal LAPSD ratio and PLAS index in TAPVC cases were significantly greater compared with those of fetuses with a normal heart (both P < 0.001). There were no significant differences in the PLAS index and LAPSD ratio between the isolated and complex TAPVC groups (both P = 1). No significant associations of the PLAS index and LAPSD ratio with fetal gender, four-chamber view type (apical, basal or lateral) or TAPVC type were found. Using values of ≥ 0.35 for the LAPSD ratio and of ≥ 1 for the PLAS index exhibited similar excellent diagnostic performance, with a sensitivity of 100% and specificity of 97.0% or 95.1% for detecting TAPVC. Our study demonstrates that the LAPSD ratio is a practical and effective screening tool for diagnosing fetal TAPVC, similar to the PLAS index. Incorporating these parameters into routine cardiac scanning may enhance the prenatal detection of TAPVC. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Prenatal amoxicillin exposure induces developmental toxicity in fetal mice and its characteristics

Amoxicillin, a widely used antibiotic in human and veterinary pharmaceuticals, is now considered as an “emerging contaminant” because it exists widespreadly in the environment and brings a series of adverse outcomes. Currently, systematic studies about the developmental toxicity of amoxicillin are still lacking. We explored the potential effects of amoxicillin exposure on pregnancy outcomes, maternal/fetal serum phenotypes, and fetal multiple organ development in mice, at different doses (75, 150, 300 mg/(kg·day)) during late-pregnancy, or at a dose of 300 mg/(kg·day) during different stages (mid-/late-pregnancy) and courses (single-/multi-course). Results showed that prenatal amoxicillin exposure (PAmE) had no significant influence on the body weights of dams, but it could inhibit the physical development and reduce the survival rate of fetuses, especially during the mid-pregnancy. Meanwhile, PAmE altered multiple maternal/fetal serum phenotypes, especially in fetuses. Fetal multi-organ function results showed that PAmE inhibited testicular/adrenal steroid synthesis, long bone/cartilage and hippocampal development, and enhanced ovarian steroid synthesis and hepatic glycogenesis/lipogenesis, and the order of severity might be gonad (testis, ovary) > liver > others. Further analysis found that PAmE-induced multi-organ developmental and functional alterations had differences in stages, courses and fetal gender, and the most obvious changes might be in high-dose, late-pregnancy and multi-course, but there was no typical rule of a dose-response relationship. In conclusion, this study confirmed that PAmE could cause abnormal development and multi-organ function alterations, which deepens our understanding of the risk of PAmE and provides an experimental basis for further exploration of the long-term harm.

Maternal expectations of fetal gender and risk of postpartum depression

BackgroundFemale offspring was associated with a high risk of postpartum depression (PPD) during the one-child policy period in China. However, little is known about the association between maternal expectations on fetal gender and the risk of PPD in the context of the new two children policy implemented in 2016.MethodsWe conducted a hospital-based cohort study of women with singleton pregnancies between 2017 and 2018 (n = 991) to address this concern. Logistic regression was run to estimate the association between unexpected fetal gender and the risk of PPD.ResultsA total of 127 women (12.8%) were diagnosed with PPD. Compared with women who achieved fetal gender expectations, the odds ratio (OR) for PPD among those who had an unexpected fetal gender was 2.44 (95% confidence interval (CI): 1.30–4.58) (in the backward method logistic regression model) and 2.25 (95% CI: 1.21–4.18) (in the forward method model), respectively. The disparity of the association was significant among primiparous and pluriparous women (OR, 2.52, 95% CI: 1.32–4.84, P = 0.005 vs. OR, 0.91, 95% CI: 0.09–8.75, P = 0.932). Fetal gender expectations accounted for about 15% of the risk of PPD in the structural equation models.ConclusionsThese results indicated that unexpected fetal gender was associated with an increased risk of PPD among Chinese primiparous women.

Impact of ethnicity and neighborhood deprivation on preterm birth: How does urban living play a role?

ObjectiveWomen of Black and other non-Western ethnicity and women who live in deprived neighborhoods are at increased risk for preterm birth (PTB). These women may live clustered in certain urban areas. If ethnicity reflects a biological rather than a socioeconomic risk factor, women should have a PTB risk independent of the urban area where they live. In this study we explored the association between urban living and the risk of PTB, combined with knowledge on ethnicity and neighborhood deprivation in these specific urban areas in the Netherlands. Study designNational cohort study of 935,381 women (2014–2019) with a singleton pregnancy resulting in live birth between 24.0 and 42.6 weeks. Antepartum death and severe congenital anomalies were excluded. We performed logistic regression analysis and analyzed the impact of living in one of the four main urban areas on PTB. We adjusted for maternal age, parity and fetal gender. We tested for interaction between ethnicity, neighborhood deprivation index (NDI) and urban living. ResultsMean PTB rate among singleton pregnancies in The Netherlands is 5.1%. There was a strong ethnic difference in PTB risk, with the highest prevalence among South Asian women (7.9%) and African women (6.6%). In the most deprived neighborhoods the PTB risk was 5.7%. We found a significant interaction between ethnicity and urban living, and between NDI and urban living. South Asian and African women living in urban areas had the greatest risk of PTB, between 7.0% and 8.8%. ConclusionEthnicity remains a fixed biological risk for PTB that cannot be fully explained by socioeconomic status or neighborhood deprivation. Independent of ethnicity and neighborhood deprivation, urban living has a great influence on the risk of preterm birth. Future studies and policies should focus on population-based interventions in those urban areas where South Asian and African ethnic groups live and where the preterm birth risk is the highest.

Predicting fetal growth retardation: mathematical modeling

Introduction. Annually, more than 13 million neonates are born with fetal growth retardation (FGR) worldwide. FGR increases prenatal mortality and morbidity. Due to no effective treatments for FGR are available, its prevention and prognosis are of extreme relevance.Aim: development of prognostic clinical and anamnestic mathematical model for assessing a risk of developing FGR during pregnancy.Materials and Methods. A prospective, controlled, open, continuous study was performed. The main group (1) included 75 patients who had FGR during pregnancy; the control group (2) consisted of 414 women with favorable pregnancy outcome. All subjects underwent examination, including collecting medical history, a complex of prenatal diagnostics in the first trimester of pregnancy – ultrasound, Doppler uterine arteries, serum level of pregnancy-associated plasma protein-A (PAPP-A), free beta-subunit of human chorionic gonadotropin (β-hCG), placental growth factor (PlGF), and non-invasive prenatal test (NIPT).Results. To determine the relative contribution of each individual trait to the formation of FGR risk and develop a prognostic index, a discriminant analysis was carried out, on the basis of which a prognostic F-index was developed. The formula for calculating the F-index includes the age of pregnant woman, obstetric history data, method of conception, recorded nicotine addiction in pregnancy, detected uterine fibroids, body mass index, biochemical parameters (PAPP-A, β-hCG, PlGF), nuchal translucency of the fetus, the pulsation index of the uterine artery, the level of the fetal fraction and fetal gender (determined during NIPT). The parameters of sensitivity and specificity of the FGR prognosis were 90.1 and 82.18 % respectively, the method effectiveness was 83.97 %.Conclusion. The method developed for predicting FGR can be used in clinical practice to form risk groups for FGR development and choose tactics for pregnancy management.

Effect of maternal cortisol levels on fetal heart rate patterns in primiparous pregnant women in the third trimester

This study aimed to determine whether maternal cortisol levels affect fetal heart rate patterns in primiparous pregnant women in the third trimester. This cross-sectional descriptive study included 400 primiparous pregnant women with uncomplicated pregnancies between November and December 2022. The study included primiparous pregnant women over 18 years old in the third trimester who had not exercised for at least 2 h before the fetal heart rate monitoring and had a healthy pregnancy without consuming any food or drink. Fetuses with decelerating heartbeats and pregnant women who showed uterine contraction and cervical dilation during the fetal heart rate monitoring were excluded from the study. Research data were collected with the data collection form. The fetal heart rate data were collected using a cardiotocograph. At least two accelerations during the 20-min nonstress test period were the basis for diagnosing a reactive nonstress test. About 5 mL of maternal saliva for cortisol measurements was collected before fetal heart rate monitoring. Research data were analyzed with IBM SPSS Statistics for Macintosh, Version 28.0. A p-value of <0.05 was considered significant. There were no significant differences in the comparison of the groups in terms of education and income status, family type, fetal gender, pregnancy planning status, BMI and age averages, or gestational week averages (p>0.05). The number of at least two accelerations required for the diagnosis of reactive NST was also higher in Group 1 (maternal salivary cortisol level ≤24.20). A moderately positive relationship between fetal heart rate and maternal salivary cortisol was observed (r=0.448, p=0.000). In total, 11.9% of the total change in fetal heart rate level is explained by maternal cortisol (R2=0.119). Maternal cortisol increases fetal heart rate level (ß=0.349). These findings suggest that stress in primiparous pregnant women with high cortisol levels may influence fetal heart rate patterns. It was revealed that the increase in cortisol level, considered a stress hormone, may be a harbinger of fetal tachycardia.