Fetal Growth Parameters Research Articles

Enrichment of trimethyl histone 3 lysine 4 in the Dlk1 and Grb10 genes affects pregnancy outcomes due to dietary manipulation of excess folic acid and low vitamin B12

The aberrant expression of placental imprinted genes due to epigenetic alterations during pregnancy can impact fetal development. We investigated the impact of dietary modification of low vitamin B12 with varying doses of folic acid on the epigenetic control of imprinted genes and fetal development using a transgenerational model of C57BL/6J mice. The animals were kept on four distinct dietary combinations based on low vitamin B12 levels and modulated folic acid, mated in the F0 generation within each group. In the F1 generation, each group of mice is split into two subgroups; the sustained group was kept on the same diet, while the transient group was fed a regular control diet. After mating, maternal placenta (F1) and fetal tissues (F2) were isolated on day 20 of gestation. We observed a generation-wise opposite promoter CpG methylation and gene expression trend of the two developmental genes Dlk1 and Grb10, with enhanced gene expression in both the sustained and transient experimental groups in F1 placentae. When fetal development characteristics and gene expression were correlated, there was a substantial negative association between placental weight and Dlk1 expression (r = − 0.49, p < 0.05) and between crown-rump length and Grb10 expression (r = − 0.501, p < 0.05) in fetuses of the F2 generation. Consistent with these results, we also found that H3K4me3 at the promoter level of these genes is negatively associated with all fetal growth parameters. Overall, our findings suggest that balancing vitamin B12 and folic acid levels is important for maintaining the transcriptional status of imprinted genes and fetal development.

Maternal iron nutrition during pregnancy and fetal intrauterine growth

BackgroundIron is critical for maternal and fetal health; however, the effect of iron nutrition on fetal intrauterine growth remains unclear. This study aimed to investigate the associations of maternal iron nutrition during pregnancy with fetal intrauterine growth parameters among the Chinese population.MethodsThis retrospective birth cohort study included 482 pregnant women. Maternal information was collected by standard questionnaires. Maternal concentrations of serum ferritin and hemoglobin were detected. Fetal ultrasound examinations in the second and third trimesters were conducted. Quantile regression or linear regression models were applied to assess the associations.ResultsParticipants took iron supplementation in early, mid, and late pregnancy accounted for 19.1%, 40.3%, and 37.8%, respectively. Iron supplementation in the first and second trimesters and total iron intake in pregnancy were positively associated with fetal intrauterine growth parameters at some percentiles. Compared with those without iron supplementation in the second trimester, women with iron supplementation in the second trimester had 0.37 (95%CI = 0.24–0.49), 0.37 (95%CI = 0.26–0.48), 0.15 (95%CI = 0.04–0.26), and 0.52 (95%CI = 0.42–0.61) higher z-scores in fetal biparietal diameter, femur length, abdominal circumference, and estimated fetal weight at the 50th percentile in the second trimester, respectively. Maternal serum ferritin and hemoglobin concentrations in the first and second trimesters were positively correlated with several fetal growth parameters.ConclusionsFetal intrauterine growth may benefit from maternal iron nutrition in the first and second trimesters.

A Comprehensive and Longitudinal View of Pregnancy from the Perspective of the Couple, Maternal Mental Health and Fetal Growth.

This study investigates the impact of both maternal psychopathological factors and adaptive psychological changes within the couple on fetal growth, emphasizing the importance of evaluating pregnancy from the perspectives of the couple, the mother, and the fetus collectively. A "couple" in this context refers to heterosexual partners engaged in the pregnancy process together, whether married or in a stable relationship. We included 189 pregnant women in their first trimester, tracking maternal depression, anxiety, body appreciation, prenatal attachment, and the couple's adjustment level across each trimester. Fetal growth parameters measured include biparietal diameter, femur length, humerus length, abdomen circumference, head circumference, β-HCG, and amniotic fluid levels, with relationships between these variables being modeled accordingly. Our findings indicate stable levels of maternal depression, anxiety, body appreciation, and couple's adjustment throughout the pregnancy, with a significant increase in prenatal attachment levels in each subsequent trimester. Prenatal attachment in the first trimester and maternal depression levels in the second and third trimesters were found to directly influence fetal growth, while other variables exhibited indirect effects. Fetal growth is influenced by a myriad of biopsychosocial factors. Ensuring healthy pregnancy and fetal development necessitates close monitoring and support of the mother's adaptive psychological changes, early identification and treatment of potential psychopathologies, and maintenance of the psychosocial health of the couple.

Association between gestational arsenic exposure and infant physical development: a prospective cohort study

BackgroundArsenic pollution is widespread worldwide. The association between gestational arsenic exposure and adverse birth outcomes has been demonstrated in previous studies; however, few investigations have examined whether gestational arsenic exposure has adverse effects on infant growth and development after birth.ObjectiveOur study was designed to evaluate particular associations between gestational arsenic exposure during pregnancy and newborn birth size and to investigate whether these associations continue to affect infants after birth.MethodsAn ongoing prospective cohort study of 1100 pregnant women was conducted at the Wuxi Maternity and Child Health Care Hospital. The total urinary arsenic concentrations in the 2nd and 3rd trimester were determined using atomic fluorescence spectrometry. The relationships between urinary arsenic concentration and foetal growth parameters (birth weight, head circumference, length, and ponderal index), SGA (Small for gestational age), and physical growth of infants within one year after birth were analysed.ResultsUrinary arsenic concentration in the 3rd trimester was associated with an increased incidence of SGA [adjusted model: OR = 2.860 (95% CI: 1.168, 7.020), P = 0.021)]. Arsenic exposure in late pregnancy had an adverse effect on the physical development of infants before the age of 1 year, and there was an interaction effect with the sex of infants. The weight and length of boys at 6 and 12 months negatively correlated with maternal urinary arsenic levels during late pregnancy.ConclusionsIn addition to affecting foetal growth, exposure to arsenic in the 3rd trimester also negatively affected the growth of offspring within the first year of life.

Effects of 'dedo de moça' pepper extract administration on wistar rat pregnancy and fetal development

Introduction: The dedo de moça pepper is spicy due to capsaicin, which activates receptors in sensory neurons, generating a burning sensation. Studies suggest that capsaicin-sensitive neurons, by releasing neuropeptides, may affect uterine contraction. Objective: To evaluate the effect of chronic administration of capsaicin extract (Cps) during pregnancy in Wistar rats and their fetuses. Methodology: Pregnant female Wistar rats were divided into 4 groups (n = 5/group): Group I – Negative Control; Group II – Positive Control; Group III – Cps 1 – 0.25 mL; Group IV – Cps 2 – 0.5 mL. Exposure was initiated after embryo implantation (3rd day of pregnancy) until full term (20th day of pregnancy), with gavage performed three times per week. Results: On the 20th day, pregnant rats were euthanized, and outcomes evaluated included weight gain, placental morphology, reproductive capacity, and embryonic/fetal development. Ingestion of capsaicin extract resulted in negative impacts on fetal intrauterine growth parameters and placental alterations, with deposition of atypical hyaline material for gestational age and changes in vascular structures. Conclusion: The results indicate that capsaicin extract interfered with placental exchange, leading to intrauterine growth restriction of the fetuses.

Periconceptional maternal and paternal alcohol consumption and embryonic and fetal development: the Rotterdam periconception cohort

Research QuestionWhat is the impact of maternal and paternal alcohol consumption in the periconception period on embryonic and foetal development assessed using three-dimensional ultrasound and VR techniques? DesignThis is a prospective observational study embedded in the Rotterdam Periconception Cohort (Predict study). Participating women received longitudinal 3D transvaginal ultrasound examinations from week 7 up to week 12 of gestation to measure crown-rump length (CRL) and embryonic volume (EV). Mid-pregnancy foetal size parameters and birthweight were retrieved from medical files. Participants filled out a periconception exposure questionnaire and a validated food frequency questionnaire. Linear mixed models were used to analyse the association between parental alcohol consumption, and embryonic and foetal developmental parameters. Results1141 female and 987 male participants were included in our analyses. Maternal moderate alcohol consumption in the periconception period resulted in a smaller head circumference (β=-1.85, SE=0.84, P=0.03), abdominal circumference (β=-2.65, SE=0.93, P=0.004), femur length (β=-0.56, SE=0.22, P=0.01), and estimated foetal weight (β=-9.36, SE=4.35, P=0.03) at 20 weeks of gestation. Paternal alcohol consumption showed significant positive associations, mainly with foetal size parameters (AC: β=0.033, SE=0.01, P=0.008; EFW: β=0.131, SE:0.06, P=0.03). ConclusionsModerate maternal alcohol consumption is negatively associated with foetal growth parameters. Moreover, alcohol is proven a strong teratogen and the consumption before and during pregnancy should be discouraged in both women and men since it affects both several parameters of embryonic and foetal development.

Association between prenatal exposure to PM2.5 and fetal growth: a prospective cohort study

Objective: To investigate the association of exposure to PM2.5 and its constituents during pregnancy and fetal growth and to further identify critical windows of exposure for fetal growth. Methods: We included 4 089 mother-child pairs from the Jiangsu Birth Cohort Study between January 2016 and October 2019. Data of general characteristics, clinical information, daily average PM2.5 exposure, and its constituents during pregnancy were collected. Fetal growth parameters, including head circumference (HC), abdominal circumference (AC), and femur length (FL), were measured by ultrasound after 20 weeks of gestation, and then estimated fetal weight (EFW) was calculated. Generalized linear mixed models were adopted to examine the associations of prenatal exposure to PM2.5 and its constituents with fetal growth. Distributed lag nonlinear models were used to identify critical exposure windows for each outcome. Results: A 10 μg/m3 increase in PM2.5 exposure during pregnancy was associated with a decrease of 0.025 (β=-0.025, 95%CI: -0.048- -0.001) in HC Z-score, 0.026 (β=-0.026, 95%CI: -0.049- -0.003) in AC Z-score, and 0.028 (β=-0.028, 95%CI:-0.052--0.004) in EFW Z-score, along with an increased risk of 8.5% (RR=1.085, 95%CI: 1.010-1.165) and 13.5% (RR=1.135, 95%CI: 1.016-1.268) for undergrowth of HC and EFW, respectively. Regarding PM2.5 constituents, prenatal exposure to black carbon, organic matter, nitrate, sulfate (SO42-) and ammonium consistently correlated with decreased HC Z-score. SO42- exposure was also associated with decreased FL Z-scores. In addition, we found that gestational weeks 2-5 were critical windows for HC, weeks 4-13 and 19-40 for AC, weeks 4-13 and 23-37 for FL, and weeks 4-12 and 20-40 for EFW. Conclusions: Our findings demonstrated that exposure to PM2.5 and its constituents during pregnancy could adversely affect fetal growth and the critical windows for different fetal growth parameters are not completely consistent.

The associations between maternal and fetal exposure to endocrine-disrupting chemicals and asymmetric fetal growth restriction: a prospective cohort study.

Recent evidence has revealed associations between endocrine-disrupting chemicals (EDCs) and placental insufficiency due to altered placental growth, syncytialization, and trophoblast invasion. However, no epidemiologic study has reported associations between exposure to EDCs and asymmetric fetal growth restriction (FGR) caused by placenta insufficiency. The aim of this study was to evaluate the association between EDC exposure and asymmetric FGR. This was a prospective cohort study including women admitted for delivery to the Maternal Fetal Center at Seoul St. Mary's Hospital between October 2021 and October 2022. Maternal urine and cord blood samples were collected, and the levels of bisphenol-A (BPA), monoethyl phthalates, and perfluorooctanoic acid in each specimen were analyzed. We investigated linear and non-linear associations between the levels of EDCs and fetal growth parameters, including the head circumference (HC)/abdominal circumference (AC) ratio as an asymmetric parameter. The levels of EDCs were compared between fetuses with and without asymmetric FGR. Of the EDCs, only the fetal levels of BPA showed a linear association with the HC/AC ratio after adjusting for confounding variables (β = 0.003, p < 0.05). When comparing the normal growth and asymmetric FGR groups, the asymmetric FGR group showed significantly higher maternal and fetal BPA levels compared to the normal growth group (maternal urine BPA, 3.99 μg/g creatinine vs. 1.71 μg/g creatinine [p < 0.05]; cord blood BPA, 1.96 μg/L vs. -0.86 μg/L [p < 0.05]). In conclusion, fetal exposure levels of BPA show linear associations with asymmetric fetal growth patterns. High maternal and fetal exposure to BPA might be associated with asymmetric FGR.

First trimester maternal tryptophan metabolism and embryonic and fetal growth: the Rotterdam Periconceptional Cohort (Predict Study).

What is the association between first trimester maternal tryptophan (TRP) metabolites and embryonic and fetal growth? Higher 5-hydroxytryptophan (5-HTP) concentrations are associated with reduced embryonic growth and fetal growth and with an increased risk of small-for-gestational age (SGA), while higher kynurenine (KYN) concentrations are associated with a reduced risk of SGA. The maternal TRP metabolism is involved in many critical processes for embryonic and fetal growth, including immune modulation and regulation of vascular tone. Disturbances in TRP metabolism are associated with adverse maternal and fetal outcomes. This study was embedded within the Rotterdam Periconceptional Cohort (Predict Study), an ongoing prospective observational cohort conducted at a tertiary hospital from November 2010 onwards. A total of 1115 women were included before 11 weeks of gestation between November 2010 and December 2020. Maternal serum samples were collected between 7 and 11 weeks of gestation, and TRP metabolites (TRP, KYN, 5-HTP, 5-hydroxytryptamine, and 5-hydroxyindoleacetic acid) were determined using a validated liquid chromatography (tandem) mass spectrometry method. Serial 3D ultrasound scans were performed at 7, 9, and 11 weeks of gestation to accurately assess features of embryonic growth, including crown-rump length (CRL) and embryonic volume (EV) offline using virtual reality systems. Fetal growth parameters were retrieved from medical records and standardized according to Dutch reference curves. Mixed models were used to assess associations between maternal TRP metabolites and CRL and EV trajectories. Linear and logistic regression models were utilized to investigate associations with estimated fetal weight (EFW) and birthweight, and with SGA, respectively. All analyses were adjusted for potential confounders. Maternal 5-HTP concentrations and the maternal 5-HTP/TRP ratio were inversely associated with embryonic growth (5-HTP, √CRL: β = -0.015, 95% CI = -0.028 to -0.001; 5-HTP 3√EV: β = -0.009, 95% CI = -0.016 to -0.003). An increased maternal 5-HTP/TRP ratio was also associated with lower EFW and birthweight, and with an increased risk of SGA (odds ratio (OR) = 1.006, 95% CI = 1.00-1.013). In contrast, higher maternal KYN concentrations were associated with a reduced risk of SGA in the unadjusted models (OR = 0.548, 95% CI = 0.320-0.921). Residual confounding cannot be ruled out because of the observational design of this study. Moreover, this study was conducted in a single tertiary hospital, which assures high internal validity but may limit external validity. The novel finding that maternal 5-HTP concentrations are associated with a smaller embryo and fetus implies that disturbances of the maternal serotonin pathway in the first trimester of pregnancy are potentially involved in the pathophysiology of fetal growth restriction. The association between higher maternal KYN concentrations and a reduced risk of SGA substantiate the evidence that the KYN pathway has an important role in fetal growth. More research is needed to delve deeper into the potential role of the maternal TRP metabolism during the periconception period and pregnancy outcome for mother and offspring. This study was funded by the Department of Obstetrics and Gynecology and the Department of Clinical Chemistry of the Erasmus MC, University Medical Center, Rotterdam, the Netherlands. The authors have no competing interests to disclose. N/A.

Analyzing the impact of phthalate and DINCH exposure on fetal growth in a cohort with repeated urine collection

BackgroundMost previous studies investigating the associations between prenatal exposure to phthalates and fetal growth relied on measurements of phthalate metabolites at a single time point. They also focused on weight at birth without assessing growth over pregnancy, preventing the identification of potential periods of fetal vulnerability. We examined the associations between pregnancy urinary phthalate metabolites and fetal growth outcomes measured twice during pregnancy and at birth. MethodsFor 484 pregnant women, we assessed 13 phthalate and two 1,2-cyclohexane dicarboxylic acid, diisononyl ester (DINCH) metabolite concentrations from two within-subject weekly pools of up to 21 urine samples (median of 18 and 34 gestational weeks, respectively). Fetal biparietal diameter, femur length, head and abdominal circumferences were measured during two routine pregnancy follow-up ultrasonographies (median 22 and 32 gestational weeks, respectively) and estimated fetal weight (EFW) was calculated. Newborn weight, length, and head circumference were measured at birth. Associations between phthalate/DINCH metabolite and growth parameters were investigated using adjusted linear regression and Bayesian kernel machine regression models. ResultsDetection rates were above 99 % for all phthalate/DINCH metabolites. While no association was observed with birth measurements, mono-iso-butyl phthalate (MiBP) and mono-n-butyl phthalate (MnBP) were positively associated with most fetal growth parameters measured at the second trimester. Specifically, MiBP was positively associated with biparietal diameter, head and abdominal circumferences, while MnBP was positively associated with EFW, head and abdominal circumferences, with stronger associations among males. Pregnancy MnBP was positively associated with biparietal diameter and femur length at third trimester. Mixture of phthalate/DINCH metabolites was positively associated with EFW at second trimester. ConclusionsIn this pregnancy cohort using repeated urine samples to assess exposure, MiBP and MnBP were associated with increased fetal growth parameters. Further investigation on the effects of phthalates on child health would be relevant for expanding current knowledge on their long-term effects.

A YOLOX-Based Deep Instance Segmentation Neural Network for Cardiac Anatomical Structures in Fetal Ultrasound Images.

Echocardiography is an essential procedure for the prenatal examination of the fetus for congenital heart disease (CHD). Accurate segmentation of key anatomical structures in a four-chamber view is an essential step in measuring fetal growth parameters and diagnosing CHD. Currently, most obstetricians perform segmentation tasks manually, but the pixel-level operation is labor-intensive and requires extensive anatomical knowledge and clinical experience. As such, efficiently and accurately detecting structures from real-world fetal ultrasound images is a key challenge. In this paper, we propose a YOLOX-based deep instance segmentation neural network (i.e., IS-YOLOX) for cardiac anatomical structure location and segmentation in fetal ultrasound images. Specifically, we reconstruct a new instance segmentation branch based on a multi-task deep learning framework. We then design a new multi-level non-maximum suppression (NMS) mechanism to further improve the segmentation performance that consists of three levels of selection. Moreover, unlike two-stage instance segmentation approaches, our method does not rely on object detection results. To the best of our knowledge, this is the first study regarding instance segmentation on 13 types of anatomical structures in the fetal four-chamber view. Extensive experiments were carried out on clinical datasets, and the experimental results show that our method outperforms nine competitive baselines.

Maternal Prenatal Depressive Symptoms and Fetal Growth During the Critical Rapid Growth Stage

Fetal growth in the critical rapid growth stage (CRGS) before delivery, approximately between 30 to 37 gestational weeks, carries significant implications for subsequent overweight, obesity, and arterial health. Previous evidence has demonstrated the association between maternal depressive symptoms and fetal growth trajectories from early to late pregnancy, but there remains limited understanding of the association of these symptoms with the longitudinal fetal growth change within the CRGS. To investigate the association between maternal depressive symptoms and fetal growth during the CRGS before delivery. This prospective birth cohort study was conducted from January 2018 to December 2020. Volunteer pregnant women were enrolled in their first trimester of prenatal visits. Women with severe disease before pregnancy and multiple births, fetuses with congenital anomalies, and preterm or postterm births were excluded. This multicenter study was based in 13 hospitals covering 81 counties across 12 cities in Sichuan Province, China. Follow-up visits were performed at the second trimester, the third trimester, and 24 hours after delivery. The analysis was conducted from January to May 2023. Maternal depressive symptoms, as a continuous variable, measured by the Edinburgh Postpartum Depression Scale (EPDS) at a median gestational week of 24 (range, 14 to 27) weeks of gestation. A higher score on the EPDS indicates worse depressive symptoms. The main outcomes included ultrasonography-measured biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC), along with calculated estimated fetal weight (EFW). These parameters were evaluated longitudinally at a median gestational week of 30 (range, 28 to 32) and 37 (range, 35 to 39) weeks. Linear mixed models were used to estimate the associations between maternal depressive symptoms and fetal growth parameters. A total of 2676 mother-offspring dyads were included, in which the mean (SD) age of mothers was 28.0 (4.4) years, and 1294 (48.4%) of the offspring were female. The median (IQR) maternal EPDS score was 5.0 (4.0 to 9.0). After adjustment for confounders, a significant correlation was found between a higher score of depressive symptoms in mothers and a slower rate of fetal growth across FL (β = -0.40; 95% CI, -0.58 to -0.22), AC (β = -1.97; 95% CI, -2.90 to -1.03), and EFW (β = -50.11; 95% CI, -68.46 to -31.75). These associations were stronger in female fetuses or those with better family socioeconomic conditions. In this prospective cohort study, maternal depressive symptoms were associated with slower fetal growth rate in the CRGS before delivery. Early screening for depressive disorders in pregnant women appears to be essential for fetal growth and later health.

Trimester-Specific Urinary Strontium Concentrations during Pregnancy and Longitudinally Assessed Fetal Growth: Findings from a Prospective Cohort

BackgroundStudies have claimed that strontium (Sr) is associated with fetal growth, but the research evidence is insufficient. ObjectivesOur study aimed to evaluate associations of trimester-specific urinary Sr concentrations with fetal growth parameters and birth size indicators. MethodsIn this prospective cohort, 9015 urine samples (first trimester: 3561, 2nd trimester: 2756, 3rd trimester: 2698) from 3810 mothers were measured for urinary Sr levels using inductively coupled plasma mass spectrometry (ICP-MS) and adjusted to urine specific gravity. We calculated standard deviation scores (SD-scores) for ultrasound-measured fetal growth parameters (head circumference, abdominal circumference, femur length, and estimated fetal weight) at 16, 24, 31, and 37 wk of gestation and birth size indicators (birth weight, birth length, and Ponderal index). Generalized linear models and generalized estimating equations models were used. Models were adjusted for potential covariates (gestational age, maternal age, body mass index, parity, passive smoking during pregnancy, education, folic acid supplements use, physical activity, maternal and paternal height, and infant sex). ResultsPositive associations of naturally logarithm-transformed Sr concentrations with fetal growth parameters and birth size indicators were observed. With each doubling increase in the urinary ln-Sr level in all 3 trimesters resulting in a percent change in SD-scores fetal growth parameters at 24, 31, and 37 wk of gestation and birth size indicators, 5.09%–8.23% in femur length, 7.57%–11.53% in estimated fetal weight, 6.56%–10.42% in abdominal circumference, 6.25% in head circumference, 5.15%–7.85% in birth weight, and 5.71%–9.39% in birth length, respectively. Most of the above statistical results could only be observed in male fetuses. ConclusionsOur findings suggest a potential association between Sr concentration and increased fetal growth, but these results and underlying mechanisms need further confirmation and clarification.

Effects of maternal pulmonary arterial hypertension on fetal hemodynamics and maternal-fetal outcome in late pregnancy.

The aim of this study was to investigate the effects of maternal pulmonary arterial hypertension (PAH) on fetal hemodynamics in the third trimester and to identify hemodynamic indicators associated with adverse maternal and fetal outcomes. We recruited 48 pregnant women with PAH in the third trimester and 32 women with normal pregnancies as controls matched for age and gestational week. Fetal growth and hemodynamic parameters were assessed by two-dimensional and color Doppler. All cases were followed up until delivery and maternal and fetal outcomes were collected. High throughput sequencing method was used to determine differential miRNA patterns in plasma exposed to pulmonary arterial hypertension (PAH) in pregnant women. We then performed the validated of key differentially expressed miRNAs by real-time PCR. Compared with the normal and mild PAH groups, resistance index (RI), pulsatility index (PI) of the fetal umbilical artery (UA) and quantitative ductus venosus (QDV) blood flow were increased in subjects with moderate to severe PAH, while PI and the ratio of peak systolic velocity (PSV) to end-diastolic velocity (EDV) (S/D) of the middle cerebral artery (MCA) were decreased. Compared with the normal group, subjects in the mild and moderate PAH groups had lower neonatal weight, shorter neonatal height, and higher preterm birth rates. In addition, miRNA sequencing data showed that PAH affected the levels of 23 miRNAs in plasma. At the same time, we showed that PAH significantly decreased the level of miR-1255a and increased the level of miR-548ar-3p by real-time PCR. In the group of pregnant women with moderate to severe pulmonary hypertension, there was a higher proportion of preterm births and low birth weight babies. Hemodynamic changes in the fetal UA, MCA, and ductus venosus (DV) during late pregnancy were associated with adverse fetal outcomes. At the same time, miRNA sequencing results showed that miR-1255a and miR-548ar-3p may play an important role in the development of PAH.

Standard fetal ultrasound plane classification based on stacked ensemble of deep learning models

Identifying standard fetal ultrasound (US) planes with key anatomical structures during mid-pregnancy prenatal screening is crucial for measuring fetal growth parameters and early detection of abnormalities. However, obtaining these standard planes is laborious and time-consuming and depends on the clinical experience of sonographers. Automatic detection of these planes can aid sonographers in identifying the correct standard planes. In recent times, various deep learning techniques have developed to automate the detection of standard fetal US planes. However, a common limitation among these approaches is their dependence on a single model prediction to make the final decision, which introduces the possibility of inaccuracies. Therefore, we propose an automated identification of commonly used standard fetal US planes based on the stacking ensemble of deep convolutional neural networks (CNN). The stacking ensemble method employs three pre-trained deep CNNs: AlexNet, VGG-19, and DarkNet-19. Softmax and random forest classifiers are used to get predictions from deep CNNs. The final prediction is made using the absolute majority voting technique. A publicly available fetal US dataset is employed to evaluate the performance of the stacking ensemble approach. The proposed ensemble model classifies fetal US planes into six distinct classes: abdomen, brain, femur, thorax, maternal cervix, and other (less commonly employed planes, such as kidney, and limbs) fetal planes. Experimental findings demonstrate that the stacking ensemble approach achieved high performance with an accuracy of 95.69%, precision of 94.02%, recall of 96.28%, F1-score of 95.08%, specificity of 99.12%, and Matthews correlation coefficient of 94.19% compared to individual deep CNN models and other competing methods.

Fetal Ultrasound Standard Plane Detection With Coarse-to-Fine Multi-Task Learning.

The ultrasound standard plane plays an important role in prenatal fetal growth parameter measurement and disease diagnosis in prenatal screening. However, obtaining standard planes in a fetal ultrasound video is not only laborious and time-consuming but also depends on the clinical experience of sonographers to a certain extent. To improve the acquisition efficiency and accuracy of the ultrasound standard plane, we propose a novel detection framework that utilizes both the coarse-to-fine detection strategy and multi-task learning mechanism for feature-fused images. First, traditional manually-designed features and deep learning-based features are fused to obtain low-level shared features, which can enhance the model's feature expression ability. Inspired by the process of human recognition, ultrasound standard plane detection is divided into a coarse process of plane type classification and a fine process of standard-or-not detection, which is implemented via an end-to-end multi-task learning network. The region-of-interest area is also recognised in our detection framework to suppress the influence of a variable maternal background. Extensive experiments are conducted on three ultrasound planes of the first-class fetal examination, i.e., the femur, thalamus, and abdomen ultrasound images. The experiment results show that our method outperforms competing methods in terms of accuracy, which demonstrates the efficacy of the proposed method and can reduce the workload of sonographers in prenatal screening.

The adverse impact of maternal ozone exposure on fetal growth in utero and the interaction with residential greenness

This study aimed to investigate the effect of maternal ozone exposure on fetal growth during pregnancy, as well as the combined effect and interaction of ozone and residential greenness. We included a total of 14990 singleton pregnancies from the Fujian Birth Cohort Study. During pregnancy, fetal growth parameters including estimated fetal weight (EFW), femur length (FL), head circumference (HC), and abdominal circumference (AC). To investigate the associations between ozone exposure and the above-mentioned outcomes, generalized estimating equation approach and generalized linear regression were used, as appropriate. In the adjusted models, we observed that the Z scores of EFW (−0.031 (−0.048, −0.014)), FL (−0.021 (−0.038, −0.004)), and AC (−0.025 (−0.042, −0.007)) decreased with per interquartile range (IQR) increase of ozone concentration. Compared to participants with low ozone exposure and high NDVI, those with high ozone exposure and low NDVI experienced the largest decrease in Z scores for EFW (−0.049 (−0.079, −0.02)), FL (−0.034 (−0.063, −0.004)), HC (−0.034 (−0.065, −0.004)), and AC (−0.041 (−0.072, −0.01)), respectively. Interestingly, we discovered the effect modification of NDVI on the relationship between ozone exposure and fetal growth restriction (P for interaction < 0.05). This study established a negative relationship of maternal ozone exposure and fetal growth. Of importance, this study discovered the joint effect and interaction between ozone and residential greenness exposure.

Preconception maternal gastric bypass surgery and the impact on fetal growth parameters

BackgroundBariatric surgery is increasingly performed in women of reproductive age. As bariatric surgery will result in postoperative rapid catabolic weight loss which potentially leads to fetal malnutrition and directly related impaired intra-uterine growth, it is advised to postpone pregnancy for at least 12–18 months after surgery. ObjectivesTo investigate the consequences of preconception gastric bypass surgery (pGB) on fetal growth parameters and maternal pregnancy outcome. SettingMaasstad Hospital, The Netherlands, general hospital and Erasmus Medical Center, The Netherlands, university hospital. MethodsWe included 97 pGB pregnancies (Maasstad hospital) and 440 non-bariatric pregnancies (Rotterdam Periconception cohort, Erasmus Medical Center). Longitudinal second and third trimester fetal growth parameters (head circumference, biparietal diameter, femur length, abdominal circumference, estimated fetal weight) were analyzed using linear mixed models, adjusting for covariates and possible confounders. Fetal growth and birthweight in pGB pregnancies were compared to non-bariatric pregnancies and Dutch reference curves. Maternal pregnancy outcome in the pGB group was compared to non-bariatric pregnancies. ResultsAll fetal growth parameters of pGB pregnancies were significantly decreased at 20 weeks’ gestation (P < .001) and throughout the remaining part of pregnancy (P < .05) compared with non-bariatric pregnancies (crude and adjusted models). In our cohort, gestational weight gain was not significantly associated with birthweight corrected for gestational age. Birthweight was significantly lower in pGB pregnancies (estimate –241 grams [95% CI, –342.7 to –140.0]) with a 2-fold increased risk of small-for-gestational-age (SGA) (adjusted odds ratio 2.053 [95% CI, 1.058 to 3.872]). Compared to the non-bariatric pregnancies, we found no significant differences in maternal pregnancy outcome. ConclusionsPGB is associated with overall reduced fetal growth trajectories and a 2-fold increased risk of SGA, without significant adverse consequences for maternal pregnancy outcome. We recommend close monitoring of fetal growth after pGB.

Automated classification of common maternal fetal ultrasound planes using multi-layer perceptron with deep feature integration

Ultrasound is a standard diagnostic tool used during prenatal care to monitor the growth and development of the fetus. During routine clinical obstetric examinations, fetal ultrasound standard planes play a significant role in evaluating fetal growth parameters and assessing abnormalities. However, acquiring common fetal ultrasound planes with accurate fetal anatomical structures is tedious and time-consuming, even for skilled sonographers. Therefore, in this article an automated classification technique is presented for common maternal fetal ultrasound planes using deep learning models to improve detection efficiency and diagnostic accuracy. Feature integration and classification modules are the main components of the proposed approach. Initially, the deep features are extracted using AlexNet and VGG-19 with the global average pooling layer as the last pooling layer and are integrated. Fusing the deep features extracted from different convolutional neural networks strengthens the overall feature representation. After that, the integrated deep features are applied to a multi-layer perceptron to classify fetal ultrasound images into six categories. The proposed model is evaluated on a common maternal fetal ultrasound dataset, and its efficiency is computed in terms of accuracy, recall, precision, and F1-score. The proposed method achieved higher classification efficiency compared to other existing state-of-the-art models.

Dietary soy prevents fetal demise, intrauterine growth restriction, craniofacial dysmorphic features, and impairments in placentation linked to gestational alcohol exposure: Pivotal role of insulin and insulin-like growth factor signaling networks.

Prenatal alcohol exposure can impair placentation and cause intrauterine growth restriction (IUGR), fetal demise, and fetal alcohol spectrum disorder (FASD). Previous studies showed that ethanol's inhibition of placental insulin and insulin-like growth factor, type 1 (IGF-1) signaling compromises trophoblastic cell motility and maternal vascular transformation at the implantation site. Since soy isolate supports insulin responsiveness, we hypothesized that dietary soy could be used to normalize placentation and fetal growth in an experimental model of FASD. Pregnant Long-Evans rat dams were fed with isocaloric liquid diets containing 0% or 8.2% ethanol (v/v) from gestation day (GD) 6. Dietary protein sources were either 100% soy isolate or 100% casein (standard). Gestational sacs were harvested on GD19 to evaluate fetal resorption, fetal growth parameters, and placental morphology. Placental insulin/IGF-1 signaling through Akt pathways was assessed using commercial bead-based multiplex enzyme-linked immunosorbent assays. Dietary soy markedly reduced or prevented the ethanol-associated fetal loss, IUGR, FASD dysmorphic features, and impairments in placentation/maturation. Furthermore, ethanol's inhibitory effects on the placental glycogen cell population at the junctional zone, invasive trophoblast populations at the implantation site, maternal vascular transformation, and signaling through the insulin and IGF1 receptors, Akt and PRAS40 were largely abrogated by co-administration of soy. Dietary soy may provide an economically feasible and accessible means of reducing adverse pregnancy outcomes linked to gestational ethanol exposure.