Fetal Growth Rate Research Articles

126: Prader-Willi syndrome: fetal phenotype can lead to prenatal diagnosis

Prader-Willi syndrome (PWS) is a severe neurogenetic disorder characterized by morbid obesity, mental retardation and severe behavioral disorders. PWS can be diagnosed by methylation analysis during invasive prenatal diagnosis procedures, however, prenatal diagnosis is rare. We aimed to characterize PWS fetal phenotype, in order to offer the possibility of prenatal diagnosis. All 99 PWS patients treated at the Israel National Multidisciplinary PWS clinic under the age of 10 years were studied. Clinical features of PWS pregnancies were reported by the mothers. Medical records including ultrasound reports, obstetric records, and genetic results were collected. Results were compared both to normal PWS sibling's pregnancies (n=70) and to the Israeli general population. PWS pregnancies were complicated by higher rates of decreased fetal movements (DFM), small for gestational age (SGA), polyhydramnios, breech presentation and cryptorchidism in males (80.4%, 56.6%, 37.4%, 36.4%, 88% respectively, (Table 1). A combination of 2,3 and 4 features was found in 35,34,15% respectively. In 52% of PWS pregnancies at least 3 features were found and in 87% at least two. High rates of asymmetric fetal growth during the 3rd trimester with increased head to abdominal circumference (HC/AC) ratio were found (38%). When evaluating AC as a marker of asymmetric growth, in 64% of the pregnancies the AC was < 10th% and in 32% < 3rd%. The most common feature accompanying abnormal HC/AC ratio or AC< 5th% was DFM. Doppler studies were mostly normal (84.4%) (Table 2). Amniocentesis was performed in 17 cases (17.2%). Methylation test was not offered and the diagnosis of PWS was missed. We describe distinct prenatal phenotype in PWS. A combination of asymmetric fetal growth with normal Doppler studies and DFM, specifically if accompanied with polyhydramnios/ breech presentation or cryptorchidism. Such phenotype should alert obstetricians to consider the possibility of PWS and perform the diagnostic methylation test when amniocentesis is pursued.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Accuracy of estimated fetal weight assessment in fetuses with congenital diaphragmatic hernia

Congenital diaphragmatic hernia is a congenital anomaly in which fetal abdominal organs herniate into the thoracic cavity through a diaphragmatic defect, which can impede fetal lung development. Standard formulas for estimated fetal weight include measurement of fetal abdominal circumference, which may be inaccurate in fetuses with congenital diaphragmatic hernia because of displacement of abdominal contents into the thorax. This study aimed to assess the accuracy of standard estimated fetal weight assessment in fetuses with congenital diaphragmatic hernia by comparing prenatal assessment of fetal weight with actual birthweight. A retrospective cohort study of fetuses diagnosed with congenital diaphragmatic hernia was performed at a single center from 2012 to 2018. Fetuses with multiple anomalies or confirmed chromosome abnormalities were excluded. Estimated fetal weight was calculated using the Hadlock formula. Published estimates of fetal growth rate were used to establish a projected estimated fetal weight at birth from the final growth ultrasound, and the percentage difference between projected estimated fetal weight at birth and actual birthweight was calculated. A Wilcoxan rank-sum test was used to examine the difference between projected estimated fetal weight and birthweight. We had complete data for 77 fetuses with congenital diaphragmatic hernia. The majority (76.6%, 55 of 77) had left-sided congenital diaphragmatic hernia. The median [interquartile range] projected estimated fetal weight was similar to median birthweight, at 3177 g [2691-3568] and 3180 g [2630-3500], respectively, which did not represent a statistically significant difference between projected estimated fetal weight and birthweight (P= .66). The median absolute percentage difference between projected birthweight and actual birthweight was 6.3% [3.2-7.0]. Estimated fetal weight was overall underestimated in a minority of cases (44.2%, 34 of 77). In fetuses with a congenital diaphragmatic hernia,standard measurements of fetal estimated fetal weight show accuracy that is at least comparable with previously established margins of error for ultrasound assessment of fetal weight. Standard estimated fetal weight assessment remains an appropriate method ofestimating fetal weight in fetuses with congenital diaphragmatic hernia.

Maternal and Neonatal Outcomes Associated With Trophectoderm Biopsy

(Abstracted from Fertil Steril 2019;112:283–290) Despite a widespread increase in the use of preimplantation genetic testing (PGT), there remains inconclusive examination of maternal and neonatal outcomes after pregnancy achieved through in vitro fertilization (IVF) with PGT. It has been proposed that abnormal placentation may occur at a higher rate in pregnancies after PGT due to the removal of trophectoderm cells during biopsy, leading to higher rates of preeclampsia and restricted fetal growth.

Integrating machine learning techniques and physiology based heart rate features for antepartum fetal monitoring

Background and objectivesIntrauterine Growth Restriction (IUGR) is a fetal condition defined as the abnormal rate of fetal growth. The pathology is a documented cause of fetal and neonatal morbidity and mortality. In clinical practice, diagnosis is confirmed at birth and may only be suspected during pregnancy. Therefore, designing an accurate model for the early and prompt identification of pathology in the antepartum period is crucial in view of pregnancy management. MethodsWe tested the performance of 15 machine learning techniques in discriminating healthy versus IUGR fetuses. The various models were trained with a set of 12 physiology based heart rate features extracted from a single antepartum CardioTocographic (CTG) recording. The reason for the utilization of time, frequency, and nonlinear indices is based on their standalone documented ability to describe several physiological and pathological fetal conditions. ResultsWe validated our approach on a database of 60 healthy and 60 IUGR fetuses. The machine learning methodology achieving the best performance was Random Forests. Specifically, we obtained a mean classification accuracy of 0.911 [0.860, 0.961 (0.95 confidence interval)] averaged over 10 test sets (10 Fold Cross Validation). Similar results were provided by Classification Trees, Logistic Regression, and Support Vector Machines. A features ranking procedure highlighted that nonlinear indices showed the highest capability to discriminate between the considered fetal conditions. Nevertheless, is the combination of features investigating CTG signal in different domains, that contributes to an increase in classification accuracy. ConclusionsWe provided validation of an accurate artificially intelligence framework for the diagnosis of IUGR condition in the antepartum period. The employed physiology based heart rate features constitute an interpretable link between the machine learning results and the quantitative estimators of fetal wellbeing.

Relationship between birth weight or fetal growth rate and postnatal allergy: A systematic review

Individual susceptibility to allergic diseases is developmentally programmed by early-life exposures. Evidence from preclinical studies suggests that intrauterine growth restriction is protective against later inflammatory responses to allergens. We sought to evaluate whether prenatal growth affects susceptibility to allergy in human subjects. We systematically searched for relevant studies in 11 databases, including Web of Science, ProQuest, EMBASE, and PubMed. We included only studies that corrected for gestational age or were restricted to full-term infants to separate effects of fetal growth from those of prematurity. The 42 eligible studies included prospective and retrospective cohort, cross-sectional, and case-control studies. Only 2 studies reported allergic asthma. Abirth weight increase of 1kg was associated with a 44% greater risk of food allergy in children (odds ratio [OR], 1.44; 95% CI, 1.04-1.99; P=.001), a 17% greater risk of ever allergic dermatitis in children (OR, 1.17; 95% CI, 1.04-1.32; P=.008), and a 34% greater risk of ever or current allergic dermatitis in infants up to 2years of age (OR, 1.34; 95% CI, 1.08-1.68; P=.009). Risks of allergic rhinitis were not associated with birth weight. The results of these meta-analyses suggest that intrauterine growth restriction protects against allergic diseases in human subjects consistent with preclinical evidence but that effects might differ between allergic diseases. The strongest evidence is available for infancy and early childhood, and additional studies in older children and adults are needed to determine whether the effects of prenatal growth on each allergic disease persist or differ between those with severe and mild phenotypes.

Effects of the Minimum Wage on Infant Health

AbstractThe minimum wage has increased in multiple states over the past three decades and it continues to be a controversial policy. Most prior research has examined the effect of the minimum wage on employment and wages. In this study, we examine the impact of the state minimum wage on infant health. Using data on the universe of births in the U.S. over 24 years, we find that an increase in the minimum wage is associated with a small, but statistically significant increase in birthweight driven primarily by increased fetal growth rate. Effects are largest for young, married mothers. In terms of mechanisms, we find no evidence that prenatal care use and smoking during pregnancy are channels through which minimum wage improves infant health.

High maternal early-pregnancy blood glucose levels are associated with altered fetal growth and increased risk of adverse birth outcomes

Aims/hypothesisThe study aimed to assess the associations of maternal early-pregnancy blood glucose levels with fetal growth throughout pregnancy and the risks of adverse birth outcomes.MethodsIn a population-based prospective cohort study among 6116 pregnant women, maternal non-fasting glucose levels were measured in blood plasma at a median 13.2 weeks of gestation (95% range 9.6–17.6). We measured fetal growth by ultrasound in each pregnancy period. We obtained information about birth outcomes from medical records and maternal sociodemographic and lifestyle factors from questionnaires.ResultsHigher maternal early-pregnancy non-fasting glucose levels were associated with altered fetal growth patterns, characterised by decreased fetal growth rates in mid-pregnancy and increased fetal growth rates from late pregnancy onwards, resulting in an increased length and weight at birth (p ≤0.05 for all). A weaker association of maternal early-pregnancy non-fasting glucose levels with fetal head circumference growth rates was present. Higher maternal early-pregnancy non-fasting glucose levels were also associated with an increased risk of delivering a large-for-gestational-age infant, but decreased risk of delivering a small-for-gestational-age infant (OR 1.28 [95% CI 1.16, 1.41], OR 0.88 [95% CI 0.79, 0.98] per mmol/l increase in maternal early-pregnancy non-fasting glucose levels, respectively). These associations were not explained by maternal sociodemographic factors, lifestyle factors or BMI. Maternal early-pregnancy non-fasting glucose levels were not associated with preterm birth or delivery complications.Conclusions/interpretationHigher maternal early-pregnancy non-fasting glucose levels are associated with decreased fetal growth rates in mid-pregnancy and increased fetal growth rates from late pregnancy onwards, and an increased risk of delivering a large-for-gestational-age infant. Future preventive strategies need to focus on screening for an impaired maternal glucose metabolism from preconception and early pregnancy onwards to improve birth outcomes.

Intrauterine position and adjacent fetal sex affects fetal and placental growth throughout gestation, but not embryonic viability, in pigs selected for component traits of litter size

Intrauterine position and sex of adjacent fetuses in litter bearing species have been implicated in physiological and behavioral differences of offspring. The effects of uterine position and sex status of flanking fetuses with crowded uterine conditions on fetal and placental growth rate was tested. Gilts were unilaterally hysterectomized-ovariectomized at 160 d of age and mated at approximately 280 d of age, with fetal harvest at 45, 65, 85, or 105 d of gestation. Uterine position relative to the cervix, fetal status (alive, dead, sex), fetal weight, and placental weight were recorded at harvest. Each fetus was coded as adjacent to 0, 1, or 2 opposite sex fetuses and analyzed using an ANOVA fitting contemporary group, line, and flanking fetal sex code as fixed effects with sire as a random effect. The fraction of live fetuses in each classification (0, 1, 2) was 26.4%, 50.1%, and 23.4%, respectively, indicating no effect on fetal survival. Fetal weight was affected by flanking sex status between 65 d (P < 0.05) and 105 d (P < 0.001), with means at 105 d of 800.0 ± 20.3, 748.5 ± 17.8, and 672.7 ± 25.2 g, respectively for flanking sex status codes 0, 1, 2. Placental weight was similarly affected (P < 0.01) by flanking sex code, but only at 105 d. It is concluded that fetal growth and placental development in pigs is influenced by sex status of adjacent fetuses. This could be a potential source of variation in behavioral and reproductive differences later in life.

Abstract 5059: Early life risk factors and childhood cancer risk

Abstract Prenatal exposures, including maternal, delivery, and newborn characteristics, may affect childhood cancer risk. Our objective was to examine whether such birth certificate-derived factors are associated with increased risk of subsequent cancer development, including leukemia and central nervous system (CNS) tumors, in children ages zero to 13. Pennsylvania state birth and cancer registry files obtained from the PA Department of Health were linked to create a cohort of children born from 2003 to 2015 who developed cancer from 2003 to 2016. After exclusions, 1,834,796 infants were included with a total of 13,785,309 person-years of observation. Among these, there were 2,355 children diagnosed with any cancer, 748 with leukemia, and 545 with CNS tumors. Older maternal age increased the hazard of developing any childhood cancer, leukemia, and CNS tumors. Children born to severely obese mothers (body mass index ≥40 kg/m2) were at over 50% higher hazard of leukemia (P=0.01) after adjustment for age and other significant risk factors; however, maternal obesity did not significantly increase the risk of childhood CNS tumors. Among the infant characteristics, having a fetal growth ratio 30% higher than expected was significantly associated with increased hazard of any childhood cancer, leukemia, or CNS tumors (hazard ratios 2.19, 1.79, and 1.77, respectively). Other fetal and newborn factors associated with higher risk of total childhood cancer included fetal intolerance of labor, lower gestational age, and having a low Apgar score at birth. This analysis demonstrated significant and independent impacts of maternal obesity and fetal growth rate on childhood cancer development, particularly leukemia, after accounting for multiple risk factors. If confirmed, weight control during pregnancy would be an effective means of childhood cancer prevention. Citation Format: Shaina L. Stacy, Jeanine M. Buchanich, Zhen-qiang Ma, Christina Mair, Linda Robertson, Ravi K. Sharma, Evelyn O. Talbott, Jian-Min Yuan. Early life risk factors and childhood cancer risk [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5059.

Deceleration of fetal growth rate as alternative predictor for childhood outcomes: a birth cohort study

BackgroundSmall for gestational age (SGA) is frequently used to define fetal growth restriction (FGR). However, FGR describes a slowdown in fetal growth and is not synonymous with SGA, which may introduce misclassification. We investigated the effect of both on delivery and childhood outcomes.MethodsFrom a prospective population-based cohort study we included 7959 live singleton births with data available on second trimester estimated fetal weight (EFW) and birth weight. We used a decrease in growth of > 40 percentiles between second trimester EFW and birthweight to define a deceleration in growth. SGA was defined as birthweight <p5.ResultsDeceleration of growth occurred in 27,2% in SGA neonates and in 10,3% of neonates with an appropriate for gestational age (AGA) birthweight. Of all fetuses with decelerated growth, 90% was born AGA. SGA neonates were more often delivered by instrumental delivery or cesarean section and admitted to NICU. Both decelerated growth and SGA were associated with accelerated growth at 2 years, a smaller aortic diameter and lower left ventricular mass at 6 years.ConclusionsBoth decelerated growth and SGA are associated with unfavorable clinical outcomes in childhood. In addition to SGA, neonates with deceleration of growth should be considered a high-risk group.

Are Global DNA methylation and telomere length useful biomarkers for identifying intrauterine growth restricted neonates?

Background: Intrauterine growth restriction (IUGR) is manifested by decreased growth rate of fetus than its normal genetic growth potential. Global DNA methylation is a crucial investigation for identification of epigenetic changes. Epigenetic change regulates Gene transcription, maintenance of genomic stability, and telomere length.Objectives: To investigate whether the global DNA methylation and telomere length are useful for identifying intrauterine growth restriction.Methods: This cohort study was conducted in the Neonatology Department of JIPMER during the period of November 2016 to December 2017. Forty (40) IUGR and forty (40) AGA neonates were recruited. Umbilical cord blood samples were collected at birth. DNA has been separated from the blood samples and using 5-mC DNA ELISA method, the percentage of genomic DNA methylated in these neonates was established. Telomere length (T/S ratio) was measured by using quantitative real time PCR. Data were expressed as a mean ± standard deviation.Results: Genomic DNA methylation varied significantly between IUGR and AGA neonates (IUGR: 3.12 ± 1.24; AGA: 4.40 ± 2.03; p: < .01). There was significant DNA hypo methylation in IUGR neonates. However, telomere length (T/S ratio) was (IUGR: 1.25 ± 0.13; AGA: 1.26 ± 0.22; p: 0.228 (NS)) similar in both groups.Conclusion: Although there is no significant difference in telomere length between IUGR and AGA neonates, global DNA methylation of 3.45 would identify IUGR with a sensitivity and specificity of 69 and 65% respectively.

Prediction of small-for-gestational age by fetal growth rate according to gestational age.

BackgroundSmall-for-gestational age (SGA) infants should be identified before birth because of an increased risk of adverse perinatal outcomes. The objective of this study was to assess the impact of fetal growth rate by gestational age on the prediction of SGA and to identify the optimal time to initiate intensive fetal monitoring to detect SGA in low-risk women. We also sought to determine which the ultrasonographic parameters that contribute substantially to the birthweight determination.MethodsThis was a retrospective study of 442 healthy pregnant women with singleton pregnancies. There were 328 adequate-for-gestational age (AGA) neonates and 114 SGA infants delivered between 37+0 and 41+6 weeks of gestation. We compared the biparietal diameters (BPD), head circumferences (HC), abdominal circumferences (AC), femur lengths (FL), and estimated fetal weights (EFW) obtained on each ultrasound to determine which of these parameters was the best indicator of SGA. We created receiver operating characteristic curves, calculated the areas under the curves (AUCs), and analyzed the data using multivariable logistic regressions to assess the ultrasound screening performances and identify the best predictive factor.ResultsAmong the four ultrasonographic parameters, the AC measurement between 24+0~28+6 weeks achieved a sensitivity of 79.5% and a specificity of 71.7%, with an AUC of 0.806 in the prediction of SGA. AC showed consistently higher AUCs above 0.8 with 64~80% sensitivities as gestational age progressed. EFW measurements from 33+0~35+6 gestational weeks achieved a sensitivity of 60.6% and a specificity of 87.6%, with an AUC of 0.826. In a conditional growth model developed from the linear mixed regression, the value differences between AC and EFW in the SGA and AGA groups became even more pronounced after 33+0~35+6 weeks.ConclusionHealthy low-risk women with a low fetal AC after 24 weeks’ gestation need to be monitored carefully for fetal growth to identify SGA infants with a risk for adverse perinatal outcomes.

Uncontrolled Eating during Pregnancy Predicts Fetal Growth: The Healthy Mom Zone Trial.

Excess maternal weight gain during pregnancy elevates infants’ risk for macrosomia and early-onset obesity. Eating behavior is also related to weight gain, but the relationship to fetal growth is unclear. We examined whether Healthy Mom Zone, an individually tailored, adaptive gestational weight gain intervention, and maternal eating behaviors affected fetal growth in pregnant women (n = 27) with a BMI > 24. At study enrollment (6–13 weeks gestation) and monthly thereafter, the Three-Factor Eating Questionnaire was completed. Ultrasounds were obtained monthly from 14–34 weeks gestation. Data were analyzed using multilevel modeling. Higher baseline levels of uncontrolled eating predicted faster rates of fetal growth in late gestation. Cognitive restraint was not associated with fetal growth, but moderated the effect of uncontrolled eating on fetal growth. Emotional eating was not associated with fetal growth. Among women with higher baseline levels of uncontrolled eating, fetuses of women in the control group grew faster and were larger in later gestation than those in the intervention group (study group × baseline uncontrolled eating × gestational week interaction, p = 0.03). This is one of the first intervention studies to use an individually tailored, adaptive design to manage weight gain in pregnancy to demonstrate potential effects on fetal growth. Results also suggest that it may be important to develop intervention content and strategies specific to pregnant women with high vs. low levels of disinhibited eating.

PHYSIOLOGY SYMPOSIUM: Effects of heat stress during late gestation on the dam and its calf12.

Heat stress during late gestation in cattle negatively affects the performance of the dam and its calf. This brief exposure to an adverse environment before parturition affects the physiological responses, tissue development, metabolism, and immune function of the dam and her offspring, thereby limiting their productivity. During the dry period of a dairy cow, heat stress blunts mammary involution by attenuating mammary apoptosis and autophagic activity and reduces subsequent mammary cell proliferation, leading to impaired milk production in the next lactation. Dairy cows in early lactation that experience prepartum heat stress display reduced adipose tissue mobilization and lower degree of insulin resistance in peripheral tissues. Similar to mammary gland development, placental function is impaired by heat stress as evidenced by reduced secretion of placental hormones (e.g., estrone sulfate) in late gestation cows, which partly explains the reduced fetal growth rate and lighter birth weight of the calves. Compared with dairy calves born to dams that are exposed to evaporative cooling during summer, calves born to noncooled dry cows maintain lower BW until 1 yr of age, but display a stronger ability to absorb glucose during metabolic challenges postnatally. Immunity of the calves, both passive and cell-mediated immune function, is also impaired by prenatal heat stress, resulting in increased susceptibility of the calves to diseases in their postnatal life. In fact, dairy heifers born to heat-stressed dry cows without evaporative cooling have a greater chance leaving the herd before puberty compared with heifers born to dry cows provided with evaporative cooling (12.2% vs. 22.7%). Dairy heifers born to late-gestation heat-stressed dry cows have lower milk yield at maturity during their first and second lactations. Emerging evidence suggests that late-gestation heat stress alters the mammary gland microstructure of the heifers during the first lactation and exerts epigenetic alterations that might explain, in part, their impaired productivity.

Ontogeny of Polycotylid Long Bone Microanatomy and Histology.

Plesiosauria is an extinct clade of diapsid marine reptiles that evolved in the Late Triassic and radiated globally for the remainder of the Mesozoic. The recent description of a pregnant specimen of Polycotylus latipinnis demonstrates that some plesiosaurs were viviparous. To establish a baseline of histological data on plesiosaur ontogeny, we sampled the mother and fetus of the gravid plesiosaur specimen. To widen the base of data concerning ontogeny and life history of plesiosaurs, we gathered additional morphologic and histologic data from a securely identified growth series of polycotylids from the Pierre Shale of South Dakota. Paleohistological thin sections were prepared from the three humeri. Both adults show a dense, heavily remodeled cortex consisting entirely of longitudinally oriented secondary osteons, except for a thin rind of superficial primary bone. The mother exhibits an external fundamental system, indicating it was fully mature; the other adult does not. In both adults the cortex grades into a spongy medulla, comprising large vascular canals and erosion rooms surrounded by secondary lamellar trabecular bone, and lacking a marrow cavity. The fetal humerus possesses a medullary region similar to that of the Dolichorhynchops bonneri adult, although its lamellar bone is primary and deposited around calcified cartilage. The medulla is demarcated from the cortex by a prominent Kastschenko’s line. The cortex of the fetus is a relatively thin layer of periosteal woven bone, longitudinally to radially vascularized, and interfingered with columns of osteoblasts surrounded by rapidly-deposited extracellular matrix. The neonate humerus resembles the fetus, with its trabeculae identical in both size and histology, although it lacks calcified cartilage. The cortex is also similar but much thicker, consisting entirely of rapidly deposited, radially vascularized, woven to fibrolamellar bone. The cortex carries a line near its surface. This feature is not a line of arrested growth, but a sudden change in vascular angle and increase in bone density. We argue this feature is a birth line indicating a change in growth regime, possibly in response to increased hydrodynamic forces after birth. The birth line indicates that the neonate was about 40% of maternal length when born. Our histological data demonstrate that polycotylids had very high fetal growth rates, and that birth size was large. Comparison with the geologically oldest plesiosaur confirms that rapid growth evolved in the Triassic, although histological details differ, and the degree to which the polycotylid ontogenetic pattern is generalizable to other plesiosaurs is currently unknown. Further histological research utilizing full growth series is needed, particularly for Jurassic taxa.

1046: Accuracy of estimated fetal weight assessment in fetuses with congenital diaphragmatic hernia

Estimated fetal weight (EFW) is determined by a formula that includes measurement of the fetal abdominal circumference. There is an accepted range of error of up to 20% in either direction for accuracy of EFW. The degree of error is potentially higher in fetuses with congenital diaphragmatic hernia (CDH), in which the abdominal contents are displaced into the fetal thorax, which may affect measurement of the abdominal circumference. There is no universally accepted method for assessing EFW in fetuses with CDH, and there are mixed results in the literature reporting on accuracy of EFW in these cases. This study aims to assess the accuracy of standard EFW assessment in fetuses with CDH. We hypothesize that standard EFW assessment will underestimate the EFW of fetuses with CDH due to decreased fetal abdominal circumference measurement. This is a retrospective cohort of fetuses diagnosed with CDH at a single center from 2012 to 2018. We excluded fetuses with multiple anomalies or confirmed chromosome abnormalities. EFW was calculated using the Hadlock formula with standard measurements of the fetal head, abdominal circumference, and femur length. To account for time interval between final growth ultrasound and birth, we used published estimates of fetal growth rate to establish a “projected” EFW. The percent difference between the projected EFW and actual birthweight was compared using the Wilcoxon Signed-Rank test. Complete data were available for 77 fetuses with CDH. The majority of fetuses (n=59, 76.6%) had left-sided CDH. The median [IQR] projected EFW was similar to the median birthweight at 3177g [2691-3568] and 3180g [2630- 3500], respectively. The median percent difference between projected birthweight and actual birthweight was 6.34% [3.21-11.83]. We found that the EFW was underestimated in a minority of cases (n=43, 44.2%). The median maternal BMI in our population was 31.4kg/m2 [25.2-37.1]. The median gestational age at delivery was 38w4d [37w1d-39w1d], with a median 13 [7-20] days between final EFW and delivery. In fetuses with CDH, standard measurements for fetal EFW show accuracy that is at least comparable to previously established margins of error for ultrasound assessment of fetal weight. Standard EFW assessment remains an appropriate method of estimating fetal weight in fetuses with CDH.

Reduced body weight at weaning followed by increased post-weaning growth rate interacts with part-per-trillion fetal serum concentrations of bisphenol A (BPA) to impair glucose tolerance in male mice.

There is evidence from longitudinal studies that being light at birth and weaning is associated with subsequent rapid weight gain in infants. This is referred to as “centile crossing”, which can lead to increased risk of lifetime obesity, glucose dysregulation and type 2 diabetes. Here, pregnant CD-1 mice were hemi-ovariectomized so that the entire litter was contained in one uterine horn to increase variability in fetal growth rate. Pregnant females were implanted on gestation day (GD) 9 with a Silastic capsule containing 6, 60 or 600 μg bisphenol A (BPA). On GD 18 the mean fetal serum unconjugated BPA concentrations were 17, 177 and 1858 pg/ml, respectively. Capsules were not removed, to avoid maternal stress, and were predicted to release BPA for at least 3 weeks. Body weight at weaning was strongly negatively correlated with post-weaning weight gain in both control and BPA-treated male mice, consistent with human data; female offspring were excluded, avoiding complications associated with postpubertal estrogens. Within each treatment group, male offspring were sorted into tertiles based on relative weight gain during the two weeks after weaning, designated as having Rapid (R), Medium (M) or Slow (S) growth rate. BPA exposure was associated with altered growth rate between weaning and postnatal week 12 (young adulthood), when a low-dose (20 mg/kg, i.p.) glucose tolerance test (GTT) was performed. We found altered glucose regulation in response to all doses of BPA. However, glucose tolerance was only significantly impaired (blood glucose levels were elevated) compared to controls in males in the rapid post-weaning growth group exposed perinatally to BPA. We conclude that male mice that are light at weaning, but then experience rapid catch-up growth immediately after weaning, represent a sensitive sub-population that is vulnerable to the metabolic disrupting effects of very low pg/ml fetal serum concentrations of BPA.

Physiological changes in iron and blood parameters during different pregnancy trimesters in pregnant women in Baghdad

SummaryThis work was carried out for four months in the province of Baghdad including many hospital in Bagdad during 1st of the November 2016 until 28 February 2017. 120 pregnant women included in the present study ranged in age from 14 - 42 years were randomly selected. Pregnant women were divided into three groups according to the different periods of pregnancy every trimester include 40 pregnant women divided to 20 pregnant women with anemia and 20 without anemia after taking a blood film and hemoglobin as a good adoption indicator for diagnosis of anemia, also, history taken by previously diagnosis and by physical examination. Result of the three trimesters in indicators the blood of pregnant women with or without anemia, showed that the first trimester all of the parameters of indicators the blood (Hb, Hct, MCV, MCH and MCHC) were decreased in women with anemia compared with women without anemia, also in second and third trimester decreased. However, in second trimester the values of Hb, Hct, MCV, MCH and MCHC decreased in women with anemia on the values of the first trimester. On the other hand a values of indicators the blood in a third trimester less than the second trimester. Indicator of iron (SI, TIBC, TS and SF) for women with anemia in first trimester was less than from women without anemia. However, in second trimester the values of SI, TIBC, TS and SF decreased in women with anemia on the values of the first trimester. Father more, the values of indicator of iron in a third trimester less than in the second trimester. When comparison in blood parameters (Hb, Hct, MCV, MCH and MCHC) between 1st, 2nd, and 3rd trimester of pregnancy women noticed that the all parameters decreased gradually from the first trimesters to second to third trimester. Iron deficiency marked increase was famous in pregnant women in the second and third trimester of pregnancy, due to high fetal and placenta growth rates and development of red cell mass mother. Thus anemia affects up to 70% of pregnant women. Blood indicators RBC, RDW, platelet and MPV for all pregnant women in the first trimester was decreased in women with anemia compared with women without anemia in all parameters of this, also in second and third trimester. Further more in second decreased from first, also in third less that from second. White blood cell and their various types (NEU, LYM, Mono, ESO and BASO) were impressed with the pregnant women with anemia in first and second trimesters WBC and NEU% increased but LYM%, Mono%, ESO% and BASO% decreased. However, in the third trimester WBC, NEU% and BASO% decreased but LYM%, Mono%, and EOS% increased. The results of the study found out that the is a clear correlation between anemia in pregnant women and some social factors, such as: occupation, monthly income and maternal education.

Differences of the Insulin and Brain Derived Neurotrophic Factor Between Normal Born Weight Baby and Baby With Intrauterine Growth Restriction

Background: Intrauterine Growth Restriction (IUGR), is a condition in which the fetal growth rate is less than 10 percentiles. Fetal growth is affected by maternal health and nutrition, the hormone insulin and placenta. Placental development is influenced by the Brain Derived Neurotropic Factor (BDNF). Insulin deficiency and BDNF can interfere with fetal development.Method: This study used an observational research method, with a comparative cross sectional design. The place of research was conducted at Bayangkara Hospital, Dr. Rasidin, TK.III Reksodiwiryo Hospital, and Biomedical Laboratory, Faculty of Medicine, Andalas University. Research time starts from October 2017 to January 2018. The sample of this study was 25 normal babies and 25 babies with IUGR. Insulin levels and BDNF were examined by enzyme-linked immunosorbent assay (ELISA). Test the normality of the data using the Kolmogorov-Smirnov test. Statistical analysis using independent t test.Results: Insulin levels of 13.2 ± 1.7 mIU / L in infants with normal birth weight and 8.5 ± 1.7 mIU / L in infants born with IUGR (p = 0.000) and BDNF levels 1.5 ± 0.2 ng / ml for infants with normal birth weight and 1.4 ± 0.3 ng / ml in infants born with IUGR (p = 0.008).Conclusion Insulin levels and BDNF levels of normal birth weight babies are higher than babies born with IUGR.

Uterine distention as a factor in birth timing: retrospective nationwide cohort study in Sweden

ObjectivesTo determine whether uterine distention is associated with human pregnancy duration in a non-invasive observational setting.DesignRetrospective cohort study modelling uterine distention by interaction between maternal height and uterine load.SettingThe study...