Rates Of Fetal Growth Restriction Research Articles

Cannabis Hyperemesis Syndrome: An Underrecognized Cause of Nausea and Vomiting in Pregnancy

Introduction: Cannabis Hyperemesis Syndrome (CHS) is characterized by refractory and recurrent nausea and vomiting in birthing people with chronic cannabis use and is emerging as an increasingly common diagnosis in patients who present to the emergency department. The objective of this retrospective case series was to describe presentation, management and outcomes of CHS during pregnancy. Methods: Patients were identified by the investigator at two tertiary care centers in Kansas City from January 2019 to October 2021. Patients were included if (1) intrauterine pregnancy (2) refractory and recurrent nausea and vomiting without acute cause, and (3) documented chronic cannabis use which preceded symptom onset were noted. The study was approved by the UMKC IRB (#308059). Results: Twelve patients were identified who met inclusion criteria, ranging in age from 17 to 32 years (mean 23.2 ± 4.5). Eleven patients reported daily cannabis use. The mean number of emergency department visits during pregnancy for nausea and vomiting was 8.9 (± 7.1). Patients presented at a wide range of gestational ages, between 4 and 37 weeks (mean 19.6 ± 9.8). Compulsive hot water bathing for symptom relief was documented in 33% of cases (4 of 12). The rate of fetal growth restriction in this series was 44% (4 of 9). Despite counseling, only one patient successfully discontinued cannabis use. Conclusions: CHS should be considered in the differential diagnosis of nausea and vomiting in pregnancy. Patients who meet criteria should be counseled about cannabis cessation as part of treatment recommendations.

Is there an increased risk of genetic abnormalities in fetuses with congenital heart disease in the setting of growth restriction?

To determine if the presence of fetal growth restriction (FGR) is associated with an increased risk of genetic abnormalities in the setting of congenital heart disease (CHD). This was a retrospective cohort study involving pregnancies that met the following criteria: (i) prenatal diagnosis of CHD, (ii) singleton live-birth, and (iii) genetic testing was performed either pre- or postnatally. Genetic results were reviewed by a clinical geneticist for updated variant classification. Fetal growth was stratified as appropriate for gestational age (AGA) or FGR. Of the total of 445 fetuses that met the study criteria, 325 (73.0%) were AGA and 120 (27.0%) were FGR. Genetic abnormalities were detected in 131 (29.4%) pregnancies. There was a higher rate of genetic abnormalities (36.7% vs. 26.8%, p=0.04), which was driven by aneuploidies (20.8% vs. 8.9%, p=0.0006) in the FGR population. Early onset growth restriction was associated with a higher rate of genetic abnormalities (44.5% vs. 25.9%, p=0.03). The rate of genetic abnormalities was significantly higher in the shunt category as compared to remainder of the cardiac anomalies (62.5% in shunt lesions vs. 24.7%, p<0.00001). The rates of FGR (40.9% vs. 21.4%, p<0.0001) and genetic abnormalities (52% vs. 20.4%, p<0.0001) were significantly higher in the presence of extra-cardiac anomalies (ECA). The presence of FGR in fetal CHD population was associated with underlying genetic abnormalities, specifically aneuploidies. Patients should be appropriately counseled regarding the higher likelihood of a genetic condition in the presence of FGR, early onset FGR, shunt lesions and ECA.

The genetics and clinical outcomes in 151 cases of fetal growth restriction: A Chinese single-center study

ObjectiveTo determine the detection rate of chromosomal abnormalities and pregnancy outcomes in fetuses with intrauterine growth restriction.Study designA total of 151 fetal samples with intrauterine growth restriction were divided into the isolated fetal growth restriction (FGR) group, FGR group with structural malformation, and FGR group with non-structural malformation, according to ultrasound abnormalities. The enrolled patients were divided into an early onset FGR group (<32 weeks) and a late-onset FGR group (≥32 weeks). Chromosomal karyotype and microarray analyses were performed and pregnancy outcomes were monitored.ResultsThe karyotypes of 122 patients were analyzed. Four patients exhibited abnormal chromosome numbers or structures. Variations in copy number were detected in 151 cases; 19 cases were found to have chromosomal abnormalities, with a positivity rate of 12.6 %. There was one trisomy in 18 cases, one trisomy in 21 cases, eight pathogenic copy number variations (CNVs), and nine CNVs of unknown clinical significance. The detection rate of FGR combined with structural malformation was significantly higher than that of isolated FGR group. The detection rate of FGR with structural malformations was significantly higher than that with non-structural malformations. The positive detection rate in the FGR group was similar to that in the FGR group with non-structural malformations, with no statistical significance. Chromosomal abnormalities were detected in 17 patients with early onset FGR, with a positivity rate of 13.8 %. Two cases of chromosomal abnormalities were detected in the late-onset FGR group, with a positive rate of 7.1 %, with no statistical significance. A total of 151 fetuses with FGR were followed up for pregnancy outcomes, resulting in 36 cases of pregnancy termination and 13 cases of loss to follow-up. Among the 102 delivered fetuses, six exhibited delayed growth and development, one presented with hypospadias, and another failed the hearing screening. The remaining 94 fetuses demonstrated normal growth and development.ConclusionsThis study confirms the value of CNV detection in fetuses and dynamic ultrasound monitoring for fetuses with intrauterine growth restriction.

In pregnant patients with a history of prior fetal growth restriction, does the addition of 81 mg aspirin reduce rates of fetal growth restriction compared with no prophylaxis?

In pregnant patients with a history of prior fetal growth restriction, does the addition of 81 mg aspirin reduce rates of fetal growth restriction compared with no prophylaxis?

Obstetric Outcomes After Chemotherapy in Pregnancy [ID 2683556

INTRODUCTION: Cancer affects approximately 1 in 1,000 pregnancies; limited data exist to guide clinical decision making and counseling regarding chemotherapy. We investigated the obstetric outcomes of patients who received chemotherapy for cancer in pregnancy at a large county hospital. METHODS: In this retrospective IRB-approved study, patients diagnosed with cancer prior to or during pregnancy from May 2009 to May 2023 were identified. Those who received chemotherapy in pregnancy were included. Type of cancer, chemotherapeutic agents, and obstetric outcomes were obtained from the electronic medical record. RESULTS: Of 22 patients who initiated or continued chemotherapy, seven had a cancer diagnosis prior to pregnancy. Fifteen were diagnosed in pregnancy, at an average gestational age of 15.5 weeks. Average maternal age was 30.5 years. Hematologic (36%) and breast (32%) cancers were most common. Four terminated pregnancy and 18 continued pregnancy. Chemotherapy initiation occurred at an average of 21.2 weeks. Most patients received alkylating agents or antitumor antibiotics, and only one required antepartum admission for chemotherapy-related complications. Patients delivered at an average of 35.6±3.0 (29–41) weeks and 9/18 (50%) patients delivered prior to 37 weeks. Severe fetal growth restriction (less than third percentile) occurred in 6/18 (33%) patients; one had a history of fetal growth restriction in a prior pregnancy. There were no neonatal deaths or congenital malformations. CONCLUSION: While high rates of fetal growth restriction and preterm birth were observed, chemotherapy was well tolerated in pregnancy and all non-terminated pregnancies delivered viable infants in the third trimester. Chemotherapy can be administered in pregnancy with counseling regarding neonatal risks.

Neonatal Outcomes Are Similar between Patients with Resolved and Those with Persistent Oligohydramnios.

Oligohydramnios (defined as amniotic fluid volume < 5 cm or deepest vertical pocket < 2 cm) is regarded as an ominous finding on prenatal ultrasound. Amniotic fluid, however, is not static, and to date, there have been no studies comparing perinatal outcomes in patients who are diagnosed with oligohydramnios that resolves and those who have persistent oligohydramnios. This is a secondary analysis of a National Institutes of Health-funded retrospective cohort study of singleton gestations delivered at a tertiary care hospital between 2002 and 2013 with mild hypertensive disorders and/or fetal growth restriction (FGR). Maternal characteristics, delivery, and neonatal information were abstracted by trained research nurses. Patients with a diagnosis of oligohydramnios were identified, and those with resolved versus persistent oligohydramnios at the time of delivery were compared. The primary outcome was a composite of neonatal resuscitation at delivery: administration of oxygen, bag-mask ventilation, continuous positive airway pressure, intubation, chest compression, or cardiac medication administration. Secondary outcomes included FGR, timing, and mode of delivery. Of 527 women meeting study criteria, 42 had oligohydramnios that resolved prior to delivery, whereas 485 had persistent oligohydramnios. There were no significant differences in patient demographics between groups. The gestational age at diagnosis was significantly lower for patients with resolved versus persistent oligohydramnios (median: 33.0 [interquartile range, IQR: 29.1-35.9] vs. 38.0 [IQR: 36.4-39.3], p < 0.001). There was not a substantial difference in rate of neonatal resuscitation (41 vs. 32%, p = 0.31). Patients with resolved oligohydramnios were more likely to have developed FGR than those with persistent oligohydramnios (55 vs. 36%, p < 0.02). There were no significant differences for gestational age at delivery, birth weight, or neonatal intensive care unit admission. Patients whose oligohydramnios resolved were diagnosed earlier yet had similar rates of neonatal resuscitation but higher rates of FGR than those who had persistent oligohydramnios. · When diagnosed earlier in pregnancy, oligohydramnios was more likely to resolve prenatally.. · Patients who were diagnosed with oligohydramnios earlier in pregnancy had higher rates of FGR.. · There were no differences in the rates of the composite outcome of need for neonatal resuscitation when comparing those with resolved versus those with persistent oligohydramnios. No differences in composite neonatal morbidity were noted between those with resolved versus persistent oligohydramnios..

The role of confined placental mosaicism in fetal growth restriction: A retrospective cohort study.

To evaluate which cytogenetic characteristics of confined placental mosaicism (CPM) detected in the first trimester chorionic villi and/or placentas in terms of chromosome aberration, cell lineage involved and trisomy origin will lead to fetal growth restriction and low birthweight. Cohort study using routinely collected perinatal data and cytogenetic data of non-invasive prenatal testing, the first trimester chorionic villi sampling and postnatal placentas. 215 CPM cases were found. Fetal growth restriction (FGR) and low birthweight below the 10th percentile (BW<p10) were seen in 34.0% and 23.1%, respectively. Excluding cases of trisomy 16, 29.1% showed FGR and 17.9% had a BW<p10. The highest rate of FGR and BW<p10 was found in CPM type 3, but differences with type 1 and 2 were not significant. FGR and BW<p10 were significantly more often observed in cases with meiotic trisomies. There is an association between CPM and FGR and BW<p10. This association is not restricted to trisomy 16, neither to CPM type 3, nor to CPM involving a meiotic trisomy. Pregnancies with all CPM types and origins should be considered to be at increased risk of FGR and low BW<p10. A close prenatal fetal monitoring is indicated in all cases of CPM.

Hypertensive disorders in pregnancy: problems of classification, differential diagnosis and management

Objective. To study the features of hypertensive disorders formation in pregnancy depending on the period and clinical form on the example of the population of Sverdlovsk region.&#x0D; Materials and methods. The outcomes of 217 pregnant women with moderate and severe preeclampsia and gestational hypertension were analyzed (41, 74, and 102 cases, respectively).&#x0D; Results. The severe preeclampsia group had the highest rate of fetal growth restriction (14.6 %), low birth weight -2045 g (1640–2650), preterm delivery (63.4 %), and cesarean delivery (87.8 %). A detailed analysis of 28 cases of gestational hypertension lasting up to 34 weeks was performed. The analysis revealed significant challenges in the differential diagnosis of this pregnancy complication, not only in terms of clinical manifestations, but also in terms of timely diagnosis in general.&#x0D; Conclusions. The findings of this study spark a debate over the use of severity-based classification in clinical practice, which lessens the doctor's vigilance in milder forms that, however, result in equally serious complications. This raises the question of whether unified tactical approaches should be used in this pathology.

The association between parental SARS-CoV-2 infection in pregnancy and fetal growth restriction.

Although the relationship between maternal viral infections and fetal growth restriction (FGR) is well established, the association between SARS-CoV-2 infection in pregnancy and FGR remains unclear. We investigated the association between SARS-CoV-2 infection in pregnancy and FGR at a single county hospital. We performed a prospective cohort study with cohorts matched by gestational age and month of SARS-CoV-2 PCR testing between April 2020 and July 2022. Individuals were included if they had a SARS-CoV-2 PCR testing up to 32weeks of gestation and had a third trimester ultrasound. Primary outcome was a diagnosis of FGR, while secondary outcomes were rates of preeclampsia, small for gestational age (SGA) and birthweight. Univariate analyses, chi-square test and logistic regression were used for analysis. Our cohorts constituted of 102 pregnant individuals with a positive SARS-CoV-2 PCR test result and 103 pregnant individuals with a negative SARS-CoV-2 PCR test result in pregnancy. FGR rates were 17.8 % and 19.42 % among positive and negative SARS-CoV-2 cohorts respectively. While a statistical difference in preeclampsia rates was noted (34.31 % vs. 21.36 %, p=0.038) between cohorts, odds of getting preeclampsia based on SARS-CoV-2 test result was not significant (aOR 1.01, CI=0.97-1.01, p=0.75). No statistical difference was noted in demographics, FGR and SGA rates, and birthweight. Our findings suggest no association between SARS-CoV-2 infection in pregnancy and FGR at a single institution. Our results validate emerging data that additional fetal growth ultrasonographic assessment is not indicated solely based on SARS-CoV-2 infection status.

1177 Low maternal cardiac index is associated with a high rate of fetal growth restriction

1177 Low maternal cardiac index is associated with a high rate of fetal growth restriction

Comparing population-based fetal growth standards in a US cohort

BackgroundNo fetal growth standard is currently endorsed for universal use in the US. Newer standards improve upon the methodologic limitations of older studies but before adopting into practice, it is important to know how recent standards perform at identifying fetal under- or over- growth and predicting subsequent neonatal morbidity or mortality in US populations. ObjectiveTo compare classification of estimated fetal weight (EFW) that is <5th or 10th percentile or >90th percentile by six population-based fetal growth standards and the ability of these standards to predict a composite of neonatal morbidity and mortality. Study DesignWe used data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to be (nuMoM2b) cohort, which recruited nulliparous women in the first trimester at eight U.S. clinical centers (2010-2014). EFW was obtained from ultrasounds at 16-21 and 22-29 weeks (n=9530 women). We calculated rates of fetal growth restriction (EFW <5th and 10th percentiles; FGR<5 and FGR<10) and EFW >90th percentile (EFW>90) from three large prospective fetal growth cohorts with similar rigorous methodologies: INTERGROWTH-21, World Health Organization (WHO) sex-specific and combined, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) race/ethnic-specific and unified, and the historical Hadlock (1991) reference. To determine whether differential classification of FGR or EFW>90 among standards was clinically meaningful, we then compared area under the curve (AUC) and sensitivity of each standard to predict SGA or LGA at birth, composite perinatal morbidity and mortality alone, and SGA or LGA with composite perinatal morbidity and mortality. ResultsThe standards classified different proportions of FGR and EFW>90 for ultrasounds at 16-21 (visit 2) and 22-29 (visit 3) weeks. At visit 2, the NICHD race/ethnic-specific, WHO sex-specific and WHO-combined identified similar rates of FGR<10 (8.4-8.5%) with the other two having lower rates, while NICHD race/ethnic-specific identified the highest rate of FGR<5 (5.0%) compared to the other references. At visit 3, WHO-sex-specific classified 9.2% of fetuses as FGR<10, while the other five classified a lower proportion: WHO-Combined 8.4%, NICHD-race/ethnic-specific 7.7%, INTERGROWTH 6.2%, Hadlock 6.1%, and NICHD unified 5.1%. INTERGROWTH classified the highest (21.3%) as EFW>90 while Hadlock classified the lowest (8.3%). When predicting composite perinatal morbidity and mortality in the setting of early-onset FGR, WHO had the highest AUC of 0.53 (0.51, 0.53) for FGR<10 at 22-29 weeks, but the AUCs were similar among standards (0.52). Sensitivity was generally low across standards (22.7-29.1%). When predicting SGA-BW with composite neonatal morbidity or mortality, for FGR<10 at 22-29 weeks, WHO-sex-specific had the highest AUC (0.64; 95% CI 0.60, 0.67) and INTERGROWTH had the lowest (AUC=0.58; 95% CI 0.55, 0.62), though all standards had low sensitivity (7.0-9.6%). ConclusionsDespite classifying different proportions of fetuses as FGR or EFW>90, all standards performed similarly in predicting perinatal morbidity and mortality. Classification of different percentages of fetuses as FGR or EFW>90 among references may have clinical implications in the management of pregnancies, such as increased antenatal monitoring for FGR or cesarean for suspected LGA. Our findings highlight the importance of knowing how standards perform in local populations, but more research is needed to determine if any standard performs better at identifying risk of morbidity or mortality.

Increased cesarean section rate and premature birth according to modified WHO maternal cardiovascular risk in pregnant women with congenital heart disease

Background During pregnancy and delivery, hemodynamics are altered and complex congenital heart disease has been associated with adverse maternal and neonatal outcomes. We sought to investigate pregnancy outcome and complications in relation to complexity of heart condition. Materials and methods We studied women with ACHD discussed at multidisciplinary conferences at Lund University Hospital March 2009-May 2021. We studied 149 pregnancies in 101 women. We scored each woman retrospectively according to the modified World Health Organization (mWHO) risk classification and included patients in risk class I (n = 36, 24.1%), II (n = 43, 28.9%), II-III (n = 43, 28.9%), III (n = 24, 16.1%) and IV (n = 3, 2.0%). Results Women with mWHO class ≥III underwent cesarean section more often than women in less complex mWHO classes, (OR, 5.1; 95% CI, 2.0–12.5; p&lt;0.001). The odds of premature delivery were significantly higher among pregnant women with mWHO class ≥III (OR, 6.7; 95% CI, 2.6–17.4; p&lt;0.001). We found no difference in incidence of preeclampsia, gestational hypertension, gestational diabetes, hemorrhage &gt;1000 ml or cardiac defect in the neonate depending on WHO-class. Women in mWHO classes III-IV had a higher rate of fetal growth restriction (FGR) compared to women in mWHO classes I, II, II-III (p&lt;0.007). Conclusions Our findings indicate that women with more complex heart disease (mWHO classes III or IV) tend to have a higher rate of cesarean section, premature birth and FGR.

Increased cesarean section rate and premature birth according to modified WHO maternal cardiovascular risk in pregnant women with congenital heart disease

Abstract Background During pregnancy and delivery, hemodynamics are altered, and women with adult congenital heart disease (ACHD) might have a higher risk of obstetric and neonatal complications. We sought to investigate pregnancy outcome and complications in relation to complexity of heart condition. Materials and methods We studied women with ACHD discussed at multidisciplinary conferences March 2009-May 2021. We studied 149 pregnancies in 101 women. We scored each woman retrospectively according to the modified World Health Organization (mWHO) risk classification and included patients in risk class I (n=36, 24.1%), II (n=43, 28.9%), II-III (n=43, 28.9%), III (n=24, 16.1% and IV (n=3, 2.0%). Relative risks were assessed with logistic regression adjusting for parity and age. Results Women with mWHO class ≥III underwent cesarean section more often than women in less complex mWHO classes, p&amp;lt;0.001. Women in mWHO classes I, II and II-III were 83.8% (CI 54.4%-94.2% p&amp;lt;0.001) less likely to give birth prematurely compared to women in mWHO classes III and IV. We found no difference in incidence of preeclampsia, gestational hypertension, gestational diabetes or hemorrhage &amp;gt;1000 ml depending on WHO-class (table 1). Women in mWHO classes III-IV had a higher rate of fetal growth restriction compared to women in mWHO classes I, II, II-III (p&amp;lt;0.007). Conclusions Women with complex congenital heart disease (mWHO ≥III) tend to have a higher rate of cesarean section, premature birth and fetal growth restriction.Table 1

Can prenatal ultrasound predict adverse neonatal outcomes in SARS-CoV-2–affected pregnancies?

On the basis of available data, at least 1 ultrasound assessment of pregnancies recovering from SARS-CoV-2 infection is recommended. However, reports on prenatal imaging findings and potential associations with neonatal outcomes following SARS-CoV-2 infection in pregnancy have been inconclusive. This study aimed to describe the sonographic characteristics of pregnancies after confirmed SARS-CoV-2 infection and assess the association of prenatal ultrasound findings with adverse neonatal outcomes. This was an observational prospective cohort study of pregnancies diagnosed with SARS-CoV-2 by reverse transcription polymerase chain reaction between March 2020 and May 2021. Prenatal ultrasound evaluation was performed at least once after diagnosis of infection, with the following parameters measured: standard fetal biometric measurements, umbilical and middle cerebral artery Dopplers, placental thickness, amniotic fluid volume, and anatomic survey for infection-associated findings. The primary outcome was the composite adverse neonatal outcome, defined as ≥1 of the following: preterm birth, neonatal intensive care unit admission, small for gestational age, respiratory distress, intrauterine fetal demise, neonatal demise, or other neonatal complications. Secondary outcomes were sonographic findings stratified by trimester of infection and severity of SARS-CoV-2 infection. Prenatal ultrasound findings were compared with neonatal outcomes, severity of infection, and trimester of infection. A total of 103 SARS-CoV-2-affected mother-infant pairs with prenatal ultrasound evaluation were identified; 3 cases were excluded because of known major fetal anomalies. Of the 100 included cases, neonatal outcomes were available in 92 pregnancies (97 infants); of these, 28 (29%) had the composite adverse neonatal outcome, and 23 (23%) had at least 1 abnormal prenatal ultrasound finding. The most common abnormalities seen on ultrasound were placentomegaly (11/23; 47.8%) and fetal growth restriction (8/23; 34.8%). The latter was associated with a higher rate of the composite adverse neonatal outcome (25% vs 1.5%; adjusted odds ratio, 22.67; 95% confidence interval, 2.63-194.91; P<.001), even when small for gestational age was removed from this composite outcome. The Cochran Mantel-Haenszel test controlling for possible fetal growth restriction confounders continued to show this association (relative risk, 3.7; 95% confidence interval, 2.6-5.9; P<.001). Median estimated fetal weight and birthweight were lower in patients with the composite adverse neonatal outcome (P<.001). Infection in the third trimester was associated with lower median percentile of estimated fetal weight (P=.019). An association between placentomegaly and third-trimester SARS-CoV-2 infection was noted (P=.045). In our study of SARS-CoV-2-affected maternal-infant pairs, rates of fetal growth restriction were comparable to those found in the general population. However, composite adverse neonatal outcome rates were high. Pregnancies with fetal growth restriction after SARS-CoV-2 infection were associated with an increased risk for the adverse neonatal outcome and may require close surveillance.

Timing of Fetal Growth Restriction Development in Patients With Preeclampsia [ID: 1363469

INTRODUCTION: Preeclampsia (PEC) and fetal growth restriction (FGR) share common pathophysiology of placental insufficiency. In pregnancies complicated by PEC, the incidence of FGR increases significantly. We sought to examine the timing of FGR development in patients with PEC. METHODS: This was a retrospective cohort study of patients with PEC and singleton pregnancy who delivered at 23 weeks or greater. Patients who had been diagnosed with FGR prior to PEC diagnosis, those who were diagnosed with FGR at the same time as PEC, and those who delivered immediately after PEC diagnosis were excluded. Demographics were compared between patients with FGR and those without FGR. We plotted Kaplan-Meier curves for the interval from the diagnosis of PEC to the development of FGR. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (HRs) for FGR. Our IRB approved this analysis. RESULTS: Of 392 patients with PEC, 31 (7.9%) developed FGR. Compared to patients who did not develop FGR, patients who developed FGR were more likely to have early-onset PEC and lower maternal weight and were less likely to have gestational diabetes (P&lt;.05). The incidence rate of FGR increased by 11.6% each week from the PEC diagnosis. Compared to patients with late-onset PEC, those with early-onset PEC had a significantly higher cumulative incidence of FGR (P&lt;.01). The Cox proportional hazards model showed that early-onset PEC was associated with FGR (adjusted HR 4.12, 95% CI 1.19–14.33) compared to late-onset PEC. CONCLUSION: Patients with early-onset PEC had a significantly higher incidence of FGR compared to those with late-onset PEC. There was a high cumulative incidence rate of FGR in patients with early-onset PEC. Patients with PEC should be followed by serial fetal growth ultrasound.

Beta-Blocker use During Pregnancy Correlates with Less Aortic Root Dilatation in Patients with Marfan Syndrome.

Background Pregnant patients with Marfan syndrome (MFS) are at an increased risk for adverse aortic outcomes. While beta-blockers are used to slow aortic root dilatation in non-pregnant MFS patients, the benefit of such therapy in pregnant MFS patients remains controversial. The purpose of this study was to investigate the effect of beta-blockers on aortic root dilatation during pregnancy in MFS patients. Methods This was a longitudinal single-center retrospective cohort study of females with MFS who completed a pregnancy between 2004 and 2020. Clinical, fetal, and echocardiographic data were compared in patients on vs off beta-blockers during pregnancy. Results A total of 20 pregnancies completed by 19 patients were evaluated. Beta-blocker therapy was initiated or continued in 13 (65%) of the 20 pregnancies. Pregnancies on beta-blocker therapy experienced less aortic growth compared to those off beta-blockers (0.10cm [IQR: 0.10-0.20cm] vs 0.30cm [IQR: 0.25-0.35cm]; P=0.03). Using univariate linear regression, maximum systolic blood pressures (SBP), increase in SBP, and absence of beta-blocker use in pregnancy were found to be significantly associated with greater increase in aortic diameter during pregnancy. There were no differences in rates of fetal growth restriction between pregnancies on vs off beta-blockers. Conclusions This is the first study to evaluate changes in aortic dimensions in MFS pregnancies stratified by beta-blocker use. Beta-blocker therapy was found to be associated with less aortic root growth during pregnancy in MFS patients.

Comparison of circulating maternal placenta growth factor levels and sonographic evaluation of patients with abnormal first trimester screening analytes.

To evaluate the role of mid-trimester placental growth factor (PlGF) in patients with abnormal circulating levels of first-trimester biomarkers. Retrospective cohort study including singleton pregnancies complicated by abnormal first-trimester biomarkers (2017-2020). Pregnancies complicated with chromosomal/structural anomalies were excluded. All patients had ultrasound imaging including uterine artery Doppler combined with measurement of maternal circulating PlGF. Sonographic findings, maternal and perinatal outcomes, and placental histopathology were compared between pregnancies with normal and low (<10th percentile for gestational age) PlGF levels. The diagnostic accuracy of PlGF for the prediction of specific placental-mediated complications was compared with the uterine artery Doppler assessment and additional sonographic findings. Seventy-one pregnancies were assessed, of which 35 (49.3%) had low PlGF levels. Maternal sociodemographic characteristics, nulliparity, and aspirin consumption were comparable. In comparison with patients with normal PlGF levels, individuals with low PlGF levels had a higher rate of fetal growth restriction (EFW <3rd centile; 42.9% vs. 8.3%, p=0.001), preterm-preeclampsia (22.9% vs. 0%, p=0.002), preterm delivery <34weeks (54.3% vs. 8.3%, p<0.001) and maternal vascular malperfusion placental pathology (72.7% vs. 21.7%, p<0.001) following delivery. Adjusting for uterine artery Doppler and fetal biometry status, mid-trimester low PlGF remained significantly associated with these placental-mediated complications. The predictive capacity of PlGF outperformed ultrasound imaging with only minimal diagnostic improvement when ultrasound information was combined with PlGF status. In pregnancies with unexplained abnormal first-trimester biomarkers, mid-trimester PlGF outperformed a comprehensive ultrasound assessment in the identification of a subset of patients destined to develop placental dysfunction. This blood test may be an alternative initial approach in this context, especially where access to specialist care is more geographically challenging.

Implementation of Uterine Artery Doppler Scanning: Improving the Care of Women and Babies High Risk for Fetal Growth Restriction.

While stillbirth rates have declined in many countries, these declines are less marked in the UK. Fetal growth restriction (FGR) affects about 3% to 7% of all pregnancies and is by far the single strongest risk factor for stillbirth. FGR implies a pathological restriction of the genetic growth potential and is not synonymous with small-for-gestational age (SGA). The Royal College of Obstetricians and Gynaecologists (RCOG) defines SGA as an estimated fetal weight (EFW) or abdominal circumference (AC) less than the 10th centile. The likelihood of FGR is higher in severe SGA defined as an EFW or AC less than the 3rd centile. The second version of Saving Babies' Lives Care Bundle (SBLCBv2) recommends the second trimester uterine artery Doppler (UtAD) pulsatility index (PI) screening for pregnancies at high risk of FGR. This study was aimed at determining the prevalence of FGR and assess pregnancy outcomes following the implementation of UtAD at the United Lincolnshire Hospitals NHS Trust (ULHT). One-year retrospective cohort study (1st September 2020-31st August 2021) was conducted across both ULHT hospitals in the UK (Lincoln County Hospital in Lincoln and Pilgrim Hospital in Boston). During the study period, 5197 women were booked at ULHT. Of 5197, 349 were identified as high risk for FGR. When numbers were compared for the two hospitals, FGR rate was higher in Lincoln 8.10% vs. 4.51% in Boston. In addition, an increased proportion of abnormal UtAD scans was observed in Lincoln (35.7%) vs. in Boston (22%) (P = 0.014). Of the 349 UtAD scans, 237 were normal (67.9%), 41 showed unilateral notching (11.7%), 43 bilateral notching (12.3%), and 28 raised PI (8%). Babies in the bilateral notching group exhibited the lowest birth weight (P = 0.005), born at an earlier gestation (P = 0.029), and with low Apgar scores at 1 (P = 0.007) and 5 minutes (P < 0.001). Discussion. UtAD is a useful second trimester screening tool for women identified as high risk for FGR and helps stratify the intensity of surveillance. However, the findings call into question a focus solely on the UtAD PI for improving FGR detection without taking into account bilateral notching.

The relationship between falling insulin requirements and serial ultrasound measurements in women with preexisting diabetes: a prospective cohort study

Introduction A large fall in insulin requirements (FIR) in women with diabetes is associated with adverse clinical outcomes but previous studies have not examined its relation with serial ultrasound parameters. Objective To determine whether FIR is associated with alteration in umbilical artery Doppler parameters and fetal growth restriction (FGR) in women with preexisting diabetes. Methods Serial obstetric Doppler ultrasounds were conducted 2 weekly from 28 weeks gestation in women with Type 1 and Type 2 diabetes who were being treated with insulin. Estimated fetal weight (EFW), head circumference:abdominal circumference (HC:AC) ratio and umbilical artery doppler parameters (SD ratio) and pulsatility index (PI) were measured. Information on insulin dose was collected prospectively throughout pregnancy and women with FIR ≥ 15% were considered cases. Linear mixed effect models were used to assess the association between FIR and ultrasound parameters. Results One hundred and forty two women were included in the study (type 1 diabetes n = 41, type 2 diabetes n = 101). Thirty women demonstrated FIR ≥ 15%. There was no significant difference in the change of S/D ratio or PI over the third trimester in cases with FIR ≥ 15%, compared to the rest of the cohort, before or after adjusting for type of diabetes. Likewise there was no difference in EFW and HC:AC ratio with advancing gestation before or after adjusting for variables known to influence fetal growth. FGR rates (3.3 vs 8% p = 0.298) and high S/D ratio > 95% (13.3 vs 8%, p = 0.296) were similar between the two groups. Conclusions FIR ≥ 15% was not associated with changes in placental flow or FGR however larger studies are needed to evaluate this further.

Fetal Echocardiographic Findings to Predict Early Surgical Repair and Neonatal Outcomes in Fetuses with Isolated Coarctation of the Aorta.

The aim of this study was to investigate fetal echocardiographic findings in predicting the need for surgical repair in fetuses with coarctation of the aorta (CoA) and to evaluate perinatal outcomes. In this retrospective study, fetuses diagnosed with CoA in a tertiary center between January 2015 and June 2021 were analyzed. Fetal echocardiographic measurements and quantitative findings, middle cerebral artery (MCA) and umbilical artery (UA) Doppler indices, and perinatal outcomes were recorded. A total of 57 fetuses with CoA were included in the study. In total, 51 (89.5%) pregnancies resulted in live births and 32 (62.8%) of the neonates underwent surgical repair. The left ventricle/right ventricle width ratio and aortic isthmus z-score were significantly lower in fetuses who underwent surgical repair (p = 0.004 0.001, respectively). Retrograde flow in the aortic isthmus (odds ratio [OR]:7.43; 95% confidence interval [CI]: 1.98-27.76), left-to-right foramen ovale shunt (OR: 8.50; 95% CI: 1.68-42.98), and ventricular septal defect (OR: 9.63; 95% CI: 1.90-48.74) were associated with the need for surgical repair. A new scoring system integrating these echocardiographic findings had 89% specificity and 54% sensitivity in predicting surgical repair. Fetal growth restriction rates, preterm birth rates, mean MCA pulsatility index (PI), and mean UA PI were similar in fetuses with and without surgical repair. A scoring system integrating echocardiographic findings in fetuses with CoA may improve the prediction of surgical repair need. There is no evidence of an increased risk of FGR, preterm birth, and brain sparing effect in fetuses with CoA who require surgical repair. · Coarctation of the aorta is one of the most difficult congenital heart defects to diagnose.. · A new scoring system may improve the prediction of surgical repair need.. · There is no increased risk of fetal growth restriction in fetuses requiring early surgical repair..