History Of Fetal Growth Restriction Research Articles

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.

Chromosomal microarray testing yield in 829 cases of microcephaly: a clinical characteristics-based analysis for prenatal and postnatal cases

IntroductionMicrocephaly, characterized by abnormal head growth, can often serve as an initial indicator of congenital, genetic, or acquired disorders. In this study, we sought to evaluate the effectiveness of chromosomal microarray (CMA) testing in detecting abnormalities in both prenatal and postnatal cases of microcephaly.Materials and methodsCMA Testing: We conducted CMA testing on 87 prenatally-detected microcephaly cases and 742 postnatal cases at a single laboratory. We evaluated the CMA yield in relation to specific clinical characteristics.ResultsIn prenatal cases, pathogenic and likely pathogenic (LP) results were identified in 4.6% of cases, a significantly higher rate compared to low-risk pregnancies. The male-to-female ratio in this cohort was 3, and the CMA yield was not influenced by gender or other clinical parameters. For postnatal cases, the CMA yield was 15.0%, with a significantly higher detection rate associated with dysmorphism, hypotonia, epilepsy, congenital heart malformations (CHM), learning disabilities (LD), and a history of Fetal growth restriction (FGR). No specific recurrent copy number variations (CNVs) were observed, and the rate of variants of unknown significance was 3.9%.ConclusionsThe yield of CMA testing in prenatal microcephaly is lower than in postnatal cases (4.6% vs. 15%). The presence of microcephaly, combined with dysmorphism, hypotonia, epilepsy, CHD, LD, and FGR, significantly increases the likelihood of an abnormal CMA result.

Third Trimester Lower Extremity Lymphorrhea

Introduction Lower extremity edema is one of the most common complaints among pregnant patients. However, there is no literature mentioning weeping edema (i.e., lymphorrhea) in a pregnant woman who has no concordant underlying renal and/or cardiac pathology. There is also a lack of evidence and recommendations regarding the therapeutic benefit and safety profile of diuretic use to treat profound pregnancy-associated edema. Herein, we present the case of 32-year-old female who presented with a significant lymphorrhea during the third trimester without cardiac or renal comorbidity and was successfully treated with torsemide. Case Report. We report a case of a 32-year-old multigravida patient pregnant with her third child and has two living full-term children (G3P2003). Her pregnancy was complicated by obesity, smoking (vape), and previous history of fetal growth restriction. The patient presented for routine prenatal care at 9-week gestation. She was diagnosed with chronic hypertension at 19 weeks of pregnancy based upon systolic blood pressure > 140. Lifestyle modifications were recommended, but the patient did not comply. At her 31-week office visit, the patient presented with anasarca and clear, slightly viscous fluid seeping through the atraumatic skin of her lower extremities. Preeclampsia, renal, cardiac, vascular, and infectious complications were all ruled out. The patient responded positively to loop diuretic therapy. Torsemide was found to be far more beneficial than furosemide. The patient was induced at 37 weeks secondary to chronic hypertension requiring antihypertensive therapy. Delivery was uncomplicated. The patient gave birth to a healthy male with birth weight of 2,920 g via spontaneous vaginal delivery. Discussion. Pitting edema of lower limbs frequently occurs as a result of fluid overload and chronic venous insufficiency, and pregnancy is one of the known risk factors. Additionally, the blockage of lymphatic channel with the gravida uterus likely was the main contributing factor for her lymphorrhea. In this patient, the capillary hydrostatic pressure was likely accentuated due to hypertension, obesity, and vaping. Furosemide was minimally effective to alleviate her symptoms. Torsemide provided much more effective diuresis and symptom control. However, her symptoms persisted until delivery. Conclusion Torsemide provided significant therapeutic benefit over furosemide in this patient without adverse maternal, fetal, or neonatal outcomes. Further study is needed to assess the safe use of loop diuretics in the pregnant population who suffers from significant lower extremity edema.

Fetal Growth Restriction with Brain Sparing: Neurocognitive and Behavioral Outcomes at 12 Years of Age

To study neurocognitive functions and behavior in children with a history of fetal growth restriction (FGR) with brain sparing. We hypothesized that children with FGR would have poorer outcomes on these domains. Subjects were 12-year-old children with a history of FGR born to mothers with severe early-onset hypertensive pregnancy disorders (n = 96) compared with a normal functioning full term comparison group with a birth weight ≥2500 g (n = 32). Outcome measures were neurocognitive outcomes (ie, intelligence quotient, executive function, attention) and behavior. For the FGR group, the mean ratio of the pulsatility index for the umbilical artery/middle cerebral artery (UC-ratio = severity of brain sparing) was 1.42 ± 0.69. The mean gestational age was 31-6/7 ± 2-2/7 weeks. The mean birth weight was 1341 ± 454 g, and the mean birth weight ratio 0.68 ± 0.12. Neurocognitive outcomes were comparable between groups. Parents of children with FGR reported more social problems (mean T-score 56.6 ± 7.7; comparison 52.3 ± 4.3, P < .001, effect size = 1, 95% CI 0.52-1.46) and attention problems (mean T-score 57.3 ± 6.9; comparison 53.6 ± 4.2, P = .004, effect size = 0.88, 95% CI 0.42-1.33). UC-ratio was not associated with any of the outcomes, but low parental education and lower birth weight ratio were. In this prospective follow-up study of 12-year-old children with a history of FGR and confirmed brain sparing, neurocognitive functions were comparable with the comparison group, but parent-reported social and attention problem scores were increased.

Prophylaxis with Low Molecular Weight Heparin for Prevention of Placenta-related Recurrent Adverse Pregnancy Outcomes

Aims: To determine whether antenatal administration of low-molecular-weight-heparin (LMWH) reduces the recurrence of adverse pregnancy outcomes (APO). Study Design: Retrospective cohort study. Place and Duration of the Study: Inova Alexandria Hospital, Alexandria, VA and Georgetown University Medical Center, Washington, DC during the period of January 1, 2006 and December 31, 2009. Methodology: All pregnant women with history of APOs, including preeclampsia or abruption at <35 weeks, birth weight <5th centile, fetal loss at ≥20 weeks, or ≥2 spontaneous losses between 12 and 20 weeks, were administered LMWH or not at the discretion of the managing physician. Excluded were cases with antiphospholipid Original Research Article Kamda et al.; IBRR, Article no. IBRR.2014.005 141 syndrome. The independent effect of LMWH on recurrence was assessed using logistic regression analysis with odds ratios (OR) having 95% confidence interval (CI) not inclusive of the unity considered significant. Results: Of the 140 women in the cohort, 44 (31%) received LMWH during the subsequent pregnancy and the remainder did not. APO recurred in 23.6% (33/140). Logistic regression analysis demonstrated that LMWH significantly and independently lowered the risk of recurrent APO (adjusted OR=0.08, 95% CI 0.01-0.45), whereas history of fetal growth restriction (OR=3.88, 95% CI 1.51-9.99) and positive results for inherited thrombophilias (OR=6.96, 95% CI 1.58-30.67) increased the risk. Conclusion: In patients with rigorously defined history of severe APO, prophylaxis with LMWH is associated with a significant reduction in recurrence of severe APO.

The association of thrombophilia with fetal growth restriction.

Thrombophilia or the tendency for thrombosis has been linked to pregnancy complications, which include fetal growth restriction. The aim of the present study was to determine the association of maternal thrombophilias with unexplained fetal growth restriction. Inherited and acquired thrombophilias were checked in 34 women whose pregnancies were complicated by fetal growth restriction and 68 women with normal growth fetuses as controls, 8-10 weeks postpartum. Cases were matched for age, body mass index, and parity with two healthy women who had normal pregnancies during the same time period. Exclusion criteria were: maternal vascular disease, structural malformations, chromosomal abnormalities, cytomegalovirus infection, and history of drug abuse. Intrauterine growth restriction was diagnosed when the fetal weight or birth weight was below the 10th percentile for gestational age. The prevalence of all thrombophilia was 55.9% in the case group compared with 10.3% in the control group (P<0.001; OR: 11; 95% CI: 3.9 - 31.1). The prevalence of thrombophilic mutations were significantly higher in the case group compared with the control group (P=0.016; OR: 14.4; 95% CI: 1.7 - 124.8). The frequency of other types of inherited or acquired thrombophilias were significantly higher in fetal growth restriction cases than controls (P< 0.001; OR: 9.9; 95% CI: 3.2 - 30.9). Protein S deficiency was the most common thrombophilic defect in the fetal growth restriction group (41.1%) compared with 2.9% of controls (P<0.001). A significant difference in the frequency of multiple thrombophilias was noted between the two groups (P<0.001). All cases that had a history of fetal growth restriction during their previous pregnancies were positive for thrombophilic defects. Fetal growth restriction pregnancies have a higher prevalence of thrombophilias.

Prior Adverse Pregnancy Outcome and the Risk of Stillbirth

To estimate whether a history of fetal growth restriction, abruptio placentae, preeclampsia, or live preterm birth is associated with excess risk of stillbirth in a subsequent pregnancy. We also estimated the maternal and paternal contributions to such effects. This was a population-based cohort study from 1967 to 2005. Pairs of first and second, second and third, third and fourth, and fourth and fifth births were identified among all births from the Medical Birth Registry of Norway; 747,221 pairs with the same parents, 51,708 with the same mother and different father, and 65,602 with the same father and different mother. The associations of gestational age categories (22-27, 28-32, 33-36, and at or above 37 weeks), small for gestational age (SGA), preeclampsia, and abruptio placenta in the first pregnancy with stillbirth and late abortion in the second were assessed by odds ratios (ORs) obtained by logistic regression. The baseline rate of stillbirth during the study period was 1.0% of all births from 16 weeks of gestation. After births with gestational age 22-27, 28-32, and 33-36 weeks of gestation, stillbirth was six, three and two times more likely to occur than after a term birth (OR 5.7, 95% confidence interval [CI] 4.2-7.6; OR 2.6, 95% CI 2.1-3.3; and OR 1.7, 95% CI 1.5-1.9, respectively). Odds ratios of stillbirth subsequent to pregnancies with SGA, preeclampsia, and abruptio placentae were 1.7 (95% CI 1.6-1.9), 1.6 (95% CI 1.5-1.9), and 2.8 (95% CI 2.2-3.5), respectively, and increased with severity of the conditions. Gestational age below 33 weeks with preeclampsia or SGA carried 6-9 and 6-13-fold effects on later stillbirth, respectively. Men who fathered a pregnancy with preterm preeclampsia were significantly more likely to father a stillbirth in another woman (OR 2.4, 95% CI 1.1-5.5). Live preterm birth, fetal growth restriction, preeclampsia, and abruptio placenta are strongly associated with later stillbirth. II.

History of Fetal Growth Restriction Is More Strongly Associated With Severe Rather Than Milder Pregnancy-Induced Hypertension

We assessed whether fetal growth restriction without pregnancy-induced hypertension (PIH) is associated with the different clinical subgroups of PIH in the subsequent pregnancy. We also assessed the maternal and paternal contributions to this effect. Pairs of first and second, second and third, third and fourth, and fourth and fifth births were identified among all of the births in Norway: 137 375 pairs with same mother and father, 18 376 pairs with same mother and different fathers, and 18 916 pairs with same father and different mothers. Second births in each pair were restricted to those that occurred in 1998-2005. Odds ratios to predict early onset, severe, and mild preeclampsia and transient hypertension in the second birth from birth weight <1500 g in the first compared with 3500 to 3999 g were 13.8, 7.1, 3.5, and 2.2, respectively. Odds ratios to predict early onset, severe, and mild preeclampsia and transient hypertension from birth weight below the 2.5th percentile compared with percentiles 10.0 to 89.9 were 4.2, 2.5, 2.1, and 1.7, respectively. Men who fathered a child with low birth weight in 1 woman were not more likely to later father a PIH pregnancy in another woman. The results indicate that placental dysfunction and PIH share a genetic factor that can be expressed as fetal growth restriction in 1 pregnancy and PIH in a subsequent pregnancy. Future genetic study is needed to confirm whether the association is caused by delayed genetic expression of endothelial dysfunction and whether the clinical subgroups of PIH have different genetic backgrounds.

Preeclampsia More Than 1 Disease

In this issue of Hypertension , Rasmussen and Irgens provide strong support for the relationship of preeclampsia and intrauterine growth restriction (IUGR). They also provide data that support but also some that argue against the concept that the pregnancy complication, preeclampsia, may be more than one disease.1 In previous studies these authors demonstrated that women who have had a growth-restricted infant without preeclampsia are more likely to have preeclampsia in a subsequent pregnancy.2 Those data and similar findings in the current study support pathological findings indicating the similarity of IUGR and preeclampsia.3 In preeclampsia, IUGR and interestingly also in about one third of cases of preterm birth,4 the maternal myometrial and decidual vessels perfusing the placental site do not undergo the normal remodeling of pregnancy. In normal pregnancy trophoblastic invasion is associated with a greatly increased diameter and removal of vascular smooth muscle from the wall of these vessels. This results in large diameter, flaccid, unresponsive tubes that greatly increase placental perfusion. These changes are not present in pregnancies complicated by IUGR, preeclampsia, and some with preterm births. Implicit in the current study is the concept that preterm birth as well as IUGR is related to subsequent preeclampsia. Although preterm birth is not assessed directly, the effect of low birth weight (IUGR and preterm birth) was greater than the effect of IUGR alone. In a far smaller study our group was able to more directly support the relationship of preterm birth and preeclampsia, as women with early onset preeclampsia were more likely to have preterm birth in a subsequent nonpreeclamptic pregnancy.5 The current study extends the prior observation of the relationship of IUGR and preeclampsia but also raises other interesting points. In this larger study the authors were …

The natural history of fetal growth restriction in women with abnormal uterine artery Doppler

The natural history of fetal growth restriction in women with abnormal uterine artery Doppler