Impaired Fetal Growth Research Articles

Analysis of Cesarean Delivery at Ain Shams Maternity Hospital Using the Ten Group Classification System

Abstract Background Cesarean section is an invasive surgical procedure in which a baby is delivered through an abdominal and uterine incision & carries with it many immediate and delayed morbidity and mortality risks. Objective To evaluate the feasibility of using the Robson Ten Group Classification System (TGCS) for cesarean delivery indications at Ain Shams Maternity hospital. Methods This is a retrospective study on women who delivered by cesarean delivery at Ain Shams Maternity hospital between July 1, 2016 and June 30, 2018. All patient files have been revised and data has been collected then categorized. The indications for this mode of delivery: suspected fetal growth impairment, fetal distress, preeclampsia/eclampsia, pregnancy duration in weeks or more pre-partum hemorrhage, cephalopelvic disproportion, dystocia, failure of progress, multiple pregnancy, suspected/imminent uterine rupture, breech or other malpresentations, previous cesarean delivery, failed induction of labor, tubal ligation, sterilization, maternal request genital herpes, extensive condyloma, any other obstetric complication, any other fetal indication or any other maternal medical complication. Results 15808 women delivered in the hospital during the study period, The CS rate was 58.04%. According to the Robson classification, Group5 and Group 10 were the most represented groups (31.72% and 29.91% of population, respectively). The major contributors to the CS rate were group 5 (27.10%), group10 (14.02%).The most commonly reported indications for CS included past CS, suspected fetal distress, preeclampsia, eclampsia.These suggested the need for further discussion on CS practices Conclusion This study provides an example on how the WHO manual for Robson classification can be used in an action-oriented manner for developing recommendations for improving the QoC, and the quality of data collected.

Prevalence of insufficient iodine intake in pregnancy worldwide: a systematic review and meta-analysis.

Iodine deficiency in pregnant women is related to impaired foetal growth and development. The objective of this study was to estimate the prevalence of insufficient iodine intake in pregnant women from different regions of the world. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, five electronic databases and Google Scholar grey literature were searched until 10 April 2021. Two reviewers independently conducted article selection, data extraction, and assessment of the risk of bias. Meta-analyses with random effects, subgroup analyses, and meta-regressions were performed. In total, 4639 observational articles were found, with 61 eligible for inclusion. The population consisted of 163,021 pregnant women adults and adolescents, and the overall prevalence of insufficient iodine intake was 53% (95% confidence interval [CI]: 47-60; I2 = 99.8%). Pregnant women who live in insufficient iodine status country had a higher prevalence (86%; 95% CI: 78-93; I² =97.0%) of inadequate iodine nutritional status than to those living in country considered sufficient (51%; 95% IC: 45-57; I² = 99.8%). Despite the progress in iodine fortification policies and periodic monitoring of the iodine nutritional status of the population worldwide, salt iodination alone may not be sufficient to provide adequate iodine status to pregnant women. Thus, other actions may be necessary to improve the nutritional clinical care of pregnant group.

Comparison of Akt Expression in the Cerebrum and Cerebellum of Newborn Mus musculus Exposed to Physical Stress and Psychological Stress During Pregnancy

Introduction: Prenatal stress prevalence is almost half of the population of pregnant women worldwide.Stress will stimulate glucocorticoids which can disrupt the PI3K-Akt cascade. PI3K-Akt deficiency willcause impaired fetal brain growth and development.Objective: To compare the Akt expression in the cerebrum and cerebellum of newborn Mus musculusexposed to physical stress, psychological stress, the combination of psychological and physical stress, andwithout stress exposure. Method: This study was experimental laboratory research. Twenty-four female mice were used as samplesand divided into four groups: physical stress exposure group, psychological stress exposure group, thecombination of psychological and physical stress exposure group, and control group. Akt expression wastested by immunohistochemistry (IHC) staining. Statistical analysis used the One Way Anova and KruskalWallis test.

522Occupational chemical exposures in pregnancy and fetal growth: evidence from the Born in Bradford Study

Abstract Background Understanding the effect of occupational exposure to endocrine disrupting chemicals (EDC) during pregnancy on inadequate fetal growth as measured by small-for-gestational age (SGA) and as measured by percentage of optimal birth weight (POBW) is not well understood. Methods We studied 4142 pregnant women who were in paid employment during pregnancy and participated in a population-based, prospective 2007–2011 birth cohort study, the Born in Bradford Study, with an estimated participation of 80%. Job titles were coded at 26–28 weeks' gestation at a 4-digit level according to 353 unit groups in the 2000 UK Standard Occupational Classification. They were then linked to expert judgment on exposure to each of ten EDC groups as assessed through a job exposure matrix. A modified Poisson regression was used to assess the risk of POBW and SGA associated with an increased risk of chemical exposures. Results The frequency of POBW<85 significantly increased for mothers exposed to pesticides [adjusted risk ratio (RRadj) 3.72, 95% confidence interval (CI) 1.40–9.91] and phthalates (RRadj 3.71, 95% CI 1.62–8.51). There was a 5-fold increase risk of SGA for mothers exposed to pesticides (RRadj 5.45, 95% CI 1.59–18.62). Veterinary nurses and horticultural trades were most frequently associated with exposure to pesticides while hairdressers, beauticians, and printing machine minders were associated with phthalates. Conclusion Maternal occupational exposure to estimated concentrations of pesticides and phthalates is associated with impaired fetal growth. Key messages The POBW is useful in measuring inadequate fetal growth in study of occupational chemical exposures.

Вплив вітаміну D на перебіг вагітності, розвиток плода та здоров’я дітей у постнатальному періоді

Значне поширення і негативні наслідки недостатності і дефіциту вітаміну D становлять проблему для широкого кола фахівців у всьому світі. Вагітні та жінки репродуктивного віку, діти і підлітки належать до груп ризику стосовно виникнення дефіциту вітаміну D, що підтверджується результатами багатьох епідеміологічних досліджень. Вітамін D відіграє важливу роль у забезпеченні системи «мати — плацента — плід», включаючи імплантацію, формування плаценти, ембріогенез, інтра- і постнатальний періоди. Аналіз літератури свідчить про негативний вплив низьких рівнів 25(ОН)D на перебіг та наслідки вагітності, розвиток плода та здоров’я новонароджених. Дефіцит вітаміну D поєднується з такими станами, як плацентарна недостатність, невиношування вагітності, прееклампсія, гестаційний цукровий діабет, синдром затримки росту плода, низька маса тіла при народженні, підвищений ризик автоімунних захворювань. Потенційні механізми, які лежать в основі таких взаємозв’язків, містять метаболічні, імуномодулюючі та протизапальні ефекти вітаміну D. Окремий інтерес становлять епігенетичні модифікації і, як наслідок, фетальне програмування, асоційоване з рівнем 25(ОН)D. На сьогодні в літературі активно обговорюються питання профілактики недостатності вітаміну D серед жінок різних етнічних груп, дози й оптимальні терміни початку терапії у вагітних, тривалість застосування і вплив на вагітність і пологи. Корекція недостатності вітаміну D сприяє поліпшенню результатів вагітності та збереженню здоров’я дітей. У той же час результати досліджень залишаються суперечливими і не дозволяють однозначно оцінити ефективні дози і безпеку вітаміну D. Необхідні подальші рандомізовані клінічні дослідження з метою вивчення терапевтичного потенціалу вітаміну D і створення чітких рекомендацій стосовно ліквідації його дефіциту у вагітних і жінок у період лактації.

Maternal Undernutrition during Pregnancy Alters Amino Acid Metabolism and Gene Expression Associated with Energy Metabolism and Angiogenesis in Fetal Calf Muscle.

To elucidate the mechanisms underlying maternal undernutrition (MUN)-induced fetal skeletal muscle growth impairment in cattle, the longissimus thoracis muscle of Japanese Black fetal calves at 8.5 months in utero was analyzed by an integrative approach with metabolomics and transcriptomics. The pregnant cows were fed on 60% (low-nutrition, LN) or 120% (high-nutrition, HN) of their overall nutritional requirement during gestation. MUN markedly decreased the bodyweight and muscle weight of the fetus. The levels of amino acids (AAs) and arginine-related metabolites including glutamine, gamma-aminobutyric acid (GABA), and putrescine were higher in the LN group than those in the HN group. Metabolite set enrichment analysis revealed that the highly different metabolites were associated with the metabolic pathways of pyrimidine, glutathione, and AAs such as arginine and glutamate, suggesting that MUN resulted in AA accumulation rather than protein accumulation. The mRNA expression levels of energy metabolism-associated genes, such as PRKAA1, ANGPTL4, APLNR, CPT1B, NOS2, NOS3, UCP2, and glycolytic genes were lower in the LN group than in the HN group. The gene ontology/pathway analysis revealed that the downregulated genes in the LN group were associated with glucose metabolism, angiogenesis, HIF-1 signaling, PI3K-Akt signaling, pentose phosphate, and insulin signaling pathways. Thus, MUN altered the levels of AAs and expression of genes associated with energy expenditure, glucose homeostasis, and angiogenesis in the fetal muscle.

Exposure to PM₂.₅ during pregnancy and ultrasound parameters of fetal growth in Massachusetts, USA

BACKGROUND AND AIM: Prior studies have examined the association between particulate matter less than 2.5 µm (PM₂.₅) and fetal growth with inconsistent results. In this study, we examined the association between PM₂.₅ exposure in the first 16 weeks of pregnancy and fetal growth in a pregnancy cohort using routine ultrasound measurements and spatiotemporally resolved PM₂.₅ in Massachusetts, USA. METHODS: We used prenatal and obstetric data from 8,811 pregnancies that delivered at Beth Israel Deaconess Medical Center from 2011-2016. There were 21,874, 21,788, 21,776, and 21,738 ultrasound measurements for biparietal diameter (BPD), head circumference (HC), femur length (FL), and abdominal circumference (AC), respectively. We used generalized additive mixed models to examine the exposure-response relationship between PM₂.₅ in the first 16 weeks of pregnancy and fetal ultrasound parameters in distinct developmental windows (weeks 14-20, weeks 21-26, weeks 27-32, weeks 33+) adjusted for sociodemographic characteristics, maternal comorbidities, season, and temperature. RESULTS:For all fetal ultrasound parameters, we observed a nonlinear exposure-response relationship in gestational weeks 14-20. Below 7 µg/m³, higher PM₂.₅ exposure was associated with reduced ultrasound measurements, while at higher concentrations, it was either not associated with fetal growth (BPD and AC) or associated with larger ultrasound measurements (HC and FL). After week 27, PM₂.₅ exposure was linearly associated with reduced BPD and AC, but these associations were weaker than those earlier in pregnancy. For example, an increase in PM₂.₅ from 0 to 7 µg/m³ was associated with BPD z-score reductions of 0.3, 0.2, and 0.1 in weeks 14-20, 27-32, and 33+, respectively. CONCLUSIONS:Gestational exposure to PM₂.₅ was associated with impaired fetal growth at levels below the current national standards, where early pregnancy appears to be a particularly sensitive window of development during which a fetus is susceptible. Nonlinearities in the exposure-response relationship in weeks 14-20 could potentially be attributed to live-birth bias. KEYWORDS: air pollution, causal inference, particulate matter, pregnancy outcomes

Association between low fetal fraction in cell-free DNA testing and adverse pregnancy outcome: A systematic review.

ObjectiveLow fetal fraction (LFF) in prenatal cell‐free DNA (cfDNA) testing is an important cause of test failure and no‐call results. LFF might reflect early abnormal placentation and therefore be associated with adverse pregnancy outcome. Here, we review the available literature on the relationship between LFF in cfDNA testing and adverse pregnancy outcome.MethodA systematic literature search was conducted in MEDLINE and EMBASE up to November 1, 2020.ResultsFive studies met the criteria for inclusion; all were retrospective observational cohort studies. The cohort sizes ranged from 370 to 6375 pregnancies, with all tests performed in the first trimester or early second trimester. A 4% cutoff for LFF was used in two studies, two studies used the 5th and 25th percentiles, respectively, and one study used a variety of cutoff values for LFF. LFF in prenatal cfDNA testing was observed to be associated with hypertensive disease of pregnancy, small for gestational age neonates, and preterm birth. Conflicting results were found regarding the association between LFF and gestational diabetes mellitus.ConclusionsLFF in cfDNA testing is associated with adverse pregnancy outcome,specifically pregnancy‐related hypertensive disorders, preterm birth, and impaired fetal growth related to placental dysfunction. Since the available evidence is limited, a large prospective cohort study on the relationship between fetal fraction and pregnancy outcomes is needed.

Prenatal household air pollutant exposure is associated with reduced size and gestational age at birth among a cohort of Ghanaian infants

BackgroundLow birth weight and prematurity are important risk factors for death and disability, and may be affected by prenatal exposure to household air pollution (HAP). MethodsWe investigate associations between maternal exposure to carbon monoxide (CO) during pregnancy and birth outcomes (birth weight, birth length, head circumference, gestational age, low birth weight, small for gestational age, and preterm birth) among 1288 live-born infants in the Ghana Randomized Air Pollution and Health Study (GRAPHS). We evaluate whether evidence of malaria during pregnancy, as determined by placental histopathology, modifies these associations. ResultsWe observed effects of CO on birth weight, birth length, and gestational age that were modified by placental malarial status. Among infants from pregnancies without evidence of placental malaria, each 1 ppm increase in CO was associated with reduced birth weight (−53.4 g [95% CI: −84.8, −21.9 g]), birth length (−0.3 cm [−0.6, −0.1 cm]), gestational age (−1.0 days [−1.8, −0.2 days]), and weight-for-age Z score (−0.08 standard deviations [−0.16, −0.01 standard deviations]). These associations were not observed in pregnancies with evidence of placental malaria. Each 1 ppm increase in maternal exposure to CO was associated with elevated odds of low birth weight (LBW, OR 1.14 [0.97, 1.33]) and small for gestational age (SGA, OR 1.14 [0.98, 1.32]) among all infants. ConclusionsEven modest reductions in exposure to HAP among pregnant women could yield substantial public health benefits, underscoring a need for interventions to effectively reduce exposure. Adverse associations with HAP were discernible only among those without evidence of placental malaria, a key driver of impaired fetal growth in this malaria-endemic area.

Prevalence of Anemia Among Women of Reproductive Age in Rural Haryana, India

ObjectivesAnemia is a public health problem in women of reproductive age in many low- and medium-income countries including India. Maternal anemia can cause low birth weight, impaired fetal growth, and preterm birth. We assessed the baseline prevalence of anemia, iron deficiency (ID), iron deficiency anemia (IDA), and inflammation using c-reactive protein (CRP) among non-pregnant, non-lactating women of reproductive age living in the Ambala District, Haryana, India prior to the start of a wheat flour fortification program. MethodsWe conducted a multistage cluster probability household and biomarker survey and analyzed venous blood samples from non-pregnant, non-lactating women aged 18–49 years residing in rural areas of two subdistricts in the Ambala District. Factors of interest were: anemia, hemoglobin < 12.0 g/dL; ID, serum ferritin < 15μg/L; IDA, presence of both anemia and iron deficiency; inflammation, CRP > 5 mg/L. We used the BRINDA regression adjustment for ferritin to account for inflammation. Prevalence and 95% confidence intervals (CI) for anemia, ID, IDA, and CRP were estimated. ResultsAmong 775 non-pregnant, non-lactating women of reproductive age, 54.3% (95% CI; 50.7, 58.0) had anemia, 86.9% (95% CI; 84.3, 89.2) were iron deficient, and 15.1% (95% CI; 12.5, 18.1) had inflammation. Among those with anemia, 58.2% (95 CI; 54.3, 62.0) had iron deficiency anemia. ConclusionsAnemia, iron deficiency, and iron deficiency anemia among non-pregnant, non-lactating women of reproductive age in Haryana are significant public health concerns. The findings from the survey helped quantify the burden of inadequate iron intake and informed the Haryana government’s prevention strategy aimed at reducing micronutrient deficiencies through a wheat flour fortification program. Funding SourcesCenters for Disease Control and Prevention.

Impact of Fusarium-Derived Mycoestrogens on Female Reproduction: A Systematic Review.

Contamination of the world’s food supply and animal feed with mycotoxins is a growing concern as global temperatures rise and promote the growth of fungus. Zearalenone (ZEN), an estrogenic mycotoxin produced by Fusarium fungi, is a common contaminant of cereal grains and has also been detected at lower levels in meat, milk, and spices. ZEN’s synthetic derivative, zeranol, is used as a growth promoter in United States (US) and Canadian beef production. Experimental research suggests that ZEN and zeranol disrupt the endocrine and reproductive systems, leading to infertility, polycystic ovarian syndrome-like phenotypes, pregnancy loss, and low birth weight. With widespread human dietary exposure and growing experimental evidence of endocrine-disrupting properties, a comprehensive review of the impact of ZEN, zeranol, and their metabolites on the female reproductive system is warranted. The objective of this systematic review was to summarize the in vitro, in vivo, and epidemiological literature and evaluate the potential impact of ZEN, zeranol, and their metabolites (commonly referred to as mycoestrogens) on female reproductive outcomes. We conducted a systematic review (PROSPERO registration CRD42020166469) of the literature (2000–2020) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources were primary literature published in English obtained from searching PubMed, Web of Science, and Scopus. The ToxR tool was applied to assess risk of bias. In vitro and in vivo studies (n = 104) were identified and, overall, evidence consistently supported adverse effects of mycoestrogens on physiological processes, organs, and tissues associated with female reproduction. In non-pregnant animals, mycoestrogens alter follicular profiles in the ovary, disrupt estrus cycling, and increase myometrium thickness. Furthermore, during pregnancy, mycoestrogen exposure contributes to placental hemorrhage, stillbirth, and impaired fetal growth. No epidemiological studies fitting the inclusion criteria were identified.

Lower birth weight-for-age and length-for-age z-scores in infants with in-utero HIV and ART exposure: a prospective study in Cape Town, South Africa

BackgroundSuccessful scale-up of antiretroviral therapy (ART) during pregnancy has minimized infant HIV acquisition, and over 1 million infants are born HIV-exposed but uninfected (HEU), with an increasing proportion also exposed in utero to maternal ART. While benefits of ART in pregnancy outweigh risks, some studies have reported associations between in utero ART exposure and impaired fetal growth, highlighting the need to identify the safest ART regimens for use in pregnancy.MethodsWe compared birth anthropometrics of infants who were HEU with those HIV-unexposed (HU) in Cape Town, South Africa. Pregnant women had gestational age assessed by ultrasound at enrolment. Women living with HIV were on ART (predominately tenofovir-emtricitabine-efavirenz) either prior to conception or initiated during pregnancy. Birth weights and lengths were converted to weight-for-age (WAZ) and length-for-age (LAZ) z-scores using Intergrowth-21st software. Linear regression was used to compare mean z-scores adjusting for maternal and pregnancy characteristics.ResultsAmong 888 infants, 49% (n = 431) were HEU and 51% (n = 457) HU. Of 431 HEU infants, 62% (n = 268) were exposed to HIV and antiretrovirals (ARVs) from conception and 38% (n = 163) were exposed to ARVs during gestation but after conception (median fetal ARV exposure of 21 weeks [IQR; 17–26]). In univariable analysis, infants who were HEU had lower mean WAZ compared with HU [β = − 0.15 (95% Confidence Interval (CI): − 0.28, − 0.020)]. After adjustment for maternal age, gravidity, alcohol use, marital and employment status the effect remained [adjusted β − 0.14 (95%CI: − 0.28, − 0.01]. Similar differences were noted for mean LAZ in univariable [β − 0.20 (95%CI: − 0.42, − 0.01] but not multivariable analyses [adjusted β − 0.18 (95%CI: − 0.41, + 0.04] after adjusting for the same variables. Mean WAZ and LAZ did not vary by in utero ARV exposure duration among infants who were HEU.ConclusionIn a cohort with high prevalence of ART exposure in pregnancy, infants who were HEU had lower birth WAZ compared with those HU. Studies designed to identify the mechanisms and clinical significance of these disparities, and to establish the safest ART for use in pregnancy are urgently needed.

Sex-Biased lncRNA Signature in Fetal Growth Restriction (FGR).

Impaired fetal growth is one of the most important causes of prematurity, stillbirth and infant mortality. The pathogenesis of idiopathic fetal growth restriction (FGR) is poorly understood but is thought to be multifactorial and comprise a range of genetic causes. This research aimed to investigate non-coding RNAs (lncRNAs) in the placentas of male and female fetuses affected by FGR. RNA-Seq data were analyzed to detect lncRNAs, their potential target genes and circular RNAs (circRNAs); a differential analysis was also performed. The multilevel bioinformatic analysis enabled the detection of 23,137 placental lncRNAs and 4263 of them were classified as novel. In FGR-affected female fetuses’ placentas (ff-FGR), among 19 transcriptionally active regions (TARs), five differentially expressed lncRNAs (DELs) and 12 differentially expressed protein-coding genes (DEGs) were identified. Within 232 differentially expressed TARs identified in male fetuses (mf-FGR), 33 encompassed novel and 176 known lncRNAs, and 52 DEGs were upregulated, while 180 revealed decreased expression. In ff-FGR ACTA2-AS1, lncRNA expression was significantly correlated with five DEGs, and in mf-FGR, 25 TARs were associated with DELs correlated with 157 unique DEGs. Backsplicing circRNA processes were detected in the range of H19 lncRNA, in both ff- and mf-FGR placentas. The performed global lncRNAs characteristics in terms of fetal sex showed dysregulation of DELs, DEGs and circRNAs that may affect fetus growth and pregnancy outcomes. In female placentas, DELs and DEGs were associated mainly with the vasculature, while in male placentas, disturbed expression predominantly affected immune processes.

Recommendations for Clinical Practice, Research, and Policy to Address the Effects of the COVID-19 Pandemic on Anxiety Symptoms in Immigrant and U.S.-Born Latina Mothers

More than one-half of pregnant women experience some level of anxiety symptoms (Meades & Ayers, 2011), with 20%–35% of women reporting high anxiety or evidence of an anxiety disorder (Fawcett, Fairbrother, Cox, White, & Fawcett, 2019; Koelewijn, Sluijs, & Vrijkotte, 2017; Nakić Radoš, Tadinac, & Herman, 2018). Experiencing anxiety during pregnancy is associated with pregnancy complications (Kurki, Hiilesmaa, Raitasalo, Mattila, & Ylikorkala, 2000; Tomfohr-Madsen et al., 2019), postnatal depressive symptoms (Coelho, Murray, Royal-Lawson, & Cooper, 2011), adverse fetal and neonatal development—including preterm birth, low birth weight (Rondó et al., 2003; Rose, Pana, & Premji, 2016; Uguz, Yakut, Aydogan, Bayman, & Gezginc, 2019), and impaired fetal growth (Henrichs et al., 2010)—and longer term adverse developmental outcomes (Irwin, Davis, Hobel, Coussons-Read, & Schetter, 2020).

Factors Affecting Anemia in Pregnant Women in Ratna Clinic

Anemia in the first trimester of pregnancy can cause abortion, missed abortion and congenital abnormalities, in the second trimester it causes premature labor, antepartum bleeding, impaired fetal growth in utero, asphyxia, LBW, low IQ and even infant death. the research objective was to determine the factors that influence anemia in pregnant women at Ratna Clinic.&#x0D; This research is an analytic survey with a cross sectional research design. The dependent variable used was the incidence of anemia and the independent variables were age, parity, ANC visit, knowledge and opinion. The population of this study were all pregnant women who were in the clinic ratna 123 people. The sample in this study amounted to 55 respondents. The sampling technique uses the Accidental Sampling technique.&#x0D; The results of the study on 55 respondents, most of whom did not experience anemia (normal) as many as 33 respondents (60%) and a small proportion had mild anemia as many as 6 respondents (10.9%).&#x0D; The conclusion from the research results is that there is no relationship between age, parity on anemia in pregnant women at the Kuta Baro Aceh Besar Community Health Center and ANC visits (p-value 0.002), knowledge (p-value 0.001) and income (0.009) on anemia in pregnant women at Ratna's Clinic. After conducting multivariate analysis, it was found that the ANC visit variable had the most influence on the incidence of anemia in pregnant women. The clinic leadership should make a policy and improve the quality of services for pregnant women by implementing and providing information to pregnant women about anemia prevention.

Intrauterine growth retardation after laparoscopic Roux-en-Y gastric bypass — clinical presentation and literature review

Bariatric surgery is associated with a higher risk of intrauterine growth retardation (IUGR) and small for gestational age neonates. We present two examples of IUGR after laparoscopic Roux-en-Y gastric bypass, both associated with excessive restriction in patients caloric intake, one due to obstetrician's indications and the other resulting from patient's anxiety of weight gain in pregnancy. IUGR was observed accordingly in the 35th and 28th week of pregnancy. The first patient had an urgent cesarean section due to pathological cardiotocography tracings in the 35th week of pregnancy, with the newborn's weight of 1690 g (< 1st percentile). The second patient, admitted in the 28th week with suspected IUGR, had an elective cesarean section in the 36th week, with the newborn's weight of 2095 g (5th percentile). Although malabsorptive mechanisms are known to be involved in the impaired fetal growth after bariatric surgery, patients' and obstetricians' adherence to nutrition and supplementation regimen are of utmost importance. The problem of optimum daily caloric intake, vitamin and micronutrients supplementation in pregnancies after bariatric surgery is presently discussed in the literature. Optimum care and advice for bariatric patients have to be diversified as malabsorptive and restrictive operations lead to changes in metabolism, nutrition and hormonal balance.

Soluble guanylate cyclase stimulation in late gestation does not mitigate asymmetric intrauterine growth restriction or cardiovascular risk induced by placental ischemia in the rat.

Stimulation of soluble guanylate cyclase (sGC) improves fetal growth at gestational day 20 in the reduced uterine perfusion pressure (RUPP) rat model of placental ischemia suggesting a role for sGC in the etiology of intrauterine growth restriction (IUGR). This study tested the hypothesis that stimulation of sGC until birth attenuates asymmetric IUGR mitigating increased cardiovascular risk in offspring. Sham or RUPP surgery was performed at gestational day 14 (G14); vehicle or the sGC stimulator Riociguat (10 mg/kg/day sc) was administered G14 until birth. Birth weight was reduced in offspring from RUPP [intrauterine growth restricted (IUGR)], sGC RUPP (sGC IUGR), and sGC Sham (sGC Control) compared with Sham (Control). Crown circumference was maintained, but abdominal circumference was reduced in IUGR and sGC IUGR compared with Control indicative of asymmetrical growth. Gestational length was prolonged in sGC RUPP, and survival at birth was reduced in sGC IUGR. Probability of survival to postnatal day 2 was also significantly reduced in IUGR and sGC IUGR versus Control and in sGC IUGR versus IUGR. At 4 mo of age, blood pressure was increased in male IUGR and sGC IUGR but not male sGC Control born with symmetrical IUGR. Global longitudinal strain was increased and stroke volume was decreased in male IUGR and sGC IUGR compared with Control. Thus late gestational stimulation of sGC does not mitigate asymmetric IUGR or increased cardiovascular risk in male sGC IUGR. Furthermore, late gestational stimulation of sGC is associated with symmetrical growth restriction in sGC Control implicating contraindications in normal pregnancy.NEW & NOTEWORTHY The importance of the soluble guanylate cyclase-cGMP pathway in a rat model of placental ischemia differs during critical windows of development, implicating other factors may be critical mediators of impaired fetal growth in the final stages of gestation. Moreover, increased blood pressure at 4 mo of age in male intrauterine growth restriction offspring is associated with impaired cardiac function including an increase in global longitudinal strain in conjunction with a decrease in stroke volume, ejection fraction, and cardiac output.

Umbilical cord artery atresia

Umbilical cord has two arteries and one vein. The absence of one artery is referred to as single umbilical artery which could be because of primary agenesis of umbilical artery or atrophy or secondary atresia of the previously normally developed umbilical artery. The former is associated with foetal malformations and later can lead to haemodynamic changes in foetal circulation resulting in impaired foetal growth and its consequences. Histopathology of the umbilical cord is the gold standard for confirmation of the diagnosis.

Risk Profiling of the Solomon Technique versus Selective Technique of Fetoscopic Laser Surgery for Twin–Twin Transfusion Syndrome

We evaluated the outcomes and adverse events after fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS) using the Solomon technique in comparison to the selective technique. A retrospective analysis of a single-center consecutive cohort of FLS-treated TTTS using the selective (January 2010 to July 2014) and Solomon (August 2014 to December 2017) techniques was performed. Among 395 cases, 227 underwent selective coagulation and 168 underwent the Solomon technique. The incidence rates of recurrent TTTS (Solomon vs. selective: 0% vs. .9%, p = .510) and twin anemia-polycythemia sequence (.6% vs. .4%, p = .670) were very low in both groups. The incidence rates of placental abruption (Solomon vs. selective: 10.7% vs. 3.5%, p = .007) and preterm premature rupture of the membranes (pPROM) with subsequent delivery before 32 weeks (20.2% vs. 7.1%, p < .001) were higher in the Solomon group. The median birth recipient weight was significantly smaller in the Solomon group (1790 g vs. 1933 g, p = .049). The rate of survival of at least one twin was significantly higher in the Solomon group (98.2% vs. 93.8%, p = .046). The Solomon technique and total laser energy were significant risk factors for pPROM (odds ratio: 2.64, 1.07, 95% CI [1.32, 5.28], [1.01, 1.13], p = .006, p = .014, respectively). These findings suggest that the Solomon technique led to superior survival outcomes but increased risks of placental abruption, pPROM and fetal growth impairment. Total laser energy was associated with the occurrence of pPROM. Close attention to adverse events is required for perinatal management after FLS to treat TTTS using the Solomon technique.

Structural Changes of the Human Fetal Brain During the COVID-19 Pandemic

Background: Elevated maternal psychological distress during pregnancy is linked to adverse short- and long-term outcomes in the offspring. The potential deleterious effects of intensified levels of maternal distress during the COVID-19 pandemic on the developing fetal brain are currently unknown.Methods: We prospectively enrolled 202 pregnant women: 65 with negative COVID-19 diagnoses during the pandemic who underwent 92 fetal MRI scans, and 137 pre-pandemic controls who had 182 MRI scans. Multi-plane, multi-phase single shot fast spin echo T2-weighted images were acquired on a GE 1.5T MRI Scanner. High-resolution 3D models of the fetal brains were reconstructed, and volumes of six brain tissue types were calculated: cortical gray matter (CGM), white matter (WM), cerebellum, deep gray matter (DGM), brainstem, and hippocampus. Cortical folding measures, including brain surface area, local gyrification index (LGI), and sulcal depth were determined. At each MRI scan, maternal distress was assessed using validated stress, anxiety and depression scales. Generalized estimating equations (GEEs) were utilized to compare maternal distress measures, brain volume and cortical folding differences between pandemic and pre-pandemic cohorts.Findings: Stress and depression scores were significantly higher in the pandemic cohort (14.2 vs. 10.4 for stress; 5.9 vs. 4.2 for depression; pConclusion: We relate heightened maternal psychological distress with impaired fetal brain growth and delayed cerebral cortical gyrification in COVID-19 pandemic era pregnancies. The potential long-term neurodevelopmental consequences of altered fetal brain development in COVID-era pregnancies complicated by elevated maternal distress merit further study.Funding: This study was funded by National Institutes of Health (NHLBI R01 HL116585-01), Intellectual and Developmental Disabilities Research Center (IDDRC), and A. James & Alice B. Clark Foundation.Declaration of Interest: None to declare. Ethical Approval: These studies received ethical approval from Children's National Hospital Institutional Review Board (Protocol: 1373 and 14257).