Incidence Of Fetal Growth Restriction Research Articles

Reduced maternal expression of adrenomedullin disrupts fertility, placentation, and fetal growth in mice

Adrenomedullin (AM) is a multifunctional peptide vasodilator that is essential for life. Plasma AM expression dramatically increases during pregnancy, and alterations in its levels are associated with complications of pregnancy including fetal growth restriction (FGR) and preeclampsia. Using AM+/- female mice with genetically reduced AM expression, we demonstrate that fetal growth and placental development are seriously compromised by this modest decrease in expression. AM+/- female mice had reduced fertility characterized by FGR. The incidence of FGR was also influenced by the genotype of the embryo, since AM-/- embryos were more often affected than either AM+/- or AM+/+ embryos. We demonstrate that fetal trophoblast cells and the maternal uterine wall have coordinated and localized increases in AM gene expression at the time of implantation. Placentas from growth-restricted embryos showed defects in trophoblast cell invasion, similar to defects that underlie human preeclampsia and placenta accreta. Our data provide a genetic in vivo model to implicate both maternal and, to a lesser extent, embryonic levels of AM in the processes of implantation, placentation, and subsequent fetal growth. This study provides the first genetic evidence to our knowledge to suggest that a modest reduction in human AM expression during pregnancy may have an unfavorable impact on reproduction.

P-896: Incidence of fetal growth restriction in single pregnancies after ART cycles

Defective embryo implantation may result in early pregnancy loss; or an abnormally prolonged inflammatory phase leading to an abnormal trophoblastic invasion with the consequent risk of developing fetal growth restriction (FGR), preeclampsia and placental abruption. We have previously published alterations in uterine perfusion in certain subgroups of infertile patients. High impedance to blood flow in uterine arteries during pregnancy is associated with poorer obstetric outcome. The incidence of FGR in the general population is reported to be between 5-10%.

The umbilical coiling index, a review of the literature

Our aim was to review the literature on umbilical cord coiling. Relevant articles in English published between 1966 and 2003 were retrieved by a Medline search and cross-referencing. The normal umbilical cord coiling index (UCI) is 0.17 (?± 0.009) spirals completed per cm. Abnormal cord coiling, i.e. UCI <?10th centile (?<?0.07) or >?90th centile (?>?0.30) is associated with adverse pregnancy outcome. Hypocoiling of the cord is associated with increased incidence of fetal demise, intrapartum fetal heart rate decelerations, operative delivery for fetal distress, anatomic-karyotypic abnormalities and chorio-amnionitis. Hypercoiling of the cord is associated with increased incidence of fetal growth restriction, intrapartum fetal heart rate decelerations, vascular thrombosis and cord stenosis. It is not clear whether abnormal coiling is actually a cause of pathology, or merely one of the sequelae, or both. We discuss the theories involving the cause of cord coiling, and the consequences of the degree of cord coiling on blood flow through the umbilical vessels. In the future ultrasonographic evaluation of the umbilical cord and the UCI may become an integral part of fetal assessment in high-risk pregnancies.

The umbilical coiling index, a review of the literature

Our aim was to review the literature on umbilical cord coiling. Relevant articles in English published between 1966 and 2003 were retrieved by a Medline search and cross-referencing. The normal umbilical cord coiling index (UCI) is 0.17 (+/- 0.009) spirals completed per cm. Abnormal cord coiling, i.e. UCI <10th centile (<0.07) or >90th centile (>0.30) is associated with adverse pregnancy outcome. Hypocoiling of the cord is associated with increased incidence of fetal demise, intrapartum fetal heart rate decelerations, operative delivery for fetal distress, anatomic-karyotypic abnormalities and chorio-amnionitis. Hypercoiling of the cord is associated with increased incidence of fetal growth restriction, intrapartum fetal heart rate decelerations, vascular thrombosis and cord stenosis. It is not clear whether abnormal coiling is actually a cause of pathology, or merely one of the sequelae, or both. We discuss the theories involving the cause of cord coiling, and the consequences of the degree of cord coiling on blood flow through the umbilical vessels. In the future ultrasonographic evaluation of the umbilical cord and the UCI may become an integral part of fetal assessment in high-risk pregnancies.

Pregnancy in renal transplant recipients: the Royal Free Hospital experience.

For women with end-stage renal failure of child-bearing age, renal transplantation offers a chance to start a family. Pregnancies in renal transplant recipients involve risks for graft and fetus, and need to be carefully managed. To identify graft, fetal and maternal outcomes in our patients, and compare our results with those of the large national transplant registries. Retrospective case-note review. We assessed the outcomes of 48 pregnancies in 24 renal transplant recipients. Obstetric data and renal parameters were examined in 27-30 pregnancies that progressed to delivery. Mean time from transplantation to pregnancy was 6.5 years, with an unfavourable outcome in patients who conceived within 1 year. There was a 41% incidence of fetal growth restriction (FGR), and 33% of infants were small for gestational age. FGR was associated with maternal hypertension, a pre-pregnancy serum creatinine (SCr) >/= 133 micro mol/l (1.5 mg/dl), calcineurin inhibitors and the use of cardioselective beta blockers. Two patients with pre-pregnancy SCr > 200 micro mol/l lost their grafts within 3 years of delivery. A permanent significant decline in graft function occurred in 20%, by 6 months post delivery. FGR with SGA infants occurs frequently. Atenolol should be avoided in pregnancy and Metoprolol should not be combined with calcineurin inhibitors. Pregnancy appeared to have a deleterious effect on graft function in patients with SCr > 155 micro mol (1.75 mg/dl). Patients with pre-pregnancy SCr 200 micro mol/l are at greatest risk.

Role of diltiazem in pregnant women with chronic renal disease

Objective: To determine whether diltiazem therapy decreases proteinuria during pregnancy in women with chronic renal disease, resulting in decreased risk of pre-eclampsia, preterm delivery and intrauterine fetal growth restriction. Methods: We undertook retrospective data collection by chart review of pregnant women with chronic renal disease. Women treated with and without diltiazem were compared by independent t test analysis. Results: Seven women were eligible for inclusion in the study. Individual patient trends revealed decreased or attenuated increase in proteinuria across gestation with diltiazem therapy. Mean arterial pressure was also decreased in the therapy group compared to increased pressure in the third trimester in the group with no therapy. The incidence of fetal growth restriction and need for labor induction were lower in the diltiazem-treated group. Conclusions: Diltiazem, a non-dihydropyridine calcium channel antagonist, decreases proteinuria and preserves renal structure and function and should be considered an alternative to angiotensin converting enzyme inhibitors in pregnancy in women with chronic renal disease.

Role of diltiazem in pregnant women with chronic renal disease

Objective: To determine whether diltiazem therapy decreases proteinuria during pregnancy in women with chronic renal disease, resulting in decreased risk of pre-eclampsia, preterm delivery and intrauterinefetal growth restriction.Methods: We undertook retrospective data collection by chart review of pregnant women with chronic renal disease. Women treated with and without diltiazem were comparedby independent t test analysis.Results: Seven women were eligible for inclusion in the study. Individual patient trends revealed decreased or attenuated increase in proteinuria acrossgestation with diltiazem therapy. Mean arterial pressure was also decreased in the therapy group compared to increased pressure in the third trimester in the group with no therapy. The incidence of fetalgrowth restriction and need for labor induction were lower in the diltiazem-treated group.Conclusions: Diltiazem, a non-dihydropyridine calcium channel antagonist, decreases proteinuria andpreserves renal structure and function and should be considered an alternative to angiotensin converting enzyme inhibitors in pregnancy in women with chronic renal disease.

Perinatal risks associated with borderline amniotic fluid index

Objective: Our purpose was to determine whether a borderline amniotic fluid index observed during antepartum testing confers a significant risk of adverse perinatal outcome. Study Design: We conducted a retrospective review of all patients entering antepartum testing at Los Angeles County–University of Southern California Women’s and Children’s Hospital during a 4-month period beginning January 1, 1996. Women with singleton pregnancies who underwent antepartum testing within 1 week of delivery and who were delivered at our institution were identified for our study. An amniotic fluid index >5 and <10 cm was defined as “borderline” and an amniotic fluid index of 10 to 24 cm was considered normal. Markers of adverse perinatal outcome included intrapartum fetal distress, 5-minute Apgar score <7, meconium-stained amniotic fluid, and intrauterine growth restriction. Results: There was a 2-fold increase in the incidence of adverse perinatal outcome among the women with borderline amniotic fluid index in comparison with control subjects with normal amniotic fluid volume. This difference reflected a 4-fold increase in the incidence of fetal growth restriction among women with a borderline amniotic fluid index. Conclusions: A borderline amniotic fluid index observed in antepartum testing is associated with an increased risk of intrauterine growth restriction and overall adverse perinatal outcome. These observations suggest that borderline amniotic fluid index merits twice-weekly antepartum testing. (Am J Obstet Gynecol 1999;180:1461-3.)

Etiologies of fetal growth restriction.

We have presented here are a long list of conditions associated with an increased incidence of fetal growth restriction. Missing from much of the literature on FGR are data that would allow more informed counseling of patients in terms of predicting their risk of carrying a pregnancy complicated by FGR. For example, very little has been published on the chances of having an infant with FGR in a woman suffering from SLE or chronic hypertension. Future studies of FGR should address these issues so that clinicians may counsel their patients properly.

Multifetal reduction increases the risk of preterm delivery and fetalgrowth restriction in twins: A case-control study: Silver R.K.; Helfand B.T.; Russell T.L.; Ragin A.; Sholl J.S.; MacGregor S.N. USA Fertil Steril 1997 67/1 (30–33)

Objective: To compare pregnancy outcome in twin gestations resulting from multifetal reduction to primary twin pregnancies derived from either spontaneous conception or infertility therapy. Design: Case-control study. Setting University-affiliated tertiary center. Patient(s): Multifetal pregnancies (quadruplets or more) reduced to twins (group A) compared with twin gestations conceived either spontaneously (group B) or through infertility therapy (group C). Intervention(s): Multifetal reduction for group A; perinatal care for groups A, B, and C. Main Outcome Measure(s): Comparison of perinatal complications between groups including antepartum bleeding, premature membrane rupture, and preterm labor. Neonatal outcomes compared including gestational age at delivery, birth weight, incidence of fetal growth restriction, and twin discordancy. Result(s): A higher incidence of idiopathic preterm labor was noted in group A cases (14/18) compared with either of the control groups (B: 26/54, or C: 24/54). As a consequence, group A had the lowest gestational age at delivery (32.6 ± 3.9 weeks) compared with groups B (33.6 ± 4.4 weeks) and C (36.0 ± 3.4 weeks). Corresponding birth weights of both first- and second-born twins were significantly lower in group A compared with group C, whereas the birth weight comparison between groups A and B showed a nonsignificant difference. The proportion of pregnancies in which one or both twins weighed less than the 10th percentile was greatest in group A pregnancies (A: 5/18 versus C: 5/54). Discordant birth weight among twin pairs was proportionately greater for group A cases at both the 20% and 30% discordance levels. Conclusion(s): Twin gestations resulting from multifetal reduction are at increased risk for preterm birth, fetal growth restriction, and discordancy when compared with fertility therapy-derived, nonreduced twins.

Increased incidence of fetal growth restriction in association with breech presentation in preterm deliveries < 32 weeks.

Breech presentation and fetal growth restriction (FGR) are each related independently with preterm delivery. This study was designed to assess the possible relationship between breech presentation and FGR in deliveries at < 32 weeks' gestation. From an established database of 465 consecutive deliveries at < 32 weeks of nonhypertensive, nondiabetic patients with singleton nonanomalous fetuses, those in whom birth weight, body length, fetal presentation (vertex or breech), and amniotic fluid volume (AFV) had been assessed were studied. Fetal growth restriction (defined as symmetric if both birth weight and body length were < 10th percentile and asymmetric if only the birth weight was < 10th percentile) was studied in relation to maternal age, parity, tobacco use, fetal presentation, AFV, membrane status, and gestational age at delivery. Statistical analyses included contingency tables and analysis of variance, with p < 0.05 considered significant. Two hundred ninety-eight patients met the inclusion criteria. In these patients 85 (28.5%) fetuses were breech and 213 (71.5%) cephalic. A total of 56 (19%) fetuses were growth restricted. Of these, 31 (10.4%) were symmetrically and 25 (8.3%) asymmetrically growth restricted. The incidence of symmetric growth restriction in the breech-presenting fetuses was 16% (n = 14) versus 8% (n = 17) in the cephalic-presenting fetuses, and of asymmetric growth restriction 12% (n = 10) versus 7% (n = 15), (overall p = 0.03). Fetal growth restriction was not associated with significant differences in maternal age, parity, smoking, AFV, membrane status, or gestational age at delivery (each p > 0.10). In preterm deliveries at < 32 weeks' gestation, breech presentation is associated with an increased incidence of intrauterine growth restriction, independent of clinical confounders.

Multifetal reduction increases the risk of preterm delivery and fetal growth restriction in twins: A case-control study

To compare pregnancy outcome in twin gestations resulting from multifetal reduction to "primary" twin pregnancies derived from either spontaneous conception or infertility therapy. Case-control study. University-affiliated tertiary center. Multifetal pregnancies (quadruplets or more) reduced to twins (group A) compared with twin gestations conceived either spontaneously (group B) or through infertility therapy (group C). Multifetal reduction for group A; perinatal care for groups A, B, and C. Comparison of perinatal complications between groups including antepartum bleeding, premature membrane rupture, and preterm labor. Neonatal outcomes compared including gestational age at delivery, birth weight, incidence of fetal growth restriction, and twin discordancy. A higher incidence of idiopathic preterm labor was noted in group A cases (14/18) compared with either of the control groups (B: 26/54, or C: 24/54). As a consequence, group A had the lowest gestational age at delivery (32.6 +/- 3.9 weeks) compared with groups B (33.6 +/- 4.4 weeks) and C (36.0 +/- 3.4 weeks). Corresponding birth weights of both first- and second-born twins were significantly lower in group A compared with group C, whereas the birth weight comparison between groups A and B showed a nonsignificant difference. The proportion of pregnancies in which one or both twins weighted less than the 10th percentile was greatest in group A pregnancies (A: 5/18 versus C: 5/54). Discordant birth weight among twin pairs was proportionately greater for group A cases at both the 20% and 30% discordance levels. Twin gestations resulting from multifetal reduction are at increased risk for preterm birth, fetal growth restriction, and discordancy when compared with fertility therapy-derived, nonreduced twins.