Incidence Of Growth Restriction Research Articles

Shear wave velocity by quantitative acoustic radiation force impulse in the placenta of normal and high-risk pregnancy

BackgroundTraditionally, the placental functional integrity is suggested by indirect ultrasound measurements like fetal growth, amniotic fluid index, and uterine and umbilical artery Doppler indices. Only recently the elasticity of the placenta is studied as a measure of placental consistency and biomechanical prosperities and may reflect the placental function. Shear wave velocity is the quantitative parameter of the shear wave elastography. A high-risk pregnancy is a situation which puts the mother, the fetus, or both at greater risk than a normal pregnancy.ResultsThe shear wave velocity (SWV) showed no significant difference between the placenta of normal pregnancies in the second and third trimesters (0.85 ± 0.43 m/s and 0.89 ± 0.57 m/s, respectively). The placenta of patients with preeclampsia/eclampsia had high SWV in the second and third trimesters (2.13 ± 1.48 m/s and 2.23 ± 1.48 m/s) with a highly significant difference from the normal placenta (P < 0.001). The placentas with abnormal location (placenta previa) and penetration (placenta accreta) had higher SWV than the placenta of normal pregnancies. The mean SWV for placenta previa was 1.1 ± 0.74 m/s and 1.3 ± 0.81 m/s in the second and third trimesters, respectively, with a mildly significant difference with the normal placenta. The placenta accreta shows high mean SWV in the second and third trimesters (1.6 ± 0.65 m/s and 1.961.6 ± 0.65, respectively) which differed significantly (P < 0.001) from SWV in the normal placenta in the second and third trimesters.ConclusionShear wave velocity measurement as the quantitative parameter of acoustic radiation force impulse (ARFI) elastography reflects the placental elasticity in normal and high-risk pregnancies. The SWV increases in conditions like hypertension, preeclampsia, maternal renal disease, and diabetes and reflects the structural and biomechanical abnormalities in such diseases. High shear wave velocity correlates with the incidence of growth restriction and abnormal Doppler parameters especially in the hypertensive disease. The virtual touch quantification (VTQ) can be used as a complementary diagnostic and prognostic tool in high-risk pregnancy.

Impact of Marijuana Legalization on Prevalence of Maternal Marijuana Use and Perinatal Outcomes.

We aimed to assess whether marijuana legalization was associated with a difference in prevalence of prenatal use or an increase in incidence of adverse perinatal outcomes. The present study is a retrospective cohort of September and October deliveries in the years 2012 through 2015 at a tertiary center in Colorado. Primary outcome of the study was use of marijuana, defined by self-report or biodetection. Secondary outcomes of the study included growth restriction, spontaneous preterm birth, stillbirth, preeclampsia, and neonatal or maternal death. Marijuana use prevalence was compared by year, and secondary outcomes between two periods, before and after the opening of the first recreational dispensary. A total of 2,392 pregnant women were included (1,165 before legalization and 1,227 after). More women used marijuana over the period of legalization (trend p = 0.01). Odds of marijuana use were higher after legalization versus before (adjusted odds ratio [aOR] = 1.8, 95% confidence interval [CI]: 1.2-2.6). Incidence of growth restriction was higher after legalization (2.9 vs. 5.1%, p = 0.0084). This difference persisted after adjustment for ethnicity and other drugs in multivariable modeling (aOR = 1.9, 95%CI: 1.2-3.0). The prevalence of prenatal marijuana use increased over the time of legalization. Further investigation into the population impact of legalization on obstetrical outcomes is warranted given the observed increase in growth restriction.

Early growth and development of extremely / very low birth weight infants after discharge

Objective To investigate the early growth and development of extremely low birth weight infants (ELBWI) and very low birth weight infants (VLBWI) through a follow-up study from hospital discharge until 18 months of corrected age. Methods ELBWI and VLBWI who were hospitalized and discharged alive from the Neonatal Intensive Care Unit of Hunan Children's Hospital from January 2013 to June 2014 were recruited. Follow-ups were performed at the corrected age of 40 weeks, as well as at one, three, six, 12 and 18 months of corrected age. Several parameters indicating the growth and development of those infants were monitored and assessed. Extrauterine growth retardation (EUGR) was defined as head circumference (HC) or weight≤10th percentile for gestational age at discharge. T-, rank-sum, or Chi-square (or Fisher's exact) test was performed for statistical analysis. Results (1) A total of 285 ELBWI and VLBWI were recruited. Among them, 145 (50.9%) were alive at last follow-up, 37 (13.0%) died, and 103 (36.1%) were lost. No significant differences in clinical data were observed between the infants who completed the follow-up and those who did not (all P>0.05). (2) Based on HC and weight, the incidences of EUGR in the 145 infants reached the peak at the corrected age of three months [42.8% (62/145) and 40.0% (58/145)], and then declined with increasing age. At 18 months of corrected age, the incidences of EUGR dropped to 31.7% (46/145) and 14.5% (21/145), respectively. (3) There were no significant differences in gender, gestational age, birth weight, length of hospital stay, duration of oxygen therapy, and incidences of complications between the infants with and without EUGR (all P>0.05). (4) The rate of pulmonary surfactant therapy in neonates with EUGR was lower than in those without [27.8% (15/54) vs 53.8% (49/91), χ2=9.340, P 0.05). Neither HC nor weight at the corrected age of 18 months showed significant differences between the two groups (both P>0.05). (5) At 18 months of corrected age, 31.7% (46/145) of the infants had their HC≤10th percentile, and 14.5% (21/145) had their weight≤10th percentile. Infants with HC≤10th percentile were at higher risk of abnormal neurodevelopment than those with HC >10th percentile [67.4% (31/45) vs 40.4% (40/99), χ2=9.154]. Infants with either HC or weight ≤10th percentile had higher risk of abnormal neurodevelopment that those with both HC and weight >10th percentile [65.5% (36/55) vs 38.9% (35/90), χ2=9.641] (both P>0.05). Conclusions ELBWI/VLBWI are at high risk of growth retardation. Incidence of growth restriction declines with age. Key words: Infant, extremely low birth weight; Infant, very low birth weight; Growth and development; Growth disorders; Follow-up studies

Substance abuse during pregnancy: effect on pregnancy outcomes

Objective To determine the contribution of drug use to maternal and perinatal complications, controlling for social confounders. Study design This is a retrospective cohort study of 247 drug-using women and 741 controls over a 4-year period from 1997 to 2000. Cases were identified from the drug dependency register. Three controls for each woman with substance abuse were selected from the delivery suite records, with calliper matching by year of delivery (any control patient who delivered within 6 months before or after the date of delivery of a drug-using woman was considered as a potential match) and district of residence (post code). The primary outcomes of interest were preterm birth, abruption, pre-eclampsia, intrauterine growth restriction and low birth weight. Results There were statistically significantly more preterm births amongst drug-using women (relative risk (RR) 2.5, 95% confidence interval (CI) 1.6–3.8), with preterm births complicating 25% of births amongst drug users. The incidence of low birth weight was 30.8% amongst drug-using women compared to 8% in control women (RR 3.6, CI 2.4–5.4), and the incidence of growth restriction was 25%, significantly higher than the control group (RR 3.82, CI 2.4–6.1). The risk of abruption was also higher (RR 2.74, CI 1.1–7.0). Of note is the extremely low incidence of pre-eclampsia among drug users, even after controlling for the confounder effects of parity and smoking. Conclusions Despite multidisciplinary co-ordinated antenatal care, women with substance abuse during pregnancy are at significant risk of adverse obstetric and perinatal outcome, controlling for social confounders. A limitation of the study is that the sample size was not large enough to clearly assess individual drugs. This is the first study to highlight low incidence of pre-eclampsia among drug users over and above the effect of smoking. Further research is needed to elucidate the underlying biological reason for the lack of pre-eclampsia in women with substance abuse during pregnancy.

Pregnancy outcome in the setting of extremely low first trimester PAPP‐A levels

Serum pregnancy-associated plasma protein-A (PAPP-A) is part of first trimester Down syndrome screening. Low levels have been associated with adverse outcome as well as chromosomal abnormality. To assess the incidence of adverse outcome when PAPP-A levels are at or below 0.2 multiples of the median (MoM). Data on consecutive patients attending a first trimester screening program were collected. Those with PAPP-A levels < or = 0.2 MoM were divided into three groups: < or = 0.1 MoM; 0.11-0.15 MoM; and 0.16-0.2 MoM. Screening 44 535 patients resulted in 197 with PAPP-A levels < or = 0.2 MoM. The incidence of karyotypic abnormality increased with decreasing PAPP-A levels. In the absence of chromosome abnormality, pregnancy outcomes were defined as 'normal' in at least 30% and 'good' in at least 60%, with both percentages increasing as the PAPP-A level rose. The PAPP-A levels were significantly lower in the group with a poor outcome. The incidence of prematurity was similar in the three groups, but higher than the statewide average, while the incidence of extreme prematurity appeared to be related to reducing PAPP-A levels. The incidence of growth restriction in the three groups was similar, but was still double the incidence in the normal population. If the PAPP-A level is < or = 0.2 MoM and the karyotype is normal, there is an increased risk of adverse outcome. Even with PAPP-A below 0.1 MoM, a good outcome can be expected in 60% of cases. Careful morphological assessment is suggested and later monitoring of fetal growth and well-being.

P37.10: Growth discordance and abnormal Doppler flow in a monochorionic triamniotic triplet pregnancy: A case report

Prevalence of spontaneous monochorionic triplet pregnancy is 1 in 7000 pregnancies with a 50–60% incidence of growth restriction. We report a case of 25 year old G1 P0 hospitalized at 24 6/7 weeks for one fetus with selective intrauterine growth restriction (IUGR) with absent or reversed end diastolic flow in the free loop of umbilical artery (FLUA). The estimated growths of the three fetuses were < 10%, 28% and 38%. There was no evidence of structural or functional cardiac abnormalities in any of the fetuses. There was no evidence of twin-twin transfusion syndrome. The patient was managed with bed rest, oxygen by nasal cannula, steroids and followed with daily biophysical profile and non-stress test, weekly Doppler and amniotic fluid evaluations. After eleven days, the IUGR fetus showed improvement in the ductus venosus and middle cerebral artery pulsatility index (PI) while FLUA showed mildly elevated PI. The plan was to prolong delivery of the triplets until after 32 weeks gestation, if possible. The antenatal course remained uneventful while on maternal oxygen therapy. At 32 weeks, the smaller fetus had grown to 37% percentile with all Doppler values within normal limits while on maternal oxygen and the delivery was conducted by scheduled cesarean section. The placental pathology showed a monochorionic placenta with one eccentric and two central insertions of the three vessel umbilical cords. The newborns weighed 1015 grams (g), 1350 g and 1530 g with normal Apgar score at 5 minutes. All of the triplets received continuous positive airway pressure and parenteral support in the newborn period. We conclude that oxygen therapy improved the Doppler flow pattern in the IUGR fetus of this triplet pregnancy and allowed for substantial growth in that fetus, thereby successfully prolonging the delivery date.

Extrauterine growth restriction in very-low-birthweight infants

Postnatal growth failure of very-low-birthweight (VLBW) infants may result from a complex interaction of genetic and environmental factors, including inadequate nutrition, morbidities affecting nutrient requirements, endocrine abnormalities and treatments. Among VLBW infants, those small for gestational age (SGA) at birth and those with postnatal growth restriction at the time of discharge are at higher risk of later growth failure and long-term consequences. Nutritional intervention with an "aggressive nutrition" during the first weeks of life may be able to minimize the interruption of nutrients that occurs at birth, and reduce as much as possible the incidence of growth restriction at the time of discharge and later. Even though aggressive parenteral and enteral nutrition appear to be effective and safe in VLBW infants, further evaluations of their long-term effect on growth and health consequences are needed. Several studies evaluating the effect of enriched nutrient formulas after hospital discharge on growth and neurodevelopment have produced conflicting results, whereas the potential deleterious long-term effects of prolonged use of high protein and/or of later catch-up growth have been questioned. In contrast, recent data seem to indicate that the use of human milk after hospital discharge could be the most beneficial diet for subsequent health and development. VLBW infants SGA at birth and those with early postnatal growth restriction are at high risk of later growth failure and long-term consequences. Therefore, the first objective of early nutrition should be to reduce the incidence of growth restriction at the time of discharge. Further studies on VLBW infants to evaluate the safety and beneficial effects of prolonged dietary manipulation during the first year of life are needed.

Incidence-based measures of birth, growth restriction, and death can free perinatal epidemiology from erroneous concepts of risk

Background Traditional perinatal epidemiology appears to embrace fallacious concepts of risk. The use of incorrect denominators for perinatal rates is commonplace both for straightforward indices such as the gestational age–specific labor induction rate and also for the more conceptually challenging indices such as the gestational age–specific neonatal mortality rate. As a consequence, perinatology is beset by several conondrums including the paradox of intersecting perinatal mortality curves. Proposition These traditions are ideally replaced by alternative concepts that may be derived a priori and measured using indices such as presented here: the incidence of birth (i.e., the gestational age–specific birth rate), the incidence of growth restriction (i.e., the gestational age–specific growth-restriction rate) and the incidence of death (i.e., the age–specific mortality rate). Results The incidence of birth, growth restriction, and death quantify the core phenomena in perinatology and reveal congruent and coherent patterns of occurrence. Conclusions These new indices can free perinatal epidemiology from erroneous concepts of risk and resolve the paradoxal phenomena that plague the perinatal domain. They also permit the development of a theoretical framework for obstetric intervention, which in recent years has been based exclusively on empirical evidence.