Mean Abdominal Circumference Research Articles

Non-invasive system delivering microwaves energy for localized adiposity reduction, skin laxity, and cellulite: Clinical evidence

Localized adiposities are the accumulation of subcutaneous adipose tissue resulting in an alteration of the body silhouette. This study evaluates the efficacy and safety of a non-invasive microwaves (MWs) device for the treatment of localized adiposities of the thighs and abdomen. Sixteen women enrolled underwent four sessions with the study device at intervals of 30 days. Clinical evaluation, anthropometric evaluation, ultrasound evaluations, and 3D photographs were performed. Cellulite and skin laxity were evaluated. Patients filled 4-points Global Aesthetic Improvement Scale (GAIS) and 10-points Visual Analog Scale. The mean abdominal circumference significantly (P <0.05) decreased 4 weeks after the last treatment, and the mean culotte/thighs circumference significantly (P < 0.05) decreased 4 weeks after the last treatment. Both cellulite and skin laxity were improved. The GAIS scores showed satisfactory results. No adverse effects were observed. This MWs system has been found to be safe and effective in the reduction of body circumferences.

Comparison of fetal growth patterns from Western India with Intergrowth-21st.

To generate longitudinal fetal growth data in an Indian population and compare it with Intergrowth-21st. Fetal biometry data was collected in a prospective longitudinal observational study (REVAMP: Research Exploring Various Aspects and Mechanisms in Preeclampsia) from 2017 to 2022. Fetal crown-rump length (CRL) was measured at 11-14 weeks gestation, and biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) at 18-22 and 32-35 weeks, and converted into Z-scores using the Intergrowth standard. Generalized Additive Models for Location, Scale and Shape (GAMLSS) models were used to construct fetal growth centile curves compared against Intergrowth centiles. Out of 1096 singleton pregnancies in REVAMP, this analysis included 655 'healthy' pregnancies (uncomplicated by pre-eclampsia, diabetes, pre-term delivery or low birth weight) and a sub-set of 106 'low-risk' pregnancies defined using Intergrowth criteria. The 'healthy' study subjects showed lower mean CRL Z-score [-0.45 SD (95% CI:-0.54,-0.37)] at 11-14 weeks, and BPD Z-score [-1.2 SD (-1.28,-1.11) and -1.17 SD (-1.23,-1.1)] at 18-22 and 32-35 weeks respectively. Mean HC Z-score was comparable to the Intergrowth standard at 18-22 weeks [-0.08 SD (-0.16, 0.02)] but smaller at 32-35 weeks [-0.25 SD (-0.32,-0.19)]. Mean AC Z-score was lower at 18-22 weeks [-0.32 SD (-0.41,-0.23)] but comparable at 32-35 weeks [0.004 SD (-0.07, 0.07)]. FL was comparable to or larger than the Intergrowth standard at both time points [0.05 SD (-0.05, 0.14); 0.82 SD (0.75, 0.89), respectively]. These findings were similar, though measurements were slightly larger, in the 'low-risk' sample. This data from healthy and low-risk pregnant women in urban western India indicates that some fetal dimensions and growth trajectories differ significantly from the Intergrowth-21st. Our data suggest the need for a larger representative study to define a population-specific fetal growth reference for India, for identification of fetal growth restriction.

Evaluation of glomerular hyper filtration in obesity: Which formula to use?

Introduction: Obesity is a progressive chronic disease that is a renal risk factor. Renal hyperfiltration is an early stage in the development of chronic kidney disease (CKD). The objective of our study is to determine the prevalence of glomerular hyperfiltration in obese patients. Materials and Methods: This is a prospective and descriptive study conducted over a period of 4 months. All patients with BMI over 30 kg/m2 who do not have diabetes, hypertension or another apparent cause of CKD. Results: A total of 85 patients were included, the mean age was 41.96 years, with a female majority. The mean BMI was 38.24kg/m2 and the mean abdominal waist circumference was 114.57cm. Obesity was common in 55.88% and secondary in 44.11%. The prevalence of glomerular hyperfiltration was 85.18% by Cockcroft formula and 48.33% by MDRD formula. Discussion: Obesity is a risk factor for CKD, which promotes increased renal blood flow by vasodilation of the afferent glomerular arteriole, resulting in glomerular hyperfiltration that leads to a change in the glomerular barrier, increasing the risk of developing CKD. According to several studies, the Cockcroft formula is a better predictor of renal function in obese patients. A 51% increase in GFR in obese patients has been observed. In our study, the prevalence of glomerular hyperfiltration is 85.18% according to the Cockcroft formula. Conclusion: Obesity is a risk factor for CKD that needs to be carefully considered.

Ambient temperature during pregnancy and fetal growth in Eastern Massachusetts, USA.

Left unabated, rising temperatures pose an escalating threat to human health. The potential effects of hot temperatures on fetal health have been under-explored. Here, we examined the association between prenatal ambient temperature exposure and fetal growth measures in a Massachusetts-based pregnancy cohort. We used ultrasound measurements of biparietal diameter (BPD), head circumference (HC), femur length and abdominal circumference (AC), in addition to birthweight (BW), from 9446 births at Beth Israel Deaconess Medical Center from 2011 to 2016. Ultrasound scans were classified into three distinct gestational periods: 16-23 weeks, 24-31 weeks, 32+ weeks; and z-scores were created for each fetal growth measure using the INTERGROWTH-21st standards. We fitted distributed lag models to estimate the time-varying association between weekly temperature and fetal growth, adjusting for sociodemographic characteristics, seasonal and long-term trends, humidity and particulate matter (PM2.5). Higher ambient temperature was associated with smaller fetal growth measures. The critical window of exposure appeared to be Weeks 1-20 for ultrasound parameters, and high temperatures throughout pregnancy were important for BW. Associations were strongest for head parameters (BPD and HC) in early to mid-pregnancy, AC late in pregnancy and BW. For example, a 5ºC higher cumulative temperature exposure was associated with a lower mean AC z-score of -0.26 (95% CI: -0.48, -0.04) among 24-31-Week scans, and a lower mean BW z-score of -0.32 (95% CI: -0.51, -0.12). Higher temperatures were associated with impaired fetal growth. This has major health implications given that extreme temperatures are more common and escalating.

The relation of residential greenness with fetal growth and the role of air pollution in Eastern Massachusetts, USA

Background and Aim: There is growing evidence that green spaces may be beneficial for health. However, the effects on pregnant individuals and fetuses, including the underlying mechanisms, have been underexplored. We examined the association between neighborhood greenness and fetal growth, and the role of air pollution in these relationships (interaction and mediation) in a Massachusetts-based cohort. Methods: Our study consisted of 9,446 pregnancies that delivered at Beth Israel Deaconess Medical Center, Massachusetts in 2011-2016. Neighborhood greenness was estimated using normalized difference vegetation index (NDVI) with 270 m resolution. Fetal growth parameters included birth weight (BW), and ultrasound measures of biparietal diameter (BPD), head circumference (HC), femur length, and abdominal circumference (AC). Ultrasound parameters were classified into three distinct gestational periods: 16-23 weeks, 24-31 weeks, and 32+ weeks. We used distributed lag models to estimate the time-varying association between monthly NDVI and fetal growth. All models were adjusted for sociodemographic characteristics, and time trends. For models in which we identified an association, we tested for potential interaction with particulate matter ≤2.5 µm (PM2.5) and nitrogen dioxide (NO2) —predicted from well-validated ensemble models— and assessed for mediation by these pollutants. Results: We found that higher NDVI was positively associated with BPD, HC, AC, and BW. For example, a 0.1 NDVI increase sustained up until week 32 was associated with a higher mean AC z-score of 0.03 (95% CI: 0.01, 0.06), and a higher mean BW z-score of 0.02 (95% CI: 0.01, 0.03). We found no evidence for interaction or mediation by air pollution. Conclusions: Residential greenness was associated with larger fetal growth measures. Our effect decomposition suggests that the association of greenness with fetal growth is independent from associations with local air pollution. Keywords: greenness, air pollution, fetal growth, ultrasound, pregnancy, interaction, mediation

Prevalence of Gestational Diabetes Mellitus in Obstetric patients using Macrosomia and Increased Amniotic Fluid on Ultrasound, as Diagnostic Markers

Aim: To determine the prevalence of gestational diabetes in obstetric patients with the help of ultrasonography and diagnostic biomarkers such as increased amniotic fluid and macrosomia. Methods: In 110 women who failed the glucose tolerance test, longitudinal ultrasound measurements of foetal growth were taken during the first, second and third trimesters with the informed consent of every pregnant women. 524 ultrasound examinations were performed in total, and uncomplicated pregnancies were included as controls for the comparison of our results. Head circumference (HC), abdominal circumference (AC), femur length (FL), and head circumference to abdominal circumference ratio (HC/AC) was evaluated at 17th and 37th weeks of gestation while amniotic fluid was measured and recorded at 13th, 27th and 37th weeks of gestation respectively. Results: The mean HbA1c (%) of the pregnant women in 1st semester recorded was 5.2±0.27SD which increased to 5.31 ±0.24SD in 2nd trimester and later changed to 5.54±0.17SD in 3rd semester. The measured amniotic fluid in ultrasound was 23.23cm ±3.18 SD at 13th weeks of gestation, 15.97cm±2.62SD at 27th weeks and 11.95cm±1.99SD at 37th week. The mean abdominal circumference at 37th week was 347.01mm ±7.28SD, mean head circumference was 1477.50mm±2.88SD, AC/HC ratio at 37th week estimated 0.89 ±0.08SD and femur length was 73.44mm ±2.28SD respectively. Conclusion: The finding suggests that increased amniotic fluid and macrosomia are important biomarkers of gestational diabetes and can be assessed through ultrasonography. Keywords: Gestational diabetes mellitus, obstetrics, macrosomiqa, amniotic fluid

Prevalence of Gestational Diabetes Mellitus in Obstetric patients, using Macrosomia and Increased Amniotic Fluid on Ultrasound as Diagnostic Markers

Aim: To determine the prevalence of gestational diabetes in obstetric patients with the help of ultrasonography and diagnostic biomarkers such as increased amniotic fluid and macrosomia. Methods: In 110 women who failed the glucose tolerance test, longitudinal ultrasound measurements of foetal growth were taken during the first, second and third trimesters with the informed consent of every pregnant women. 524 ultrasound examinations were performed in total, and uncomplicated pregnancies were included as controls for the comparison of our results. Head circumference (HC), abdominal circumference (AC), femur length (FL) and head circumference to abdominal circumference ratio (HC/AC) was evaluated at 17th and 37th weeks of gestation while amniotic fluid was measured and recorded at 13th, 27th and 37th weeks of gestation respectively. Results: The mean HbA1c (%) of the pregnant women in 1st semester recorded was 5.2±0.27SD which increased to 5.31±0.24SD in 2nd trimester and later changed to 5.54±0.17SD in 3rd semester. The measured amniotic fluid in ultrasound was 23.23cm±3.18 SD at 13th weeks of gestation, 15.97cm±2.62SD at 27th weeks and 11.95cm±1.99SD at 37th week. The mean abdominal circumference at 37th week was 347.01mm±7.28SD, mean head circumference was 1477.50mm±2.88SD, AC/HC ratio at 37th week estimated 0.89±0.08SD and femur length was 73.44mm±2.28SD respectively. Conclusion: The finding suggests that increased amniotic fluid and macrosomia are important biomarkers of gestational diabetes and can be assessed through ultrasonography. Keywords: Gestational diabetes, ultrasonograpy, increased antibiotic, macrosomia

Exposure to during Pregnancy and Fetal Growth in Eastern Massachusetts, USA.

Background:Prior studies have examined the association between fine particulate matter [PM in aerodynamic diameter ()] and fetal growth with either limited spatial or temporal resolution.Objectives:In this study, we examined the association between exposure during pregnancy and fetal growth measures (ultrasound parameters and birth weight) in a pregnancy cohort using spatiotemporally resolved in Eastern Massachusetts, USA.Methods:We used ultrasound measures of biparietal diameter (BPD), head circumference, femur length, and abdominal circumference (AC), in addition to birth weight, from 9,446 pregnancies that were delivered at the Beth Israel Deaconess Medical Center from 2011–2016. We used linear mixed-effects models to examine the associations of in two exposure windows (the first 16 wk of pregnancy and the cumulative exposure up until the assessment of fetal growth) with anatomic scans (ultrasound ), growth scans (ultrasound ), and birth weight. All models were adjusted for sociodemographic characteristics, long-term trends, and temperature.Results:Higher exposure in the first 16 wk was associated with smaller fetal growth measures, where associations were particularly strong for BPD, AC, and birth weight. For example, a increase in was associated with a lower mean BPD -score of (95% CI: , ) before 24 wk, a lower mean AC -score of (95% CI: , ) after 24 wk, and a lower mean birth weight -score of (95% CI: , ). Analyses examining the associations with cumulative exposure up until the assessment of fetal growth produced attenuated associations.Conclusions:Higher gestational exposure to was associated with smaller fetal growth measures at levels below the current national standards. https://doi.org/10.1289/EHP9824

Utility of the cerebroplacental ratio (CPR) in marijuana exposed growth restricted fetuses

Objective Fetal growth restriction (FGR) is associated with an increased risk of adverse perinatal outcomes. The cerebroplacental ratio (CPR) represents the interaction of alterations in blood flow to the fetal brain and placenta. CPR has been utilized as a superior reflection of fetal hypoxia/acidemia and therefore a better predictor of fetal morbidity. We sought to determine the role of the CPR as an adjunctive tool to identify fetuses at increased risk of adverse perinatal outcomes in a study population of marijuana (MJ) exposed FGR fetuses. Methods This was a retrospective cohort study of high-risk singleton pregnancies over a 4-year period. Self-identified daily MJ users with FGR fetuses in the 3rd trimester were isolated. Fetal biometry, amniotic fluid indices, and CPRs were calculated. A CPR <1 was considered abnormal. FGR fetuses with normal and abnormal CPRs were then compared. Results 26/192 (13.5%) of MJ exposed fetuses were diagnosed with FGR in the 3rd trimester. 12/26 (46%) had an abnormal CPR and 14 had a normal CPR (mean CPR 0.60 vs 1.57, p = .0001). The mean EFW percentile was lower in the abnormal CPR group in comparison to the group with normal CPR (3.33 vs 7.64, p = .0001). Both groups showed evidence of brain sparing with an overall mean head circumference of 17.55 in comparison to a mean abdominal circumference of 5.63. A CPR <1 was associated with more severe FGR, oligohydramnios, and abnormal UA Doppler studies. Conclusions Approximately half of the MJ exposed FGR fetuses had an abnormal CPR. In this subset of patients, >90% had severe FGR, a higher proportion had absence/reversal of end diastolic flow in the UA, and a higher proportion had oligohydramnios. This demonstrates that an abnormal CPR identifies a group of FGR fetuses at a greater risk of adverse perinatal outcomes.

Beta Cell Function and Insulin Resistance in Nondiabetic, Prediabetic and Diabetic in a Subset of Obese Pakistani Population

Objective: To compare insulin resistance and beta-cell function in nondiabetic, prediabetic, and diabetic subjects in a subset of obese Pakistani population.&#x0D; Materials and Methods: Two hundred and ten obese subjects underwent anthropometric measurements. After overnight fasting for 8 hours, 6 cc blood was drawn for fasting blood glucose level, fasting insulin level. Blood glucose samples were taken after drinking 75 gm glucose in 260 ml water. HOMA IR and HOMA BETA% were calculated by the formula. Subjects were divided into obese nondiabetic, obese prediabetic and obese diabetic according to WHO criteria.&#x0D; Results: Out of 210 obese subjects, 53 (25.2%) were males and 157 (74.8%) were females. The mean BMI was 32.39±5.21. Mean abdominal circumference was 102.78±10.16. There were 101(48%) obese nondiabetic, 51(24%) were found to be obese prediabetic, 58(28%) were found to be obese diabetic. Mean insulin resistance in obese nondiabetic subjects was 2.8 ±3.7, in prediabetic 8.5± 12.3, in diabetic was 17.7±24.6. Mean HOMA beta was 245.3±267.4 in obese nondiabetic subjects, 290.5±298.4 in prediabetic, and 16.6±57 in diabetic.&#x0D; Conclusion: There was a significantly increased incidence of prediabetes and diabetes in obese subjects. Prediabetic and diabetic subjects were found to have marked insulin resistance. Beta-cell function was markedly reduced in diabetic subjects having a family history of diabetes, emphasizing the genetic predisposition to develop beta-cell exhaustion.

Antenatal prediction of fetal macrosomia in pregnancies affected by maternal pre-gestational diabetes

Aims Higher rates of fetal macrosomia may occur in infants of women with pre-gestational diabetes compared with non-diabetic controls. Antenatal predication of fetal macrosomia remains challenging. Ultrasound over-estimated fetal weight could result in over-classification of fetuses as macrosomic with corresponding inappropriate clinical interventions. Previously we had studied a measurement – the anterior abdominal wall measurement (AAW) – to predict fetal macrosomia in fetal estimation of weight. The purpose of the study was to study whether specific third trimester ultrasound measurements with measures of glycaemic control (HbA1c) predicted macrosomia in babies born to women with pre-gestational diabetes. In particular, a new variant of this measurement (fetal anterior abdominal wall thickness (AAW), abdominal circumference (AC) ratio: AAW:AC) was investigated. Methods This was a prospective cohort study in a tertiary referral maternity hospital. Serial growth scans including measurement of AAW and AC: AAW ratio was performed at 30, 33- and 36-weeks’ gestation. Birth-weight data was collected, and macrosomia was defined as >90th centile based on gestational age and gender of the baby. Serial HbA1c as measured at the first antenatal visit, 14, 20- and 36-weeks’ gestation were reported for this study. Results Of the 416 pregnancies analyzed, mean maternal age was 33.3 years. One in five women were primigravida’s. The mean birthweight was 3548 g (+/− 581 g), of which 142 (34%) babies were classified as macrosomic. The median gestational age at delivery was 383 weeks (314 − 402 weeks). There were 37 (9%) babies born preterm at <37 weeks’ gestation. Mean AC measurements in fetuses that would be born with macrosomia compared with those with a non-macrosomic birth weight were 282 mm vs. 266 mm at 30 weeks, 318.3 mm vs. 297 mm at 33 weeks and 350 mm vs. 325 mm at 36 weeks’ gestation (all p < .001). Mean AAW measurements in macrosomic fetuses compared with normal size fetuses were 3.7 mm vs. 3.3 mm at 30 weeks, 4.9 mm vs 4.3 mm at 33 weeks and 5.9 mm vs. 5.3 mm at 36 weeks’ gestation (all p < .001). The mean AC: AAW was 0.01 for both normal and macrosomic fetuses at 30 weeks. There was no clinical or statistical difference in AC:AAW ratios between non-macrosomic and macrosomic infants. Binary logistic regression showed that AC at 36 weeks was most predictive of macrosomia (76.5%), followed by AAW at 30 weeks (68.5%). Using a combination of HbA1c booking, 14, 20, 36 weeks and AAW 30, 33, 36 weeks and AC 30, 33, 36 weeks predicted macrosomia in 80.9%. The ratio of AC: AAW did not act as a useful antenatal clinical predictor of macrosomia at birth. Conclusions Abdominal circumference at 36 weeks was the single best predictor of fetal macrosomia. A combined model of HbA1c, AC and AAW was the best antenatal predictor of macrosomia, with intriguing clinical possibilities in the possible prevention of maternal and fetal complications of macrosomia.

Irisin Precursor FNDC5 and Glycemic Control in Patients With Type 2 Diabetes

Introduction: Irisin is a newly discovered myokine whose expression is induced by exercise and PGC1α. Studies have reported its action on adipose tissue cells, leading to their “browning,” and consequent increase in energy expenditure and thermogenesis. In the first description of this hormone, which is a product of cleavage of its precursor (protein 5 containing fibronectin type III domain), elevated irisin levels were associated with improved insulin sensitivity, weight reduction, and better glucose tolerance in animal models. Hence, studies have tried to characterize the role of irisin in glucose regulation, with controversial results. Muscle mass has been a good predictor of irisin circulation in humans and, because it is predominantly synthesized and secreted by skeletal muscle, its use as a potential biomarker of sarcopenia has been investigated. Methods: The aim of this study was to evaluate serum FNDC5 levels according to clinical and metabolic parameters as well as muscle mass from patients with type 2 diabetes (T2DM). Body composition was evaluated by Dual X-ray absortptiometry (DXA) and multifrequency Bioelectric Impedance (BIA) and FNDC5 was measured using an ELISA kit. Results: We evaluated 44 women with type-2 diabetes, mean age of 61.95±8.52 years, mean diabetes duration of 10.25±7.06 years, mean HbA1c of 7.66±1.37, mean fasting plasma glucose of 149.11±38.26 mg/dL, mean BMI of 29.20±5.15 kg/m2, and mean abdominal circumference of 95.02±12.80 cm. Mean FNDC5/irisin was 18.69±3.67 ng/mL. Although there were no differences in DXA and BIA analyses according to first and top quartiles of serum FNDC5, we identified a negative correlation of serum FNDC5 with fasting plasma glucose (−0.479; P=0.001) and a positive correlation with age (0.422; P=0.004). Conclusion: our data demonstrated that increased serum FNDC5 is related to increased age and poor glycemic control in T2DM. Reference: (1) Perakakis N et al., Physiology and role of irisin in glucose homeostasis. Nat Rev Endocrinol. 2017 (2) Hyun HP et al., The novel myokine irisin:clinical implications and potential role as a biomarker for sarcopenia in postmenopausal women. Endocrine. 2018.

A sex-stratified long-term clinical outcome analysis in coronary chronic total occlusion patients

BackgroundDifferences in outcomes for women and men after percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) patients remain controversial. Herein, we compared the clinical outcomes by sex in CTO patients undergoing PCI.MethodsA total of 563 consecutive patients (19% women) who were diagnosed with CTO at a single center in China from June 2017 to December 2019 were included in this study. Three hundred patients were revascularized by PCI, and 263 were not revascularized. The clinical outcomes of these patients stratified by sex were examined. The primary endpoints included the risk of major adverse cardiovascular and cerebrovascular events (MACCE); the secondary endpoint was cardiac death; hazard ratios were generated using multivariable Cox regression.ResultsWomen represented 19% of the cohort (107/563 patients). Women have lower mean body mass index (BMI) and abdominal circumference compared with men; however, the proportion of hypertension, diabetes, and previous coronary heart disease is higher in female patients. At 2-year follow-up, there were no differences between men and women for MACCE (15.8% vs 20.6%, p = 0.234) and cardiac death (3.1% vs 5.6%, p = 0.202). Predictors of CTO recanalization revealed that age < 65 years, absence of prior CABG, no history of DM, and non-triple vessel were predictors of CTO recanalization. Sex did not predict recanalization in this regression model. Successful CTO PCI was associated with reduced MACCE.ConclusionOur study suggests an equal benefit of CTO recanalization with a marked reduction in MACCE in women and men alike. Further dedicated studies are needed to confirm these findings.

Swedish intrauterine growth reference ranges of biometric measurements of fetal head, abdomen and femur

Ultrasonic assessment of fetal growth is an important part of obstetric care to prevent adverse pregnancy outcome. However, lack of reliable reference ranges is a major barrier for accurate interpretation of the examinations. The aim of this study was to create updated Swedish national reference ranges for intrauterine size and growth of the fetal head, abdomen and femur from gestational week 12 to 42. This prospective longitudinal multicentre study included 583 healthy pregnant women with low risk of aberrant fetal growth. Each woman was examined up to five times with ultrasound from gestational week 12 + 3 to 41 + 6. The assessed intrauterine fetal biometric measurements were biparietal diameter (outer–inner), head circumference, mean abdominal diameter, abdominal circumference and femur length. A two-level hierarchical regression model was employed to account for the individual measurements of the fetus and the number of repeated visits for measurements while accounting for the random effect of the identified parameterization of gestational age. The expected median and variance, expressed in both standard deviations and percentiles, for each individual biometric measurement was calculated. The presented national reference ranges can be used for assessment of intrauterine size and growth of the fetal head, abdomen and femur in the second and third trimester of pregnancy.

Relationship of mesenteric panniculitis with visceral and subcutaneous adipose tissue

Background/aim Mesenteric panniculitis (MP) is an idiopathic benign disease characterized by fat necrosis, chronic inflammation, and fibrosis. The relationship between obesity and chronic low-grade inflammation has been reported. This study investigated the relationship of MP diagnosed using multidetector computed tomography (MDCT) with visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas.Materials and methods We retrospectively enrolled 104 patients with no radiological findings other than MP. Additionally, 76 individuals without any indicative radiological findings were included as controls. VAT and SAT were separately calculated (cm2) using a 3-dimensional workstation. The abdominal circumference was measured (cm). Results The mean abdominal circumference was 99.9 ± 7.9 cm, SAT was 195.3 ± 89.1 cm2, and VAT was 203.9 ± 72.8 cm2 in the MP group. The abdominal circumference, VAT, and SAT were significantly higher in the MP group than in the control group (P < 0.001). According to the receiver operating characteristic (ROC) analysis, cut-off level VAT and SAT were 167.5 cm2 (sensitivity 71%, specificity 69%) and 117.5 cm2 (sensitivity 78%, specificity 51 %), respectively.Conclusion Increased VAT and SAT were associated with MP, suggesting their role in the etiology of MP.

1028: Utility of the cerebroplacental ratio (CPR) in marijuana exposed growth restricted fetuses

Severe fetal growth disorders are associated with an increased risk of adverse perinatal outcome (APO). The CPR represents the interaction of alterations in blood flow to the fetal brain and placenta. It is calculated by dividing the Doppler indices of the middle cerebral artery (MCA) by those of the umbilical artery (UA). CPR has been toted as a superior reflection of fetal hypoxia/acidemia and therefore a better predictor of APO. We sought to determine the role of CPR as a predictor of severe fetal growth restriction (FGR), defined as an estimated fetal weight (EFW) less than the 5th percentile, in a study population of marijuana (MJ) exposed FGR fetuses. This was a retrospective cohort study of high-risk singleton pregnancies over a four-year period. Self-identified daily MJ users with FGR fetuses, defined as fetuses with an EFW less than the 10th percentile, in the 3rd trimester were isolated. Fetal biometry, amniotic fluid indices, and CPRs were calculated. A CPR < 1 was considered abnormal. FGR fetuses with normal and abnormal CPRs were then compared. 26 /192 (13.5%) of MJ exposed fetuses were diagnosed with FGR in 3rd trimester. 12/26 (46%) had an abnormal CPR and 14 had a normal CPR (mean CPR 0.60 vs 1.57, p = 0.0001). The mean EFW percentile was lower in the abnormal CPR group in comparison to the group with normal CPR (3.33 vs 7.64, p=0.0001). Both groups showed evidence of brain sparing with an overall mean head circumference of 17.55 in comparison to a mean abdominal circumference of 5.63. A CPR < 1 was associated with more severe FGR, oligohydramnios, and abnormal UA Doppler studies (see table 1). Approximately half of the MJ exposed FGR fetuses had an abnormal CPR. In this subset of patients, > 90% had severe FGR, a higher proportion had absence/reversal of end diastolic flow in the UA, and a higher proportion had oligohydramnios. This demonstrates that an abnormal CPR identifies a group of FGR fetuses at a greater risk for severe FGR and possibly APO.

Maternal cardiometabolic markers are associated with fetal growth: a secondary exploratory analysis of the LIMIT randomised trial

BackgroundTo determine the association between maternal cardiometabolic and inflammatory markers with measures of fetal biometry and adiposity.MethodsWomen included in this exploratory analysis were randomised to the ‘Standard Care’ group (N = 911) from the LIMIT randomised trial involving a total of 2212 pregnant women who were overweight or obese (ACTRN12607000161426, Date of registration 9/03/2007, prospectively registered). Fetal biometry including abdominal circumference (AC), estimated fetal weight (EFW), and adiposity measurements (mid-thigh fat mass, subscapular fat mass, abdominal fat mass) were obtained from ultrasound assessments at 28 and 36 weeks’ gestation. Maternal markers included C reactive protein (CRP), leptin and adiponectin concentrations, measured at 28 and 36 weeks’ gestation and fasting triglycerides and glucose concentrations measured at 28 weeks’ gestation.ResultsThere were negative associations identified between maternal serum adiponectin and fetal ultrasound markers of biometry and adiposity. After adjusting for confounders, a 1-unit increase in log Adiponectin was associated with a reduction in the mean AC z score [− 0.21 (− 0.35, − 0.07), P = 0.004] and EFW [− 0.23 (− 0.37, − 0.10), P < 0.001] at 28 weeks gestation. Similarly, a 1-unit increase in log Adiponectin was association with a reduction in the mean AC z score [− 0.30 (− 0.46, − 0.13), P < 0.001] and EFW [− 0.24 (− 0.38, − 0.10), P < 0.001] at 36 weeks gestation. There were no consistent associations between maternal cardiometabolic and inflammatory markers with measurements of fetal adiposity.ConclusionAdiponectin concentrations are associated with measures of fetal growth. Our findings contribute to further understanding of fetal growth in the setting of women who are overweight or obesity.

Lipid profile and statin use in critical care setting: implications for kidney outcome.

ABSTRACTObjective:To determine whether pre-hospital statin use is associated with lower renal replacement therapy requirement and/or death during intensive care unit stay.Methods:Prospective cohort analysis. We analyzed 670 patients consecutively admitted to the intensive care unit of an academic tertiary-care hospital. Patients with ages ranging from 18 to 80 years admitted to the intensive care unit within the last 48 hours were included in the study.Results:Mean age was 66±16.1 years old, mean body mass index 26.6±4/9kg/m2 and mean abdominal circumference was of 97±22cm. The statin group comprised 18.2% of patients and had lower renal replacement therapy requirement and/or mortality (OR: 0.41; 95%CI: 0.18-0.93; p=0.03). The statin group also had lower risk of developing sepsis during intensive care unit stay (OR: 0.42; 95%CI: 0.22-0.77; p=0.006) and had a reduction in hospital length-of-stay (14.7±17.5 days versus 22.3±48 days; p=0.006). Statin therapy was associated with a protective role in critical care setting independently of confounding variables, such as gender, age, C-reactive protein, need of mechanical ventilation, use of pressor agents and presence of diabetes and/or coronary disease.Conclusion:Statin therapy prior to hospital admission was associated with lower mortality, lower renal replacement therapy requirement and sepsis rates.

Ultrasound Assessment of Fetal Biometry in Iranian Normal Pregnancies.

Background:The objective of this study was to provide biometric charts for Iranian fetuses.Methods:One thousand four hundred and twenty-two women enrolled. Four hundred and eighty-four were in the second trimester of pregnancy and 940 were in the third trimester. Data were presented as mean ± standard deviation for continuous variables. Percentiles (5th, 50th, 75th, and 90th) reported.Results:Mean femoral length ranged from 16 to 53 mm in our study in the second trimester and 55–79 mm in the third trimester. Mean biparietal diameter (BPD) for fetuses with in the second trimester was between 14 and 71 and for fetuses in the third trimester was between 74 and 98 mm. Mean abdominal circumference (AC) in our cases with gestational age between 14 and 41 ranged between 86 and 365 mm.Conclusions:We have provided normal reference ranges and percentiles for BPD, AC, femur length, and weight during the second and third trimester of pregnancy in an Iranian population.

The Prevalence of Metabolic Syndrome in the Different Phenotypes of Polycystic Ovarian Syndrome.

To evaluate the prevalence of metabolic syndrome (MetS) in the phenotypes of polycystic ovarian syndrome (PCOS). This was a cross-sectional study involving 111 women aged between 18 and 39 years old diagnosed with PCOS, according to the Rotterdam Criteria, and grouped into four phenotypes: A: ovulatory dysfunction + hyperandrogenism + polycystic ovaries; B: ovulatory dysfunction + hyperandrogenism; C: hyperandrogenism + polycystic ovaries; D: ovulatory dysfunction + polycystic ovaries. To evaluate the presence of MetS, we measured serum triglyceride levels, HDL cholesterol, fasting blood glucose, blood pressure, and waist circumference. The prevalence of MetS found in this sample was 33.6%, and there was no statistically significant difference (p < 0.05) among the 4 phenotypes. However, phenotype D presented a significantly higher mean glucose level after fasting (93.6 mg/dL) and 2 hours after ingesting a solution with 75 g of anhydrous glucose (120 mg/dL), as well as the lowest mean level of high-density lipoprotein (HDL) cholesterol (44.7 mg/dL). The women in this group demonstrated a high prevalence of abdominal circumference ≥ 80 cm (68.2%), as well as the highest mean abdominal circumference (90.1 cm). Amongst the women with an abdominal circumference ≥ 80 cm, phenotype A increased approximately six-fold the chance of developing metabolic syndrome in relation to phenotype C. The four phenotypes of PCOS demonstrated similar prevalence rates of metabolic syndrome; abdominal obesity presented a relevant role in the development of metabolic alterations, regardless of the phenotype.