Occurrence Of Intrauterine Growth Restriction Research Articles

Heat Stress-Induced Fetal Intrauterine Growth Restriction Is Associated with Elevated LPS Levels Along the Maternal Intestine-Placenta-Fetus Axis in Pregnant Mice.

The exacerbation of the greenhouse effect has made heat stress (HS) an important risk factor for the occurrence of intrauterine growth restriction (IUGR). The experiment aims to uncover the effects of maternal HS on IUGR and its mechanisms. The results showed that HS leads to decreased maternal and fetal birth weights, accompanied by increased serum oxidative stress and cortisol levels. Moreover, HS inflicted significant damage to both the intestinal and placental barriers, altering maternal gut microbiota and increasing intestinal LPS levels. As a result, LPS levels increased in maternal serum, placenta, and fetus. Furthermore, HS damaged the intestinal structure, intensifying inflammation and disrupting the redox balance. The placenta exposed to HS exhibited changes in the placental structure along with disrupted angiogenesis and decreased levels of nutritional transporters. Additionally, the leakage of LPS triggered placental JNK and ERK phosphorylation, ultimately inducing severe placental inflammation and oxidative stress. This study suggests that LPS translocation from the maternal intestine to the fetus, due to a disrupted gut microbiota balance and compromised intestinal and placental barrier integrity, may be the primary cause of HS-induced IUGR. Furthermore, increased LPS leakage leads to placental inflammation, redox imbalance, and impaired nutrient transport, further restricting fetal growth.

P-224 Basonuclin 1 prevents intrauterine growth restriction via inhibiting necroptosis

Abstract Study question Is basonuclin 1 (BNC1) involved in intrauterine growth restriction (IUGR), and what’s the underlying mechanism? Summary answer BNC1 is significantly decreased in the placenta of IUGR patients. BNC1 deficiency engenders IUGR in Bnc1 truncation mutation (Bnc1tr/tr) mice model by inducing placental necroptosis. What is known already IUGR is among the leading causes of perinatal morbidity and mortality. IUGR occurs due to multiple factors, including genetic, placental, fetal, and maternal factors. Among which genetic factors remain largely unknown. Our previous exploration found that Bnc1 mutationmice exhibit low birth weight and survival rates, indicating BNC1 may play a potential role in fetal and placental development. Necroptosis is a recently recognized cell death pathway that may contribute to placental pathophysiology in IUGR patients. While the underlying mechanism remains largely unknown. Study design, size, duration A clinical retrospective cohort study of 40 IUGR patients (diagnosed by Hadlock ultrasound measurements) and 40 controls were included (2017–2022) for placenta collection. Bnc1 targeted mutation mouse was on a C57BL/6 J background. Male and female mice of the Bnc1+/tr genotype were mated to produce Bnc1+/+, Bnc1+/tr, and Bnc1tr/tr mice. Placenta and fetuses were obtained on the 15th and 18th days of pregnancy. Participants/materials, setting, methods The following analyses were performed: (i) Immunohistochemistry for detecting the location and expression of BNC1 in the placenta of humans and mice, (ii) placental and fetal weights for evaluation of IUGR development, (iii) morphometric evaluation of fetal utilizing Alcian blue and alizarin red staining, (iv) morphometric evaluation of placental compartments utilizing H&E staining, TUNEL staining, and TEM analysis, (v) RNA sequencing (RNA-seq) of placental tissues. Main results and the role of chance BNC1 was specifically highly expressed in trophoblasts and endothelial cells in the early and mature placental development stages of humans and mice. The expression of BNC1 was significantly decreased in the placenta of IUGR patients compared to the control group (P < 0.0001). In the mice model, the number of Bnc1tr/tr fetuses was significantly decreased compared with wild-type Bnc1+/+ fetuses on the 18th day of pregnancy. While the number of Bnc1tr/tr fetuses and Bnc1+/+ fetuses was similar on the 15th day of pregnancy, indicating the loss of Bnc1tr/tr fetuses between the two stages. Besides, both the Bnc1tr/tr fetal and placental weights were significantly decreased on the 15th day of pregnancy compared with Bnc1+/+ fetuses and placenta (P < 0.01). The Bnc1 truncation mutation caused poor development of the placental labyrinthine layer with an increased number of TUNEL-positive foci. Transmission electron microscopy also revealed a disorganized labyrinthine layer with defects in cytoplasm translucence, loss of plasma membrane integrity, swollen mitochondria, and decondensed chromatin. Finally, RNA sequencing of placental tissues indicated BNC1 deficiency-induced IUGR may be modulated by necroptosis. In conclusion, we found a relationship between the disturbed BNC1 expression and the occurrence of IUGR through necroptosis. Limitations, reasons for caution This study used only Bnc1 truncation mutation mice model, the other animal model with placenta-conditional knockout mice was needed to consolidate the results. Besides, further mechanism exploration should be conducted in both human and mouse cell lines. Wider implications of the findings Our work suggests a new gene related to the development of IUGR, which provides early diagnosis and treatment for managing IUGR, thus improving outcomes for both fetal and gravida. Trial registration number not applicable

Anti-BP180 IgG antibody ELISA values correlate with adverse pregnancy outcomes in pemphigoid gestationis.

Adverse pregnancy outcomes (APO) occur in 35% of patients with pemphigoid gestationis (PG). No biological predictor of APO has been established yet. To assess a potential relationship between the occurrence of APO and the serum value of anti-BP180 antibodies at the time of PG diagnosis. Multicentre retrospective study conducted from January 2009 to December 2019 in 35 secondary and tertiary care centres. (i) diagnosis of PG according to clinical, histological and immunological criteria, (ii) ELISA measurement of anti-BP180 IgG antibodies determined at the time of PG diagnosis with the same commercial kit and (iii) obstetrical data available. Of the 95 patients with PG included, 42 had one or more APO, which mainly corresponded to preterm birth (n= 26), intrauterine growth restriction (IUGR) (n= 18) and small weight for gestational age at birth (n= 16). From a ROC curve, we identified a threshold of 150 IU ELISA value as the most discriminating to differentiate between patients with or without IUGR, with 78% sensitivity, 55% specificity, 30% positive and 91% negative predictive value. The threshold >150 IU was confirmed using a cross-validation based on bootstrap resampling, which showed that the median threshold was 159 IU. Upon adjusting for oral corticosteroid intake and main clinical predictors of APO, an ELISA value of >150 IU was associated with the occurrence of IUGR (OR=5.11; 95% CI: 1.48-22.30; p=0.016) but not with any other APO. The combination of blisters and ELISA values higher than 150 IU led to a 2.4-fold higher risk of all-cause APO (OR: 10.90; 95% CI: 2.33-82.3) relative to patients with blisters but lower values of anti-BP180 antibodies (OR of 4.54; 95% CI 0.92-34.2). These findings suggest that anti-BP180 antibody ELISA value in combination with clinical markers is helpful in managing the risk of APO, in particular IUGR, in patients with PG.

ASSOCIATION BETWEEN MATERNAL BASAL GLUCOSE LEVEL AND INTRAUTERINE GROWTH RESTRICTION: A COMPARATIVE CROSS-SECTIONAL STUDY

Background: Intrauterine life is the most pivotal period of development that determines vital outcomes in postnatal life. Diabetes Mellitus may lead to disturbed fetal growth and maternal vasculopathy resulting in placental insufficiency with subsequent development of intrauterine growth restriction (IUGR). This study aims to find an association between hyperglycemia and the risk of IUGR, comparing pregnancies with IUGR with those with adequate for gestational age pregnancies.
 Methods: This cross sectional study was conducted in Federal Post Graduate Medical Institute (FPGMI) from January 2015 to January 2016, including 106 pregnant women using non-probability convenient sampling technique. Participants were divided into two groups: Group A comprises of pregnant women with adequate for gestational age pregnancies (n=53) and groups B includes pregnant women with intrauterine growth restricted pregnancies (n=53). Random blood sugar level was estimated by glucose/oxidase test and IUGR was confirmed by ultrasonography at 28-35 weeks of gestation. Shapiro-Wilk test was used to examine data normality and independent t-test was used to compare statistically significant difference. A p- value of <0.05 was considered significant.
 Results: Mean basal sugar level of group A was 98.9 ± 7.1 mg/dL and that of group B was 97.9 ± 6.0mg/dL. This mean difference was not statistically significant (p-value= 0.566).
 Conclusion: We found no statistically significant association between raised maternal basal glucose level and the occurrence of intrauterine growth restriction at 28-35 weeks of pregnancy.

Altered Liver Metabolism, Mitochondrial Function, Oxidative Status, and Inflammatory Response in Intrauterine Growth Restriction Piglets with Different Growth Patterns before Weaning.

Frequent occurrence of intrauterine growth restriction (IUGR) causes huge economic losses in the pig industry. Accelerated catch-up growth (CUG) in the early stage of life could restore multiple adverse outcomes of IUGR offspring; however, there is little knowledge about this beneficial phenomenon. We previously found that nutrient absorption related to intestinal function was globally promoted in CUG-IUGR piglets before weaning, which might be the dominant reason for CUG, but what this alteration could lead to in subsequent liver metabolism is still unknown. Firstly, a Normal, CUG, and non-catch-up growth (NCUG) piglet model before weaning was established by dividing eighty litters of newborn piglets into normal birth weight (NBW) and IUGR groups according to birth weight, and those piglets with IUGR but above-average weanling body weight were considered CUG, and the piglets with IUGR still below average body weight were considered NCUG at weaning day (d 26). Liver samples were collected and then systematically compared in glycolipid metabolism, mitochondrial function, antioxidant status, and inflammatory status among these three different growth models. Enhanced hepatic uptake of fatty acids, diminished de novo synthesis of fatty acids, and increased oxidation of fatty acids were observed in CUG livers compared to Normal and NCUG. In contrast, the NCUG liver showed enhanced glucose uptake and gluconeogenesis compared to Normal and CUG. We also observed deteriorating hepatic vacuolation in NCUG piglets, while increasing hepatic lipid deposition in CUG piglets. Besides, the expression of genes related to mitochondrial energy metabolism and biogenesis was reduced in CUG piglets and the phosphorylation level of AMPK was significantly higher compared to Normal (p < 0.05). Moreover, NCUG liver showed decreased T-AOC (p < 0.01) and GSH-PX (p < 0.05), increased MDA concentrations (p < 0.01), upregulated phosphorylation levels of ERK and NF-κB (p < 0.05), and elevated pro-inflammatory factors IL-1β, IL-6 and TNF-α (p < 0.05) compared to Normal. Furthermore, correlation analysis revealed a significant positive correlation between glucose metabolism and inflammatory factors, while a negative correlation between mitochondrial function-related genes and fatty acid transport. NGUG piglets showed simultaneous enhancement of glucose uptake and gluconeogenesis, as well as reduced antioxidant capacity and increased inflammatory status, whereas CUG comes at the expense of impaired hepatic mitochondrial function and pathological fat accumulation.

Fluoxetine-induced perinatal morbidity in a sheep model.

Selective serotonin reuptake inhibitors (SSRI) are the most common antidepressants used by pregnant women. However, adverse pregnancy outcomes have been described in women taking SSRI during pregnancy—placental lesions, premature birth, poor neonatal adaptation. We aimed to investigate the effects of fluoxetine (Prozac® most commonly used SSRI) treatment during the last month of gestation on pregnancy complications, placental and neonatal health in a non-depressed sheep model. On day 119 ± 1 postbreeding (experimental day 0; E0) of a 151-day expected gestation, Hampshire ewes were randomly assigned to receive fluoxetine (n = 9 ewes, 15 lambs; daily intravenously treatment with 10 mg/kg on E0 and E1 and 5 mg/kg daily thereafter until parturition) or to a control group (n = 10; 14 lambs; vehicle only). Blood samples from ewes were collected throughout the experimental period and postpartum; blood from lambs were collected postpartum. Analysis of variance was used for statistical analysis. Fluoxetine treatment reduced placentome growth during the last month of pregnancy. Gestation length was decreased by 4.5 days in fluoxetine-treated ewes. Birthweight was reduced in lambs exposed to fluoxetine in utero; weights remained decreased until postnatal day 3. Placentome diameter by birthweight ratio was not different between groups suggesting that the decreased placentome diameter was accompanied by decreased lamb birthweight. During the first week postnatal, lambs exposed to fluoxetine in utero had decreased blood pH and decreased total carbon dioxide, bicarbonate, and base excess and increased lactate (days 3–6), collectively indicative of metabolic acidemia. Additionally, ionized calcium was decreased between postnatal days 0 to 4 in lambs exposed to fluoxetine in utero. Using a non-depressed animal model clearly defines a role for SSRI on the occurrence of perinatal complications and neonatal morbidity. The decreased placentome diameter, shortened gestation, decreased birthweight, decreased calcium levels, and neonatal acidemia suggest the occurrence of intrauterine growth restriction. The persistence of neonatal acidemia for several days postpartum suggests poor neonatal adaptation to extrauterine environment.

Effect of Excessive Body Weight and Psoriasis in Women Undergoing ICSI Procedure and State of Health of the Newborn

Excessive body weight and some concomitant diseases, such as psoriasis, accompany women treated due to infertility by intracytoplasmic sperm injection (ICSI). This study is aimed to assess effect of obesity and psoriasis on quality of egg cells, embryos, course of pregnancy, and state of a newborn after treatment with ICSI. A total of 140 women were included into the study (110 healthy women and 30 with psoriasis). Among healthy women, BMI negatively correlated with total recovery rate, total oocyte score, blastocyst formation rate (BFR) and amount and quality of blastocysts (r < 0, p < 0.001). The relationships were similar in psoriasis, however apart from average blastocyst quality (p = 0.17) and BFR (p = 0.352). In healthy patients, BMI negatively correlated with gestational age at delivery (r = −0.444, p = 0.010) and APGAR (r = −0.481, p = 0.005). An excess of adipose tissue exerts an unfavourable effect on female reproductive functions, especially with a simultaneous burden of psoriasis. Excessive body weight is conducive to development of gestational diabetes and shortens the duration of pregnancy. The burden of psoriasis in combination with excessive body weight has an impact on the risk of occurrence of intrauterine growth restriction of foetus. Overweight and obesity negatively affect the state of a newborn, measured using APGAR scale.

Factores de riesgo de parto pretérmino en Bogotá D.C., Colombia

Introducción. El parto pretérmino es aquel que ocurre antes de la semana 37 de gestación. Este tipo de parto se asocia a múltiples factores de riesgo, algunos de los cuales pueden ser prevenidos. En Colombia son escasos los estudios sobre los factores de riesgo asociados al parto pretérmino, de ahí la importancia de su análisis.Objetivo. Identificar los factores de riesgo para parto pretérmino en un grupo de gestantes de Bogotá D.C., Colombia.Materiales y métodos. Estudio de cohorte retrospectivo. La muestra estuvo compuesta por 452 pacientes que habían participado en un estudio primario y que ya habían dado a luz.Resultados. La prevalencia de parto pretérmino fue de 10.4% (IC95%: 7.60-13.20) y los factores de riesgo asociados fueron los siguientes: ser diagnosticada con preeclampsia severa, con un riesgo relativo (RR) de 7.4 (IC95%: 4.59-11.95); tener preeclampsia (severa y no severa), con un RR=5.1 (IC95%: 3.0-8.51), y ocurrencia de restricción del crecimiento intrauterino (RCIU), con un RR=4.4 (IC95%: 2.44-7.98).Conclusiones. De acuerdo con los hallazgos reportados en el presente estudio, es necesario planear e implementar estrategias y políticas públicas en Bogotá D.C. que promuevan mejores prácticas de atención prenatal que, a su vez, permitan la detección temprana de condiciones como la preeclampsia y la RCIU, lo que hará posible reducir la incidencia de partos pretérmino en la ciudad y utilizar la experiencia y resultados obtenidos en el resto del país.

Антенатальная поддержка микронутриентами — залог здоровья будущего ребенка

Adequate intake of macro- and microelements during pregnancy meets the growing needs of a female organism and lays the basis for a child’s health. According to the World Health Organization, in malnutrition or chronic health conditions (i. e. gastrointestinal disorders, diabetes, hypo-thyroidism etc.) in a pregnant woman, additional intake of essential micronutrients is required. Cochrane Reviews demonstrate that multivitamin supplements reduce the occurrence of intrauterine growth restriction and low birthweight. Zinc is a microelement whose adequate intake is of crucial importance. Mild zinc deficiency manifests as recurrent respiratory infections, taste and smell loss, night blindness, impaired spermato-genesis, and (sometimes) mild psoriasis-like dermatitis. Severe zinc deficiency is characterized by more often respiratory infections and more severe skin conditions (e. g., acrodermatitis with erythematous, squamous, vesicular bullous, or pustular rash in perioral and perianal areas), alopecia, persistent diarrhea, stomatitis, and glossitis, growth and developmental delay, and various psychoneurological disorders.Keywords: pregnancy, newborn, infant, vitamin mineral supplement, microelements, zinc, atopic dermatitis, deficiency.For citation: Borovkova E.I., Zaplatnikov A.L., Zhdakaeva E.D. Antenatal micronutrient support is essential for a healthy child. Russian Journal of Woman and Child Health. 2020;3(2):77–82. DOI: 10.32364/2618-8430-2020-3-2-77-82.

204 Discriminating intrauterine growth-restricted piglets through near-infrared spectroscopy of amniotic fluids

The occurrence of intrauterine growth restriction (IUGR) is a great concern in animal production systems, leading to substantial economic losses. The multifactorial causes of IUGR make their prediction before or during pregnancy a challenging task. The amniotic fluid, containing chemical secretions of both the developing fetus and the amnion-allantois membrane, may offer a unique opportunity to investigate the causes of IUGR in piglets. Here we applied near-infrared spectroscopy (NIRS) as a rapid tool to discriminate the chemical composition of the amniotic fluid from IUGR fetuses at different gestational ages. The uteri of gravid sows were dissected at 60% (n=6 sows) and 90% (n=6 sows) of gestational age. Amniotic fluids were collected with a sterile 10-mL syringe connected to an 18-G needle under visual guidance, and samples without blood contamination were kept at 4°C while the fetus was measured. Samples were selected according to fetal weight and were classified as small (mean − 2 SD), medium (mean), and large (mean + 2 SD) sizes in each litter. Selected samples were kept at −80°C until NIRS transmittance spectra collection (350-2500nm). At 60% of gestational age, male fetuses weighed 96±1.2, 133±1.7, and 159±1.9g and female fetuses weighed 117±1.1, 137±1.8, and 152±1.8g for small, medium, and large groups, respectively. The fetal weights at 90% of gestational age averaged 517±0.6, 757±0.6, and 912±0.7g for males and 532±0.6, 718±0.9, and 911±0.6g for females for small, medium, and large sizes, respectively. Chemometric analysis of the amniotic fluid spectra was applied to the wavelength range 1300-1600nm using a balanced data set (n=425) with an 80/20 calibration/validation distribution for linear discriminant analysis (LDA-PCA). Overall, we were able to discriminate samples according to fetal size and gestational age; LDA-PCA showed the highest size classification occurring with spectra derived from the small fetuses with an accuracy of 94.5-100% and 100% and 70.6% for the calibration and validation processes from 60% and 90% of gestational age, respectively. By contrast, when the analysis considered each sex at 60% of gestational age, the medium and small fetuses presented the highest size classification for females and males correspondingly. At 90% of gestational age, the large fetuses presented the best discrimination for both sexes. In conclusion, we were able to detect and discriminate chemical changes of the amniotic fluid from different fetuses using NIRS, indicating that this fluid contains molecules that may characterise IUGR in piglets. These observations will permit future investigations to identify specific molecules associated with IUGR that would lead to possible real-time corrective actions before birth. This work was supported by USDA-ARS grant no. 58-6402-3-018.

Pregnancy in patient with X-linked hypophosphatemic rickets – management and outcome

Introduction: X-linked hypophosphatemia (XLH) is a genetically determined disorder inherited as a dominant trait associated with mutation within the PHEX gene. Phenotypic presentation of XLH ranges from isolated hypophosphatemia to severe lower-extremity bowing. Case Report: Preterm hypotrophic infant was born to a mother with a history of XLH, arterial hypertension, and aortic valve insufficiency. The course of pregnancy was complicated by severe symmetric intrauterine growth restriction (IUGR), abnormal umbilical artery flow, and fetal heart rate decelerations during the non-stress test. Discussion: Occurrence of IUGR was most probably due to severe maternal disorders, as no data suggesting association between XLH in mother and symmetric IUGR is available. XLH, treatment side effects, and secondary hyperparathyroidism may manifest by variety of medical conditions including nephrocalcinosis, hypertension or heart disease. Proper management of pregnancy in this group of patients requires appropriate preconception counseling and multidisciplinary approach during pregnancy and after delivery.

Maternal L-glutamine supplementation during late gestation alleviates intrauterine growth restriction-induced intestinal dysfunction in piglets.

Maternal dietary supplementation with L-glutamine (Gln) has been considered as an option to improve fetal growth and to prevent the occurrence of intrauterine growth restriction (IUGR). This study investigated whether maternal Gln supplementation could improve fetal growth as well as the intestinal development during late pregnancy. Sixty pregnant Landrace × Large White multiparous sows were assigned to two groups, either the group fed the control diet or the group with the diet supplemented with 1% Gln from d 85 of gestation until farrowing. One normal body weight piglet and one IUGR piglet were obtained from six litters in each group. Reproductive performance, plasma concentrations of free amino acids and related metabolites as well as piglet growth and tissue indexes were determined. Maternal Gln supplementation during late gestation increased the average birth weight, while decreasing the within-litter variation of newborn piglets. The concentrations of Gln in plasma were lower in IUGR piglets than in normal piglets. Glutamine supplementation enhanced Gln concentrations in maternal and piglet plasma and the piglet jejunum, compared with the Control group. Supplementing Gln suppressed intestinal miR-29a levels, and increased the abundance of extracellular matrix (ECM) and tight junction (TJ) proteins, resulting in increased intestinal weight and improved morphologies of the piglets. Collectively, Gln supplementation to the sow's diet increased fetal growth, decreased the within-litter variation of newborn piglets, and alleviated the IUGR-induced intestinal impairment. These findings suggest the possibility of maternal glutamine supplementation in the prevention and treatment of IUGR in animal production and human medicine.

Efecto del sexo y la restricción de crecimiento intrauterino en la composición de ácidos grasos en lechones ibéricos recién nacidos

The occurrence of Intrauterine Growth Restriction is a spontaneous event which negatively influences the postnatal development. This effect has been assessed in pigs, but there are few data about potential changes in fatty acid composition. Hence, we analyzed fatty acids composition in the liver and muscle (longissimus dorsi) of 43 Iberian x Duroc newborn piglets. Sixteen of them were classified as Normal Birth-Weight piglets (8 males and 8 females, average weight 1402.2 ±321 g) and 27 were identified as Low Birth-Weight piglets (14 males and 13 females, average weight 635.7 ±159.1 g; P<0.0001). Regarding the fatty acid composition in both liver and muscle, significant differences were observed between Low Birth-Weight and Normal Birth-Weight. Therefore, the liver fatty acids also showed sex-related significant effects; especially in the polar fraction. The analysis of the neutral fraction in muscle showed lower monounsaturated fatty acids (MUFA; P<0.0001) concentration and higher polyunsaturated fatty acids (PUFA; P<0.005) concentration in Low Birth-Weight neonates. In relation to polar lipids of the liver, Low Birth-Weight piglets had lower saturated fatty acids concentration (SFA) than Normal Birth-Weight (P<0.05). Sex affected the neutral MUFA/SFA ratio and the polar polyunsaturated fatty acids concentration of the liver, being respectively higher and lower in females (P<0.05 for both). In conclusion, the present study shows that Intrauterine Growth Restriction and sex are related to changes in the muscle and liver fatty acid composition that may affect meat quality.

The effect of antenatal L-arginine and antioxidant supplementation on oxidative stress marker levels in newborns.

The present study was conducted in the Department of Obstetrics, Paediatrics & Biophysics IMS, BHU, Varanasi with an aim to study the role of L-arginine and oral antioxidants as a part of therapy in patients diagnosed with IUGR (Intra uterine growth restriction ) and cord serum NO and oxidative stress markers GSH and SOD in newborns following delivery of such patients. The study included 40 pregnant patient between 30-32 weeks of gestation diagnosed with IUGR who were divided into 3 groups: Group I (treated with L-arginine N=10), Group II (treated with antioxidants N=10), Group III (without nutritional supplementation N=10) and Group IV (healthy control pregnant patients of same gestational age range N=10) were taken. Cord serum NO & oxidative stress markers (GSH & SOD) were measured following delivery of patients from those four groups. The cord serum NO levels (μmol/lt) showed a significant increase & SOD (U/ml) & GSH (U/lt) values were increased in newborns to mothers diagnosed with IUGR after treatment with L-arginine. Similar results were obtained for treatment with antioxidants. The reduced NO & reduced cord serum circulating levels of oxidative stress markers (GSH & SOD) activity may play an important role in the occurrence of IUGR.

Assessment of interleukin-6, interleukin-8 and interleukin-18 count in the serum of IUGR newborns

Aim: Aim of this study was to assess concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8) and interleukin-18 (IL-18) in the serum of newborns with diagnosed intrauterine growth restriction (IUGR) in comparison to concentrations in serum of newborns with weight appropriate for gestational age (AGA).Materials: Research was conducted at the Lodz Medical University Clinic of Neonatology during 2010–2011. Surveyed group consisted of 50 hypotrophic full-term infants of single pregnancies (average weight: 2329 ± 287 g); control group, enclosing 50 infants AGA (average weight: 3544 ± 2161 g). Both groups received average Apgar score of 9 points. Concentrations of analysed cytokines were marked between 4–6 hours after birth. The enzyme-linked immunosorbent assay (ELISA) test was used to determine interleukins concentrations. Study was prospective. Statistics on the data were conducted with the Kolmogorov–Smirnov test. Significance level: p < 0.05.Results: Concentrations of IL-6 and IL-18 were elevated in the IUGR group in a statistically significant manner in comparison to the control group.Conclusions: An elevated level of IL-6 and IL-18 in the IUGR group, comparing to control group, signifies the existence of inflammation in the process of developing IUGR, therefore, screening tests estimating levels of interleukins as IL-6 and IL-18 might be clinically useful in predicting the occurrence of IUGR and help preventing it.

Magnetic resonance imaging of the placenta identifies placental vascular abnormalities independently of Doppler ultrasound

To evaluate the relationship between placental vascular pathology detected by prenatal magnetic resonance imaging (MRI) and perinatal outcome. This was a retrospective, hospital-based, cross-sectional study in which all fetal MRI examinations of singleton pregnancies with vascular placental pathology (i.e. infarction with/without hemorrhage, subchorionic thrombi/hemorrhages, intervillous thrombi/hemorrhages, or retroplacental hematoma) in the period 2002-2007 were included. The extent of the pathology was expressed as a percentage of the total placental volume. Abnormalities of umbilical artery Doppler ultrasound examinations within 7 days between MRI and ultrasound examination were noted. Death in utero or postnatally was the primary outcome. Gestational age at MRI and at birth and the occurrence of intrauterine growth restriction (IUGR) were noted. Logistic regression analysis was performed to assess the impact of gestational age at MRI, extent of the vascular lesion and presence of pathological Doppler ultrasound measurements on the prediction of mortality. Fifty-nine structurally normal singleton pregnancies with placental vascular abnormalities were included in the analysis. Mortality rate was 36%; among the survivors, 87% were born before 37 + 0 gestational weeks and 50% suffered from IUGR. In 55% of the pregnancies pathological umbilical artery Doppler findings were identified, of which 27% were non-survivors. Mortality was predicted by earlier gestational age at fetal MRI for placental pathology (P < 0.05) and increasing extent of the vascular lesion (P < 0.05), but not by the presence of pathological Doppler ultrasound data. Accuracy of the prediction was 82%, sensitivity was 67% and specificity 89%. MRI-detected vascular placental pathologies may help to identify pregnancies at risk for adverse outcome and fetal death independently of umbilical artery Doppler status.

Assessing the Value of Customized Birth Weight Percentiles

Customized birth weight percentiles are weight-for-gestational-age percentiles that account for the influence of maternal characteristics on fetal growth. Although intuitively appealing, the incremental value they provide in the identification of intrauterine growth restriction (IUGR) over conventional birth weight percentiles is controversial. The objective of this study was to assess the value of customized birth weight percentiles in a simulated cohort of 100,000 infants aged 37 weeks whose IUGR status was known. A cohort of infants with a range of healthy birth weights was first simulated on the basis of the distributions of maternal/fetal characteristics observed in births at the Royal Victoria Hospital in Montreal, Canada, between 2000 and 2006. The occurrence of IUGR was re-created by reducing the observed birth weights of a small percentage of these infants. The value of customized percentiles was assessed by calculating true and false positive rates. Customizing birth weight percentiles for maternal characteristics added very little information to the identification of IUGR beyond that obtained from conventional weight-for-gestational-age percentiles (true positive rates of 61.8% and 61.1%, respectively, and false positive rates of 7.9% and 8.5%, respectively). For the process of customization to be worthwhile, maternal characteristics in the customization model were shown through simulation to require an unrealistically strong association with birth weight.

Single Umbilical Artery and Its Associated Findings

Single umbilical artery (SUA) is diagnosed in about 1% of live-born fetuses. Although there is no consensus on the clinical relevance of this diagnosis, a number of studies have reported associations between SUA and adverse fetal outcomes, such as intrauterine growth restriction (IUGR), prematurity, and congenital renal anomalies. However, these findings have been refuted by other studies that found no increased risk of IUGR or congenital malformations associated with SUA. Many of these negative studies have limited value because of small sample size, incomplete follow-up, and lack of adjustment for possible confounding factors (especially demographic differences between the comparison populations). This retrospective cohort study investigated the association between a finding of SUA and the occurrence of IUGR, fetal death, renal and cardiac anomalies, and other adverse pregnancy outcomes. The cohort was comprised of all consecutive patients with singleton pregnancies, undergoing a routine sonographic anatomic survey between 1990 and 2007 at a major tertiary medical center. Demographic information on history and pregnancy outcomes was entered into a prenatal database. The incidence of adverse pregnancy outcomes in pregnancies with SUA and those with 2 umbilical arteries (dual umbilical arteries [DUA]) was compared. The primary study outcomes were IUGR (less than the 10th percentile for gestational age), and renal and cardiac anomalies. Multivariable logistic regression was used to assess the association between SUA and defined outcomes and to adjust for potentially confounding variables. Of the 64,047 pregnancies available for follow-up analysis, 392 were cases of SUA (0.61%) and 63,655 were cases of DUA. After excluding all fetuses with known anomalies and adjusting for gestational diabetes, smoking, African-American race, and preeclampsia, pregnancies with SUA were associated with a greater than 2-fold increased risk in IUGR compared to those with DUA (adjusted odds ratio [aOR], 2.1; 95% confidence interval [CI], 1.6-2.7; P < 0.01). After adjusting for pregestational diabetes, SUA was associated with a more than 20-fold increased risk of cardiac anomalies compared to cases with DUA (aOR, 20.3; 95% CI, 13.6-30.5; P < 0.01) and after adjusting for fetal male sex and advanced maternal age, it was associated with a nearly 3-fold increased risk of renal anomalies (aOR, 3.0; 95% CI, 1.9-4.9; P < 0.01). These findings indicate a significant increase in the incidence of IUGR and renal and cardiac anomalies in pregnancies with SUA compared to those with DUA. These data suggest that it would be reasonable to perform ultrasound screening for IUGR and structural anomalies in pregnancies complicated by SUA.

Serial Sonographic Growth Assessment in Pregnancies Complicated by an Isolated Single Umbilical Artery

Pregnancies complicated by an isolated single umbilical artery (SUA) are thought to be at increased risk for intrauterine growth restriction (IUGR). The management of these pregnancies often includes serial sonographic assessments of fetal growth. The goal of our study was to test the validity of this assertion. We conducted a longitudinal sonographic assessment of intrauterine fetal growth in pregnancies complicated by a SUA. We included pregnancies where fetal growth was assessed three or more times, and the presence of SUA was repeatedly demonstrated. Pregnancies with fetal anomalies and multiple gestations were excluded. IUGR was defined as an estimated fetal weight (EFW) < or = 10th percentile of the normal ranges established by Hadlock. Between January 1999 and December 2005, we identified 273 pregnancies with SUA, for an overall incidence of 0.48% within the total population of patients examined at our institution. One hundred and thirty-five pregnancies did not meet our inclusion criteria. Of the 138 we analyzed, four pregnancies (2.9%) were found to have EFW < or = 10th percentile. We concluded that the occurrence of IUGR in pregnancies complicated by an isolated SUA is not increased. Serial sonographic assessments of fetal growth do not appear to be indicated in the management of such pregnancies.

Intrauterine growth restriction, preeclampsia, and intrauterine mortality at high altitude in Bolivia.

Infant mortality and stillbirth rates in Bolivia are high and birth weights are low compared with other South American countries. Most Bolivians live at altitudes of 2500 m or higher. We sought to determine the impact of high altitude on the frequency of preeclampsia, gestational hypertension, and other pregnancy-related complications in Bolivia. We then asked whether increased preeclampsia and gestational hypertension at high altitude contributed to low birth weight and increased stillbirths. We performed a retrospective cohort study of women receiving prenatal care at low (300 m, Santa Cruz, n = 813) and high altitude (3600 m, La Paz, n = 1607) in Bolivia from 1996 to 1999. Compared with babies born at low altitude, high-altitude babies weighed less (3084 +/- 12 g versus 3366 +/- 18 g, p < 0.01) and had a greater occurrence of intrauterine growth restriction [16.8%; 95% confidence interval (CI): 14.9-18.6 versus 5.9%; 95% CI: 4.2-7.5; p < 0.01]. Preeclampsia and gestational hypertension were 1.7 times (95% CI: 1.3-2.3) more frequent at high altitude and 2.2 times (95% CI: 1.4-3.5) more frequent among primiparous women. Both high altitude and hypertensive complications independently reduced birth weight. All maternal, fetal, and neonatal complications surveyed were more frequent at high than low altitude, including fetal distress (odds ratio, 7.3; 95% CI: 3.9-13.6) and newborn respiratory distress (odds ratio, 7.3; 95% CI: 3.9-13.6; p < 0.01). Hypertensive complications of pregnancy raised the risk of stillbirth at high (odds ratio, 6.0; 95% CI: 2.2-16.2) but not at low altitude (odds ratio, 1.9; 95% CI: 0.2-17.5). These findings suggest that high altitude is an important factor worsening intrauterine mortality and maternal and infant health in Bolivia.