Preterm Intrauterine Growth Restriction Research Articles

Interpregnancy Body Mass Index Changes: Distribution and Impact on Adverse Pregnancy Outcomes in the Subsequent Pregnancy.

To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes. We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category. In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1-32.7; p = 0.003). Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM.

Oxidative Stress and Dyslipidemia as Indicators of Pathogenesis of Preeclampsia in Pregnant Sudanese Women

Background: Preeclampsia (PE) still ranks as one of obstetrics major problems and is still a serious threat, mainly in underdeveloped countries where its incidence and mortality rates are higher and is a major cause of preterm birth and intra-uterine growth restriction. Aim: To evaluate the role of oxidative stress and dyslipidemia as indicators of pathogenesis and risks of preeclampsia in pregnant Sudanese women attending Wad-Medani Obstetrics and Gynecology Teaching Hospital. Material and Method: This was a cross-sectional (case-control) study carried out in preeclamptic pregnant Sudanese women attending Wad-Medani Obstetrics and Gynecology Teaching Hospital. A total of 208 pregnant women were enrolled in the study, 111 patients and 97 women with normal pregnancy as controls; pregnant women suffering from any systemic or endocrine disorder were excluded. We compared the serum levels of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, nitric oxide, and total antioxidant capacity between preeclamptic and controls. Result and Conclusion: Pregnant women with increase in BMI have a higher chance of developing PE. Low level of high-density lipoprotein cholesterol and high level of low-density lipoprotein cholesterol define that dyslipidemia increases the risk of PE. Decreased levels of NO and TAC might reflect the oxidative stress and likely contribute to the pathophysiological mechanisms of PE.

Moderate to late preterm intrauterine growth restriction: A restrospective, observational study of the indications for delivery and outcomes in an Australian perinatal centre.

The management of preterm intrauterine growth restriction is limited to fetal surveillance and timely delivery. Despite the existence of evidence-based guidelines, uncertainty regarding the optimal timing of delivery is common, and management remains individualised for each patient. To provide recent Australian data on the indications for delivery of moderate to late preterm growth restricted infants and the outcomes of these deliveries. Retrospective study of singleton live births delivered between 32+0 and 36+6weeks gestation over a three-year period (2012-2014) at a Melbourne Metropolitan Hospital. 'Small for gestational age' (birthweight<10th centile for gestation) identified intrauterine growth restricted infants. Indications for iatrogenic delivery were broadly categorised into maternal, fetal or pregnancy related. Obstetric and neonatal outcome variables were compared to other preterm infants using logistic regression. Of the 146 (18.6%) small for gestational age infants born during the study period, 103 were iatrogenic deliveries, most commonly due to fetal indications (53.4%). Small for gestational age infants had higher odds of hypoglycaemia (adjusted odds ratio=1.87, 95% CI: 1.23-2.84, P=0.003) and jaundice (1.52, 1.01-2.28, P=0.043) than their appropriately grown counterparts; however, there was no increase in the risk of serious morbidity or mortality. In this cohort, iatrogenic preterm delivery of small for gestational age infants between 32+0 and 36+6weeks gestation was most commonly due to fetal indications and did not increase the risk of serious, short-term neonatal outcomes compared to their appropriately grown counterparts.

EP11.01: Preterm intrauterine growth restriction and amniotic band syndrome

Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

P3257The impact of maternal hemodynamics on preterm delivery and intrauterine growth restriction in gestational hypertension

P3257The impact of maternal hemodynamics on preterm delivery and intrauterine growth restriction in gestational hypertension

OP 1 Comparing the pregnancy outcome in nuliparas both with and without microalbuminuria at the end of the second trimester of pregnancy

Poor pregnancy outcome and complications during pregnancy such as pre-eclampsia, preterm delivery, preterm premature rupture of membranes (PPROM) and intra uterine growth restriction (IUGR), are very important and the finding of new methods for their prediction has always been a matter of serious concern. The purpose of the present study is to evaluate the poor pregnancy outcome in nulliparas who had microalbuminuria at the end of second trimester of their pregnancy. The study was conducted as a prospective cohort study on 490 nulliparous women who were at the end of the second trimester of pregnancy. Urine tests for albuminuria and creatinine measurements were performed in all women and an albumin creatinine ratio (ACR) was calculated according to milligram per gram. The women were then divided into 3 categories of severe, moderate and mild microalbuminuria according to the ratio.The women with microalbuminuria (case group) and without microalbuminuria (control group) were monitored to the end of their pregnancy and compared for preterm labor, preeclampsia, intra uterine growth restriction (IUGR) and preterm premature rupture of membranes (PPROM). Preterm labor [21 (55.26%) cases VS 65 (14.38%), P = 0.001], preeclampsia [19 (50%) cases VS 39 (8.62%) cases, P = 0.0001], IUGR [15 (39.47%) cases VS 30 (6.63%) cases, P = 0.001] and PPROM [11 (28.94%) cases VS 47 (10.39%) cases, P = 0.001] showed more in the case group than control group. Gestational diabetes did not show any significant difference between the 2 groups. Using multivariate logistic regression analyses, microalbominuria showed an increased risk for PTL [Adjusted OR (95% CI) = 2.4 (1.1–5.5), P = 0.03] and preeclampsia [Adjusted OR (95% CI) = 9.5 (4.6–19.3), P = 0.000]. Preterm labor, precclampsia, IUGR and PPROM were higher in the women who had microalbuminuria at the end of the second trimester of their pregnancy.

Early versus Late Enteral Feeding in Preterm Intrauterine Growth Restricted Neonates with Antenatal Doppler Abnormalities: An Open-Label Randomized Trial.

Enteral feeding in preterm neonates with intrauterine growth restriction (IUGR) and absent or reversed end diastolic flow (AREDF) on umbilical artery (UA) Doppler is delayed owing to an increased risk of necrotizing enterocolitis (NEC). Delaying enteral feeding with longer duration of parenteral nutrition (PN) carries an increased risk of sepsis. To study early versus late feeding in preterm IUGR neonates for time required to attain sufficient feed volume to discontinue PN and increased risk of NEC or feed intolerance (FI). Open-label randomized controlled trial. Tertiary care neonatal unit and fetal-maternal medicine unit in India. Preterm intrauterine growth restricted neonates' ≤32 weeks with AREDF on UA Doppler enrolled from 1 January 2014 to 31 July 2015. Randomized to receive early or late feeding using mothers own or donor breast milk as per a feed initiation and advancement protocol. Time in days required to attain sufficient feed volume allowing discontinuation of PN and incidence of NEC in neonates fed early versus late. There were 77 eligible neonates. Sixty-two neonates were included and stratified as extreme preterm (27-29 weeks) (n = 20) and very preterm (30-32 weeks) (n = 42). Ten extreme preterm and 21 very preterm neonates were randomized to each early feeding and late feeding arm. There was a significantly faster attainment of sufficient feeds in the early feeding arm of both the stratified groups [extreme preterm: median 14 days (Interquartile range IQR: 12-15) compared with 18 days (IQR: 18-20), hazard ratio (HR): 1.59, 95% CI: 0.626-4.078; very preterm: 12 days (IQR: 10-14) as compared with 16 days (IQR 15-17), HR: 1.89, 95% CI: 1.011-3.555]. There was no difference in the incidence of NEC, FI and combined outcome of NEC and FI. Early feeding in preterm IUGR neonates with AREDF on antenatal UA Doppler allowed earlier discontinuation of PN, allowing birth weight to be regained earlier and did not increase the incidence of NEC and FI.

Maternal Demographic and Placental Risk Factors in Term Low Birth Weight in Ghana

Background: Several studies report on factors that associate preterm birth and intrauterine growth restriction with low birth weight (LBW). However, few studies discuss risk factors that associate with LBW for full-term births. No such studies exist that involve a population from Ghana. Method: We used a nested case-control study approach to examine maternal socio-demographic and placental factors that contribute significantly to term LBW in Ghana. We assessed also the incidence of LBW in general at a major teaching hospital facility in Ghana. Results: Univariate and multivariate logistic regression analysis were used to investigate maternal sociodemographic and placental factors that associate with LBW. Following the preliminary univariate analysis, a stepwise logistic regression analysis showed that unstable income source, single motherhood, combined effect of pre-eclampsia and anaemia; ORs of 5.366 (95% CI: 1.986 to 14.497), 21.390 (95% CI: 3.610 to 126.734) and 3.246 (95% CI: 1.074 to 9.814), respectively, and placental weight and irregular insertion of the umbilical cord (variables scaled by a factor of 10-2 to aid interpretation) ORs 0.28 (95% CI: 0.115 to 0.683), 0.010 (95% CI: 0.001 to 0.173 respectively) on the chorionic plate, were risk factors for LBW. The socio-demographic and placental factors reveal a core role of maternal and infant nutritional deficiencies in term LBW in Ghana. The general prevalence of LBW in the Hospital facility was 6.2%. Conclusion: We conclude that poor maternal and infant nutrient supply is key factors in term LBW in Ghana. These factors are amenable to appropriate nutritional and educational interventions.

Brain metabolite alterations in infants born preterm with intrauterine growth restriction: association with structural changes and neurodevelopmental outcome

Intrauterine growth restriction and premature birth represent 2 independent problems that may occur simultaneously and contribute to impaired neurodevelopment. The objective of the study was to assess changes in the frontal lobe metabolic profiles of 1 year old intrauterine growth restriction infants born prematurely and adequate-for-gestational-age controls, both premature and term adequate for gestational age and their association with brain structural and biophysical parameters and neurodevelopmental outcome at 2 years. A total of 26 prematurely born intrauterine growth restriction infants (birthweight <10th centile for gestational age), 22 prematurely born but adequate for gestational age controls, and 26 term adequate-for-gestational-age infants underwent brain magnetic resonance imaging and magnetic resonance spectroscopy at 1 year of age during natural sleep, on a 3 Tesla scanner. All brain T1-weighted and diffusion-weighted images were acquired along with short echo time single-voxel proton spectra from the frontal lobe. Magnetic resonance imaging/magnetic resonance spectroscopy data were processed to derive structural, biophysical, and metabolic information, respectively. Neurodevelopment was evaluated at 2 years of age using the Bayley Scales 3rd edition, assessing cognitive, language, motor, socioemotional, and adaptive behavior. Prematurely born intrauterine growth restriction infants had slightly smaller brain volumes and increased frontal lobe white matter mean diffusivity compared with both prematurely born but adequate for gestational age and term adequate for gestational age controls. Frontal lobe N-acetylaspartate levels were significantly lower in prematurely born intrauterine growth restriction than in prematurely born but adequate for gestational age infants but increased in prematurely born but adequate for gestational age compared with term adequate-for-gestational-age infants. The prematurely born intrauterine growth restriction group also showed slightly lower choline compounds, borderline decrements of estimated glutathione levels, and increased myoinositol to choline ratios, compared with prematurely born but adequate for gestational age controls. These specific metabolite changes were locally correlated to lower gray matter content and increased mean diffusivity and reduced white matter fraction and fractional anisotropy. Prematurely born intrauterine growth restriction infants also showed a tendency for poorer neurodevelopmental outcome at 2 years, associated with lower levels of frontal lobe N-acetylaspartate at 1year within the preterm subset. Preterm intrauterine growth restriction infants showed altered brain metabolite profiles during a critical stage of brainmaturation, which correlate with brain structural and biophysical parameters and neurodevelopmental outcome. Our results suggest alteredneurodevelopmental trajectories in preterm intrauterine growth restriction and adequate-for-gestational-age infants, compared with termadequate-for-gestational-age infants, which require further characterization.

When is the optimal time to deliver late preterm IUGR fetuses with abnormal umbilical artery Dopplers?

Objective: To determine the optimal timing of delivery in late preterm intrauterine growth restriction (IUGR) fetuses with abnormal umbilical artery Doppler (UAD) indices.Methods: A decision-analytic model was built to determine the optimal gestational age (GA) of delivery in a theoretic cohort of 10 000 IUGR fetuses with elevated UAD systolic/diastolic ratios diagnosed at 34 weeks. All inputs were derived from the literature. Strategies involving expectant management accounted for the probabilities of stillbirth, spontaneous delivery and induction of labor for UAD absent or reversed end-diastolic flow (AREDF) at each successive week. Outcomes included short- and long-term neonatal morbidity and mortality with quality-adjusted life years (QALYs) generated based on these outcomes. Base case, sensitivity analyses and a Monte Carlo simulation were performed.Results: The optimal GA for delivery is 35 weeks, which minimized perinatal deaths and maximized total QALYs. Earlier delivery became optimal once the risk of stillbirth was threefold our baseline assumption; our model was also robust until the risk of AREDF at 35 weeks was half our baseline assumption, after which delivery at 36 weeks was preferred. Delivery at 35 weeks was the optimal strategy in 77% of trials in Monte Carlo multivariable sensitivity analysis.Conclusions: Weighing the risks of iatrogenic prematurity against the poor outcomes associated with AREDF, the ideal GA to deliver late preterm IUGR fetuses with elevated UAD indices is 35 weeks.

The impact of anxiety and depression during pregnancy on fetal growth and the birth outcome

Background Maternal depressive and anxiety symptoms during pregnancy have been reported in some, but not all, studies to be associated with an increased risk of preterm birth and intrauterine growth restriction (IUGR). Objectives The aim of this study was to estimate the risk of preterm birth and IUGR associated with antenatal anxiety and depression during early pregnancy and to evaluate their impact on fetal growth and the birth outcome. Patients and methods The following measures were applied to 54 pregnant mothers: the Edinburgh Postnatal Depressive Scale (EPDS), the Beck Anxiety Inventory (BAI), and fetal biometric data and behavior were recorded during ultrasound examination at 24-36 weeks of gestation and the placental blood perfusion was measured by Doppler assessment of the systolic/diastolic ratio (S/D ratio) of the umbilical artery in the third trimester. Results This study revealed that women with depressive and anxiety symptoms in the third trimester of pregnancy exhibit an increased likelihood of having oligohydramnios, IUGR, diminished placental perfusion, and preterm labor. Conclusion This study provides evidence that maternal depressive and anxiety symptoms during pregnancy are associated with various fetal developmental problems.

Early childhood neurodevelopment after intrauterine growth restriction: a systematic review.

Children who experienced intrauterine growth restriction (IUGR) may be at increased risk for adverse developmental outcomes in early childhood. The objective of this study was to carry out a systematic review of neurodevelopmental outcomes from 6 months to 3 years after IUGR. PubMed, Embase, PsycINFO, Maternity and Infant Care, and CINAHL databases were searched by using the search terms intrauterine, fetal, growth restriction, child development, neurodevelopment, early childhood, cognitive, motor, speech, language. Studies were eligible for inclusion if participants met specified criteria for growth restriction, follow-up was conducted within 6 months to 3 years, methods were adequately described, non-IUGR comparison groups were included, and full English text of the article was available. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-documented quality-appraisal guidelines. Of 731 studies reviewed, 16 were included. Poorer neurodevelopmental outcomes after IUGR were described in 11. Ten found motor, 8 cognitive, and 7 language delays. Other delays included social development, attention, and adaptive behavior. Only 8 included abnormal Doppler parameters in their definitions of IUGR. Evidence suggests that children are at risk for poorer neurodevelopmental outcomes following IUGR from 6 months to 3 years of age. The heterogeneity of primary outcomes, assessment measures, adjustment for confounding variables, and definitions of IUGR limits synthesis and interpretation. Sample sizes in most studies were small, and some examined preterm IUGR children without including term IUGR or AGA comparison groups, limiting the value of extant studies.

The Efficacy of Surfactant Replacement Therapy in the Growth-Restricted Preterm Infant: What is the Evidence?

Background: Surfactant replacement therapy (SRT) is an integral part of management of preterm surfactant deficiency respiratory distress syndrome (RDS). Its role in the management of RDS has been extensively studied. However, its efficacy in the management of lung disease in preterm infants born with intrauterine growth restriction (IUGR) has not been systematically studied.Objective: To evaluate the efficacy of exogenous SRT in the management of preterm IUGR lung disease.Methods: A systematic search of all available randomized clinical trials (RCT) of SRT in preterm IUGR infants was done according to the standard Cochrane collaboration search strategy. Neonatal respiratory outcomes were compared between the preterm IUGR and appropriately grown for gestational age (AGA) preterm infant populations in eligible studies.Results: No study was identified which evaluated the efficacy or responsiveness of exogenous SRT in preterm IUGR infants as compared to preterm AGA-infants. The only study identified through the search strategy used small for gestational age (SGA; defined as less than tenth centile for birth weight) as a proxy for IUGR. The RCT evaluated the efficacy or responsiveness of SRT in preterm SGA group as compared to AGA-infants. The rate of intubation, severity of RDS, rate of surfactant administration, pulmonary air leaks, and days on the ventilator did not differ between both groups. However, the requirement for prolonged nasal continuous positive airway pressure (p < 0.001), supplemental oxygen therapy (p < 0.01), and the incidence of bronchopulmonary dysplasia at 28 days and 36 weeks (both p < 0.01) was greater in SGA-infants.Discussion: There is currently insufficient data available to evaluate the efficacy of SRT in preterm IUGR lung disease. A variety of research strategies will be needed to enhance our understanding of the role and rationale for use of SRT in preterm IUGR lung disease.

Abnormal uterine artery Doppler velocimetry predicts adverse outcomes in patients with abnormal analytes.

Our aim was to determine if uterine artery (UtA) Doppler studies would risk-stratify women with abnormal serum analytes on prenatal genetic screening into those at baseline and increased risk for preeclampsia and small-for-gestational age (SGA). This retrospective cohort study examined outcomes of patients with ⩾one abnormal analyte (PAPP-A<0.3, hCG>3.0, AFP>2.5, inhibin>2.0, or unconjugated estriol<0.3MoM). At approximately 24weeks, we assessed UtA pulsatility index (PI). Preeclampsia, preterm preeclampsia, SGA (birthweight (BW) <10%) and intrauterine growth restriction (IUGR) (BW<3%). We identified 132 patients with ⩾one abnormal analyte, UtA Doppler screening, and delivery outcomes. Twenty-four (18%) had an elevated UtA PI (PI>1.6); preeclampsia occurred in 16 (12%) and 26 (20%) delivered a SGA neonate. Abnormal UtA Doppler PI increased the likelihood of a composite outcome of preeclampsia or SGA from 27% to 71% (LR 6.48 (2.93, 14.30)); a negative UtA Doppler PI reduced the likelihood to 18% (LR 0.57 (0.42, 0.78)). Abnormal UtA Doppler PI increased the likelihood of a more severe composite outcome of preterm preeclampsia or IUGR from 11% to 39% (LR 5.49 (3.03, 9.97)); a negative UtA Doppler study reduced the likelihood to 4% (LR 0.35 (0.16, 0.80)). In patients with abnormal serum analytes, abnormal UtA Doppler PI is significantly associated with preeclampsia or SGA and improves the prediction of these adverse outcomes by 9-15-fold. Providers can incorporate UtA Doppler PI into an abbreviated surveillance regimen; they can be reassured that a normal study markedly decreases the risk of a severe early adverse outcome.

Folic acid protects against lipopolysaccharide-induced preterm delivery and intrauterine growth restriction through its anti-inflammatory effect in mice.

Increasing evidence demonstrates that maternal folic acid (FA) supplementation during pregnancy reduces the risk of neural tube defects, but whether FA prevents preterm delivery and intrauterine growth restriction (IUGR) remains obscure. Previous studies showed that maternal lipopolysaccharide (LPS) exposure induces preterm delivery, fetal death and IUGR in rodent animals. The aim of this study was to investigate the effects of FA on LPS-induced preterm delivery, fetal death and IUGR in mice. Some pregnant mice were orally administered with FA (0.6, 3 or 15 mg/kg) 1 h before LPS injection. As expected, a high dose of LPS (300 μg/kg, i.p.) on gestational day 15 (GD15) caused 100% of dams to deliver before GD18 and 89.3% of fetuses dead. A low dose of LPS (75 μg/kg, i.p.) daily from GD15 to GD17 resulted in IUGR. Interestingly, pretreatment with FA prevented LPS-induced preterm delivery and fetal death. In addition, FA significantly attenuated LPS-induced IUGR. Further experiments showed that FA inhibited LPS-induced activation of nuclear factor kappa B (NF-κB) in mouse placentas. Moreover, FA suppressed LPS-induced NF-κB activation in human trophoblast cell line JEG-3. Correspondingly, FA significantly attenuated LPS-induced upregulation of cyclooxygenase (COX)-2 in mouse placentas. In addition, FA significantly reduced the levels of interleukin (IL)-6 and keratinocyte-derived cytokine (KC) in amniotic fluid of LPS-treated mice. Collectively, maternal FA supplementation during pregnancy protects against LPS-induced preterm delivery, fetal death and IUGR through its anti-inflammatory effects.

Definition and management of fetal growth restriction: a survey of contemporary attitudes

ObjectiveTo evaluate opinions among Irish obstetricians and obstetric trainees regarding the optimal definition, assessment and management of pregnancies affected by intrauterine growth restriction (IUGR). Study designAn anonymous, structured, web-based survey that comprised 14 questions was sent to 200 obstetricians and obstetric trainees in Ireland. ResultsOf the 113 participants (57% response rate), the majority (50%) were consultants, with over 10 years’ clinical experience (46%), who worked in large maternity units (58%) with neonatal units providing care for preterm IUGR fetuses (94%). Eighty-three clinicians (74%) agreed that an estimated fetal weight (EFW) below the 10th centile constitutes small-for-gestational age (SGA). The majority (n=93; 82%) would deliver the SGA fetus between 37+0 and 39+6 weeks gestation. In total, the survey yielded 30 different IUGR definitions; the top three definitions were (i) an EFW below the 5th centile (n=18; 16%), (ii) an EFW below the 10th centile with oligohydramnios and abnormal umbilical artery (UA) Doppler (n=16; 14%), and (iii) an EFW below the 10th centile (n=12; 11%). In the evaluation of the preterm IUGR fetus with abnormal UA Doppler, the assessment of amniotic fluid volume, middle cerebral artery, ductus venosus, cardiotocograph (CTG) and biophysical profiling was performed in 74%, 60%, 60%, 54% and 52% respectively. The majority of clinicians applied three or more assessment modalities and 60% referred to a maternal-fetal medicine (MFM) subspecialist. Interestingly, even among MFM subspecialists there was no common consistent management approach. Most doctors (81%) would deliver the IUGR fetus for CTG abnormalities but MFM subspecialists more commonly deliver on the basis of absent end-diastolic flow in the UA alone (37% vs. 10%; p=0.006). Two-thirds of doctors (n=74) would implement customised growth charts if they became available for their population and over 80% thought that a national guideline on IUGR would be beneficial. ConclusionThe results of this survey confirm the inconsistencies surrounding the clinical management of IUGR pregnancies and highlight the need for standardisation of terminology and antenatal surveillance, implementation of fetal weight customisation and national guidance for Ireland.

Oxidatively modified LDL particles in the human placenta in early and late onset intrauterine growth restriction

IntroductionReduced serum LDL concentrations have been observed in pregnancies complicated by intrauterine growth restriction (IUGR) as compared to healthy pregnant women. Since increased oxidative stress has been suggested to play a major role in IUGR we now hypothesized that the lower LDL concentrations are accompanied by an accumulation of oxidized LDLs in the placenta. MethodsFifteen placentas of near term and preterm born IUGR, and a gestational age matched control group (CTRL n = 15) were analyzed. Placental minimal modified LDL and fully oxidized LDL particles were measured by ELISA, and by immunohistochemistry, and were related to maternal and fetal serum lipid profiles. ResultsWe found fully oxidized LDL but not minimal modified LDL being increased in the preterm subgroup of IUGR (n = 10) as compared to preterm CTRL (n = 10; p < 0.05). An increased staining intensity of trophoblasts in preterm IUGR subjects as compared to preterm CTRL has been confirmed by immunohistochemistry (p < 0.05). No difference could be found between the term groups (n = 5 each). Correlation analysis revealed an inverse relationship of maternal LDL (ρ = −0.49, p = 0.03) and fetal HDL cholesterol (ρ = −0.46, p = 0.04) with placental fully oxidized LDL particle concentration within preterms. DiscussionIUGR is a heterogeneous entity. Different pathomechanisms seem to underlie the disease in preterm and term subjects with oxidation of LDL within the placenta possibly taking place in preterm IUGRs. ConclusionsWe conclude that the reduced maternal LDL cholesterol concentration in IUGR pregnancies is attributed to increased accumulation of oxidized LDL particles within the placenta at least in early onset IUGR.

The Contribution of Preterm Birth and Intrauterine Growth Restriction to Infant Mortality in Tanzania

Our objectives were to examine the associations of neonatal and infant mortality with preterm birth and intrauterine growth restriction (IUGR), and to estimate the partial population attributable risk per cent (pPAR%) of neonatal and infant mortality due to preterm birth and IUGR. Participants were HIV-negative pregnant women and their infants enrolled in Dar es Salaam, Tanzania. Gestational age calculated from date of last menstrual period was used to define preterm, and small for gestational age (SGA) was used as proxy for IUGR. Survival of infants was ascertained at monthly follow-up visits. Cox proportional hazard models were used to estimate the associations of preterm and SGA with neonatal and infant mortality. Study included 7225 singletons, of whom 15% were preterm and 21% were SGA; majority of preterm or SGA babies had birthweight ≥2500 g. Compared to term and appropriately sized babies (AGA), relative risks (RR) of neonatal mortality among preterm-AGA was 2.6 [95% CI 1.8, 3.9], RR among term-SGA was 2.3 [95% CI 1.6, 3.3], and the highest risk was among the preterm-SGA babies (RR 15.1 [95% CI 8.2, 27.7]). Risk associated with preterm was elevated throughout the infancy, and risk associated with SGA was elevated during the neonatal period only. The pPAR% of neonatal mortality for preterm was 22% [95% CI 17%, 26%] and for SGA it was 26% [95% CI 16%, 36%]. Preterm and SGA birth substantially increased the risk of mortality. Interventions for prevention and management of these conditions are likely to reduce of infant mortality in Tanzania.

Obstetrical complications associated with first‐trimester screening markers in twin pregnancies

The aim of this retrospective study was to investigate the relation between perinatal complications in twin pregnancies and the combination of first-trimester maternal serum pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotrophin (β-hCG) levels. The study was conducted at the Perinatology Department of Baskent University between January 2005 and December 2011. In total, 104 patients with twin pregnancies were recruited. The association of first-trimester maternal serum-screening markers with perinatal complications was investigated for small-for-gestational-age (SGA) fetuses or intrauterine growth restriction (IUGR), preterm delivery (before 34 weeks of gestation), pregnancy-induced hypertension (PIH), and growth discordance between fetuses. Low serum PAPP-A (below 10th percentile) levels were not correlated with preterm labor, PIH, or IUGR in twin gestations. Elevated free β-hCG levels (>90th percentile) were linked to increased rates of PIH and small-for-gestational-age fetuses or IUGR. Elevated first-trimester free β-hCG was related to adverse pregnancy outcomes in twin pregnancies, whereas low PAPP-A levels were not linked to adverse pregnancy outcomes.

PP033. Oxidized LDL particles in the placenta of intrauterine growth restriction (IUGR) subgroups

Maternal serum LDL concentrations are lower in IUGR pregnancies as compared to controls (CTRL). We now hypothesized that an increased oxidative stress results in the formation of oxidized LDL (oxLDL) particles which than accumulates within the placenta. This is particularly hypothesized for the severe early onset subgroup of IUGR with preeclampsia (PE). OxLDL (minimal modified and fully oxidized LDL) levels in placental biopsies from term IUGR (>37 weeks, t-IUGR, n=5), preterm IUGR (<34 weeks, p-IUGR, n=5), and preterm IUGR with PE (PE-IUGR, n=5) were compared to a CTRL group consisted of gestational age matched preterm (p-CTRL, n=10) and term (t-CTRL, n=5) placentas by ELISA and immunohistochemistry (IHC). Fully oxidized LDL but not minimally oxidized LDL concentrations were higher in p-IUGR and tend to be increased in PE-IUGR when compared to p-CTRL (p=0.040 and p=0.075). There was virtually no difference of fully oxidized LDL levels between p-CTRL, t-CTRL, and t-IUGR. We confirmed a higher oxLDL accumulation in trophoblasts of p-IUGR and PE-IUGR as compared to both CTRL groups by IHC though this was not statistically significant. Conformational changes of LDL during the process of oxidation might lead to an accumulation of oxLDL particles in placental tissue of IUGR. The pathogenesis of early onset IUGR might differ from those of late onset IUGR.