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Fetal neurosonography at 31–35 weeks reveals altered cortical development in pre‐eclampsia with and without small‐for‐gestational‐age fetus
Basso, A.; Youssef, L.; Nakaki, A. ...
Ultrasound in obstetrics & gynecology,
June 2022, 2022-Jun, 2022-06-00, 20220601, Letnik:
59, Številka:
6
Journal Article
ABSTRACT
Objective
To explore the pattern of fetal cortical development in pregnancies complicated by pre‐eclampsia (PE), with and without a small‐for‐gestational‐age (SGA) fetus, compared to ...
uncomplicated pregnancies.
Methods
This was a prospective observational study including singleton pregnancies complicated by normotensive SGA (birth weight < 10th centile) (n = 77), PE with an appropriate‐for‐gestational‐age (AGA) fetus (n = 76) or PE with a SGA fetus (n = 67), and 128 uncomplicated pregnancies (normotensive AGA) matched by gestational age at ultrasound. All pregnancies underwent detailed neurosonography, using a transabdominal and transvaginal approach, at 31–35 weeks' gestation to assess the depth of the insula, Sylvian fissure, parieto‐occipital sulcus, cingulate sulcus and calcarine sulcus. All measurements were adjusted for biparietal diameter (BPD). In addition, a grading score of cortical development was assigned to each brain structure, ranging from Grade 0 (no development) to Grade 5 (maximum development). Univariate and multiple regression analyses were conducted.
Results
Similar to findings in previous studies, normotensive pregnancies with a SGA fetus showed significant differences in cortical development compared with controls, with reduced Sylvian fissure depth adjusted for BPD (14.5 ± 2.4 vs 16.6 ± 2.3; P < 0.001) and increased insula depth adjusted for BPD (33.2 ± 2.0 vs 31.8 ± 2.0; P < 0.001). Interestingly, a similar cortical development pattern was observed in PE pregnancies with a SGA fetus and in PE pregnancies with an AGA fetus, manifested by reduced Sylvian fissure depth adjusted for BPD (14.2 ± 2.3 and 14.3 ± 2.3 vs 16.6 ± 2.3; P < 0.001 for both) and greater insula depth adjusted for BPD (33.2 ± 2.1 and 32.8 ± 1.7 vs 31.8 ± 2.0; P < 0.001 for both) compared with controls. No significant differences were observed in parieto‐occipital, cingulate sulcus or calcarine sulcus depth across the study groups. The Sylvian fissure was scored as Grade 4 in significantly more (93.2% vs 59.5%) and as Grade 5 in significantly fewer (2.7% vs 37.3%) PE pregnancies with an AGA fetus compared with controls (P < 0.05 for both). These differences remained significant even after statistical adjustment for potential confounders, including ethnicity, low socioeconomic status, nulliparity, chronic hypertension, pregestational diabetes, assisted reproductive technologies, smoking and fetal gender, with the application of Benjamini–Hochberg procedure for multiple comparisons.
Conclusions
PE with or without SGA is associated with a differential fetal cortical development pattern which is similar to that described previously in small fetuses. Future research is warranted to elucidate better the mechanism(s) underlying these changes. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
več
13.
Fetal neurosonography and infant neurobehavior following conception by assisted reproductive technology with fresh or frozen embryo transfer
Boutet, M. L.; Eixarch, E.; Ahumada‐Droguett, P. ...
Ultrasound in obstetrics & gynecology,
November 2022, Letnik:
60, Številka:
5
Journal Article
ABSTRACT
Objective
We aimed to explore fetal cortical brain development by neurosonography in fetuses conceived by assisted reproductive technology (ART), including frozen and fresh embryo transfer ...
(ET), compared with those conceived spontaneously (SC), and to investigate its association with infant neurobehavior at 12 months of age.
Methods
This was a prospective cohort study of 210 singleton pregnancies, including 70 SC pregnancies, 70 conceived by in‐vitro fertilization (IVF) following frozen ET and 70 conceived by IVF after fresh ET. Fetal neurosonography was performed at 32 ± 2 gestational weeks to assess cortical development. Sulci depths were measured offline and normalized by biparietal diameter (BPD). Ages and Stages Questionnaires (ASQ) were completed postnatally, at 12 ± 1 months of corrected age. Neurosonographic findings were adjusted by regression analysis for maternal age, ethnicity, parity, fetal sex and fetal‐weight centile and gestational age at scan, and ASQ scores were adjusted for maternal age, ethnicity, parity, educational level and employment status, gestational age at birth, breastfeeding, infant sex and infant age at the ASQ evaluation.
Results
Overall, in comparison to the SC fetuses, fetuses conceived by ART showed statistically significant differences in cortical development, with reduced parieto‐occipital sulci depth adjusted for BPD (mean ± SD: fresh ET, 12.5 ± 2.5 vs frozen ET, 13.4 ± 2.6 vs SC, 13.4 ± 2.6, P < 0.001), cingulate sulci depth adjusted for BPD (median (interquartile range (IQR)): fresh ET, 5.8 (4.2–7.4) vs frozen ET, 5.8 (4.1–7.5) vs SC, 6.5 (4.8–7.8), P = 0.001) and calcarine sulci depth adjusted for BPD (median (IQR): fresh ET, 13.5 (10.1–16.1) vs frozen ET, 14.5 (12.1–15.8) vs SC, 16.4 (14.3–17.9), P < 0.001), together with lower Sylvian fissure grading score. Changes in cortical development were more pronounced in the fresh ET than in the frozen ET group. ART infants showed lower ASQ scores as compared to SC infants, particularly in the fresh ET group (mean ± SD global ASQ Z‐score: fresh ET, –0.3 ± 0.4 vs frozen ET, –0.2 ± 0.4 vs SC, 0 ± 0.4, P < 0.001).
Conclusions
Fetuses conceived by ART show a distinctive pattern of cortical development and suboptimal infant neurodevelopment, with more pronounced changes in those conceived following fresh ET. These findings support the existence of in‐utero brain reorganization associated with ART and warrant follow‐up studies to assess its long‐term persistence. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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14.
Ten‐year experience of protocol‐based management of small‐for‐gestational‐age fetuses: perinatal outcome in late‐pregnancy cases diagnosed after 32 weeks
Meler, E.; Mazarico, E.; Eixarch, E. ...
Ultrasound in obstetrics & gynecology,
January 2021, 2021-01-00, 20210101, Letnik:
57, Številka:
1
Journal Article
ABSTRACT
Objective
To report our 10‐year experience of protocol‐based management of small‐for‐gestational‐age (SGA) fetuses, based on standardized clinical and Doppler criteria, in late‐pregnancy ...
cases.
Methods
A retrospective cohort was constructed of consecutive singleton pregnancies referred for late‐onset (> 32 weeks) SGA (defined as estimated fetal weight (EFW) < 10th centile) that were classified as fetal growth restriction (FGR) or low‐risk SGA, based on the severity of smallness (EFW < 3rd centile) and the presence of Doppler abnormalities (uterine artery pulsatility index (UtA‐PI) ≥ 95th centile or cerebroplacental ratio (CPR) < 5th centile). Low‐risk SGA pregnancies were followed at 2‐week intervals and delivered electively at 40 weeks. FGR pregnancies were followed at 1‐week intervals, or more frequently if there were signs of fetal deterioration, and were delivered electively after 37 + 0 weeks' gestation. The occurrence of stillbirth and composite adverse outcome (CAO; defined as neonatal death, metabolic acidosis, need for endotracheal intubation or need for admission to the neonatal intensive care unit) was analyzed in low‐risk SGA and FGR pregnancies.
Results
A total of 1197 pregnancies with EFW < 10th centile were identified and classified at diagnosis as low‐risk SGA (n = 619; 51.7%) or FGR (n = 578; 48.3%). Of these, 160 were delivered before 37 weeks' gestation; for obstetric reasons in 93 (58.1%) cases, severe pre‐eclampsia in 33 (20.6%), FGR with severe hypoxia in 47 (29.4%) and stillbirth in four (2.5%) (indications are non‐exclusive). During follow‐up, 52/574 (9.1%) low‐risk SGA pregnancies were reclassified as FGR, whereas 22/463 (4.8%) FGR pregnancies were reclassified as low‐risk SGA. Overall, there were no stillbirths in the low‐risk SGA group and four in the FGR group, all of which occurred before 37 weeks. There were no instances of neonatal death in pregnancies delivered ≥ 37 weeks. The risk of CAO was higher in those meeting antenatal criteria for FGR at 37 weeks than in those classified as low‐risk SGA (32/493 (6.5%) vs 15/544 (2.8%); odds ratio, 2.5 (95% CI, 1.3–4.6)). In FGR pregnancies, the adjusted odds ratio (95% CI) for CAO was 6.3 (1.8–21.1) in those with EFW < 3rd centile, while it was 3.2 (1.5–6.8) and 4.2 (1.9–8.9) in those with UtA‐PI ≥ 95th centile and CPR < 5th centile, respectively, as compared to FGR pregnancies without each of these criteria.
Conclusion
Protocol‐based risk stratification with different management and monitoring schemes for late pregnancy with a suspected SGA baby, based on clinical and Doppler criteria, enables identification and tailored assessment of high‐risk FGR, while allowing expectant management with safe perinatal outcome for low‐risk SGA fetuses. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
več
15.
Childhood and recent maternal adverse experiences and mother-infant attachment influence early newborns’ neurobehavioural profiles
San Martín, N.; Castro Quintas, Á.; Daura-Corral, M. ...
European psychiatry,
06/2022, Letnik:
65, Številka:
S1
Journal Article
Introduction
Maternal stress during pregnancy influences fetal neurodevelopment, especially by the dysregulation of the HPA axis. However, less is known about whether maltreatment or stressful life ...
experiences previous to pregnancy influence on developmental outcomes in the offspring.
Objectives
To analyze newborns’ neurobehavioral profiles in a cohort of healthy pregnant women, according to 1) childhood and recent maternal adverse experiences and 2) mother-infant attachment.
Methods
150 women were followed during the three trimesters of pregnancy. CTQ and AAT tests were employed to evaluate childhood and recent experiences of maltreatment, while infant and recent adverse experiences were evaluated using ETI-SR and SRSS, respectively. Newborns neurobehavioral profiles were defined at 8 weeks using the Neonatal Behavioral Assessment Scale (NBAS) and their temperament was assessed with IBQ. PBQ and PAI scales were employed to assess mother-infant attachment. A linear regression model was performed, adjusting for possible confounders.
Results
Maternal childhood sexual abuse seems to be associated with greater difficulties in the newborns control of reactivity to external stimuli (β=0,517;
p-value=0.001
), while recent maternal stressful experiences are related to difficulties for states regulation (β=0,29; p-value=0,038). Regarding attachment, maltreated mothers tend to show ambivalent and avoidant styles. Interestingly, postnatal mother-infant attachment seems to modulate autonomous, motor and social-interactive abilities in the offspring (β=-0,227; p-value=0,033 // β=-0,329; p-value=0,006).
Conclusions
Newborns from mothers exposed to maltreatment and negative life events previous to pregnancy show difficulties to organize and regulate the reactions to psychosocial stimuli. Future studies must disentangle whether maternal attachment style is a modulator of this association.
Disclosure
No significant relationships.
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16.
Neurodevelopmental outcome in 2‐year‐old infants who were small‐for‐gestational age term fetuses with cerebral blood flow redistribution
Eixarch, E.; Meler, E.; Iraola, A. ...
Ultrasound in obstetrics & gynecology,
December 2008, Letnik:
32, Številka:
7
Journal Article
Objective
To assess the neurodevelopmental outcome at 2 years of age of children who had been small‐for‐gestational‐age (SGA) term babies with cerebral blood flow redistribution.
Methods
Perinatal ...
outcome was assessed in a cohort of 97 term singleton appropriate‐for‐gestational‐age and 125 term singleton SGA fetuses with normal umbilical artery Doppler, stratified according to the presence of cerebral blood flow redistribution. Neurodevelopmental outcome was assessed prospectively at 2 years of age by means of the 24‐month Age & Stage Questionnaire (ASQ).
Results
Of the 125 SGA fetuses, 25 had redistribution of the cerebral blood flow, and 100 did not. There were no significant differences in perinatal outcome between these two SGA groups. At 2 years of age, children who had been SGA fetuses with middle cerebral artery (MCA) pulsatility index (PI) < 5th centile had a higher incidence of suboptimal neurodevelopmental outcome compared with those with normal MCA‐PI (52% vs. 31%; P = 0.049) and a lower mean centile in communication (53.1 vs. 67.4; P = 0.006) and problem‐solving (39.7 vs. 47.4; P = 0.04) areas.
Conclusion
SGA fetuses with cerebral blood flow redistribution have a higher risk of subtle neurodevelopmental deficits at 2 years of age. This challenges the concept that fetal cerebral redistribution is an entirely protective mechanism and suggests MCA‐PI as a risk stratifying factor for adverse neurodevelopmental outcome. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.
več
17.
Predictiveness of antenatal umbilical artery Doppler for adverse pregnancy outcome in small‐for‐gestational‐age babies according to customised birthweight centiles: population‐based study
Figueras, F; Eixarch, E; Gratacos, E ...
BJOG,
April 2008, Letnik:
115, Številka:
5
Journal Article
Objective To examine the relationship between smallness at birth and the predictive value of umbilical artery Doppler.
Design Retrospective cohort.
Setting Tertiary referral university hospital, ...
Barcelona.
Population A total of 7645 singleton pregnancies delivered between January 2002 and June 2004.
Methods The associations with adverse outcome were assessed for small‐for‐gestational‐age (SGA) babies according to customised standards who had normal and abnormal umbilical artery Doppler.
Main outcome measures Neonatal morbidity and perinatal mortality.
Results Of the 369 SGA fetuses that had been identified antenatally, 70 (19%) had an abnormal umbilical artery Doppler and the babies from these pregnancies had a higher risk for neonatal morbidity when compared with babies with normal birthweight (OR 3.99, 95% CI 1.04–11.03). However, the remaining 299 (81%) fetuses with normal umbilical artery Doppler also had an elevated risk of neonatal morbidity (OR 2.26, 95% CI 1.04–4.39). Overall, many of the instances of adverse outcome associated with smallness for gestational age were attributable to the group with normal Doppler than to the group with abnormal Doppler.
Conclusion Normal antenatal umbilical artery Doppler cannot be taken as an indicator of low risk in pregnancies where the fetus is SGA according to customised percentiles.
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18.
19.
20.
Angiogenic imbalance in maternal and cord blood is associated with neonatal birth weight and head circumference in pregnancies with major fetal congenital heart defect
Sánchez, O.; Ribera, I.; Ruiz, A. ...
Ultrasound in obstetrics & gynecology,
February 2024, 2024-02-00, 20240201, Letnik:
63, Številka:
2
Journal Article
ABSTRACT
Objectives
To ascertain whether abnormalities in neonatal head circumference and/or body weight are associated with levels of angiogenic/antiangiogenic factors in the maternal and cord blood ...
of pregnancies with a congenital heart defect (CHD) and to assess whether the specific type of CHD influences this association.
Methods
This was a multicenter case–control study of women carrying a fetus with major CHD. Recruitment was carried out between June 2010 and July 2018 at four tertiary care hospitals in Spain. Maternal venous blood was drawn at study inclusion and at delivery. Cord blood samples were obtained at birth when possible. Placental growth factor (PlGF), soluble fms‐like tyrosine kinase‐1 (sFlt‐1) and soluble endoglin (sEng) were measured in maternal and cord blood. Biomarker concentrations in the maternal blood were expressed as multiples of the median (MoM).
Results
PlGF, sFlt‐1 and sEng levels were measured in the maternal blood in 237 cases with CHD and 260 healthy controls, and in the cord blood in 150 cases and 56 controls. Compared with controls, median PlGF MoM in maternal blood was significantly lower in the CHD group (0.959 vs 1.022; P < 0.0001), while median sFlt‐1/PlGF ratio MoM was significantly higher (1.032 vs 0.974; P = 0.0085) and no difference was observed in sEng MoM (0.981 vs 1.011; P = 0.4673). Levels of sFlt‐1 and sEng were significantly higher in cord blood obtained from fetuses with CHD compared to controls (mean ± standard error of the mean, 447 ± 51 vs 264 ± 20 pg/mL; P = 0.0470 and 8.30 ± 0.92 vs 5.69 ± 0.34 ng/mL; P = 0.0430, respectively). Concentrations of sFlt‐1 and the sFlt‐1/PlGF ratio in the maternal blood at study inclusion were associated negatively with birth weight and head circumference in the CHD group. The type of CHD anomaly (valvular, conotruncal or left ventricular outflow tract obstruction) did not appear to alter these findings.
Conclusions
Pregnancies with fetal CHD have an antiangiogenic profile in maternal and cord blood. This imbalance is adversely associated with neonatal head circumference and birth weight. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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