Identification of large-for-gestational age fetuses using antenatal customized fetal growth charts: Can we improve the prediction of abnormal labor course?

2020 ◽  
Vol 248 ◽  
pp. 81-88
Author(s):  
Andrea Dall'Asta ◽  
Giuseppe Rizzo ◽  
Ariane Kiener ◽  
Nicola Volpe ◽  
Elvira Di Pasquo ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Growth Charts

Effects of vitrification and the superovulated environment on placental function and fetal growth in an IVF mouse model

2020 ◽  
Vol 26 (8) ◽  
pp. 624-635
Author(s):  
C Roeca ◽  
E Silva ◽  
C Barentsen ◽  
T L Powell ◽  
T Jansson
Keyword(s):  
Mouse Model ◽  
Fetal Growth ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Placental Development ◽  
Developmental Potential ◽  
Placental Function ◽  
Uterine Environment ◽  
Embryonic Viability ◽  
Human Ivf

Abstract In studies of human IVF, as compared to frozen embryo transfer (ET), fresh ET is associated with smaller infants and higher risk of small for gestational age infants. Recent observations suggest that ET using vitrified embryos is associated with higher pregnancy and live birth rates compared to fresh ET, but increased rates of large for gestational age infants. The mechanisms underlying these associations are largely unknown, and available evidence suggests that the influence of IVF, vitrification and the superovulated (SO) uterine environment on placental function and fetal growth is complex. This warrants further investigation given the prevalent practice in human IVF of both fresh ET into a SO uterine environment, and vitrification with ET into a more physiologic uterine environment. Using a mouse model that closely resembles human IVF, we investigated if vitrification of IVF embryos better preserves placental function and results in better pregnancy outcomes as compared to fresh ET because of transfer into a more physiologic endometrium. We found that the SO environment, independent of vitrification status, reduced implantation rates, inhibited placental mechanistic target of rapamycin signaling and induced placental stress signaling, resulting in fetal growth restriction (1.080 ± 0.05 g estrous fresh (n = 17 litters), 1.176 ± 0.05 g estrous vitrified (n = 12), 0.771 ± 0.06 g SO fresh (n = 15), 0.895 ± 0.08 g SO vitrified (n = 10), P < 0.0001). In addition, our study suggests that vitrification impairs the developmental potential of IVF blastocysts that resulted in a significantly smaller litter size (2.6 ± 2.3 fresh estrous vs 2.5 ± 2.4 fresh SO vs 1.6 ± 1.7 estrous vitrified vs 1.7 ± 1.8 SO vitrified, P = 0.019), with no effect on fetal growth or placental function at term. Our findings suggest that vitrification may negatively impact early embryonic viability, while the SO maternal uterine environment impairs both placental development and fetal growth in IVF.

scholarly journals Differential Changes in Akt and AMPK Phosphorylation Regulating mTOR Activity in the Placentas of Pregnancies Complicated by Fetal Growth Restriction and Gestational Diabetes Mellitus With Large-For-Gestational Age Infants

2021 ◽  
Vol 8 ◽  
Author(s):  
Tai-Ho Hung ◽  
Chung-Pu Wu ◽  
Szu-Fu Chen
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Gestational Age ◽  
Fetal Growth Restriction ◽  
Large For Gestational Age ◽  
Mtor Phosphorylation ◽  
Mtor Activity

Background: Dysregulation of placental mechanistic target of rapamycin (mTOR) activity has been implicated in the pathophysiology of pregnancies complicated by idiopathic fetal growth restriction (FGR) and gestational diabetes mellitus (GDM) with large-for-gestational-age (LGA) infants. However, the underlying mechanisms remain unclear.Methods: We obtained placentas from women with normal pregnancies (n = 11) and pregnancies complicated by FGR (n = 12) or GDM with LGA infants (n = 12) to compare the levels of total and phosphorylated forms of Akt, AMPK, TSC2, and mTOR among the three groups and used primary cytotrophoblast cells isolated from 30 normal term placentas to study the effects of oxygen–glucose deprivation (OGD) and increasing glucose concentrations on the changes of these factors in vitro.Results: Placentas from FGR pregnancies had lower phosphorylated Akt (p-Akt) levels (P < 0.05), higher p-AMPKα levels (P < 0.01), and lower mTOR phosphorylation (P < 0.05) compared to that of normal pregnant women. Conversely, women with GDM and LGA infants had higher p-Akt (P < 0.001), lower p-AMPKα (P < 0.05), and higher p-mTOR levels (P < 0.05) in the placentas than normal pregnant women. Furthermore, primary cytotrophoblast cells subjected to OGD had lower p-Akt and p-mTOR (both P < 0.05) and higher p-AMPKα levels (P < 0.05) than those cultured under standard conditions, but increasing glucose concentrations had opposite effects on the respective levels. Administering compound C, an AMPK inhibitor, did not significantly affect Akt phosphorylation but partially reversed mTOR phosphorylation. Administering LY294002, an Akt inhibitor, decreased p-mTOR levels, but did not change the levels of total and phosphorylated AMPKα.Conclusion: These results suggest that Akt and AMPK are involved in the regulation of trophoblast mTOR activity in the placentas of pregnancies complicated by FGR and GDM with LGA infants.

New Reference for Neonatal Growth: 10-Year Data of Phramongkutklao Hospital

2020 ◽  
Vol 103 (12) ◽  
pp. 1284-1291
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Admission Rate ◽  
Large For Gestational Age ◽  
Growth Chart ◽  
Growth Charts ◽  
International Growth ◽  
Neonatal Growth ◽  
Growth Assessment

Background: Growth assessment including birth weight, length, and head circumference is important to identify infants at risk. However, using international growth curves may be inappropriate for growth assessment of Thai neonates. Objective: To generate a growth chart of infants at the Phramongkutklao Hospital (PMK), and to compare PMK’s growth chart assessment with other international growth charts. Materials and Methods: The authors generated a PMK growth chart from PMK’s newborn database between 2007 and 2016. Birth weight of infants born in 2017 was assessed by using the PMK growth chart in comparison with the Fenton, Lubchenco and Intergrowth Twenty-first growth charts. Results: To generate a PMK growth chart, 22,926 infants were enrolled to the present study. Comparing with other international growth charts, the Fenton exhibited a higher ninetieth percentile of birth weight than others, especially at gestational age of 36 to 41 weeks. In contrast, the Lubchenco exhibited the lowest tenth percentile of birth weight. In 2017, 2,314 infants were born and evaluated by using the PMK, the Fenton, the Lubchenco, and the Intergrowth-21st growth charts. Large for gestational age (LGA) was identified in 185 (8.64%), 55 (2.57%), 166 (7.75%) and 166 (7.75%) infants, respectively. In contrast, small for gestational age (SGA) was identified in 220 (10.27%), 228 (10.64%), 34 (1.59%) and 148 (6.91%) infants, respectively. The admission rate of infants diagnosed as LGA by PMK, but appropriate for gestational age (AGA) by Fenton was higher than other AGA infants. Conclusion: The PMK reference of neonatal growth is up-to-date and applicable. Growth assessment using the Fenton growth chart at late preterm and term gestations may be inaccurate to identify LGA infants. In contrast, the Lubchenco growth chart has limitation to identify SGA infants. Data accumulation from multi-centers at different regions of Thailand are warranted to generate a Thai neonatal growth reference. Keywords: Growth curve, Neonatal growth, Large for gestational age, Small for gestational age

scholarly journals Uterine distention as a factor in birth timing: retrospective nationwide cohort study in Sweden

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022929 ◽  
Author(s):  
Jonas Bacelis ◽  
Julius Juodakis ◽  
Kristina M Adams Waldorf ◽  
Verena Sengpiel ◽  
Louis J Muglia ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Fetal Growth ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Maternal Height ◽  
Birth Timing ◽  
Gestational Age At Birth ◽  
Age At Birth ◽  
Singleton Pregnancies

ObjectivesTo determine whether uterine distention is associated with human pregnancy duration in a non-invasive observational setting.DesignRetrospective cohort study modelling uterine distention by interaction between maternal height and uterine load.SettingThe study is based on the 1990–2013 population data from all delivery units in Sweden.ParticipantsUncomplicated first pregnancies of healthy Nordic-born mothers with spontaneous onset of labour. Pregnancies were classified as twin (n=2846) or singleton (n=527 868). Singleton pregnancies were further classified as carrying a large for gestational age fetus (LGA, n=24 286) or small for gestational age fetus (SGA, n=33 780).Outcome measuresStatistical interaction between maternal height and uterine load categories (twin vs singleton pregnancies, and LGA vs SGA singleton pregnancies), where the outcome is pregnancy duration.ResultsIn all models, statistically significant interaction was found. Mothers carrying twins had 2.9 times larger positive linear effect of maternal height on gestational age than mothers carrying singletons (interaction p=5e−14). Similarly, the effect of maternal height was strongly modulated by the fetal growth rate in singleton pregnancies: the effect size of maternal height on gestational age in LGA pregnancies was 2.1 times larger than that in SGA pregnancies (interaction p<1e−11). Preterm birth OR was 1.4 when the mother was short, and 2.8 when the fetus was extremely large for its gestational age; however, when both risk factors were present together, the OR for preterm birth was larger than expected, 10.2 (interaction p<0.0005).ConclusionsAcross all classes, maternal height was significantly associated with child’s gestational age at birth. Interestingly, in short-statured women with large uterine load (twins, LGA), spontaneous delivery occurred much earlier than expected. The interaction between maternal height, uterine load size and gestational age at birth strongly suggests the effect of uterine distention imposed by fetal growth on birth timing.

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