Can Inflammatory Hematological Parameters be a Guide to Late-onset Fetal Growth Restriction?

Abstract Purpose To compare the rates obtained from hematological parameters in cases of late-onset idiopathic fetal growth restriction (FGR) with healthy pregnancies and to evaluate the effect on neonatal outcomes. Methods The study group consisted of 63 pregnant women with late-onset idiopathic FGR and the control group consisted of 91 healthy pregnant women. The determined rates were calculated from the control hemograms of patients at 28 weeks. Both groups were compared for neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and other parameters. Results NLR, leukocyte and neutrophil levels were significantly higher in the FGR group (p<0.05). There was no significant difference in PLR, platelet and lymphocyte levels between the groups (p>0.05). To predict FGR, the best cut-off value of NLR was determined to be 4.11 with 56% sensitivity and 88% specificity values. Conclusion Neutrophil, lymphocyte and platelet interactions have an important role in FGR development. Inflammation can be involved in the etiopathogenesis in late-onset FGR.

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Significance of pregnancy-associated plasma protein a (PAPP-a) concentration determination in the assessment of final outcome of pregnancy

Vojnosanitetski pregled ◽

10.2298/vsp110530023l ◽

2013 ◽

Vol 70 (1) ◽

pp. 46-50 ◽

Cited By ~ 3

Author(s):

Dragan Loncar ◽

Mirjana Varjacic ◽

Slobodan Arsenijevic

Keyword(s):

Pregnant Women ◽

Fetal Growth ◽

Plasma Protein ◽

Gestational Age ◽

Fetal Growth Restriction ◽

Protein A ◽

Growth Restriction ◽

Control Group ◽

Group I ◽

Significant Difference

Background/Aim. Pregnancy-associated plasma protein A (PAPP-A) is high molecular matrix metalloproteinase originally isolated in the serum of pregnant women. The aim of this study was to analyze the values of concentration of PAPP-A in assessment of progress and outcome of pregnancy in pregnant women diagnosed with threatening preterm delivery, preeclampsia and fetal growth restriction in relation to physiological pregnancy of the same gestational age. Methods. The study included 60 pregnant women that were divided into three groups according to gestational age and the diagnosis of imminent premature birth upon reception, preeclampsia and fetal growth restriction as follows: the group I from 28 to 32 weeks of gestation, a total of 25 pregnant women, the group II from 33 to 36 weeks of gestation, a total of 23 pregnant women, and the group III from 37 to 41 weeks of gestation, a total of 12 pregnant women. The control group consisted of 60 pregnant women without complications of pregnancy that were identically divided into three groups according to gestational age as in the sample. We performed quantitative determination of PAPP-A from the venous blood of patients by using commercial tests of the company Diagnostics Product Corporation (DPC), Los Angeles, California, USA. Results. There was a statistically significant difference in PAPP-A values in the examined groups in all gestational ages (p < 0.01). The value of the PAPP-A concentration in different gestational ages with equal statistical significance indicated the possibility of complications, which was examined during pregnancy in relation to the control group of pregnant women with physiological pregnancies. This study confirmed that there was a statistically significant difference in fetal body weight at birth (p < 0.05), Apgar score in 5 min after birth (p < 0.05), and gestational age at birth (p < 0.05), as parameters of the outcome of pregnancy course, between the examined groups of pregnant women in relation to the value of PAPP-A concentration. The age of pregnant women was not statistically different in the examined groups (p > 0.05). Conclusion. Differences in PAPP-A concentration should point out to the obstetrician the need for more intensive antepartum fetal surveillance in order to increase the chances of favorable perinatal outcome, regardless gestational age.

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miR-16-5p, miR-103-3p, and miR-27b-3p as Early Peripheral Biomarkers of Fetal Growth Restriction

Frontiers in Pediatrics ◽

10.3389/fped.2021.611112 ◽

2021 ◽

Vol 9 ◽

Author(s):

Salvatore Tagliaferri ◽

Pasquale Cepparulo ◽

Antonio Vinciguerra ◽

Marta Campanile ◽

Giuseppina Esposito ◽

...

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Fetal Growth Restriction ◽

Late Onset ◽

Maternal Blood ◽

Growth Restriction ◽

Therapeutic Interventions ◽

Control Group ◽

Fetal Hypoxia ◽

Blood Samples

Current tests available to diagnose fetal hypoxia in-utero lack sensitivity thus failing to identify many fetuses at risk. Emerging evidence suggests that microRNAs derived from the placenta circulate in the maternal blood during pregnancy and may be used as non-invasive biomarkers for pregnancy complications. With the intent to identify putative markers of fetal growth restriction (FGR) and new therapeutic druggable targets, we examined, in maternal blood samples, the expression of a group of microRNAs, known to be regulated by hypoxia. The expression of microRNAs was evaluated in maternal plasma samples collected from (1) women carrying a preterm FGR fetus (FGR group) or (2) women with an appropriately grown fetus matched at the same gestational age (Control group). To discriminate between early- and late-onset FGR, the study population was divided into two subgroups according to the gestational age at delivery. Four microRNAs were identified as possible candidates for the diagnosis of FGR: miR-16-5p, miR-103-3p, miR-107-3p, and miR-27b-3p. All four selected miRNAs, measured by RT-PCR, resulted upregulated in FGR blood samples before the 32nd week of gestation. By contrast, miRNA103-3p and miRNA107-3p, analyzed between the 32nd and 37th week of gestation, showed lower expression in the FGR group compared to aged matched controls. Our results showed that measurement of miRNAs in maternal blood may form the basis for a future diagnostic test to determine the degree of fetal hypoxia in FGR, thus allowing the start of appropriate therapeutic interventions to alleviate the burden of this disease.

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Predictive Value of Maternal Anemia in Cases of Fetal Growth Restriction

Obstetrics Gynecology and Reproductive Sciences ◽

10.31579/2578-8965/089 ◽

2021 ◽

Vol 5 (06) ◽

pp. 01-06

Author(s):

Waleed M. Tawfik ◽

Shaimaa R. Abdelmaksoud ◽

Ghada M. Mahmoud

Keyword(s):

Pregnant Women ◽

Fetal Growth ◽

Gestational Age ◽

Fetal Growth Restriction ◽

Growth Restriction ◽

Deficiency Anemia ◽

Haematocrit Level ◽

Maternal Anemia ◽

Anemic Patient ◽

Significant Difference

Anemia can be defined as a state of inadequate O2 delivery to tissues due to reduction of the O2 carrying capacity of blood practically, anemia is diagnosed when there is reduction in the hemoglobin concentration or haematocrit level below normal values. Iron deficiency anemia is a major public health problem among women of reproductive age in most of developing countries approximately 50% of pregnant women and 35% of non pregnant women are anemic. These nutritional disorders, has profound negative effects on pregnancy outcome, health of mothers and babies. The objective of this study: Is to evaluate the maternal anemia during pregnancy as a risk factor for fetal growth restriction. The study was done this study conducted on 120 pregnant women. Pregnant women with inclusion criteria: Singleton pregnancy, Gestational age more than 28 week and Hb level less than 10mg/dl. We exclude multiple pregnancy, Gestational age less than 28 week, Hb level more than 10 mg/dl and other medical disorder with pregnancy. The results of this study reveal the following: There was significant difference between group 1, 2, 3, 4 as regard to Hb level, (PCV), (MCV), (MCH), (MCHC), (Ht) and (CBC). The restriction of fatal growth was significant lower in sever anemic patient rather than mild or moderate anemic patient In conclusions: The result of this study shows that there was restriction of fatal growth was significantly high in sever anemic group than mild or moderate group also, incidence of low birth weight and risk of fatal morbidity or mortality was significantly high in sever anemic group than mild or moderate group.

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Galectin-1 expression in the serum and placenta of pregnant women with fetal growth restriction and its significance

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03477-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiao-Xiao Jin ◽

Xiang Ying ◽

Min-Yue Dong

Keyword(s):

Pregnant Women ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Diagnostic Marker ◽

Growth Restriction ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Singleton Pregnancy ◽

The Difference ◽

Single Birth

Abstract Background This study aims to investigate galectin-1 (Gal-1) expression in the serum and placenta of pregnant women with fetal growth restriction (FGR) and its significance. Methods Thirty-one pregnant women with single-birth FGR but without comorbidities, eight pregnant women with FGR and preeclampsia (PE), and eight pregnant women with FGR and gestational diabetes mellitus (GDM) were enrolled as the study group, while 20 pregnant women with normal singleton pregnancy in the same period were enrolled as the control group. The serum Gal-1 level was detected using an enzyme-linked immunosorbent assay (ELISA), and Gal-1 expression in the placenta was detected by western blot. Results The results revealed that, compared with the control group, the serum Gal-1 level decreased in the women with FGR without comorbidities, and the difference was statistically significant (P < 0.001). Compared with the control group, the difference in serum Gal-1 expression in the FGR-PE group was not statistically significant (P = 0.29). The peripheral serum Gal-1 level decreased in the FGR-GDM group compared with the control group, and the difference was statistically significant (P < 0.001). The serum Gal-1 level was positively correlated with birth weight (r2 = 0.172, P < 0.01). Compared with the control group, the Gal-1 expression level decreased in the placenta of the pregnant women with FGR without comorbidities (P < 0.05). Conclusions Gal-1 exhibits low expression in the serum and placenta of pregnant women with FGR. In addition, Gal-1 may be involved in the pathogenesis of FGR and could represent a new diagnostic marker of the disease.

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Correlation between Severity of Fetal Growth Restriction and Oxidative Stress in Severe Small-for-Gestational-Age Infants

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182010726 ◽

2021 ◽

Vol 18 (20) ◽

pp. 10726

Author(s):

Mariko Ashina ◽

Takumi Kido ◽

Yuki Kyono ◽

Asumi Yoshida ◽

Shutaro Suga ◽

...

Keyword(s):

Oxidative Stress ◽

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Fetal Growth Restriction ◽

Growth Restriction ◽

Stress Index ◽

Control Group ◽

Z Score ◽

Significant Difference

Severe small-for-gestational-age (sSGA) infants exhibit increased mortality and morbidity. Oxidative stress is suggested to be involved in intrauterine growth restriction. This retrospective study aimed to evaluate the oxidative stress level at birth in an sSGA population. Sera of 28 sSGA (sSGA group) and 31 non-sSGA (control group) infants, born at our hospital between March 2017 and March 2020, were evaluated. Oxidative stress (derivative of reactive oxidative metabolites: d-ROM level), biological antioxidant potential (BAP) level, and the ratio of d-ROM/BAP level (oxidative stress index: OSI) were measured. The sSGA group had a significantly lower birth weight (BW), BW z-score, head circumference, and height than the control group (all p < 0.05). No significant difference was noted in the BAP level; sSGA infants exhibited a significantly higher d-ROM level than control infants. sSGA infants showed a significantly increased OSI compared with control infants, and the BW z-score was inversely correlated with d-ROM levels and OSI in sSGA infants (R2 = 0.300; p < 0.01 and R2 = 0.319; p = 0.02, respectively) but not in controls. In conclusion, sSGA infants, including preterm infants, exhibited higher oxidative stress at birth. The severity of fetal growth restriction was significantly correlated with oxidative stress levels at birth in sSGA infants.

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A pilot study on investigating the role of Salvia miltiorrhiza in fetal growth restriction

Bioscience Reports ◽

10.1042/bsr20201222 ◽

2020 ◽

Vol 40 (6) ◽

Author(s):

Fanghua Shen ◽

Hongdao Lv ◽

Yun Shi ◽

Sandy Lau ◽

Fang Guo ◽

...

Keyword(s):

Pilot Study ◽

Treatment Group ◽

Pregnant Women ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Odds Ratio ◽

Salvia Miltiorrhiza ◽

Growth Restriction ◽

Abdominal Circumference ◽

Control Group

Abstract To date there is no effective treatment for pregnancies complicated by fetal growth restriction (FGR). Salvia miltiorrhiza, a traditional Chinese herb has been shown to promote blood flow and improve microcirculatory disturbance. In this pilot study, we evaluated whether S. miltiorrhiza can potentially become a possible therapy for FGR. Nineteen pregnant women with FGR were treated with S. miltiorrhiza and ATP supplementation for an average of 7 days, and 17 cases received ATP supplementation as controls. The estimated fetal weights (EFWs) were measured by ultrasound after treatment, and the birthweights were recorded after birth. After treatment with S. miltiorrhiza, 7 (37%) FGR cases showed an increase in EFW to above the 10th percentile, compared with 4 (23%) FGR cases in controls (odds ratio: 1.896, 95% confidence limits (CLs): 0.44–8.144). At delivery, 10 (53%) FGR cases in the treatment group delivered babies with a birthweight above the 10th percentile, compared with 6 (35%) FGR cases in the control group (odds ratio: 2.037, 95% CL: 0.532–7.793); 80 or 64% FGR cases in the treatment group showed an increase in fetal abdominal circumference (AC) or biparietal diameter (BPD) above the 10th percentile before delivery. While 44 or 30% FGR cases in the control group showed an increase in AC or BPD. No improvement of head circumference (HC) or femur length (FL) was seen. These pilot data suggest the need for multicenter randomized clinical trials on the potential of S. miltiorrhiza to improve perinatal outcome in pregnant women complicated by FGR.

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Are the Mean Platelet Volume and Neutrophil/Lymphocyte Ratio Predictive for Gestational Cholestasis?

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2020.1064 ◽

2020 ◽

pp. 1

Author(s):

Hasan Eroglu ◽

Harun Egemen Tolunay ◽

Kemal Sarsmaz ◽

Gokcen Orgul ◽

Dilek Sahin ◽

...

Keyword(s):

Pregnant Women ◽

Intrahepatic Cholestasis ◽

Mean Platelet Volume ◽

Predictive Marker ◽

Control Group ◽

Healthy Controls ◽

Platelet Volume ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Significant Difference

OBJECTIVES: We aimed to determine whether mean platelet volume value and/or neutrophil/lymphocyte ratio values are useful as a predictive marker for gestational cholestasis. STUDY DESIGN: Retrospective analysis of the data of patients diagnosed with pregnancy cholestasis between 2018-2019 in a perinatology clinic. 352 pregnant women were enrolled in the study (122 pregnant women with Intrahepatic cholestasis as study group and 230 pregnant women with no morbidity as the control group) RESULTS: Mean platelet volume was significantly higher in pregnant women with intrahepatic cholestasis compared to the healthy controls, 9.30 (7-18) and 8.6 (6.7-11.5), respectively. The neutrophil/lymphocyte ratio was significantly higher in pregnant women with intrahepatic cholestasis compared to the healthy controls, 3.93 (0.46-13.75) and 4.25 (0.87-17.1), respectively. There was a statistically significant difference between the two groups for mean platelet volume (p <0.001). In the roc analysis, 8.85 fL for mean platelet volume had a sensitivity of 65% and a specificity of 59%.CONCLUSION: When compared with healthy pregnancies, mean platelet volume value in gestational cholestasis increases significantly. However, the predictive strength of mean platelet volume for cholestasis is not strong enough to recommend its usage as a single parameter in clinical practice.

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Comparison of fetal cardiac functions between small-for-gestational age fetuses and late-onset growth-restricted fetuses

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0206 ◽

2019 ◽

Vol 47 (8) ◽

pp. 879-884

Author(s):

Başak Kaya ◽

Ahmet Tayyar ◽

Deniz Kanber Açar ◽

Serdar Kaya

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Fetal Growth Restriction ◽

Late Onset ◽

Growth Restriction ◽

Doppler Imaging ◽

Control Group ◽

Ejection Time ◽

Cardiac Functions

Abstract Background This study aimed to investigate fetal cardiac functions by spectral tissue Doppler imaging (s-TDI) in pregnancies complicated with late-onset fetal growth restriction (LO-FGR) and small-for-gestational age (SGA). Methods Forty pregnancies complicated with late-onset FGR and 40 pregnancies complicated with SGA between the 34th and 37th weeks of gestation were enrolled in this study. Forty gestational age-matched pregnant women with no obstetrics complication were randomly selected as a control group. Small fetuses were classified as fetal growth restriction or SGA according to estimated fetal weight (EFW), umbilical artery pulsatility index (PI), cerebroplacental ratio (CPR) and uterine artery PI. s-TDI measurements were obtained at the right atrioventricular valve annulus. Results SGA and LO-FGR fetuses had significantly lower A′ and S′ values, and higher E′/A′ ratio than the control group (P < 0.001). In comparison to controls, significantly prolonged isovolumetric contraction time (ICT′) and isovolumetric relaxation time (IRT′) and, significantly shortened ejection time (ET′) were observed in fetuses with SGA and LO-FGR. Increased myocardial performance index (MPI′) values were also found in fetuses with SGA and LO-FGR compared to controls. Conclusion The signs of cardiac dysfunction were observed both in fetuses with SGA and LO-FGR. The fetal cardiac function assessment with s-TDI could be a valuable method in the diagnosis of true growth restricted fetuses and in the management of these fetuses.

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Changes of the sleep in pregnant women with intrauterine fetal growth restriction

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2018-22(1)-30 ◽

2018 ◽

Vol 22 (1) ◽

pp. 160-162

Author(s):

A.M. Berbets

Keyword(s):

Pregnant Women ◽

Sleep Disorders ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Intrauterine Growth Restriction ◽

Placental Insufficiency ◽

Growth Restriction ◽

Control Group ◽

Intrauterine Growth ◽

Intrauterine Fetal Growth Restriction

Objective – to study the reasons of appearance, terms of manifestation and types of the sleep disorders in pregnant women with intrauterine growth restriction of fetus. 80 pregnant women with placental insufficiency, manifesting as intrauterine fetal growth restriction (IUGR) of II–III degree in the 3rd pregnancy trimester (study group) and 30 women with normal clinical flow of pregnancy (control group) were questioned. They were asked about pregnancy term when the complains of the sleep disorders were firstly expressed, as well as about types of the sleep disorders and their frequency (in times per week). Questioning showed that pregnant women with IUGR in 86% cases experience the sleep disorders starting from pregnancy term 12–22 weeks (healthy pregnant women — mostly after 30 weeks, 57% cases), more commonly wake up 2 or more times per night (71% of positive answers, in control group – 23%), and 3 or more times per week (78% of positive answers, in control group – 17%). Thus, sleep disorders in pregnant women with IUGR appear earlier and seem to be more expressed then in pregnant women with normal fetal growth. Expression of the complains of insomnia, in our opinion, might be considered as an early diagnostic sign of forming of placental insufficiency, which is later realized as IUGR.

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The ability of various cerebroplacental ratio thresholds to predict adverse neonatal outcomes in term fetuses exhibiting late-onset fetal growth restriction

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0244 ◽

2020 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Rauf Melekoglu ◽

Ercan Yilmaz ◽

Seyma Yasar ◽

Irem Hatipoglu ◽

Bekir Kahveci ◽

...

Keyword(s):

Pregnant Women ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Umbilical Artery ◽

Late Onset ◽

Growth Restriction ◽

Neonatal Outcomes ◽

Fetal Medicine ◽

Cerebroplacental Ratio ◽

Adverse Neonatal Outcomes

AbstractObjectivesOur primary aim was to evaluate the ability of various cerebroplacental ratio (CPR) reference values suggested by the Fetal Medicine Foundation to predict adverse neonatal outcomes in term fetuses exhibiting late-onset fetal growth restriction (LOFGR). Our secondary aim was to evaluate the effectiveness of other obstetric Doppler parameters used to assess fetal well-being in terms of predicting adverse neonatal outcomes.MethodsThis was a retrospective cohort study of 317 pregnant women diagnosed with LOFGR at 37–40 weeks of gestation between January 1, 2016, and September 1, 2019. Receiver operating characteristic (ROC) curves were drawn to determine the predictive performance of CPR <1, CPR <5th or <10th percentile, and umbilical artery pulsatility (PI) >95th percentile in terms of predicting adverse neonatal outcomes.ResultsPregnant women exhibiting LOFGR who gave birth in our clinic during the study period at a mean of 38 gestational weeks (minimum 37+0; maximum 40+6 weeks); the median CPR was 1.51 [interquartile range (IQR) 1.12–1.95] and median birthweight 2,350 g (IQR 2,125–2,575 g). The CPR <5th percentile best predicted adverse neonatal outcomes [area under the curve (AUC) 0.762, 95% confidence interval (CI) 0.672–0.853, p<0.0001] and CPR <1 was the worst predictor (AUC 0.630, 95% CI 0.515–0.745, p=0.021). Of other Doppler parameters, neither the umbilical artery systole/diastole ratio nor the mid-cerebral artery to peak systolic velocity ratio (MCA–PSV) predicted adverse neonatal outcomes (AUC 0.598, 95% CI 0.480–0.598, p=0.104; AUC 0.521, 95% CI 0.396–0.521, p=0.744 respectively).ConclusionsThe CPR values below the 5th percentile better predicted adverse neonatal outcomes in pregnancies complicated by LOFGR than the UA PI and CPR <1 by using Fetal Medicine Foundation reference ranges.

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