scholarly journals Corpus luteum number and the maternal renin-angiotensin-aldosterone system as determinants of utero-placental (vascular) development: the Rotterdam Periconceptional Cohort

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Rosalieke E. Wiegel ◽  
Maud J. H. Karsten ◽  
Igna F. Reijnders ◽  
Lenie van Rossem ◽  
Sten P. Willemsen ◽  
...  
Keyword(s):  
Corpus Luteum ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Uterine Artery ◽  
Vascular Development ◽  
First Trimester ◽  
Placental Weight ◽  
Renin Angiotensin Aldosterone System ◽  
Vascular Volume ◽  
Placental Volume

Abstract Background Pregnancies with > 1 corpus luteum (CL) display a hyperdynamic circulation and an increased risk of small-for-gestational age deliveries. Among the factors released by the CL is prorenin, the inactive precursor of renin. Since the renin-angiotensin-aldosterone system (RAAS) is involved in early hemodynamic pregnancy adaptation, we linked both CL number and first-trimester concentrations of prorenin (as an indicator of RAAS activity) and the aldosterone/renin ratio (as an indicator of angiotensin-independent aldosterone effectiveness) to non-invasive markers of utero-placental (vascular) development, measured longitudinally from the first trimester onwards. Methods A total of 201 women, who conceived naturally or after in-vitro fertilization treatment (with 0 (n = 8), 1 (n = 143), or > 1 (n = 51) CL), were selected from the Rotterdam Periconceptional Cohort. Maternal RAAS components were determined at 11 weeks gestation. Placental volume and utero-placental vascular volume were measured from transvaginal 3D ultrasound scans at 7, 9 and 11 weeks gestation, pulsatility and resistance indices of the uterine arteries were assessed by pulsed wave Doppler ultrasounds at 7, 9, 11, 13, 22 and 32 weeks gestation. At birth placental weight was obtained using standardized procedures. Results Pregnancies without a CL show lower uterine artery indices throughout gestation than 1 CL and > 1 CL pregnancies, while parameters of placental development are comparable among the CL groups. After adjustment for patient- and treatment-related factors, first-trimester prorenin concentrations are positively associated with uterine artery pulsatility and resistance indices (β 0.06, 95% CI 0.01;0.12, p = 0.04 and β 0.10, 95% CI 0.01;0.20, p = 0.04, respectively), while high prorenin concentrations are negatively associated with first-trimester utero-placental vascular volume (β -0.23, 95% CI -0.44;-0.02, p = 0.04) and placental weight (β -93.8, 95%CI -160.3;-27.4, p = 0.006). In contrast, the aldosterone/renin ratio is positively associated with first-trimester placental volume (β 0.12, 95% CI 0.01;0.24, p = 0.04). Conclusions The absence of a CL, resulting in low prorenin concentrations, associates with low uterine artery pulsatility and resistance, while high prorenin concentrations associate with a low utero-placental vascular volume and weight. These data support a scenario in which excess prorenin, by upregulating angiotensin II, increases uterine resistance, thereby preventing normal placental (vascular) development, and increasing the risk of small-for-gestational age deliveries. Simultaneously, high aldosterone concentrations, by ensuring volume expansion, exert the opposite.

scholarly journals OP07.03: First-trimester uterine artery Doppler and small-for-gestational-age infants

2006 ◽  
Vol 28 (4) ◽  
pp. 461-461 ◽  
Author(s):  
F. Prefumo ◽  
A. T. Papageorghiou ◽  
N. Fratelli ◽  
A. Bhide ◽  
B. Thilaganathan
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Uterine Artery ◽  
First Trimester ◽  
Uterine Artery Doppler

Predictive values of clinical parameters and biophysical and biochemical markers in the first trimester for the detection of small-for-gestational age fetuses

2021 ◽  
Vol 49 (1) ◽  
pp. 73-79
Author(s):  
Irene Reali Antunes ◽  
Guilherme Antonio Rago Lobo ◽  
Edward Araujo Júnior ◽  
David Baptista da Silva Pares
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Biochemical Markers ◽  
Biochemical Parameters ◽  
Uterine Artery ◽  
First Trimester ◽  
Predictive Values ◽  
Maternal Characteristics ◽  
Group Iii ◽  
Group Ii

AbstractObjectivesTo evaluate the predictive values of maternal characteristics, biophysical parameters (mean arterial pressure [MAP] and Doppler uterine artery measurements), and biochemical parameters (pregnancy-associated plasma protein A [PAPP-A] and placental growth factor [PlGF]) alone and in association for small-for-gestational age (SGA) fetuses.MethodsWe performed a retrospective analysis of a prospective observational study that evaluated 615 pregnant women in the first trimester using ultrasonography. For all the women, information regarding clinical and obstetric histories, MAP, and uterine artery mean pulsatility index (UtA-PI), and blood samples for analysis of biochemical markers (PAPP-A and PlGF) were obtained. The patients were grouped according to birth weight as follows: group I (n=571), >10th percentile (control); group II (n=44), <10th percentile; and group III (n=34), <5th percentile. The predictive values of the variables for the detection of SGA fetuses were calculated using a logistic regression model and an analysis of the area under the receiver-operating characteristic curve (AUC).ResultsThe sensitivity rates of the maternal characteristics, biophysical markers (MAP and UtA-PI), biochemical markers (PAPP-A and PlGF), and the association between them were: 23.3, 32.5, 25, and 30% respectively, at a false-positive (FP) rate of 10%, in group II and 26.5, 26.5, 23.5, and 23.5%, respectively, at a FP rate of 10% in group III.ConclusionsThe predictive performances of the combination of maternal characteristics and biophysical and biochemical parameters were unsatisfactory, with a slight improvement in the predictive capacity for SGA fetuses <10th percentile.

113. VASCULAR ENDOTHELIAL GROWTH FACTOR GENE POLYMORPHISMS IN PLACENTAL IMPAIRMENT AND SMALL FOR GESTATIONAL AGE BIRTH

2010 ◽  
Vol 22 (9) ◽  
pp. 31
Author(s):  
P. H. Andraweera ◽  
G. A. Dekker ◽  
R. C. Nowak ◽  
S. D. Thompson ◽  
L. M. E. McCowan ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Uterine Artery ◽  
Umbilical Artery ◽  
First Trimester ◽  
Vascular Endothelial ◽  
Vegf Expression ◽  
Endothelial Growth Factor

Impaired placental angiogenesis is implicated in the pathophysiology of small for gestational age (SGA) infants. Placental expression of vascular endothelial growth factor (VEGF), a potent angiogenic factor, is reduced in SGA pregnancies. We aimed to evaluate the association of two single nucleotide polymorphisms (SNPs, VEGF-2578C/A and VEGF+936C/T) in VEGF gene which reduce VEGF expression, in SGA pregnancies andexamine their effects on first trimester placental VEGF expression. 3196 nulliparous pregnant women, their partners and babies were recruited in Adelaide and Auckland to a prospective multicentre cohort study (SCOPE Study). Amongst 2123 Caucasian women, 216 (11.9%) delivered a SGA infant defined as <10th customised centile. Uncomplicated Caucasian pregnancies served as controls (n = 1176). Uterine and umbilical artery Doppler velocimetry was performed at 20 weeks gestation. DNA extracted from peripheral blood from couples and cord blood from babies was genotyped using Sequenom MassARRAY. 74 first trimester placentae collected from elective terminations of pregnancy were genotyped for the same SNPs and the VEGF expression determined by RT-PCR. Neonatal VEGF+936 CT+TT genotypes associate with SGA (OR 1.6, 95%CI 1.1–2.3), lower birthweight (P = 0.005), customised birthweight centile (p=0.03), lower placental weight (P = 0.04) and an increased uterine artery resistance index (RI, P = 0.004). Maternal VEGF+936 CT+TT associate with bilateral notching of the uterine artery waveform (OR 1.4, 95%CI 1.0–1.8) and an increased umbilical artery RI (OR 1.5, 95%CI 1.1–2.1). VEGF+936 CT first trimester placentae have lower VEGF expression compared to CC (P = 0.045). Neonatal VEGF-2578 AA associates with bilateral uterine artery notching (OR 1.5, 95%CI 1.1–2.2) and increased umbilical artery RI (OR 1.6, 95%CI 1.0–2.6). Maternal VEGF-2578 CA+AA associate with increased umbilical artery RI (OR 1.5, 95%CI 1.0–2.2). VEGF polymorphisms reduce first trimester VEGF expression and associate with increased resistance in the placental circulation suggesting impaired placental function. VEGF+936 SNP confers increased risk for SGA.

scholarly journals Comparison of Placental Three-Dimensional Power Doppler Vascular Indices and Placental Volume in Pregnancies with Small for Gestational Age Neonates

2019 ◽  
Vol 8 (10) ◽  
pp. 1651 ◽  
Author(s):  
Sue-Jar Chen ◽  
Chie-Pein Chen ◽  
Fang-Ju Sun ◽  
Chen-Yu Chen
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Power Doppler ◽  
Three Dimensional ◽  
First Trimester ◽  
Flow Index ◽  
Second Trimester ◽  
Significant Difference ◽  
Placental Volume ◽  
Singleton Pregnancies

This prospective observational study aimed to compare the changes in placental vascular indices and placental volume using three-dimensional power Doppler (3DPD) ultrasound in pregnancies with small for gestational age (SGA) neonates. We enrolled 396 women with singleton pregnancies from September 2013 to June 2016. Placental vascular indices, including the vascularization index (VI), flow index (FI), and vascularization flow index (VFI), and placental volume were obtained using 3DPD ultrasound in the first and second trimesters. Of the enrolled women, 21 delivered SGA neonates and 375 did not. In the first trimester, the SGA group had a significantly lower mean FI (25.10 ± 7.51 versus 33.10 ± 10.97, p < 0.001) and VFI (4.59 ± 1.95 versus 6.28 ± 2.35, p = 0.001) than the non-SGA group. However, there was no significant difference in the placental volume between the two groups during the first trimester. In the second trimester, the SGA group also had a significantly lower mean FI (27.08 ± 7.97 versus 31.54 ± 11.01, p = 0.022) and VFI (6.68 ± 1.71 versus 8.68 ± 3.09, p < 0.001) than the non-SGA group. In addition, a significantly smaller placental volume was noted in the SGA group (104.80 ± 24.23 cm3 versus 122.67 ± 26.35 cm3, p = 0.003) than in the non-SGA group during the second trimester. The results showed that a decreased placental VFI occurred earlier than a decreased placental volume in SGA pregnancies.

Perinatal outcomes in women affected by different types of headache disorders: A prospective cohort study

Cephalalgia ◽  
2021 ◽  
pp. 033310242110292
Author(s):  
Isabella Neri ◽  
Daniela Menichini ◽  
Francesca Monari ◽  
Ludovica Spanò Bascio ◽  
Federico Banchelli ◽  
...  
Keyword(s):  
Migraine With Aura ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Migraine Without Aura ◽  
Perinatal Outcomes ◽  
First Trimester ◽  
Tension Type Headache ◽  
Headache Disorders ◽  
Aneuploidy Screening ◽  
Type Headache

Objective This study aims to investigate pregnancy and perinatal outcomes in women with tension-type headache, migraine without aura and migraine with aura by comparing them to women without any headache disorders. Study design Prospective cohort study including singleton pregnancies attending the first trimester aneuploidy screening at the University Hospital of Modena, in Northern Italy, between June 2018 and December 2019. Results A total of 515 consecutive women were included and headache disorders were reported in 43.5% of them (224/515). Tension-type headache was diagnosed in 24.3% of the cases, while 14% suffered from migraine without aura and 5.2% from migraine with aura. Birthweight was significantly lower in women affected by migraine with aura respective to other groups, and a significantly higher rate of small for gestational age infants was found in tension-type headache (10.4%) and in migraine with aura (24.9%) groups respective to the others (p < 0.001). Moreover, the admission to the neonatal intensive care unit was significantly higher in all the headache groups (p = 0.012). Multivariate analysis showed that women presenting tension-type headache (OR 4.19, p = 0.004), migraine with aura (OR 5.37, p = 0.02), a uterine artery pulsatility index >90th centile (OR 3.66, p = 0.01), low multiple of the median (MoM) of Pregnancy-associated plasma protein-A (PAPP-A) (OR 0.48, p = 0.05) and high MoM of Inhibin-A (OR 3.24, p = 0.03) at first trimester, are independently associated with the delivery of small for gestational age infants when compared to women without headache disorders. Conclusion Migraine with aura and tension type headache expose women to an increased risk of delivering small for gestational age infants, in association with some utero-placenta markers evaluated at first trimester. These women with headache disorders have an additional indication to undergo first trimester aneuploidy screening and would possibly benefit from specific interventions.

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