Folic Acid Supplementation on Fetal Growth at Different Gestational Ages

Introduction: Folate, Vitamin B9, is found naturally in our day to day foods. It is vital for synthesis of DNA and normal cell division in humans. Studies have revealed constantly that maternal folic acid[FA] intake prior to and in early conception decreases neural tube defects. Aim: The aim of the current study is to evaluate the relationship between FA intake by the mother during conception and fetal growth at different gestational ages and also if, periconceptional and preconceptional FA intake has a positive effect on fetal growth, hence reducing the risk of low birth weight babies or small for gestational age (SGA) babies. Materials and methods: 180 pregnant women were classified based on their period of FA intake as preconception, periconception FA intake and nil FA intake. Standard fetal biometric parameters were measured using ultrasonogram during the 1st , 2nd and 3rd trimester of their pregnancy. Results: Preconception FA intake had a positive effect on fetal growth as compared to those who abstained from FA supplementation. Intake during preconception and peri-conception i.e. immediately after confirmation of pregnancy was found to have a reduced risk of low fetal weight as against those who did not consume FA. Fetal biometry showed significant difference between preconception and periconception groups. Conclusion: In conclusion, preconceptional and periconceptional FA supplementation of 0.4-0.5 mg/day was positively affecting fetal growth and caused an optimal birth weight by decreasing the incidence of low birth weight.

Ultrasound fetal biometry in third trimester in urban Nepalese population

INTRODUCTION: Fetal biometry is an important component of fetal growth surveillance and can detect small for gestation age fetuses. However, we use growth curves from studies done in other high-income countries and do not have a standard of our own. This study aims to study the deviation of biometry and expected fetal weight from these curves in pregnancy with normal birth weight term deliveries. METHODS: The study was a retrospective hospital record-based study including term delivery from 2018 May to 2020 January. All lowrisk patients visiting ultrasound OPD in our hospital in 3rd trimester were retrieved and included in the study. Patient with low AFI, major fetal anomaly, abnormal fetal heart rate, preterm delivery, birth weight less than 2500 gm (low birth weight), intrauterine fetal demise, preeclampsia or other complications were excluded from the study. Fetal biometry and expected fetal weight were evaluated. Data was entered in predesigned performa and analysis was performed with IBM SPSS 20.0. RESULTS: A total of 590 ultrasound examinations done in 372 patients were included in the study. Mean age of the patients was 30.78+/-3.98 years, median age was 30 years (IQ range-5). Approximately 316(53.6%) patients were under 30 years of age, 198(33.6%) patients were between 30-35 and 76(12.9%) patients were above 35 years. Median gestational age at birth was 39 weeks and median birth weight was 3120 grams. Median and percentile for various biometry was calculated. EFW was below 50th percentile in 424(71.9%) according to WHO chart. The median percentile for EFW was 30.6 (IQ-33.6). CONCLUSION: Expected fetal weight in Nepalese population is smaller than that predicted by WHO chart. Development of country specific fetal growth curve is recommended for accurate fetal growth surveillance.

Importance of Windows of Exposure to Maternal High-Fat Diet and Feto-Placental Effects: Discrimination Between Pre-conception and Gestational Periods in a Rabbit Model

Context and Aim: Lipid overnutrition in female rabbits, from prepuberty, leads to impaired metabolism (dyslipidemia and increased adiposity) and follicular atresia, and, when continued during gestation, affects offspring phenotype with intrauterine growth retardation (IUGR) and leads to placental and lipid metabolism abnormalities. Growth retardation is already observed in embryo stage, indicating a possible implication of periconceptional exposure. The objective of this study was to discriminate the effects of preconception and gestational exposures on feto-placental development.Materials and Methods: Rabbit 1-day zygotes were collected from female donors under control (CD) or high-fat-high-cholesterol (HD) diet and surgically transferred to the left and right uterus, respectively, of each H (n = 6) or C (n = 7) synchronized recipients. Close to term, four combinations, CC (n = 10), CH (n = 13), HC (n = 13), and HH (n = 6), of feto-placental units were collected, for biometry analyses. Fatty acid (FA) profiles were determined in placental labyrinth, decidua, fetal plasma, and fetal liver by gas chromatography and explored further by principal component analysis (PCA). Candidate gene expression was also analyzed by RT-qPCR in the placenta and fetal liver. Data were analyzed by Kruskal–Wallis followed by Dunn’s pairwise comparison test. Combinations of different data sets were combined and explored by multifactorial analysis (MFA).Results: Compared to controls, HH fetuses were hypotrophic with reduced placental efficiency and altered organogenesis, CH presented heavier placenta but less efficient, whereas HC presented a normal biometry. However, the MFA resulted in a good separation of the four groups, discriminating the effects of each period of exposure. HD during gestation led to reduced gene expression (nutrient transport and metabolism) and big changes in FA profiles in both tissues with increased membrane linoleic acid, lipid storage, and polyunsaturated-to-saturated FA ratios. Pre-conception exposure had a major effect on fetal biometry and organogenesis in HH, with specific changes in FA profiles (increased MUFAs and decreased LCPUFAs).Conclusion: Embryo origin left traces in end-gestation feto-placental unit; however, maternal diet during gestation played a major role, either negative (HD) or positive (control). Thus, an H embryo developed favorably when transferred to a C recipient (HC) with normal biometry at term, despite disturbed and altered FA profiles.

Deep learning to estimate gestational age from blind ultrasound sweeps of the gravid abdomen

Background: Ultrasound is indispensable to gestational age estimation, and thus to quality obstetric care, yet high equipment cost and need for trained sonographers limit its use in low-resource settings. Methods: From September 2018 through June 2021, we recruited 4,695 pregnant volunteers in North Carolina and Zambia and obtained blind ultrasound sweeps (cineloops) of the gravid abdomen alongside standard fetal biometry. We trained a neural network to estimate gestational age from the sweeps and, in three test sets, assessed performance of the model and biometry against previously established gestational age. Results: In our main test set, model mean absolute error (MAE) was 3.9 days (standard error [SE] 0.12) vs. 4.7 days (SE 0.15) for biometry (difference -0.8 days; 95% CI -1.1, -0.5; p<0.001). Results were similar in North Carolina (difference -0.6 days, 95% CI -0.9, -0.2) and Zambia (-1.0 days, 95% CI -1.5, -0.5). Findings were supported in the test set of women who conceived by in vitro fertilization (model MAE 2.8 days [SE 0.28] vs. 3.6 days [SE 0.53] for biometry; difference -0.8 days, 95% CI -1.7, 0.2), and in the set of women from whom sweeps were collected by untrained users with low-cost, battery-powered devices (model MAE 4.9 days [SE 0.29] vs. 5.4 days [SE 0.28] for biometry; difference -0.6, 95% CI -1.3, 0.1). Conclusions: Our model estimated gestational age more accurately from blindly obtained ultrasound sweeps than did trained sonographers performing fetal biometry. These results presage a future where all pregnant people - not just those in rich countries - can access the diagnostic benefits of sonography.

Sonographic Estimation of the Fetal Head Circumference: Accuracy and Factors Affecting the Error

Background Sonographic measurement of fetal head circumference (HC) is an essential parameter for the estimation of fetal weight as well as in cases with abnormal fetal head size. Since there is a lack of data, the present study was to assess the accuracy of ultrasonographic estimation of fetal HC and to identify factors that affect the accuracy of fetal HC estimation. Material and Methods A prospective cohort observational study was conducted for a year. Sonographic fetal biometry including HC was performed, and fetal HC was measured postnatally. Measures of accuracy and various factors which affect the accuracy are analyzed. Results Ultrasonographic HC underestimated actual postnatal HC in 87.5% and overestimated actual HC in 12.5%. Sonographic underestimation of HC persisted throughout gestation and became more pronounced as gestational age increased. Error in HC was statistically significant in those with low liquor and anterior placenta and in those who had instrumental delivery. Parity, fetal presentation, and maternal diabetes did not affect the error in ultrasonographic measurement of head circumference. When the HC was beyond 95th centile on ultrasound, the error detected postnatally was significant (− 14 mm vs. − 8 mm), though not statistically significant (p value 0.82). The difference between the sonographic and postnatal HC was also related to the mode of delivery with the highest error seen in those who had instrumental vaginal delivery (p value 0.031). Conclusion The ultrasound estimation of fetal HC is associated with significant underestimation of the actual HC measured postnatally. The error in measuring fetal HC increased in those with advanced gestational age, low liquor, and anterior location of the placenta and in those who had instrumental vaginal delivery. The measurement error may have important implications in specific clinical scenarios like monitoring pregnancy with fetal growth restriction, suspected fetal head growth abnormalities, and labor outcome.

Correlation of placental thickness with birth weight in singleton pregnancies

Background: The placenta provides the physiologic link between a pregnant woman and the fetus. During pregnancy, the normal placenta increases its thickness at a rate of approximately 1 millimeter per week. The thickness is considered normal throughout the 2nd and 3rd trimester if between 2 and 4 cm. There is a need to identify the fetus failing to reach its growth potential because an early detection of intrauterine growth retardation will be beneficial to obstetric and neonatal care.Methods: After applying inclusion and exclusion criteria, 251 antenatal women from 24-39 weeks gestation were included in the study. After informed written consent, relevant history, examination, abdominal ultrasound was performed noting fetal biometry and placental thickness. The participants were followed until delivery and birth weight noted. Statistical analysis of birth weight (< and >2500 gm) with placental thickness was done.Results: Mean age of the study was 25.88±4.34 years. The mean placental thickness in group A was 3.33±0.92 cm and in group B was 3.38±0.68 cm. Placental thickness showed a positive correlation with fetal weight (r=0.013), however it was not statistically significant. Uncomplicated pregnancy group had mean placental thickness of 3.40±0.70 cm. The difference of mean for placental thickness was statistically significant with respect to medical disorders (p=0.042).Conclusions: Placental thickness does increase with increasing birth weight of the fetus and hence, subnormal or more than normal placental thickness is helpful in signalling important maternal conditions that may be detrimental to the fetus.