Effect of vitamin D supplementation on fetal growth and development in pregnant women

Introduction and Aim: Fetal growth is a dynamic process that must be monitored in pregnant women to reduce the long-term consequences of fetal anomalies and post-natal effects on their life. The current study was aimed to find out the effectiveness and association of vitamin D on fetal growth during the prenatal period. Materials and Methods: It was a randomized control trial undertaken in 100 pregnant women who were allocated randomly into two groups based on calcemic state. After giving 6000 IU of vitamin D intervention the fetal growth was measured at the end of 3 months and the variables were obtained before and after the intervention. Results: The mean difference of fetal weight between groups was 77g was significantly increased to 277g (p<0.01) after 3 months. The mean difference of femur length before intervention was 0.95mm (p-0.18) significantly increased to 3.03mm (p<0.01). Further, the mean biparietal diameter difference was 0.13mm (p-0.92) was substantially increased to 4.77mm(p<0.01). Conclusion: The current study suggests that the fetal growth variables were significantly increased in post-intervention phases which can be attributed to vitamin D. It has an immense effect on fetal growth which can be supplemented during different trimesters to enhance fetal development.

Evaluation of biparietal diameter and femur length by ultrasonography method, its correlation with fetal gestational age a comparative study in Chhattisgarh state of India

There few studies which tried to corelate biparietal diameter and gestational age in which an increase in biparietal diameter with the increase in gestational age was found but there was a discrepancy between 17 week of pregnancy and term and which is approximately 3 weeks. We conducted the present study to compare the gestational age and femur length and biparietal diameter in the population of Chhattisgarh state of India.A total of 380 pregnant females were enrolled for the study. They were between the 20 weeks to 38 weeks of gestation with their age ranging from 18-35 years.In the present study we observed a total of 158 cases in 2 trimester i.e. ranging from 20 to 27 weeks and 220 cases were in 3 trimester of pregnancy. Mean of BPD and FL observed was 73.1 and 56.2 respectively. The standard deviation and standard error of mean for biparietal diameter and femur length were 12.8, 11.6 and 0.63, 0.57 respectively.All parameters of present study are found to be highly correlated with gestational age. (r=, 0.987, 0.980 for, FL and BPD respectively).

Association between Fat-Free Mass and Brain Size in Extremely Preterm Infants

Postnatal growth restriction and deficits in fat-free mass are associated with impaired neurodevelopment. The optimal body composition to support normal brain growth and development remains unclear. This study investigated the association between body composition and brain size in preterm infants. We included 118 infants born <28 weeks of gestation between 2017–2021, who underwent body composition (fat-free mass (FFM) and fat mass (FM)) and cerebral magnetic resonance imaging to quantify brain size (cerebral biparietal diameter (cBPD), bone biparietal diameter (bBPD), interhemispheric distance (IHD), transverse cerebellar diameter (tCD)) at term-equivalent age. FFM Z-Score significantly correlated with higher cBPD Z-Score (rs = 0.69; p < 0.001), bBPD Z-Score (rs = 0.48; p < 0.001) and tCD Z-Score (rs = 0.30; p = 0.002); FM Z-Score significantly correlated with lower brain size (cBPD Z-Score (rs = −0.32; p < 0.001) and bBPD Z-Score (rs = −0.42; p < 0.001). In contrast weight (rs = 0.08), length (rs = −0.01) and head circumference Z-Score (rs = 0.14) did not. Linear regression model adjusted for important neonatal variables revealed that FFM Z-Score was independently and significantly associated with higher cBPD Z-Score (median 0.50, 95% CI: 0.59, 0.43; p < 0.001) and bBPD Z-Score (median 0.31, 95% CI: 0.42, 0.19; p < 0.001); FM Z-Score was independently and significantly associated with lower cBPD Z-Score (median −0.27, 95% CI: −0.42, −0.11; p < 0.001) and bBPD Z-Score (median −0.32, 95% CI: −0.45, −0.18; p < 0.001). Higher FFM Z-Score and lower FM Z-scores were significantly associated with larger brain size at term-equivalent age. These results indicate that early body composition might be a useful tool to evaluate and eventually optimize brain growth and neurodevelopment.

Is Cardiomegaly an Indication of “Heart-Sparing Effect” in Small Fetuses?

<b><i>Introduction:</i></b> This study aimed to test the hypothesis that cardiac size is maintained in small fetuses presenting with cardiomegaly. <b><i>Materials and Methods:</i></b> We identified singleton fetuses with estimated fetal weight &#x3c;10th centile and with cardiomegaly without another more likely cardiac or extra-cardiac cause. We used <i>Z</i>-scores for cardiac and thoracic circumferences normalized for gestational age (GA), biparietal diameter (BPD), head circumference (HC), and femur length (FL), obtained from 188 normally grown fetuses. <b><i>Results:</i></b> When comparing chest size, small fetuses had significantly lower thoracic circumferences median <i>Z</i>-scores (IQR) for GA = −4.82 (−6.15 to −3.51), BPD = −2.42 (−4.04 to −1.48), HC = −2.72 (−4.53 to −1.90), and FL = −1.60 (−2.87 to −0.71); <i>p</i> &#x3c; 0.001 for all. When comparing heart size, small fetuses showed lower cardiac circumferences median <i>Z</i>-scores (IQR) for GA = −1.59 (−2.79 to −0.16); <i>p</i> &#x3c; 0.001, similar cardiac circumferences <i>Z</i>-scores for BPD = 0.29 (−0.65 to 1.28); <i>p</i> = 0.284 and HC = 0.11 (−1.13 to 0.96); <i>p</i> = 0.953, and higher cardiac circumferences <i>Z</i>-scores for FL = 0.94 (−0.05 to 2.13); <i>p</i> &#x3c; 0.001. <b><i>Conclusions:</i></b> Our results show that in small fetuses with cardiomegaly, the heart maintains normal dimensions when normalized to cranial diameters and higher dimensions when normalized to long bones. This provides insight into cardiac adaptation to adverse intrauterine environment.

EVALUATION OF FETAL THIGH CIRCUMFERENCE AS AN ADDITIONAL MARKER FOR FOETAL BIOMETRY

Objective: Accurate determination of gestational age is the sine qua non of optimal management and hence prognostication of all pregnancies.A meticulous biometry ensures timely interventions resulting in favorable maternal and fetal outcomes. Traditionally, the parameters of Biparietal diameter (BPD), Femur length (FL), Head circumference (HC), and Abdominal circumference (AC) have been utilized for routine fetal biometry. The present study aims to assess the utility of Fetal Thigh Circumference (ThC) as an additional marker for fetal biometry. Methods: The present retrospective, observational, and cross-sectional study was done in the Departments of Radiodiagnosis and Obstetrics and Gynaecology in an ethically and socio-economically diverse group of pregnant females. All pregnant females with singleton pregnancies between 22 and 40 weeks of gestation and fulfilling the inclusion and exclusion criteria were subjected to ultrasound examination. Subsequently analysis was done for the data collected. Results: There were a total of 287 participants in present study group with mean age of 23±3.4 years. The strength of agreement almost perfect (>0.99) between the mean observed ThC to ThC values by Deter et al. taken as standard. There was a highly significant positive correlation between gestational period and standard biometry parameters and ThC. ThC model for prediction will be better than standard biometry parameters of BPD, HC and AC but not as good as FL model according to the regression analysis of the present study. Conclusions: There is concordance of fetal ThC as an accurate predictor of period of gestation only after FL. It can be combined with standard biometry parameters to give a better estimation of period of gestation.

Can trans-cerebellar diameter supersede other fetal biometry in measuring gestational age? A prospective study

Background Estimation of gestational age plays a pivotal role in day to day clinical practice for appropriate management of newborn. The trans-cerebellar diameter can predict gestational age in cases of variations of fetal head shape such as dolichocephaly and brachycephaly or even when fetus is in posterior position. Trans-cerebellar diameter (TCD) may be useful in gestational age estimation. Aim and methodology To determine the accuracy of trans-cerebellar diameter in the estimation of gestational age of fetus and comparing the conventional parameters like head circumference, biparietal diameter, abdominal circumference and femur length in the measurement of gestational age. This is a prospective, cross-sectional analytical study done in the Radiology Department in those patients who were referred to the department for a routine antenatal ultra-sonogram checkup. Results Comparison of trans-cerebellar diameter with gestational age derived from last menstrual period indicates that there is a linear relationship throughout the gestational ages. There is a strong correlation of trans-cerebellar diameter with other conventional parameters namely biparietal diameter, femur length and abdominal circumference of which Femur length correlates well with the trans-cerebellar diameter. Correlation of transcerebellar diameter with gestational age shows a R2 of 0.995 (p value < 0.001). Conclusion Trans-cerebellar diameter is best in estimation of gestational age when compared to biparietal diameter, femur length and abdominal circumference. The regression formula derived from trans-cerebellar diameter measurement can be applied to determine the gestational age of fetus.

A Study of Crinio-facial Measurement (Biparietal Diameter) of Fetus by Ultrasonography in Different Age Group of The Tribal Population of Jharkhand

Introduction: The pregnancy cannot be dated accurately by clinical evaluation alone. Sonography is a useful and an accurate tool for estimation of the gestational age. Biparietal diameter is one the robust method of the basic biometric parameter used to assess fetal size and age. Aims and objective: The aim of this study was to collect data on craniofacial measurement of fetuses of the different age group by Ultrasonography at RIMS, Ranchi and to correlate its relationship with the different fetal age group. Materials and methods: The study was carried out on 100 pregnant women who gave definite history of their last menstrual period and 100 pregnant women who were not able to give definite history of their last menstrual period, in the tribal population of Jharkhand. The cases were selected from antenatal clinic of out-patients department of obstetrics and gynecology of RIMS, Ranchi. The ultrasonography was done by Dept of Radiology, RIMS, Ranchi. Discussion: In obstetrics the duration of pregnancy is calculated by the first day of the last menstrual period at present study standard variation of gestation age base on L M P when the pregnancy cannot be date accurately alone by clinical evaluation alone. Sonography is accepted as the most useful and accurate tool for estimating gestational age. BPD diameter was measured by ultrasonography and along with clinical findings, average gestational age was determined. Conclusion: Sonography is accepted as the most useful and accurate tool for estimating gestational age in those pregnant women who were not able to give definitive history of last menstrual period. Our study showed that the Growth rate of fetal BPD increases progressively as the fetal age increase in early weeks of pregnancy whereas growth is slow in later weeks of pregnancy, our study also showed that measurement of Biparietal diameter is a useful criterion to predict GA & determining EDD. KEY WORD: Pregnancy, Gestational age (GA), Biparietal diameter (BPD), Ultrasonography (USG), Expected date of delivery (EDD).

Ultrasonographic Estimation of Total Brain Volume: 3D Reliability and 2D Estimation. Enabling Routine Estimation During NICU Admission in the Preterm Infant

Objectives: The aim of this study is to explore if manually segmented total brain volume (TBV) from 3D ultrasonography (US) is comparable to TBV estimated by magnetic resonance imaging (MRI). We then wanted to test 2D based TBV estimation obtained through three linear axes which would enable monitoring brain growth in the preterm infant during admission.Methods: We included very low birth weight preterm infants admitted to our neonatal intensive care unit (NICU) with normal neuroimaging findings. We measured biparietal diameter, anteroposterior axis, vertical axis from US and MRI and TBV from both MRI and 3D US. We calculated intra- and interobserver agreement within and between techniques using the intraclass correlation coefficient and Bland-Altman methodology. We then developed a multilevel prediction model of TBV based on linear measurements from both US and MRI, compared them and explored how they changed with increasing age. The multilevel prediction model for TBV from linear measures was tested for internal and external validity and we developed a reference table for ease of prediction of TBV.Results: We used measurements obtained from 426 US and 93 MRI scans from 118 patients. We found good intra- and interobserver agreement for all the measurements. US measurements were reliable when compared to MRI, including TBV which achieved excellent agreement with that of MRI [ICC of 0.98 (95% CI 0.96–0.99)]. TBV estimated through 2D measurements of biparietal diameter, anteroposterior axis, and vertical axis was comparable among both techniques. We estimated the population 95% confidence interval for the mean values of biparietal diameter, anteroposterior axis, vertical axis, and total brain volume by post-menstrual age. A TBV prediction table based on the three axes is proposed to enable easy implementation of TBV estimation in routine 2D US during admission in the NICU.Conclusions: US measurements of biparietal diameter, vertical axis, and anteroposterior axis are reliable. TBV segmented through 3D US is comparable to MRI estimated TBV. 2D US accurate estimation of TBV is possible through biparietal diameter, vertical, and anteroposterior axes.