Perinatal characteristics and early postnatal circulatory function changes in the larger fetus in twin pregnancy with selective intrauterine growth restriction / 中华围产医学杂志

Objective:To explore the perinatal characteristics and early postnatal circulatory function of the larger fetus in monochorionic diamniotic twin pregnancy complicated with selective intrauterine growth restriction (sIUGR).Methods:From February 2018 to August 2022, a total of 91 larger fetuses of the sIUGR pregnancies who were hospitalized in the neonatal intensive care unit of Peking University Third Hospital were retrospectively included. The perinatal factors, clinical monitoring indicators, and echocardiographic data of the larger twins in pregnancies with three types of sIUGR were compared using one-way analysis of variance and LSD test, Kruskal-Wallis H test, Chi-square test, and Bonferroni correction. Results:The gestational age, birth weight, and placental weight were (30.6±1.5) weeks, (1 503.9±286.4) g, and (548±120) g in the type Ⅱ sIUGR larger twins and were (30.5±2.3) weeks, (1 523.5±424.4) g, and (560±109) g in type Ⅲ, which were all smaller, lower, and lighter than those in the type Ⅰ[(33.0±1.7) weeks, (2 022.1±372.3) g, and (630±131) g, respectively] (LSD test, all P<0.05). Compared with type Ⅰ sIUGR larger twins, type Ⅱ and Ⅲ sIUGR larger twins had longer hospital stay [36.0 d (27.0-43.0 d) and 32.0 d (15.0-47.0 d) vs. 17.0 d (9.5-22.0 d)], higher proportion of preterm births due to fetal distress [63.6% (21/33) and 75.0% (15/20) vs. 31.6% (12/38), χ2=7.30 and 9.93] (Bonferroni correction, all P<0.017); Compared with type Ⅰ sIUGR larger twins, type Ⅱ sIUGR larger twins had higher proportion of postnatal use of vasoactive drugs [45.5% (15/33) vs. 18.4% (7/38), χ2=6.04, P=0.014]. The interventricular septum thickness was larger in the type Ⅲ sIUGR larger twins than those in the type Ⅰ and Ⅱ twins [(4.4±1.4) vs. (3.8±0.9) and (3.3±0.9) mm]; the thickness of left ventricular free wall was the largest in the type Ⅲ larger twins, followed by those in the type Ⅰ and type Ⅱ [(4.6±1.3) vs. (3.1±0.7) vs. (2.7±0.6) mm]; the left ventricular end-diastolic diameter, right ventricular outflow tract diameter, right ventricular anteroposterior diameter, and pulmonary artery diameter in type Ⅰ larger twins were increased comparing with those in type Ⅱ and Ⅲ [left ventricular end-diastolic diameter: (15.0±2.1) vs. (13.4±2.3) and (12.3±3.2) mm; right ventricular outflow tract diameter: (8.7±1.4) vs. (7.3±1.4) and (7.1±0.8) mm; right ventricular anteroposterior diameter: (7.1±1.5) vs. (6.5±0.9) and (6.4±1.0) mm; pulmonary artery diameter: (6.8±1.1) vs. (6.3±0.9) and (6.3±0.8) mm] (LSD test, all P<0.05). Conclusion:The larger fetuses of type Ⅱ and Ⅲ sIUGR pregnancies had smaller gestational age and lighter birth weight who are more prone to have fetal distress, so it is necessary to strengthen dynamic monitoring and circulatory support for such neonates during the perinatal period and early postnatal period. The thickening of the left ventricular wall and interventricular septum in the early postnatal period of type Ⅲ larger fetuses may lead to the decrease of ventricular diastolic function reserve, thereby the evaluation and monitoring of the myocardial diastolic function of these neonates in the early postnatal period are critical.

Value of uterine arterial blood flow combined with cerebral placental rate in predicting fetal growth restriction / 中国现代医生

@#Objective To analyze the application value of uterine artery flow and cerebral placental rate(CPR)in diagnosing fetal growth restriction(FGR).Methods A total of 114 pregnant women with clinically diagnosed late-onset FGR who were hospitalized in Jiangxi Maternal and Child Health Hospital from January 2021 to June 2022 were assigned to study group,and 122 pregnant women with normal intrauterine development were assigned to control group.The blood flow parameters of uterine artery(UtA),umbilical artery(UA)and middle cerebral artery(MCA)in two groups were determined by ultrasound,and CPR in two groups was calculated.The blood flow difference and pregnancy outcome of two groups were compared.Receiver operating characteristic(ROC)curve was used to analyze the application value of UtA and CPR alone and combined in the clinical diagnosis of FGR.Results The UtA resistance index(RI)of pregnant women in study group was higher than that of control group,the fetal UA blood flow parameter was higher than that of control group,the MCA blood flow parameter and the CPR value were both lower than those of control group,the differences were statistically significant(P<0.05).The birth weight and 1min Apgar score of study group were lower than those of control group(P<0.001).In addition,the incidence of emergency cesarean section operation,premature delivery and neonates transferred to neonatal intensive care unit(NICU)due to various complications in study group were significantly higher than those in control group(P<0.05).ROC curve showed that in predicting FGR,the area under the curve(AUC)of UtA-RI was 0.82(95%CI:0.77-0.88).The predictive efficiency of CPR was 0.75(95%CI:0.69-0.81).The combination of UtA-RI and CPR parameters had the highest efficiency in predicting FGR,with an AUC of 0.92(95%CI:0.89-0.95).Conclusion CPR combined with UtA-RI monitoring has clinical application value for early detection of FGR,guiding intervention,and improving adverse perinatal outcomes.

Effects of puerarin on maternal gestational diabetes mellitus rats and fetal growth / 中国药理学通报

Aim To observe the effects of oral puerarin (Pue) on the maternal gestational diabetes mellitus (GDM) rats and its fetal growth and development, so as to provide references for the application of Pue in the treatment of GDM. Methods The GDM rat model was established by injecting streptozotocin (STZ) into the tail vein of pregnant female rats, and the rats were treated with Pue orally for 12 days; the body weight and abortion of pregnant rats were recorded. The fasting blood glucose of pregnant rats was detected before and at the end of the treatment, and the glucose tolerance was tested on the 5th and 10th days after the administration of the drug. The cesarean sections were carried out on the 20th day of pregnancy. The blood glucose content of the fetal rats was detected, and the state of development was observed. The body weight and length were measured, as well as the placenta and the important organs weight, and the indexes of the organs were calculated. Results Compared with the model group, Pue could significantly reduce the fasting blood glucose of GDM pregnant rats and fetal rats, improve the glucose tolerance of pregnant rats, effectively alleviate the excessive weight gain of pregnant rats and overweight of fetal rats caused by GDM, and reduce the abortion rate; it could also reverse the decrease in the indexes of the organs of brain, heart, and liver, and the increase in the indexes of organs of kidney in fetal rats caused by GDM. Conclusions Pue can relieve the maternal and the fetal hyperglycemia in GDM, reduce the rate of miscarriage, reduce the incidence of macrosomia, and promote the development of vital fetal organs.

Characteristics of the left heart structure and function in 86 term neonates with intrauterine growth restriction / 中国当代儿科杂志

OBJECTIVES@#To study the left heart structure and functional characteristics of term neonates with intrauterine growth restriction (IUGR).@*METHODS@#This study included 86 term neonates with IUGR admitted to the Neonatal Ward of Beijing Friendship Hospital, Capital Medical University from January 2019 to January 2022 as the IUGR group, as well as randomly selected 86 term neonates without IUGR born during the same period as the non-IUGR group. The clinical data and echocardiographic data were compared between the two groups.@*RESULTS@#The analysis of left heart structure and function showed that compared with the non-IUGR group, the IUGR group had significantly lower left ventricular mass, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left atrial diameter, end-diastolic interventricular septal thickness, left ventricular posterior wall thickness, left ventricular end-diastolic volume, left ventricular end-systolic volume, and stroke volume (P<0.05) and significantly higher ratio of end-diastolic interventricular septal thickness to left ventricular posterior wall thickness, proportion of neonates with a mitral peak E/A ratio of ≥1, and cardiac index (P<0.05). The Spearman correlation analysis suggested that stroke volume was positively correlated with birth weight and body surface area (rs=0.241 and 0.241 respectively; P<0.05) and that the ratio of end-diastolic interventricular septal thickness to left ventricular posterior wall thickness was negatively correlated with birth weight and body surface area (rs=-0.229 and -0.225 respectively; P<0.05).@*CONCLUSIONS@#The left ventricular systolic function of neonates with IUGR is not significantly different from that of neonates without IUGR. However, the ventricular septum is thicker in neonates with IUGR. This change is negatively correlated with birth weight and body surface area. The left ventricular diastolic function may be impaired in neonates with IUGR.

Application of the fetal adrenal volume evaluated by three-dimensional ultrasound in fetuses with intrauterine growth restriction and its correlation with adverse perinatal outcomes / 中华超声影像学杂志

Objective:To evaluate the fetal adrenal gland volume (AGV) and corrected adrenal gland volume (cAGV) in intrauterine growth restriction (IUGR) fetuses and observe their associations with the adverse perinatal outcomes.Methods:From February 2021 to August 2022, 32 IUGR fetuses who underwent fetal ultrasound examination in the Second Xiangya Hospital of Central South University were prospectively selected as the IUGR group, and 32 normal fetuses matched for gestational age during the same period were selected as the control group. Three-dimensional ultrasound was used to obtain fetal adrenal volume images, and the virtual organ computer-aided analysis (VOCAL) was used to measure AGV, then the cAGV was calculated. The values of AGV and cAGV were appropriately compared between the IUGR and the control groups. The pregnancy outcomes were noted. Multiple logistic regression analysis was employed to evaluate the relationship between the cAGV and adverse perinatal outcomes in IUGR fetus, with maternal age and the CPR included as covariates to control for confounding factors.Results:A total of 32 fetuses with IUGR and 32 controls were involved in this prospective study. There was no significant difference in the AGV between these two groups ( P=0.417). The cAGV of the IUGR fetus was substantially larger than that of the normal fetus ( P=0.034). In the multivariate logistic regression analysis, after adjusting for maternal age and fetal CPR, the fetal cAGV was noticeably associated with the fetal distress (adjusted OR=0.005, 95% CI=0.000-0.587, P=0.029) and the total adverse perinatal outcomes (adjusted OR=0.014, 95% CI=0.000-0.475, P=0.018). Conclusions:The value of cAGV is increased in the IUGR fetuses and associated with adverse perinatal outcomes. The evaluation of fetal AGV could be beneficial to monitoring and managing IUGR fetuses.

Comparison of clinical features and outcomes of different chorionic twins with selective intrauterine growth restriction / 安徽医科大学学报

Objective @#To delineate the similarities and differences among general characteristics and maternal⁃fetal outcomes in patients with selective intrauterine growth restriction( sIUGR) in monochorionic and dichorionic twin , and to compare the disparate patient types with dichorionic twin sIUGR , with an intent to furnish vital insights for clinical diagnosis and prognostic assessment. @*Methods @#Clinical data were collected from 89 patients with twin pregnancies diagnosed with sIUGR. Statistical analyses used the t ⁃test , rank⁃sum test , and chi⁃square test.@*Results@#Pregnant women with dichorionic twins often leverage multiple assisted reproductive technologies. The maternal outcome for dichorionic twins were significantly later than that for monochorionic twins. Furthermore , the incidence of gestational diabetes mellitus was higher in dichorionic twins compared to monochorionic twins. In terms of fetal outcomes , the proportion of normal neonates with Apgar scores ≥8 , body mass , and the incidence of type I sIUGR in dichorionic twin pregnancieswere significantly higher than those in monochorionic twin pregnancies. Conversely , occurrences of umbilical cord sail attachment and a smaller placental share were significantly higher in monochorionic twins. In assessing variations in sIUGR typologies among dichorionic twins , one case of intrauterine death was happened in a pregnancy with type Ⅱ/ Ⅲ sIUGR typology , but none in type I. Pregnancies with type I sIUGR typology had a significantly higher proportion of large and small fetuses with Apgar scores ≥8 and better birth quality of smaller fetuses. @*Conclusions @#Compared to monochorionic twin pregnancies , there are superior maternal and fetal prognosis for dichorionic twin pregnancies with sIUGR . Clinical management should , therefore , prioritize greater attention to monochorionic twin pregnancies. In addition , this study discovers more complex outcomes in type Ⅱ/ Ⅲ pregnancies among dichorionic twins , a subject area currently lacking sufficient domestic research , thereby underlining the need for meticulous monitoring and prompt intervention.

Poor nutritional status of fifteen-year-old or younger adolescent mothers enhances the risk of small-for-gestational-age newborns

Introduction: To analyze the factors (socio-demographic, clinical, prenatal care, delivery, postpartum data and anthropometric measures) associated with the birth of small for gestational age newborns.Methods: A cross-sectional study was performed with 15 years old or younger postpartum adolescents divided into small-for-gestational-age newborn (SGA) and non-small-for-gestational age newborn groups (NSGA). Socio-demographic, clinical, prenatal care, delivery, postpartum data and anthropometric measures (triceps skinfold (TS), and mid-arm circumference, (MAC)) were collected.Results: 8,153 women gave birth at the obstetric ward and 364 (4.46%) ≤ 15 years old adolescents were enrolled in the study. The proportion of SGA newborns was 34.61%. The SGA group attended fewer prenatal visits (p = 0.037), had a higher prevalence of nutritional status classified as "very low weight" (p < 0.001) and vaginal delivery (p = 0.023), compared to the NSGA group. The nutritional status and vaginal delivery remained significant even after adjustment for confounders. The prevalence risk for SGA birth was 30% higher in the group of mothers with nutritional status classified as "very low weight" (odds ratio 1.30, 95% confidence interval 1.13 to 1.50) (p < 0.001).Conclusions: 15.4% of adolescents ≤ 15 years of age had an arm circumference compatible with the "very low weight" condition, demonstrating the high prevalence of poor maternal nutritional status in this group. The birth of SGA among adolescents ≤ 15 years of age is independently associated with maternal nutritional status classified as "very low weight" by the mid-arm circumference measures (MAC).

Management of Intra-Uterine Growth Restriction by Ayurvedic Regime: A Case Report

Maternal nutrition and congenital malformation are considered as very important factors for intra uterine growth restriction. Present case deals with these two factors in parallel way. A 32 years young lady second gravida, G2P0A1, housewife, residence of Jaipur, came to NIA OPD with complaint of amenorrhea since a month. According to patient her last menstrual period was on 3/3/20. Her antenatal care was continued in NIA OPD. First fetal wellbeing scan reveals mild ventriculomegaly so she was advised for second level scan and quadruple marker but due to low socioeconomic condition patient was not able to do second level anomaly scan and she continued her pregnancy on her own risk. After 7 months she came to us with the complaints of decreased fetal movements. Fundal height corresponding to period of gestation and fetal heart sound was present which was regular. A color doppler was advised which shows normal fetoplacental and uteroplacental circulation, fetal weight was normal according to period of gestation. On the eighth month the fundal height was found decreased along with maternal weight decreased by 1kg. She was suspected for IUGR and planned for Ksheerbasti. After four episodes Ksheer basti on the 36 weeks of gestation, mother had significant weight gain of 2 kg along with increase in fundal height. USG was done which reveals Single live intra uterine pregnancy of 33 weeks 2 days with lumbar spina bifida with meningomyelocele, CHIARI-II brain malformation, EFW– 2282gm. She delivered a live female child of 2300gm through normal vaginal delivery at maternity hospital. Child was having severe form of myelomeningocele with brain malformation.

Epidemiological characteristics of hypertensive disorders during pregnancy in a high-risk population / Características epidemiológicas de los trastornos hipertensivos durante el embarazo en una población de alto riesgo

Abstract Objectives: the aim is to determine the prevalence of hypertensive disorders and to describe the sociodemographic aspects and risk factors for preeclampsia, gestational hypertension and intrauterine growth restriction. Methods: a descriptive cross-sectional study. Maternal characteristics, history from the first prenatal visit and outcomes were obtained. The prevalence and percentages were calculated and described. Results: the prevalence of hypertensive disorders was 12.7%, preeclampsia was 8.0%, followed by gestational hypertension at 4.7%. Of the preeclampsia, 54.8% were severe and 11.9% were of early onset. Moreover, 56.5% of the severe preeclampsia had preterm deliveries. IUGR had a prevalence of 5.3%. Based on maternal history, the most relevant risk factors were a family and personal history of preeclampsia and IUGR. Conclusions: we found a considerable prevalence of preeclampsia with a high percentage of preterm deliveries, associated with varying severity. This data helps health professionals to be aware of the risk factors that can be followed up for preventing complications. The determination of the risk of developing a hypertensive disorder during pregnancy is fundamental to encouraging proper counseling and care for these women through gestation.

Resumen Objetivos: determinar la prevalencia de trastornos hipertensivos y describir los aspectos sociodemográficos y los factores de riesgo de preeclampsia, hipertensión gestacional y restricción del crecimiento intrauterino (RCIU). Métodos: estudio descriptivo de corte transversal. Se obtuvieron características maternas, antecedentes del primer control prenatal y los resultados obstétricos. Se calcularon y describieron las prevalencias y porcentajes. Resultados: la prevalencia de trastornos hipertensivos fue del 12.7%, la de la preeclampsia fue del 8.0%, seguida de la hipertensión gestacional con el 4.7%. Del total de gestantes con preeclampsia, el 54.8% fueron graves y el 11.9% fue de inicio temprano. Además, el 56.5% de las gestantes con preeclampsia severa tuvieron partos prematuros. La RCIU tuvo una prevalencia del 5.3%. Según los antecedentes maternos, los factores de riesgo más relevantes fueron los antecedentes familiares y personales de preeclampsia y RCIU. Conclusiones: se encontró una prevalencia considerable de preeclampsia con un alto porcentaje de partos prematuros, asociada a una severidad variada. Estos datos ayudan a los profesionales de la salud a conocer los factores de riesgo que se pueden monitorear para prevenir complicaciones. La determinación del riesgo de desarrollar un trastorno hipertensivo durante el embarazo es fundamental para fomentar el asesoramiento y la atención adecuados para estas mujeres durante la gestación.

Impact of socioeconomic factors on deciduous teeth eruption among infants born after low-risk pregnancy compared to infants diagnosed with intrauterine growth restriction

Aim: The aim is to assess the impact of socioeconomic factors on deciduous teeth eruption among infants born after low-risk pregnancy and infants diagnosed with intrauterine growth restriction (IUGR). Materials and Methodology: The cross-sectional study included 110 neonates recruited at birth using stratified random sampling based on inclusion and exclusion criteria. Neonates diagnosed without IUGR were allocated to Group I (n = 55) and those diagnosed with IUGR were allocated to Group II (n = 55). The perinatal case history was recorded, followed by intraoral examination at birth, 6 months, and monthly up to 1 year or till first evidence of teeth eruption. Results: The difference between both groups based on socioeconomic status (SES) was found statistically significant (P = 0.043). The first evidence of eruption of deciduous teeth was found delayed in Group II (P = 0.0001). Secondary school education was found statistically significant between both the groups (P = 0.024). The difference between the two groups based on religion (P = 0.353) and gravidity (P = 0.571) was found statistically insignificant. Conclusion: Lower SES and secondary maternal education can be considered statistically significant risk factors of IUGR and delayed deciduous teeth eruption. No correlation of IUGR with religion and gravidity was found.

Magnetic resonance imaging of skull and brain parameters in fetuses with intrauterine growth restriction

Abstract Objective: To compare fetuses with intrauterine growth restriction (IUGR) and those with normal growth, in terms of skull and brain measurements obtained by magnetic resonance imaging (MRI). Materials and Methods: This was a prospective cohort study including 26 single fetuses (13 with IUGR and 13 with normal growth), evaluated from 26 to 38 weeks of gestation. Using MRI, we measured skull and brain biparietal diameters (BPDs); skull and brain occipitofrontal diameters (OFDs); corpus callosum length and area; transverse cerebellar diameter; extracerebral cerebrospinal fluid (eCSF); and right and left interopercular distances (IODs). Results: The following were significantly smaller in IUGR fetuses than in control fetuses: skull BPD (76.9 vs. 78.2 mm; p = 0.0029); brain BPD (67.8 vs. 71.6 mm; p = 0.0064); skull OFD (93.6 vs. 95 mm; p = 0.0010); eCSF (5.5 vs. 8.2 mm; p = 0.0003); right IOD (9.8 vs. 13.9 mm; p = 0.0023); and left IOD (11.8 vs. 16.3 mm; p = 0.0183). The skull BPD/eCSF, brain BPD/eCSF, skull OFD/eCSF, and brain OFD/eCSF ratios were also lower in IUGR fetuses. Conclusion: IUGR fetuses had smaller OFD and BPD, both skull and brain, and less eCSF when compared to normal growth fetuses.

Resumo Objetivo: Comparar medidas do crânio e encéfalo por meio da ressonância magnética (RM) de fetos com restrição do crescimento intrauterino (RCIU) e com crescimento adequado. Materiais e Métodos: Realizou-se um estudo de coorte prospectivo com 13 fetos com RCIU e 13 controles entre 26 e 38 semanas. Foram realizadas as seguintes medidas por RM: diâmetro biparietal (DBP) e diâmetro occipitofrontal (DOF) cerebral e ósseo, comprimento e área do corpo caloso (CPC), diâmetro transverso do cerebelo, líquido cerebroespinhal (LCE) extracerebral e distância interopercular (DIO) direita e esquerda. Resultados: Observaram-se diferenças significativas nas medidas do DBP ósseo (76,9 vs. 78,2 mm; p = 0,0029), DBP cerebral (67,8 vs. 71,6 mm; p = 0,0064) e DOF ósseo (93,6 vs. 95 mm; p = 0,0010) em fetos com RCIU em relação aos fetos com crescimento normal. Observaram-se, ainda, diferenças significativas nas médias do LCE extracerebral (5,5 vs. 8,2 mm; p = 0,0003) e DIO direita (9,8 vs. 13,9 mm; p = 0,0023) e esquerda (11,8 vs. 16,3 mm; p = 0,0183) em fetos com RCIU em relação aos controles. Fetos com RCIU e normais tiveram diferenças entre DBP ósseo/LCE, DBP cerebral/LCE, DOF/LEC, e DOF cerebral/LCE. Conclusão: Fetos com RCIU tiveram menores DBP e DOF, ambos crânio e encéfalo, e menor LCE extracerebral que fetos com crescimento adequado.

Desarrollo renal fetal alterado y riesgo aumentado de enfermedades del adulto / Alterations in fetal kidney development and increased risk for adult diseases

El bajo peso al nacer (BP, < 2500 g), la restricción del crecimiento intrauterino (RCIU) y el parto prematuro (PP, < 37 semanas de gestación) son los factores clínicos más habituales para la programación alterada del número de nefronas y se asocian con un mayor riesgo de hipertensión, proteinuria y enfermedad renal futura en la vida. En la actualidad la evaluación indirecta del número total de nefronas mediante el uso de marcadores en el período posnatal representa el enfoque principal para evaluar el riesgo de evolución futura de los trastornos renales en los recién nacidos con BP, RCIU o PP.Se presentan los avances en la investigación en animales y sobre marcadores bioquímicos en humanos, y recomendaciones para la prevención del daño renal preconcepcional, incluidos los factores sociales y las enfermedades crónicas. La evidencia demuestra que la restricción de crecimiento y la prematuridad solas son capaces de modular la nefrogénesis y la función renal y, cuando son concurrentes, sus efectos tienden a ser acumulativos.

A low birth weight (LBW, < 2500 g), intrauterine growth restriction (IUGR), and preterm birth (PB, < 37 weeks of gestational age) are the most common clinical factors for an altered programming of nephron number and are associated with a greater risk for hypertension, proteinuria, and kidney disease later in life. At present, an indirect assessment of total nephron number based on postnatal markers is the most important approach to evaluate the risk for future kidney disorders in newborn infants with a LBW, IUGR or PB.Here we describe advances made in animal experiments and biochemical markers in humans, and the recommendations for the prevention of preconception kidney injury, including social factors and chronic diseases. According to the evidence, IUGR and prematurity alone can modulate nephrogenesis and kidney function, and, if occurring simultaneously, their effects tend to be cumulative.

Resultados perinatales tras la suplementación de una cohorte de gestantes con vitamina D / Perinatal results after vitamin D supplementation in a pregnant women cohort

INTRODUCCIÓN Y OBJETIVOS: La deficiencia de vitamina D es muy prevalente durante la gestación, siendo cada vez más numerosos los estudios que relacionan esta condición con peores resultados perinatales. El objetivo del presente trabajo es describir los resultados perinatales y el curso del embarazo de una cohorte de gestantes deficitarias en vitamina D durante el primer trimestre del embarazo, suplementándolas con colecalciferol, así como establecer una comparación entre los resultados perinatales de aquellas pacientes con déficit o insuficiencia que lograron niveles normales de vitamina D en el tercer trimestre frente a aquellas que no lo lograron. Como objetivo secundario se describe el curso del embarazo de una cohorte de pacientes que durante el mismo periodo de tiempo del estudio presentaban normovitaminosis al inicio de la gestación. MÉTODOS: La cohorte de 190 pacientes analizada procede de casos consecutivos en la primera consulta de embarazo. Se determinaron los niveles de 25-hidroxivitamina D (25-OH-D) en la analítica del primer trimestre de 190 gestantes diferenciando entre valores normales (>30ng/mL), insuficiencia (30-15 ng/mL) y deficiencia (<15 ng/mL). Las pacientes con insuficiencia se suplementaron con 1000 UI/día de colecalciferol y las pacientes con deficiencia con 2000 UI/día. En el tercer trimestre se determinaron de nuevo los niveles de 25-OH-D en las pacientes suplementadas, suspendiendo la prescripción en caso de haberse normalizado los valores. Se comparan estadísticamente los resultados perinatales entre aquellas pacientes que mejoraron con la suplementación frente a aquellas que no lo hicieron. RESULTADOS: De las 190 pacientes analizadas, un 45% presentaban insuficiencia; un 27,5% deficiencia; y un 27,5% valores normales. De forma global, un 61% de las pacientes suplementadas habían normalizado sus niveles de vitamina D en la analítica del tercer trimestre, suspendiéndose la prescripción. De ese 61% normalizado, un 63% pertenecían al grupo de insuficiencia y un 37% al de deficiencia. Dentro del grupo suplementado con colecalciferol, un 1,4% de las pacientes desarrollaron hipertensión arterial, mientras que un 33% desarrollaron diabetes en el embarazo, de las cuales un 87% la controlaron exclusivamente con dieta y un 13% precisaron insulina. Un 3,6% de las gestaciones cursaron con retraso del crecimiento y la tasa de prematuridad fue igualmente del 3,6%. La tasa de cesáreas fue del 23%, de las cuales un 77% fueron indicadas intraparto y un 23% cesáreas programadas. El peso medio al nacimiento fue 3205g. Dentro del grupo con valores normales de 25-OH-D en el primer trimestre de la gestación, ninguna paciente desarrolló hipertensión arterial, mientras que un 15% presentaron diabetes gestacional controlada con dieta. Un 3,8% de dichas gestaciones cursaron con retrasos del crecimiento y la tasa de prematuridad fue del 1,9%. La tasa de cesáreas fue del 23%, de las cuales un 50% fueron indicadas intraparto y el 50% restante programadas. El peso medio al nacimiento fue de 3280g. En el análisis comparativo de los resultados perinatales entre el grupo de pacientes suplementadas que normalizaron sus cifras de vitamina D y aquellas que no lo hicieron, no se hallan diferencias estadísticamente significativas para ninguno de los parámetros analizados. CONCLUSIONES: La elevada tasa de hipovitaminosis D en la muestra analizada apoya la extensión del cribado y suplementación a todas las embarazadas y no solamente a aquellas con factores de riesgo. Dado que no se observaron diferencias estadísticamente significativas entre los niveles de vitamina D en el tercer trimestre y las variables perinatales estudiadas, podemos concluir que en nuestro estudio la suplementación con vitamina D no se ha comportado como factor protector de eventos obstétricos adversos.

INTRODUCTION AND OBJECTIVES: Vitamin D deficiency is highly prevalent during pregnancy, with an increasing number of studies linking this condition with worse perinatal outcomes. The objective of this present work is to describe the perinatal results and the course of pregnancy in a cohort of pregnant women deficient in vitamin D during the first trimester of pregnancy, supplementing them with cholecalciferol, as well as to establish a comparison between perinatal results of those patients with deficiencnieve or insufficiency who achieved normal levels of vitamin D in the third trimester compared to those who did not. As a secondary objective, the course of pregnancy is described in a cohort of patients who presented normal levels at the beginning of gestation during the same period of time of the study. METHODS: The cohort of 190 patients analyzed comes from consecutive cases in the first pregnancy visit. The levels of 25-hydroxyvitamin D (25-OH-D) were determined in the analysis of the first trimester of 190 pregnant women, differentiating between normal values (> 30ng / mL), insufficiency (30-15 ng / mL) and deficiency (<15 ng / mL). Patients with insufficiency were supplemented with 1000 IU/day of cholecalciferol and patients with deficiency with 2000 IU/day. In the third trimester, the 25-OH-D levels were determined again in the supplemented patients, suspending the prescription if the values had normalized. Perinatal outcomes are statistically compared between those patients who improved with supplementation versus those who did not. RESULTS: Of the 190 patients analyzed, 45% had insufficiency; 27.5% deficiency; and 27.5% normal values. Overall, 61% of the supplemented patients had normalized their vitamin D levels in the third trimester analysis, suspending the prescription. Within that 61% normalized, 63% belonged to the insufficiency group and 37% to the deficiency group. In the group supplemented with cholecalciferol, 1.4% of the patients developed arterial hypertension, while 33% developed diabetes in pregnancy, of which 87% controlled it exclusively with diet and 13% required insulin. 3.6% of pregnancies had intrauterine growth restriction and the prematurity rate was also 3.6%. The caesarean section rate was 23%, of which 77% were indicated intrapartum and 23% scheduled caesarean sections. The mean weight at birth was 3205g. Within the group with normal 25-OH-D values in the first trimester of pregnancy, no patient developed hypertension, while 15% had diet-controlled gestational diabetes. 3.8% of these pregnancies had intrauterine growth restriction and the prematurity rate was 1.9%. The cesarean section rate was 23%, of which 50% were indicated intrapartum and the remaining 50% scheduled. The mean weight at birth was 3280g. In the comparative analysis of the perinatal results between the group of supplemented patients who normalized their vitamin D levels and those who did not, no statistically significant differences were found for any of the parameters analyzed. CONCLUSIONS: The high rate of hypovitaminosis D in the analyzed sample supports the extension of screening and supplementation to all pregnant women and not only to those with risk factors. Since no statistically significant differences were observed between vitamin D levels in the third trimester and the perinatal outcomes studied, we can conclude that in our study vitamin D supplementation has not behaved as a protective factor against adverse obstetric events.

Effect of prenatal taurine supplementation on sensorimotor ability and hippocampal synaptophysin expression of juvenile rats with intrauterine growth restriction / 中华实用儿科临床杂志

Objective:To investigate the effect of prenatal taurine supplementation on sensorimotor ability and synaptophysin (Syn) expression in the hippocampus of juvenile rats with intrauterine growth restriction (IUGR).Methods:The IUGR rat model was induced by food restriction throughout pregnancy.Pregnant rats were randomly divided into normal control group, IUGR group and IUGR+ taurine group.Sensorimotor ability was tested in 2-week-old juvenile rats via grading the tail suspension scores and beam balance test scores, followed by detecting Syn expression in the hippocampus of juvenile rats by immunohistochemistry and Western blot.The correlation between sensorimotor ability scores and Syn expression was assessed.Results:Tail suspension time[(14.62±3.46) s vs.(25.38±5.92) s, P<0.001] and beam balance test scores [(9.08±1.38) scores vs.(12.08±1.16) scores, P<0.001] in the IUGR group were significant lower than those of normal control group.Tail suspension time (22.77±5.16) s and beam balance test scores (11.08±1.38) scores in IUGR+ taurine group were significantly higher than those in IUGR group (all P<0.05), but there was no significant difference comparable to those in normal control group ( P>0.05). The average optical density ( A) value [(53.96±2.37)% vs.(61.68±3.07)%, P<0.001] and protein expression of Syn (1.82±0.23 vs.2.23±0.17, P<0.001) in rat hippocampus of IUGR group were all signi-ficantly lower than those in normal control group.The A value [(60.27±2.59)%] and expression of Syn protein (2.07±0.17) in IUGR+ taurine group were significantly higher than those in IUGR group (all P<0.05), but there was no significant difference comparable to those in normal control group ( P>0.05). The expression of Syn in rat hippocampus was positively correlated with the tail suspension test time and beam balance test scores (all P<0.05). Conclusions:Prenatal taurine supplementation can improve the sensorimotor ability of juvenile rats with IUGR by upregulating Syn in the hippocampus.

Effect of electroacupuncture on lung dysplasia in rats with intrauterine growth restriction induced by maternal food restriction / 中国针灸

OBJECTIVE@#To investigate the protective effect of electroacupuncture (EA) at "Zusanli" (ST 36) in pregnant rats on lung dysplasia of newborn rats with intrauterine growth restriction (IUGR) induced by maternal food restriction.@*METHODS@#Twenty-four female SD rats were randomly divided into a control group, a control+EA group, a model group and a model+EA group, 6 rats in each group. From the 10th day into pregnancy to the time of delivery, the rats in the model group and the model+EA group were given with 50% dietary restriction to prepare IUGR model. From the 10th day into pregnancy to the time of delivery, the rats in the control+EA group and the model+EA group were treated with EA at bilateral "Zusanli" (ST 36), once a day. The body weight of offspring rats was measured at birth, and the body weight and lung weight of offspring rats were measured on the 21st day after birth. The lung function was measured by small animal lung function detection system; the lung tissue morphology was observed by HE staining; the content of peroxisome proliferator activated receptor γ (PPARγ) in lung tissue was detected by ELISA.@*RESULTS@#Compared with the control group, the body weight at birth as well as the body weight, lung weight, lung dynamic compliance (Cdyn) and PPARγ at 21 days after birth in the model group were significantly decreased (@*CONCLUSION@#EA at "Zusanli" (ST 36) may protect the lung function and lung histomorphology changes by regulating the level of PPARγ of lung in IUGR rats induced by maternal food restriction.

Advances in the role of silence information regulator family in pathological pregnancy / 浙江大学学报·医学版

Aberrant maternal inflammation and oxidative stress are the two main mechanisms of pathological pregnancy. The silence information regulator (sirtuin) family is a highly conserved family of nicotinamide adenine dinucleotide (NAD)-dependent deacylases. By regulating the post-translational modification of proteins, sirtuin is involved in various biological processes including oxidative stress and inflammation. Nowadays, emerging evidence indicates that sirtuin may be closely related to the occurrence and development of pathological pregnancy. The down-regulation of sirtuin can cause spontaneous preterm delivery by promoting uterine contraction and rupture of fetal membranes, cause gestational diabetes mellitus through promoting oxidative stress and affecting the activity of key enzymes in glucose metabolism, cause preeclampsia by reducing the proliferation and invasion ability of trophoblasts, cause intrahepatic cholestasis of pregnancy by promoting the production of bile acids and T helper 1 cell (Th1) cytokines, and cause intrauterine growth restriction through inducing mitochondrial dysfunction. Moreover, the expression and activation of sirtuin can be modulated through dietary interventions, thus sirtuin is expected to become a new target for the prevention and treatment of pregnancy complications. This article reviews the role of the sirtuin family in the occurrence and development of pathological pregnancy and its influence on the development of the offspring.

Recent research on the influence of intrauterine growth restriction on the structure and function of the nervous system / 中国当代儿科杂志

Intrauterine growth restriction (IUGR) is caused by many factors, and most newborns with IUGR are small for gestational age (SGA). SGA infants have a relatively high risk of death and disease in the perinatal period, and the nervous system already has structural changes in the uterus, including the reduction of brain volume and gray matter volume, accompanied by abnormal imaging and pathological changes. IUGR fetuses undergo intrauterine blood flow redistribution to protect brain blood supply, and there are still controversies over the clinical effect of brain protection mechanism. SGA infants have a relatively high risk of abnormal cognitive, motor, language, and behavioral functions in the neonatal period and childhood, and preterm infants tend to have a higher degree of neurological impairment than full-term infants. Early intervention may help to improve the function of the nervous system.

Partial molar pregnancy with live fetus complicated by intrauterine growth restriction and severe preeclampsia. Case report and review of the literature / Mola parcial con feto vivo, complicado con restricción de crecimiento intrauterino y preeclamsia severa. Reporte de caso y revisión de la literatura

RESUMEN Objetivo: reportar un caso de mola parcial con feto vivo y realizar una revisión de la literatura sobre las complicaciones maternas y fetales asociadas a esta condición. Materiales y métodos: se presenta el reporte de un caso de mola parcial y feto vivo de 33 semanas, complicado por restricción de crecimiento intrauterino, oligoamnios y preeclampsia severa. Después de seguimiento del recién nacido a un año reportamos un resultado satisfactorio materno-fetal. Se realiza una búsqueda de la literatura en Medline vía PubMed, Lilacs, OVID, Uptodate y Google Scholar, con los siguientes términos MESH: "hiditadiform mole", "partial mole", "live fetus", "coexisting live fetus". Se seleccionaron estudios de series de caso y reportes de caso de gestantes con coexistencia de mola parcial y feto vivo al momento del diagnóstico, y se extrajo información sobre el pronóstico materno-fetal. Resultados: se identificaron inicialmente 129 títulos relacionados, de los cuales 29 cumplieron los criterios de inclusión, 4 artículos fueron excluidos por no obtener acceso al texto completo. Se analizaron 31 casos reportados, 9 casos terminaron en aborto, 8 terminaron en óbito o muerte perinatal y 14 (45 %) casos terminaron con un recién nacido vivo. La complicación materna más frecuente fue preeclampsia, en 6 (19,35 %) casos. Conclusión: la coexistencia de mola parcial con feto vivo presenta un riesgo alto de resultado perinatal adverso y preeclampsia. Se requiere más información sobre esta rara condición para determinar de mejor manera posibles intervenciones en los casos de fetos euploides y dar una adecuada asesoría en la práctica clínica, por lo que es importante el reporte de estos casos para tener suficiente evidencia sobre el comportamiento natural de la enfermedad.

ABSTRACT Objective: To report the case of a partial molar pregnancy with live fetus and conduct a review of the literature regarding maternal and fetal complications associated to this condition. Materials and methods: Case report of a partial mole with a 33 weeks live fetus complicated by intrauterine growth restriction, oligohydramnios and severe preeclampsia. We report satisfactory maternal and neonatal outcomes and 1-year follow-up. A search was conducted in the Medline via Pubmed, Lilacs, Ovid, Uptodate and Google Scholar databases using the following MESH terms: hiditadiform mole, partial mole, live fetus, coexisting live fetus. Case series and case reports of pregnant women with coexisting partial mole and live fetus at the time of diagnosis were selected and information regarding maternal and fetal prognosis was extracted Results: Initially, 129 related titles were identified. Of these, 29 met the inclusion criteria, and 4 articles were excluded due to failed access to the full text. Overall, 31 reported cases were included; 9 ended in miscarriage, 8 in fetal demise or perinatal death, and 14 (45 %) resulted in a live neonate. The most frequent maternal complication was preeclampsia in 6 (19.35 %) cases. Conclusion: The coexistence of a partial mole with a live fetus poses a high risk of adverse perinatal outcomes and preeclampsia. The volume of information regarding this rare condition must be increased in order to better determine potential interventions in cases of euploid fetuses and to provide adequate counseling in clinical practice. Therefore, reporting these cases is important to build sufficient evidence about the natural course of this condition.

Effects of antenatal corticosteroids administration on fetoplacental circulation in preterm pregnancies with intrauterine growth restriction and its correlation with perinatal outcome

Background: Antenatal corticosteroid administration in preterm pregnancies is recommended to promote fetal lung maturation. Studies have reported temporary reduction in fetal heart rate, breathing and movements following maternal corticosteroid administration. Authors studied effect of maternal corticosteroid administration on fetoplacental circulation in preterm pregnancies with IUGR and its correlation with perinatal outcome.Methods: Observational study included 77 preterm singleton pregnant women with IUGR. Color doppler day 0 (before betamethasone) of umbilical artery of 77 cases done. All received two doses of 12 mg of betamethasone intramuscularly 24 hours apart. Umbilical artery doppler on day 2 (24 to 48 hours of 1st dose of betamethasone) and day 4 (72 to 96 hours of 1st dose of betamethasone) done. Pulsatility index (PI) of umbilical artery on doppler and Neonatal details of all women noted.Results: On day 2 doppler, 56 (73%) women (Group A) showed decrease in umbilical artery PI while 21 (27%) women (Group B) did not show decrease in umbilical artery PI. Mean umbilical artery PI of 77 cases on day 0 and day 2 were 1.73±0.73 and 1.54±0.76 respectively (p<0.001). Mean Umbilical artery PI values of undelivered 60 cases on day 0, day 2 and day 4 were 1.55±0.61, 1.33±0.55 and 1.47±0.63 respectively (p<0.001). Group B neonates had poorer Apgar scores, higher neonatal complication, longer hospital stay, lesser umbilical pH at birth and higher perinatal mortality rate than Group A neonates.Conclusions: Significant reduction in mean umbilical artery PI observed on day 2 following betamethasone administration (p<0.001), which was maintained till 4th day after 1st dose of betamethasone (p<0.05). Women who showed improvement in umbilical artery pulsatility index following betamethasone administration had a better perinatal outcome as compared to women who did not.

Aortic isthmus doppler velocimetry in fetuses with intrauterine growth restriction: A literature review / Dopplervelocimetria do istmo aórtico em fetos com crescimento intrauterino restrito: Uma revisão da literatura

Abstract Intrauterine growth restriction (IUGR) is associated with poor perinatal prognosis and a higher risk of stillbirth, neonatal death, and cerebral palsy. Its detection and the evaluation of its severity by new Doppler velocimetric parameters, such as aortic isthmus (AoI), are of great relevance for obstetrical practice. The AoI is a vascular segment that represents a point of communication between the right and left fetal circulations. It is considered to be a functional arterial shunt that reflects the relationship between the systemic and cerebral impedances, and has recently been proposed as a tool to detect the status of hemodynamic balance and prognosis of IUGR in fetuses. In the present review, we noticed that in healthy fetuses, the AoI net flow is always antegrade, but in fetuses with IUGR the deterioration of placental function leads to progressive reduction in its flow until it becomes mostly retrograde; this point is associated with a drastic reduction in oxygen delivery to the brain. The more impaired the AoI flow is, the greater is the risk of impairment in the Doppler velocimetry of other vessels; and the alterations of the AoI Doppler seem to precede other indicators of severe hypoxemia. Although there seems to be an association between the presence of retrograde flow in the AoI and the risk of long-term neurologic disability, its role in the prediction of perinatal morbi-mortality remains unclear. The AoI Doppler seems to be a promising tool in the management of fetuses with IUGR, but more studies are needed to investigate its employment in clinical practice.

Resumo O crescimento intrauterino restrito (CIUR) está associado a um prognóstico perinatal adverso, com maior risco de óbito intrauterino e neonatal, bem como de paralisia cerebral. Assim, sua detecção e a determinação de sua gravidade por novos parâmetros Dopplervelocimétricos, como o istmo aórtico (IAo), são de fundamental importância na prática obstétrica. O IAo é um segmento vascular que representa um ponto de comunicação entre os sistemas circulatórios fetais esquerdo e direito. É considerado um shunt arterial funcional, capaz de refletir a relação entre as impedâncias dos circuitos cerebral e sistêmico, e foi proposto como uma ferramenta para detecção do status do equilíbrio hemodinâmico e do prognóstico de fetos com CIUR. Na presente revisão, observou-se que, em fetos saudáveis, o fluxo predominante no IAo é sempre anterógrado; mas em fetos com CIUR a deterioração do estágio de insuficiência placentária acarreta reduções progressivas no fluxo ístmico até este apresentar sentido predominantemente retrógrado e levar a uma drástica redução no aporte de oxigênio ao sistema nervoso central. Quanto mais alterado estiver o fluxo no IAo, maior a chance de haver alteração na Dopplervelocimetria de outros vasos; e as alterações no Doppler do IAo parecem preceder outros indicadores de hipoxemia severa. Embora o fluxo retrógrado no IAo pareça se correlacionar com maior risco de alteração no desenvolvimento neurológico a longo prazo, ainda não está claro o seu papel na predição de morbimortalidade perinatal. O Doppler do IAo parece ser um parâmetro promissor no manejo do CIUR; entretanto, mais estudos são necessários para avaliar seu emprego na prática clínica.