Performance of different fetal growth charts in prediction of large-for-gestational age and associated neonatal morbidity in multiethnic obese population.

OBJECTIVES: To examine the performance of different fetal growth charts in the prediction of large-for-gestational age (LGA) and associated neonatal morbidity at term in a multiethnic, obese population. METHODS: This was a retrospective cohort study of 253 non-anomalous, singleton, term pregnancies that underwent serial third-trimester ultrasound scans due to maternal body mass index ≥ 35 kg/m2 . We compared the performance of the Hadlock, Gestation Related Optimal Weight (GROW), INTERGROWTH-21st (IG-21), World Health Organization (WHO) and Fetal Medicine Foundation (FMF) fetal growth reference charts in the prediction of LGA at birth, defined as birth weight > 90th percentile, and neonatal morbidity, defined as a composite of neonatal intensive care unit admission or 5-min Apgar score < 7. RESULTS: In the study population, 53 (20.9%) infants were born LGA, 27 (10.7%) experienced neonatal morbidity and nine (3.6%) were LGA with associated neonatal morbidity. The Hadlock and GROW charts showed similar performance in predicting LGA, with sensitivity of 66.0% for both and specificity of 82.5% and 83.5%, respectively. The positive likelihood ratios (LR+) were 3.77 (95% CI, 2.64-5.40) and 4.00 (95% CI, 2.77-5.78), respectively. The IG-21, WHO and FMF charts performed similarly and had higher sensitivity of about 85%, with specificity between 66% and 72%. LR+ was 2.74 (95% CI, 2.16-3.47), 2.50 (95% CI, 2.00-3.12) and 3.03 (95% CI, 2.36-3.89), respectively. All charts had high sensitivity for predicting neonatal morbidity associated with LGA, with LR+ ranging between 2.35 and 3.61. CONCLUSIONS: In our multiethnic, obese population, all fetal growth charts performed well in predicting LGA and associated neonatal morbidity. However, the choice of fetal reference chart is likely to affect intervention rates. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Umbilical vein testosterone in female infants born to mothers with polycystic ovary syndrome is elevated to male levels.

The aetiology of polycystic ovary syndrome (PCOS) is poorly understood, but an intrauterine hyperandrogenic environment has been implicated. This study was designed to assess whether the female offspring of mothers with PCOS are exposed to raised levels of testosterone (T) in utero. In this case-control study, three groups of pregnant women were recruited from the labour ward: PCOS women with a female baby (n = 10, PCOS girls); control women with a female baby (n = 20, control girls) and control women with a male baby (n = 10, control boys). Maternal and umbilical vein (UV) blood was assayed for T levels. UV T in PCOS girls was significantly raised, compared with control girls (p < 0.012). The difference in UV T between PCOS girls and control boys was not significant (p < 0.254). This is the first demonstration of a hyperandrogenic in utero environment in PCOS pregnancies; UV T in female infants is raised to male levels.

Maternal cardiac function in normotensive and pre-eclamptic intrauterine growth restriction.

OBJECTIVES: To compare maternal cardiac function between pregnancies complicated by normotensive and pre-eclamptic intrauterine growth restriction (IUGR). METHODS: Two-dimensional Doppler echocardiography and Doppler tissue imaging (DTI) were used to examine 19 pregnant women with IUGR and 17 with pre-eclampsia complicated by IUGR at 20-38 weeks of gestation. Indices were converted into differences in SDs from the expected normal mean for gestation (Z-scores) and compared. RESULTS: With respect to normal pregnancy, in the normotensive IUGR compared with the pre-eclamptic IUGR group, there were similar reductions in maternal cardiac output (Z-score, - 1.71 vs. - 1.37, P = 0.26) and heart rate (Z-score, - 3.67 vs. - 9.43, P = 0.1) and a similar increase in total vascular resistance (Z-score, 2.91 vs. 3.93, P = 0.05). There was also a greater decrease in stroke volume (Z-score, - 1.72 vs. - 0.69, P = 0.01), a smaller increase in mean arterial pressure (Z-score, 0.73 vs. 2.94, P < 0.01) and a smaller decrease in DTI systolic velocity at the lateral mitral margin (Z-score, - 0.4 vs. - 1.42, P = 0.02). In terms of diastolic function, there was a smaller transmitral late diastolic velocity (Z-score, 0.04 vs. 0.93, P = 0.03) and a greater DTI early diastolic velocity at the lateral mitral margin (Z-score, - 0.17 vs. - 1.6, P < 0.01). CONCLUSIONS: In normotensive IUGR and pre-eclamptic IUGR there is a similar alteration in maternal left ventricular systolic function, but there is greater impairment in maternal diastolic function in pre-eclamptic IUGR.

Maternal cardiac function and uterine artery Doppler at 11-14 weeks in the prediction of pre-eclampsia in nulliparous women.

OBJECTIVE: To assess maternal cardiac function in nulliparous women in the first trimester of pregnancy and evaluate its potential role for predicting pre-eclampsia and small for gestational age (SGA). DESIGN: Prospective, observational, cross-sectional study. SETTING: Maternity unit of a teaching hospital. POPULATION: Nulliparous women with singleton pregnancies presenting consecutively for routine antenatal care (n= 534). METHODS: Two-dimensional and M-mode echocardiography and uterine artery Dopplers were carried out at 11-14 weeks. MAIN OUTCOME MEASURES: Cardiac output (CO), stroke volume (SV), mean arterial pressure (MAP), total vascular resistance and uterine artery pulsatility index (UAPI) were compared in four outcome groups according to the development of pre-eclampsia and/or SGA. RESULTS: Compared with the normal outcome group (n= 457), in those with pre-eclampsia but not SGA (n = 8), CO and MAP were increased; in the group with pre-eclampsia and SGA (n= 19) MAP, TRP and UAPI were increased and in the group with SGA but no pre-eclampsia (n= 50) total peripheral resistance and UAPI were increased. Independent predictors of pre-eclampsia were MAP, SV and UAPI and of SGA SV and UAPI. CONCLUSIONS: Alterations in maternal cardiac function and UAPI are observed in the first trimester of pregnancy in nulliparous women that subsequently develop pre-eclampsia and/or SGA.

Reference ranges for tissue Doppler measures of maternal systolic and diastolic left ventricular function.

OBJECTIVES: Tissue Doppler imaging (TDI) is an echocardiographic technique that evaluates longitudinal myocardial tissue velocities during left ventricular systolic and diastolic function, relatively independently of loading conditions. Limited data are available regarding maternal cardiac function using TDI. The aim of this study was to construct reference charts for TDI indices in normal pregnancy. METHODS: This was a cross-sectional study on 104 pregnant women at 11-38 weeks of gestation and 19 non-pregnant controls. Doppler echocardiography was used to assess transmitral inflow velocities during diastole (peak velocity of early (E) and late (A) atrial filling), whilst TDI at the septal and lateral margins of the mitral annulus measured diastolic velocities (peak velocity of early (E') and late (A') diastolic filling) and peak systolic velocity (S'). The left ventricular filling index (E : E' ratio) was derived. The Tei index (ratio of isovolumetric time to ejection time) was measured. RESULTS: Systolic function assessed by TDI S' velocity was unaltered at the septal and lateral margins, although S' velocity at the lateral margin was higher (12%, P = 0.028) in the first two trimesters, compared to non-pregnant controls. Diastolic function was modified as demonstrated by an increase in A velocity (P P = 0.024). Similarly, A' increased at the septal and lateral margins ( P < 0.001 and P = 0.02, respectively), resulting in a decrease in E' : A' ratios at the septal and lateral mitral margins ( P = 0.001 and P = 0.001, respectively). E : E' at both mitral margins and Tei index were unaltered. CONCLUSION: This study gives normal ranges for TDI indices in pregnancy. TDI demonstrated modified longitudinal systolic and diastolic function. Future studies will evaluate the potential of this technique in pregnancies complicated by hypertension and cardiac disease. Published by John Wiley & Sons, Ltd.

Maternal cardiac function in fetal growth-restricted and non-growth-restricted small-for-gestational age pregnancies.

OBJECTIVE: To compare maternal cardiac function in women with intrauterine growth restriction (IUGR) to those with small-for-gestational age (SGA) pregnancies (non-IUGR). METHODS: This was a cross-sectional study involving maternal echocardiography and uterine, umbilical and fetal middle cerebral artery Doppler assessment in 52 normotensive women at 20-36 weeks' gestation with SGA fetuses (26 IUGR and 26 non-IUGR). RESULTS: In the IUGR (compared to the non-IUGR) group, maternal cardiac output (CO) was lower (4.7 vs. 6.1 L/min, P<0.001) and total vascular resistance (TVR) was higher (1444 vs. 1088 dynes/s/cm5, P<0.001). The lower CO was due to a lower preload, demonstrated by a reduced stroke volume (59.9 vs. 73.6 mL, P<0.01) and smaller left atrial diameter (LAD) (31.5 vs. 34.1 mm, P=0.01). Mean arterial pressure and diastolic function were similar between the groups. Logistic regression and receiver-operating characteristics curve analysis for detection of IUGR demonstrated that a model using TVR, LAD, fetal middle cerebral artery pulsatility index and gestational age, had a sensitivity of 96.2% and a specificity of 84.6%. CONCLUSIONS: Maternal echocardiography can provide a very sensitive tool for identifying IUGR pregnancies.

Maternal cardiac function in fetal growth restriction.

OBJECTIVE: To assess the maternal central haemodynamics in normotensive women with pregnancies complicated by severe fetal growth restriction (FGR). DESIGN: Cross-sectional study. SETTING: A tertiary referral fetal medicine unit. POPULATION: The study groups comprised 107 women with normal singleton pregnancies and 20 with singleton pregnancies complicated by FGR at 25-37 weeks. In the latter group, assessment was carried out within 10 days prior to their delivery. All the women were normotensive, without any medical problems. METHODS: Two-dimensional and M-mode echocardiography of the left ventricle. MAIN OUTCOME MEASURES: Maternal left ventricular systolic and diastolic function. RESULTS: In the FGR group, compared with the normal group, there was increased total vascular resistance (TVR), reduced systolic function characterised by lower cardiac output, stroke volume, heart rate, ejection time and septal and lateral long-axis shortening. Mean arterial pressure (MAP) was not significantly different between the groups. CONCLUSIONS: Severe FGR is associated with reduced maternal systolic function and increased TVR but no change in MAP. TVR may be a useful tool in the classification and management of FGR. The findings suggest that in FGR, there is increased blood viscosity due to lack of intravascular space expansion.