Birth outcomes in women exposed to diagnostic radiology procedures during first trimester of pregnancy: a prospective cohort study.

INTRODUCTION: Exposure of the embryo or fetus to ionizing radiations is a potential danger since it may induce clinically relevant fetal and/or neonatal damages. The aim of the present study was to examine fetal and neonatal outcomes after maternal exposure to radio-diagnostic procedures during first trimester of pregnancy, and to evaluate whether these effects might be related to the fetal absorbed dose of ionizing radiations. METHODS: A 10-year prospective cohort study was performed on 1979 pregnant women who underwent a radio-diagnostic procedure within the first trimester of pregnancy. Women were divided into two groups: those exposed to abdominal or lumbar radio-diagnostic procedure (Cohort A, n = 130), and those exposed to radio-diagnostic procedures in any other body regions (Cohort B, n = 415). Health physicists performed tailored fetal radiation dose calculation. Multivariate logistic regression model was used to estimate the risk of adverse pregnancy outcomes. RESULTS: The tailored fetal radiation dose was calculated for a total of 97 women (range 0.05-92 mSv). Major congenital malformations were detected in four infants in Cohort A, six infants in Cohort B, and 24 infants in controls (p = 0.445). Multivariate analysis confirmed the negative association between age and adverse pregnancy outcomes (OR 1.08 [1.06-1.11]), and the protective role of folic acid. A higher rate of small for gestational age seems to be present in women who underwent radio-diagnostic procedures that involve maternal thyroid. CONCLUSION: Despite several limitations, our study confirms that exposure to radio-diagnostic procedures that may involve uterus at doses below 100 mSv does not increase the risk of embryo-fetal toxicity. The relationship between maternal thyroid irradiation and small for gestational age needs to be further investigated.

Early lifecycle UV-exposure calibrates adult vitamin D metabolism: Evidence for a developmentally originated vitamin D homeostat that may alter related adult phenotypes.

OBJECTIVES: Within the Developmental Origins of Adult Disease (DOHaD) model, early life environmental exposures can confer a long-term legacy on human health. This mechanism may be adaptive or maladaptive depending on lifestyle circumstances. This article examines the role of first trimester UV-exposure on late-life vitamin D levels, and potentially related adaptive and maladaptive phenotypes (height and osteoporosis respectively). METHODS: Six hundred and forty nine subjects were examined for vitamin D2 and D3 (HPLC) and height (stadiometer). Osteoporosis was assessed with an extensive medical history questionnaire. RESULTS: Solar irradiance over the first 90 days postconception correlated positively with late-life vitamin D3 (R2 = .0140; P = .0082; ß = .1075), but not vitamin D2 levels. It also correlated positively with female adult height (R2 = .170; P = .0103; ß = .1291) and negatively with the occurrence of female osteoporosis (P = .0495). All data were adjusted for age and gender as appropriate (unadjusted data also provided). From a contemporary perspective, vitamin D levels varied significantly according to season of blood sampling as might be predicted (P = .0009). CONCLUSIONS: Increased solar irradiance/UV exposure during the first trimester of pregnancy calibrates adult vitamin D metabolism, which is an important hormone in maintaining calcium balance. This may explain how very early lifecycle UV exposure can influence skeletal development (adult height) and modify risk for the skeletal degenerative disorder osteoporosis. The data demonstrate humans are tuned to the world (exposome) in ways we have not yet fully considered, and which are entrained at the earliest phase of the lifecycle.

Pregnancy outcome after first trimester exposure to ionizing radiations.

OBJECTIVE: To evaluate the effects of ionizing radiation exposure during the first trimester of pregnancy in usual clinical situations. STUDY DESIGN: We conducted a prospective observational cohort study using data collected between 1987 and 2014. This database was authorized by the French "Commission Nationale de l'Informatique et des Libertés". The exposed group consisted of 319 pregnant women exposed to sub diaphragmatic ionizing radiations for diagnostic purposes, during the first trimester of pregnancy, and the control group consisted of 319 pregnant women without any exposure or exposed to non-teratogenic agents. Data on maternal history and radiations exposure were collected on first contact, and pregnancy outcomes were documented at follow-up. An univariate analysis was performed to compare both groups for the main outcomes. RESULTS: Exposure to sub diaphragmatic ionizing radiation for diagnosis purpose (median fetal dose of 3.1 mGy [0.2-130.0]) during the first trimester of pregnancy was not significantly associated with an increased risk of malformations (1.5% vs 1.8%, p = 1.00), miscarriage (7.8% vs 7.2%, p = 0.88), in utero fetal death (0.3% vs 0%, p = 1.00) or fetal growth restriction (5.4% vs 3.5%, p = 0.62). CONCLUSION: Pregnant women exposed to irradiant diagnostic procedures do not present a higher risk of malformations, miscarriage, in utero fetal death or fetal growth restriction and should be reassured, even if the examination focused on the pelvis.

Resultados perinatales y obstétricos en fetos con translucencia nucal incrementada / Perinatal and obstetric outcomes in fetuses with increased nuchal translucency

El objetivo es analizar los resultados perinatales y obstétricos de las gestaciones en cuya ecografía del primer trimestre se objetivó translucencia nucal incrementada. Obtuvimos 170 translucencias nucales aumentadas (mayor o igual a 3,5 mm), en 62 casos (36,47%) el cariotipo fue normal, en 84 casos (49,41%) fue patológico y en 24 casos (14,11%) no se realizó técnica invasiva. Del total de cariotipos normales (62 casos), 47 gestaciones llegaron a término con parto en nuestro centro y recién nacido normal, dos abortos tras realización de técnica invasiva y hubo diez interrupciones legales del embarazo. Los hallazgos ecográficos encontrados son los siguientes: un caso con megavejiga (2,12%), un caso con onfalocele (2,12%), dos casos de higroma quístico (4,3%), dos hidrops fetales severos, ambos con canal aurícoventricular completo, dos ausencias del hueso nasal (4,3%) y cuatro comunicaciones interventriculares (8,5%). En cuanto al total de translucencia nucal incrementada, 39 casos se correspondieron con trisomía del par 21 (23%), 18 con de trisomía 18 (10,6%), 10 con trisomía 13 (5,9%), 14 con 45XO (8,2%), 1 con 47XXX, (0,7% ), 1 con trisomía 10 (0,7%) y 1 con translocación balanceada 45 XX (t 8;21) (p11;q11)(0,7%). El incremento del grosor de la translucencia nucal entre las 11 y 13 semanas y seis días constituye una expresión fenotípica común de las aneuploidías y una gama de malformaciones fetales y síndromes genéticos. En los fetoseuploides, la prevalencia de las anormalidades fetales y los resultados perinatales adversos aumenta con el incremento de la translucencia nucal (AU)

The objective was to analyze the perinatal and obstetric outcomes of pregnancies, in which increased NT was detected onfirst-trimesterroutine ultrasoundstudy. A total of 170 cases of increased nuchal translucency (equal to or higher than 3.5mm)were detected. Within these cases, 62 (36,47%) had normal karyotype, 84 (49,41%) had aneuplody and 24 (14,11%) were not subjected to invasive techniques. From the group of patients with augmented nuchal translucency and normal karyotype (62), 47 reached full-term delivery at our hospital and the newborns were normal; 2 ended in miscarriage after undergoing an invasive technique, 10 ended in legal termination of pregnancy and 3 did not give birth at our hospital and their data were not available. Ultrasound findings in these patients included: one case of megacystis (2,12%), one case of omphalocele (2,12%), two cases of cystic hygroma (4,3%), two cases of severe hydrops fetalis both with complete AV canal (4,3%), two cases of absent nasal bone (4,3%) and four cases of interventricular communication (IVC) (8,5%). From the total of cases of increased nuchal translucency, 39 corresponded to trisomy-21 (23%); 18 (10,6%) to trisomy-18; 10 to trisomy-13 (5,9%); 14 to Turner’s syndrome (8,2%), 1 to karyotype 47XXX (0,7%); 1 to trisomy-10 (0,7%) and 1 to balanced translocation 45 XX (t 8;21) (p11;q11) (0,7%). Nuchal translucency thickening between weeks 11 and 13+6 days is a common phenotypical manifestation of a neuploidy and a wide range of fetal malformations and genetic syndromes. In euploid fetuses, the prevalence of fetal abnormal findings and adverse perinatal outcome increases with the nuchal translucency value (AU)

Acrania en feto con síndrome de Turner / Acrania in fetus with Turner syndrome

El síndrome de Turner es la alteración cromosómica más frecuente de los caracteres sexuales. Puede ser sospechado intraútero mediante ecografía por la frecuente presencia de malformaciones fetales asociadas, siendo las más habituales las cardiacas, renales y esqueléticas. Excepcionalmente se han descrito malformaciones del sistema nervioso central en fetos con síndrome de Turner. Presentamos el primer caso publicado hasta el momento de un feto acráneo afectado por síndrome de Turner. Como han señalado diversos estudios, la presencia de malformaciones fetales del sistema nervioso central debe hacer sospechar la presencia de aneuplodías (AU)

Turner’s síndrome is the most common sex chromosome abnormality. It may be suspected in utero by ultrasound by the frequent presence of associated fetal malformations, the most common being congenital heart defects, renal abnormalities and skeletal anomalies. Rarely central nervous system malformations have been described in fetuses with Turner’s syndrome. We present the first reported case of anacranial fetus affected by Turner’s syndrome. As noted by different studies, the presence of fetal malformations of the central nervous system should alert the presence of aneuploidies (AU)

Diagnóstico prenatal de otocefalia. Importancia de la ecografía de primer trimestre en el diagnóstico de las dismorfias faciales / Prenatal diagnosis of otocephaly. Importance of first trimester ultrasound in the diagnosis of facial dysmorphia

La otocefalia es una malformación congénita rara y en la mayoría de casos letal, caracterizada por la presencia de agnatia, microstomia, aglosia y melotia. La mayoría de los casos reportados en la literatura corresponden a diagnósticos prenatales tardíos. Reportamos a continuación un caso de otocefalia diagnosticado en la exploración ecográfica de primer trimestre. La ecografía es la herramienta diagnóstica de elección desde el primer trimestre de la gestación, permitiendo un diagnóstico precoz de las malformaciones craneo-faciales y un mejor manejo prenatal (AU)

Otocephaly is a rare congenital facial dysmorphia with a poor prognosis, characterised by the presence of agnathia, microstomia, aglossia and melotia. Most of the cases reported until now are second and especially late third trimester diagnosis. We report a case of prenatal detection of otocephaly at the first trimester ultrasound scan: the case was diagnosed at 13 weeks’ gestation and confirmed at autopsy. Currently, first-trimester ultrasound allowed the detection of this and other malformations, obtaining an early suspected diagnosis and enabling to perform invasive diagnostic tests to obtain information necessary to convey to the patient (AU)

Exploración ecográfica del primer trimestre / First-trimester ultrasound examination

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Acoustic output measured by thermal and mechanical indices during fetal echocardiography at the time of the first trimester scan.

We measured acoustic output, expressed as the thermal index (TI) and mechanical index (MI), during fetal echocardiography at the time of the first trimester scan. TI and MI were retrieved from the saved displays during gray-mode, high-definition color flow Doppler and pulsed-wave Doppler (tricuspid flow) ultrasound examinations of the fetal heart and from the ductus venosus assessment. A total of 399 fetal cardiac examinations were evaluated. There was a significant increase in TI values from B-mode studies (0.07 ± 0.04 [mean ± SD]) to color flow mapping (0.2 ± 0.0) and pulsed-wave Doppler studies (0.36 ± 0.05). The TI from ductus venosus assessment (0.1 ± 0.01) was significantly lower than those from Doppler examinations of the heart. MI values from B-mode scans (0.65 ± 0.12) and color flow mapping (0.71 ± 0.11) were comparable, although different, and both values were higher than those from pulsed-wave Doppler tricuspid evaluation (0.39 ± 0.03). There were no differences in MI values from power Doppler assessment between the tricuspid flow and ductus venosus. Safety indices were remarkably stable and were largely constant, especially for color Doppler (TI), tricuspid flow (MI) and ductus venosus assessment (TI, MI). We acquired satisfactory Doppler images and/or signals at acoustic levels that were lower than the actual recommendations and never reached a TI of 0.5.

Foetal and neonatal outcomes in first-trimester pregnant women exposed to abdominal or lumbar radiodiagnostic procedures without administration of radionucleotides.

BACKGROUND/AIM: Little is known about exposures to low radiation doses in the first trimester of pregnancy and deterministic adverse effects in the offspring, and risks are extrapolated from catastrophic events or from exposures to radiotherapy. The study aimed to assess the foetal and neonatal outcomes of pregnant women exposed to radiodiagnostic procedures with abdominal or lumbar irradiation. METHODS: In a prospective cohort design, we studied the foetal and neonatal outcomes in 115 singleton pregnant women who required abdominal or lumbar radiodiagnostic procedures without the administration of radionucleotides, and in 527 age-matched (± 2 years) control pregnant women. RESULTS: In the exposed group, lumbar spine radiography (33.9%), plain abdominal radiography (16.5%) and upper gastrointestinal tract radiography with abdominal irradiation (15.7%) were the most common radiodiagnostic procedures. Major congenital malformations were identified in two (1.9%) babies born in the exposed group and in two (0.4%) babies born in the control group (odds ratio = 4.7; 95% confidence interval 0.7-33.6; P = 0.15). The rest of the foetal and neonatal outcomes was similar in the two groups except by a marginally higher rate of admissions to the neonatal intensive care unit among babies born to exposed women (odds ratio = 2.9; 95% confidence interval 1.0-9.4; P = 0.06). CONCLUSION: Our results indicate that X-ray and computed tomography scan exposure involving abdominal irradiation without the administration of radionucleotides is not associated with adverse foetal and neonatal deterministic outcomes. Efforts are required to reduce the use of radiodiagnostic procedures for general check-ups in childbearing age women.

Maternal exposure to magnetic fields from high-voltage power lines and the risk of birth defects.

The issue of adverse human health effects due to exposure to electromagnetic fields is still unclear, and congenital anomalies are among the outcomes that have been inconsistently associated with such exposure. We conducted a population-based, case-control study to examine the risk of congenital anomalies associated with maternal exposure to magnetic fields (MF) from high-voltage power lines during pregnancy in a community in northern Italy. We identified 228 cases of congenital malformations diagnosed in live births, stillbirths, and induced abortions among women living in the municipality of Reggio Emilia during the period 1998-2006, and a reference group of healthy newborns was matched for year of birth, maternal age, and hospital of birth. We identified maternal residence during early pregnancy and used Geographic Information System to determine whether the residences were within geocoded corridors with MF ≥0.1 µT near high-voltage power lines, then calculated the relative risk (RR) of congenital anomalies associated with maternal exposure. One case and 5 control mothers were classified as exposed, and the RR associated with MF ≥0.1 µT was 0.2 (95% CI: 0.0-2.0) after adjusting for maternal education. While small or moderate effects may have gone undetected due to low statistical power, the results of this study overall do not provide support for major effects of a teratogenic risk due to exposure to MF during early pregnancy.

Visualización de la anatomía fetal por ecografía prenatal entre las semanas 11-13+6 / Visualising foetal anatomy by prenatal ultrasound between weeks 11-13+6

Objetivo. Comunicar la capacidad de visualización de estructuras anatómicas fetales durante la ecografía habitual de valoración de marcadores entre las semanas 11 y 13+6 de gestación en la Unidad de Ecografía del Centro Gutenberg de Málaga. Métodos. Evaluamos 990 pacientes que consultaron para valoración del cálculo de riesgo para trisomía 21, de las cuales 652 fueron utilizadas para el análisis. En 20 minutos realizamos la evaluación del grosor de la translucencia nucal y marcadores ecográficos adicionales, además de intentar valorar las principales estructuras anatómicas fetales, incluido el corazón, por vía abdominal o transvaginal según preferencia del operador. Resultados. El índice de masa corporal materno medio fue de 23,9; la media de la edad gestacional fue de 12 semanas; la longitud craneocaudal media fue de 62,6mm y la translucencia nucal se consideró por encima del percentil 95 en el 8,6% de los casos. Obtuvimos más del 90% de visualización (normal o con malformación) de cabeza y cerebro, cara, cuello, tórax, abdomen, extremidades y columna. Sin embargo, el corazón y los riñones ofrecieron mayor dificultad con una identificación global del 76 y 67% respectivamente. La mayoría del las exploraciones se realizaron con abordaje abdominal. Conclusiones. Es posible visualizar la anatomía fetal en más del 90% de los fetos, con más facilidad y éxito en la semana 13. La valoración del corazón y los riñones presentó siempre más dificultades. Destacamos la importancia de evaluar la anatomía fetal junto a los marcadores de aneuploidía en las semanas 11-13+6(AU)

Objective. To report the feasibility of identifying the foetal anatomy during the routine 11 to 13+6 weeks scan in the Ultrasound Unit at the Gutenberg Centre in Malaga, Spain. Methods. We examined 990 patients who attended our Unit to carry out the ultrasound screening for chromosomal abnormalities and risk assessment for trisomy 21, and 652 were included for the analysis. We measured the nuchal translucency thickness and additional ultrasound markers during the 20minutes allocated. In addition, we tried to visualise the main foetal anatomic structures, including the heart. The scans were done abdominally or by transvaginal approach, according to the preference of the operator. Results. The mean maternal body mass index was 23.9 and the mean gestation was 12 weeks; the mean crown rump length was 62.6mm and the nuchal translucency thickness was above the 95th centile for gestation in 8.6% of the foetuses. Visualisation of the foetal anatomy was successful in 90% of cases, classified as normal or abnormal, in most of the structures. However, the heart and kidneys were more difficult to identify with confidence and success was achieved in 76% and 67%, respectively. The large majority (93%) of the scans were performed abdominally. Conclusions. It is feasible to visualise the foetal anatomy in more than 90% of the cases during the routine first trimester scan. The heart and the kidneys remained the most difficult. We would like to stress the importance of the anatomical survey in the 11 to 13+6 weeks scan, in addition to the ultrasound markers assessment for the screening of chromosomal defects(AU)

Effects of 50-Hz magnetic field exposure on hormone secretion and apoptosis-related gene expression in human first trimester villous trophoblasts in vitro.

Evidence from epidemiological and animal studies showed that exposure to extremely low frequency magnetic fields (ELF-MF) could produce deleterious effects on reproduction. In order to investigate the possible mechanism of MF exposure on reproductive effects, first trimester human chorionic villi at 8-10 weeks' gestation were obtained, and trophoblasts were isolated, cultured, and exposed to a 50-Hz MF for different durations. The human chorionic gonadotropin (hCG) and progesterone in the culture medium was measured by electrochemiluminescence immunoassay. The mRNA levels of apoptosis-related genes bcl-2, bax, caspase-3, p53, and fas in trophoblasts were analyzed using real-time RT-PCR. The results showed that exposure of trophoblasts to MF at 0.2 mT for 72 h did not affect secretion of hCG and progesterone from these cells. There was also no significant change in secretion of these hormones when trophoblasts were exposed to a 0.4 mT MF for 48 h. However, MF significantly inhibited hCG and progesterone secretion of trophoblasts after exposure for 72 h at 0.4 mT. Results of apoptosis-related gene expression analysis showed that, within 72 h of exposure at 0.4 mT, there was no significant difference between MF exposure and control on the expression pattern of each gene. Based on results of the present experiment, it is suggested that exposure to MF for a longer duration (72 h) could inhibit secretion of hCG and progesterone by human first trimester villous trophoblasts, however, the effect might not be related to trophoblast apoptosis.

Actividad biológica de los compartimientos extraembrionarios / Biological activity of the extraembryonic compartments

Los avances en los equipos ecográficos y la realización de técnicas invasivas durante el primer trimestre del embarazo han permitido un acercamiento sin precedentes al entendimiento del desarrollo embrionario. Durante el primer trimestre del embarazo, el análisis de las muestras procedentes de suero materno, celoma extraembrionario, saco vitelino y saco amniótico, obtenidas tanto en humanos como en modelos animales, han puesto de manifiesto los cambios sucesivos que se producen en las características fisicoquímicas de estos líquidos en respuesta al desarrollo del propio embrión y sus anejos (AU)

Dismorfología facial fetal a través de la ecografía 3D / Fetal facial dysmorphology by 3D echography

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Embryo depth during the first trimester. Data required for embryo dosimetry.

RATIONALE AND OBJECTIVES: To provide data regarding embryo depth during the extremely radiosensitive gestational stages of organogenesis and early fetal period for use in embryo dosimetry. METHODS: Ultrasound examination was performed in 73 pregnant women at gestational age 5 to 13 weeks and in a control group of 75 nonpregnant women. Embryo skull and abdominal depth from the maternal skin surface were determined in the anteroposterior direction. Uterus depth was measured in the control group. Measurements were taken before and after voiding. Gestational age and maternal age, height, and weight were noted. Body mass index (BMI) was estimated for every woman from the formula BMI = W/H2. RESULTS: The mean embryo pre- and postvoid skull depth was 8.3 and 5.7 cm and the mean abdominal depth was 8.4 and 5.8 cm, respectively. The mean pre- and postvoid uterus depth was 9.5 and 4.7 cm. Mean abdominal depth and mean skull depth values were significantly different than mean uterus depth for full as well as for empty bladder. Embryo skull depth and abdominal depth were found to be significantly correlated with maternal BMI. Skull and abdominal dimensions were found to be significantly correlated with gestational age. CONCLUSIONS: During the first trimester, embryo depth ranges from 4 to 10 cm, depending on the individual, the status of the bladder, and the maternal BMI. For an accurate determination of embryo depth, ultrasound measurement should be performed.