Fetal growth, fetal development, and placental features in women with polycystic ovary syndrome: analysis based on fetal and placental magnetic resonance imaging.

OBJECTIVE: Polycystic ovary syndrome (PCOS), a common endocrine-metabolic dysfunction in reproductive-aged women, may be involved in compromised pregnancy and offspring outcomes. This study aimed to investigate whether maternal PCOS affects fetal growth, fetal development, and placental features. METHODS: This retrospective case-control study included 60 pregnant women with PCOS (PCOS group) and 120 healthy pregnant women without PCOS (control group). Fetal magnetic resonance imaging (MRI) was performed followed by an ultrasound examination and indications for imaging, including known or suspected fetal pathology, history of fetal abnormality in previous pregnancy or in a family member, and concern for placenta accreta. Fetal MRI images were analyzed for head circumference (HC), abdomen circumference (AC), lung-to-liver signal intensity ratio (LLSIR, a prenatal marker of fetal lung maturity), lengths of liver and kidney diameters in fetuses, and placental relative signal intensity on T2-weighted single-shot fast spin echo (SSFSE) imaging (rSISSFSE), and placental relative apparent diffusion coefficient value (rADC). Data on height and weight of offspring were collected through telephone follow-up. RESULTS: Compared to the control group, the PCOS group showed the following characteristics: (1) smaller biparietal diameter and femur length in fetuses (P=0.026 and P=0.005, respectively), (2) smaller HC in fetuses (evident after 32 weeks; P=0.044), (3) lower LLSIR and smaller dorsoventral length of liver in fetuses (evident before 32 weeks; P=0.005 and P=0.019, respectively), and (4) smaller placental thickness (evident before 32 weeks; P=0.017). No significant differences in placental rSISSFSE or rADC were observed between the groups (all P>0.05). No significant differences in height and weight of offspring during childhood existed between the groups (all P>0.05). CONCLUSIONS: There exist alterations of fetal growth, fetal development, and placental features from women with PCOS.

Utilidad de la espectroscopia por resonancia magnética en fetos con resistencias arteriales normales y resistencias arteriales elevadas / Usefulness of magnetic resonance spectroscopy in fetuses with normal arterial resistence and elevated arterial resistance

Determinar si la espectroscopia por resonancia magnética puede utilizarse en la evaluación del desarrollo cerebral de fetos con resistencias arteriales normales y resistencias arteriales elevadas y predecir daño neuronal. Unidad de Perinatología del Hospital Universitario de Caracas. Estudio prospectivo. Se midieron las resistencias arteriales del cordón umbilical y de la arteria cerebral media a nivel del segmento M2 a sesenta embarazadas de edad de gestación entre 26 y 36 semanas. Imágenes sagitales coronales y axiales del cuerpo y cerebro se obtuvieron de todos los fetos. La espectroscopia cerebral se realizó con la técnica del univoxel, con tiempo de eco corto e intermedio. Se analizaron las relaciones N-acetil aspartato/creatina, N-acetil aspartato/colina, colina/creatina, colina/N-acetil aspartato, mioInositol/N-acetil aspartato e mioInositol/creatina. La prueba estadística se realizó mediante frecuencias absolutas, porcentajes, medias, desviaciones estándar y el test de Fisher. Treinta presentaron resistencias arteriales normales (fetos control) y treinta presentaron resistencias elevadas. Las resistencias del cordón umbilical fueron significativamente mayores en fetos con resistencias arteriales elevadas que en fetos control. La morfo-anatomía fue normal en todos los fetos. En los fetos control, N-acetil aspartato/colina y N-acetil aspartato/creatina aumentaron con la edad gestacional y colina/N-acetil aspartato, mioInositol/N-acetil aspartato y mioinositol/creatina disminuyeron. Las relaciones en fetos con resistencias arteriales elevadas presentaron mucha variabilidad y un 69 por ciento de los espectros presentaron lactato. La espectroscopia por resonancia magnética puede evaluar el desarrollo cerebral de fetos y la presencia de lactato cerebral refleja una condición de hipoxia que puede predecir daño neurológico

To determine if proton magnetic resonance spectroscopy could be used to evaluate fetal brain development with normal and high arterial resistances, and to predict neurological damage. Unidad de Perinatología del Hospital Universitario de Caracas.Umbilical cord and brain median artery at M2 segment level arterial resistances were measured to sixty pregnant women with gestation age of 26 to 36 weeks. Thirty had normal arterial resistances (control fetuses) and thirty had high arterial resistances. Body and cerebral axial, coronal and sagittal images were obtained from all fetuses. Cerebral spectroscopy was performed with short and medium-length eco time. Single voxel was located in the basal ganglia. N-acetylaspartate/creatine, N-acetylaspartate/choline, choline/creatine, choline/N-acetylaspartate, mio-inositol/N-acetilaspartate and mio-inositol/creatine ratios were analyzed. Absolute frequencies, percentages, median, standard deviations and Fisher test were used for statistical analysis. Fetuses with high umbilical cord arterial resistances were significant higher than the obtained for control fetuses. Anatomical images were normal in all fetuses. N-acetylaspartate/choline and N-acetylaspartate/creatine increased and choline/N-acetylaspartate, myo-inositol/N-acetylaspartate and myo-inositol/creatine decreased with gestational age in control fetuses. Large variability resulted on metabolite ratios of fetuses with high umbilical cord arterial resistances. No significant differences on metabolites ratios were found between control fetuses and fetuses with high umbilical cord arterial resistances. Lactate was detected in 68 percent of brain fetuses with high umbilical cord arterial resistances. Conclusion: Proton magnetic resonance spectroscopy is able to evaluate fetal brain development and brain lactate, which is indicative of hypoxia, might predict neurological damage