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Perkovic-Kepeci S, Cirkovic A, Milic N, Dugalic S, Stanisavljevic D, Milincic M, Kostic K, Milic N, Todorovic J, Markovic K, Aleksic Grozdic N, Gojnic Dugalic M. Doppler Indices of the Uterine, Umbilical and Fetal Middle Cerebral Artery in Diabetic versus Non-Diabetic Pregnancy: Systematic Review and Meta-Analysis. Medicina (Kaunas) 2023; 59:1502. [PMID: 37629792 PMCID: PMC10456372 DOI: 10.3390/medicina59081502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/20/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: The aim of this study was to assess the differences in Doppler indices of the uterine (Ut), umbilical (UA), and middle cerebral artery (MCA) in diabetic versus non-diabetic pregnancies by conducting a comprehensive systematic review of the literature with a meta-analysis. Materials and Methods: PubMed, Web of Science, and SCOPUS were searched for studies that measured the pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio index (S/D ratio) of the umbilical artery, middle cerebral artery, and uterine artery in diabetic versus non-diabetic pregnancies. Two reviewers independently evaluated the eligibility of studies, abstracted data, and performed quality assessments according to standardized protocols. The standardized mean difference (SMD) was used as a measure of effect size. Heterogeneity was assessed using the I2 statistic. Publication bias was evaluated by means of funnel plots. Results: A total of 62 publications were included in the qualitative and 43 in quantitative analysis. The UA-RI, UtA-PI, and UtA-S/D ratios were increased in diabetic compared with non-diabetic pregnancies. Subgroup analysis showed that levels of UtA-PI were significantly higher during the third, but not during the first trimester of pregnancy in diabetic versus non-diabetic pregnancies. No differences were found for the UA-PI, UA-S/D ratio, MCA-PI, MCA-RI, MCA-S/D ratio, or UtA-RI between diabetic and non-diabetic pregnancies. Conclusions: This meta-analysis revealed the presence of hemodynamic changes in uterine and umbilical arteries, but not in the middle cerebral artery in pregnancies complicated by diabetes.
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Affiliation(s)
- Sonja Perkovic-Kepeci
- General Hospital Pancevo, 26000 Pancevo, Serbia;
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
| | - Andja Cirkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.M.); (D.S.)
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.M.); (D.S.)
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Stefan Dugalic
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (S.D.); (M.M.)
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.M.); (D.S.)
| | - Milos Milincic
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (S.D.); (M.M.)
| | - Konstantin Kostic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
| | - Nikola Milic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
| | - Jovana Todorovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Ksenija Markovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
| | - Natasa Aleksic Grozdic
- Institute for Process Engineering Environmental Engineering and Technical Life Sciences, Technical University of Vienna, 1180 Vienna, Austria;
| | - Miroslava Gojnic Dugalic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (K.K.); (N.M.); (K.M.); (M.G.D.)
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (S.D.); (M.M.)
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van Poppel MNM, Damm P, Mathiesen ER, Ringholm L, Zhang C, Desoye G. Is the Biphasic Effect of Diabetes and Obesity on Fetal Growth a Risk Factor for Childhood Obesity? Diabetes Care 2023; 46:1124-1131. [PMID: 37220261 DOI: 10.2337/dc22-2409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/03/2023] [Indexed: 05/25/2023]
Abstract
In pregnancies of women with obesity or diabetes, neonates are often overgrown. Thus, the pregnancy period in these women offers a window of opportunity to reduce childhood obesity by preventing neonatal overgrowth. However, the focus has been almost exclusively on growth in late pregnancy. This perspective article addresses possible growth deviations earlier in pregnancy and their potential contribution to neonatal overgrowth. This narrative review focuses on six large-scale, longitudinal studies that included ∼14,400 pregnant women with at least three measurements of fetal growth. A biphasic pattern in growth deviation, including growth reduction in early pregnancy followed by overgrowth in late pregnancy, was found in fetuses of women with obesity, gestational diabetes mellitus (GDM), or type 1 diabetes compared with lean women and those with normal glucose tolerance. Fetuses of women with these conditions have reduced abdominal circumference (AC) and head circumference (HC) in early pregnancy (observed between 14 and 16 gestational weeks), while later in pregnancy they present the overgrown phenotype with larger AC and HC (from approximately 30 gestational weeks onwards). Fetuses with early-pregnancy growth reduction who end up overgrown presumably have undergone in utero catch-up growth. Similar to postnatal catch-up growth, this may confer a higher risk of obesity in later life. Potential long-term health consequences of early fetal growth reduction followed by in utero catch-up growth need to be explored.
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Affiliation(s)
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
| | - Cuilin Zhang
- Global Center for Asian Women's Health and Asia Center for Reproductive Longevity and Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gernot Desoye
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Medical University Graz, Graz, Austria
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Maduro C, Castro LFD, Moleiro ML, Guedes-Martins L. Pregestational Diabetes and Congenital Heart Defects. Rev Bras Ginecol Obstet 2022; 44:953-961. [PMID: 36446562 PMCID: PMC9708403 DOI: 10.1055/s-0042-1755458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Studies have consistently shown a significant increase in the risk of congenital heart defects in the offspring of diabetic mothers compared with those of nondiabetic pregnancies. Evidence points that all types of pregestational diabetes have the capacity of generating cardiac malformations in a more accentuated manner than in gestational diabetes, and there seems to be an increased risk for all congenital heart defects phenotypes in the presence of maternal diabetes. Currently, the application of some therapies is under study in an attempt to reduce the risks inherent to diabetic pregnancies; however, it has not yet been possible to fully prove their effectiveness. The present review aims to better understand the mechanisms that govern the association between pregestational diabetes and congenital heart defects and how maternal diabetes interferes with fetal cardiac development, as there is still a long way to go in the investigation of this complex process.
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Affiliation(s)
- Catarina Maduro
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal,Address for correspondence Catarina Maduro, MSc Rua Jorge de Viterbo Ferreira 228, 4050-313, PortoPortugal
| | - Luís Ferreira de Castro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal
| | - Maria Lúcia Moleiro
- Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal,Departamento da Mulher e da Medicina Reprodutiva, Centro Hospitalar do Porto EPE, Centro Materno Infantil do Norte, Largo Prof. Abel Salazar, Porto, Portugal,Unidade de Investigação e Formação, Centro Materno Infantil do Norte, Porto, Portugal,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Abstract
Ultrasound imaging is a vital tool for exploring in vivo the placental function which is essential to understand pathological phenomena such as preeclampsia or intrauterine growth restriction. As technology advances including ready availability of three-dimensional (3D) probes and novel software, new markers of placental function become possible. The objective of this review was to provide an overview of the new ultrasound markers of placental function with a focus on the potential clinical application of three-dimensional power Doppler (3DPD). A broad-free text literature search was undertaken based on human placental studies and sixty full-text studies were included in this review. Three-dimensional power Doppler is a promising technique to predict preeclampsia in the first trimester. However, the influence of external factors such as body mass index, parameter standardisation and machine settings still need to be addressed. Contrast-enhanced ultrasound is currently reserved for research, because the required injected contrast mediums are not currently approved for use in pregnancy, although the safety data is reassuring.
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Affiliation(s)
- C Bertholdt
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000 Nancy, France; Université de Lorraine, Inserm, IADI, F-54000 Nancy, France.
| | - M Dap
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000 Nancy, France
| | - M Beaumont
- CHRU-Nancy, Inserm, Université de Lorraine, CIC, Innovation Technologique, F-54000 Nancy, France
| | - J Duan
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Hubei, 430071, China; Gynecology and Obstetrical Service, Zhongnan Hospital of Wuhan University, Hubei, 430071, China
| | - O Morel
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000 Nancy, France; Université de Lorraine, Inserm, IADI, F-54000 Nancy, France
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Atarod Z, Ebrahemian M, Jafarpour H, Moraghebi M, Sharafkhani E. Association between serum adiponectin levels with gestational diabetes mellitus and postpartum metabolic syndrome:A case control study. Endocr Regul 2020; 54:119-25. [PMID: 32597154 DOI: 10.2478/enr-2020-0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Pregnancy can cause diabetic conditions and gestational diabetes is the most common metabolic disorder of the era. Scientific evidence suggests that obesity increases the incidence and severity of gestational diabetes. Adipokines are proteins secreted from adipose tissue in response to extracellular stimuli and altered metabolism. These hormones are involved in regulating the energy balance, lipid metabolism, and insulin sensitivity. One of the types of adipokines is called adiponectin, which has anti-diabetic, anti-inflammatory, and anti-atherogenic effects. Accordingly, this study is aimed to investigate the correlation between the serum adiponectin level with the gestational diabetes and the postpartum metabolic syndrome. METHODS This case-control study was carried out on 37 pregnant women (in Sari, Iran) with gestational diabetes and 37 non-diabetic pregnant women who were matched regarding age and body mass index (BMI). Serum adiponectin and glucose levels were measured. Finally, six weeks after termination of pregnancy, women in both groups were evaluated for metabolic syndrome. All statistical analyses of this study were performed using IBM SPSS software version 21 and, in all cases, the two-way p value less than 0.05 was considered statistically significant. RESULTS The mean age of pregnant women was 28.46±4.11 years in the non-diabetic group and 30.03±4.71 in the diabetic group. There was no statistically significant difference found between the mean age (p=0.123) and BMI (p=0.727) in two groups. Serum adiponectin levels in the diabetic group (5.51±3.15 µg/ml) were significantly lower than in the non-diabetic group (8.35±4.54 µg/ml) (p=0.003). In the diabetic group, serum adiponectin level did not correlate with the maternal age, maternal BMI, and postpartum metabolic syndrome (p>0.005). CONCLUSIONS The results of the present study indicate a correlation of low adiponectin concentrations with gestational diabetes, but this association with postpartum metabolic syndrome is uncertain. However, to elucidate the mechanism of adiponectin in predicting gestational diabetes and postpartum metabolic syndrome further studies are required.
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Elhelaly AM, Elnaggar AK, Mohamed MEDM, Abdelfattah MH, Farag AH. First trimester placental volume and vascular indices in pregestational diabetic compared to nondiabetic pregnant women. J Obstet Gynaecol Res 2020; 46:1326-1332. [PMID: 32585732 DOI: 10.1111/jog.14271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/13/2020] [Accepted: 04/09/2020] [Indexed: 12/11/2022]
Abstract
AIM Comparing placental volume (PV) and vascular indices in pregestational diabetic and nondiabetic pregnant women at 11 and 13 weeks gestation. METHODS A case-control study conducted at Ain Shams University Maternity Hospital in collaboration with Feto-maternal Unit for Ultrasound Assessment, Ain Shams University Maternity Hospital, Egypt. Ninety-two pregnant women divided into two groups: Group A included 46 women with pregestational diabetes mellitus and group B included 46 nondiabetic pregnant women as control. All participants had PV, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) calculated using three-dimensional (3D) ultrasonography and 3D power Doppler at 11 and 13 weeks of pregnancy. RESULTS At 11 weeks, the mean VI, FI and VFI in diabetic group (17.70 ± 12.62, 40.72 ± 11.03 and 7.77 ± 6.37, respectively) were insignificantly higher than in nondiabetic group (12.14 ± 12.62, 34.59 ± 9.66 and 6.52 ± 14.20, respectively) while mean PV in diabetic group (26.90 ± 14.74) was insignificantly lower than in nondiabetic group (27.53 ± 17.46). Also at 13 weeks, the results were not different as the mean VI, FI and VFI in diabetic group (16.51 ± 9.81, 42.52 ± 7.47 and 8.12 ± 7.55, respectively) were insignificantly higher than in nondiabetic group (16.37 ± 14.17, 40.29 ± 17.52 and 7.08 ± 4.35, respectively), and mean PV in diabetic group (52.04 ± 17.95) was insignificantly lower than in nondiabetic group (54.46 ± 17.85). There was strong positive correlation between HbA1C level and VFI measured at 13 weeks gestation. CONCLUSIONS Placental indices in early pregnancy do not seem to be useful markers to anticipate placental pathology in pregestational diabetes, however there might be a role for HbA1C level measurement to anticipate such complications.
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Affiliation(s)
- Amr M Elhelaly
- Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Cairo, Egypt
| | - Ahmed K Elnaggar
- Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Cairo, Egypt
| | - Magd El Din M Mohamed
- Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Cairo, Egypt
| | - Mahmoud H Abdelfattah
- Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Cairo, Egypt
| | - Amr H Farag
- Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Cairo, Egypt.,Department of Obstetrics and Gynecology, Walsall Manor Hospital, Walsall, UK
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Hamidi OP, Hameroff A, Kunselman A, Curtin WM, Sinha R, Ural SH. Placental thickness on ultrasound and neonatal birthweight. J Perinat Med 2019; 47:331-334. [PMID: 30504523 DOI: 10.1515/jpm-2018-0100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 11/05/2018] [Indexed: 11/15/2022]
Abstract
Objective To investigate the relationship between maximal placental thickness during routine anatomy scan and birthweight at delivery. Methods This retrospective descriptive study analyzed 200 term, singleton deliveries in 2016 at Penn State Hershey Medical Center. We measured maximal placental thickness in the sagittal plane from the ultrasound images of the placenta obtained at the 18-21-week fetal anatomy screen. The relationship between placental thickness and neonatal birthweight was assessed using Pearson's correlation coefficient (r) with 95% confidence interval (CI). Logistic regression was used to assess the association between placental thickness and secondary binary outcomes of neonatal intensive care unit (NICU) admission and poor Apgar scores. Two-sample t-tests, or exact Wilcoxon rank-sum test for non-normally distributed data, were used to assess for differences attributable to medical comorbidities (pre-gestational diabetes, gestational diabetes, chronic hypertension, gestational hypertension, preeclampsia and eclampsia). Results Placental thickness had a positive correlation with neonatal birthweight [r=0.18, 95% CI=(0.05, 0.32)]. The mean placental thickness measured 34.2±9.7 mm. The strength of the correlation remained similar when adjusting for gestational age (r=0.20) or excluding medical comorbidities (r=0.19). There was no association between placental thickness and NICU admission, Apgar scores <7 or medical comorbidities. Conclusion Our study demonstrated a positive correlation between sonographic placental thickness and birthweight. Future prospective studies are warranted in order to further investigate whether a clinically significant correlation exists while adjusting for more covariates.
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Affiliation(s)
- Odessa P Hamidi
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, 500 University Dr., Hershey, PA, USA
| | - Avi Hameroff
- Penn State Hershey Medical Center, Division of Maternal Fetal Medicine, Hershey, PA, USA
| | - Allen Kunselman
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, USA
| | - William M Curtin
- Penn State Hershey Medical Center, Division of Maternal Fetal Medicine, Hershey, PA, USA
| | - Risha Sinha
- Penn State Hershey College of Medicine, Hershey, PA, USA
| | - Serdar H Ural
- Penn State Hershey Medical Center, Division of Maternal Fetal Medicine, Hershey, PA, USA
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Hoch D, Gauster M, Hauguel-de Mouzon S, Desoye G. Diabesity-associated oxidative and inflammatory stress signalling in the early human placenta. Mol Aspects Med 2019; 66:21-30. [DOI: 10.1016/j.mam.2018.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/08/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022]
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Chen CY, Chang HT, Chen CP, Sun FJ. First trimester placental vascular indices and volume by three-dimensional ultrasound in pre-gravid overweight women. Placenta 2019; 80:12-17. [PMID: 31103061 DOI: 10.1016/j.placenta.2019.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/14/2019] [Accepted: 03/25/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To investigate changes of placental vascular indices and volume in pre-gravid overweight Chinese women during the first trimester using three-dimensional power Doppler ultrasound. METHODS This was a prospective observational study of the morphology of placentas in pre-gravid overweight (body mass index (BMI) ≥ 24 kg/m2) and non-overweight (BMI < 24 kg/m2) Chinese women during the first trimester of pregnancy. Data on placental vascular indices (vascularization index, flow index, and vascularization flow index (VFI)), placental volume, uterine artery pulsatility index (PI), and neonatal outcomes were obtained during the first trimester and analyzed. Linear regression analysis was used to evaluate confounding factors between BMI and ultrasound indices. RESULTS Of the 429 pregnant women enrolled, 68 (15.9%) were pre-gravid overweight. Placental VFI was significantly lower in the overweight group (p = 0.037). Conversely, placental volume was significantly larger in the overweight group (p = 0.044), and uterine artery PI was significantly higher in the overweight group (p = 0.021). After adjustments for confounding factors, there were still significant differences in placental VFI (unstandardized coefficient (B) -0.666, 95% confidence interval (CI) -1.306 - (-0.025)), placental volume (B 2.458, 95% CI 0.071-4.844), and uterine artery PI (B 0.152, 95% CI 0.030-0.274) between the two groups. CONCLUSIONS Placental vascular indices using three-dimensional power Doppler ultrasound can provide an insight into placental vascularization in pre-gravid overweight women in early pregnancy. Alterations in placental VFI, placental volume, and uterine artery PI occur during the first trimester in pre-gravid overweight women.
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Affiliation(s)
- C Y Chen
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
| | - H T Chang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - C P Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - F J Sun
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
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Kozinszky Z, Altorjay A, Molnar A, Nyári T, Vari SG, Nemeth G, Suranyi A. Ultrasonographic Evaluation of Glycemic Control Effect on Placental Vascularization in Pregnancy with Type 1 Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2019; 128:788-795. [PMID: 30641608 DOI: 10.1055/a-0824-6362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS The aim of our study was to assess the effect of glycemic control on placental vascularization in pregnancies complicated by type 1 diabetes mellitus (T1DM) and to compare dataset of optimal/suboptimal glycemic control to normal placental 3-dimensional power Doppler (3-DPD) indices in 2nd and 3rd trimester. METHODS Placental vascularization of pregnant women was prospectively evaluated by 3-DPD ((vascularization-index (VI); flow-index (FI); vascularization-flow-index (VFI)) ultrasound technique. The normal pregnancies (n=214) were compared to those complicated by T1DM (n=53) with optimal (HbA1C≤6%;≤ 42 mmol/mol) and suboptimal (HbA1C>6%;>42 mmol/mol) glycemic control. RESULTS Pregnancies complicated by T1DM expressed lower placental vascularization indices as compared with normal pregnancies (adjusted odds ratio (AOR) for VI:0.86; FI:0.94; VFI:0.76). Placental 3-DPD indices have a significant correlation with HbA1C and optimal glycemic control is associated with lower placental perfusion (AOR for VI:1.64; FI:1.13; VFI:2.34). Short-term adverse neonatal outcome was predicted by lower 3-DPD indices (AORVI:0.83, AORFI:0.93, AORVFI:0.66, p<0.05 for each index). Besides the glycemic control, the pregestational body mass index (BMI), had significant influences on placental perfusion. CONCLUSIONS VI displayed the best screening ability for suboptimal glycemic control with a sensitivity of 90.9%. The suboptimal glycemic control has a direct deteriorating effect on placental vasculature. Therefore the ultrasound examination could be an adjunct diagnostic modality for pregnant women with T1DM.
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Affiliation(s)
- Zoltan Kozinszky
- Department of Obstetrics and Gynecology, Blekinge Hospital, Karlskrona, Sweden
| | - AbelT Altorjay
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Andras Molnar
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Sandor G Vari
- International Research and Innovation in Medicine Program, Cedars - Sinai Medical Center, Los Angeles, CA, USA
| | - Gabor Nemeth
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Andrea Suranyi
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
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Wong CH, Chen CP, Sun FJ, Chen CY. Comparison of placental three-dimensional power Doppler indices and volume in the first and the second trimesters of pregnancy complicated by gestational diabetes mellitus. J Matern Fetal Neonatal Med 2018; 32:3784-3791. [PMID: 29716432 DOI: 10.1080/14767058.2018.1472226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective: To compare the changes of placental three-dimensional power Doppler indices and volume in the first and the second trimesters of pregnancy with gestational diabetes mellitus (GDM). Methods: This was a prospective case-control study of singleton pregnancies with risk factors for GDM. Data on placental vascular indices including vascularization index (VI), flow index (FI), and vascularization flow index (VFI), as well as placental volume were obtained and analyzed during the first and the second trimesters between pregnant women with and without GDM. Results: Of the 155 pregnant women enrolled, 31 developed GDM and 124 did not. VI and VFI were significantly lower in the GDM group during the first and second trimesters (VI: p = .023, and VFI: p = .014 in the first trimester; VI: p = .049, and VFI: p = .031 in the second trimester). However, the placental volume was similar in both the groups during the first trimester, while it was significantly increased in the GDM group during the second trimester (p = .022). There were no significant differences in FI and uterine artery pulsatility index between the two groups. After adjustments in multivariate logistic regression analysis, significant differences were observed in the first trimester VFI (adjusted odds ratio (OR) 0.76, 95% confidence interval (CI) 0.61-0.93), second trimester VFI (adjusted or 0.83, 95%CI 0.71-0.96), and second trimester placental volume (adjusted or 1.03, 95%CI 1.01-1.05). Conclusions: Placental vascular indices can provide an insight into placental vascularization in GDM during early pregnancy. VFI rather than placental volume may be a sensitive sonographic marker in the first trimester of GDM placentas.
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Affiliation(s)
- Chian-Huey Wong
- a Department of Medicine , Mackay Medical College , New Taipei City , Taiwan.,b Department of Obstetrics and Gynecology , Mackay Memorial Hospital , Taipei , Taiwan
| | - Chie-Pein Chen
- a Department of Medicine , Mackay Medical College , New Taipei City , Taiwan.,b Department of Obstetrics and Gynecology , Mackay Memorial Hospital , Taipei , Taiwan
| | - Fang-Ju Sun
- c Department of Medical Research , Mackay Memorial Hospital , Taipei , Taiwan
| | - Chen-Yu Chen
- a Department of Medicine , Mackay Medical College , New Taipei City , Taiwan.,b Department of Obstetrics and Gynecology , Mackay Memorial Hospital , Taipei , Taiwan
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González-González NL, González Dávila E, Padrón E, Armas Gonzalez M, Plasencia W. Value of Placental Volume and Vascular Flow Indices as Predictors of Early and Late Preeclampsia at First Trimester. Fetal Diagn Ther 2018; 44:256-263. [PMID: 29393218 DOI: 10.1159/000481433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/07/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION We evaluated the utility of placental volume and three-dimensional (3D) vascular flow indices to predict early and late preeclampsia. MATERIAL AND METHODS In 1,004 pregnancies attending routine care, we recorded first-trimester screening program for aneuploidy (FTSA) parameter and measured uterine artery pulsatility index (uterine-a PI). Placental volume and vascular flow indices were obtained using 3D power Doppler and VOCAL techniques. RESULTS Placental volume was lower and uterine-a PI was higher in both early and late preeclampsia groups versus nonaffected pregnancies. The prediction rate of placental volume in late preeclampsia was higher than that of uterine-a PI (AUROC 0.707 vs. 0.581, p < 0.011). The inclusion of placental volume improved significantly the prediction rate of total and late preeclampsia in the models constructed with maternal characteristics, FTSA, and uterine-a PI (AUROC 0.745 vs. 0.818, p < 0.004, and 0.740 vs. 0.812, p < 0.012, respectively). The inclusion of vascular indices did not improve the predictive value of these models. DISCUSSION Placental volume was an independent predictor of total, early, and late preeclampsia and its inclusion in combined predictive models significantly improved prediction rates. Reduced placental volume observed at first trimester in women with early and late preeclampsia suggests that these entities are the clinical expression of a similar pathophysiological process.
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Affiliation(s)
- Nieves L González-González
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Universidad de La Laguna, La Laguna,
| | - Enrique González Dávila
- Departamento de Matemáticas, Estadística e Investigación Operativa, Universidad de La Laguna, La Laguna, Spain
| | - Erika Padrón
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Universidad de La Laguna, La Laguna, Spain
| | - Marina Armas Gonzalez
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Universidad de La Laguna, La Laguna, Spain
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Kalagiri RR, Vora N, Wilson JL, Afroze SH, Raju VN, Govande V, Beeram MR, Kuehl TJ, Uddin MN. Diabetes and pre-eclampsia affecting pregnancy: a retrospective cross-sectional study. J Investig Med 2017; 66:728-732. [PMID: 29170244 DOI: 10.1136/jim-2017-000537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2017] [Indexed: 12/16/2022]
Abstract
The interaction between pre-eclampsia and diabetes mellitus (DM) is far from being completely understood. In this study, we compared normal pregnancies with those complicated with pre-eclampsia, gestational DM, and/or pre-existing diabetes to assess the effects of hyperglycemia on placental development. AnInstitutional Review Board (IRB) approved retrospective cross-sectional study with 621 subjects was performed. Statistical analysis was performed using Duncan's post hoc test and analysis of variance. Regardless of diabetes status, patients with pre-eclampsia delivered prematurely. Patients in the group with pre-eclampsia and pregestational diabetes delivered much earlier, at 35.0±0.4 weeks, when compared with the patients that had pre-eclampsia with gestational diabetes and pre-eclampsia with no diabetes (*P<0.05 for each). Additionally, patients with pre-existing diabetes who developed pre-eclampsia delivered smaller babies than those with pre-existing diabetes without pre-eclampsia (1.00±0.03, P<0.05 for each). Pre-existing diabetes with added insult of pre-eclampsia led to fetal growth restriction. This outcome validates the understanding that elevated glucose earlier in pregnancy alters placentogenesis and leads to fetal growth restriction.
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Affiliation(s)
- Ram R Kalagiri
- Departments of Pediatrics, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Niraj Vora
- Departments of Pediatrics, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Jessica L Wilson
- College of Medicine, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Syeda H Afroze
- Department of Medical Physiology, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Venkata N Raju
- Departments of Pediatrics, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Vinayak Govande
- Departments of Pediatrics, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Madhava R Beeram
- Departments of Pediatrics, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA.,College of Medicine, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Thomas J Kuehl
- Departments of Pediatrics, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA.,College of Medicine, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA.,Obstetrics and Gynecology, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Mohammad Nasir Uddin
- Medical Physiology, Texas A&M Health Science Center College of Medicine, Baylor Scott and White Health, Temple, Texas, USA
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Haidar ZA, Papanna R, Sibai BM, Tatevian N, Viteri OA, Vowels PC, Blackwell SC, Moise KJ. Can 3-dimensional power Doppler indices improve the prenatal diagnosis of a potentially morbidly adherent placenta in patients with placenta previa? Am J Obstet Gynecol 2017; 217:202.e1-202.e13. [PMID: 28400306 DOI: 10.1016/j.ajog.2017.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Traditionally, 2-dimensional ultrasound parameters have been used for the diagnosis of a suspected morbidly adherent placenta previa. More objective techniques have not been well studied yet. OBJECTIVE The objective of the study was to determine the ability of prenatal 3-dimensional power Doppler analysis of flow and vascular indices to predict the morbidly adherent placenta objectively. STUDY DESIGN A prospective cohort study was performed in women between 28 and 32 gestational weeks with known placenta previa. Patients underwent a two-dimensional gray-scale ultrasound that determined management decisions. 3-Dimensional power Doppler volumes were obtained during the same examination and vascular, flow, and vascular flow indices were calculated after manual tracing of the viewed placenta in the sweep; data were blinded to obstetricians. Morbidly adherent placenta was confirmed by histology. Severe morbidly adherent placenta was defined as increta/percreta on histology, blood loss >2000 mL, and >2 units of PRBC transfused. Sensitivities, specificities, predictive values, and likelihood ratios were calculated. Student t and χ2 tests, logistic regression, receiver-operating characteristic curves, and intra- and interrater agreements using Kappa statistics were performed. RESULTS The following results were found: (1) 50 women were studied: 23 had morbidly adherent placenta, of which 12 (52.2%) were severe morbidly adherent placenta; (2) 2-dimensional parameters diagnosed morbidly adherent placenta with a sensitivity of 82.6% (95% confidence interval, 60.4-94.2), a specificity of 88.9% (95% confidence interval, 69.7-97.1), a positive predictive value of 86.3% (95% confidence interval, 64.0-96.4), a negative predictive value of 85.7% (95% confidence interval, 66.4-95.3), a positive likelihood ratio of 7.4 (95% confidence interval, 2.5-21.9), and a negative likelihood ratio of 0.2 (95% confidence interval, 0.08-0.48); (3) mean values of the vascular index (32.8 ± 7.4) and the vascular flow index (14.2 ± 3.8) were higher in morbidly adherent placenta (P < .001); (4) area under the receiver-operating characteristic curve for the vascular and vascular flow indices were 0.99 and 0.97, respectively; (5) the vascular index ≥21 predicted morbidly adherent placenta with a sensitivity and a specificity of 95% (95% confidence interval, 88.2-96.9) and 91%, respectively (95% confidence interval, 87.5-92.4), 92% positive predictive value (95% confidence interval, 85.5-94.3), 90% negative predictive value (95% confidence interval, 79.9-95.3), positive likelihood ratio of 10.55 (95% confidence interval, 7.06-12.75), and negative likelihood ratio of 0.05 (95% confidence interval, 0.03-0.13); and (6) for the severe morbidly adherent placenta, 2-dimensional ultrasound had a sensitivity of 33.3% (95% confidence interval, 11.3-64.6), a specificity of 81.8% (95% confidence interval, 47.8-96.8), a positive predictive value of 66.7% (95% confidence interval, 24.1-94.1), a negative predictive value of 52.9% (95% confidence interval, 28.5-76.1), a positive likelihood ratio of 1.83 (95% confidence interval, 0.41-8.11), and a negative likelihood ratio of 0.81 (95% confidence interval, 0.52-1.26). A vascular index ≥31 predicted the diagnosis of a severe morbidly adherent placenta with a 100% sensitivity (95% confidence interval, 72-100), a 90% specificity (95% confidence interval, 81.7-93.8), an 88% positive predictive value (95% confidence interval, 55.0-91.3), a 100% negative predictive value (95% confidence interval, 90.9-100), a positive likelihood ratio of 10.0 (95% confidence interval, 3.93-16.13), and a negative likelihood ratio of 0 (95% confidence interval, 0-0.34). Intrarater and interrater agreements were 94% (P < .001) and 93% (P < .001), respectively. CONCLUSION The vascular index accurately predicts the morbidly adherent placenta in patients with placenta previa. In addition, 3-dimensional power Doppler vascular and vascular flow indices were more predictive of severe cases of morbidly adherent placenta compared with 2-dimensional ultrasound. This objective technique may limit the variations in diagnosing morbidly adherent placenta because of the subjectivity of 2-dimensional ultrasound interpretations.
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González-gonzález NL, González-dávila E, González Marrero L, Padrón E, Castro-conde JR, Plasencia W. Value of placental volume and vascular flow indices as predictors of intrauterine growth retardation. Eur J Obstet Gynecol Reprod Biol 2017; 212:13-9. [DOI: 10.1016/j.ejogrb.2017.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/22/2017] [Accepted: 03/03/2017] [Indexed: 11/23/2022]
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Gibbons A, Flatley C, Kumar S. The fetal cerebro-placental ratio in diabetic pregnancies is influenced more by the umbilical artery rather than middle cerebral artery pulsatility index. Eur J Obstet Gynecol Reprod Biol 2017; 211:56-61. [PMID: 28189724 DOI: 10.1016/j.ejogrb.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to assess the relationship between the cerebro-placental ratio (CPR) and intrapartum and perinatal outcomes in pregnancies complicated by pre-existing insulin dependent diabetes (pT1DM) mellitus, pre-existing non-insulin dependent diabetes mellitus (pT2DM) and gestational diabetes mellitus (GDM). STUDY DESIGN This was a retrospective cohort study of 1281 women with diabetes mellitus birthing at the Mater Mothers' Hospital in Brisbane between 2007 and 2015. The CPR in non-anomalous singleton fetuses was measured between 34+0 and 36+6 weeks gestation and compared between types of DM treatment groups and correlated with intrapartum and perinatal outcomes. RESULTS Of the study cohort, 9.7% (124/1281) had pT1DM, 5.3% (68/1281) had pT2DM and 85.0% (1089/1281) had GDM. Of women with pT2DM and GDM, 61.8% (42/68) and 28.9% (315/1089) respectively, required insulin during pregnancy. Women with pT1DM had an increased odds of having a CPR <5th centile (OR 3.73, 95%CI: 1.90-6.96, p=0.0001) or a CPR <10th centile (OR 3.01, 95% CI: 1.80-4.91, p<0.0001) respectively. The odds of a UA PI >90th centile (OR 2.69, 95% CI: 1.60-4.39, p=0.0001) was higher in the pT1DM cohort. There was however no significant difference in the mean MCA PI between the three groups. Stratification by CPR centiles (<10th centile vs. ≥10th centile) demonstrated a lower birth weight in the CPR <10th centile cohort for all DM categories. The proportion of neonates with birth weights <10th centile were higher in the CPR <10th centile cohort with the GDM cohort having an odds ratio of 8.28 (95% CI 4.22-16.13, p<0.0001) of this complication. The CPR <10th centile cohort also had a greater proportion of adverse composite neonatal outcome regardless of type of DM. CONCLUSIONS Regardless of the type of DM, a low CPR was associated with poorer neonatal outcomes. Women with pT1DM also had the highest mean UA PI and lowest mean CPR despite no difference in the mean MCA PI between the three groups.
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Affiliation(s)
- Anthea Gibbons
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Christopher Flatley
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia; School of Medicine, The University of Queensland, Brisbane, Australia.
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Abstract
Located at the feto-maternal interface, the placenta is involved in exchange, endocrine and immune functions, which impact fetal development. In contact with the maternal environment, this organ is sensitive to metabolic disorders as over-nutrition, obesity or diabetes. The alteration of blood parameters associated with these pathologies affects placental histology, vascularization and nutrient transfers and, according to the types of troubles, induces local inflammation or hypoxia. These placental changes lead to disturbance of development and fetal growth, which increase the risk of pathologies in offspring in adulthood. The placenta thus appears as a crucial player in the fetal programming.
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Affiliation(s)
- Anne Gabory
- Inra, UMR 1198 biologie du développement et reproduction, Domaine de Vilvert, F-78350 Jouy-en-Josas, France
| | - Pascale Chavatte-Palmer
- Inra, UMR 1198 biologie du développement et reproduction, Domaine de Vilvert, F-78350 Jouy-en-Josas, France - Fondation PremUp, 4, avenue de l'Observatoire, F-75006 Paris, France
| | - Anne Vambergue
- Hôpital Claude Huriez, CHRU Lille, université Lille2, EA 4489 environnement périnatal et croissance, Faculté de médecine, place de Verdun, F-59000 Lille, France
| | - Anne Tarrade
- Inra, UMR 1198 biologie du développement et reproduction, Domaine de Vilvert, F-78350 Jouy-en-Josas, France - Fondation PremUp, 4, avenue de l'Observatoire, F-75006 Paris, France
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Plasencia W, González-Dávila E, González Lorenzo A, Armas-González M, Padrón E, González-González NL. First trimester placental volume and vascular indices in pregnancies complicated by preeclampsia. Prenat Diagn 2015; 35:1247-54. [PMID: 26395429 DOI: 10.1002/pd.4692] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To analyze placental volume and vascularization at first trimester in women with pre-eclampsia, and secondarily, the effect of maternal characteristics on placental development and perinatal outcomes. METHODS This was a prospective cohort study including women seen between 11 and 14 weeks of pregnancy. Biophysical and biochemical markers included in the screening program for aneuploidy were recorded. Placental volume and vascularization indices were obtained using three-dimensional power-Doppler imaging and Virtual Organ Computer-aided Analysis (VOCAL) techniques. RESULTS We compared 84 women with pre-eclampsia versus 904 non-affected. Placental volume and all vascular indices were lower in those with pre-eclampsia. Multivariate analysis showed that parity and maternal weight had a significant effect on placental volume and vascularization indices (p = 0.004 and p = 0.011). In women with pre-eclampsia, multiparity showed a negative effect on placental volume, gestational age, birth weight and Apgar test score. By contrast, in the non-affected group, multiparity had a protective effect. Low maternal weight had a significantly worse effect on placental vascularization and perinatal outcomes in women with pre-eclampsia. CONCLUSIONS Women with pre-eclampsia showed significantly lower placental volume and vascularization indices at first trimester. Multiparity and low maternal weight independently exacerbated the negative effects of pre-eclampsia on placental characteristics and perinatal outcomes. © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Enrique González-Dávila
- Departamento de Matemáticas, Estadística e Investigación Operativa, Universidad de La Laguna, Canary Islands, Spain
| | - Alejandra González Lorenzo
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Universidad de La Laguna, Canary Islands, Spain
| | - Marina Armas-González
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Universidad de La Laguna, Canary Islands, Spain
| | - Erika Padrón
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Universidad de La Laguna, Canary Islands, Spain
| | - Nieves L González-González
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Universidad de La Laguna, Canary Islands, Spain
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Mosimann B, Amylidi S, Risch L, Wiedemann U, Surbek D, Baumann M, Stettler C, Raio L. First-Trimester Placental Growth Factor in Screening for Gestational Diabetes. Fetal Diagn Ther 2015; 39:287-91. [PMID: 26421599 DOI: 10.1159/000441027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/07/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was first to assess whether first-trimester serum concentrations of placental growth factor (PlGF) differ between patients with and without gestational diabetes (GDM) and second to test whether there is a correlation between glycosylated hemoglobin (HbA1c), a factor recently shown to be useful in predicting GDM, and PlGF. METHODS PlGF was measured at 8-14 weeks with the Kryptor Immunoassay Analyzer (Brahms, Berlin, Germany). Absolute values were converted to multiples of the median using the software provided by the Fetal Medicine Foundation London. GDM was diagnosed using internationally accepted criteria. HbA1c levels were quantified using the TOSOH G7 automated hemoglobin analyzer. RESULTS From January to December 2014, 328 women were included in the study, 51 (15.5%) of whom developed GDM. First-trimester PlGF quantification does not discriminate between women at risk to develop GDM and controls, while HbA1c is able to do so. No correlation was found between PlGF and HbA1c. CONCLUSION Our findings do not lend support to the hypothesis that early PlGF values are different in women who later develop GDM.
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Affiliation(s)
- Beatrice Mosimann
- Department of Obstetrics and Gynecology, University Hospital and University of Bern, Bern, Switzerland
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Tonni G, Martins WP, Guimarães Filho H, Araujo Júnior E. Role of 3-D ultrasound in clinical obstetric practice: evolution over 20 years. Ultrasound Med Biol 2015; 41:1180-1211. [PMID: 25748522 DOI: 10.1016/j.ultrasmedbio.2014.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 06/04/2023]
Abstract
The use of 3-D ultrasound in obstetrics has undergone dramatic development over the past 20 years. Since the first publications on this application in clinical practice, several 3-D ultrasound techniques and rendering modes have been proposed and applied to the study of fetal brain, face and cardiac anatomy. In addition, 3-D ultrasound has improved calculations of the volume of fetal organs and limbs and estimations of fetal birth weight. And furthermore, angiographic patterns of fetal organs and the placenta have been assessed using 3-D power Doppler ultrasound quantification. In this review, we aim to summarize current evidence on the clinical relevance of these methodologies and their application in obstetric practice.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Gynecology, Guastalla Civil Hospital, ASL Reggio Emilia, Italy; Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto School of Medicine, University of São Paulo (DGO-FMRP-USP), Ribeirão Preto-SP, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.
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Desoye G, van Poppel M. The Feto-placental Dialogue and Diabesity. Best Pract Res Clin Obstet Gynaecol 2015; 29:15-23. [DOI: 10.1016/j.bpobgyn.2014.05.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/02/2014] [Indexed: 01/20/2023]
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Cvitic S, Desoye G, Hiden U. Glucose, insulin, and oxygen interplay in placental hypervascularisation in diabetes mellitus. Biomed Res Int 2014; 2014:145846. [PMID: 25258707 DOI: 10.1155/2014/145846] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/06/2014] [Indexed: 02/07/2023]
Abstract
The placental vasculature rapidly expands during the course of pregnancy in order to sustain the growing needs of the fetus. Angiogenesis and vascular growth are stimulated and regulated by a variety of growth factors expressed in the placenta or present in the fetal circulation. Like in tumors, hypoxia is a major regulator of angiogenesis because of its ability to stimulate expression of various proangiogenic factors. Chronic fetal hypoxia is often found in pregnancies complicated by maternal diabetes as a result of fetal hyperglycaemia and hyperinsulinemia. Both are associated with altered levels of hormones, growth factors, and proinflammatory cytokines, which may act in a proangiogenic manner and, hence, affect placental angiogenesis and vascular development. Indeed, the placenta in diabetes is characterized by hypervascularisation, demonstrating high placental plasticity in response to diabetic metabolic derangements. This review describes the major regulators of placental angiogenesis and how the diabetic environment in utero alters their expression. In the light of hypervascularized diabetic placenta, the focus was placed on proangiogenic factors.
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