Association between maternal plasma one-carbon biomarkers during pregnancy and fetal growth in twin pregnancies / 中华妇产科杂志

Objective: To characterize the relationship between the levels of plasma methyl donor and related metabolites (including choline, betaine, methionine, dimethylglycine and homocysteine) and fetal growth in twin pregnancies. Methods: A hospital-based cohort study was used to collect clinical data of 92 pregnant women with twin pregnancies and their fetuses who were admitted to Peking University Third Hospital from March 2017 to January 2018. Fasting blood was collected from the pregnant women with twin pregnancies (median gestational age: 18.9 weeks). The levels of methyl donors and related metabolites in plasma were quantitatively analyzed by high-performance liquid chromatography combined with mass spectrometry. The generalized estimation equation was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and neonatal outcomes of twins, and the generalized additive mixed model was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and fetal growth ultrasound indicators. Results: (1) General clinical data: of the 92 women with twin pregnancies, 66 cases (72%) were dichorionic diamniotic (DCDA) twin pregnancies, and 26 cases (28%) were monochorionic diamniotic (MCDA) twin pregnancies. The comparison of the levels of five plasma methyl donors and related metabolites in twin pregnancies with different basic characteristics showed that the median levels of plasma choline and betaine in pregnant women ≥35 years old were higher than those in pregnant women <35 years old, and the differences were statistically significant (all P<0.05). (2) Correlation between plasma methyl donor and related metabolites levels and neonatal growth indicators: after adjusting for confounding factors, plasma homocysteine level in pregnant women with twins was significantly negatively correlated with neonatal birth weight (β=-47.9, 95%CI:-94.3- -1.6; P=0.043). Elevated methionine level was significantly associated with decreased risks of small for gestational age infants (SGA; OR=0.5, 95%CI: 0.3-0.9; P=0.021) and low birth weight infants (OR=0.6, 95%CI: 0.4-0.9; P=0.020). Increased homocysteine level was associated with increased risks of SGA (OR=1.5, 95%CI: 1.0-2.2; P=0.029) and inconsistent growth in twin fetuses (OR=1.9, 95%CI: 1.0-3.7; P=0.049). (3) Correlation between the levels of plasma methyl donors and related metabolites and intrauterine growth indicators of twins pregnancies: for every 1 standard deviation increase in plasma choline level in pregnant women with twin pregnancies, fetal head circumference, abdominal circumference, femoral length and estimated fetal weight in the second trimester increased by 1.9 mm, 2.6 mm, 0.5 mm and 20.1 g, respectively, and biparietal diameter, abdominal circumference and estimated fetal weight increased by 0.7 mm, 3.0 mm and 38.4 g in the third trimester, respectively, and the differences were statistically significant (all P<0.05). (4) Relationship between plasma methyl donor and related metabolites levels in pregnant women with different chorionicity and neonatal birth weight and length: the negative correlation between plasma homocysteine level and neonatal birth weight was mainly found in DCDA twin pregnancy (β=-65.9, 95%CI:-110.6- -21.1; P=0.004). The levels of choline, betaine and dimethylglycine in plasma of MCDA twin pregnancy were significantly correlated with the birth weight and length of newborns (all P<0.05). Conclusion: Homocysteine level is associated with low birth weight in twins, methionine is associated with decreased risk of SGA, and choline is associated with fetal growth in the second and third trimesters of pregnancy.

Avaliação da maturidade pulmonar de cabritos nascidos a termo e prematuros / [Evaluation of lung maturity of term and premature kid]

Avaliou-se a maturidade pulmonar de cabritos no líquido amniótico de suas mães pela coloração de Shor, pelo azul de Nilo e pela contagem de corpos lamelares, bem como a vitalidade e os níveis de glicose e lactato séricos em cabritos nascidos a termo e prematuros. Para tanto, foram utilizados 32 cabritos, divididos em três grupos, a saber: grupo I: cabritos nascidos de cesarianas com 149 dias de gestação; grupo II: cabritos nascidos de cesarianas com 143 dias de gestação; e grupo III: cabritos nascidos de cesarianas com 143 dias de gestação, oriundos de mães que receberam, por via intramuscular, 20mg/cabra de dexametasona, 36 horas antes da cirurgia eletiva. A coloração de Shorr e a contagem de corpos lamelares demonstraram ser métodos diagnósticos promissores para a avaliação da maturidade pulmonar em neonatos caprinos. Contudo, a administração de dexametasona nas cabras no período antenatal não influenciou a maturidade fetal. Constatou-se, entretanto, que a avaliação física do paciente, logo após o nascimento, também se mostra fundamental no que tange à percepção da vitalidade e da viabilidade de cabritos recém-nascidos.(AU)

Pulmonary maturity of goats in their amniotic fluid was evaluated by Shor, Nile blue staining, and lamellar body count, as well as vitality and serum glucose and lactate levels in term and premature goats. Twenty-four kids were divided into three groups: group I: comprised of eight animals born by cesarean section with 149 days of gestation; group II: comprised of eight animals born by cesarean section with 143 days of gestation; and group III: comprised of eight animals born by cesarean section with 143 days of gestation, in which the does received intramuscular dexamethasone (20mg/goat) 36 hours prior to elective cesarean section. Shorr staining and lamellar body count have shown to be promising diagnostic methods for the assessment of lung maturity in goat neonates. However, the administration of dexamethasone to goats during antenatal period did not influence fetal maturity. It was verified that the physical evaluation of the patient, shortly after birth, is fundamental for the perception of vitality and viability of newborn goats.(AU)

Intrauterine growth and the vitamin e status of full-term and preterm newborns / Crescimento intrauterino e status de vitamina e de recém-nascidos a termo e pré-termo

ABSTRACT Objective: To determine the concentration of alpha-tocopherol in umbilical cord serum of full-term and preterm newborns, in order to assess the nutritional status of both groups in relation to the vitamin and its possible correlation with intrauterine growth. Methods: A cross-sectional observational study conducted with 140 newborns, of which 64 were preterm and 76 were full-term. They did not have any malformations, they came from healthy mothers, who were nonsmokers, and delivered a single baby. Intrauterine growth was evaluated by weight-to-gestational age at birth, using Intergrowth-21st. Thealpha-tocopherol levels of umbilical cord serum were analyzed by High Performance Liquid Chromatography. Results: The mean concentration of alpha-tocopherol in umbilical cord serum for preterm and full-term infants was 263.3±129.5 and 247.0±147.6 µg/dL (p=0.494). In the preterm group, 23% were small for gestational age, whereas in the full-term group, this percentage was only 7% (p=0.017). Low levels of vitamin E were found in 95.3% of preterm infants and 92.1% of full-term infants. There was no correlation between alpha-tocopherol levels and weight to gestational age Z score (p=0.951). Conclusions: No association was found between alpha-tocopherol levels and weight to gestational age at birth. Intrauterine growth restriction was more frequent in preterm infants and most infants had low levels of vitamin E at the time of delivery.

RESUMO Objetivo: Determinar a concentração de alfatocoferol em soro de cordão umbilical de recém-nascidos a termo e pré-termo, a fim de avaliar o estado nutricional de ambos os grupos com relação a essa vitamina e sua possível correlação sobre o crescimento intrauterino. Métodos: Estudo observacional de caráter transversal realizado com 140 recém-nascidos, 64 pré-termo e 76 a termo, sem malformações, oriundos de mães saudáveis, não fumantes e com parto de concepto único. O crescimento intrauterino foi avaliado pelo índice peso por idade gestacional ao nascer, utilizando a Intergrowth-21st. Os níveis de alfatocoferol do soro do cordão umbilical foram analisados por cromatografia líquida de alta eficiência. Resultados: A concentração média de alfatocoferol no soro do cordão umbilical para recém-nascidos pré-termo e a termo foi de, respectivamente, 263,3±129,5 e 247,0±147,6 µg/dL (p=0,494). Baixos níveis de vitamina E foram encontrados em 95,3% dos prematuros e em 92,1% dos neonatos a termo. Nogrupo pré-termo, 23% eram pequenos para a idade gestacional, enquanto no grupo a termo esse percentual foi de apenas 7% (p=0,017). Não houve correlação entre os níveis de alfatocoferol e o escore Z de peso para idade gestacional (p=0,951). Conclusões: Não foi encontrada associação entre os níveis de alfatocoferol e a adequação do peso à idade gestacional ao nascer. A restrição do crescimento intrauterino foi mais frequente nos nascidos pré-termo, e a maioria dos recém-nascidos apresentou níveis baixos de vitamina E no momento do parto.

Is willingness to exercise programmed in utero? Reviewing sedentary behavior and the benefits of physical activity in intrauterine growth restricted individuals / A vontade de se exercitar é programada ainda no útero? Análise do comportamento sedentário e dos benefícios da atividade física em indivíduos com crescimento intrauterino restrito

Abstract Objective: The literature suggests that a fetus will adapt to surrounding adversities by optimizing its use of energy to improve survival, ultimately leading to the programming of the individual's energy intake and expenditure. While recent reviews focused on the fetal programming of energy intake and food preferences, there is also some evidence that fetal adversity is associated with diminished physical activity levels. Therefore, we aimed to review (a) the evidence for an association between being born with intrauterine growth restriction and sedentarism over the life-course and (b) the potential benefits of physical activity over cardiometabolic risk factors for this population. Sources: PubMed, Scielo, Scopus and Embase. Summary of findings: Most clinical studies that used objective measures found no association between intrauterine growth restriction and physical activity levels, while most studies that used self-reported questionnaires revealed such relationships, particularly leisure time physical activity. Experimental studies support the existence of fetal programming of physical activity, and show that exposure to exercise during IUGR individuals' life improves metabolic outcomes but less effect was seen on muscle architecture or function. Conclusions: Alterations in muscle strength and metabolism, as well as altered aerobic performance, may predispose IUGR individuals to be spontaneously less physically active, suggesting that this population may be an important target for preventive interventions. Although very heterogeneous, the different studies allow us to infer that physical activity may have beneficial effects especially for individuals that are more vulnerable to metabolic modifications such as those with IUGR.

Resumo Objetivo: A literatura sugere que um feto se adaptará às adversidades externas ao aprimorar seu gasto energético para melhorar a sobrevida, o que leva, em última instância, à programação do consumo e gasto energético do indivíduo. Apesar de análises recentes terem focado na programação fetal do consumo energético e preferências alimentares, ainda há alguma comprovação de que as adversidades fetais estão associadas aos baixos níveis de atividade física. Portanto, visamos a analisar: a) a comprovação de uma associação entre nascer com restrição de crescimento intrauterino (RCIU) e sedentarismo durante o curso de vida e b) os possíveis benefícios da atividade física sobre os fatores de risco cardiometabólico dessa população. Fontes: PubMed, Scielo, Scopus e Embase. Resumo dos achados: A maior parte dos estudos clínicos que usaram medidas objetivas não constatou associação entre RCIU e os níveis de atividade física, ao passo que a maior parte dos estudos que usaram questionários de autorrelato revelou essas relações, principalmente no que diz respeito à atividade física de lazer. Estudos experimentais corroboram a existência de programação fetal de atividade física e mostram que a exposição a exercícios durante a vida de indivíduos com RCIU melhora os resultados metabólicos, porém menos efeito foi visto sobre a arquitetura ou função muscular. Conclusões: Alterações na força muscular e no metabolismo, bem como o desempenho aeróbico alterado, podem predispor indivíduos com RCIU a serem espontaneamente menos ativos fisicamente, sugere que essa população pode ser um importante alvo de intervenções preventivas. Apesar de muito heterogêneos, os diferentes estudos nos possibilitam deduzir que a atividade física pode ter efeitos benéficos principalmente em indivíduos mais vulneráveis a modificações metabólicas, como aqueles com RCIU.

Conteúdo de gordura e energia no colostro: efeito da idade gestacional e do crescimento fetal / Colostrum fat and energy content: effect of gestational age and fetal growth

RESUMO Objetivo: Avaliar se o conteúdo de gordura e o valor energético estimado no colostro diferem em função da idade gestacional e do crescimento fetal. Métodos: Estudo transversal com mães de recém-nascidos pré-termo e a termo nascidos em centro terciário em 2015-2016. Critério de inclusão: gestação única, sem diabetes, corioamnionite e mastite, sem uso de drogas ilícitas e álcool, ausência de malformação ou infecção congênita fetal. Foram constituídos quatro grupos conforme idade gestacional e crescimento fetal: pré-termo pequeno para a idade gestacional (n=33); pré-termo adequado (n=60); a termo pequeno (n=59) e a termo adequado para a idade gestacional (controle, n=73). O colostro foi coletado por extração manual entre 24 e 72 h pós-parto. Foram analisadas variáveis gestacionais e de nascimento. Os desfechos foram o conteúdo de gordura no colostro, pelo método do crematócrito, e o valor energético estimado. Na comparação entre grupos foram utilizados os testes do qui-quadrado ou Exato de Fisher, ANOVA e regressão linear multivariada. Resultados: A idade gestacional média foi de 34 semanas nos neonatos pré-termo e 39 semanas nos a termo. O crematócrito não diferiu entre os grupos, com valores médios de 3,3 a 4,0%; e o valor energético estimado foi de 52 a 56 kcal/dL. Crematócrito ≥4% foi mais frequente no grupo a termo pequeno para idade gestacional. Apenas no grupo de recém-nascidos pré-termo pequenos para a idade gestacional houve correlação entre crematócrito e índice de massa corpórea materno. Conclusões: O conteúdo de gordura e o valor energético estimado do colostro não diferiram em função da idade gestacional e do crescimento fetal.

ABSTRACT Objective: To determine whether fat content and energy value change in colostrum according to gestational age and fetal growth. Methods: Cross-sectional study with mothers of preterm and term infants born in a tertiary center in 2015-2016. Inclusion criteria: single pregnancy, absence of diabetes, chorioamnionitis and mastitis, no use of illicit drugs or alcohol, without fetal congenital malformation or infection. Four groups were formed according to gestational age and fetal growth: preterm infants small for gestational age (PT-SGA; n=33) and appropriate for gestational age (PT-AGA; n=60), term infants small for gestational age (T-SGA; n=59) and appropriate for gestational age (T-AGA; control, n=73). Colostrum was collected between 24-72 hours postpartum. Gestational and birth variables were analyzed. Outcome variables were: fat content in colostrum (evaluated by crematocrit method) and estimated energy value. Chi-square or Fisher exact tests, ANOVA, and multivariable linear regression were used for comparison among groups. Results: Mean gestational age was 34 weeks in preterm infants and 39 weeks in term neonates. Crematocrit did not differ between groups, with mean values varying between 3.3 and 4.0%; estimated energy value was 52 to 56 kcal/dL. Crematocrit ≥4% was more frequent in the T-SGA group. Only in the PT-SGA group there was a correlation between crematocrit and body mass index of the mother. Conclusions: The fat content and energy value of colostrum did not change according to gestational age or fetal growth.

Low-protein diet does not alter reproductive, biochemical, and hematological parameters in pregnant Wistar rats

The aim of this study was to investigate the reproductive, biochemical, and hematological outcomes of pregnant rats exposed to protein restriction. Wistar rat dams were fed a control normal-protein (NP, 17% protein, n=8) or a low-protein (LP, 8% protein, n=14) diet from the 1st to the 20th day of pregnancy. On the 20th day, the clinical signs of toxicity were evaluated. The pregnant rats were then anesthetized and blood samples were collected for biochemical-hematological analyses, and laparotomy was performed to evaluate reproductive parameters. No sign of toxicity, or differences (P>0.05) in body weight gain and biochemical parameters (urea, creatinine, albumin, globulin, and total protein) between NP and LP pregnant dams were observed. Similarly, hematological data, including red blood cell count, white blood cell count, hemoglobin, hematocrit, red blood cell distribution width (coefficient of variation), mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, % lymphocytes, absolute lymphocyte count, platelet count, and mean platelet volume were similar (P>0.05) at the end of pregnancy. Reproductive parameters (the dam-offspring relationship, ovary mass, placenta mass, number of corpora lutea, implantation index, resorption index, and the pre- and post-implantation loss rates) were also not different (P>0.05) between NP and LP pregnant dams. The present data showed that a protein-restricted diet during pregnancy did not alter reproductive, biochemical, and hematological parameters and seems not to have any toxic effect on pregnant Wistar rats.

Alteraciones del neurodesarrollo en pacientes con hipotiroidismo congénito: Recomendaciones para el seguimiento / Neurodevelopmental assessment of patients with congenital hypothyroidism

Congenital hypothyroidism (CH) is the most common cause of preventable cognitive disability worldwide. Generally, it is produced by an alteration in the embryogenesis of the thyroid gland or by an alteration in the synthesis of thyroid hormones, which determine that affected patients have low or absent thyroid hormone concentrations. The importance of this fact is that brain development during the first three years of life is highly dependent on thyroid hormones. Prior to the implementation of national neonatal screening programs around the world, 8 to 27% of children with CH had an IQ lower than 70. Nowadays, this percentage is close to 0 in countries that have implemented the program. In Chile, CH neonatal screening program achieved national coverage in 1996. Currently, the incidence of the disease in our country is 1: 3163. The degree of disability produced by CH not only depends on the time of detection of the disease and the prompt start of therapy, but also on an adequate monitoring. Despite screening programs, neurocognitive impairment in schoolchildren and teenagers with CH is still observed, reflected in lower scores in cognitive, language and gross motor assessments, receptive communication, expressive communication, fine motor and gross motor skills compared to healthy children. Also, lesser achievements in learning and language disorders are observed. The objective of this review is to update the information available on neurodevelopment of patients with CH.

Placental weight and birth weight to placental weight ratio in monochorionic and dichorionic growth-restricted and non-growth-restricted twins

OBJECTIVE: The aim of the present study was to compare the placental weight and birth weight/placental weight ratio for intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. METHODS: This was a retrospective analysis of placentas from twin pregnancies. Placental weight and the birth weight/placental weight ratio were compared in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. The association between cord insertion type and placental lesions in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins was also investigated. RESULTS: A total of 105 monochorionic (intrauterine growth restriction=40; non-intrauterine growth restriction=65) and 219 dichorionic (intrauterine growth restriction=57; non-intrauterine growth restriction=162) placentas were analyzed. A significantly lower placental weight was observed in intrauterine growth-restricted monochorionic (p=0.022) and dichorionic (p<0.001) twins compared to non-intrauterine growth-restricted twins. There was no difference in the birth weight/placental weight ratio between the intrauterine growth restriction and non-intrauterine growth restriction groups for either monochorionic (p=0.36) or dichorionic (p=0.68) twins. Placental weight and the birth weight/placental weight ratio were not associated with cord insertion type or with placental lesions. CONCLUSION: Low placental weight, and consequently reduced functional mass, appears to be involved in fetal growth restriction in monochorionic and dichorionic twins. The mechanism by which low placental weight influences the birth weight/placental weight ratio in intrauterine growth-restricted monochorionic and dichorionic twins needs to be determined in larger prospective studies.

Comparative analysis of two different models of swimming applied to pregnant rats born small for pregnant age

ABSTRACT The aim of this study was to compare two models of swimming applied to pregnant rats born small for pregnancy age (SPA). Diabetes was chemically induced in adult female rats to develop an inadequate intrauterine environment, leading to birth of a SPA offspring. In adulthood, the female SPA rats were mated and submitted to different swimming programs. The exercise program 1 (Ex1) consisted of swimming for 15 minutes, followed by 15 minutes of rest and another 15 minutes of swimming, 3 days a week before and during pregnancy. Another program (Ex2) was applied during 60 minutes uninterrupted a day, 6 days/week during pregnancy. The pregnant rats presented no interference on body weight and glycemia. The rats submitted to Ex2 model showed decreased insulin and blood glucose levels by oral glucose tolerance test, and reduction in area under curve values. The offspring from dams submitted to both exercise protocols presented an increased rate of newborns SPA. However, the offspring from Ex2 dams showed percentage twice higher of newborns SPA than Ex1 offspring. Our data suggests that continuous exercise of 60 min/day ameliorated the enhanced peripheral insulin sensitivity in growth-restricted females. However, this protocol employed at pregnancy leads to intrauterine growth restriction.

Estudo de ovários fetais equinos: uma abordagem histológica / Study of fetal equine ovary: an histological approach

O estudo do desenvolvimento embriológico de órgãos reprodutivos representa uma ferramenta importante para a compreensão das particularidades da espécie equina, assim como ampliar os conhecimentos sobre o desenvolvimento de folículos antrais que podem ser utilizados para produção in vitro de embriões. O presente trabalho teve como objetivo descrever as alterações morfológicas de ovários fetais equinos ocorrentes durante o desenvolvimento gestacional. Foram utilizados fetos equinos provenientes de abatedouro. Imediatamente após o abate foi realizada medição da distância cefalococcígea para o cálculo da idade gestacional em dias (dias de gestação - DG) e dissecação dos fetos para a retirada e fixação dos ovários. Foram realizadas avaliações macroscópicas e histológicas pelas técnicas de Hematoxilina-eosina e PAS. Foram utilizados 19 fetos com idade de 50-269 dias de gestação, distribuídos em 9 grupos de DG. Na avaliação macroscópica foi observada diferença entre o volume dos ovários de acordo com a idade gestacional, sendo observado maior volume ovariano entre os dias 210 a 269 de desenvolvimento gestacional. Na avaliação histológica foi observado epitélio de revestimento cúbico e distinção entre as camadas cortical e medular nos ovários fetais a partir de 50-89 DG. As principais características identificadas foram à distinção morfológica entre as camadas cortical e medular nos ovários fetais equinos: os cordões ovígeros surgiram no intervalo de 150-179 DG; o córtex iniciada como uma camada delgada e por volta do 210º dia de gestação apresentou espessamento pelo aumento da quantidade de tecido conjuntivo rico em vasos sanguíneos, o qual se manteve até os estágios finais da gestação; a região medular adquiriu uniformidade estrutural por volta do 150º dia, mostrando células similares em tamanho e vasos sanguíneos de calibre maior. A partir desta etapa, as células medulares diminuíram em tamanho e feixes de tecido conjuntivo denso tornaram esta zona parcialmente dividida.(AU)

The study of embryological development of reproductive organs is an important tool for understanding the particularities of the equine species. Also it is important for increasing knowledge about the development of antral follicles that can be used for in vitro production of embryos. This study aimed to describe the morphological changes of fetal equine ovaries occurring during gestational development. It was used equine fetuses from a slaughterhouse. After slaughter, it was performed the measurement of cefalococcígea distance to calculate the gestational age (days of pregnancy - DP). Afterwards, the ovaries were grossly evaluated, removed and fixed. Then, they were histologically assessed by hematoxylin-eosin and PAS techniques. It was used 19 fetuses aged 50 to 269 days of gestation, distributed in 9 groups divided according to DP. In the grossly evaluation, it was observed differences between the volume of the ovaries according to gestational age, being observed bigger/larger ovarian volume between 210 days to 269 DP. During the histological evaluation, it was observed a simple cuboidal epithelium and a distinction between the cortical and medullary layers in fetal ovaries from 50-89 DP. The main characteristics identified were: the morphological distinction between the cortical and medullary layers in equine fetal ovaries; the ovigerous cords emerged in the interval between 150 and 179 DP; the cortex initiated as a thin layer with an increased amount of connective tissue rich in blood vessels by the 210 DP, structural uniformity acquired in the medular region by the 150 DP, showing similar cells in size and blood vessels of larger caliber. From this stage, the cells in this region had decreased in size and dense connective tissue bundles, which made this zone partially divided.(AU)

Autonomic and Renal Alterations in the Offspring of Sleep-Restricted Mothers During Late Pregnancy

OBJECTIVES: Considering that changes in the maternal environment may result in changes in progeny, the aim of this study was to investigate the influence of sleep restriction during the last week of pregnancy on renal function and autonomic responses in male descendants at an adult age. METHODS: After confirmation of pregnancy, female Wistar rats were randomly assigned to either a control or a sleep restriction group. The sleep-restricted rats were subjected to sleep restriction using the multiple platforms method for over 20 hours per day between the 14th and 20th day of pregnancy. After delivery, the litters were limited to 6 offspring that were designated as offspring from control and offspring from sleep-restricted mothers. Indirect measurements of systolic blood pressure (BPi), renal plasma flow, glomerular filtration rate, glomerular area and number of glomeruli per field were evaluated at three months of age. Direct measurements of cardiovascular function (heart rate and mean arterial pressure), cardiac sympathetic tone, cardiac parasympathetic tone, and baroreflex sensitivity were evaluated at four months of age. RESULTS: The sleep-restricted offspring presented increases in BPi, glomerular filtration rate and glomerular area compared with the control offspring. The sleep-restricted offspring also showed higher basal heart rate, increased mean arterial pressure, increased sympathetic cardiac tone, decreased parasympathetic cardiac tone and reduced baroreflex sensitivity. CONCLUSIONS: Our data suggest that reductions in sleep during the last week of pregnancy lead to alterations in cardiovascular autonomic regulation and renal morpho-functional changes in offspring, triggering increases in blood pressure.

Programação fetal e alterações metabólicas em escolares: metodologia de um estudo caso-controle / Fetal programming and metabolic abnormalities: design of a case-control study

RESUMO: Objetivo: Descrever a metodologia de um estudo sobre associações entre crescimento intrauterino restrito (CIUR) e prevalência de sobrepeso, obesidade e hipertensão arterial em escolares. Métodos: O estudo, conduzido em dois estágios, foi desenvolvido em 2 escolas municipais de Niterói (RJ) de junho a dezembro de 2010, sendo elegíveis todos os escolares de 6 a 14 anos. O primeiro estágio consistiu em um inquérito nutricional e de potenciais fatores de risco. Foram aplicados questionários aos responsáveis e adolescentes. Concomitantemente, foram selecionados os participantes de um estudo caso-controle, com casos prevalentes definidos como todos os escolares que apresentaram excesso de peso (Z-score de índice de massa corporal -IMC/idade/sexo > +1,00). O grupo controle consistiu em uma amostra aleatória da população de estudo do inquérito, o que permitiu o cálculo de razões de prevalências. Foram realizados bioimpedância elétrica, exames de sangue, ultrassonografia da carótida e entrevistas. As variáveis proxy de CIUR foram definidas a partir de informações sobre peso ao nascer (PN) e idade gestacional (IG). Adicionalmente, foram coletadas informações sobre os dois primeiros anos de vida dos escolares a partir de seus prontuários médicos. Resultado s: Entre os 1.040 escolares elegíveis, participaram do estudo 795 escolares (76,4%). A taxa de retorno do questionário enviado para os responsáveis foi de 85,1%. Para o estudo caso-controle, 62,5% (n = 363) dos selecionados participaram, resultando em uma razão caso:controle de 1:1,8. Foram localizados 55,8% (n = 444) dos prontuários, dos quais em 65,7% (n = 292) foram coletadas informações dos primeiros anos de vida. Conclusão: O presente estudo permitirá a análise de múltiplos desfechos e exposições relacionados ao CIUR e alterações metabólicas.

ABSTRACT: Objective: To describe the methodological features of a study on the association between restricted intrauterine growth and prevalence of overweight, obesity and hypertension in school aged children. Methods: The study was conducted in two stages in two public schools in Niterói (RJ), from June through December 2010. All students aged 6 to 14 years were eligible to participate. The first stage consisted of an interview to collect information on demographic variables, diet and other variables. A sample was selected for the second stage, in order to conduct an equivalent of a case-cohort study. There was an interval of about 15 days between the two stages. Cases were overweight students, defined as a Z-score for BMI/age/sex > +1.00 in the first stage. Controls were selected by using a random schedule in which the sample frame was the whole cohort. Bioelectrical impedance analysis, carotid ultrasound to measure intimal-medial thickness, blood measurements and interviews were obtained. Gestational age and weight at birth were used to define proxy variables of restricted intrauterine growth. Early health information was obtained from medical registers. Results: The study participation was 76.4% (n = 795) out of 1,040 eligible to participate). 85.1% of parent's questionnaires were returned. 62.5% of the eligible children participated in the case-control study (case: control ratio = 1:1.8). Early life health information was obtained from 292 children. Conclusion: The present study has the potential to provide important information about multiple outcomes and exposures related to restricted intrauterine growth and metabolic abnormalities.

Fetal growth according to different reference ranges in twin pregnancies with placental insufficiency

The aim of this study was to compare different fetal growth curves in twin pregnancies with severe placental insufficiency. A retrospective cross-sectional analysis of 47 twin pregnancies with absent or reverse end diastolic flow in the umbilical artery of one fetus was performed. Pregnancies with major fetal abnormalities, twin-twin transfusion or three or more fetuses were not included. The estimated fetal weight zeta-scores were calculated for both fetuses (abnormal Doppler and co-twin) according to the following criteria: Hadlock, Liao and Araújo. The abdominal circumference zeta-scores were calculated according to Hadlock, Liao, Araújo, Ong and Stirrup. The mean estimates of the zeta-score values were calculated using generalized estimating equation regression analysis. The mean gestational age at inclusion was 27.4±4.7 weeks. The fetal sex and the interaction Doppler findings × criteria correlated significantly with the zeta-score values (p <0.001 for both variables). The estimated fetal weight mean zeta-scores (standard error) according to each criteria were as follows: Hadlock - abnormal Doppler: -2.98 (0.18), co-twin: -1.16 (0.15); Liao - abnormal Doppler: -2.89 (0.24), co-twin: -0.58 (0.19); and Araújo - abnormal Doppler: -3.05 (0.29), co-twin: -0.75 (0.18). Values for abdominal circumference were as follows: Hadlock - abnormal Doppler: -3.14 (0.26), co-twin: -1.13 (0.19); Liao - abnormal Doppler: -2.63 (0.27), co-twin: -0.42 (0.19); Araújo - abnormal Doppler: -2.44 (0.22), co-twin: -0.71 (0.14); Ong - abnormal Doppler: -3.36 (0.34), co-twin: -1.48 (0.23); and Stirrup AD -- -2.36 (0.14), co-twin: -1.18 (0.10). Sex- and plurality-specific charts should be used in the evaluation of fetal growth in twin pregnancies with placental insufficiency.

Razão peso/perímetro cefálico ao nascer na avaliação do crescimento fetal / Weight/head circumference ratio at birth for assessing fetal growth / La razón peso/perímetro cefálico al nacer para evaluar el crecimiento fetal

Objetivou-se utilizar a razão peso/perímetro cefálico ao nascer para avaliar o crescimento fetal. Foi realizado um estudo de coorte retrospectiva na Zona da Mata de Pernambuco, Brasil, com 915 crianças nascidas a termo. As medidas antropométricas da criança, assistência pré-natal, fumo durante a gestação, renda familiar, escolaridade e estado nutricional materno foram coletados nas primeiras 24 horas pós-parto. As crianças foram classificadas em proporcionais (razão peso/perímetro cefálico ≥ 0,90) e desproporcionais (< 0,90). Recém-nascidos de mães fumantes, com menor idade, sem consulta pré-natal, baixos IMC, altura e prega cutânea tricipital apresentaram menores médias da razão peso/perímetro cefálico. As médias do peso, comprimento, perímetros cefálico e torácico, circunferência braquial e prega cutânea tricipital foram menores entre as crianças classificadas como desproporcionais, por meio da razão peso/perímetro cefálico, ajustadas pelo sexo da criança. Conclui-se que a razão peso/perímetro cefálico e peso ao nascer são importantes indicadores do crescimento fetal.

The objective of this study was to use weight/head circumference ratio at birth to assess fetal growth. A retrospective cohort study was conducted in Zona da Mata, Pernambuco State, Brazil, with 915 term infants. Infants’ anthropometric measurements and data on prenatal care, smoking during pregnancy, family income, and maternal schooling and nutritional status were collected in the first 24 hours after birth. Infants were classified as proportionate (weight/head circumference ratio ≥ 0.90) versus disproportionate (< 0.90). Lower mean weight/head circumference ratio was associated with maternal smoking, younger age, inadequate prenatal care, and low BMI, height, and triceps skinfold thickness. Mean weight, length, head and chest circumference, arm circumference, and triceps skinfold thickness were lower among infants with disproportionate weight/head circumference ratio, independently of sex. In conclusion, weight/head circumference ratio and birth weight are important indicators of fetal growth.

El objetivo era usar el peso/perímetro cefálico al nacer para evaluar el crecimiento fetal. Se realizó un estudio de cohorte retrospectivo en Pernambuco Zona Mata con 915 niños recién nacidos. Las medidas antropométricas del niño, cuidado prenatal, fumar durante el embarazo, ingresos familiares, educación y estado nutricional de la madre se recogieron durante las primeras 24 horas después del parto. Los niños fueron clasificados en: proporcionados (peso/perímetro cefálico ≥ 0,90) y desproporcionados (< 0,90). Los recién nacidos de madres fumadoras con una menor edad, sin atención prenatal, bajo índice de masa corporal, altura y el espesor del pliegue cutáneo tricipital tuvieron promedios más bajos de peso/perímetro cefálico. La media de peso, talla, circunferencia de la cabeza y el pecho, circunferencia del brazo y el espesor del pliegue cutáneo tricipital fueron menores entre los niños clasificados como desproporcionados en peso/perímetro cefálico, sin independencia del sexo del niño. Se concluye que el peso/perímetro cefálico y el peso al nacer es un indicador importante del crecimiento fetal.

A study on the structure and morphologic development of calcaneal tendon and triceps surae muscle in human fetuses during the fetal period and the evaluation of clinical importance of calcaneal tendon / Estudio sobre la estructura y desarrollo morfológico del tendón calcáneo y el músculo tríceps sural en fetos humanos durante el período fetal y evaluación de la importancia clínica del tendón calcáneo

It was aimed that the morphometric development of calcaneal tendon and the structures building it up in human fetuses during the fetal period be anatomically studied and that its clinical importance be evaluated. The study comprised a total of 102 fetus legs (51 human fetuses: 26 male and 25 female) whose ages varied between 15-40 gestational week, without external pathology or anomaly. The fetuses were divided in groups according to gestational weeks, trimesters and months. In the wake of the general external measurements of fetuses, leg dissection was performed. Afterwards, the morphometric parameters of gastrocnemius muscle, soleus muscle and calcaneal tendon were measured. The averages and the standard deviations of the measured parameters were determined according to gestational weeks, trimesters and months. There was a significant correlation between the measured parameters and the gestational age (p<0.001). There was no difference between sexes in terms of parameters (p>0.005). All the obtained results were discussed by making a comparison between them and the previous studies made. We are of the opinion that the data obtained in our study will be of use to the involved clinicians in the evaluation of the development of calcaneal tendon and the structures constituting it during the fetal period and in clinical studies and applications as well.

El objetivo de esta investigación consiste en el estudio del desarrollo morfométrico del tendón calcáneo y las estructuras que se desarrollan con él durante el período fetal humano y evaluar su importancia clínica. El estudio comprendió un total de 102 piernas de fetos (51 fetos humanos: 26 masculinos y 25 femeninos) cuyas edades variaron entre 15 a 40 semanas de edad gestacional, sin presencia de patología externa o anomalía. Los fetos fueron divididos en grupos de acuerdo con las semanas de gestación, trimestres y meses. Luego de realizar mediciones generales externas en los fetos, se procedió a la disección de las piernas. Se midieron parámetros morfométricos correspondientes a los músculos gastrocnemio, sóleo y tendón calcáneo. Los promedios y las desviaciones estándar de los parámetros medidos se determinaron de acuerdo a la edad gestacional de los fetos, en semanas trimestres y meses. Hubo una correlación significativa entre los parámetros medidos y la edad gestacional (p<0,001). No hubo diferencias entre los sexos en términos de parámetros (p>0,005). Todos los resultados obtenidos se discutieron haciendo una comparación entre ellos y los estudios previos realizados. Los datos obtenidos en nuestro estudio serán de utilidad para los médicos en la evaluación del desarrollo del tendón calcáneo y las estructuras que lo constituyen, durante el período fetal, para la utilización de este conocimiento en estudios clínicos y diversas aplicaciones.

Histomorphological evaluation of the digital coronary region at different fetal development stages of Holstein cattle / Avaliação histomorfológica da região coronária digital em diferentes fases de desenvolvimento fetal de bovinos da raça Holandesa

The scientific literature lacks detailed morphological descriptions of the histological development and cell differentiation of fetal bovine hoof. In this study, 40 extremity members of Holstein bovine fetuses were collected and divided into four groups (G1 to G4) based on the estimated age. Fragments were removed from wall and sole, processed and stained with hematoxylin - eosin (HE) for light microscopy observation. In G1, it was found that the epidermis was very thin, including keratinocyte layers and clusters of mesenchymal cells. In group G2 it was observed that the thickness of the epidermis covering the limbs remained variable and laminar corium developed in the germinal layer. In group G3 it was noted that in the germinal epithelium there were papillae in little advanced development and cells of the stratum corneum in the initial process of keratinization. In G4, the epidermis was well developed with layers distributed homogeneously, containing symmetrical and long papillae and intense production of keratin. In this work, the most important cellular events for the formation of the fetal hoof in Holstein cattle were first described in different stages of their formation.

A literatura científica carece de descrições morfológicas detalhadas sobre o desenvolvimento histológico e diferenciação celular do casco fetal bovino. Neste estudo, 40 extremidades de membros de fetos bovinos da raça Holandesa foram coletados e divididos em quatro grupos (G1 a G4) com base na estimativa da idade. Desses membros, foram retirados fragmentos da parede e sola, processados e corados por hematoxilina-eosina (HE) para observação em microscopia óptica. No grupo G1, observou-se que a epiderme era bastante delgada, incluindo camadas de queratinócitos e conjuntos de células mesenquimais. No grupo G2, foi observado que a espessura da epiderme, cobrindo as extremidades dos membros, permaneceu variável, e o cório laminar desenvolveu-se na camada germinativa. No grupo G3, notou-se, no epitélio germinal, papilas em desenvolvimento pouco avançado e células da camada córnea no processo inicial de queratinização. No grupo G4, a epiderme apresentava-se bem desenvolvida, com camadas distribuídas de forma homogênea, contendo papilas simétricas e longas e com intensa produção de queratina. Neste trabalho, os eventos celulares mais importantes para a formação do casco fetal em bovinos da raça Holandesa foram descritos pela primeira vez, em diferentes etapas da sua formação.

Placental efficiency in the equine species: which factors may be related? / Eficiência placentária na espécie equina: quais fatores podem estar relacionados?

This review intends to show the main factors that may affect intrauterine growth and the placentals nutrients supply to the fetus, morphofunctional aspects placental efficiency, correlating them with performance indexes, such as breed, age and pluriparious. This study aims to discuss the interrelationships that determine greater placental efficiency, proposing a comparative parallel between various species in order to understand more about the placental efficiency in the equine species.

Esta revisão de literatura propõe levantar os principais fatores que podem influenciar o crescimento intrauterino e o suprimento de nutrientes placentários para o feto, abordando aspectos morfofuncionais relacionados à eficiência placentária, correlacionando-os com aspectos zootécnicos, como raça, pluriparidade e idade das fêmeas gestantes. O objetivo foi estabelecer as interrelações que determinem maior eficiência placentária, propondo um paralelo comparativo entre espécies a fim de ser entendida a eficiência placentária na espécie equina.