An Effective Management for Thalassaemic Patients during Pregnancy

Background : Presence of thalassaemia is considered high risk in pregnancy. The present study find out the role of antenatal and intrapartum care to improve the outcome of pregnancy in thalassaemia. Materials and Method : The prospective longitudinal study was carried out on 25 patients. CBC, LFT, Ferritin, Hb electrophoresis, serial USG was done. Chorionic villous sampling was offered to thalassaemic women to decrease the number of babies born with Thalassaemia. Furthermore, management and treatment options provided to mother to overcome the incidence of maternal and neonatal complications during current pregnancy. Results : 44% of thalassaemic pregnant women had HbE ? thalassaemia, 8% ? thalassaemia major and others had thalassaemia carriers, while only 20% of their partners showed ? thalassaemia trait. All patients were anemic and during delivery mean Hb% were 8.42 g/dl, MCH 22.09 pg, MCV 73.56 fl, MCHC 29.86 g/dl and ferritin 241.51 ng/ ml. Third trimester USG exhibited 32% developed IUGR (Intrauterine growth restriction). 40% patients received blood transfusion after delivery. ? thalassaemia trait was identified in 20% babies at 6 month. Conclusion : Postpartum haemorrhage is a major complication of thalassaemia in pregnancy. After delivery a thorough neonatal check-up and haematological work-up is important for prevention of neonatal mortality and early detection of thalassaemia.

Study Of Maternal Near Miss Events At The Tertiary Care Hospital

Background:A maternal near miss case is defined as a “a woman who nearly died but survived a complication that occurred during pregnancy,child birth or within 42 days of termination of pregnancy”1.MMR is defined as ratio of number of maternal deaths per 1000 live births. All pregnant women deserve a good quality of care especially Emergency Obstetric Care including proper infrastructure, human resources that can detect and manage such complications earliest. The objective of this study was to evaluate the causes of maternal near miss cases, various management modalities performed and maternal and fetal outcome in near miss cases. Material And Methods:A retrospective study was carried out in obstetrics and gynaecology department of SCL municipal general hospital, Ahmedabad for identification of MNM as per MNM-R operational guidelines (2014) in a tertiary care hospital from August 2020 to March 2022. Result:Total deliveries during our study period were 9266 out of which 535 number of patients developed complications, 75 patients ended up becoming near miss cases and 30 maternal mortalities were observed.Hypertensive disorders (38.6%) followed by severe anemia (18.6%) and haemorrhage (13.3%) were the commonest underlying causes leading to MNM. More than one management modality was followed in one case. 25% of patients required blood transfusion. Out of which 11 patients required massive blood transfusion (>5 units of blood) and 16% of patients required blood products along with blood resulting from either severe anemia or altered coagulopathy (DIC). 69.3% of patients required ICU stay of <5 days and majority of patients required hospital stay of 9-14 days.63.6% of patients required ICU stay of 1-4 days.Live birth rate was 82.6%.Conclusion:Maternal health is the direct indicator of prevailing health status in a country. Reduction in maternal mortality is one of the targets of MILLENIUM DEVELOPMENT GOALS13for 2015 but in spite of full efforts by all the health care professionals, it still remains a challenge in developing countries.There should be prompt and proper management of high-risk groups by frequent antenatal visits. Aggressive management of each complication and close monitoring of women in labour, decision making in mode and time of termination of pregnancy are important to prevent further complications.

Effects of FTO and PPARγ variants on intrauterine growth restriction in a Brazilian birth cohort

Intrauterine growth restriction (IUGR) is related to a higher risk of neonatal mortality, minor cognitive deficit, metabolic syndrome, and cardiovascular disease in adulthood. In previous studies, genetic variants in the FTO (fat mass and obesity-associated) and PPARγ (peroxisome proliferator-activated receptor-gamma) genes have been associated with metabolic disease, body mass index, and obesity among other outcomes. We studied the association of selected FTO (rs1421085, rs55682395, rs17817449, rs8043757, rs9926289, and rs9939609) and PPARγ (rs10865710, rs17036263, rs35206526, rs1801282, rs28763894, rs41516544, rs62243567, rs3856806, and rs1805151) single-nucleotide polymorphisms (SNPs) with IUGR, through a case-control study in a cohort of live births that occurred from June 1978 to May 1979 in a Brazilian city. We selected 280 IUGR cases and 256 controls for analysis. Logistic regression was used to jointly analyze the SNPs as well as factors such as maternal smoking, age, and schooling. We found that the PPARγ rs41516544 increased the risk of IUGR for male offspring (OR 27.83, 95%CI 3.65-212.32) as well as for female offspring (OR=8.94, 95%CI: 1.96-40.88). The FTO rs9939609 TA genotype resulted in a reduced susceptibility to IUGR for male offspring only (OR=0.47, 95%CI: 0.26-0.86). In conclusion, we demonstrated that PPARγ SNP had a positive effect and FTO SNP had a negative effect on IUGR occurrence, and these effects were gender-specific.

Effect of electroacupuncture on lung dysplasia in rats with intrauterine growth restriction induced by maternal food restriction / 中国针灸

OBJECTIVE@#To investigate the protective effect of electroacupuncture (EA) at "Zusanli" (ST 36) in pregnant rats on lung dysplasia of newborn rats with intrauterine growth restriction (IUGR) induced by maternal food restriction.@*METHODS@#Twenty-four female SD rats were randomly divided into a control group, a control+EA group, a model group and a model+EA group, 6 rats in each group. From the 10th day into pregnancy to the time of delivery, the rats in the model group and the model+EA group were given with 50% dietary restriction to prepare IUGR model. From the 10th day into pregnancy to the time of delivery, the rats in the control+EA group and the model+EA group were treated with EA at bilateral "Zusanli" (ST 36), once a day. The body weight of offspring rats was measured at birth, and the body weight and lung weight of offspring rats were measured on the 21st day after birth. The lung function was measured by small animal lung function detection system; the lung tissue morphology was observed by HE staining; the content of peroxisome proliferator activated receptor γ (PPARγ) in lung tissue was detected by ELISA.@*RESULTS@#Compared with the control group, the body weight at birth as well as the body weight, lung weight, lung dynamic compliance (Cdyn) and PPARγ at 21 days after birth in the model group were significantly decreased (@*CONCLUSION@#EA at "Zusanli" (ST 36) may protect the lung function and lung histomorphology changes by regulating the level of PPARγ of lung in IUGR rats induced by maternal food restriction.

Prevalence of thyroid dysfunction in neonatal population

Background: The objectives of this study was to study the prevalence of thyroid disorders in high risk neonatal populations and to study association of maternal thyroid dysfunction with neonatal thyroid problems and outcome.Methods: This was an observational study, conducted in NICU at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. The study included neonates born to mothers with thyroid disorder or with clinical features suggestive of thyroid dysfunction. Neonates with history of maternal thyroid dysfunction were screened at 72 to 96 hrs of postnatal age. Those with TSH >10 mIU/L or free T4 <1.1 ng /ml were followed up after two weeks. The neonates with clinical features suggestive of thyroid dysfunction were screened at presentation and those with abnormal thyroid profile were followed up after two weeks. Results obtained were statistically analyzed using SPSS 17.0 software.Results: Out of 260 neonates screened, 208 neonates were born to mothers with hypothyroidism, 6 neonates had increased levels of TSH during first week which normalised on follow up during third week. One neonate born to hyperthyroid mother, showed increased TSH levels during first week and 2nd week which declined to normal level on follow up at 3rd week. Out of 51 neonates with clinical features suggestive of thyroid dysfunction, born to euthyroid mothers, 3 neonates had increased levels of TSH on presentation which normalised on further follow up. Thus, majority of high risk neonates at birth show transient hypothyroidism.Conclusions: None of the neonate was labelled as hypothyroid, all the 10 neonates showed transient hyperthyrotropinemia.

A retrospective interventional study for evaluation of efficacy and safety of sildenafil citrate in improving intrauterine growth restriction and oligohydramnios using ultrasound Doppler velocimetry

Background: Intrauterine growth restriction (IUGR) is one of the major reasons for neonatal morbidity and mortality. Oligohydramnios is a common finding in IUGR. In majority of these cases diminished utero-placental blood flow is observed. However, in spite of this understanding and identification of high-risk patients, the management options are limited. Sildenafil citrate, a phosphodiesterase type-5 inhibitor improves utero-placental perfusion.Methods: We present a retrospective interventional study involving 50 adult pregnant women diagnosed with early-onset IUGR (n=38) and oligohydramnios (n=12). Vaginal sildenafil citrate 25 mg t.i.d. was started from the day of diagnosis till delivery. Primary efficacy endpoints included changes in Doppler parameters i.e., amniotic fluid index (AFI), uterine artery (UA)- pulsatility index (PI), resistance index (RI) and systolic diastolic ratio (S/D ratio). Secondary endpoints included live birth, birth weight, Apgar score at birth, neonatal survival to hospital discharge and adverse maternal side effects.Results: There was a statistically significant improvement in UA-PI, RI and S/D ratios (p<0.0001) in all cases. In oligohydramnios cases, treatment showed a statistical significant increase in AFI score (2.86±1.33 cm). The mean birth weight on delivery was 2200 gm with good Apgar scores. No major adverse effects were reported by women using sildenafil citrate vaginally.Conclusions: Sildenafil citrate, by increasing utero-placental perfusion, improves uterine artery Doppler patterns, AFI, fetal weight and overall better neonatal survival rates by reducing neonatal morbidity and mortality. Sildenafil citrate may hold a promising treatment strategy for management of IUGR and oligohydramnios.

The role of pregnancy-associated plasma protein-a level in the first trimester of pregnancy and clinical outcome in an urban referral centre

Background: Estimation of serum PAPP-A levels studied predictability for adverse perinatal outcome. This case control study tries to establish the association between low PAPP-A levels among the pregnant woman and adverse maternal foetal outcome.Methods: This is an case-control study during 2017-2018 in the women delivered at Department of OBG at Mehta Hospitals. Women delivered in the labour room  had a first trimester screening of PAPP-A level were explained, taken informed consent, questionnaire which include detailed antenatal history, mode of delivery and baby data.  Depending upon outcome, the subjects are classified as case group or control group, out of the study sample of 264 subjects, 88 patients who had complications were taken as cases and 176 patients with no complications taken as control were undertaken.Results: Low PAPP-A level (<0.5 MoM) showed high incidence of PIH and preeclampsia, followed by IUGR and Preterm. PAPP-A level >0.5 MoM, normal outcome is more than the adverse outcome. The difference in the PAPP-A levels is statistically significant. In women with low PAPP A level, low birth weight found statistically significant when compared with <0.5 PAPP A level. The sensitivity of PAPP A levels in identifying the complicated outcomes was 17.04%.The specificity was 98.85%. The positive predictive value of predicting the complications was 88.23% and negative predictive value of 70.44%.Conclusions: The low PAPP-A levels confirmed during first trimester of pregnancy is associated with adverse maternal and foetal outcome such as PIH, preeclampsia, preterm, IUGR and LBW.

Analysis of still births in a tertiary care system and changed scenario over six year period

Background: In India, the maternal and infant mortality rates have been steadily decreasing in recent years, but there has been no corresponding decrease in the perinatal mortality. Hence, there is need to evaluate the factors leading to this unfortunate event. The objective of this study was to find out various factors (especially preventable) responsible for perinatal stillbirths.Methods: An analytical comparative study in a tertiary care hospital comparing fresh and macerated still births over a period of one year in 2011 and 2017 and responsible factors were analysed.Results: Amazingly, despite improvement in the antenatal services, more institutional deliveries, there is no change in the incidence of still birth rate. However, there was decrease in the rate of still births due to extreme prematurity and congenital malformations. There was no change in incidence of PIH/ Eclampsia, IUGR and placental causes but there was substantial increase in the incidence of GDM.Conclusions: Perinatal mortality can definitely be reduced by strengthening and improving quality of antenatal services, early identification of high risk pregnancies, timely referral and appropriate intervention.

Frequency, Risk Factors and Outcome of Clinical Management of Intrauterine Growth Restricted Infants in a Tertiary Care Hospital in Bangladesh

Background: Fetal growth is a complex process whichdepends on nutrient and oxygen availability and transport fromthe mother to the fetus across the placenta. This involveshormones and growth factors as well as maternal and fetalgenes. The failure of the fetus to reach his or her full potentialfor growth is called intrauterine growth restriction (IUGR) andimplies risk for adverse short- and long-term outcomes.Objective: To study the frequency, risk factors and outcome ofthe clinical management of IUGR infants in the NICU of atertiary care hospital.Methods: This case control study was conducted from August2015 to July 2016 in the department of Neonatology,Bangabandhu Sheikh Mujib Medical University (BSMMU). Priorapproval from Institutional Review Board (IRB) for this researchwork was taken.After taking consent from parents/Guardians, particulars of theneonates, antenatal, natal and postnatal history were recordedin a data collection form. All Newborn in the NICU during studyperiod were the study population. Newborn who meet theinclusion criteria were divided into two groups as case group(IUGR babies) and control group (AGA babies). The riskfactors were identified by taking face to face interview ofmother regarding prenatal period whereas the outcome ofclinical management was observed by the caution and carefulNICU follow up of the baby. Data were analyzed by statisticalpackage for social sciences (SPSS) version 20. At firstfrequency of IUGR was found among all admitted newborn.Risk factors were analyzed to calculate the odds ratio. Thenrisk factors were analyzed with chi square test to find outsignificant risk factors. P values less than 0.05 (95% CI) wereconsidered statistically significant.Results: The frequency of IUGR babies in this one year studywas found 11.86%. Congenital malformation (p=0.02) wasfound as significant fetal risk factor. Congenital CMV infectionwas found in 16.3 % case of IUGR babies. Maternal weight(p=<0.001), height (p=<0.001), socioeconomic status of mother(p=0.001), Inter pregnancy Interval (p=0.04), placentalinsufficiency (p=0.001), Pregnancy Induced hypertension(p=0.001) are significant maternal risk factor. Hypoglycemia(p=0.007) and hyperbilirubinemia (p=<0.001) were foundsignificant co-morbidities. Length of hospital stay wassignificantly higher among IUGR babies (p= 0.001) thatproclaim the outcome of clinical management. In case group16.3% and in control 8.2% babies expired even after providingall available standard clinical management. Most of thepatients died due to sepsis in both the groups. But the mortalityshowed no significant differences as outcome of clinicalmanagement.Conclusion: IUGR babies in BSMMU was 11.86%. Maternalweight, height, inter pregnancy interval, socioeconomic status,Pregnancy induced hypertension, placental insufficiency, lessANC visits were maternal risk factors for IUGR babies.

A Retrospective Study of Perinatal outcome in ART and Spontaneous Pregnancies

Introduction: In today’s world, infertility is one of themajor emerging health issues which effects about 8-9% ofreproductive age group. Infertility due to certain male factorsand complete tubal obstruction may require interventionalprocedure. Increased risk of adverse perinatal outcomes areassociated with ART. Study objctive was to asses perinataloutcome in pregnant women conceived with inventionaltechniques.Material and Methods: A Retrospective study was done attertiary care hospital from January 2018 to June 2018. anddata was collected. The maternal and fetal condition werenoted as per records.Results: Women > 40 years of age had 11.53% of intrauterinedeath, 65.38% requires NICU admission, 11.53% requiresventilator support and 7.69% had neonatal death.Study alsorevealed foetal complications like intra uterine death (pvalue=0.0004), fetal anomalies, IUGR (P value=0.0003)which were atleast four times more in ART group than inspontaneous conception.Study also revealed that out of 167new born in ART group,there were 28.74% having verylow birth weight,19.76% were having low birth weight and51.50% had adequate weight, i.e around half of them werehaving weight less than 2 kgs as compared to spontaneouspregnancy group were only 5.71% i.e 6 babies were born lessthan 2 kg weight(P value < .0001 highly significant).Conclusion: Maternal age was significantly associatedwith perinatal and obstetrical complications. To improvematernal and perinatal outcomes, pre-existing diseases likehypertension, anaemia, diabetes mellitus and hypothyroidismshould be treated before conception. Overall aim should beto minimize iatrogenic preterm birth for minor ailments,close supervision of such women can add few more weeks topregnancy thus improving neonatal outcome.

Perinatal outcome in cases of severe oligohydramnios

Background: Oligohydramnios is defined as when on ultrasonography the single largest pocket in horizontal and vertical diameter is less than 2cm or amniotic fluid index is less than 5cm. Normal amniotic fluid index is 5-25cm. The overall incidence is 0.5 to more than 5%. However, the incidence increases in post dated pregnancies as many as 11%. It is increasing these days because of changes in lifestyle and also reduced maternal fluid intake.Methods: A prospective randomized study was done in Dept of Obstetrics and Gynaecology, MGMMC and MYH, Indore during the period of 6 months from 1st July 2017 to 31st December 2017. It included 200 cases from all the antenatal patients attending Antenatal OPD in routine and emergency and who are admitted in MYH beyond 28 weeks of pregnancy.Results: Most of the perinatal cases nearly 64% of babies were handover, 26% were IUDs (intra uterine devices) and rest 10% requiring neonatal care in nursery. The color Doppler changes showed normal flow in 54% in cases with 26% showing early fetal hypoxia and 14% showing uteroplacental insufficiency. Rest of the 6% cases were IUD. Incidence of IUGR was 50% in babies most commonly being constitutionally small. About 8% cases were found to be associated with abruption and 24% cases were found to be associated with pregnancy induced hypertension. Most common mode of delivery was vaginal delivery in 68% cases. However, 32% cases underwent LSCS.Conclusions: There has been reported cases of sudden IUD in severe oligohydramnios presenting with loss of fetal movements.

Impact of Dietary Pattern on Nutritional Status of Pregnant Women in Low and High Strata between the Age Group of 30-39 Years in Mumbai

Background: Maternal Nutrition plays an important role in shaping the mother’s and fetal health. Therefore intake of high salt, high fat, high sugar in the diet might lead to over nutrition among pregnant women due to varied food choices of the since most of the subjects consumed outside food, Sugar Sweetened Beverages such as (Cola, Pepsi, Thumps Up, Soda, Sherbet etc), Processed Food such as(Ready to eat food, Mayonnaise, Cheese spread etc) which consist of increase amount of preservative which might affect the mother and foetal’s health. Since there was increase intake of above food groups and decrease intake of macro and micronutrients in the diet through food group such as Fruits, Nuts and Oilseed, Green Leafy Vegetables etc. Therefore there might be increased risk of Over nutrition among women which might lead to GDM (Gestational Diabetes Mellitus), IUGR(Intra Uterine Growth Retardation), Low Birth weight etc.Aim: To study the impact of dietary pattern on Nutritional of pregnant women in Low and High Strata. Method: A purposive random sampling was done among pregnant women because only 2ndtrimester pregnant women were selected for the study. The 50 subjects were divided into LSES (Lower Socioeconomic Strata) &HSES (Higher Socioeconomic Strata) on the basis of Kuppuswamy Index. The dietary pattern of the subjects was assessed through FFQ (Food Frequency Questionnaire) & 3 Day Diet Recall. Result: There was increase consumptionof High Fat, High Salt, High Sugar in the diet through consumption if food group such as Outside Food, Processed Food, Sugar Sweetened Beverages etc and in comparison the consumption of Macro and Micronutrient rich food group was lower which included Fruits, Green Leafy Vegetables, Nuts and oilseed etc. In Lower Strata the consumption of above food group was low because they were financially not stable therefore they were given additional services where the company paid their ration balance so that they could consume selective food group which were costing comparatively more. Since the RDA(Recommended Dietary Allowances) requirements were not met therefore the women were prescribed Iron, Calcium and Folic Acid supplements in the diet to decrease the risk ofMaternal and fetal complication such as GDM(Gestational Diabetes Mellitus), NTD(Neural Tube Defect), IUGR(Intra Uterine Growth Retardation) etc.Conclusion: Therefore to decrease the risk of Maternal and Fetal Complications intake of Macro and Micro nutritions in the diet is imperative and it is important to organize Nutrition Intervention programmes and counsel the pregnant women about Maternal Nutrition and how decrease intake of Nutrients in the diet might lead to Maternal Under nutrition and over nutrition and its related risk

Study of antenatal and postnatal factors affecting catchup growth in intrauterine growth retarded babies during first year

Background: The burden of IUGR is concentrated mainly in Asia with the proportion of IUGR 54% in India. Higher rates of IUGR should be a cause of concern because they signal high risk of malnutrition, morbidity and mortality for the new born. This study was done to see the factors affecting catchup growth (CUG) of IUGR babies during first year.Methods: The study was done in 120 SGA babies for a period of 18 months from October 2013 to March 2015. Antenatal, postnatal factors and anthropometry at 1st, 2nd, 3rd, 6th, 9th and 12 months were noted and analysed.Results: 78.3% babies showed CUG with in the first year. Preterm IUGR infants showed better CUG than full term. Asymmetric IUGR infants showed better CUG than symmetric. Teenage pregnancy, hypertensive disorders, multiple pregnancies, cardiac disease, anemia, type of IUGR, NICU stay, type of feeding, socioeconomic status, mother age, mother height, mother hemoglobin, gestational age, multiple gestation, birth weight, birth length, head circumference at birth all influenced CUG.Conclusions: Teenage pregnancies should be avoided. In SGA babies of pregnancy induced hypertension and preeclampsia, failure in CUG occurred more, these babies need to be followed in high risk clinics. SGA infants of mothers with low haemoglobin failed to show CUG, so antenatal nutrition improvement of mother should be done. Breastfed babies had higher CUG rates than formula fed babies, so exclusive breastfeeding should be promoted.

US Doppler Indices in Umbilical and Fetal MCA in Diagnosis of IUGR Fetuses

Background: Intrauterine growth restriction remains a leading contributor to perinatal mortality and morbidity. There is no cure, management is reliant on a structured antenatal surveillance program with timely intervention. Recent advances in ultrasound and Doppler have elucidated several mechanisms of evolution of disease and prediction of threat of intrauterine hypoxia and acidaemia well in advance of other surveillance tests. Materials and methods: This prospective study was conducted in 110 high risk pregnant women attending OPD, admitted in antenatal wards and labor room at Government General Hospital, Siddipet, over a period of 2 years from October-2016 to September 2018; Ultrasound examination was done for interval growth, AFI, placental pathology. Fetal well-being was assessed with Doppler studies of UA and MCA, daily fetal movement count, NST, BPP. Results: In the present study, PIH was found to be the commonest (50.9%) cause of IUGR. Abnormal Doppler Indices in Umbilical and MCA correlated statistically with lower birth weight, higher rates of caesarean delivery, oligohydramnios, lower Apgar scores, perinatal death, and higher admissions to NICU. AEDF/REDF was associated with highest perinatal loss, poor perinatal outcome. Cerebroplacental ratio < 1 (C/U<1) had 100% specificity and 100% PPV. Conclusion: Doppler technology enables a better understanding of the hemodynamic changes in the fetus. It can help in identifying the changes in the fetal circulation well in advance of other surveillance tests, thus identify the truly hypoxic fetus. Interval changes in Doppler indices are useful in determining monitoring frequencies and optional time for delivery.

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.

Role of Adrenomedullin in Trophoblast Invasion

The Adrenomedullin peptide hormone has a potent vasodilatory activity. Nevertheless this novel peptide has exposed to be almost a ubiquitous peptide, with the many number of tissues and cell types synthesizing adrenomedullin. Adrenomedullin (ADM) and its related family peptides are calcitonin gene-related peptides (α and β-CGRPs), and intermedin/adrenomedullin-2 (IMD/ADM2) which play vital role as regulators of vascular tone and cardiovascular advances in vertebrates. Current research into their functions in reproduction has acknowledged the function of these peptides and their cognate receptors (calcitonin receptor-like receptor/receptor activity-modifying protein (CLR/RAMP) receptors) in fetal cum maternal blood circulation, feto-placental and uteroimplantation development along with that of female gamete development as well as gamete movement in the oviduct. Moreover, recent findings have enlightened the novelty, potential opportunities for the deterrence and treatment of aberrant pregnancies such as pregnancy-stimulated hypertension, preeclampsia, and IUGR. Conversely, chief efforts are still required to clarify the relationships between evident components of the CLR/RAMP signaling pathway and aberrant pregnancies before CLR/RAMP receptors can develop targets for clinical management. With this comprehension, this review summarizes current progression with specific focus on role of adrenomedullin during early implantation.

Comparison of rat models of intrauterine growth retardation established by three different methods / 中国比较医学杂志

Objective Intrauterine growth retardation (IUGR) is characterized by low birth weight of neonates. The aim of this study was to provide a reference for the establishment of IUGR models in scientific research, by comparing the experimental data of different rat models of IUGR established by three commonly-used methods. Methods A total of 20 pregnant rats on the day 0 of gestation were divided into 4 groups, with 5 rats in each group (n=5). Among them, 3 groups of rats were treated with alcohol intervention (group A), uterine artery ligation (group U), and low protein diet (LP group), respectively, to establish rat models of IUGR, and the fourth group served as the normal control group (CON group). Fetal rats were taken through cesarean section on the 20th day of gestation. The body mass, brain mass, placental mass, two-kidney mass, body length and tail length of the fetal rats were measured, and the incidence rate of IUGR, stillbirth rate and their brain to placenta ratio were calculated. The fetal rats in each group were continuously raised and the body mass, perirenal fat pad mass and some organ masses were determined at the 3rd, 6th and 12th weeks. Results The average body mass of the fetal rats in the groups A, U and LP group was significantly lower than that of the normal control group (P＜ 0. 05), and the incidence rate of IUGR of the fetal rats was significantly higher than that of the normal control group (P＜ 0. 05). In addition, the stillbirth rate of pregnant rats in the group U was significantly higher than those of the group A and LP group (P ＜ 0. 05). After raising the rats for 3 weeks, the average body mass of rats in the three experimental groups was significantly lower than that of the normal control group (P ＜ 0. 05), and after raising for 6 weeks, the average body mass in the three experimental groups was still lower than that of the normal control group, but with a non-significant difference (P＞ 0. 05). However, after raising for 12 weeks, the average body mass of the rats in the group A and LP group was significantly higher than that of the normal control group (P ＜ 0. 05). Conclusions Rat models of IUGR can be successfully established either by alcohol intervention, uterine artery ligation or low protein diet. The IUGR model established by low protein diet has the advantages of a higher incidence rate of IUGR and lower stillbirth rate, being more suitable for animal model research. As regards the catch-up growth, the average body mass of the rats during the postpartum period and lactation period after delivered by cesarean section in the group A and LP group is lower than that of the normal control group, but after lactation the rats grow faster than those in the normal control group, indicating the existence of a catch-up growth in the group A and LP group.

An Audit of Pregnancies complicated by Intrauterine Growth Restriction at Lautoka Hospital

Introduction@#IUGR is an obstetrical complication that is difficult to identify in order to allow intervention to lessen morbidity and mortality. The Lancet series on stillbirths highlighted the causes of stillbirths globally, identifying IUGR as one of the five major causes. IUGR has accounted for almost a third of all still births at Lautoka Hospital over the past three years. The aim of this study was to audit all pregnancies complicated by IUGR, the contributing risk factors and their outcomes at Lautoka Hospital from 1st January to 31st December 2016. @*Aim@#To conduct a retrospective audit of pregnancies complicated by IUGR at Lautoka Hospital from 1st January 2016 to 31st December 2016.@*Method@#This is a retrospective descriptive audit using clinical notes, conducted on 170 women diagnosed with IUGR in 2016. @*Results@#There were 4,131 deliveries during the study period; 191 patients of whom were diagnosed with IUGR of which 170 folders were retrieved. The Incidence rate of those diagnosed with IUGR during this period was 4.3%. Seventy percent of women with IUGR had low to normal Body Mass Index (BMI) and booked in the late second to third trimester. The risk of developing IUGR was significantly increased in Fijians of Indian Descent (FID) (RR 4, CI 2.9-5.3, p-value <0.0001); in primigravida (RR 4.1, CI 3.5 – 4.7, p-value <0.0001); and those with previously Low Birth Weight baby (LBW) (< 2500g) (RR 2.3, CI 1.67 – 3.26, p-value <0.0001). Anaemia or hypertension diagnosed during pregnancy significantly increased the risk of developing IUGR (RR 1.7, CI 1.3-2.40, p-value 0.0002) and (RR 2.6, CI 1.75 – 4.05, p-value <0.0001) respectively. Women with IUGR have a 6 times higher chance of having a Still Birth (SB) (RR 6.1, CI 3.78-9.92, p-value <0.0001); higher risk of Induction of Labour (RR 4.2, CI 3.65-5.64, p-value <0.0001) and caesarean section delivery (RR 2.1, CI 1.54-2.85, p-value <0.0001). Seventy eight percent of still births were delivered beyond 37 weeks, a possible delay, which could have been avoided potentially improving the SB rate. SB risk was significantly higher in those diagnosed at or > 37 weeks gestation compared to those with an earlier diagnosis (RR 1.61 95% CI 1.11 – 2.35, p value 0.05). @*Conclusion@#IUGR contributes significantly to still births. There were delays in diagnosis and appropriate surveillance to allow timely delivery at Lautoka Hospital, which could have reduced the still birth rate.

Tyrosine phosphorylation of Kv1. 5 is upregulated in intrauterine growth retardation rats with exaggerated pulmonary hypertension

Intrauterine growth retardation (IUGR) is associated with the development of adult-onset diseases, including pulmonary hypertension. However, the underlying mechanism of the early nutritional insult that results in pulmonary vascular dysfunction later in life is not fully understood. Here, we investigated the role of tyrosine phosphorylation of voltage-gated potassium channel 1.5 (Kv1.5) in this prenatal event that results in exaggerated adult vascular dysfunction. A rat model of chronic hypoxia (2 weeks of hypoxia at 12 weeks old) following IUGR was used to investigate the physiological and structural effect of intrauterine malnutrition on the pulmonary artery by evaluating pulmonary artery systolic pressure and vascular diameter in male rats. Kv1.5 expression and tyrosine phosphorylation in pulmonary artery smooth muscle cells (PASMCs) were determined. We found that IUGR increased mean pulmonary artery pressure and resulted in thicker pulmonary artery smooth muscle layer in 14-week-old rats after 2 weeks of hypoxia, while no difference was observed in normoxia groups. In the PASMCs of IUGR-hypoxia rats, Kv1.5 mRNA and protein expression decreased while that of tyrosine-phosphorylated Kv1.5 significantly increased. These results demonstrate that IUGR leads to exaggerated chronic hypoxia pulmonary arterial hypertension (CH-PAH) in association with decreased Kv1.5 expression in PASMCs. This phenomenon may be mediated by increased tyrosine phosphorylation of Kv1.5 in PASMCs and it provides new insight into the prevention and treatment of IUGR-related CH-PAH.

Retinal Hemorrhage Incidence of Newborn with Intra-uterine Growth Retardation in Korea

PURPOSE: We report 3 cases of patients with retinal hemorrhage among 27 newborns with intrauterine growth retardation. CASE SUMMARY: Twenty-seven newborns with intrauterine growth retardation were examined using the indirect ophthalmoscope for confirming retinal hemorrhage which was observed in 3 patients. The mean gestational age and birth weight (g) of the 3 patients were 37⁺⁶ weeks and 2,086.7 g, respectively. Among the 3 newborns, 1 patient's mother had oligohydramnios. Two patients were delivered vaginally and 1 by cesarean section. All 3 patients had no birth trauma and the retinal hemorrhage was resolved within 2 weeks after the first eye examination. CONCLUSIONS: We observed 3 cases with retinal hemorrhage in neonates with intrauterine growth retardation which improved within 2 weeks.