The sterile-womb dogma in uncomplicated pregnancy has been lively debated. Data regarding the in utero microbiome environment are based mainly on studies performed at the time of delivery. Aim: To determine whether human placenta and amniotic fluid are populated by a bacterial microbiota in the first and second trimesters of pregnancy. Materials & methods: We analyzed by next-generation sequencing method 24 and 29 samples from chorionic villus sampling (CVS) and amniocentesis (AC), respectively. The V3 region of the 16S rRNA gene was sequenced. Results: 37.5% of CVS and 14% of AC samples showed the presence of bacterial DNA. Conclusion: Our study suggests that bacterial DNA can be identified in the placenta and amniotic fluid during early prenatal life.

What are the novel findings of this work?This research adds to the knowledge of the incidence, clinical features and perinatal outcome of fetuses with anomalous late-onset fetal growth restriction (FGR). The majority of cases with anomalous late-onset FGR are associated with isolated structural malformations. Anomalous late-onset FGR is associated with a higher incidence of respiratory complications at birth and admission to the neonatal intensive care unit (NICU) and with a longer stay in the NICU compared with non-anomalous late-onset FGR. What are the clinical implications of this work?The identification of anomalies in the context of late-onset FGR is associated with an increased incidence of composite adverse perinatal outcome, a 3-fold higher incidence of need for respiratory support at birth and a 10-fold higher incidence of need for intubation compared with cases with non-anomalous late-onset FGR. Such information is important for parental counseling in pregnancies complicated by anomalous late-onset FGR.

What are the novel findings of this work?The findings of this study show that, at the time of diagnosis of late-onset fetal growth restriction (FGR), estimated-fetal-weight percentile is the only ultrasound parameter associated independently with composite adverse perinatal outcome, defined as stillbirth or at least two of the following: obstetric intervention due to intrapartum fetal distress, neonatal acidemia, birth weight < 3 rd centile and transfer to the neonatal intensive care unit, while uterine artery pulsatility index multiples of the median > 95 th percentile is associated with intrapartum fetal distress leading to obstetric intervention. What are the clinical implications of this work?In this cohort study, including non-anomalous singleton pregnancies defined as late-onset FGR according to the study inclusion criteria, we observed a low frequency of maternal, perinatal and postnatal complications. Our data can be used for antenatal counseling of prospective parents.

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