Fetal growth restriction: current knowledge to the general Obs/Gyn

Nardozza, Luciano Marcondes Machado; Júnior, Edward Araujo; Barbosa, M. P.; Caetano, Ana Carolina Rabachini; Lee, Desireé Ji Re

doi:10.1007/s00404-012-2330-6

Cited by 106 publications

(96 citation statements)

References 62 publications

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“…The most frequently studied long‐term repercussions of IUGR are those involving metabolic programming, which lead to the so‐called metabolic syndrome that is associated with a high risk of developing hypertension, diabetes, and cardiovascular disease. Nonetheless, longitudinal studies have also revealed a high incidence of learning, school and behavioral problems in IUGR babies compared with babies born at the same gestational age but with an adequate BW (Leitner et al., 2007; Nardozza et al., 2012). It is important to note that the diagnosis of true IUGR remains a challenge in clinical practice since children <10th percentile in size are not always pathological, and some children with appropriate weight for their gestational age might not have achieved their target growth (Campbell et al., 2012; Zhang et al., 2010).…”

Section: Discussionmentioning

confidence: 99%

Learning and memory disabilities in IUGR babies: Functional and molecular analysis in a rat model

et al. 2017

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IntroductionIntrauterine growth restriction (IUGR) is the failure of the fetus to achieve its inherent growth potential, and it has frequently been associated with neurodevelopmental problems in childhood. Neurological disorders are mostly associated with IUGR babies with an abnormally high cephalization index (CI) and a brain sparing effect. However, a similar correlation has never been demonstrated in an animal model. The aim of this study was to determine the correlations between CI, functional deficits in learning and memory and alterations in synaptic proteins in a rat model of IUGR.MethodsUtero‐placental insufficiency was induced by meso‐ovarian vessel cauterization (CMO) in pregnant rats at embryonic day 17 (E17). Learning performance in an aquatic learning test was evaluated 25 days after birth and during 10 days. Some synaptic proteins were analyzed (PSD95, Synaptophysin) by Western blot and immunohistochemistry.ResultsPlacental insufficiency in CMO pups was associated with spatial memory deficits, which are correlated with a CI above the normal range. CMO pups presented altered levels of synaptic proteins PSD95 and synaptophysin in the hippocampus.ConclusionsThe results of this study suggest that learning disabilities may be associated with altered development of excitatory neurotransmission and synaptic plasticity. Although interspecific differences in fetal response to placental insufficiency should be taken into account, the translation of these data to humans suggest that both IUGR babies and babies with a normal birth weight but with intrauterine Doppler alterations and abnormal CI should be closely followed to detect neurodevelopmental alterations during the postnatal period.

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Section: Discussionmentioning

confidence: 99%

Learning and memory disabilities in IUGR babies: Functional and molecular analysis in a rat model

et al. 2017

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“…Assessing the growth potential in infants with CCHD is further complicated by the fact that cardiac lesion–specific differences in BW have been described 39. Additionally, with the lack of head circumference data, we were unable to distinguish between symmetric and asymmetric growth restriction 38. Future studies should focus on these unanswered questions and assess lesion‐specific outcomes to better understand the nuanced relationship between BW and GA in neonates with CCHD.…”

Section: Discussionmentioning

confidence: 98%

“…First, the data set used does not contain data on longitudinal intrauterine growth or information on head circumference, thus we were unable to assess fetal growth restriction per se because this term implies an in utero insult that led to a fetus not meeting its growth potential 38. Assessing the growth potential in infants with CCHD is further complicated by the fact that cardiac lesion–specific differences in BW have been described 39.…”

Section: Discussionmentioning

confidence: 99%

Effect of Fetal Growth on 1‐Year Mortality in Neonates With Critical Congenital Heart Disease

Steurer

Baer

Burke

et al. 2018

JAHA

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BackgroundInfants with critical congenital heart disease (CCHD) are more likely to be small for gestational age (GA). It is unclear how this affects mortality. The authors investigated the effect of birth weight Z score on 1‐year mortality separately in preterm (GA <37 weeks), early‐term (GA 37–38 weeks), and full‐term (GA 39–42 weeks) infants with CCHD.Methods and ResultsLive‐born infants with CCHD and GA 22 to 42 weeks born in California 2007–2012 were included in the analysis. The primary predictor was Z score for birth weight and the primary outcome was 1‐year mortality. Multivariable logistic regression was used. Results are presented as adjusted odds ratios and 95% confidence intervals (CIs). The authors identified 6903 infants with CCHD. For preterm and full‐term infants, only a Z score for birth weight <−2 was associated with increased mortality compared with the reference group (Z score 0–0.5, adjusted odds ratio, 2.15 [95% CI, 1.1–4.21] and adjusted odds ratio, 3.93 [95% CI, 2.32–6.68], respectively). In contrast, in early‐term infants, the adjusted odds ratios for Z scores <−2, −2 to −1, and −1 to −0.5 were 3.42 (95% CI, 1.93–6.04), 1.78 (95% CI, 1.12–2.83), and 2.03 (95% CI, 1.27–3.23), respectively, versus the reference group.Conclusions GA seems to modify the effect of birth weight Z score on mortality in infants with CCHD. In preterm and full‐term infants, only the most severe small‐for‐GA infants (Z score <−2) were at increased risk for mortality, while, in early‐term infants, the risk extended to mild to moderate small‐for‐GA infants (Z score <−0.5). This information helps to identify high‐risk infants and is useful for surgical planning.

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“…1 Fetuses with FGR have an increased risk for perinatal morbidity and mortality, impaired neurological and cognitive development during childhood and adolescence, and cardiovascular and endocrine disorders in adulthood. 2 Fetal growth restriction is characterized by cases wherein the fetus does not achieve full intrauterine growth and development because of impaired placental function. 1 However, in clinical practice, FGR is difficult to define, and there is currently no gold standard for its diagnosis.…”

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confidence: 99%

“…In the final stage, some possible algorithms were presented to experts, and the algorithm with the highest number of votes was considered the final algorithm for defining FGR. 2 The consensus concluded that the cutoff value between early and late FGR would be gestational age (GA) of 32 weeks, and the following parameters were used to define FGR in the absence of fetal malformations: early FGR (< 32 weeks): (i) fetal abdominal circumference below the third percentile for GA OR estimated fetal weight below the third percentile for GA OR zero diastole of the umbilical artery on Doppler (isolated criteria) and (ii) estimated fetal weight or waist circumference below the tenth percentile for GA AND the pulsatility index of the uterine and umbilical arteries above the 95th percentile for GA (combined parameters) and late FGR ( 32 weeks): (i) fetal abdominal circumference below the third percentile for GA OR estimated fetal weight below the third percentile for GA and (ii) the combination of at least two of the following parameters: (a) estimated fetal weight or fetal abdominal circumference below the tenth percentile for GA, (b) the reduction of more than two quartiles in the growth curve, and (c) the cerebroplacental association below the fifth percentile for GA or the pulsatility index of the umbilical artery above the 95th percentile for GA.…”

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confidence: 99%

New Definition of Fetal Growth Restriction: Consensus Regarding a Major Obstetric Complication

Nardozza

Zamarian

Júnior

2017

Rev Bras Ginecol Obstet

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Fetal growth restriction: current knowledge to the general Obs/Gyn

Abstract: Early diagnosis of FGR is very important, because it permits the etiological identification and adequate monitoring of fetal vitality, minimizing the risks related to prematurity and intrauterine hypoxia.

Cited by 106 publications

References 62 publications

Learning and memory disabilities in IUGR babies: Functional and molecular analysis in a rat model

Learning and memory disabilities in IUGR babies: Functional and molecular analysis in a rat model

Effect of Fetal Growth on 1‐Year Mortality in Neonates With Critical Congenital Heart Disease

New Definition of Fetal Growth Restriction: Consensus Regarding a Major Obstetric Complication

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