Fetal thoracic circumference and lung volume and their rlation to fetal size and pulmonary artery blood flow

Objective: Research on early origins of lung disease suggests the need for studying the relationships of thoracic and lung size with fetal size and pulmonary circulation. The primary aim of this study is therefore to explore the associations between fetal thoracic circumference, lung volume, and fetal size. We also aim to assess if lung volume and thoracic circumference are associated with fetal pulmonary artery blood flow velocity measures. Methods: Cross-sectional assessment of singleton pregnancies from the general population (n = 447) at 30 gestational weeks (GW) was performed using ultrasound measurement of fetal thoracic circumference, lung volume, head and abdominal circumference, and femur length. We obtained Doppler blood flow velocity measures from the proximal branches of the fetal pulmonary artery. Associations between variables were studied using Pearson's correlation and multiple linear regression analyses. Results: Both thoracic circumference and lung volume correlated with fetal size measures, ranging from r = 0.64 between thoracic circumference and abdominal circumference, to r = 0.28 between lung volume and femur length. Adjustment for gestational age, maternal nicotine use, pre-pregnancy body mass index, and fetal sex marginally influenced the associations with abdominal circumference. The correlations of thoracic circumference and lung volume with pulmonary artery blood flow velocity measures were weak (r ≤ 0.17). Conclusion: We found moderate to low correlation between thoracic circumference, lung volume, and fetal size at 30 GW. The closest relationship was with the abdominal circumference. We found low correlations of thoracic circumference and lung volume with pulmonary artery blood flow velocity measures.publishedVersio

The effect of nicotine-containing products and fetal sex on placenta-associated circulating midpregnancy biomarkers

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Kardiovaskulær risikokartlegging etter gjennomgått hypertensiv svangerskapskomplikasjon

Tema/problemstilling: Hypertensive svangerskapskomplikasjoner rammer 7-10% av alle gravide i Norge. Dette gir økt risiko for komplikasjoner og senfølger under graviditeten og senere i livet. Norsk gynekologisk forening (NGF) foreslår kontroller i primærhelsetjenesten for å optimalisere kardiovaskulær risikoprofil og forebygge senere hjerte-/karsykdom hos kvinnen etter gjennomgått hypertensiv svangerskapskomplikasjon. Basert på NGF sine forslag ønsker vi å gjøre et kvalitetsforbedringsprosjekt hvor målet er bedre behandling og oppfølging av disse kvinnene. Kunnskapsgrunnlag: Kunnskapsgrunnlaget ble innhentet gjennom samtale med en professor innen feltet og et søk i McMaster Plus via Helsebiblioteket. Oppgaven baserer seg hovedsakelig på kapittelet «Hypertensive svangerskapskomplikasjoner og eklampsi» fra NGFs «Veileder i fødselshjelp». NGF anbefaler informasjon om primærforebygging av hjerte- og karsykdom, og foreslår kontroller i primærhelsetjenesten for å forebygge modifiserbare risikofaktorer for senere hjerte-/kar-sykdom etter gjennomgått hypertensiv svangerskapskomplikasjon. Tiltak og indikator: Vi ønsker å innføre oppfølgingen veilederen foreslår gjennom tiltak som internundervisning, informasjonsskriv til pasientene, flytskjema og en listeoversikt felles for legekontoret. Som mål for forbedring bruker vi en prosessindikator: antall kvinner med hypertensiv svangerskapskomplikasjon som får oppfølging i primærhelsetjenesten 6-12 uker postpartum. Prosess, ledelse og organisering: Prosjektet gjennomføres ved et fastlegekontor hvor det skal opprettes en prosjektgruppe og Folkehelseinstituttets modell for kvalitetsforbedring skal brukes aktivt. Prosjektet vil i første omgang strekke seg over en seks måneders periode som avsluttes med en evaluering. Konklusjon: Tidlig identifisering av modifiserbare risikofaktorer for kardiovaskulær sykdom vil potensielt føre til lavere kardiovaskulær morbiditet og mortalitet hos kvinner etter hypertensiv svangerskapskomplikasjon

The effect of nicotine-containing products and fetal sex on placenta-associated circulating midpregnancy biomarkers

Background: In utero exposure to nicotine, largely assessed by smoking, is a risk factor for impaired ofspring health, while potential efects of non-combustible nicotine use such as snus (oral moist tobacco), are less well-known. Maternal serum concentrations of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) may be viewed as “placenta health markers”, known to difer by fetal sex. Maternal smoking during pregnancy has been associated with lower levels of circulating sFlt-1, while the efect of snus on placenta-associated angiogenic factors is unknown. Our aim was to explore if snus and/or smoking exposure was associated with midpregnancy maternal levels of sFlt-1, PlGF and sFlt-1/PlGF ratio if these associations were modifed by fetal sex. Methods: Midpregnancy (16–22 gestational weeks) serum from 2603 Scandinavian women enrolled in the population-based multi-center PreventADALL (Preventing Atopic Dermatitis and ALLergies in children) study was analysed for sFlt-1 and PlGF concentrations by electrochemiluminescence, deriving the sFlt-1/PGF ratio. Nicotine use was assessed by electronic questionnaires at enrollment in 2278 of the women. Univariable and multivariable linear regression models on log transformed outcomes were used to assess the association between nicotine use and biomarker levels. Interaction terms were included to identify whether the associations were modifed by fetal sex. Results: Median sFlt-1, PlGF and sFlt-1/PlGF ratios among women with nicotine exposure information were similar to those of all included women and difered by fetal sex. Current snus use was signifcantly associated with reduced maternal circulating PlGF levels in adjusted analyses [β−0.12, (95% CI−0.20; 0.00) compared to never use, p=0.020]. A signifcant interaction between fetal sex and snus exposure was observed for PIGF (p=0.031). Prior or periconceptional snus use was signifcantly associated with PIGF in male fetus pregnancies [β−0.05 (95% CI−0.09 to (−0.02)) and β−0.07 (95% CI−0.12 to (−0.02)) compared to never use, p=0.002]. Smoking was not signifcantly associated with any circulating biomarkers levels. Conclusions: Midpregnancy maternal angiogenic profle difered by periconceptional snus use and fetal sex. Snus exposure, perceived as “safe” by users, before or during pregnancy seems to afect midpregnancy placental health in a sex dimorphic manner