"Implicaciones clínicas tras la introducción del test fetal no invasivo (TFNI) en el diagnóstico prenatal durante el periodo 2010-2019"

Introducción: En Aragón, desde 2015 se implementó el uso del TFNI dentro del protocolo de diagnostico prenatal, lo que nos permite tener una perspectiva de larga evolución para poder valorar los cambios acontecidos.Objetivo: El objetivo principal del estudio consiste en evaluar el impacto sobre las TI tras la implantación del TFNI en nuestro centro en 2015.Material y métodos: Se trata de un estudio descriptivo retrospectivo de la tasa de técnicas de diagnóstico prenatal invasivas durante dos periodos de tiempo definidos: primer periodo desde 2010 a 2014 y segundo periodo desde 2015 a 2019, tras la implementación en 2015 del TFNI. Se incluyeron todas aquellas pacientes que se sometieron a alguna TI, y se excluyeron todos aquellos casos en los que la realización de la TI fuese tras el diagnóstico de un aborto espontáneo, un óbito fetal o debido a un cribado genético oportunista.Resultados: Se incluyeron un total de 3562 pacientes gestantes. Se objetivó una disminución en el número global de TI realizadas en el segundo periodo (OR=0,581 IC95% [0,49-0,68], pConclusiones: El hallazgo principal de nuestro estudio es la evidente reducción de la tasa de TI tras la introducción del TFNI en el año 2015, con una reducción de casi un 40% en gestaciones de alto riesgo, disminuyendo la tasa en función de los nacimientos de un 11,82% en el primer periodo (2010-2014) a un 5,66% en el segundo (2015-2019). Se han observado importantes cambios en la indicación para estas técnicas, así como cambios en los resultados obtenidos y el tipo de técnicas aplicadas.Palabras clave: “TFNI”, “test fetal no invasivo”, “impacto clínico”, “técnicas invasivas”<br /

Brain-Derived Neurotrophic Factor Levels in Cord Blood from Growth Restricted Fetuses with Doppler Alteration Compared to Adequate for Gestational Age Fetuses

Background and Objectives: Fetal growth restriction (FGR) is a severe obstetric disease characterized by a low fetal size entailing a set of undesired consequences. For instance, previous studies have noticed a worrisome association between FGR with an abnormal neurodevelopment. However, the precise link between FGR and neurodevelopmental alterations are not yet fully understood yet. Brain-derived neurotrophic factor (BDNF) is a critical neurotrophin strongly implicated in neurodevelopmental and other neurological processes. In addition, serum levels of BDNF appears to be an interesting indicator of pathological pregnancies, being correlated with the neonatal brain levels. Therefore, the aim of this study is to analyze the blood levels of BDNF in the cord blood from fetuses with FGR in comparison to those with weight appropriate for gestational age (AGA). Materials and Methods: In this study, 130 subjects were recruited: 91 in group A (AGA fetuses); 39 in group B (16 FGR fetuses with exclusively middle cerebral artery (MCA) pulsatility index (PI) 95th percentile). Serum levels of BDNF were determined through ELISA reactions in these groups. Results: Our results show a significant decrease in cord blood levels of BDNF in FGR and more prominently in those with UA PI >95th percentile in comparison to AGA. FGR fetuses with exclusively decreased MCA PI below the 5th percentile also show reduced levels of BDNF than AGA, although this difference was not statistically significant. Conclusions: Overall, our study reports a potential pathophysiological link between reduced levels of BDNF and neurodevelopmental alterations in fetuses with FGR. However, further studies should be conducted in those FGR subjects with MCA PI < 5th percentile in order to understand the possible implications of BDNF in this group.Depto. de Salud Pública y Materno - InfantilFac. de MedicinaTRUEUnión EuropeaComunidad de MadridInstituto de Salud Carlos IIIHalekulani S.LFundación Santiago Dexeus Fontpu

Influence of Cerebral Vasodilation on Blood Reelin Levels in Growth Restricted Fetuses

Fetal growth restriction (FGR) is one of the most important obstetric pathologies. It is frequently caused by placental insufficiency. Previous studies have shown a relationship between FGR and impaired new-born neurodevelopment, although the molecular mechanisms involved in this association have not yet been completely clarified. Reelin is an extracellular matrix glycoprotein involved in development of neocortex, hippocampus, cerebellum and spinal cord. Reelin has been demonstrated to play a key role in regulating perinatal neurodevelopment and to contribute to the emergence and development of various psychiatric pathologies, and its levels are highly influenced by pathological conditions of hypoxia. The purpose of this article is to study whether reelin levels in new-borns vary as a function of severity of fetal growth restriction by gestational age and sex. We sub-grouped fetuses in: normal weight group (Group 1, n = 17), FGR group with normal umbilical artery Doppler and cerebral redistribution at middle cerebral artery Doppler (Group 2, n = 9), and FGR with abnormal umbilical artery Doppler (Group 3, n = 8). Our results show a significant association of elevated Reelin levels in FGR fetuses with cerebral blood redistribution compared to the normal weight group and the FGR with abnormal umbilical artery group. Future research should focus on further expanding the knowledge of the relationship of reelin and its regulated products with neurodevelopment impairment in new-borns with FGR and should include larger and more homogeneous samples and the combined use of different in vivo techniques in neonates with impaired growth during their different adaptive phases