STUDIO DI NUOVI FATTORI PROGNOSTICI ECOGRAFICI FETALI NELLA GRAVIDANZA CON DIABETE PRE-GESTAZIONALE

Study of new ultrasonographic fetal prognostic factors in pregnancies with pre-gestational diabetes mellitus Objective: Firstly, to study fetal and placental biometry along with placental and fetal cardiac function at 11+0-13+6 weeks in pregnancies with pre-gestational diabetes mellitus (PGDM), by means of a series of two-dimensional (2D), three-dimensional (3D), Doppler ultrasound measurements as well as with free serum chorionic gonadotropin-\u3b2 (free-\u3b2hCG), pregnancy associated plasma protein A (PAPP-A) and glycosylated hemoglobin (HbA1c) concentrations. Secondly, to evaluate differences of such measurements between normal and PGDM and eventually, to investigate their prognostic capability in the prediction of neonatal macrosomia. Materials and methods: 50 normal controls and 50 PGDM pregnant patients at 11+0-13+6 weeks were recruited in a twenty-six months period. Demographic characteristics were recorded and 2D, 3D and Doppler ultrasound assessment were performed collecting the following measurements: crown rump length (CRL), nuchal translucency (NT), nasal bone (NB), tricuspid Doppler (TR), ductus venosus Doppler (DV), left sided myocardial performance index (MPI), fetal head and trunk volume (FV), head volume (HV), placental volume (PV). The trunk volume (TV) was obtained subtracting HV from FV and the head to trunk ratio (HTR) was calculated. VOCAL technology was used to obtain 3D ultrasound measurements as previously described. DV Doppler was defined normal with positive or negative A wave and abnormal with reverse A wave. In 35 patients of both groups we also obtained maternal serum free-\u3b2hCG and PAPP-A measurements and in all PGDM cases maternal serum HbA1c was measured with High-Performance Liquid Chromatography in the periconceptional period, at 11+0-13+6 weeks and in the second trimester. All of the ultrasound measurements were performed by a single operator blind to the pregnancy outcome and according to the methodology described in separate publications-guidelines. We collected pregnancies outcomes and birthweight (BW) was transformed in centile for gestational age. Categorical variables of both groups were compared by non-parametric chi-square test. Continuous variables of both groups were compared using mean differences from expected measurements (delta values) obtained from available regression equations with non-parametric Mann Whitney U test. BW was analyzed firstly as a continuous variable by means of regression of each continuous measurements of the study and subsequently as a dichotomous variable using non parametric statistics, as previously described. Macrosomia was defined as a BW greater than the 95th centile for gestation. Statistical significance was considered with p<0.05. Results: Gestational age at delivery was significantly smaller in PGDM compared to controls (p<0.001), whereas maternal age (p<0.05), body mass index (p<0.05) and BW centile (p<0.001) were significantly greater in PGDM compared to controls. Macrosomia occurred in 13 (26%) patients with PGDM and in 2 (4%) of the normals. No significant differences between normal controls and PGDM were found for the following measurements: CRL (p=0.240), NT (p=0.521), NB (p=0.317), TR (p=0.317), free-\u3b2hCG (p=0.374), PAPP-A (p=0.725), FV (p=0.072), HV (p=0.521). Abnormal DV Doppler was more frequent in PGDM group compared to normal (LR: 6.50; p<0.001) as well as in PGDM developing neonatal macrosomia compared to those with no macrosomia (LR: 3.32; p=0.008). MPI was significantly greater in PGDM group compared to normal (p<0.001) as well as in PGDM developing macrosomia compared to those with no macrosomia (p<0.001). TV and PV were significantly smaller in PGDM compared to normal (p<0.001; p<0.001) and in PGDM with macrosomia compared to those without (p<0.001; p=0.005). HTR was significantly greater in PGDM compared to normal (p<0.001) and in PGDM with macrosomia compared to those without (p<0.001). Regression analysis showed a significant correlation between BW centile and HTR (r=0.387; p=0.006), but not with other study variables. Periconceptional HbA1c and HbA1c at 11+0-13+6 weeks were not different in PGDM with and without macrosomia (p=0.293 and p=0.187, respectively), whereas HbA1c in the second trimester was greater in PGDM developing neonatal macrosomia compared to those who did not (p=0.014). Conclusions: in our series PGDM was associated with asymmetric fetal growth restriction, reduced placental volume, abnormal ductus venosus perfusion and impaired cardiac function at 11+0-13+6 weeks of pregnancy. Fetal trunk volume, head to trunk ratio, placental volume, myocardial performance index, ductus venosus Doppler may predict neonatal macrosomia at 11+0-13+6 weeks of pregnancy and eventually may be indicators of fetal metabolic impairment in PGDM pregnancies

Uterine artery Doppler pulsatility index at 11-38 weeks in ICSI pregnancies with egg donation

BACKGROUND: Uterine artery Doppler pulsatility index (UtA-PI) may be different in pregnancies with egg donation (ICSI-ED) as compared to conceptions with autologous intra-cytoplasmatic sperm injection (autologous ICSI) and to spontaneous conceptions (SC). METHODS: One hundred and ninety-four pregnant women with different modes of conception (MC) were prospectively evaluated: 53 ICSI-ED, 36 autologous ICSI and 105 SC. To evaluate the effects of different MC on PI, multivariable linear regression (MLR) models predicting UtA-PI were fitted after adjustment for maternal age, body mass index, race, parity, smoking status and gestational age. RESULTS: In the first trimester, at MLR, autologous ICSI was not associated with a significantly different UtA-PI [estimate (EST) 0.01; 95% confidence interval (CI) -0.19, 0.2; P=0.9] when compared to SC. Conversely, MC by ICSI-ED was associated with lower first trimester UtA-PI (EST -0.32; CI -0.55, -0.08; P=0.01) when compared to SC. At MLR, MC by autologous ICSI and by ICSI-ED were not associated with significant differences in the second and third trimester UtA-PI when compared to SC. CONCLUSION: ICSI-ED conception presented lower UtA-PI when compared to SC at 11+0-13+6 weeks but not at later assessments. Correction of UtA-PI measurement specifying the origin of oocyte may be useful in first trimester screening

Postnatal outcome and associated anomalies of prenatally diagnosed right aortic arch with concomitant right ductal arch: a systematic review and meta-analysis

Right aortic arch presents a reported incidence of 0.1% of the general population; the aim of our study was to evaluate the risk of associated intracardiac (ICA), extracardiac (ECA), or chromosomal abnormalities in fetuses with right aortic arch (RAA) and concomitant right ductal arch (RDA). A systematic review of the literature selected 18 studies including 60 cases of RAA/RDA. A meta-analysis with a random effect model calculated for each outcome the pooled crude proportion of associated abnormal outcomes in cases of RAA/RDA and the pooled proportions and odds ratios in RAA with LDA or RDA. Quality assessment of the included studies was achieved using the NIH quality assessment tool for case series studies. RAA/RDA presents risk of associated conotruncal CHDs of about 30% and risk of 22q11 microdeletion in the region of 1%. Two-thirds of 22q11 microdeletions had concomitant thymic hypoplasia and no other chromosomal defects were described. Risks for ICA, ECA, 22q11 microdeletion, and aberrant left subclavian artery are not substantially different in RAA with right or left arterial duct. RAA increases the risk of associated cardiac defects regardless of laterality of the ductal arch. In isolated RDA/RAA cases, absolute risks of extracardiac associated problems or surgery are rather low, we would therefore recommend reassurance, particularly when the thymus and karyotype are normal