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Article ; Online: Third-trimester uterine artery Doppler for prediction of adverse outcome in late small-and adequate for-gestational-age fetuses.

Mula, Cristina / Hidalgo, Judit / Peguero, Anna / Mazarico, Edurne / Martinez, Judit / Figueras, Francesc / Meler, Eva

2023 Volume 75, Issue 5, Page(s) 440–448

Abstract: Fetal growth restriction includes all those fetuses that do not reach their own growth potential due to placental insufficiency and therefore at higher risk of adverse perinatal outcomes. Identification and follow-up of these fetuses is essential to ... ...

Abstract	Fetal growth restriction includes all those fetuses that do not reach their own growth potential due to placental insufficiency and therefore at higher risk of adverse perinatal outcomes. Identification and follow-up of these fetuses is essential to decrease this additional risk. Although estimated fetal weight under the 3rd centile and pathological cerebroplacental ratio are the most accepted predictive criteria, some evidence suggests that abnormal uterine artery Doppler may be a useful prognostic parameter in late-onset growth restriction fetuses at the moment of diagnosis. However, its prediction capacity as a standalone parameter is limited. In that context, integrated models of biometric and hemodynamic ultrasound parameters including uterine Doppler have been proposed as an effective approach to stratify the risk and improve perinatal outcomes. Moreover, an association of abnormal uterine artery Doppler and histological findings of placental underperfusion due to vascular obstruction has been described. Finally, it has also been suggested that the evaluation of uterine artery Doppler at third trimester in appropriate-for-gestational-age fetuses could identify cases of subclinical placental insufficiency, but further evidence is needed to define such predictive strategies.
MeSH term(s)	Pregnancy ; Female ; Humans ; Pregnancy Trimester, Third ; Placental Insufficiency/diagnostic imaging ; Placental Insufficiency/pathology ; Placenta/diagnostic imaging ; Uterine Artery/diagnostic imaging ; Middle Cerebral Artery/diagnostic imaging ; Ultrasonography, Prenatal ; Prospective Studies ; Fetus
Language	English
Publishing date	2023-03-21
Publishing country	Italy
Document type	Journal Article
ZDB-ID	3062815-5
ISSN	2724-6450
ISSN (online)	2724-6450
DOI	10.23736/S2724-606X.23.05229-6
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Article ; Online: Doppler studies of placental function.

Meler, Eva / Martínez, Judit / Boada, David / Mazarico, Edurne / Figueras, Francesc

Placenta

2021 Volume 108, Page(s) 91–96

Abstract: Placental-associated diseases account for most cases of adverse perinatal outcome in developing countries. Doppler evaluation has been incorporated as a predictive parameter at early pregnancy for high-risk placental disease, in the diagnosis and ... ...

Abstract	Placental-associated diseases account for most cases of adverse perinatal outcome in developing countries. Doppler evaluation has been incorporated as a predictive parameter at early pregnancy for high-risk placental disease, in the diagnosis and management of those fetuses with impaired intrauterine growth and for the evaluation of fetal wellbeing in those high-risk pregnancies. Uterine Doppler at second trimester predicts most instances of early-onset preeclampsia and intrauterine growth restriction. However, the growing evidence of an effective early propylactic strategy, has turned Uterine Doppler an essential parameter to be included in first trimester predictive algorithms. Umbilical artery Doppler helps in the identification of small-for-gestational-age fetuses at higher risk, and is one of the essential vessels in the assessment of fetal hypoxia impairment, especially in the early cases. It helps in the decision timing for ending the pregnancy improving thus perinatal outcomes. Moreover, in high-risk pregnancies, umbilical artery Doppler has demonstrated to reduce the risk of perinatal deaths and the risk of obstetric interventions. On the other hand, middle cerebral artery Doppler reflects fetal adaptation to hypoxia, and with the cerebroplacental ratio, they improve the detection of fetuses a high risk of adverse perinatal outcome, mostly of those late small fetuses, where most instances of adverse outcome occur in fetuses with normal umbilical artery. Ductus venosous Doppler waveform is a surrogate parameter of the fetal base-acid status. Its use has demonstrated to improve perinatal outcomes, mainly reducing the risk of fetal intrauterine death. Alone or in combination with computerized CTG, it helps tailoring the best moment to end the pregnancy among early cases.
MeSH term(s)	Female ; Fetal Growth Retardation/diagnostic imaging ; Humans ; Placenta/diagnostic imaging ; Pregnancy ; Prognosis ; Ultrasonography, Doppler ; Umbilical Arteries/diagnostic imaging
Language	English
Publishing date	2021-04-02
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	603951-0
ISSN	1532-3102 ; 0143-4004
ISSN (online)	1532-3102
ISSN	0143-4004
DOI	10.1016/j.placenta.2021.03.014
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Article ; Online: Prediction of adverse neonatal outcome at admission for early-onset preeclampsia with severe features.

Peguero, Anna / Fernandez-Blanco, Lorena / Mazarico, Edurne / Benitez, Leticia / Gonzalez, Alba / Boada, David / Borràs, Cristina / Youssef, Lina / Crispi, Fàtima / Hernandez, Sandra / Figueras, Francesc

Pregnancy hypertension

2023 Volume 32, Page(s) 64–69

Abstract: Background: Preeclampsia remains the leading cause of maternal morbidity and mortality. Consequently, research has focused on validating tools to predict maternal outcomes regarding clinical and biochemical features from the maternal compartment. ... ...

Abstract	Background: Preeclampsia remains the leading cause of maternal morbidity and mortality. Consequently, research has focused on validating tools to predict maternal outcomes regarding clinical and biochemical features from the maternal compartment. However, preeclampsia also leads to neonatal complications due to placental insufficiency and prematurity, being the early-onset type associated with the poorest outcome. Hence, it is imperative to study whether these existing tools can predict adverse neonatal outcome. Objective: To assess the predictive value for adverse neonatal outcome of Doppler ultrasound, angiogenic factors and multi-parametric risk-score models in women with early-onset severe preeclampsia. Study design: This is a prospective cohort study of consecutive singleton pregnancies complicated by early-onset (developed before 34 week's gestation) severe preeclampsia. Results: 63 women with early-onset severe preeclampsia, 18 (28.6%) presented an adverse neonatal outcome. Placental growth factor (PlGF) showed the best discrimination between neonatal outcomes among angiogenic factors. PREP-L score is a multi-parametric risk-score for the prediction of complications in early-onset preeclampsia which includes maternal characteristics and clinical and analytical data obtained at admission. Good predictive values for the prediction of neonatal complications were found with the combination of PREP-L score with advanced Doppler (AUC ROC 0.9 95% CI 0.82-0.98]) and with PlGF levels (AUC ROC 0.91 [95% CI 0.84-0.98]). Conclusions: The combination of maternal risk scoring (PREP-L score) with angiogenic factors or fetal Doppler ultrasound at the time of diagnosis of early-onset preeclampsia with severe features performs well in predicting adverse neonatal outcome.
MeSH term(s)	Infant, Newborn ; Pregnancy ; Female ; Humans ; Pre-Eclampsia/diagnosis ; Placenta Growth Factor ; Prospective Studies ; Placenta/metabolism ; Placental Insufficiency ; Biomarkers ; Vascular Endothelial Growth Factor Receptor-1/metabolism
Chemical Substances	Placenta Growth Factor (144589-93-5) ; Biomarkers ; Vascular Endothelial Growth Factor Receptor-1 (EC 2.7.10.1)
Language	English
Publishing date	2023-04-26
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2584464-7
ISSN	2210-7797 ; 2210-7789
ISSN (online)	2210-7797
ISSN	2210-7789
DOI	10.1016/j.preghy.2023.04.004
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Article ; Online: Deficient neural encoding of speech sounds in term neonates born after fetal growth restriction.

Ribas-Prats, Teresa / Arenillas-Alcón, Sonia / Lip-Sosa, Diana Lucia / Costa-Faidella, Jordi / Mazarico, Edurne / Gómez-Roig, María Dolores / Escera, Carles

Developmental science

2021 Volume 25, Issue 3, Page(s) e13189

Abstract: Infants born after fetal growth restriction (FGR)-an obstetric condition defined as the failure to achieve the genetic growth potential-are prone to neurodevelopmental delays, with language being one of the major affected areas. Yet, while verbal ... ...

Abstract	Infants born after fetal growth restriction (FGR)-an obstetric condition defined as the failure to achieve the genetic growth potential-are prone to neurodevelopmental delays, with language being one of the major affected areas. Yet, while verbal comprehension and expressive language impairments have been observed in FGR infants, children and even adults, specific related impairments at birth, such as in the ability to encode the sounds of speech, necessary for language acquisition, remain to be disclosed. Here, we used the frequency-following response (FFR), a brain potential correlate of the neural phase locking to complex auditory stimuli, to explore the encoding of speech sounds in FGR neonates. Fifty-three neonates born with FGR and 48 controls born with weight adequate-for-gestational age (AGA) were recruited. The FFR was recorded to the consonant-vowel stimulus (/da/) during sleep and quantified as the spectral amplitude to the fundamental frequency of the syllable and its signal-to-noise ratio (SNR). The outcome was available in 45 AGA and 51 FGR neonates, yielding no differences for spectral amplitudes. However, SNR was strongly attenuated in the FGR group compared to the AGA group at the vowel region of the stimulus. These findings suggest that FGR population present a deficit in the neural pitch tracking of speech sounds already present at birth. Our results pave the way for future research on the potential clinical use of the FFR in this population, so that if confirmed, a disrupted FFR recorded at birth may help deriving FGR neonates at risk for postnatal follow-ups.
MeSH term(s)	Adult ; Child ; Female ; Fetal Growth Retardation ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Phonetics ; Pregnancy ; Speech ; Speech Perception/physiology
Language	English
Publishing date	2021-11-18
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2023952-X
ISSN	1467-7687 ; 1363-755X
ISSN (online)	1467-7687
ISSN	1363-755X
DOI	10.1111/desc.13189
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Article ; Online: Heparin therapy in placental insufficiency: Systematic review and meta-analysis.

Mazarico, Edurne / Molinet-Coll, Cristina / Martinez-Portilla, Raigam Jafet / Figueras, Francesc

Acta obstetricia et gynecologica Scandinavica

2019 Volume 99, Issue 2, Page(s) 167–174

Abstract: Introduction: The objective of this study was to establish whether heparin improves the neonatal outcome of fetuses with suspected placental insufficiency.: Material and methods: Before data extraction, the project was registered in the PROSPERO ... ...

Abstract	Introduction: The objective of this study was to establish whether heparin improves the neonatal outcome of fetuses with suspected placental insufficiency. Material and methods: Before data extraction, the project was registered in the PROSPERO International Prospective Register of Systematic Reviews (registration number: CRD42019117627). A systematic search was performed to identify relevant studies, using PubMed, SCOPUS, ISI Web of Knowledge, and PROSPERO database for meta-analysis. Suspected placental insufficiency was defined as either an estimated fetal weight or abdominal circumference below the 10th centile or when at least 2 of the following criteria were met: (1) abnormal biochemical markers, (2) sonographic evidence of abnormal placental morphology, or (3) abnormal uterine artery Doppler. Heparin in any commercial presentation was defined as the intervention. Mean difference (MD) by random effects model was used. Heterogeneity between studies was assessed using Cochran's Q, H, and I Results: From 1159 assessed studies, two were retained for analysis. The results showed a significantly higher birthweight (MD 365; 95% CI 236 to 494; P < 0.001) and a significant increase of gestational age at birth by 1 week in those women treated with heparin (MD 0.806; 95% CI 0.354 to 1.258; P < 0.001). However, there were no significant differences in Apgar scores, neonatal admission, neonatal mortality, or composite neonatal morbidity. Conclusions: In women with very high suspicion of placental insufficiency, heparin may increase fetal growth and prolong pregnancy. There is no evidence for a beneficial effect of heparin in reducing neonatal adverse outcomes.
MeSH term(s)	Adult ; Anticoagulants/therapeutic use ; Birth Weight ; Female ; Gestational Age ; Heparin/therapeutic use ; Humans ; Placental Insufficiency/diagnostic imaging ; Placental Insufficiency/drug therapy ; Pregnancy ; Pregnancy Outcome
Chemical Substances	Anticoagulants ; Heparin (9005-49-6)
Language	English
Publishing date	2019-10-08
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	80019-3
ISSN	1600-0412 ; 0001-6349
ISSN (online)	1600-0412
ISSN	0001-6349
DOI	10.1111/aogs.13730
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Article ; Online: Death and severe morbidity in isolated periviable small-for-gestational-age fetuses.

Meler, Eva / Mazarico, Edurne / Peguero, Anna / Gonzalez, Alba / Martinez, Judit / Boada, David / Vellvé, Killian / Arca, Gemma / Gómez-Roig, Maria Dolores / Gratacós, Eduard / Figueras, Francesc

BJOG : an international journal of obstetrics and gynaecology

2022 Volume 130, Issue 5, Page(s) 485–493

Abstract: Objective: This study aims to predict perinatal death or severe sequelae in isolated small-for-gestational-age fetuses, diagnosed at a periviable gestational age, based on ultrasound and Doppler parameters at diagnosis.: Design: Observational study.!# ...

Abstract	Objective: This study aims to predict perinatal death or severe sequelae in isolated small-for-gestational-age fetuses, diagnosed at a periviable gestational age, based on ultrasound and Doppler parameters at diagnosis. Design: Observational study. Setting: A tertiary perinatal centre. Population: A cohort of singleton non-malformed fetuses suspected to be small for gestational age (estimated fetal weight, EFW, <10th centile) diagnosed at 22.0-25.6 weeks of gestation. The following parameters were recorded at diagnosis: severe smallness (<3rd centile); absent or reversed end-diastolic velocity in umbilical artery; abnormal middle cerebral artery Doppler; abnormal cerebroplacental ratio; abnormal uterine artery Doppler; and absent or reversed end-diastolic velocity in the ductus venosus. Methods: Logistic regression analysis. Main outcome measures: Predictive performance of EFW and Doppler parameters for short-term adverse outcome of perinatal morbimortality and composite serious adverse outcomes (death, neurological impairment or severe bronchopulmonary dysplasia). Results: A total of 155 pregnancies were included. There were 13 (8.4%) intrauterine and 11 (7.7%) neonatal deaths. A short-term adverse perinatal outcome occurred in 40 (25.8%) pregnancies. There were 31 (20%) cases of serious adverse outcomes. For the prediction of serious adverse outcomes, the combination of absent or reversed end-diastolic velocity in the umbilical artery and impaired middle cerebral artery detected by Doppler evaluation achieved a detection rate of 87%, with a false-positive rate of 14% (accuracy 86%). Conclusion: In periviable isolated small-for-gestational-age fetuses, a Doppler evaluation of the umbilical and fetal brain circulation can accurately predict short-term adverse perinatal complications and serious adverse outcomes.
MeSH term(s)	Pregnancy ; Infant, Newborn ; Female ; Humans ; Infant ; Ultrasonography, Prenatal ; Fetal Growth Retardation/diagnostic imaging ; Infant, Small for Gestational Age ; Fetus/diagnostic imaging ; Gestational Age ; Perinatal Death ; Umbilical Arteries/diagnostic imaging ; Ultrasonography, Doppler ; Pregnancy Outcome
Language	English
Publishing date	2022-06-01
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2000931-8
ISSN	1471-0528 ; 0306-5456 ; 1470-0328
ISSN (online)	1471-0528
ISSN	0306-5456 ; 1470-0328
DOI	10.1111/1471-0528.17181
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Article ; Online: Maternal and neonatal immune response to SARS-CoV-2, IgG transplacental transfer and cytokine profile.

Rubio, Rocío / Aguilar, Ruth / Bustamante, Mariona / Muñoz, Erica / Vázquez-Santiago, Miquel / Santano, Rebeca / Vidal, Marta / Melero, Natalia Rodrigo / Parras, Daniel / Serra, Pau / Santamaria, Pere / Carolis, Carlo / Izquierdo, Luis / Gómez-Roig, Maria Dolores / Dobaño, Carlota / Moncunill, Gemma / Mazarico, Edurne

Frontiers in immunology

2022 Volume 13, Page(s) 999136

Abstract: SARS-CoV-2 infected pregnant women are at increased risk of severe COVID-19 than non-pregnant women and have a higher risk of adverse pregnancy outcomes like intrauterine/fetal distress and preterm birth. However, little is known about the impact of SARS- ...

Abstract	SARS-CoV-2 infected pregnant women are at increased risk of severe COVID-19 than non-pregnant women and have a higher risk of adverse pregnancy outcomes like intrauterine/fetal distress and preterm birth. However, little is known about the impact of SARS-CoV-2 infection on maternal and neonatal immunological profiles. In this study, we investigated the inflammatory and humoral responses to SARS-CoV-2 in maternal and cord blood paired samples. Thirty-six pregnant women were recruited at delivery at Hospital Sant Joan de Déu, Barcelona, Spain, between April-August 2020, before having COVID-19 available vaccines. Maternal and pregnancy variables, as well as perinatal outcomes, were recorded in questionnaires. Nasopharyngeal swabs and maternal and cord blood samples were collected for SARS-CoV-2 detection by rRT-PCR and serology, respectively. We measured IgM, IgG and IgA levels to 6 SARS-CoV-2 antigens (spike [S], S1, S2, receptor-binding domain [RBD], nucleocapsid [N] full-length and C-terminus), IgG to N from 4 human coronaviruses (OC43, HKU1, 229E and NL63), and the concentrations of 30 cytokines, chemokines and growth factors by Luminex. Mothers were classified as infected or non-infected based on the rRT-PCR and serology results. Sixty-four % of pregnant women were infected with SARS-CoV-2 (positive by rRT-PCR during the third trimester and/or serology just after delivery). None of the newborns tested positive for rRT-PCR. SARS-CoV-2 infected mothers had increased levels of virus-specific antibodies and several cytokines. Those with symptoms had higher cytokine levels. IFN-α was increased in cord blood from infected mothers, and in cord blood of symptomatic mothers, EGF, FGF, IL-17 and IL-15 were increased, whereas RANTES was decreased. Maternal IgG and cytokine levels showed positive correlations with their counterparts in cord blood. rRT-PCR positive mothers showed lower transfer of SARS-CoV-2-specific IgGs, with a stronger effect when infection was closer to delivery. SARS-CoV-2 infected mothers carrying a male fetus had higher antibody levels and higher EGF, IL-15 and IL-7 concentrations. Our results show that SARS-CoV-2 infection during the third trimester of pregnancy induces a robust antibody and cytokine response at delivery and causes a significant reduction of the SARS-CoV-2-specific IgGs transplacental transfer, with a stronger negative effect when the infection is closer to delivery.
MeSH term(s)	Antibodies, Viral ; COVID-19 ; Chemokine CCL5 ; Epidermal Growth Factor ; Female ; Humans ; Immunity ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Infant, Newborn ; Interleukin-15 ; Interleukin-17 ; Interleukin-7 ; Male ; Pregnancy ; Premature Birth ; SARS-CoV-2 ; Vaccines
Chemical Substances	Antibodies, Viral ; Chemokine CCL5 ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Interleukin-15 ; Interleukin-17 ; Interleukin-7 ; Vaccines ; Epidermal Growth Factor (62229-50-9)
Language	English
Publishing date	2022-09-27
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2022.999136
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Article ; Online: Efficacy and safety of hydroxychloroquine for treatment of mild SARS-CoV-2 infection and prevention of COVID-19 severity in pregnant and postpartum women: A randomized, double-blind, placebo-controlled trial.

Acta obstetricia et gynecologica Scandinavica

2023 Volume 103, Issue 3, Page(s) 602–610

Abstract: Introduction: Pregnant women have an increased risk of severe COVID-19. Evaluation of drugs with a safety reproductive toxicity profile is a priority. At the beginning of the pandemic, hydroxychloroquine (HCQ) was recommended for COVID-19 treatment.: ... ...

Abstract	Introduction: Pregnant women have an increased risk of severe COVID-19. Evaluation of drugs with a safety reproductive toxicity profile is a priority. At the beginning of the pandemic, hydroxychloroquine (HCQ) was recommended for COVID-19 treatment. Material and methods: A randomized, double-blind, placebo-controlled clinical trial was conducted in eight teaching hospitals in Spain to evaluate the safety and efficacy of HCQ in reducing viral shedding and preventing COVID-19 progression. Pregnant and postpartum women with a positive SARS-CoV-2 PCR (with or without mild COVID-19 signs/symptoms) and a normal electrocardiogram were randomized to receive either HCQ orally (400 mg/day for 3 days and 200 mg/day for 11 days) or placebo. PCR and electrocardiogram were repeated at day 21 after treatment start. Enrollment was stopped before reaching the target sample due to low recruitment rate. Trial registration EudraCT #: 2020-001587-29, on April 2, 2020. Clinical trials: gov # NCT04410562, registered on June 1, 2020. Results: A total of 116 women (75 pregnant and 41 post-partum) were enrolled from May 2020 to June 2021. The proportion of women with a positive SARS-CoV-2 PCR at day 21 was lower in the HCQ group (21.8%, 12/55) than in the placebo group (31.6%, 18/57), although the difference was not statistically significant (P = 0.499). No differences were observed in COVID-19 progression, adverse events, median change in QTc, hospital admissions, preeclampsia or poor pregnancy and perinatal outcomes between groups. Conclusions: HCQ was found to be safe in pregnant and postpartum women with asymptomatic or mild SARS-CoV-2 infection. Although the prevalence of infection was decreased in the HCQ group, the statistical power was insufficient to confirm the potential beneficial effect of HCQ for COVID-19 treatment.
MeSH term(s)	Female ; Humans ; Pregnancy ; COVID-19/prevention & control ; SARS-CoV-2 ; Hydroxychloroquine/adverse effects ; COVID-19 Drug Treatment ; Postpartum Period ; Double-Blind Method ; Treatment Outcome
Chemical Substances	Hydroxychloroquine (4QWG6N8QKH)
Language	English
Publishing date	2023-12-14
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	80019-3
ISSN	1600-0412 ; 0001-6349
ISSN (online)	1600-0412
ISSN	0001-6349
DOI	10.1111/aogs.14745
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Article ; Online: Second- to Third-Trimester Longitudinal Growth Assessment for the Prediction of Largeness for Gestational Age and Macrosomia in an Unselected Population.

Caradeux, Javier / Eixarch, Elisenda / Mazarico, Edurne / Basuki, Tri Rahmat / Gratacós, Eduard / Figueras, Francesc

Fetal diagnosis and therapy

2017 Volume 43, Issue 4, Page(s) 284–290

Abstract: Background: Prenatal detection of excessive growth remains inaccurate. Most strategies rely on a single cross-sectional evaluation of fetal size during the third trimester.: Objectives: To compare second- to third-trimester longitudinal growth ... ...

Abstract	Background: Prenatal detection of excessive growth remains inaccurate. Most strategies rely on a single cross-sectional evaluation of fetal size during the third trimester. Objectives: To compare second- to third-trimester longitudinal growth assessment with cross-sectional evaluation at the third trimester in the prediction of largeness for gestational age (LGA) and macrosomia. Methods: A cohort of 2,696 unselected singleton pregnancies scanned at 21 ± 2 and 32 ± 2 weeks was created. Abdominal circumference (AC) measurements were transformed to z values according to the INTERGROWTH-21st standards. Longitudinal growth assessment was performed by calculation of z velocity and conditional growth. Both methods were compared to cross-sectional assessment at 32 ± 2 weeks. Predictive performance for LGA and macrosomia was determined by receiver operating characteristic curve analysis. Result: A total of 188 (7%) newborns qualified for LGA and 182 (6.8%) for macrosomia. The areas under the curve (AUCs) for 32-week AC z score, AC z velocity, and conditional AC were 0.78, 0.61, and 0.55, respectively, for the prediction of LGA, and 0.75, 0.61, and 0.55, respectively, for the prediction of macrosomia. Both AUCs of AC z velocity and conditional AC were significantly lower (p < 0.001) than the AUC of cross-sectional AC z scores. Conclusions: In the general population, second- to third-trimester longitudinal assessment of fetal growth is inferior to third-trimester cross-sectional evaluation of size in the prediction of LGA and macrosomia.
MeSH term(s)	Adult ; Cross-Sectional Studies ; Female ; Fetal Development/physiology ; Fetal Macrosomia/diagnosis ; Fetal Weight/physiology ; Gestational Age ; Humans ; Male ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Ultrasonography, Prenatal
Language	English
Publishing date	2017-07-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	1066460-9
ISSN	1421-9964 ; 1015-3837
ISSN (online)	1421-9964
ISSN	1015-3837
DOI	10.1159/000477460
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Article ; Online: Early Prophylactic Enoxaparin for the Prevention of Preeclampsia and Intrauterine Growth Restriction: A Randomized Trial.

Llurba, Elisa / Bella, Miriam / Burgos, Jorge / Mazarico, Edurne / Gómez-Roig, María Dolores / De Diego, Raül / Martínez-Astorquiza, Txanton / Alijotas-Reig, Jaume / Sánchez-Durán, María Ángeles / Sánchez, Olga / Carreras, Elena / Cabero, Lluís

Fetal diagnosis and therapy

2020 Volume 47, Issue 11, Page(s) 824–833

Abstract: Background: Preeclampsia (PE) and intrauterine growth restriction (IUGR) are major causes of maternal and perinatal morbidity and mortality. Previous studies have shown that intervention with low-dose aspirin resulted in a reduction in the occurrence of ...

Abstract	Background: Preeclampsia (PE) and intrauterine growth restriction (IUGR) are major causes of maternal and perinatal morbidity and mortality. Previous studies have shown that intervention with low-dose aspirin resulted in a reduction in the occurrence of preterm PE. However, no data are currently available on the effect of low-molecular-weight heparin (LMWH) for the prevention of pregnancy complications in women enrolled at first trimester screening. Objective: We aimed to assess the effectiveness of LMWH in the prevention of PE, IUGR, fetal death, and abruptio placentae in women classified as high risk based on their medical history and in women selected by first trimester screening of PE. Study -Design: This was a multicenter, randomized, open-label, parallel controlled trial in women without thrombophilia between 6.0 and 15.6 weeks of gestation. Inclusion criteria were severe PE or IUGR before 34 weeks of gestation and/or abruptio placentae or unexplained intrauterine death in a previous pregnancy; uterine artery mean pulsatility index Doppler >95th percentile and/or positive first trimester screening for PE. Pregnant women were randomly assigned to receive no intervention or LMWH until the 36th week of gestation. The primary composite outcome consisted of 1 or more of the following: development of PE, IUGR, abruptio placentae, and intrauterine fetal death. Results: A total of 278 pregnant women were randomly allocated to receive LMWH (n = 134) or no intervention (n = 144). Overall, 115 (41%) women experienced placental insufficiency complications, with no significant differences between the 2 arms: 50/144 (34.7%) in the LMWH arm and 43/134 (32%) in the control arm (p = 0.64, OR: 1.13, 95% CI: 0.68-1.85). Conclusion: LMWH did not reduce the incidence of placenta-mediated complications either in women with previous adverse obstetric history without thrombophilia or in women selected by first trimester screening for PE. Based on these results, we cannot recommend the use of LMWH alone in women at risk of placental complications.
MeSH term(s)	Enoxaparin/therapeutic use ; Female ; Fetal Growth Retardation/prevention & control ; Heparin, Low-Molecular-Weight/therapeutic use ; Humans ; Infant, Newborn ; Placenta ; Pre-Eclampsia/diagnosis ; Pre-Eclampsia/epidemiology ; Pre-Eclampsia/prevention & control ; Pregnancy
Chemical Substances	Enoxaparin ; Heparin, Low-Molecular-Weight
Language	English
Publishing date	2020-08-25
Publishing country	Switzerland
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	1066460-9
ISSN	1421-9964 ; 1015-3837
ISSN (online)	1421-9964
ISSN	1015-3837
DOI	10.1159/000509662
Database	MEDical Literature Analysis and Retrieval System OnLINE

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