Exposure to placental insufficiency alters postnatal growth trajectory in extremely low birth weight infants

Abstract

<jats:title>Abstract</jats:title><jats:p>Growth in the immediate postnatal period for extremely low birth weight (ELBW, birth weight &lt; 1000 g) infants is an important topic in neonatal medicine. The goal is to ensure adequate postnatal growth and to minimize complications resulting from suboptimal growth. Past efforts have focused on postnatal nutrition as well as on minimizing comorbidities. It has not been systematically assessed whether antenatal factors play a role in postnatal growth. In this report, we conducted a retrospective study on 91 maternal–neonatal pairs. We prospectively collected maternal and neonatal demographic data, neonatal nutrition in the first 7 days of life and after enteral nutrition is fully established, comorbidity data, as well as weight data from birth to 50 weeks corrected gestational age. We developed a linear mixed-effects model to examine the role of placental insufficiency, as defined by fetal Doppler studies, in postnatal weight <jats:italic>z</jats:italic>-score trajectory over time in the ELBW population. We relied on Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) for model selection. Interestingly, the selected model included a quadratic term of time and a placental insufficiency-by-time interaction term. In a covariate analysis, AIC and BIC both favored a model that included calories intake in the first 7 days of life and the total duration of antibiotics as fixed-effects, but not their interaction terms with time. Overall, we demonstrated for the first time that placental insufficiency, an antenatal factor, is a major determinant of postnatal weight trajectory in the ELBW population. Prospective studies are warranted to confirm our findings.</jats:p>

Child wasting and concurrent stunting in low- and middle-income countries

“…Additionally, placental insufficiency causes a large proportion of intrauterine growth restriction leading to birth wasting, and rapid WLZ gain after may reflect true recovery to a child’s growth potential after this constraint is removed. 35, 36 Consistent with larger WLZ increases during recovery from wasting among younger children, a larger proportion of children recovered within 30, 60, and 90 days if the wasting episode occurred before 6 months of age (Fig 3d). Younger children had more variable WLZ (SD: 0.81 <6 months, 0.54 from 6-24 months) and shorter wasting episodes (Extended Data Fig 9).…”

“…Seasonal food insecurity coincides with peak energy demands during agricultural work periods, which in turn leads to undernutrition among pregnant and lactating mothers and their children. 17, 36, 51 Women working in agriculture often have less time to spend with their children, which can reduce breastfeeding frequency and can result in early morning preparation of weaning foods that become contaminated in hot, humid conditions. 53, 54 Weather-driven seasonal increases in infectious disease transmission could also play a role in seasonal wasting, but the effect would vary spatially and temporally and would not fully explain the consistent patterns observed here.…”

The SLC25A42 Transcript Is a Biomarker for Fetal Reprogramming in Response to Placental Insufficiency in Preterm Newborns Under 32 Weeks Gestation—A Pilot Study

“…However, in such case, fetal reprogramming likely has already occurred, and therefore the associated short-term and long-term adverse outcomes (e.g., neurodevelopmental abnormalities and cardiometabolic risks) may have already become irreversible. Indeed, a recent study suggested that exposure to placental insufficiency by itself was sufficient to significantly alter postnatal growth trajectories, likely due to fetal reprogramming ( 10 ). Therefore, it is very likely that the developmental trajectory of the fetus is already altered and compromised when IUGR becomes detectable clinically.…”

“…Based on the absence or presence of maternal preeclampsia and placental insufficiency, E/VPNs were assigned to one of the three groups for comparison: [1] no maternal preeclampsia or placental insufficiency (the non-PE/PI group); [2] maternal preeclampsia but no placental insufficiency (the PE group); and [3] placental insufficiency (the PI group). Maternal preeclampsia diagnosis was based on maternal chart review, and placental insufficiency in this study was defined as abnormal UA blood flow, including a pulsatility index of >95%, absent end-diastolic flow, or reversed end-diastolic flow ( 8 , 10 ). The grouping strategy was based solely on chart review of maternal diagnosis and the most recent umbilical Doppler findings prior to delivery without further considering underlying etiologies (e.g., TORCH infections, maternal smoking, pre-existing maternal hypertension, etc.).…”

The application of in utero magnetic resonance imaging in the study of the metabolic and cardiovascular consequences of the developmental origins of health and disease

“… 105 Since the placenta provides nutrients and oxygen to the developing fetus via the maternal blood supply, any reduction in the placenta’s blood flow and perfusion may result in FGR. 106 , 107 To improve clinical diagnostic capabilities for FGR and better understand placental function, several studies have used specialized MRI techniques to investigate normal and abnormal perfusion across placental compartments and assess microstructure and microvasculature. These techniques include diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), intravoxel incoherent motion (IVIM), arterial spin-labeling (ASL), and phase-contrast MRI (PC-MRI).…”