Interval growth across gestation in pregnancies with fetal gastroschisis

Zhang-Rutledge, Kathy; Jacobs, Marni; Patberg, Elizabeth; Field, Nancy T.; Holliman, Kerry; Strobel, K.; Murphy, Aisling; Robles, Diana; Rangwala, Naseem; González, Juan M.; Sparks, Teresa N.

doi:10.1016/j.ajogmf.2021.100415

Cited by 2 publications

(6 citation statements)

References 28 publications

(22 reference statements)

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“…We accounted for this uncertainty using sensitivity analyses and found that our results were robust across a wide range of values. Estimates of weight in fetuses with gastroschisis are known to be limited by inaccurate measurements of abdominal circumference, and the positive predictive value of prenatal ultrasounds for the prediction of birth weight <10th percentile is 53% or less 8,43 . Thus, our model accounted for neonates who were truly growth restricted as well as those who were incorrectly diagnosed with FGR.…”

Section: Discussionmentioning

confidence: 99%

“…Estimates of weight in fetuses with gastroschisis are known to be limited by inaccurate measurements of abdominal circumference, and the positive predictive value of prenatal ultrasounds for the prediction of birth weight <10th percentile is 53% or less. 8,43 Thus, our model accounted for neonates who were truly growth restricted as well as those who were incorrectly diagnosed with FGR. However, this reflects real life clinical practice and diagnosis of FGR in fetuses with gastroschisis.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of gastroschisis has increased over time for reasons that are not well understood, with a 105%–137% change between 2005 and 2018 3,4 . Gastroschisis is an important diagnosis to identify prenatally given the risks of numerous associated complications such as FGR; preterm birth; stillbirth; and atresia, stenosis, perforation, volvulus or necrosis of the intestines 5–7 . However, the optimal antenatal management strategy for fetuses with gastroschisis is not clear, particularly when it comes to timing of delivery for cases with FGR.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Sixty percent of fetuses with gastroschisis meet criteria for FGR during pregnancy, although interval growth across gestation may be more robust than previously understood. 7 Importantly, a concomitant diagnosis of FGR further increases risks of stillbirth, preterm birth, and other adverse neonatal outcomes, and the optimal timing of delivery for mitigating risks associated with gastroschisis and FGR are not known. 8,9 Previous studies, including one decision analysis and another that evaluated prospective risk of stillbirth, suggested that delivery at 37-38 weeks gestation minimizes risks of pre-and postnatal mortality in cases of gastroschisis.…”

Section: Introductionmentioning

confidence: 99%

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Optimal timing of delivery for growth restricted fetuses with gastroschisis: A decision analysis

Packer,

Pilliod,

Caughey

et al. 2023

Prenatal Diagnosis

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ObjectiveOur objective was to determine the optimal timing of delivery of growth restricted fetuses with gastroschisis in the setting of normal umbilical artery (UA) Dopplers.MethodsWe designed a decision analytic model using TreeAge software for a hypothetical cohort of 2000 fetuses with isolated gastroschisis, fetal growth restriction (FGR), and normal UA Dopplers across 34–39 weeks of gestation. This model accounted for costs and quality adjusted life years (QALYs) for the pregnant individual and the neonate. Model outcomes included stillbirth, respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), short gut syndrome (SGS), neonatal sepsis, neonatal death, and neurodevelopmental disability (NDD).ResultsWe found 38 weeks to be the optimal timing of delivery for minimizing overall perinatal mortality and leading to the highest total QALYs. Compared to 37 weeks, delivery at 38 weeks resulted in 367.98 more QALYs, 2.22 more cases of stillbirth, 2.41 fewer cases of RDS, 0.02 fewer cases of NEC, 1.65 fewer cases of IVH, 0.5 fewer cases of SGS, 2.04 fewer cases of sepsis, 11.8 fewer neonatal deaths and 3.37 fewer cases of NDD. However, 39 weeks were the most cost‐effective strategy with a savings of $1,053,471 compared to 38 weeks. Monte Carlo analysis demonstrated that 38 weeks was the optimal gestational age for delivery 51.70% of the time, 39 weeks were optimal 47.40% of the time, and 37 weeks was optimal 0.90% of the time.ConclusionTaking into consideration a range of adverse perinatal outcomes and cost effectiveness, 38–39 weeks gestation is ideal for the delivery of fetuses with gastroschisis, FGR, and normal UA Dopplers. However, there are unique details to consider for each case, and the timing of delivery should be individualized using shared multidisciplinary decision making.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Optimal timing of delivery for growth restricted fetuses with gastroschisis: A decision analysis

Packer,

Pilliod,

Caughey

et al. 2023

Prenatal Diagnosis

Self Cite

View full text Add to dashboard Cite

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The amniotic fluid proteome changes across gestation in humans and rhesus macaques

Shorey-Kendrick,

Crosland,

Spindel

et al. 2023

Sci Rep

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Amniotic fluid is a complex biological medium that offers protection to the fetus and plays a key role in normal fetal nutrition, organogenesis, and potentially fetal programming. Amniotic fluid is also critically involved in longitudinally shaping the in utero milieu during pregnancy. Yet, the molecular mechanism(s) of action by which amniotic fluid regulates fetal development is ill-defined partly due to an incomplete understanding of the evolving composition of the amniotic fluid proteome. Prior research consisting of cross-sectional studies suggests that the amniotic fluid proteome changes as pregnancy advances, yet longitudinal alterations have not been confirmed because repeated sampling is prohibitive in humans. We therefore performed serial amniocenteses at early, mid, and late gestational time-points within the same pregnancies in a rhesus macaque model. Longitudinally-collected rhesus amniotic fluid samples were paired with gestational-age matched cross-sectional human samples. Utilizing LC–MS/MS isobaric labeling quantitative proteomics, we demonstrate considerable cross-species similarity between the amniotic fluid proteomes and large scale gestational-age associated changes in protein content throughout pregnancy. This is the first study to compare human and rhesus amniotic fluid proteomic profiles across gestation and establishes a reference amniotic fluid proteome. The non-human primate model holds promise as a translational platform for amniotic fluid studies.

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Interval growth across gestation in pregnancies with fetal gastroschisis

Cited by 2 publications

References 28 publications

Optimal timing of delivery for growth restricted fetuses with gastroschisis: A decision analysis

Optimal timing of delivery for growth restricted fetuses with gastroschisis: A decision analysis

The amniotic fluid proteome changes across gestation in humans and rhesus macaques

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