Prophylaxis and treatment of foetal growth restriction

Nawathe, Aamod; David, Anna L.

doi:10.1016/j.bpobgyn.2018.02.007

Cited by 21 publications

(10 citation statements)

References 80 publications

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“…Hypertension during pregnancy is a known cause of IUGR (98), and although we found women at risk of HDPs based on elevated MAP, none of the blood pressure indicators was associated with low SFH. This differs from several other studies.…”

Section: Bp Measurements and Symphysis-fundal Heightcontrasting

confidence: 66%

Identification of High-Risk Pregnancies in a Remote Setting Using Ambulatory Blood Pressure: The MINDI Cohort

Gonzalez‐Fernandez

Pons²,

Rueda

et al. 2020

Front. Public Health

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Conclusion: MINDI were bi-directionally associated with blood pressure indicators. In this MINDI cohort, infections, nutrients and cytokines both raised, and lowered BP indices. The presence of eMAP identified pregnant women at risk of hypertension whereas low PP was associated with lower SFH. Therefore, MAP and PP may help in detecting women at risk of adverse pregnancy outcomes in settings with limited access to technology.

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Section: Bp Measurements and Symphysis-fundal Heightcontrasting

confidence: 66%

Identification of High-Risk Pregnancies in a Remote Setting Using Ambulatory Blood Pressure: The MINDI Cohort

Gonzalez‐Fernandez

Pons²,

Rueda

et al. 2020

Front. Public Health

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“…To date, there is no cure for pregnancy complicated by chronic fetal hypoxia to protect against fetal growth restriction or programmed cardiovascular dysfunction in the offspring. Treatment options are restricted to monitoring surrogate measures of fetal hypoxia and fetal growth, ultimately ending up in elective delivery of the offspring [20]. This highlights the need for experimental studies addressing underlying mechanisms to identify plausible intervention.…”

Section: Introductionmentioning

confidence: 99%

Intervention against hypertension in the next generation programmed by developmental hypoxia

et al. 2019

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Evidence derived from human clinical studies and experimental animal models shows a causal relationship between adverse pregnancy and increased cardiovascular disease in the adult offspring. However, translational studies isolating mechanisms to design intervention are lacking. Sheep and humans share similar precocial developmental milestones in cardiovascular anatomy and physiology. We tested the hypothesis in sheep that maternal treatment with antioxidants protects against fetal growth restriction and programmed hypertension in adulthood in gestation complicated by chronic fetal hypoxia, the most common adverse consequence in human pregnancy. Using bespoke isobaric chambers, chronically catheterized sheep carrying singletons underwent normoxia or hypoxia (10% oxygen [O2]) ± vitamin C treatment (maternal 200 mg.kg−1 IV daily) for the last third of gestation. In one cohort, the maternal arterial blood gas status, the value at which 50% of the maternal hemoglobin is saturated with oxygen (P50), nitric oxide (NO) bioavailability, oxidative stress, and antioxidant capacity were determined. In another, naturally delivered offspring were raised under normoxia until early adulthood (9 months). Lambs were chronically instrumented and cardiovascular function tested in vivo. Following euthanasia, femoral arterial segments were isolated and endothelial function determined by wire myography. Hypoxic pregnancy induced fetal growth restriction and fetal oxidative stress. At adulthood, it programmed hypertension by enhancing vasoconstrictor reactivity and impairing NO-independent endothelial function. Maternal vitamin C in hypoxic pregnancy improved transplacental oxygenation and enhanced fetal antioxidant capacity while increasing NO bioavailability, offsetting constrictor hyper-reactivity and replenishing endothelial function in the adult offspring. These discoveries provide novel insight into mechanisms and interventions against fetal growth restriction and adult-onset programmed hypertension in an animal model of complicated pregnancy in a species of similar temporal developmental milestones to humans.

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“…Fetal growth restriction (FGR) and associated placental disorders emerge in early pregnancy, when the inadequate remodeling of maternal spiral arteries leads to persistent, high-resistance, lowflow uteroplacental circulation. Current interventions have been targeting placental ischemia-reperfusion injuries and oxidative stress associated with imbalance in angiogenic and antiangiogenic factors [25]. Hence, the current results indicate that heparin can improve fetal prognosis by reducing the likelihood of having pregnant women with thrombophilia giving birth to low growth-pattern fetuses.…”

Section: Resultsmentioning

confidence: 90%

“…Importantly, studies conducted in vitro and in vivo have suggested that low molecular weight heparin can prevent fetal growth restriction. However, randomized controlled trials have shown inconsistent and conflicting evidences [23][24][25][26][27].…”

Section: Resultsmentioning

confidence: 99%

Heparin Use in Pregnant Women Diagnosed With Thrombophilia: Obstetric Outcomes

Andrade¹,

Camargos²,

Reis³

et al. 2019

Clinics Mother Child Health

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Introduction: Thrombophilias are associated with venous thromboembolism. According to reports, uteroplacental thrombosis can lead to preeclampsia, intrauterine growth restriction (IUGR), placental abruption (PA) and even to fetal death. The Brazilian Ministry of Health recommends the application of heparin treatment-associated, or not, with ASA to pregnant women diagnosed with thrombophilia, based on its type. However, many studies have not been able to confirm the beneficial effects of heparin use on maternal and fetal health. Methods: The current research is a case-control study comprising pregnant women treated at the Obstetrics Service of Federal University of Juiz de Fora and at the Medical School of Barbacena, who used heparin in the current pregnancy due to previously diagnosed thrombophilia. Current pregnancy associated with heparin use was named 'case', whereas previous pregnancy without heparin use was named 'control'. Thus, 47 cases (current pregnancy) and 32 controls were selected (1,4 cases: 1,0 control). Results: Association between heparin and miscarriage, intrauterine fetal death and preeclampsia were analyzed. Results showed that heparin acted as protective factor against miscarriage (OR=0.04; CI=0.01-0.14; p<0.0001), intrauterine fetal death (OR=0.01; CI=0.01-0.11; but heparin use did not reduce the frequency of preeclampsia cases (OR=0.35; CI=0.07-1.6; p=0.17). Conclusion: Based on the current results, the early heparin application to pregnant women with thrombophilia was able to reduce the number of miscarriage, intrauterine death, but did not reduce the frequency of preeclampsia.

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Prophylaxis and treatment of foetal growth restriction

Cited by 21 publications

References 80 publications

Identification of High-Risk Pregnancies in a Remote Setting Using Ambulatory Blood Pressure: The MINDI Cohort

Identification of High-Risk Pregnancies in a Remote Setting Using Ambulatory Blood Pressure: The MINDI Cohort

Intervention against hypertension in the next generation programmed by developmental hypoxia

Heparin Use in Pregnant Women Diagnosed With Thrombophilia: Obstetric Outcomes

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