The predictive value of the uterine artery pulsatility index during the early third trimester for the occurrence of adverse pregnancy outcomes depending on the maternal obesity

Kim, Yeon Hee; Lee, Hee Joung; Shin, Joon Han; Lee, Young; Shin, Jong Chul; Park, Tae Chul; Park, In Yang

doi:10.1016/j.orcp.2014.12.001

Cited by 11 publications

(6 citation statements)

References 23 publications

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“…Kim et al, in their study examining the relationship between maternal obesity and uterine artery in obese pregnancies at 24-38th weeks, reported that the increase in uterine artery PI caused vascular dysfunction and consequently negative fetal outcomes. 39 In addition to the limited literature on this subject, our study found similar results at 24-28th weeks.…”

Section: Discussionsupporting

confidence: 84%

Comparison of brachial artery flow‐mediated dilatation, uterine artery Doppler, and umbilical artery Doppler measurements in obese and normal pregnant women

Aksin

Andan

Tunç

et al. 2021

J of Obstet and Gynaecol

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Objective In this study, we aimed to compare vascular function at trimesters 1, 2, and 3 between obese and normal pregnant women through brachial artery flow‐mediated dilatation (FMD), uterine artery Doppler, and umbilical artery Doppler measurements. Methods Pregnant women between the ages of 18 and 40 who presented to our clinic were included. Brachial artery FMD, uterine and umbilical artery Doppler, and clinical parameters of 40 obese pregnant women from each trimester between 11 and 14 weeks, 24 and 28 weeks, 37 and 40 weeks and control pregnant group in the same number and gestational week were examined. Results In all three trimesters, the FMD value was lower in obese pregnant women compared to normal women with adequate weight (p < 0.001). In obese pregnant women, lower FMD values were observed in the second trimester compared to other trimesters (p = 0.011) Cut‐off value of FMD below 14.35 in obese pregnant women was found to be associated with gestational diabetes mellitus. Uterine artery Doppler in obese pregnant women started to increase from the second trimester compared to normal women with adequate weight. Conclusion Obese pregnant women have endovascular dysfunction compared to normal pregnant women and this becomes evident from the second trimester.

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Section: Discussionsupporting

confidence: 84%

Comparison of brachial artery flow‐mediated dilatation, uterine artery Doppler, and umbilical artery Doppler measurements in obese and normal pregnant women

Aksin

Andan

Tunç

et al. 2021

J of Obstet and Gynaecol

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“…2020) and there is increased likelihood of uterine artery PI above the normal range (Kim et al . 2015). GDM has been associated with impairment of endothelium‐dependent vasorelaxation (Knock et al .…”

Section: Discussionmentioning

confidence: 99%

“…The physiological drop in uterine artery PI via vascular remodelling during pregnancy is essential to enable low resistance placental blood flow to support fetal growth. In human pregnancy, maternal overweight/obesity is associated with an attenuation in the physiological drop in uterine artery PI (Teulings et al 2020) and there is increased likelihood of uterine artery PI above the normal range (Kim et al 2015). GDM has been associated with impairment of endothelium-dependent vasorelaxation (Knock et al 1997), which has been demonstrated in a murine GDM model with consequent increased uterine artery resistance (Stanley et al 2011).…”

Section: Discussionmentioning

confidence: 99%

Maternal but not fetoplacental health can be improved by metformin in a murine diet‐induced model of maternal obesity and glucose intolerance

Hufnagel

Fernandez‐Twinn

Blackmore

et al. 2021

The Journal of Physiology

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Maternal obesity is a global problem that increases the risk of short-and long-term adverse outcomes for mother and child, many of which are linked to gestational diabetes mellitus. Effective treatments are essential to prevent the transmission of poor metabolic health from mother to child. Metformin is an effective glucose lowering drug commonly used to treat gestational diabetes mellitus; however, its wider effects on maternal and fetal health are poorly explored. In this study we used a mouse (C57Bl6/J) model of diet-induced (high sugar/high fat) maternal obesity to explore the impact of metformin on maternal and feto-placental health. Metformin (300 mg kg −1 day −1 ) was given to obese females via the diet and was shown to achieve clinically relevant concentrations in maternal serum (1669 ± 568 nM in late pregnancy). Obese dams developed glucose intolerance during pregnancy and had reduced uterine artery compliance. Metformin treatment of obese dams improved maternal glucose tolerance, reduced maternal fat mass and restored uterine artery function. Placental efficiency was reduced in obese dams, with increased calcification and reduced labyrinthine area. Consequently, fetuses from obese dams weighed less (P < 0.001) at the end of gestation. Despite normalisation of maternal parameters, metformin did not correct placental structure or fetal growth restriction. Metformin levels were substantial in the placenta and fetal circulation (109.7 ± 125.4 nmol g −1 in the placenta and 2063 ± 2327 nM in fetal plasma). These findings reveal the distinct effects of metformin administration during pregnancy on mother and fetus and highlight the complex balance of risk vs. benefits that are weighed in obstetric medical treatments.

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“…This is the basis for the "developmental origins of health and disease" theory set forth by Dr. David Barker and colleagues. The importance of understanding the developmental programming of chronic disease is becoming increasingly relevant due to the rising exposure rates of offspring to poor intrauterine environments, such as maternal smoking and drug use, maternal under-or overnutrition, obe-sity, maternal diabetes, environmental toxins, or hypertensive disorders of pregnancy (25,57,107,216). Hypertensive disorders of pregnancy, including preeclampsia (PE), affect~9% of pregnancies in the United States (retrieved February 12, 2018: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/ pregnancy-complications-data.htm).…”

Section: Introductionmentioning

confidence: 99%

Developmental origins of nonalcoholic fatty liver disease as a risk factor for exaggerated metabolic and cardiovascular-renal disease

Spradley

Smith

Alexander

et al. 2018

American Journal of Physiology-Endocrinology and Metabolism

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Intrauterine growth restriction (IUGR) is linked to increased risk for chronic disease. Placental ischemia and insufficiency in the mother are implicated in predisposing IUGR offspring to metabolic dysfunction, including hypertension, insulin resistance, abnormalities in glucose homeostasis, and non-alcoholic fatty liver disease (NAFLD). Whether these metabolic disturbances contribute to the developmental origins of exaggerated cardiovascular-renal disease (CVRD) risk accompanying IUGR is unclear. IUGR impacts the pancreas, adipose tissue, and liver, which are hypothesized to program for hepatic insulin resistance and subsequent NAFLD. NAFLD is projected to become the major cause of chronic liver disease and contributor to uncontrolled Type 2 Diabetes Mellitus (T2DM), which is a leading cause of chronic kidney disease. While NAFLD is increased in experimental models of IUGR, lacking is a full comprehension of the mechanisms responsible for programming of NAFLD and whether this potentiates susceptibility to liver injury. The use of well-established and clinically relevant rodent models, which mimic the clinical characteristics of IUGR, metabolic disturbances, and increased blood pressure in the offspring, will permit investigation into mechanisms linking adverse influences during early life and later chronic health. The purpose of this review is to propose mechanisms, including those pro-inflammatory in nature, whereby IUGR exacerbates the pathogenesis of NAFLD and how these adverse programmed outcomes contribute to exaggerated CVRD risk. Understanding the etiology of the developmental origins of chronic disease will allow investigators to uncover treatment strategies to intervene in the mother and her offspring to halt the increasing prevalence of metabolic dysfunction and CVRD.

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The predictive value of the uterine artery pulsatility index during the early third trimester for the occurrence of adverse pregnancy outcomes depending on the maternal obesity

Cited by 11 publications

References 23 publications

Comparison of brachial artery flow‐mediated dilatation, uterine artery Doppler, and umbilical artery Doppler measurements in obese and normal pregnant women

Comparison of brachial artery flow‐mediated dilatation, uterine artery Doppler, and umbilical artery Doppler measurements in obese and normal pregnant women

Maternal but not fetoplacental health can be improved by metformin in a murine diet‐induced model of maternal obesity and glucose intolerance

Developmental origins of nonalcoholic fatty liver disease as a risk factor for exaggerated metabolic and cardiovascular-renal disease

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