First trimester origins of fetal growth impairment
Section snippets
Early pregnancy assessment of growth
The major ultrasonic measure of fetal growth in early pregnancy is the crown rump length (CRL), which is conceptually self-explanatory and technically described elsewhere.2 Early fetal growth can be assessed by comparing the actual size of the embryo or fetus with the expected size on the basis of standard growth charts and the last menstrual period (LMP).5 Use of the LMP assumes ovulation occurs on day 14, where day 1 is the first day of the last menses. While this is true on average, the
Placental function in the first trimester
A detailed discussion of placental development in the first trimester of pregnancy is outside the scope of this review and many key aspects of this subject has previously been reviewed in detail.18, 19, 20 The key issue in the context of this review is the mechanism by which the fetus obtains nutrition at different stages of pregnancy. Since invasion of the decidua and myometrium is a feature of the first trimester in the human, it might be assumed that fetal nutrition in early pregnancy is
Biochemical and doppler interrogation of early placental function
There are several approaches which have interrogated the relationship between first trimester placentation and subsequent pregnancy outcome. First, the relationship between circulating concentrations of trophoblast derived proteins in early pregnancy and subsequent outcome has been studied. Second the predictive ability of first trimester Doppler assessment of uterine vascular resistance has been studied as a proxy for the effectiveness of early trophoblast invasion. Third, a number of studies
PAPP-A and free β human chorionic gonadotrophin
Large scale studies relating the outcome of pregnancy to maternal circulating concentrations of trophoblast derived proteins in the first trimester have tended to focus on biochemical assays employed in assessment of Down syndrome risk, specifically, pregnancy associated plasma protein A (PAPP-A) and the free β subunit of human chorionic gonadotrophin (FβhCG). Early studies of first trimester measurement of PAPP-A, FβhCG and perinatal outcome reported inconsistent results. One study compared
Other indicators of first trimester placental function
There are very few data on other circulating placentally derived proteins and later pregnancy complications. A single study reported higher levels of placenta growth factor in early pregnancy among fetuses which were ultimately delivered small for gestational age.40 However, ultrasound can also be used to assess early placental function. It has been shown that women with a uterine artery pulsatility index in the uppermost quartile at 12 to 13 weeks have a 4-fold risk of hypertensive disorders
References (59)
Maternal weight gain, infant birth weight, and dietcausal sequences
Am J Clin Nutr
(1991)- et al.
Impairment of growth in fetuses destined to deliver preterm
Am J Obstet Gynecol
(2001) - et al.
Intertwin disparity in fetal size in monochorionic and dichorionic pregnancies
Obste Gyneco
(1998) - et al.
Maternal menstrual history and small-for-gestational-age births in a population-based Chinese birth cohort
Early Hum Dev
(1997) - et al.
Nutrition of the human fetus during the first trimester—a review
Placenta
(2001) - et al.
Post-implantation differentiation and proliferation of cytotrophoblast cellsIn vitro models--A review
Placenta
(2000) The human placental bed revisited
Placenta
(2002)- et al.
Maternal arterial connections to the placental intervillous space during the first trimester of human pregnancyThe Boyd collection revisited
Am J Obstet Gynecol
(1999) - et al.
Combined ultrasound and biochemical screening for Down’s syndrome in the first trimesterA Scottish multicentre study
Br J Obstet Gynaecol
(2002) Role of insulin-like growth factor binding proteins in controlling IGF actions
Mol Cell Endocrinol
(1998)
First-trimester maternal serum levels of placenta growth factor as predictor of preeclampsia and fetal growth restriction
Obstet. Gynecol
Three-dimensional ultrasound measurement of the placental volume in early pregnancyMethod and correlation with biochemical placenta parameters
Placenta
Fetal nutrition and adult disease
Am J Clin Nutr
Pregnancy complications and maternal risk of ischaemic heart diseaseA retrospective cohort study of 129,290 births
Lancet
Occurence of pregnancy, abortion and artificial menopause among women with coronary heart diseaseA preliminary study
J Chron Dis
Age trend of mortality from coronary heart disease in women and observations on the reproductive patterns of those affected
Am Heart J
Regulation of fetal growth
Clinical applications of ultrasonic fetal measurements
Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia5 year randomised controlled trial
BMJ
A critical evaluation of sonar “crown-rump length” measurements
Br J Obstet Gynaecol
The normal menstrual cycle
Ultrasound evidence for variability in the size and development of normal human embryos before the tenth post-insemination week after assisted reproductive technologies
Hum Reprod
Incidence and significance of unequal gestational sac diameter or embryo crown-rump length in twin pregnancy
Hum Reprod
First-trimester growth and the risk of low birth weight
N Engl J Med
First trimester growth and the risk of adverse pregnancy outcome
J Soc Gynecol Invest
Gestational age and induction of labour for prolonged pregnancy
Br J Obstet Gynaecol
Does a discrepancy between gestational age determined by biparietal diameter and last menstrual period sometimes signify early intrauterine growth retardation?
Br J Obstet Gynaecol
A discrepancy between gestational age estimated by last menstrual period and biparietal diameter may indicate an increased risk of fetal death and adverse pregnancy outcome
Br J Obstet Gynaecol
Adverse obstetric outcome in fetuses that are smaller than expected at second trimester routine ultrasound examination
Acta Obstet Gynecol Scand
Cited by (91)
3.05 - Diet and Microbiota During Pregnancy
2022, Comprehensive Gut MicrobiotaTransrectal three-dimensional fetal volumetry in early pregnant mares: Relationships between maternal factors and equine fetal volume measurements
2021, TheriogenologyCitation Excerpt :As the fetus grows its requirements for oxygen and nutrients increase and any imbalance can have a limiting effect on fetal growth and maturation [19]. However, there is a growing body of evidence in human reproductive medicine that the origin of fetal growth retardation is established during early pregnancy [20]. In women it was found that FV measurements during the first trimester of pregnancy are superior for detection of impaired fetal growth [6,7] and moreover correlate better with birth weight than CRL measurements [8].
Term birthweight and critical windows of prenatal exposure to average meteorological conditions and meteorological variability
2020, Environment InternationalCitation Excerpt :More research is certainly needed, but this hints at the possibility that epigenetic programing might be involved in the relationship between humidity and fetal growth. In our study, reduced term birthweight was associated with increased mean humidity during the end of the pregnancy, which corresponds to the developmental period where the baby gains the most weight (Smith 2004). Boys and girls are known to have different fetal growth patterns both early and late in gestation, and have also been found to have different levels of sensitivity to various prenatal stressors (Jedrychowski et al. 2009; Vik et al. 2003).
Regulation of human trophoblast syncytialization by histone demethylase LSD1
2019, Journal of Biological Chemistry