In cancer patients, including women with a diagnosis of ovarian cancer, cancer antigen 125 (CA125... more In cancer patients, including women with a diagnosis of ovarian cancer, cancer antigen 125 (CA125) is used to evaluate the presence of peritoneal involvement. The aims of the present study were to assess CA125 reference intervals and reference change values (RCV) in postmenopausal reference women, postmenopausal women breast cancer free, reference men and cancer free men. The series consisted of 433 subjects: 105 postmenopausal breast cancer free women and 56 cancer free men in addition to a total of 272 reference subjects (145 postmenopausal women and 127 men). Repeated CA125 measurements were made in a subset of 149 women and 54 men to calculate RCV and index of individuality. Serum CA125 levels were evaluated by a chemiluminescent assay. In postmenopausal reference women, the mean CA125 value and 2.5th-97.5th percentiles were 6.70, 2.60-11.00 kU/L, respectively, with a unidirectional RCV of 38.4%. In postmenopausal breast cancer free women, the mean CA125 value and 2.5th-97.5th percentile were 7.45, 4.09-10.92 kU/L, respectively, with a RCV of 34.5%. The difference between the means was statistically significant (t=-3.02, p=0.003). In the two male subgroups, the difference between the means for CA125 was not statistically significant (t=0.43, p=0.665). On considering the entire male population, the mean CA125 value and 2.5th-97.5th percentiles were 7.50 and 2.40-13.2 kU/L, respectively, while the unidirectional RCV was 34.3%. In all the studied groups, the indices of individuality were equal to or below 0.6. The extremely low index of individuality found underlines the importance of using the RCV instead of absolute values as a parameter when interpreting the CA125 data in the monitoring and follow-up of patients with ovarian cancer.
Labor induction has been associated with breastfeeding suppression, but reasons for why this asso... more Labor induction has been associated with breastfeeding suppression, but reasons for why this association exists have not been well determined. We examined the influence of elective labor induction by vaginal prostaglandin at gestational week 41(+3)days on affective, cognitive, and behavioural adaptations early in puerperium and on breastfeeding pattern at 1 and 3months. One hundred and eighty consecutive puerperae were assigned to two groups: mothers having received vaginal prostaglandin E2 gel (Prepidil®, dinoprostone) before labor (PGE group, n=90) and mothers having received no treatment (unmedicated group, n=90). The day of discharge mothers completed the Edinburg Postnatal Depression Scale, (EPDS), State and Trait Anxiety Inventory (STAI-Y), and Mother to-Infant Bonding Scale (MIBS). Later they participated in telephone interviews concerning their breastfeeding practices at 1 and 3months, which were classified according to WHO definitions. When compared with unmedicated, PGE group puerperae scored [median, (IQR)] significantly higher EPDS [9 (7-13) vs 5 (3-8), p 0.003], STAI-state [46 (39-51) vs 39 (34-48), p 0.002], STAI-trait [39 (36-48) vs 34 (32-45), p 0.04], and MIBS [10 (5.25-10) vs 5 (3-4), p 0.002] scores. In addition, while the breastfeeding practices were similar at hospital discharge, at follow-up the labor induced mothers were less likely to maintain full breastfeeding with respect to untreated mothers: 1month (p 0.001); and 3months (p 0.003). We present evidence that elective induction of labor by prostaglandins at gestational week 41(+3)days is associated with reduced exclusive breastfeeding rates at 1 and 3months after discharge and higher EPDS, STAI, and MIBS scores.
Women with type 2 diabetes were less likely to have diabetes related complications than women wit... more Women with type 2 diabetes were less likely to have diabetes related complications than women with type 1. Women with type 1 diabetes had a high prepregnancy care and showed a worse glycemic control than women with type 2 both in the preconception period and during pregnancy. Obstetrical outcomes showed that preeclampsia and stillbirth rate is almost doubled in type 1 patients while perinatal deaths and SGA importantly increased in type 2 diabetes. In modern obstetrical care it is mandatory to maintain glucose levels as close to normal as possible particularly in diabetic population. HbA1C no higher than 6% before pregnancy and during the first trimester seems to decrease the risk of adverse obstetrical outcomes. Both the preconceptional counseling and glycemic profile optimization represent a fundamental step to improve pregnancy outcomes in women with preexisting diabetes. A systematic approach to family planning and the availability of preconception care for all diabetic women who desire pregnancy could be an essential step for diabetic management program.
Oral poster abstracts between IUGR and SGA (P = 0.003), IUGR and AGA (P < 0.0001), SGA and AGA P ... more Oral poster abstracts between IUGR and SGA (P = 0.003), IUGR and AGA (P < 0.0001), SGA and AGA P < 0.003). IUGR showed a significant difference in perinatal morbidity between SGA and AGA (P < 0.0001). Conclusions: The present study highlights that aIMT is higher in IUGR compared to SGA vs. AGA and in SGA vs. AGA fetuses, highlighting that Doppler velocimetry and birth weight are predictors of aorta stiffness. Moreover, to our knowledge this is the first study considering aIMT in twin pregnancies, which may be considered a model of study to consider early cardiovascular markers in the same environment.
prenatal clinic setting. Maternal levels of PAPP-A were measured at the time of the first prenata... more prenatal clinic setting. Maternal levels of PAPP-A were measured at the time of the first prenatal visit (9 to 13+6 weeks) as part of the combined ultrasound and biochemical screening study. Low PAPP-A was defined as the lowest 5% of values for gestational age (< 0.4 MoM) and high AFP was defined as the top 5% of values for gestational age (> 1.9 MoM). Intrauterine growth restriction was defined as birth-weight ≤ 3 th centile according to our local customized charts. The risk of IUGR in women with a low PAPP-A and normal AFP was compared with a control group with low PAPP-A and high AFP. No results were reported to either the obstetrician or patient. Results: A total of 5617 pregnant women were attended for prenatal care in our institution between January 2010 and December 2011. Of the 301 patients with a PAPP-A < 0.4 MoM, 141 had a determination of AFP done between 15 and 18 weeks and perinatal outcome is known for 96 of these patients. Women with a low PAPP-A were not more likely to have elevated levels of AFP. Only 4 patients (4.2%) had a low PAPP-A and high AFP. We had 6 cases of IUGR (6%): 3 cases (3.2%) in the group of low PAPP-A and normal AFP and 3 cases (75%) in the group of low PAPP-A and high AFP. The odds ratio for delivering a baby with IUGR for women with low PAPP-A and high AFP was 89 (95% confidence interval [CI] 7-1127). Conclusions: Although the small numbers of the study, this preliminary data suggest that low maternal levels of PAPP-A between 8 and 13+6 weeks and high levels of AFP between 15 and 18 weeks are highly associated with IUGR.
Objectives: Ultrasound dating is essential in modern pregnancy care. Thus, it is imperative that ... more Objectives: Ultrasound dating is essential in modern pregnancy care. Thus, it is imperative that the dating models are reliable. In early prenatal diagnostics, the international use of standardized measurement techniques and analyses has contributed to reproducible results
Objectives: Ultrasound dating is essential in modern pregnancy care. Thus, it is imperative that ... more Objectives: Ultrasound dating is essential in modern pregnancy care. Thus, it is imperative that the dating models are reliable. In early prenatal diagnostics, the international use of standardized measurement techniques and analyses has contributed to reproducible results
Intrauterine growth restriction (IUGR) may be associated with significantly higher aortic intima-... more Intrauterine growth restriction (IUGR) may be associated with significantly higher aortic intima-media thickening (aIMT) values. It is unknown if fetal aIMT is associated with glomerulosclerosis and amniotic albuminuria in utero. Fetal abdominal aIMT and amniotic albumin/creatinine ratio (ACR) were measured in 126 individual twin fetuses, recruited by the Obstetrics and Gynaecology Clinics of the University of Padua (Italy) Medical Center. The IUGR twin fetuses were classified into two groups: Group A were those fetuses whose estimated fetal weight (EFW) was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10th percentile with pulsatility index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;2 SD and Group B were those fetuses whose EFW was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10th percentile and had no velocimetry abnormalities. The median fetal aIMT was significantly different in the three groups (Group A = 0.9 mm; Group B = 0.7 mm; and appropriate for gestational age (AGA) = 0.5 mm; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). It was significantly higher in Group A than in the AGA group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001) and than in the Group B fetuses (p = .003), respectively. In addition, ACR was different in the three groups (Group A = 183,500 mg/g; Group B = 6,4720 mg/g; and AGA = 8,2750 mg/g; p = .0002). It was significantly higher in Group A than in the AGA group (p = .03) and than in Group B (p = .02), respectively. Growth-restricted twin fetuses with velocimetry abnormalities present are associated with aIMT and higher ACR levels in amniotic fluid, which could be possible markers in utero of preclinical atherosclerosis, and early glomerulosclerosis.
Background and aims: Low birth weight, caused either by preterm birth and/or intrauterine growth ... more Background and aims: Low birth weight, caused either by preterm birth and/or intrauterine growth restriction (IUGR), has recently been associated with increased rates of renal and cardiovascular disease in adulthood. Since aortic intima-media thickening (aIMT) is a non-invasive marker of preclinical vascular disease (Skilton MR et al. Lancet 2005; Cosmi E et al.Obstet Gynecol 2009) in IUGR neonates, we compared abdominal aIMT and glomerular function among IUGR and appropriate gestational age foetuses (AGA) in-utero and at 18 months of age. . The relationship between IUGR, fetal aIMT and glomerular function, particularly microalbuminuria (immunochromatographic method), creatininuria (Jaffé's method), ACR and related sodiuria (nephelometric method) during infancy was measured by enrolling 50 mothers with single-fetus pregnancies during third trimester ultrasound scan: 25 IUGR and 25 AGA as controls. aIMT was measured by ultrasound at enrollment and again at 18 months.
Journal of Developmental Origins of Health and Disease, 2013
Over recent years, studies have demonstrated links between risk of cardiovascular disease in adul... more Over recent years, studies have demonstrated links between risk of cardiovascular disease in adulthood and adverse events that occurred very early in life during fetal development. The concept that there are embryonic and fetal adaptive responses to a sub-optimal intrauterine environment often brought about by poor maternal diet that result in permanent adverse consequences to life-long health is consistent with the definition of "programming". The purpose of this review is to provide an overview of the current knowledge of the effects of intrauterine growth restriction (IUGR) on long-term cardiac structure and function, with particular emphasis on the effects of maternal protein restriction. Much of our recent knowledge has been derived from animal models. We review the current literature of one of the most commonly used models of IUGR (maternal protein restriction in rats), in relation to birth weight and postnatal growth, blood pressure and cardiac structure and function. In doing so, we highlight the complexity of developmental programming, with regards to timing, degree of severity of the insult, genotype and the subsequent postnatal phenotype.
To develop an Electronic Data Capture (EDC) software framework and web interface for the multi-ce... more To develop an Electronic Data Capture (EDC) software framework and web interface for the multi-centric clinical studies from the International Endometrial Tumor Analysis (IETA) group. Additionally, to take into account the specific requirements of imaging modalities, it should be possible to show pictograms to clarify questions. The software framework should have a modular design and make defining new studies easy. Methods: The software framework and web interface were developed using a test-driven development approach, allowing automated quality assurance. For security purposes, all communication between clinicians' computers and server are encrypted, and the server runs a firewall. To prevent data loss, the database is backed up and replicated daily to a remote location. Results: New studies can be defined using Excel spreadsheets. Pictograms can be shown next to questions or next to the possible selections of multiple-choice questions. Apart from input fields and multiple-choice questions, the interface supports the use of Visual Analogue Scales (VAS). Fields only applicable for certain values of a previous field will be shown or skipped depending on the previous field's value (''skip pattern''). The web interface provides auto-completion and interactive validation. The software so far has been used by four clinicians for a total of 102 patients. A survey among five clinicians from three different clinical centers showed high satisfaction with CDM's user-friendliness (median 8, range 7-9). Conclusions: We have created a multi-centric EDC software framework that can be applied to a broad range of clinical studies. The framework is built in a modular way, enabling e.g. integration in hospital IT-environments. The possibility to show images next to questions or multiple-choice categories is very useful for studies evaluating imaging modalities.
Methods: 196 patients who underwent laser therapy for TTTS between 2004 and 2007 were included. C... more Methods: 196 patients who underwent laser therapy for TTTS between 2004 and 2007 were included. Cervical lengths (CL), measured by trans-vaginal ultrasound (TVS), and cervical colonization patterns were analyzed 24 h before laser. All women received a single dose of 1 g Cefazolin i.v. before the procedure. We investigated the association between cervical length, an abnormal smear and spontaneous abortion or PTD leading to fetal loss. Results: 16 women (8.2%) lost both fetuses by miscarriage or extremely PTD leading to immediate neonatal death. CL was significantly shorter in those who aborted. However, 7 women with a CL of < 20 mm gave birth to at least one survivor. Smear results were attributed to 3 groups: local standard flora (1), bacterial vaginosis or other abnormality and presence of fetopathic microorganisms. Of 190 smears, 79 were classified as normal , 111 as abnormal (group 2: n = 63, group 3: n = 48). There was no association between an abnormal smear (group 2+3) before laser and pregnancy loss (OR 0.8; P = 0.53). Conclusions: TVS is superior to cervical smears in identifying patients at risk for pregnancy loss. There is no reason to deny laser treatment to any woman with TTTS not in labor on the basis of an abnormal smear or a short cervix. Questionable negative effects of group B streptococci (GBS) infection will undergo further investigation.
Oral poster abstracts between IUGR and SGA (P = 0.003), IUGR and AGA (P < 0.0001), SGA and AGA P ... more Oral poster abstracts between IUGR and SGA (P = 0.003), IUGR and AGA (P < 0.0001), SGA and AGA P < 0.003). IUGR showed a significant difference in perinatal morbidity between SGA and AGA (P < 0.0001). Conclusions: The present study highlights that aIMT is higher in IUGR compared to SGA vs. AGA and in SGA vs. AGA fetuses, highlighting that Doppler velocimetry and birth weight are predictors of aorta stiffness. Moreover, to our knowledge this is the first study considering aIMT in twin pregnancies, which may be considered a model of study to consider early cardiovascular markers in the same environment.
Results: Median fetal aIMT was significantly greater in Group A IUGR twin fetuses compared with G... more Results: Median fetal aIMT was significantly greater in Group A IUGR twin fetuses compared with Group B IUGR and AGA twin fetuses (P < 0.001). In addition, median amniotic fluid albumin concentration and median albumin/creatinine ratio were significantly higher in the group A IUGR twins, compared with group B IUGR and AGA twin fetuses (P = 0.01 and P = 0.0002, respectively). Conclusions: This natural twinning model of pregnancy nutrient restriction highlights that IUGR twin fetuses with Doppler velocimetry abnormalities showed greater values of aIMT, higher microalbumin and ACR levels in amniotic fluid. These alterations might be possible markers of preclinical atherosclerosis and early glomerulosclerosis in utero.
Results: A total of 653 cases were analyzed. The isthmus had been completely opened (isthmus leng... more Results: A total of 653 cases were analyzed. The isthmus had been completely opened (isthmus length = 0 mm) in 15.9%, 21.6% and 24.1% of the cases at 11, 12 and 13 weeks' gestation. The frequencies of perinatal complications in the cases whose isthmus had been opened (cases) and the other cases (controls) were as follows; 1.4% and 1.0% (ns) for placenta previa, 1.4% and 1.2% (ns) for abnormal cord insertion, 3.5% and 4.3% (ns) for preeclampsia, 9.9% and 9.0% (ns) for small for gestational age, and 12.0% and 7.6% (ns) for preterm delivery, respectively. Conclusions: Early opening of the uterine isthmus at 11 to 13 weeks' gestation does not appear to adversely affect either the placental development or the course of pregnancy.
In cancer patients, including women with a diagnosis of ovarian cancer, cancer antigen 125 (CA125... more In cancer patients, including women with a diagnosis of ovarian cancer, cancer antigen 125 (CA125) is used to evaluate the presence of peritoneal involvement. The aims of the present study were to assess CA125 reference intervals and reference change values (RCV) in postmenopausal reference women, postmenopausal women breast cancer free, reference men and cancer free men. The series consisted of 433 subjects: 105 postmenopausal breast cancer free women and 56 cancer free men in addition to a total of 272 reference subjects (145 postmenopausal women and 127 men). Repeated CA125 measurements were made in a subset of 149 women and 54 men to calculate RCV and index of individuality. Serum CA125 levels were evaluated by a chemiluminescent assay. In postmenopausal reference women, the mean CA125 value and 2.5th-97.5th percentiles were 6.70, 2.60-11.00 kU/L, respectively, with a unidirectional RCV of 38.4%. In postmenopausal breast cancer free women, the mean CA125 value and 2.5th-97.5th percentile were 7.45, 4.09-10.92 kU/L, respectively, with a RCV of 34.5%. The difference between the means was statistically significant (t=-3.02, p=0.003). In the two male subgroups, the difference between the means for CA125 was not statistically significant (t=0.43, p=0.665). On considering the entire male population, the mean CA125 value and 2.5th-97.5th percentiles were 7.50 and 2.40-13.2 kU/L, respectively, while the unidirectional RCV was 34.3%. In all the studied groups, the indices of individuality were equal to or below 0.6. The extremely low index of individuality found underlines the importance of using the RCV instead of absolute values as a parameter when interpreting the CA125 data in the monitoring and follow-up of patients with ovarian cancer.
Labor induction has been associated with breastfeeding suppression, but reasons for why this asso... more Labor induction has been associated with breastfeeding suppression, but reasons for why this association exists have not been well determined. We examined the influence of elective labor induction by vaginal prostaglandin at gestational week 41(+3)days on affective, cognitive, and behavioural adaptations early in puerperium and on breastfeeding pattern at 1 and 3months. One hundred and eighty consecutive puerperae were assigned to two groups: mothers having received vaginal prostaglandin E2 gel (Prepidil®, dinoprostone) before labor (PGE group, n=90) and mothers having received no treatment (unmedicated group, n=90). The day of discharge mothers completed the Edinburg Postnatal Depression Scale, (EPDS), State and Trait Anxiety Inventory (STAI-Y), and Mother to-Infant Bonding Scale (MIBS). Later they participated in telephone interviews concerning their breastfeeding practices at 1 and 3months, which were classified according to WHO definitions. When compared with unmedicated, PGE group puerperae scored [median, (IQR)] significantly higher EPDS [9 (7-13) vs 5 (3-8), p 0.003], STAI-state [46 (39-51) vs 39 (34-48), p 0.002], STAI-trait [39 (36-48) vs 34 (32-45), p 0.04], and MIBS [10 (5.25-10) vs 5 (3-4), p 0.002] scores. In addition, while the breastfeeding practices were similar at hospital discharge, at follow-up the labor induced mothers were less likely to maintain full breastfeeding with respect to untreated mothers: 1month (p 0.001); and 3months (p 0.003). We present evidence that elective induction of labor by prostaglandins at gestational week 41(+3)days is associated with reduced exclusive breastfeeding rates at 1 and 3months after discharge and higher EPDS, STAI, and MIBS scores.
Women with type 2 diabetes were less likely to have diabetes related complications than women wit... more Women with type 2 diabetes were less likely to have diabetes related complications than women with type 1. Women with type 1 diabetes had a high prepregnancy care and showed a worse glycemic control than women with type 2 both in the preconception period and during pregnancy. Obstetrical outcomes showed that preeclampsia and stillbirth rate is almost doubled in type 1 patients while perinatal deaths and SGA importantly increased in type 2 diabetes. In modern obstetrical care it is mandatory to maintain glucose levels as close to normal as possible particularly in diabetic population. HbA1C no higher than 6% before pregnancy and during the first trimester seems to decrease the risk of adverse obstetrical outcomes. Both the preconceptional counseling and glycemic profile optimization represent a fundamental step to improve pregnancy outcomes in women with preexisting diabetes. A systematic approach to family planning and the availability of preconception care for all diabetic women who desire pregnancy could be an essential step for diabetic management program.
Oral poster abstracts between IUGR and SGA (P = 0.003), IUGR and AGA (P < 0.0001), SGA and AGA P ... more Oral poster abstracts between IUGR and SGA (P = 0.003), IUGR and AGA (P < 0.0001), SGA and AGA P < 0.003). IUGR showed a significant difference in perinatal morbidity between SGA and AGA (P < 0.0001). Conclusions: The present study highlights that aIMT is higher in IUGR compared to SGA vs. AGA and in SGA vs. AGA fetuses, highlighting that Doppler velocimetry and birth weight are predictors of aorta stiffness. Moreover, to our knowledge this is the first study considering aIMT in twin pregnancies, which may be considered a model of study to consider early cardiovascular markers in the same environment.
prenatal clinic setting. Maternal levels of PAPP-A were measured at the time of the first prenata... more prenatal clinic setting. Maternal levels of PAPP-A were measured at the time of the first prenatal visit (9 to 13+6 weeks) as part of the combined ultrasound and biochemical screening study. Low PAPP-A was defined as the lowest 5% of values for gestational age (< 0.4 MoM) and high AFP was defined as the top 5% of values for gestational age (> 1.9 MoM). Intrauterine growth restriction was defined as birth-weight ≤ 3 th centile according to our local customized charts. The risk of IUGR in women with a low PAPP-A and normal AFP was compared with a control group with low PAPP-A and high AFP. No results were reported to either the obstetrician or patient. Results: A total of 5617 pregnant women were attended for prenatal care in our institution between January 2010 and December 2011. Of the 301 patients with a PAPP-A < 0.4 MoM, 141 had a determination of AFP done between 15 and 18 weeks and perinatal outcome is known for 96 of these patients. Women with a low PAPP-A were not more likely to have elevated levels of AFP. Only 4 patients (4.2%) had a low PAPP-A and high AFP. We had 6 cases of IUGR (6%): 3 cases (3.2%) in the group of low PAPP-A and normal AFP and 3 cases (75%) in the group of low PAPP-A and high AFP. The odds ratio for delivering a baby with IUGR for women with low PAPP-A and high AFP was 89 (95% confidence interval [CI] 7-1127). Conclusions: Although the small numbers of the study, this preliminary data suggest that low maternal levels of PAPP-A between 8 and 13+6 weeks and high levels of AFP between 15 and 18 weeks are highly associated with IUGR.
Objectives: Ultrasound dating is essential in modern pregnancy care. Thus, it is imperative that ... more Objectives: Ultrasound dating is essential in modern pregnancy care. Thus, it is imperative that the dating models are reliable. In early prenatal diagnostics, the international use of standardized measurement techniques and analyses has contributed to reproducible results
Objectives: Ultrasound dating is essential in modern pregnancy care. Thus, it is imperative that ... more Objectives: Ultrasound dating is essential in modern pregnancy care. Thus, it is imperative that the dating models are reliable. In early prenatal diagnostics, the international use of standardized measurement techniques and analyses has contributed to reproducible results
Intrauterine growth restriction (IUGR) may be associated with significantly higher aortic intima-... more Intrauterine growth restriction (IUGR) may be associated with significantly higher aortic intima-media thickening (aIMT) values. It is unknown if fetal aIMT is associated with glomerulosclerosis and amniotic albuminuria in utero. Fetal abdominal aIMT and amniotic albumin/creatinine ratio (ACR) were measured in 126 individual twin fetuses, recruited by the Obstetrics and Gynaecology Clinics of the University of Padua (Italy) Medical Center. The IUGR twin fetuses were classified into two groups: Group A were those fetuses whose estimated fetal weight (EFW) was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10th percentile with pulsatility index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;2 SD and Group B were those fetuses whose EFW was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10th percentile and had no velocimetry abnormalities. The median fetal aIMT was significantly different in the three groups (Group A = 0.9 mm; Group B = 0.7 mm; and appropriate for gestational age (AGA) = 0.5 mm; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). It was significantly higher in Group A than in the AGA group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001) and than in the Group B fetuses (p = .003), respectively. In addition, ACR was different in the three groups (Group A = 183,500 mg/g; Group B = 6,4720 mg/g; and AGA = 8,2750 mg/g; p = .0002). It was significantly higher in Group A than in the AGA group (p = .03) and than in Group B (p = .02), respectively. Growth-restricted twin fetuses with velocimetry abnormalities present are associated with aIMT and higher ACR levels in amniotic fluid, which could be possible markers in utero of preclinical atherosclerosis, and early glomerulosclerosis.
Background and aims: Low birth weight, caused either by preterm birth and/or intrauterine growth ... more Background and aims: Low birth weight, caused either by preterm birth and/or intrauterine growth restriction (IUGR), has recently been associated with increased rates of renal and cardiovascular disease in adulthood. Since aortic intima-media thickening (aIMT) is a non-invasive marker of preclinical vascular disease (Skilton MR et al. Lancet 2005; Cosmi E et al.Obstet Gynecol 2009) in IUGR neonates, we compared abdominal aIMT and glomerular function among IUGR and appropriate gestational age foetuses (AGA) in-utero and at 18 months of age. . The relationship between IUGR, fetal aIMT and glomerular function, particularly microalbuminuria (immunochromatographic method), creatininuria (Jaffé's method), ACR and related sodiuria (nephelometric method) during infancy was measured by enrolling 50 mothers with single-fetus pregnancies during third trimester ultrasound scan: 25 IUGR and 25 AGA as controls. aIMT was measured by ultrasound at enrollment and again at 18 months.
Journal of Developmental Origins of Health and Disease, 2013
Over recent years, studies have demonstrated links between risk of cardiovascular disease in adul... more Over recent years, studies have demonstrated links between risk of cardiovascular disease in adulthood and adverse events that occurred very early in life during fetal development. The concept that there are embryonic and fetal adaptive responses to a sub-optimal intrauterine environment often brought about by poor maternal diet that result in permanent adverse consequences to life-long health is consistent with the definition of "programming". The purpose of this review is to provide an overview of the current knowledge of the effects of intrauterine growth restriction (IUGR) on long-term cardiac structure and function, with particular emphasis on the effects of maternal protein restriction. Much of our recent knowledge has been derived from animal models. We review the current literature of one of the most commonly used models of IUGR (maternal protein restriction in rats), in relation to birth weight and postnatal growth, blood pressure and cardiac structure and function. In doing so, we highlight the complexity of developmental programming, with regards to timing, degree of severity of the insult, genotype and the subsequent postnatal phenotype.
To develop an Electronic Data Capture (EDC) software framework and web interface for the multi-ce... more To develop an Electronic Data Capture (EDC) software framework and web interface for the multi-centric clinical studies from the International Endometrial Tumor Analysis (IETA) group. Additionally, to take into account the specific requirements of imaging modalities, it should be possible to show pictograms to clarify questions. The software framework should have a modular design and make defining new studies easy. Methods: The software framework and web interface were developed using a test-driven development approach, allowing automated quality assurance. For security purposes, all communication between clinicians' computers and server are encrypted, and the server runs a firewall. To prevent data loss, the database is backed up and replicated daily to a remote location. Results: New studies can be defined using Excel spreadsheets. Pictograms can be shown next to questions or next to the possible selections of multiple-choice questions. Apart from input fields and multiple-choice questions, the interface supports the use of Visual Analogue Scales (VAS). Fields only applicable for certain values of a previous field will be shown or skipped depending on the previous field's value (''skip pattern''). The web interface provides auto-completion and interactive validation. The software so far has been used by four clinicians for a total of 102 patients. A survey among five clinicians from three different clinical centers showed high satisfaction with CDM's user-friendliness (median 8, range 7-9). Conclusions: We have created a multi-centric EDC software framework that can be applied to a broad range of clinical studies. The framework is built in a modular way, enabling e.g. integration in hospital IT-environments. The possibility to show images next to questions or multiple-choice categories is very useful for studies evaluating imaging modalities.
Methods: 196 patients who underwent laser therapy for TTTS between 2004 and 2007 were included. C... more Methods: 196 patients who underwent laser therapy for TTTS between 2004 and 2007 were included. Cervical lengths (CL), measured by trans-vaginal ultrasound (TVS), and cervical colonization patterns were analyzed 24 h before laser. All women received a single dose of 1 g Cefazolin i.v. before the procedure. We investigated the association between cervical length, an abnormal smear and spontaneous abortion or PTD leading to fetal loss. Results: 16 women (8.2%) lost both fetuses by miscarriage or extremely PTD leading to immediate neonatal death. CL was significantly shorter in those who aborted. However, 7 women with a CL of < 20 mm gave birth to at least one survivor. Smear results were attributed to 3 groups: local standard flora (1), bacterial vaginosis or other abnormality and presence of fetopathic microorganisms. Of 190 smears, 79 were classified as normal , 111 as abnormal (group 2: n = 63, group 3: n = 48). There was no association between an abnormal smear (group 2+3) before laser and pregnancy loss (OR 0.8; P = 0.53). Conclusions: TVS is superior to cervical smears in identifying patients at risk for pregnancy loss. There is no reason to deny laser treatment to any woman with TTTS not in labor on the basis of an abnormal smear or a short cervix. Questionable negative effects of group B streptococci (GBS) infection will undergo further investigation.
Oral poster abstracts between IUGR and SGA (P = 0.003), IUGR and AGA (P < 0.0001), SGA and AGA P ... more Oral poster abstracts between IUGR and SGA (P = 0.003), IUGR and AGA (P < 0.0001), SGA and AGA P < 0.003). IUGR showed a significant difference in perinatal morbidity between SGA and AGA (P < 0.0001). Conclusions: The present study highlights that aIMT is higher in IUGR compared to SGA vs. AGA and in SGA vs. AGA fetuses, highlighting that Doppler velocimetry and birth weight are predictors of aorta stiffness. Moreover, to our knowledge this is the first study considering aIMT in twin pregnancies, which may be considered a model of study to consider early cardiovascular markers in the same environment.
Results: Median fetal aIMT was significantly greater in Group A IUGR twin fetuses compared with G... more Results: Median fetal aIMT was significantly greater in Group A IUGR twin fetuses compared with Group B IUGR and AGA twin fetuses (P < 0.001). In addition, median amniotic fluid albumin concentration and median albumin/creatinine ratio were significantly higher in the group A IUGR twins, compared with group B IUGR and AGA twin fetuses (P = 0.01 and P = 0.0002, respectively). Conclusions: This natural twinning model of pregnancy nutrient restriction highlights that IUGR twin fetuses with Doppler velocimetry abnormalities showed greater values of aIMT, higher microalbumin and ACR levels in amniotic fluid. These alterations might be possible markers of preclinical atherosclerosis and early glomerulosclerosis in utero.
Results: A total of 653 cases were analyzed. The isthmus had been completely opened (isthmus leng... more Results: A total of 653 cases were analyzed. The isthmus had been completely opened (isthmus length = 0 mm) in 15.9%, 21.6% and 24.1% of the cases at 11, 12 and 13 weeks' gestation. The frequencies of perinatal complications in the cases whose isthmus had been opened (cases) and the other cases (controls) were as follows; 1.4% and 1.0% (ns) for placenta previa, 1.4% and 1.2% (ns) for abnormal cord insertion, 3.5% and 4.3% (ns) for preeclampsia, 9.9% and 9.0% (ns) for small for gestational age, and 12.0% and 7.6% (ns) for preterm delivery, respectively. Conclusions: Early opening of the uterine isthmus at 11 to 13 weeks' gestation does not appear to adversely affect either the placental development or the course of pregnancy.
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Papers by Martina Bertin