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Long-term adaptive changes occurring in a developing fetus in response to unstable in utero environmental conditions, which appear at a particular time (critical window), are called intrauterine or fetal programming. These adaptive changes are beneficial during the intrauterine period because they adapt the fetus to current needs, but may turn out to be harmful in the end and lead to development of chronic diseases in adult life. Fetal programming means the structural and functional changing of an organism, metabolism and function of some cells, tissues and systems, that occur even despite intrauterine limitations. Events of fetal life influence the determination of physiological patterns which may manifest as disease processes in the adulthood (Barker's hypothesis). Genetic and environmental factors (poor diet in pregnancy chronic intrauterine fetal hypoxia, the effects of xenobiotics and drugs, as well as hormonal disorders) influence the phenotype of a newborn and are involved in the intrauterine programming process. The effects of fetal programming may be passed along to the next generations via not fully understood pathways, which probably include epigenetic mechanisms. Most of the mechanisms underlying this process remain unclear and need to be elucidated.

Caffeine is a widespread known psychoactive substance that is present mainly in coffee, tea, soft and energy drinks. As a natural methylopxanthine it blocks A1 and A2 adenosine receptors and in high doses inhibits the phosphodiesterase activity. Caffeine also decreases calcium ion accumulation in the mitochondria of cardiomyocytes. A clinical and experimental data indicates that the caffeine and coffee increase the arterial wall stiffness, blood pressure and endothelium-dependent flow mediated dilatation. Caffeine also elevates cholesterol and homocysteine blood level. Moderate coffee consumption decreases the mortality of the cardiac infarct. However, acceleration of acute ischemic cardiac disease correlates with high coffee intake. The metyloxantine easily crosses the blood-placenta barrier, and may induce intrauterine growth retardation. Due to chronotropic and inotropic activity it may induce fetal tachycardia and/or extrasystolic beats.

Pregnancy is a physiological state which still needs close observation from the very beginning till the delivery to decrease the potential risk of complications for the mother and her baby. The finding of pathology is possible thanks to advanced diagnostic technology--cardiotocograph and ultrasonography, especially Doppler technique. Monitoring of the fetus is based not only on the routine obstetric examination, but also on the observation and analysis of the fetal heart rate, biometry measurements with expected fetus weight, as well as assessment of blood flow in the fetal, the umbilical and uterine vessels. Assuming that pathology in fetal heart rate can predict intrauterine discomfort, early examination and appropriate reaction to the situation is essential. Early identification of intrauterine growth restriction enables intensive treatment which improves the outcome and reduces perinatal mortality. Information concerning biophysical monitoring of a fetus and basic rules of test result interpretations of are presented in this article.

Doppler evaluation of the fetal venous system at present improves assessment of fetal well-being in many conditions. Actually, analysis of ductus venosus waveforms seems to be the most important. It place role in detection of genetic abnormalities (in low pregnancies), prediction of outcomes growth-restricted fetuses, assessment of severity of heart failure due to congestive heart anomalies, fetal infections, hydrops fetalis. Hepatic veins are known rather as an additional parameter (for ductus venosus) in the severely compromised fetus. Doppler evaluation of pulmonary veins may be useful in prediction of fetal lung maturity and in detection some difficult circulatory anomalies.

Unlabelled: The aim of the study was to evaluate cardiac function in foetuses with IUGR, using the Tei Index., Material and Methods: Prenatal echocardiographic examination was performed in 64 foetuses with intrauterine growth retardation between 25-27, 30-32, and 34-37 weeks of gestation. The control group included 30 healthy foetuses. Flow velocity waveforms of mitral and tricuspid valve and flow velocity waveforms of the aortic and pulmonic valves were obtained. The Tei Index for left and right ventricle was calculated. The heart rate was measured in all foetuses., Results: The Tei Index for left ventricle in foetuses with intrauterine growth retardation was significantly higher than in healthy foetuses (25-27 hbd - 0.6 vs. 0.58; p<0.05: 30-32 hbd -0.59 vs. 0.52; p<0.05: 34-36 hbd - 0.58 vs. 0.48; p<0.001). The Tei Index for right ventricle was also significantly higher in foetuses with intrauterine growth retardation than in the control group. The Tei Index decreased gradually with advancing gestational age and is independent of heart rate., Conclusions: l. Foetuses with intrauterine growth retardation have abnormal cardiac function in later part of gestation. 2. The Tei Index may be applied to evaluate cardiac function in foetuses.

Aim: Intrauterine growth restriction and its treatment still constitute a major clinical problem in perinatology. Since low doses of aspirin could improve the utero-placental circulation (by shifting the prostacyclin/thromboxane A2 balance), we have evaluated the impact of low-dose aspirin treatment of IUGR during pregnancy on umbilical (UA) and middle cerebral artery (MCA) blood flow., Material and Methods: The study comprised 32 pregnant women with idiopathic fetal intrauterine growth restriction (IUGR) diagnosed during pregnancy on the basis of ultrasound examination of biometric parameters (BPD, FL, AC). All the patients were treated only by low-dose aspirin (1.5 mg/kg) for 8-14 days. The: fetal biometry and calculation of blood flow indices (S/D, RI, PI) in umbilical and middle cerebral artery were performed before and after treatment., Results: Mean values of all biometric parameters of the fetuses measured before and after treatment did not show statistically important differences (AC-borderline significantly). Umbilical artery blood flow indices calculated after the treatment were slightly lower and MCA indices slightly higher, as compared to those before the treatment. Cerebro-placental ratio changed from 1.37 to 1.63 (borderline significantly)., Conclusions: IUGR treatment by low-dose aspirin had beneficial but non-significant impact on umbilical and middle cerebral artery blood flow. Since the number of subjects in this study was relatively small, further clinical studies are necessary to evaluate the effectiveness of IUGR treatment by low dose aspirin.

The second part of discussion incorporates maternal conditions influencing the risk of intrauterine growth retardation. Special attention was paid to the systemic abnormalities, and those pregnancy related, known for their links with affected placenta-uterine barrier or otherwise related to abnormal fetal growth. Both social and environmental groups of factors potentially influencing prenatal development have been discussed.

Intrauterine growth retardation (IUGR) increases a risk of perinatal complications and may carry a negative influence on a later baby's mental and physical development. Poorer function revealed by many vital organs seems to be the effect of their lower mass and their relative immaturity. In the first part of a paper the authors discuss two groups of factors thought to be responsible for IUGR. The first one has been related to the fetal status-genetic anomalies, other primary developmental defects and different growth patterns.

Ultrasonic velocimetry of the fetal circulation became a very useful method in assessment of fetal well-being, especially in high risk pregnancies. There are many papers concerning on distribution and regulation of blood flow in umbilical artery, middle cerebral artery, and much less dealing with flow velocity waveforms in inferior vena cava and ductus venosus and their clinical significance. Fetal compromise is associated with significant alterations in the fetal arterial and venous circulation. Changes in venous Doppler waveforms develop due to increased afterload and perhaps myocardial failure in deterioration after arterial redistribution is established. Doppler investigation of the fetal venous circulation may play an important role in monitoring the redistribution and may help to determine the optimal time for delivery.

Intrauterine growth restriction is associated with higher rate of complications occurring during pregnancy and in labour, increased morbidity and mortality rate in neonatal period, impaired psychosomatic development in childhood and increased susceptibility for particular diseases in adulthood. For improvement of perinatal outcome it is essential to establish objective criteria based on biophysical surveillance methods for prediction and prophylaxis of adverse outcome in IUGR pregnancies. The aim of the study was to compare selected biophysical surveillance methods in prediction and prophylaxis of complications associated with adverse pregnancy outcome in intrauterine growth restriction. There were statistically significant differences in CTG, BPS, AFI, and pulsatile index values in umbilical artery and MCA between IUGR and normal fetuses. The best predictor of adverse pregnancy outcome in IUGR fetuses was PI value in umbilical artery.

Objectives: In a pregnancy complicated with hypertension, blood flow analysis in the artery allows us to foresee threat to the fetus. Abnormal blood flow in umbilical artery makes it possible to discover vascular changes in the placenta which can endanger the life of the fetus. DESIGN IN THIS STUDY: I tried to find possible correlations between quality indices of blood flow in the foetal umbilical artery evaluated in Doppler USG in pregnancies complicated with hypertension and parameters of low molecular exchange., Material and Methods: 53 pregnancies complicated with hypertension were selected for evaluation. On basis of the result of umbilical artery flow, patients were divided into two groups: first group of 35 patients with normal values of foeto-placental flow, the second--18 patients with abnormal results of foeto-placental flow out of whom 2 were diagnosed with absence of end-diastolic blood flow. The number of epithelial plates, the number of epithelial plates in 1 mm2 and number of vessels in terminal villi were counted. The area, perimeter and diameters of terminal villi, length, thickness and area of thin epithelial plate, area of the blood vessel were estimated., Results: The morphometric analysis indicates that the quality of the foeto-placental blood flow in pregnant women with hypertension results in parameters of the filtration area in terminal villi. In cases of complicated foeto-placental blood flow, thicker blood-placental barrier i.e. epithelial plate was found., Conclusions: The results of our study indicate that the quality of feto-placental flow in pregnant women with hypertension results in parameters of the filtration area in terminal villi. In cases of complicated feto-placental blood flow a thicker blood-placental barrier i.e. epithelial plate was found.

Many papers showed that the pulsatility index of the fetal middle cerebral artery decreases during gestation. We observed equalization of the PI in MCA and PI in UMB in the perinatal period (after 38 weeks of gestation). We observed the increase the diastolic cerebral flow through the brain in cases of hypoxia. We interpreted that situation as a vasomotor response to fetal hypoxia (for example in IUGR). This phenomenon, is called in the literature as brain sparing effect. The aim of our study was estimation of application Doppler technique in diagnosis of changes in circulatory system in pregnancies complicated by intrauterine growth restriction (IUGR). We included 66 fetuses with IUGR and sonographic signs of the brain sparing effects, without any congenital malformation, oedema and genetic abnormalities to the study group. We included 1730 foetuses from normal, physiological pregnancies to the control group. In all cases time of gestation were calculated from Naegele's rule and were confirmed in sonographic examination before 16 weeks of gestation. SGA fetuses were defined on the basis of ultrasonographic measurements of BPD, HC, AC, FL and weight below 10th percentile of our reference curve. Sonographic examination were performed on Acuson 128 XP/10 with transducers (2.5 MHz-5 MHz). We performed Doppler examinations in MCA and UMB. Redistribution (brain sparing effect) was diagnosed when CPR (cerebroplacental ratio) was less than 1. We analysed the way and time of delivery and neoanatal follow up. Obtained in advance of researches results made possible expression of following conclusions: 1. Use of Doppler techniques in pregnancies complicated by IUGR makes possible diagnosis of hypoxia that helps in settlement of continuing or ending of pregnancy. 2. Changes in Doppler flows in foetus resoluteness outdistance irregular other values of biophysical methods of foetus monitoring.

We tested the concentration of alpha-2-macroglobulin in sera of 33 women bearing eutrophic newborns, 36 women bearing hypotrophic newborns and 30 healthy not pregnant women in reproductive age. The concentration of this inhibitor was measured using radial immunodiffusion method according to Mancini et al. We found distinct decrease of alpha-2-macroglobulin concentration in sera of bearing women. In women bearing eutrophic newborns we found 154 mg/dl, in women bearing hypo-trophic newborns 171 mg/dl whereas in controls 250 mg/dl. We have noted statistically significant differences between tested groups to controls and between investigated groups. Taking under consideration the role of alpha-2-macroglobulin as the modulator of immune system as well as the activity of several cytokins, therefore one can suppose that alpha-2-M may affect on cellular growth developed foetus in intrauterine.

In this paper authors presented the advantages of measuring the fibronectin levels in several diseases occurring during the pregnancy. They established usefulness of evaluating the fibronectin concentration in premature rupture of the amniotic membranes, preterm delivery, postdate pregnancy, preeclampsia, and intrauterine growth retardation.

The findings of many authors show that reduced fetal growth is followed by increased mortality from cardiovascular disease in adult life. They are further evidence that cardiovascular disease originates, among other risk factors, through programming of the bodies structure and metabolism during fetal and early post-natal life. Wrong maternal nutrition may have an important influence on programming.

Longitudinal evaluation of development at the infantile period involved 415 children, born during the period from 1985.12.01 to 1987.03.31 in two Obstetric Clinics, PMA, in Szczecin. The studied group comprised 108 eutrophic premature infants, 25 premature babies with hypotrophy, 116 full-term neonates with intrauterine hypotrophy. The control group was made up of 166 infants born at term, being eutrophic neonates. Physical development was analyzed on the basis of measuring 13 anthropometric parameters, determined in monthly compartments. Evaluation of psychomotoric development was performed by the aid of Denver's test in the 3, 6, 9 and 12 month of life. The accomplished studies have disclosed that delays in physical and psychomotor development persisted still in the 12th month of life in children of the investigated group as compared with the control one. Retardations in somatic development were more pronounced in children with hypotrophy, while disturbances in psychomotor development were recorded more frequently in premature infants, and involved spheres of locomotion and visual-motorial coordination. In the studied population the achievements in children's development were significantly correlated with the degree of maturity after birth, and past infectious diseases. Among the environmental factors, an essential influence was exerted by the education of parents, social-existential conditions of the family as well as cigarette-smoking by the mother.

The aim of the work was to study the changes in the blood flow velocity in three vessels of the uteroplacental and fetal circulation simultaneously (in umbilical artery, arcuate artery and fetal aorta) in the course of normal pregnancy and pathological one. The studies were being performed between the 20-th and 40-th weeks of gestation. The group with normal pregnancy comprised 260 patients. The second group was made up of 20 patients with pregnancies complicated by fetal hypotrophy, 15 with EPH gestosis, and 6 patients, in whom the Doppler examination revealed fetal risk state. The studies were carried out by implementing "Kranzbühler ADR 8130" ultrasonographic apparatus. Qualitative method was employed to estimate the Doppler's flow velocity waveform. For analyzing each sonogram obtained from the studied vessels use was made of three indices simultaneously: AB index, resistance index, (RI), and pulsatility index (PI). It has been recorded that the blood flow velocity in umbilical artery and arcuate artery in the course of physiological pregnancy was increasing with the progress of the pregnancy development, whereas in the fetal aorta it persisted at a constant level. In pregnancy complicated by fetal hypotrophy the blood flow velocity was diminished as compared with the norm. However, in the pregnancy complicated by EPH gestosis no significant differences were seen in the flow velocity in the umbilical artery, arcuate artery and the fetal aorta as compared with the norm, except cases being accompanied by the fetal hypotrophy. It has also been disclosed that a marked diminution of the blood flow velocity, in the final phase of diastole at the time of the heart cycle, in umbilical artery and the fetal aorta is an early indication of a fetal risk state.

Longitudinal studies of physical development in the first year of life were carried out in the group of children born with low body weight. Results were compared with those obtained in the control group. The examined group consisted of 73 children born from single pregnancies in hospitals from families living in Wola district of Warsaw. Out of 73 children, 35 were born t term as small-for-date children (DW). Remaining 38 children were prematurely born (W). The control group (K) consisted of 40 children born in hospital at term, from single pregnancy, with body-weight at birth corresponding to foetal age (25-75 centiles). They came also from families living in Wola district. Analysis of physical development was based on the results of anthropometric measurements carried out at monthly intervals through the first year of life, considering required age tolerance, using standardized measuring methods and instruments. The principles of feeding, nursing, prophylaxis of rickets and iron deficiency as well as preventive vaccinations were the same for all children. Variability with age as well as monthly and yearly gains and the index of sexual dimorphism of the following parameters were analysed: body-weight, body-length, head and chest circumference thorax and head length, shoulders width, hip width. Longitudinal observation of these children through evaluation of growth increments made the analysis of the dynamics of somatic development possible. The analysis showed differences in physical development in the first year of life in children under examination. These differences concerned both the variability of separate traits with age, and the dynamics of development, development of sexual dimorphism index in relation to the control group. The differences ere also observed between the small-to-date and prematurely born children. Developmental differences ere noted among the children born with low body-weight dependent on the achieved foetal age at birth. No tendency in small-for-date infants to decrease the differences as compared to the control group was noted. This tendency was typical of the prematurely born children. The highest developmental rate was observed in prematurely born infants.(ABSTRACT TRUNCATED AT 400 WORDS)

In the Clinical Department of Metabolic Studies of the National Research Institute of Mother and Child the attempt was made to stimulate physical development of S-F-D infants through introducing modifications in standard feeding in order to make up for the deficits of foetal age. In the years 1970-1975, 118 infants were under observation: 44 out of this group, in the Clinical Department, 70 in the Outpatient Clinic of Infant Nutrition disorders, 4 were observed both in the Clinical Department and in the Outpatient Clinic. The control group of 40 S-F-D- infants was observed in the Child Outpatient Department of Wola Borough of Warsaw. Foetal age of S-F-D infants underwent anthropometric measurements, psychological and neurological examinations. Investigations of haematological and biochemical indices were also carried out. Physical development of children in 4 (S,G,H,C) dietary groups was observed and compared with the control group. Initial diet differed from the standard diet, used at the National Research Institute of Mothers and Child, by excluding gluten and by replacing saccharose with glucose. In other diets (G, H and C) milk formulas with different quantitative and qualitative protein and fat content were enriched with unsaturated fatty acids. Longitudinal analysis included 61 infants from single pregnancies which were put on regular and sufficiently long (5-12 months) diet. Evaluation of physical development was based on the analysis of mean values, increments and rate of growth of body--length, body weight, arm, scapular and abdominal skin-fold thickness. These data are presented in Tables I-IX, variate curves of individual features in Figures 1-9. Somewhat higher developmental indices were observed in the group of infants fed enriched formulas with unsaturated fatty acids. Growth rate of skin-fold thickness in group S, was extremely intensive all the first year through and decreasing physiological tendencies were not observed in 4th trimester of life.

The clinical condition of 184 newborns born by primipara older than 35 years and 500 randomisly selected newborns born by multipara older than 35 years in 27,821 newborns born at 1st Department of Obstetrics and Gynecology in Bytom between 1975 and 1985 has been analysed. The results were compared with the results of the control group of 500 randomisly selected newborns born by primipara younger than 35 years. It was observed that newborns of mothers older than 35 years and specially primipara are biologically weaker than newborns of mothers of the optimal reproduction age. There are often born with signs of prematurity and intrauterine dystrophy, have lower body weight, higher incidence of developmental anomaly, labour complications and adaptation difficulties during early neonatal period. The importance was stressed of the monitoring of pregnancy and delivery in this patients as well as the intensive perinatal pharmacotherapy in the newborns, to decrease perinatal mortality.