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Objective: To describe the acute cardiovascular adaptation of the fetus after connection to an artificial placenta (AP) in a sheep model, using ultrasound and invasive and non‐invasive hemodynamic assessment. Methods: This was an experimental study of 12 fetal sheep that were transferred to an AP system, consisting of a pumpless circuit with umbilical cord connection, at 109–117 days' gestation. The study was designed to collect in‐utero and postcannulation measurements in all the animals. The first six consecutive fetuses were fitted with intravascular catheters and perivascular probes to obtain invasive physiological data, including arterial and venous intravascular pressures and perivascular blood flows, with measurements taken in utero and at 5 and 30 min after cannulation. These experiments were designed with a survival goal of 1–3 h. The second set of six fetuses were not fitted with catheters, and experiments were aimed at 3–24 h of survival. Echocardiographic assessment of cardiac anatomy and function, as well as measurements of blood flow and pre‐ and postmembrane pressures recorded by circuit sensors in the AP system, were available for most of the fetuses. These data were acquired in utero and at 30 and 180 min after cannulation. Results: Compared with in‐utero conditions, the pulsatility index at 30 and 180 min after connection to the AP system was reduced in the umbilical artery (median, 1.36 (interquartile range (IQR), 1.06–1.50) vs 0.38 (IQR, 0.31–0.50) vs 0.36 (IQR, 0.29–0.41); P < 0.001 for extreme timepoints) and the ductus venosus (median, 0.50 (IQR, 0.41–0.67) vs 0.29 (IQR, 0.22–0.33) vs 0.36 (IQR, 0.22–0.41); P = 0.011 for extreme timepoints), whereas umbilical venous peak velocity increased (median, 20 cm/s (IQR, 18–22 cm/s) vs 39 cm/s (IQR, 31–43 cm/s) vs 43 cm/s (IQR, 34–54 cm/s); P < 0.001 for extreme timepoints) and flow became more pulsatile. Intravascular monitoring showed that arterial and venous pressures increased transiently after connection, with median values for mean arterial pressure at baseline, 5 min and 30 min of 43 mmHg (IQR, 35–54 mmHg), 72 mmHg (IQR, 61–77 mmHg) and 58 mmHg (IQR, 50–64 mmHg), respectively (P = 0.02 for baseline vs 5 min). Echocardiography showed a similar transient elevation of fetal heart rate at 30 and 180 min after connection compared with in utero (median, 145 bpm (IQR, 142–156 bpm) vs 188 bpm (IQR, 171–209 bpm) vs 175 bpm (IQR, 165–190 bpm); P = 0.001 for extreme timepoints). Fetal cardiac structure and function were mainly preserved; median values for right fractional area change were 36% (IQR, 34–41%) in utero, 38% (IQR, 30–40%) at 30 min and 37% (IQR, 33–40%) at 180 min (P = 0.807 for extreme timepoints). Conclusions: Connection to an AP system resulted in a transient fetal hemodynamic response that tended to normalize over hours. In this short‐term evaluation, cardiac structure and function were preserved. However, the system resulted in non‐physiologically elevated venous pressure and pulsatile flow, which should be corrected to avoid later impairment of cardiac function. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

EP33.06: Does Mediterranean diet provide most of the necessary nutrients in adequate proportion during pregnancy? To assess adequacy of dietary nutrient intake according to Mediterranean diet (MedDiet) adherence in a cohort of pregnant women in Barcelona, Spain. Results Significant differences in the majority of nutrient intake were found according to MedDiet adherence, as shown in table 1. [Extracted from the article]

Conclusions The centralisation of different rare pathologies with involvement of the placenta in an outpatient placental clinic allows a standardised approach. To describe the activity, experience in prenatal diagnosis and management in an outpatient Placental Clinic. The specialised management in the Unit is the basis to coordinate a multidisciplinary team to properly address PAS disorder cases. [Extracted from the article]

To describe the experience in the prenatal diagnosis and management of vasa previa in an Outpatient Placental Unit. Conclusions Prenatal diagnosis of vasa previa allows optimal management of pregnancy and decreases the probability of associated neonatal complications. Three patients (50%) were nulliparous and the other three had a previous Caesarean section (CS). [Extracted from the article]

An appropriate clinical screening to identify epidemiological risk factors for PAS and improving the training for ultrasound placental evaluation are necessary to increase diagnostic sensitivity of PAS disorder. To describe the experience in diagnosis of placenta accreta spectrum (PAS) disorder in an Outpatient Placental Unit. Eight cases presented a focal PAS disorder and only one patient (12.5%) was diagnosed prenatally due to her history of uterine septoplasty with focal PAS in a previous pregnancy. [Extracted from the article]

While right ventricular GLS was preserved in fetuses with AoS (AoS mean -19.26% ± 2.89 versus controls -18,58% ± 3.08, I p = 0,487 i ), left ventricular GLS was significantly reduced in AoS cases as compared to controls (AoS -11.21% ± 10.17 versus controls 20.17% ± 3.59, I p = 0.008 i ) as shown in figure 1. EP19.02: 2D speckle-tracking assessment of biventricular strain in fetuses with aortic stenosis To assess biventricular global longitudinal strain (GLS) in fetuses with aortic stenosis (AoS) using 2D speckle-tracking echocardiography (STE) by FetalHQ® and to compare it to healthy fetuses. [Extracted from the article]

To assess biventricular global longitudinal strain (GLS) in fetuses with pulmonary stenosis (PS) using 2D speckle-tracking echocardiography (STE) by FetalHQ® and to compare it to healthy fetuses. Conclusions Fetuses with PS showed reduced right GLS when compared to controls, with preserved left GLS. EP19.07: 2D speckle-tracking assessment of biventricular strain in fetuses with pulmonary stenosis. [Extracted from the article]

Conclusions Fetuses whose mothers had a better wellbeing status, revealed by an excellent WHO-5 score, seem to have a different cortical development in the Sylvian fissure and the insula depth. However, those fetuses whose mothers had an Excellent WHO-5 score, had a larger Sylvian fissure/BPD (mean, SD 16.65 (2.3); Bad: 15.7 (2.4), p = 0.06; Poor: 15.70 (2.4), p = 0.06; Fair: 15.66 (2.3); p < 0.01; Good: 15.80 (2.2); p = 0.01) and smaller insula/BPD (mean, SD 31.65 (1.8); Bad: 32.18 (1.9), p = 0.28; Poor: 32.18 (1.9), p = 0.28; Fair: 32.40 (1.8); p = 0.01; Good: 32.35 (1.6); p = 0.01) compared to Good and Fair categories. A detailed neurosonography with transabdominal approach was performed at 33-34 weeks of gestation, measuring biparietal diameter (BPD), insula depth, Sylvian fissure, parieto-occipital sulci, and then normalised by BPD. [Extracted from the article]

Conclusions This study show that NRM in twins could be predicted by a non-invasive lung texture analysis with an overall good specificity, negative predicted value, and accuracy. Evaluate the performance of quantitative ultrasound of the fetal lung texture analysis to predict neonatal respiratory morbidity (NRM) in twin pregnancies. [Extracted from the article]

Conclusions Fetuses whose mothers followed a MedDiet intervention during pregnancy have a different cortical development than those without intervention; further research to elucidate the behind mechanisms is warranted. When normalised by BPD, data remained confirmed (insula depth/BPD 32.40 versus 32.13 p < 0.05; POS/BPD 15.92 versus 15.53, p < 0.05). To assess whether a Mediterranean diet (MedDiet) or a mindfulness-based stress reduction (MBSR) intervention during pregnancy affects fetal cortical development. [Extracted from the article]

The neurodevelopmental key events migration distance, migration corona, oligodendrocyte (OL) differentiation and cell viability were assessed. To evaluate the effects of epigallocatechin gallate (EGCG) in basic neurogenesis processes by using an I in vitro i neurosphere model of fetal growth restriction (FGR). [Extracted from the article]

References 1 Paules C, Miranda J, Policiano C, Crovetto F, Youssef L, Hahner N, Nakaki A, Crispi F, Gratacós E, Eixarch E. Fetal neurosonography detects differences in cortical development and corpus callosum in late-onset small fetuses. First of all, we did not recommend "universal" targeted neurosonography in this population, although we believe that, in selected cases, it may be a suitable tool to detect subtle brain differences, identify small fetuses and counsel parents on the potentially higher risker of neurobehavioral problems. We appreciate the interest of D'Antonio and colleagues in our work on the use of fetal neurosonography in late-onset small fetuses1, and would like to comment on some of the points that they have raised. [Extracted from the article]

Introduction: Adverse perinatal outcomes (APO) pose a significant global challenge, particularly in low- and middle-income countries (LMICs). This study aims to analyse two cohorts of high-risk pregnant women for APO to comprehend risk factors and improve prediction accuracy., Methods: We considered an LMIC and a high-income country (HIC) population to derive XGBoost classifiers to predict low birth weight (LBW) from a comprehensive set of maternal and fetal characteristics including socio-demographic, past and current pregnancy information, fetal biometry and fetoplacental Doppler measurements. Data were sourced from the FeDoC (Fetal Doppler Collaborative) study (Pakistan, LMIC) and theIMPACT (Improving Mothers for a Better PrenAtal Care Trial) study (Spain, HIC), and included 520 and 746 pregnancies assessed from 28 weeks gestation, respectively. The models were trained on varying subsets of the mentioned characteristics to evaluate their contribution in predicting LBW cases. For external validation, and to highlight potential differential risk factors for LBW, we investigated the generalisation of these models across cohorts. Models' performance was evaluated through the area under the curve (AUC), and their interpretability was assessed using SHapley Additive exPlanations., Results: In FeDoC, Doppler variables demonstrated the highest value at predicting LBW compared with biometry and maternal clinical data (AUC Doppler , 0.67; AUC Clinical , 0.65; AUC Biometry , 0.63), and its combination with maternal clinical data yielded the best prediction (AUC Clinical+Doppler , 0.71). In IMPACT, fetal biometry emerged as the most predictive set (AUC Biometry , 0.75; AUC Doppler , 0.70; AUC Clinical , 0.69) and its combination with Doppler and maternal clinical data achieved the highest accuracy (AUC Clinical+Biometry+Doppler , 0.81). External validation consistently indicated that biometry combined with Doppler data yielded the best prediction., Conclusions: Our findings provide new insights into the predictive role of different clinical and ultrasound descriptors in two populations at high risk for APO, highlighting that different approaches are required for different populations. However, Doppler data improves prediction capabilities in both settings, underscoring the value of standardising ultrasound data acquisition, as practiced in HIC, to enhance LBW prediction in LMIC. This alignment contributes to bridging the health equity gap., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Perinatal mortality remains high in low- and middle-income countries. Accurate assessment of fetal gestational age (GA) is crucial to distinguish between prematurity and intrauterine growth restriction, two conditions commonly associated with perinatal mortality that require different preventive strategies and management. Ultrasound measurements of the cerebellum have been shown to be accurate in assessing GA during pregnancy, but their post-mortem performance has not yet been evaluated., Objective: We aimed to explore the feasibility and validity of GA estimation in fetal and perinatal deaths by ultrasound measurements of the cerebellum., Study Design: This is an observational cross-sectional study. Between August 2020 and November 2022 post-mortem cerebellar ultrasound measurements were conducted in a tertiary referral hospital in Barcelona, Spain. Extrauterine assessment included transcerebellar diameter, cerebellar vermis height and cerebellar vermis. Moreover, intrauterine ultrasound and autopsy direct cerebellar assessments were undertaken in a subset of cases. A total of 137 fetal and perinatal deaths [63 (46.0%) fetal deaths, 69 (50.4%) stillbirths and 5 (3.6%) neonates] were included. First, we correlated different types of transcerebellar diameter measurements between them (intrauterine, extrauterine and autopsy-based). Then, we evaluated the relationship between the extrauterine cerebellar ultrasound measurements and GA, and their performance across trimesters of gestation and in different abnormalities., Results: GA ranged from 15.2 to 40.6 weeks. High correlation was observed between extrauterine, intrauterine, and autopsy transcerebellar measurements (p<0.001), and between all extrauterine cerebellar measurements and GA (p<0.001). Extrauterine transcerebellar diameter was identified as the strongest predictor of GA (R 2 =0.88; p<0.001), and its accuracy was not affected by the trimester of gestation, intrauterine growth restriction or central nervous system alterations., Conclusions: This study shows the feasibility and accuracy of post-mortem GA evaluation by extrauterine ultrasound measurements of the cerebellum, especially of transcerebellar diameter. Implementation of this method as part of post-mortem assessment could improve cause of death attribution, especially in resource-constrained settings., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: The IMPACT BCN trial-a parallel-group randomized clinical trial where 1221 pregnant women at high risk for small-for-gestational age (SGA) newborns were randomly allocated at 19- to 23-week gestation into three groups: Mediterranean diet, Mindfulness-based Stress reduction or non-intervention-has demonstrated a positive effect of Mediterranean diet and Stress reduction in the prevention of SGA. However, the mechanism of action of these interventions remains still unclear. The aim of this study is to investigate the effect of Mediterranean diet and Stress reduction on placental volume and perfusion., Material and Methods: Participants in the Mediterranean diet group received monthly individual and group educational sessions, and free provision of extra-virgin olive oil and walnuts. Women in the Stress reduction group underwent an 8-week Stress reduction program adapted for pregnancy, consisting of weekly 2.5-h and one full-day sessions. Non-intervention group was based on usual care. Placental volume and perfusion were assessed in a subgroup of randomly selected women (n = 165) using magnetic resonance (MR) at 36-week gestation. Small placental volume was defined as MR estimated volume <10th centile. Perfusion was assessed by intravoxel incoherent motion., Results: While mean MR placental volume was similar among the study groups, both interventions were associated with a lower prevalence of small placental volume (3.9% Mediterranean diet and 5% stress reduction vs. 17% non-intervention; p = 0.03 and p = 0.04, respectively). Logistic regression showed that small placental volume was significantly associated with higher risk of SGA in both study groups (OR 7.48 [1.99-28.09] in Mediterranean diet and 20.44 [5.13-81.4] in Stress reduction). Mediation analysis showed that the effect of Mediterranean diet on SGA can be decomposed by a direct effect and an indirect effect (56.6%) mediated by a small placental volume. Similarly, the effect of Stress reduction on SGA is partially mediated (45.3%) by a small placental volume. Results on placental intravoxel incoherent motion perfusion fraction and diffusion coefficient were similar among the study groups., Conclusions: Structured interventions during pregnancy based on Mediterranean diet or Stress reduction are associated with a lower proportion of small placentas, which is consistent with the previously observed beneficial effects of these interventions on fetal growth., (© 2024 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Objective: To evaluate medium-term self-reported respiratory and gastrointestinal (GI) outcomes in children with congenital diaphragmatic hernia (CDH)., Design: Self-reported respiratory and GI outcomes correlated with prenatal severity indicators., Setting: Prospective study at three fetal medicine units., Population: Families of children prenatally diagnosed with isolated, left-sided CDH surviving for >1 year., Methods: Families received validated questionnaires for GI outcomes (Infant Gastroesophageal Reflux Questionnaire Revised, I-GERQ-R, for infants aged <2 years, or Paediatric Gastro-oesophageal Symptom and Quality of Life Questionnaire, PGSQ, for children aged aged 2-8 years or >9 years) and respiratory outcomes (preschool respiratory outcome questionnaire, for children aged ≤5 years, or the International Study of Asthma and Allergies in Childhood asthma questionnaire, for children aged 6-8 years or ≥9 years). Prenatal data collected from the medical records included lung size (percentage observed/expected lung-to-head ratio, O/E LHR %), liver position, fetal endoluminal tracheal occlusion (FETO) gestational age (GA) at delivery, and perinatal data included birthweight, location, patch repair and respiratory support., Main Outcome Measures: The GI and respiratory scores were correlated with O/E LHR using linear and logistic regression models. Univariate analysis was used to evaluate associations with perinatal variables., Results: We obtained 142 responses from 342 families (representing a response rate of 45%). The baseline characteristics of participants and non-participants were comparable. No correlations between perinatal variables and respiratory or GI scores were identified. Children aged ≤5 years with lower O/E LHR values reported higher respiratory scores (P = 0.0175); this finding was not reported in older children. Overall, the children who underwent FETO (n = 51) had GI (P = 0.290) and respiratory (P = 0.052) scores that were comparable with those of children who were expectantly managed., Conclusions: Families and children with prenatally diagnosed CDH reported fewer respiratory symptoms with increasing age. There was no correlation between O/E LHR or the use of FETO and self-reported outcomes., (© 2024 John Wiley & Sons Ltd.)

Background: Non-time-consuming and easy-to-administer dietary assessment tools specific for pregnancy are needed., Objectives: The aim of this validation study nested in the IMPACT BCN (Improving Mothers for a better PrenAtal Care Trial BarCeloNa) trial is to determine the concurrent validity of the 17-item pregnancy-adapted Mediterranean diet score (preg-MEDAS) and to analyze whether changes in the preg-MEDAS score were associated with maternal favorable dietary and cardiometabolic changes after 3 mo of intervention in pregnant women., Methods: Dietary data was collected in 812 participants using the preg-MEDAS and a 151-item validated food frequency questionnaire (FFQ) at baseline (19-23 wk gestation) and final visit (31-34 wk gestation). Concurrent preg-MEDAS validity was evaluated by Pearson and intraclass correlation coefficients, κ statistic, and Bland-Altman methods., Results: The preg-MEDAS had a good correlation with the FFQ (r = 0.76 and intraclass correlation coefficient 0.75). The agreement of each of the preg-MEDAS items ranged from 40.9% to 93.8% with a substantial agreement mean concordance (κ = 0.61). A 2-point increase in preg-MEDAS was associated with a decrease in maternal mean and systolic blood pressure (β: -0.51 mmHg; 95% confidence interval [CI]: -0.97, -0.04 mmHg and -0.87 mmHg; 95% CI: -1.48, -0.26 mmHg, respectively)., Conclusions: The preg-MEDAS displays good validity for assessing adherence to the Mediterranean diet, allowing detection of dietary changes over time. In addition, changes observed in preg-MEDAS are significantly associated with a decrease in maternal blood pressure. Therefore, we propose preg-MEDAS as a rapid and simple dietary assessment tool during pregnancy. This trial was registered at clinicaltrials.gov as NCT03166332., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Temporary fetoscopic endoluminal tracheal occlusion (FETO) promotes lung growth and increases survival in selected fetuses with congenital diaphragmatic hernia (CDH). FETO is performed percutaneously by inserting into the trachea a balloon designed for vascular occlusion. However, reports on the potential postnatal side-effects of the balloon are scarce. This study aimed to evaluate the prevalence of tracheomalacia in infants with CDH managed with and without FETO and other consequences related to the use of the balloon., Methods: In this multicentre, retrospective cohort study, we included infants who were live born with CDH, either with FETO or without, who were managed postnatally at four centres (UZ Leuven, Leuven, Belgium; Antoine Béclère, Clamart, France; BCNatal, Barcelona, Spain; and HCor-Heart Hospital, São Paulo, Brazil) between April 5, 2002, and June 2, 2021. We primarily assessed the prevalence of all (symptomatic and asymptomatic) tracheomalacia as reported in medical records among infants with and without FETO. Secondarily we assessed the prevalence of symptomatic tracheomalacia and its resolution as reported in medical records, and compared tracheal diameters as measured on postnatal x-rays. Crude and adjusted risk ratios (aRRs) and 95% CIs were calculated via modified Poisson regression models with robust error variances for potential association between FETO and tracheomalacia. Variables included in the adjusted model were the side of the hernia, observed-to-expected lung-to-head ratio, and gestational age at birth. Crude and adjusted mean differences and 95% CIs were calculated via linear regression models to assess the presence and magnitude of association between FETO and tracheal diameters. In infants who had undergone FETO we also assessed the localisation of balloon remnants on x-rays, and the methods used for reversal of occlusion and potential complications associated with balloon remnants as documented in clinical records. Finally we investigated whether the presence of balloon remnants was influenced by the interval between balloon removal and delivery., Findings: 505 neonates were included in the study, of whom 287 had undergone FETO and 218 had not. Tracheomalacia was reported in 18 (6%) infants who had undergone FETO and in three (1%) who had not (aRR 6·17 [95% CI 1·83-20·75]; p=0·0030). Tracheomalacia was first reported in the FETO group at a median of 5·0 months (IQR 0·8-13·0). Symptomatic tracheomalacia was reported in 13 (5%) infants who had undergone FETO, which resolved in ten (77%) children by 55·0 months (IQR 14·0-83·0). On average, infants who had undergone FETO had a 31·3% wider trachea (with FETO tracheal diameter 7·43 mm [SD 1·24], without FETO tracheal diameter 5·10 mm [SD 0·84]; crude mean difference 2·32 [95% CI 2·11-2·54]; p<0·0001; adjusted mean difference 2·62 [95% CI 2·35-2·89]; p<0·0001). At birth, the metallic component was visible within the body in 75 (37%) of 205 infants with available thoraco-abdominal x-rays: it was located in the gastrointestinal tract in 60 (80%) and in the lung in 15 (20%). No side-effects were reported for any of the infants during follow-up. The metallic component was more likely to be in the lung than either outside the body or the gastrointestinal tract when the interval between occlusion reversal and birth was less than 24 h., Interpretation: Although FETO was associated with an increased tracheal diameter and an increased probability of tracheomalacia, symptomatic tracheomalacia typically resolved over time. There is a higher risk of retention of metallic balloon components if reversal of the occlusion occurs less than 24 h before delivery. Finally, there were no reported side-effects of the metallic component of the balloon persisting in the body during follow-up. Longer-term follow-up is needed to ensure that no tracheal problems arise later in life., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Introduction: We investigated whether structured maternal lifestyle interventions based on Mediterranean diet or stress reduction influence fetal-infant neurodevelopment detected by detailed fetal neurosonography and Ages and Stages Questionnaires 3rd edition (ASQ) at 12 months old., Methods: This was a secondary analysis of a randomized clinical trial (2017-2020), including 1,221 singleton pregnancies at high risk for small-for-gestational age. Participants were randomized into three groups at 19-23 weeks' gestation: Mediterranean diet intervention, stress reduction program, or usual care. A detailed neurosonography was performed on 881 participants at mean (SD) 33.4 (1.1) weeks' gestation. Neurosonographic measurements were done offline. ASQ was performed on 276 infants at 1 year of corrected age., Results: Biparietal diameter was similar among study groups. Mediterranean diet group fetuses had deeper insula (26.80 [1.68] versus 26.63 [1.75], mm, p = 0.02) and longer corpus callosum (42.98 [2.44] versus 42.62 [2.27], mm, p = 0.04), with a lower rate of suboptimal score infants in ASQ problem-solving domain (6.2 vs. 16.3%, p = 0.03). Stress reduction group fetuses had deeper insula (26.90 [1.75] versus 26.63 [1.75], mm, p = 0.04) and lower rates of suboptimal score infants in ASQ fine motor domain (4.3 vs. 12.8%, p = 0.04), compared to usual care group fetuses., Conclusion: Maternal structured intervention during pregnancy of the trial has the potential to modify offspring's neurodevelopment., (© 2024 S. Karger AG, Basel.)