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Objective: The maternal cardiovascular system of women with hypertensive disorders of pregnancy (HDP) can be impaired, with higher rates of left ventricular (LV) remodeling and diastolic dysfunction compared to those with normotensive pregnancy. The primary objective of this prospective study was to correlate cardiac indices obtained by transthoracic echocardiography (TTE) and circulating angiogenic markers, such as soluble fms‐like tyrosine kinase‐1 (sFlt‐1) and placental growth factor (PlGF). Methods: In this study, 95 women with a pregnancy complicated by HDP and a group of 25 with an uncomplicated pregnancy at term underwent TTE and blood tests to measure sFlt‐1 and PlGF during the peripartum period (before delivery or within a week of giving birth). Spearman's rank correlation was used to derive correlation coefficients between biomarkers and cardiac indices in the HDP and control populations. Results: The HDP group included 61 (64.2%) pre‐eclamptic patients and, among them, 42 (68.9%) delivered before 37 weeks' gestation. Twelve women with HDP (12.6%) underwent blood sampling and TTE after delivery, and, as they showed significantly lower levels of angiogenic markers, they were excluded from the analysis. There was a correlation between sFlt‐1 and LV mass index (LVMI) (r = 0.246; P = 0.026) and early diastolic mitral inflow velocity (E) and early diastolic mitral annular velocity (e′) ratio (r = 0.272; P = 0.014) in the HDP group (n = 83), while in the controls, sFlt‐1 showed a correlation with relative wall thickness (r = 0.409; P = 0.043), lateral e′ (r = −0.562; P = 0.004) and E/e′ ratio (r = 0.417; P = 0.042). PlGF correlated with LVMI (r = −0.238; P = 0.031) in HDP patients and with lateral e′ (r = 0.466; P = 0.022) in controls. sFlt‐1/PlGF ratio correlated with lateral e′ (r = −0.568; P = 0.004) and E/e′ ratio (r = 0.428; P = 0.037) in controls and with LVMI (r = 0.252; P = 0.022) and E/e′ ratio (r = 0.269; P = 0.014) in HDP. Conclusions: Although the current data are not able to infer causality, they confirm the intimate relationship between the maternal cardiovascular system and angiogenic markers that are used both to diagnose and indicate the severity of HDP. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article discusses the impact of different strategies for dating twin pregnancies on the rates of preterm birth and the detection of fetal growth restriction (FGR). The study evaluated the use of the larger twin crown-rump length (CRL), the smaller twin CRL, and the mean twin CRL for dating. The findings suggest that dating by the smaller, larger, or mean twin CRL does not significantly affect the prediction of gestational age, rates of extreme preterm birth, or the detection of small for gestational age (SGA) babies. The authors recommend using the mean twin CRL for dating to minimize parental anxiety without impacting clinical outcomes. [Extracted from the article]

Objective: To investigate longitudinal trends in fetal and offspring cardiovascular adaptation in fetal growth restriction (FGR)., Design: Prospective longitudinal study., Setting: Fetal Medicine Unit., Sample: Thirty-five FGR pregnancies and 37 healthy controls assessed as term fetuses (mean age 37 ± 1 weeks) and again in infancy (mean age 8 ± 2 months)., Methods: Conventional echocardiographic techniques, tissue Doppler imaging and speckle tracking echocardiography., Main Outcome Measures: Left ventricular (LV) and right ventricular (RV) geometry and function. Echocardiographic parameters were normalised by ventricular size adjusting for differences in body weight between groups., Results: Compared to healthy controls, late FGR fetuses showed significant alterations in cardiac geometry with more globular LV chamber (LV sphericity index, 0.56 vs. 0.52), increase in biventricular global longitudinal systolic contractility (MAPSE, 0.29 vs. 0.25 mm; TAPSE, 0.42 vs. 0.37 mm) and elevated cardiac output (combined CO: 592 vs. 497 mL/min/kg, p < 0.01 for all). Indices of LV diastolic function in FGR fetuses were significantly impaired with myocardial diastolic velocities (LV A', 0.30 vs. 0.26 cm/s; IVS E', 0.19 vs. 0.16 cm/s) and LV torsion (1.2 vs. 3.5 deg./cm, p < 0.01 for all). At postnatal assessment, FGR offspring revealed persistently increased SAPSE (0.27 vs. 0.24 mm), LV longitudinal strain (-19.0 vs. -16.0%), reduced LV torsion (1.6 vs. 2.1 deg./cm) and elevated CO (791 vs. 574 mL/min/kg, p < 0.01 for all)., Conclusions: Perinatal cardiac remodelling and myocardial dysfunction in late FGR fetuses is most likely due to chronic placental hypoxaemia. Persistent changes in cardiac geometry and function in FGR offspring may reflect fetal cardiovascular maladaptation that could predispose to long-term cardiovascular complications in later life., (© 2024 John Wiley & Sons Ltd.)

Objective: The identification of fetal growth restriction (FGR) due to uteroplacental insufficiency is important to improve perinatal outcomes. To distinguish FGR from small for gestational age (SGA), FGR consensus definition is currently based on biometry and/or additional biophysical parameters. This study aims to verify if this definition might be modified by including circulating angiogenic factors., Study Design: This historical cohort study included singleton pregnancies with SGA fetuses after 20 weeks. All patients underwent detailed ultrasound and measurements of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) at first assessment. ISUOG criteria for FGR were applied. Total PlGF was calculated using free PlGF, sFlt-1 and a receptor pharmacology model, and multiple of the median (MoM) values for sFlt-1, free PlGF, total PlGF and sFlt-1/PlGF ratio were calculated to adjust for gestational age., Results: 72 pregnancies with SGA were first evaluated at median (IQR) of 28 +5 (26 +2 -31 +3 ) weeks' gestation, and 51 fetuses (70.8 %) satisfied the FGR consensus definition. Pregnancies with FGR showed significantly lower levels of free and total PlGF MoM (0.12, 95 % IQR: 0.07-0.36 vs 0.32, 95 % IQR: 0.20-0.53, p = 0.008) and 0.26, 95 % CI: 0.16-0.55 vs 0.43, 95 % IQR: 0.23-0.53, p = 0.028) respectively; and higher sFlt-1 MoM (4.62, 95 % IQR: 1.80-7.30 vs 1.74, 95 % IQR:1.11-3.61, p = 0.014) than pregnancies not classified as FGR. Free and total PlGF MoM correlated significantly with gestational age at delivery (r = 0.776, p < 0.001 and r = 0.707, p < 0.001, respectively). sFlt-1 MoM and sFlt-1/PlGF ratio MoM also correlated with gestational age at delivery (r = -0.681, p < 0.001 and r = -0.823, p < 0.001). Six cases identified as FGR at first ultrasound were not confirmed at birth showing significantly higher levels of free PlGF MoM (0.77, 95 % IQR: 0.27-3.07 vs 0.17, 95 % IQR: 0.08-0.43, p = 0.022)., Conclusion: These findings show that total as well as free PlGF levels are lower in pregnancies affected with placental growth restriction. Angiogenic biomarkers might improve the differentiation between placental growth restriction and constitutional smallness. Further studies are needed to determine how to integrate them into the current definitions of FGR., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Preterm preeclampsia is a pregnancy complication associated with myocardial dysfunction and premature cardiovascular disease morbidity and mortality. Left atrial (LA) strain is a noninvasive index of left ventricular end diastolic pressure and an early marker of heart failure risk. This study aimed to evaluate LA strain during the postpartum period in participants with and without preterm preeclampsia and to assess whether this varied in the presence of hypertension, cardiac dysfunction or both., Methods: In this longitudinal cohort study, 321 women from 28 hospitals with preterm preeclampsia (cases) underwent cardiovascular assessment 6 months postpartum. This is a secondary analysis of the PHOEBE study (ISRCTN01879376). An uncomplicated pregnancy control group (n=30) was recruited from a single center for comparison. A full cross-sectional transthoracic echocardiogram was performed, and from these images, the myocardial strain of the left atrium, including reservoir, conduit, and contractile strain, as well as LA stiffness, were calculated., Results: At 6 months postpartum, compared with controls, prior preeclampsia was associated with a significantly attenuated LA reservoir, conduit, and contractile strain, as well as increased LA stiffness (all P <0.001). LA strain was further reduced in preeclamptic women who had and had not developed hypertension, systolic, or diastolic dysfunction at 6 months postpartum (all P <0.05)., Conclusions: LA mechanics were significantly attenuated at 6 months postpartum in participants with preterm preeclampsia, whether or not they remained hypertensive or had evidence of ventricular dysfunction. Further studies are needed to determine whether postnatal LA strain may identify women at greater risk for future cardiovascular disease., Competing Interests: Disclosures None.

The acceptability of upcycled foods is influenced by individual, context and product-related factors. This study aimed at investigating the impact of circular economy (CE) information on consumers' sensory acceptability, purchase intention and perceived value of upcycled foods, taking into account eating behaviours and personality traits that could be related to the consumers' sustainable consumption habits. To this aim, a group of young subjects (n = 80, 18-35 years old) participated in a two-step study. Firstly, an online questionnaire was administered to participants to gather information about their individual characteristics. Then, participants were divided into two groups, one receiving CE information (CE+) and one not receiving it (CE-), and they were asked to indicate the sensory acceptability, purchase intention and the perceived value of three upcycled foods, such as biscuits with grape pomace flour, beer brewed with leftover bread and a dairy product made from recovered crushed cheese. Questionnaire results showed that high individual responsibility, interest in healthy foods and high awareness of the social impact of their behaviours could be linked to a positive purchase intention for upcycled foods, as opposed to individual disgust sensitivity. No significant effect of CE information (p > 0.05) on sensory acceptability and purchase intention of all three upcycled foods was observed. Moreover, application of Principal Component Analysis (PCA) to the sensory data resulted in satisfactory classification of upcycled foods in terms of perceived values, explaining 86.83 % of data variability: the first principal component discriminated samples according to product category whereas the second principal component was able to clearly separate products according to CE information. Findings from this study provided valuable insights into the key individual characteristics that impact sustainable consumption habits, also highlighting the role of communication strategies in shaping consumer perceptions of upcycled foods so as to encourage a more sustainable consumption behaviour., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)