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To describe the growth dynamics of fetuses with initial fetal growth restriction (FGR) later outgrowing the 10th centile for estimated fetal weight with respect to perinatal outcomes and maternal factors.A multicenter prospective study recruited 1116 patients for ultrasound surveillance between 2010 and 2012. All pregnancies were growth-restricted singleton gestations between 24 + 0 and 36 + 0 weeks. Biometry and Doppler analysis were carried out, and delivery and adverse perinatal outcomes were recorded.A total of 193 (17%) fetuses outgrew their diagnosis of initial FGR (surpassed the 10th centile) on their last sonogram before delivery. These fetuses were termed "growers," to compare with the true FGR group. The mothers of "growers" were less likely to be smokers (14% vs 25%, P = 0.0001) or affected by hypertensive pregnancy complications (5.2% vs 15%, P = 0.001). Of the growers, 49 (25%) had an abnormal umbilical artery Doppler; however, in most cases (33/49, 67%), this was a single episode of raised umbilical artery pulsatility index, which subsequently normalized.There were dynamic growth changes in FGR fetuses, with 17% outgrowing their original diagnosis. Positive growth spurts more commonly occurred in healthy mothers. Once a fetus had outgrown the 10th centile, antenatal surveillance could be decreased.

Background Maternal obesity and depression are common and both have been associated with adverse pregnancy outcomes. Aims The aim of this observational study was to examine the relationship between maternal body mass index (BMI) category and self-reported depression at the first antenatal visit. Methods Women who delivered a baby weighing ≥ 500 g over nine years 2009–2017 were included. Self-reported sociodemographic and clinical details were computerised at the first antenatal visit by a trained midwife, and maternal BMI was calculated after standardised measurement of weight and height. Results Of 73,266 women, 12,304 (16.7%) had obesity, 1.6% (n = 1126) reported current depression and 7.5% (n = 3277) multiparas reported a history of postnatal depression. The prevalence of self-reported maternal depression was higher in women who had obesity, > 35 years old, were socially disadvantaged, smokers, had an unplanned pregnancy and used illicit drugs. After adjustment for confounding variables, obesity was associated with an increased odds ratio (aOR) for current depression in both nulliparas (aOR 1.7, 95% CI 1.3–2.3, p 0.001) and multiparas (aOR 1.8, 95% CI 1.5–2.1, p 0.001) and postnatal depression in multiparas (aOR 1.4, 95% CI 1.3–1.5, p 0.001). The prevalence of current depression was higher in women with moderate/severe obesity than in women with mild obesity (both p 0.001). Conclusions We found that self-reported maternal depression in early pregnancy was independently associated with obesity. The prevalence of depression increased with the severity of obesity. Our findings highlight the need for implementation of strategies and provision of services for the prevention and treatment of both obesity and depression.

peer-reviewed The full text of this article will not be available in ULIR until the embargo expires on the 08/01/2022 Objective To evaluate the correlation between Umbilical Artery (UA) Doppler and its feasibility across categories of maternal BMI in the presence of foetal growth restriction (FGR). Methods 1074 Singleton pregnancies with suspected FGR on ultrasound examination between 24+0 and 36+0 weeks' gestation were reviewed. Evaluation of the UA Doppler was performed at 1‐2 weekly intervals. Abnormal UA Doppler findings and delivery outcomes were compared between the different maternal BMI categories. Results Increased UA pulsatility index (PI > 95th centile) was reported in 81% of obese category 2 patients (BMI

ObjectivesTo examine associations between maternal pregnancy-specific stress and umbilical (UA PI) and middle cerebral artery pulsatility indices (MCA PI), cerebroplacental ratio, absent end diastolic flow (AEDF), birthweight, prematurity, neonatal intensive care unit admission and adverse obstetric outcomes in women with small for gestational age pregnancies. It was hypothesised that maternal pregnancy-specific stress would be associated with fetoplacental haemodynamics and neonatal outcomes. DesignThis is a secondary analysis of data collected for a large-scale prospective observational study. SettingThis study was conducted in the seven major obstetric hospitals in Ireland and Northern Ireland. ParticipantsParticipants included 331 women who participated in the Prospective Observational Trial to Optimise Paediatric Health in Intrauterine Growth Restriction. Women with singleton pregnancies between 24 and 36 weeks gestation, estimated fetal weight Primary and secondary outcome measuresSerial Doppler ultrasound examinations of the umbilical and middle cerebral arteries between 20 and 42 weeks gestation, Pregnancy Distress Questionnaire (PDQ) scores between 23 and 40 weeks gestation and neonatal outcomes. ResultsConcerns about physical symptoms and body image at 35–40 weeks were associated with lower odds of abnormal UAPI (OR 0.826, 95% CI 0.696 to 0.979, p=0.028). PDQ score (OR 1.073, 95% CI 1.012 to 1.137, p=0.017), concerns about birth and the baby (OR 1.143, 95% CI 1.037 to 1.260, p=0.007) and concerns about physical symptoms and body image (OR 1.283, 95% CI 1.070 to 1.538, p=0.007) at 29–34 weeks were associated with higher odds of abnormal MCA PI. Concerns about birth and the baby at 29–34 weeks (OR 1.202, 95% CI 1.018 to 1.421, p=0.030) were associated with higher odds of AEDF. Concerns about physical symptoms and body image at 35–40 weeks were associated with decreased odds of neonatal intensive care unit admission (OR 0.635, 95% CI 0.435 to 0.927, p=0.019). ConclusionsThese findings suggest that fetoplacental haemodynamics may be a mechanistic link between maternal prenatal stress and fetal and neonatal well-being, but additional research is required.

Prediction of hypertensive disease in pregnancy re- mains challenging. Risk factor based screening util- izing history, physical characteristics, uterine artery Doppler and serum markers have been used with va- rying success. As hypertension in pregnancy appears to be associated with changes in the maternal vascu- lature, we have investigated the utility of maternal ar- terial elasticity measurement, prior to 20 weeks gesta- tion, in the prediction of hypertensive disease in preg- nancy. A HDI/Pulsewave CR2000 Research Cardio- vascular Profiling System was used to obtain radial artery pulse pressure waveforms from 623 Caucasian women at the time of their first antenatal visit. Out- come data were available in 610 cases and these com- prised the study group. The results showed that wo- men who subsequently developed gestational hypertension (n = 20) had higher baseline systolic, diastolic and pulse pressure values (though within the normal range) but similar arterial elasticity to those patients who did not develop hypertension. Women who later developed pre-eclampsia (n = 23) had, in addition, re- duced large artery elasticity and increased systemic vascular resistance compared with women who did not develop hypertension. The measurement of mater- nal radial artery elasticity in early pregnancy may pro- vide an additional refinement in screening for hyperten- sive disease, particularly pre-eclampsia, in pregnancy.

Background: The Prenatal Distress Questionnaire (PDQ) is a short measure designed to assess specific worries and concerns related to pregnancy. The aim of this study was to confirm the factor structure of the PDQ in a group of pregnant women with a small for gestational age infant (< 10th centile). Methods: The first PDQ assessment for each of 337 pregnant women participating in the Prospective Observational Trial to Optimise paediatric health (PORTO) study was analysed. All women enrolled in the study were identified as having a small for gestational age foetus (< 10th centile), thus representing an 'elevated risk' group. Data were analysed using confirmatory factor analysis (CFA). Three models of the PDQ were evaluated and compared in the current study: a theoretical uni-dimensional measurement model, a bi-dimensional model, and a three-factor model solution. Results: The three-factor model offered the best fit to the data while maintaining sound theoretical grounds(χ2 (51df) = 128.52; CFI = 0.97; TLI = 0.96; RMSEA = 0.07). Factor 1 contained items reflecting concerns about birth and the baby, factor 2 concerns about physical symptoms and body image and factor 3 concerns about emotions and relationships. Conclusions: CFA confirmed that the three-factor model provided the best fit, with the items in each factor reflecting the findings of an earlier exploratory data analysis. © 2013 Society for Reproductive and Infant Psychology.

Objective: The purpose of this nested cohort study was to compare the rate of pre-pregnancy supplementation in obese women with that of women with a normal BMI. Methods: Pregnant women were enrolled at their convenience in a large university hospital. Weight and height were measured in the first trimester and BMI categorised. Results: Of the 288 women, 35.1% were in the normal, 29.5% in the overweight and 35.4% in the obese BMI categories. Only 45.1% (n = 46) of the obese women took pre-pregnancy folic acid compared with 60.4% (n = 61) of women with a normal BMI (p < 0.03). The lower incidence of folic acid supplementation in obese women was associated with an unplanned pregnancy in 36.3% of women compared with 22.8% in the normal BMI category (p < 0.04). Conclusions: Obese women should take folate supplements whether they are planning to conceive or not.

Objective To establish reference ranges using longitudinal data for aortic isthmus (AoI) Doppler indices in appropriate-for-gestational-age (AGA) fetuses and to document the longitudinal trends in a cohort of small-for-gestational-age (SGA) fetuses with normal umbilical artery Doppler and in fetuses with intrauterine growth restriction (IUGR) and abnormal umbilical artery Doppler. Methods AoI Doppler reference ranges were established from longitudinal data on 72 AGA singleton fetuses. Reliability of AoI Doppler flow measurements at two different sites and reproducibility between two operators was reviewed. A prospective longitudinal study of AoI Doppler indices in 48 SGA fetuses with normal umbilical artery Doppler and 10 IUGR fetuses was performed. Results The AoI pulsatility index (PI) and peak systolic velocity (PSV) in AGA fetuses showed a significant increase with gestational age. Analysis of intra- and interoperator variability revealed no significant mean difference in measurements of AoI-PI or AoI-PSV. Observations of AoI-PI and AoI-PSV from SGA fetuses did not differ significantly from those of AGA or IUGR fetuses. Retrograde flow in the AoI did not predate changes in the ductus venosus in IUGR fetuses. Conclusions Reference ranges for fetal AoI Doppler parameters in AGA fetuses constructed using longitudinal data are consistent with those obtained from cross-sectional data. The AoI Doppler parameters in SGA fetuses did not differ from those in AGA fetuses. Preterm IUGR fetuses did not manifest alterations in AoI-PI or AoI-PSV prior to changes in biophysical profile or ductus venosus Doppler. Further large-scale prospective studies are needed to determine whether AoI Doppler parameters are of any value in timing delivery or reducing adverse neurodevelopmental outcome. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

Objective. To examine the relationship between maternal glucose levels and intrauterine fetal adiposity distribution in women with a normal oral glucose tolerance test (OGTT) at 28 weeks gestation.Study Design. We recruited 231 women with a singleton pregnancy. At 28 and 37 weeks gestation, sonographic measurements of fetal body composition were performed. Multiple regression analysis was used to study the influence of different maternal variables on fetal adiposity distribution.Results. Maternal glucose levels correlated with the fetal abdominal subcutaneous tissue measurements (; ) and with birth weight (; ). Maternal glucose levels did not correlate with the fetal mid-thigh muscle thickness and mid-thigh subcutaneous tissue measurements.Conclusion. We found that in nondiabetic women maternal glucose levels not only influence fetal adiposity and birth weight, but also influence the distribution of fetal adiposity. This supports previous evidence that maternal glycemia is a key determinant of intrauterine fetal programming.

Objective To review the prenatal diagnosis of apparently isolated severe ventriculomegaly (SVM) in a tertiary referral fetal medicine unit and report on perinatal and neurodevelopmental outcomes. Methods All cases of isolated SVM referred to Fetal Medicine at the NMH between 2000 and 2008 were identified. Outcome information was obtained from detailed telephone interviews with parents and paediatric records and histopathology in cases of stillborn fetuses. Results Thirty-six cases of SVM were referred, out of which 19 were diagnosed with ‘apparently’ isolated SVM. Macrocrania was present in 88% at 36 weeks (mean HC 439 mm). Cephalocentesis was performed in six cases with poor prognosis. All resulted in perinatal loss. The neurodevelopmental outcome of survivors with isolated SVM (ten live-born survivors) showed major neurological morbidity in 50% (5/10) of the cases, mild morbidity in 40% (4/10) and a normal outcome in only one case. Conclusion Isolated SVM had a very poor perinatal outcome with neurological and physical disability in the overwhelming majority. Only one case of the 17 (6%) diagnosed initially with ‘apparently’ isolated SVM was born alive without handicap. Information from our series may aid couples in decision making about pregnancy interruption and the difficult decision of prenatal or intrapartum cephalocentesis. Copyright © 2009 John Wiley & Sons, Ltd.

Objective To determine whether the use of ultrasound can reduce the incidence of incorrect diagnosis of the fetal head position at instrumental delivery and subsequent morbidity. Design Two-arm, parallel, randomised trial, conducted from June 2011 to December 2012. Setting Two maternity hospitals in the Republic of Ireland. Sample A cohort of 514 nulliparous women at term (≥37 weeks of gestation) with singleton cephalic pregnancies, aiming to deliver vaginally, were recruited prior to an induction of labour or in early labour. Methods If instrumental delivery was required, women who had provided written consent were randomised to receive clinical assessment (standard care) or ultrasound scan and clinical assessment (ultrasound). [Correction added on 17 April 2014, after first online publication: Sentence was amended.] Main outcome measure Incorrect diagnosis of the fetal head position. Results The incidence of incorrect diagnosis was significantly lower in the ultrasound group than the standard care group (4/257, 1.6%, versus 52/257, 20.2%; odds ratio 0.06; 95% confidence interval 0.02–0.19; P

Background: Intrauterine growth restriction (IUGR) is the single largest contributing factor to perinatal mortality in non-anomalous fetuses. Advances in antenatal and neonatal critical care have resulted in a reduction in neonatal deaths over the past decades, while stillbirth rates have remained unchanged. Antenatal detection rates of fetal growth failure are low, and these pregnancies carry a high risk of perinatal death. Methods: The Prospective Observational Trial to Optimize Paediatric Health in IUGR (PORTO) Study recruited 1,200 ultrasound-dated singleton IUGR pregnancies, defined as EFW

OBJECTIVE: The purpose of this retrospective cohort study was to review pregnancy outcomes in morbidly obese women who delivered a baby weighing 500 g or more in a large tertiary referral university hospital in Europe. METHODS: Morbid obesity was defined as a BMI ≥40.0 kg/m(2) (WHO). Only women whose BMI was calculated at their first antenatal visit were included. The obstetric out-comes were obtained from the hospital's computerised database. RESULTS: The incidence of morbid obesity was 0.6% in 5,824 women. Morbidly obese women were older and were more likely to be multigravidas than women with a normal BMI. The pregnancy was compli-cated by hypertension in 35.8% and diabetes mellitus in 20.0% of women. Obstetric interventions were high, with an induction rate of 42.1% and a caesarean section rate of 45.3%. CONCLUSIONS: Our findings show that maternal morbid obesity is associated with an alarmingly high incidence of medical complications and an increased level of obstetric interventions. Consideration should be given to developing specialised antenatal services for morbidly obese women. The results also highlight the need to evaluate the effectiveness of prepregnancy interventions in morbidly obese women.

Objective: To compare the incidence of spontaneous miscarriage in women with moderate to severe obesity to that in women with a normal BMI after sonographic confirmation of the foetal heart rate in the first trimester. Methods: Women were enrolled in a prospective observational study at their convenience in the first trimester after an ultrasound confirmed an ongoing singleton pregnancy with foetal heart activity present. Maternal height and weight were measured digitally and BMI was calculated. Results: In the 3,000 women enrolled, the miscarriage rate overall was 3.9% (n = 117). The mean gestational age at enrolment was 11.1 weeks. In the class 2–3 (BMI > 34.9 kg/m2) obese primigravidas the miscarriage rate was 11.3% (n = 8) compared with 2.7% (n = 24) in the normal BMI category (p = 0.003), and 3.7% (n = 5) in the class 1 obese category (not significant). In multigravidas, there was no increased rate of miscarriage among class 2–3 obese women compared with multigravidas in the normal BMI category. The mean body composition values showed that primigravidas who miscarried had both increased fat and fat-free masses compared with those who did not, but multigravidas who miscarried had a similar fat mass and fat-free mass with those who did not. Conclusions: In women with sonographic evidence of foetal heart activity in the first trimester, the rate of spontaneous miscarriage is low. It was increased in moderate to severely obese primigravidas, but was not increased in other obese women compared to women in the normal BMI category.

Objective The objective of this analysis, as part of the multicentre prospective PORTO Trial, was to determine whether increasing maternal BMI decreases the accuracy of sonographic fetal weight estimation in IUGR pregnancies. Study design The PORTO Trial recruited 1,118 consecutive ultrasound-dated singleton IUGR pregnancies, defined as EFW Results Of the 1,076 recruited patients with complete records, 693 (64%) were of normal weight (BMI Conclusion These data show that ultrasound is reliable in the assessment of fetal weight in IUGR in the presence of increased maternal BMI.

Background Despite both Ireland and the United Kingdom providing free maternity care to all women, adverse fetal and maternal outcomes remain closely linked to social disadvantage and lack of support during pregnancy. A European survey found 42.4% of respondents had limited functional health literacy, closely liked to economic deprivation. Written information remains the main medium of communication for maternity services. It is likely that many of these messages are not adequately communicated to those most at risk. Objectives This study examined the use of digital media by pregnant women to access healthcare information for pregnancy. Methods A survey was distributed to all antenatal patients attending clinics at a large Dublin maternity hospital. Results Of the 218 women surveyed, 81% attended public clinics and 19% attended private clinics, 60% lived in Dublin and 40% were from surrounding counties, 18% were unemployed. Overall 94% used the internet to access information about pregnancy; 100% of unemployed women use the internet to access healthcare information and 75% of women have a smartphone. Newspapers were read by only 29% of women. All women wanted some form of online/digital support during their pregnancy, including weekly text messages about pregnancy stage-specific issues (cited by 45%), a maternity smartphone App (44%) and a website for feedback regarding their care (42%). Conclusion Digital media use is widespread across all socioeconomic groups. Healthcare communication in pregnancy should focus on digital communication channels.

Objective To profile longitudinal changes in the fetal mid thigh muscle and subcutaneous tissue measurements in fetuses with a normal growth velocity in euglycemic pregnancies and evaluate the association between mid thigh parameters and birthweight. Methods A prospective longitudinal study of 351 singleton fetuses in euglycemic pregnancies. Reliability of fetal abdominal subcutaneous tissue (FAST) measurements and mid thigh indices including thigh muscle (TM) and thigh fat (TF) between two operators was also reviewed. Results The FAST and fetal mid thigh muscle and fat in AGA fetuses show a significant increase with gestational age. At 28 weeks gestation the Abdominal circumference, TF, FAST and EFW centile were all found to be statistically significant predictors of birthweight. Using backwards stepwise linear regression to find the optimal multivariate model for predicting birthweight a combination of EFW centile and TF were found to be the best predictors. At 37 weeks optimal multivariate model for BW prediction was EFW centile, FAST and TF. The results reveal acceptable reproducibility for fetal mid thigh muscle and fat for a single operator and between operators. Conclusion This prospective study provides reference ranges for fetal mid thigh fat and muscle throughout gestation in fetuses with a normal growth velocity. The inclusion of fetal mid thigh fat in the birthweight algorithm improves the predictive power of birthweight estimation at 28 weeks and 37 weeks. This information is important to explore the role of fetal mid thigh in the detection of fetal IUGR at point estimations of EFW within normal centiles.

Objective The objective of this analysis, as part of the multicentre prospective PORTO Trial, was to describe and compare perinatal outcomes of IUGR pregnancies with normal and abnormal umbilical artery (UA) Doppler studies. Study design The PORTO Trial recruited over 1,100 consecutive ultrasound-dated singleton IUGR pregnancies, defined as EFW th centile. All fetuses underwent serial sonographic assessment until birth. Perinatal outcomes were documented for all participants. Results Of the 1,118 recruited patients, 606 (54%) had normal UA Doppler studies and 512 (46%) had abnormal UA Dopplers, defined as UA PI > 95 th centile or AREDF. The group with abnormal UA Doppler was delivered earlier and more commonly by CS, had more admissions to NICU and adverse perinatal outcomes (Table 1). The 4 mortalities with normal Doppler all had EFW rd centile. Conclusion IUGR fetuses with normal UA Doppler studies have better perinatal outcomes than those with abnormal UA Doppler, however adverse perinatal outcome can occur with normal UA in more severe IUGR cases (EFW

Objective The introduction of new models of care in the Irish maternity services has been recommended by both advocacy groups and strategic reports. The purpose of this study was to seek the views of women about the different models of care. Subjects and methods We surveyed women who were attending the out-patients department in early pregnancy in a large Dublin maternity hospital. Demographic and clinical details were recorded prospectively. Results Of the 501 women surveyed, 45.5% preferred to deliver in a doctor-led unit, while 42.9% preferred a midwifery-led unit. Of those 42.9%, 55% met the inclusion criteria. There was minimal demand (1.6%) for home births. Of the 8 who opted for home delivery, only 4 (0.8% overall) were suitable on clinical grounds. 70% wanted shared antenatal care between their general practitioner and either an obstetrician or midwife. Choice was influenced by whether the woman was attending for private care or not. Safety is the most important factor for women when choosing the type of maternity care they want. A private room and a desire to avoid hospitals are least important. Of women surveyed, 86% believed they had enough information to allow them to choose the model of maternity care. Conclusion We found that pregnant women in Ireland want a range of choices when it comes to models of maternity care. Their choice is strongly influenced by childbirth safety issues and least influenced by the physical surroundings for childbirth.