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Background: The hypothalamic–pituitary–adrenal (HPA) and -gonadal (HPG) axes are two major pathways that connect the neural and endocrine systems in vertebrates. Factors such as prenatal stress and maternal exposure to exogenous steroids have been shown to affect these pathways during fetal development. Another less studied factor is the transfer of hormones across fetuses in multifetal pregnancies. This form of transfer has been shown to influence the morphology, anatomy, physiology, and behavior of the offspring in litter-bearing mammals, an influence termed the intrauterine position (IUP) effect. In this study, we sought to delineate how the IUP effects HPA and HPG brain receptors, peptides, and enzymes (hereafter components) in utero and how these influences may differ between males and females. Methods: We utilized the unconventional model of culled free-ranging nutria (Myocastor coypus), with its large natural variation. We collected brain tissues from nutria fetuses and quantified the expression of key HPA and HPG components in three brain regions: prefrontal cortex, hypothalamus, and striatum. Results: We found an interaction between sex and IUP in the mineralocorticoid receptor (MR), gonadotropin-releasing hormone receptor (GNRHR), androgen receptor (AR), and estrogen receptor alpha (ESR1). IUP was significant in both gonadotropin-releasing hormone (GnRH) and its receptor GNRHR, but in different ways. In the hypothalamus, fetuses adjacent to same-sex neighbors had higher expression of GnRH than fetuses neighboring the opposite sex. Conversely, in the cortex, GNRHR exhibited the inverse pattern, and fetuses that were neighboring the opposite sex had higher expression levels than those neighboring the same sex. Regardless of IUP, in most components that showed significant sex differences, female fetuses had higher mRNA expression levels than male fetuses. We also found that HPA and HPG components were highly related in the early stages of gestation, and that there was an interaction between sex and developmental stage. In the early stages of pregnancy, female component expression levels were more correlated than males', but in the last trimester of pregnancy, male components were more related to each other than female's. Conclusions: This study suggests that there are sexually different mechanisms to regulate the HPA and HPG axes during fetal development. Higher mRNA expression levels of endocrine axes components may be a mechanism to help females cope with prolonged androgen exposure over a long gestational period. Additionally, these findings suggest different coordination requirements of male and female endocrine axes during stages of fetal development. Highlights: This study is the first to analyze HPA and HPG axes receptors, peptides, and enzyme mRNA expression levels in the brains of fetuses in the wild. Higher HPA and HPG axes receptors mRNA expression levels in females hint towards alternative sex-specific mechanisms that regulate endocrine axes during fetal development. Coordination of HPA and HPG axes components' expression levels is different between males and females at different stages of gestation. Plain language summary: In litter-bearing mammals, the positioning of a fetus in the uterus relative to other fetuses of the same or opposite sex has been shown to directly influence fetal morphology and physiology, and later behavior, reproductive success, and survival in adults. In this study, we sought to understand the mechanisms by which the location in the uterus influences two major neuroendocrine pathways in fetal brains. We quantified expression of multiple receptors and an enzyme (referred to as 'components') of the endocrine axes in three different brain regions in fetal free-ranging nutrias. Our results showed higher expression in females than in males for some endocrine axes components. The location inside the uterus was also related to the expression of some components. Lastly, coordination between the axes was higher earlier on in gestation, and females were more coordinated than males in the second trimester, whereas males were more coordinated than females in the third trimester. The results of this study point to the mechanisms by which the sexes regulate key neuroendocrine pathways during fetal development. [ABSTRACT FROM AUTHOR]

Objectives: External environmental heat exposure during gestation impacts the physiology of human development in utero, but evidence for these impacts has not yet been explored in dentition. We examined deciduous teeth for fluctuating asymmetry (FA), a measure of developmental instability, together with gestational environmental temperature data drawn from historical weather statistics. Materials and Methods: We measured dental casts from the longitudinal Burlington Growth Study, representing 172 participants (ages 3–6 years) with health records. FA was calculated from crown dimensions and intercuspal distances that develop during gestation. Multiple regression separated by sex (nfemale = 81) examined the effects of mean temperatures in each trimester, controlling for birth year. Results: In females, increased temperatures during the first trimester are significantly associated with an increase in FA (p = 0.03), specifically during the second and third prenatal months (p = 0.03). There is no relationship between temperature and FA for either sex in the second or third trimesters, when enamel is formed. Discussion: Dental instability may be sensitive to temperature in the first trimester in females during the scaffolding of crown shape and size in the earliest stages of tooth formation. Sexual dimorphism in growth investment strategies may explain the differences in results between males and females. Using enduring dental characteristics, these results advance our understanding of the effects of temperature on fetal physiology within a discrete period. [ABSTRACT FROM AUTHOR]

Introduction: Prenatal exposure to supraphysiological glucocorticoid (GC) levels may lead to long‐lasting developmental changes in numerous biological systems. Our prior study identified an association between prenatal GC prophylaxis and reduced cognitive performance, electrocortical changes, and altered autonomic nervous system (ANS) activity in children aged 8–9 years. This follow‐up study aimed to examine whether these findings persisted into adolescence. Material and Methods: Prospective observational follow‐up study involving twenty‐one 14‐ to 15‐year‐old adolescents born to mothers who received betamethasone for induction of fetal lung maturation in threatened preterm birth, but who were born with a normal weight appropriate for their gestational age (median 37+4 gestational weeks). Thirty‐five children not exposed to betamethasone served as the reference group (median 37+6 gestational weeks). The primary endpoint was cognitive performance, measured by intelligence quotient (IQ). Key secondary endpoints included symptoms of attention‐deficit/hyperactivity disorder (ADHD) and metabolic markers. Additionally, we determined electrocortical (electroencephalogram), hypothalamus–pituitary–adrenal axis (HPAA), and ANS activity in response to a standardized stress paradigm. Results: No statistically significant group difference was observed in global IQ (adjusted mean: betamethasone 103.9 vs references 105.9, mean difference −2.0, 95% confidence interval [CI]: −7.12 to 3.12, p = 0.44). Similarly, ADHD symptoms, metabolic markers, the overall and stress‐induced activity of the HPAA and the ANS did not differ significantly between groups. However, the betamethasone group exhibited reduced electrocortical activity in the frontal brain region (spectral edge frequency–adjusted means: 16.0 Hz vs 17.8 Hz, mean difference −1.83 Hz, 95% CI: −3.21 to −0.45, p = 0.01). Conclusions: In 14‐ to 15‐year‐old adolescents, prenatal GC exposure was not associated with differences in IQ scores or ANS activity compared to unexposed controls. However, decelerated electrocortical activity in the frontal region potentially reflects disturbances in the maturation of cortical and/or subcortical brain structures. The clinical significance of these changes remains unknown. Given the small sample size, selective participation/loss of follow‐up and potential residual confounding, these findings should be interpreted cautiously. Further research is required to replicate these results in larger cohorts before drawing firm clinical conclusions. [ABSTRACT FROM AUTHOR]

The article comments on the need to amend the constitution allowing human life protection in the U.S. Topics mentioned include the Supreme Court's distinction of three stages of pregnancy, the court's definition of health, the Judeo-Christian medical and legal ethic of abortion and the application of the right to life to all human beings.

Maternal, fetal, and placental factors are involved in the growth, development, and metabolism of the fetus. This paper presents the development of the placenta and its functions, fetal growth and metabolism, the structural and functional development of the fetal organ systems, and fetal stress and its prenatal and postnatal consequences. [ABSTRACT FROM AUTHOR]

Chorioamnionitis is a common antecedent of preterm birth and induces inflammation and oxidative stress in the fetal lungs. Reducing inflammation and oxidative stress in the fetal lungs may improve respiratory outcomes in preterm infants. Creatine is an organic acid with known anti-inflammatory and antioxidant properties. The objective of the study was to evaluate the efficacy of direct fetal creatine supplementation to reduce inflammation and oxidative stress in fetal lungs arising from an in utero proinflammatory stimulus. Fetal lambs (n = 51) were instrumented at 90 days gestation to receive a continuous infusion of creatine monohydrate (6 mg·kg-1 ·h-1) or saline for 17 days. Maternal chorioamnionitis was induced with intra-amniotic lipopolysaccharide (LPS; 1 mg, O55:H6) or saline 7 days before delivery at 110 days gestation. Tissue creatine content was assessed with capillary electrophoresis, and inflammatory markers were analyzed with Luminex Magpix and immunohistochemistry. Oxidative stress was measured as the level of protein thiol oxidation. The effects of LPS and creatine were analyzed using a two-way ANOVA. Fetal creatine supplementation increased lung creatine content by 149% (PCr < 0.0001) and had no adverse effects on lung morphology. LPS-exposed groups showed increased levels of interleukin-8 in the bronchoalveolar lavage (PLPS < 0.0001) and increased levels of CD45 þ leukocytes (PLPS < 0.0001) and MPO þ (PLPS < 0.0001) cells in the lung parenchyma. Creatine supplementation significantly reduced the levels of CD45 þ (PCr = 0.045) and MPO þ cells (PCr = 0.012) in the lungs and reduced thiol oxidation in plasma (PCr < 0.01) and lung tissue (PCr = 0.02). In conclusion, fetal creatine supplementation reduced markers of inflammation and oxidative stress in the fetal lungs arising from chorioamnionitis.NEW & NOTEWORTHY We evaluated the effect of antenatal creatine supplementation to reduce pulmonary inflammation and oxidative stress in the fetal lamb lungs arising from lipopolysaccharide (LPS)-induced chorioamnionitis. Fetal creatine supplementation increased lung creatine content and had no adverse effects on systemic fetal physiology and overall lung architecture. Importantly, fetuses that received creatine had significantly lower levels of inflammation and oxidative stress in the lungs, suggesting an anti-inflammatory and antioxidant benefit of creatine. [ABSTRACT FROM AUTHOR]

Parthenogenesis is a form of asexual reproduction in which a gamete (ovum or sperm) develops without being fertilized. Tomer Jordi Chaffer uses parthenogenesis to challenge Don Marquis' future‐like‐ours (FLO) argument against abortion. According to Marquis, (1) what makes it morally wrong to kill us is that it would deprive us of a possible future that we might come to value—a future "like ours" (FLO) and (2) human fetuses are numerically identical to any adult human organism they may develop into, and thus have a FLO. Chaffer contends that if human ova are capable of parthenogenesis, then they would have a FLO, which contraception may deprive them of, but contends this is absurd. Bruce P. Blackshaw challenges Chaffer, contending sexually fertilized embryos are not identical to unfertilized ovum, but this would yield a more absurd implication, that fertilization deprives an ovum of a FLO! Here I show Marquis' account of identity rules out both Chaffer's and Blackshaw's accounts. [ABSTRACT FROM AUTHOR]

In numerous medical conditions, including pregnancy, gravity and posture interact to impact physiology and pathophysiology. Recent investigations, for example, pertaining to maternal sleeping posture during the third trimester and possible impact on fetal growth and stillbirth risk highlight the importance and potential clinical implications of the subject. In this review, we provide an extensive discussion of the impact of maternal posture on fetal physiology from conception to the postpartum period in human pregnancy. We conducted a systematic literature search of the MEDLINE database and identified 242 studies from 1991 through 2021, inclusive, that met our inclusion criteria. Herein, we provide a synthesis of the resulting literature. In the first section of the review, we group the results by the impact of maternal posture at rest on the cervix, uterus, placenta, umbilical cord, amniotic fluid, and fetus. In the second section of the review, we address the impact on fetal-related outcomes of maternal posture during various maternal activities (e.g., sleep, work, exercise), medical procedures (e.g., fertility, imaging, surgery), and labor and birth. We present the published literature, highlight gaps and discrepancies, and suggest future research opportunities and clinical practice changes. In sum, we anticipate that this review will shed light on the impact of maternal posture on fetal physiology in a manner that lends utility to researchers and clinicians who are working to improve maternal, fetal, and child health. [ABSTRACT FROM AUTHOR]

Objective: To investigate associations between maternal testosterone status and offspring birth anthropometrics. Design: Population‐based prospective cohort study. Setting: University Hospital. Population: 1486 mother–child dyads from Odense Child Cohort. Methods: Maternal blood samples were collected at gestational weeks 27–30 and free testosterone (FT) levels were calculated using the Vermeulen equation from total testosterone (TT) analysed by mass spectrometry and sex hormone binding globulin. Associations between FT or TT levels and birth anthropometrics were analysed with multiple linear regression models according to offspring sex with adjustment for maternal age, parity, smoking and educational level. Analyses were repeated with polycystic ovary syndrome as exposure for offspring birth anthropometrics. Main outcome measures: Offspring birth weight (BW), birth length, abdominal and head circumferences. Results: Maternal mean (SD) age was 30.2 (4.5) years and pre‐pregnancy body mass index was 23.5 (5.3) kg/m2. In boys (n = 787), higher FT was associated with lower birth weight (adjusted doubling constant = −65.53, P = 0.010), shorter birth length (adjusted doubling constant = −0.43, P < 0.001), and lower abdominal circumference (adjusted doubling constant = −0.39, P < 0.001); Higher TT was associated with lower abdominal circumference (adjusted doubling constant = −0.25, P = 0.028). In girls, no associations were found between maternal FT or TT and offspring anthropometrics. Conclusions: Higher maternal free testosterone exposure was linked to reduced birth weight, length and abdominal circumference in boys, whereas girls were not susceptible to maternal testosterone exposure. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the impact of air pollution on birth outcomes in the USA over several decades. Approximately 70 million birth records were assessed for the years 1980–2020. This study focussed on seven measures of birth outcomes, including birth weight, low birth weight, very low birth weight, full-term birth weight, foetal growth, gestational age and very premature birth. An instrumental variable identification strategy was used that exploited within county-month and within month-year of birth variations in exposure to precipitation-induced changes in air pollution. Air pollution was found to have negative and large effects on a wide range of birth outcomes. The study findings suggest that a one-standard-deviation increase in ozone was associated with a 6.4% and 12.8% increase (from the mean) in the proportion of low birth weight and very preterm birth infants, respectively. Further analyses suggest that these effects were heterogeneous across trimesters of pregnancy and reveal larger impacts during the second and third trimesters. The results suggest that the ordinary least square estimates of previous studies considerably underestimate the true effects of pollution on birth outcomes. Policies that aim to improve the health capital of future generations should allocate more resources and initiatives to improving environmental air quality. [ABSTRACT FROM AUTHOR]

Background: In this study, we assessed the communication strategies used by neonatologists in antenatal consultations which may influence decision-making when determining whether to provide resuscitation or comfort measures only in the care of periviable neonates. Methods: This study employed a qualitative study design using inductive thematic discourse analysis of 'naturally occurring data' in the form of antenatal conversations around resuscitation decisions at the grey zone of viability. The study occurred between February 2017 and June 2018 on a labor and delivery unit within a large Midwestern tertiary care hospital. Participants included 25 mothers who were admitted to the study hospital with anticipated delivery in the grey zone of viability and practicing neonatologists or neonatology fellows who partnered in antenatal consultation. We used a two-stage inductive analytic process to focus on how neonatologists' discourses constructed SDM in antenatal consultations. First, we used a thematic discourse analysis to interpret the recurring patterns of meaning within the transcribed antenatal consultations, and second, we theorized the subsequent effects of these discourses on shaping the context of SDM in antenatal encounters. Results: In this qualitative study, that included discourse analysis of real-time audio conversations in 25 antenatal consults, neonatologists used language that creates projected autonomy through (i) descriptions of fetal physiology (ii) development of the fetus's presence, and (iii) fetal role in decision-making. Conclusion: Discourse analysis of real-time audio conversations in antenatal consultations was revelatory of how various discursive patterns brought the fetus into decision-making, thus changing who is considered the key actor in SDM. [ABSTRACT FROM AUTHOR]

Newborn screening for congenital adrenal hyperplasia using 17- hydroxyprogesterone by immunoassay remains controversial despite screening been available for almost 40 years. Screening is confounded by poor immunoassay specificity, fetal adrenal physiology, stress, and illness which can result in a large number of false positive screening tests. Screening programmes apply higher screening thresholds based on co-variates such as birthweight or gestational age but the false positive rate using immunoassay remains high. Mass spectrometry was first applied to newborn screening for congenital adrenal hyperplasia over 15 years ago. Elevated 17-hydroxprogesterone by immunoassay can be retested with a specific liquid chromatography tandem mass spectrometry assay that may include additional steroid markers. Laboratories register with quality assurance programme providers to ensure accurate steroid measurements. This has led to improvements in screening but there are additional costs and added laboratory workload. The search for novel steroid markers may inform further improvements to screening. Studies have shown that 11-oxygenated androgens are elevated in untreated patients and that the adrenal steroidogenesis backdoor pathway is more active in babies with congenital adrenal hyperplasia. There is continual interest in 21-deoxycortisol, a specific marker of 21-hydroxylase deficiency. The measurement of androgenic steroids and their precursors by liquid chromatography tandem mass spectrometry in bloodspots may inform improvements for screening, diagnosis, and treatment monitoring. In this review, we describe how liquid chromatography tandem mass spectrometry has improved newborn screening for congenital adrenal hyperplasia and explore how future developments may inform further improvements to screening and diagnosis. [ABSTRACT FROM AUTHOR]

Doppler imaging is a non-invasive method in evaluating fetal circulation. Renal artery doppler (RAD) has been used for assessing fetal well-being in several studies. The aim of this narrative review was to accumulate and classify current evidence on RAD in fetal sonography. Articles until November 2022 were searched. After removing ineligible articles, 51 studies were included. Present articles were about RAD assessment in cases with amniotic fluid level changes, fetal growth restriction, fetal renal diseases, monochorionic twin pregnancies, preeclampsia, and gestational diabetes mellitus. The complex physiology of fetal kidney function may explain different results observed in different studies about the role of RAD in fetal assessment. It seems this factor can be useful in assessing some groups like diabetic pregnant women, and it should be used accompanying other related factors like kidney size. Further research is needed to evaluate the effectiveness of RAD in clinical management. [ABSTRACT FROM AUTHOR]

This article examines the effects of excess vitamin A and/or vitamin E on the ovarian function of primiparous dairy cows after giving birth. The study found that a single dose of either vitamin A or vitamin E can improve ovarian function in cows during the early postpartum period. However, caution should be exercised in regions where colostrum curd is consumed as a regional cuisine, as the concentration of vitamin A in colostrum increased after administration. The authors emphasize that further studies are needed to determine the optimal quantity of vitamins that can be safely administered to promote ovulation while protecting the cow's health. [Extracted from the article]

Objectives: Literature on cerebroplacental hemodynamics in fetuses with transposition of the great arteries (TGA) is scarce and provides conflicting results regarding the presence of a brain‐sparing effect. The aims of this study were to examine Doppler parameters in the middle cerebral artery (MCA) and umbilical artery (UA) in a large cohort of fetuses with TGA, and to assess their possible utility in predicting the need for urgent balloon atrial septostomy (BAS) in the neonate. Methods: This was a retrospective observational study of fetuses diagnosed with TGA between 2008 and 2022 and an age‐matched cohort of normal fetuses, conducted in a single tertiary fetal cardiology center. Medical records and echocardiographic examinations were reviewed to collect demographic, sonographic and follow‐up data. Selected Doppler parameters were compared between fetuses with TGA and normal fetuses, as well as between TGA fetuses with and those without an associated ventricular septal defect (VSD), to assess the impact of this congenital heart defect on cerebroplacental circulation. Additionally, Doppler indices in patients with a restrictive foramen ovale (FO) were analyzed to identify potential predictors of the need for urgent BAS. Results: A total of 541 examinations of 159 fetuses with TGA performed between 19 and 40 weeks' gestation and 1300 examinations of 1215 age‐matched normal fetuses were included in the study. MCA pulsatility index (PI) and UA‐PI followed expected trends throughout pregnancy, with slightly higher values observed in TGA fetuses, albeit within the limits for the normal population. Cerebroplacental ratio (CPR) values were similar in normal and TGA fetuses. The presence of a small VSD did not have a clinically significant impact on Doppler parameters. Peak systolic velocity (PSV) in the MCA increased gradually after 35 weeks' gestation, especially in fetuses that did not develop restriction of the FO after birth. MCA‐PSV values below 1.16 multiples of the median measured at 38 weeks or later predicted the need for urgent BAS with 81.4% sensitivity and 52.4% specificity. Conclusions: MCA‐PI, UA‐PI and CPR values in fetuses with TGA usually fall within normal limits throughout pregnancy. The presence of a small VSD does not affect the Doppler parameters significantly. MCA‐PSV increases in TGA fetuses after 35 weeks, and its value measured at the last prenatal examination (ideally after 37 weeks) may serve as an additional predictive factor for the need for urgent BAS. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Assessment of redox potential in the porcine ejaculate: Relationships with seminal parameters... E. Pintus; M. Scaringi; J. Ros-Santaella Czech University of Life Sciences, Prague, Czech Republic Oxidative stress is associated with male infertility and reduced sperm survival during storage. The assessment of seminal oxidation-reduction potential (ORP) has been recently introduced in andrology laboratories, but its application in animal reproduction is still little explored. This study aimed to evaluate the ORP of boar ejaculate and its relationships with seminal parameters and changes during storage at 17°C. Seminal ORP, pH, osmolarity, sperm concentration and morphology were evaluated in the sperm-rich fractions from Duroc boars ( I N i = 19). Then, samples were diluted to 2 × 10*7 sperm/mL in Beltsville thawing solution supplemented with 25% autologous seminal plasma and evaluated at 0 and 72 h of storage. At each time, ORP was evaluated in presence or absence of spermatozoa (removed by centrifugation). Data were analysed by paired samples I t i -test and Pearson/Spearman correlation tests. The absolute and normalized ORP values of the ejaculates were -57.29 ± 3.10 mV and - 0.13 ± 0.01 mV/10*6 sperm/mL, respectively (mean ± SE). More reducing ORP values were found in the semen than in the seminal plasma. Ejaculate's ORP was negatively associated with the seminal pH and sperm concentration, but neither with seminal osmolarity nor normal sperm morphology, which are partly consistent with human studies. During storage, ORP showed more reducing values in samples with spermatozoa than those without them at 0 h, while sperm presence did not affect the redox balance at 72 h. Irrespective of sperm presence, sperm redox status showed a significant increase during storage period. In conclusion, ORP is a useful and interesting tool for assessing sperm redox homeostasis. Supported by NAZV project no. QK21010327. [Extracted from the article]

Vitamins and minerals have key roles in hormone production and action, enzyme activity, tissue synthesis, oxygen transport, and energy production. These micronutrients are efficiently transferred from the dam to the fetus during gestation to be partitioned for metabolic use and stored as postnatal mineral reserves. Maternal nutrient intake is one of the main factors that influence the availability of vitamins and minerals to the fetus. Thus, an inadequate supply of these critical nutrients can have a long-lasting impact on offspring growth and health. Evidence suggests that biological processes regulating normal growth, development, and nutrient utilization are programmed in utero, even during the earliest developmental stages. Therefore, there is a critical need to evaluate the effects of micronutrient supplementation during gestation on fetal physiology and metabolic programming. Our research group has developed research models examining the impact of maternal vitamin and mineral supplementation (VTM, supplemented vs. NoVTM, not supplemented) during the periconceptual period or throughout gestation in beef heifers. A metabolomic analysis revealed that metabolites in the oxidative phosphorylation pathway were more abundant in the liver of fetuses from VTM than NoVTM dams, suggesting that a greater supply of micronutrients during the periconceptual period and first trimester of pregnancy may positively modulate mitochondrial energy metabolism in offspring. These changes in the abundance of metabolites suggested physiological adaptations to meet fetal metabolic needs. Further, high-resolution respirometry analysis revealed greater efficiency of energy utilization in small intestinal samples of neonatal calves from VTM dams. In fact, VTM offspring were heavier from weaning to breeding phase than NoVTM offspring, suggesting that maternal nutrition affects physiological mechanisms in utero that modulate offspring energetics and efficiency of nutrient utilization in the postnatal period. Furthermore, we reported increased concentrations of histidine, aspartate, and 12 out of 14 neutral amino acids in the allantoic fluid of VTM-supplemented dams. Finally, genes involved with amino acid transport in fetal liver were upregulated in response to VTM supplementation, highlighting the intricate relationship between maternal and fetal nutrition. Vitamin and mineral supplementation were also associated with changes in gene expression, biological processes and pathways in placental tissue at d 83 of gestation. We observed an upregulation of genes in the calcium signaling and cyclic guanosine monophosphate (CGMP)-PKG signaling pathways in response to micronutrient supplementation. Calciummediated systems may modulate cell proliferation and steroidogenic activity in bovine placentomes, while CGMP-PKG plays a key role in vascular homeostasis. Placental blood vessel vascularity at term was indeed increased in heifers supplemented throughout gestation, emphasizing the importance of micronutrient supplementation beyond early pregnancy. Altogether, our findings suggest that vitamin and mineral supplementation in the periconceptual period and during gestation play a pivotal role in fetal metabolic programming with consequences extending to the postnatal period. [ABSTRACT FROM AUTHOR]

Most obstetrical studies have focused on maternal response to the SARS-CoV-2 virus but much less is known about the effect of COVID-19 on fetal physiology. We aimed to evaluate the effect of the maternal SARS-CoV-2 infection on the fetal homeostasis with the use of detailed ultrasonography and echocardiography and consideration of the effect of vaccination. This was a multi-center study of fetuses who had prenatal detailed ultrasound and echocardiographic examinations performed by fetal cardiology specialists. The subjects were divided based on the COVID vaccination status (vaccinated women who did not have COVID-group V, unvaccinated women who had COVID-group UV, and unvaccinated women who did not have COVID-control group). We evaluated the ultrasound and echocardiography results obtained. The study group included 237 gravidas from four prenatal cardiology centers. In the group of fetuses with normal heart anatomy, normal cardiovascular function had 147 (81%) fetuses and functional cardiovascular anomalies were present in 35 (19%) cases. Functional cardiovascular anomalies were present in 11 (16%) fetuses in the V group, 19 (47%) fetuses in the UV group and 5 (8%) fetuses in the control group (p < 0.01). There were 56 (24%) fetuses with extracardiac anomalies. Extracardiac anomalies were present in 20 (22%) fetuses in the V group, 22 (45%) fetuses of the UV group and in 14 (14%) fetuses in the control group (p < 0.01). Our study has proved that maternal COVID-19 infection can affect the fetal physiology and mild cardiac and extracardiac markers detected by fetal ultrasonography and echocardiography. Moreover, maternal vaccination results in lower occurrence of these findings in fetuses. [ABSTRACT FROM AUTHOR]

Background: Safe and effective local anesthesia is a prerequisite for emergency oral surgeries and most dental treatments. Pregnancy is characterized by complex physiological changes, and increased sensitivity to pain. Pregnant women are particularly vulnerable to oral diseases, such as caries, gingivitis, pyogenic granuloma and third molar pericoronitis. Maternally administered drugs can affect the fetus through the placenta. Therefore, many physicians and patients are reluctant to provide or accept necessary local anesthesia, which leads to delays in the condition and adverse consequences. This review is intended to comprehensively discuss the instructions for local anesthesia in the oral treatment of pregnant patients. Methodology: An in-depth search on Medline, Embase, and the Cochrane Library was performed to review articles concerned with maternal and fetal physiology, local anesthetic pharmacology, and their applications for oral treatment. Results: Standard oral local anesthesia is safe throughout the pregnancy. At present, 2% lidocaine with 1:200,000 epinephrine is considered to be the anesthetic agent that best balances safety and efficacy for pregnant women. Maternal and fetal considerations must be taken into account to accommodate the physiological and pharmacological changes in the gestation period. Semi-supine position, blood pressure monitoring, and reassurance are suggested for high-risk mothers to reduce the risk of transient changes in blood pressure, hypoxemia, and hypoglycemia. For patients with underlying diseases, such as eclampsia, hypertension, hypotension, and gestational diabetes, the physicians should use epinephrine cautiously and control the dose of anesthetic. New local anesthesia formulations and equipment, which contribute to minimizing injection pain and relieving the anxiety, have and are being developed but remain understudied. Conclusions: Understanding the physiological and pharmacological changes during pregnancy is essential to ensure the safety and efficiency of local anesthesia. Optimal outcomes for the mother and fetus hinge on a robust understanding of the physiologic alterations and the appropriate selection of anesthetic drugs and approaches. [ABSTRACT FROM AUTHOR]

The article focuses on the physiology of the placenta, detailing its anatomy, blood flow, and various functions during pregnancy. Topics include the development of the placenta from the blastocyst stage, uteroplacental circulation, and the role of the placenta in gas exchange, metabolic transfer, endocrine function, immunological protection, anticoagulation, and drug transfer across the placenta.

BACKGROUND: There is no consensus on the relationship between maternal glucose levels and fetal movements. OBJECTIVE: This study aimed to investigate the correlation between gross fetal movements and maternal glucose levels in the hours around food intake. STUDY DESIGN: This was an observational study with 2 newly developed technologies, which were a glucose monitoring system and a fetal movement acceleration measurement recorder. A total of 15 women with singleton pregnancies were provided with the glucose monitoring system that automatically recorded their glucose levels every 15 minutes. In addition, fetal movements were recorded using the fetal movement acceleration measurement recorder, for 4 hours starting from 1 hour before lunch, once a week beginning at 28 weeks of gestation. For the four 1-hour periods, the ratios of the number of 10-second epochs with fetal movement divided by the total number of epochs (defined as the fetal movement parameter) were compared at the earlier (28–33 weeks of gestation), later (34–39 weeks of gestation), and overall (28–39 weeks of gestation) gestational weeks using analysis of variance analyses. A linear regression analysis was developed between the glucose level and the movement parameter for the earlier, later, and overall gestational weeks. All data were divided into 4 categories: (1) both the glucose level and the fetal movement parameter increased from the previous 15 minutes; (2) the glucose level increased, but the fetal movement parameter did not increase; (3) the glucose level did not increase, but the fetal movement parameter increased; and (4) both glucose level and fetal movement parameter did not increase. The numbers for each category were compared for the earlier, later, and overall gestational weeks using χ2 analyses. RESULTS: There was no significant change in the fetal movement parameter among the four 1-hour periods at the earlier (P=.509), later (P=.884), and overall (P=.816) gestational weeks. There was a positive correlation between the glucose level and the movement parameter at 28 to 33 weeks of gestation (P=.001), but not at 33 to 39 (P=.129) and 28 to 39 (P=.115) weeks of gestation. Compared with fetuses whose mothers did not have increased glucose levels, fetuses whose mothers had increased glucose levels moved more at 28 to 33 weeks of gestation (P=.031), but not at 34 to 39 (P=.398) and 28 to 39 (P=.238) weeks of gestation. CONCLUSION: Having a meal did not change gross fetal movement counting; however, there are positive correlations between maternal glucose level and gross fetal movement at 28 to 33 weeks of gestation, but not at 34 to 39 weeks of gestation, for both glucose values and value changes under natural conditions of the mother and fetus.

The placenta represents a non-neuronal organ capable of transporting and metabolizing monoamines. Since these bioactive molecules participate in numerous processes essential for placental and fetal physiology, any imbalance in their levels during pregnancy may affect brain development, projecting a higher risk of behavioral disorders in childhood or adulthood. Notably, the monoamine system in the placenta is a target of various psychoactive drugs and can be disrupted in several pregnancy pathologies. As research in pregnant women poses significant ethical restrictions, animal models are widely employed to study monoamine homeostasis as a mechanism involved in fetal programming. However, detailed knowledge of monoamine transport in the rat placenta is still lacking. Moreover, relatability to the human placental monoamine system is not examined. The present study provides insights into the transplacental monoamine dynamics between maternal and fetal circulation. We show that norepinephrine maternal-to-fetal transport is <4% due to high metabolism within the trophoblast. In contrast, dopamine maternal-to-fetal transport exceeds 25%, likely through passive transport across the membrane. In addition, we show high clearance of norepinephrine and dopamine from the fetal circulation mediated by the organic cation transporter 3 (OCT3). Altogether, we present transcriptional and functional evidence that the in situ rat placenta perfusion represents a suitable model for (patho)physiological investigation of dopamine and norepinephrine homeostasis in the fetoplacental unit. With the rapid advancements in drug discovery and environmental toxicity, the use of rat placenta as a preclinical model could facilitate screening of possible xenobiotic effects on monoamine homeostasis in the placenta. [ABSTRACT FROM AUTHOR]

Pregnancy induces reprogramming of maternal physiology to support fetal development and growth. Maternal hepatocytes undergo hypertrophy and hyperplasia to drive maternal liver growth and alter their gene expression profiles simultaneously. This study aimed to further understand maternal hepatocyte adaptation to pregnancy. Timed pregnancies were generated in mice. In a nonpregnant state, most hepatocytes expressed Cd133, α-fetal protein (Afp) and epithelial cell adhesion molecule (Epcam) mRNAs, whereas overall, at the protein level, they exhibited a CD133-/AFP- phenotype; however, pericentral hepatocytes were EpCAM+. As pregnancy advanced, although most maternal hepatocytes retained Cd133, Afp, and Epcam mRNA expression, they generally displayed a phenotype of CD133+/AFP+, and EpCAM protein expression was switched from peri-central to periportal maternal hepatocytes. In addition, we found that the Hippo/yes-associated protein (YAP) pathway does not respond to pregnancy. Yap1 gene deletion specifically in maternal hepatocytes did not affect maternal liver growth or metabolic zonation. However, the absence of Yap1 gene eliminated CD133 protein expression without interfering with Cd133 transcript expression in maternal livers. We demonstrated that maternal hepatocytes acquire heterogeneous and dynamic developmental phenotypes, resembling fetal hepatocytes, partially via YAP1 through a posttranscriptional mechanism. Moreover, maternal liver is a new source of AFP. In addition, maternal liver grows and maintains its metabolic zonation independent of the Hippo/YAP1 pathway. Our findings revealed a novel and gestation-dependent phenotypic plasticity in adult hepatocytes. [ABSTRACT FROM AUTHOR]

Intrapartum fetal surveillance aims to predict significant fetal hypoxia and institute timely intervention to avoid fetal injury, and do so without unnecessary operative delivery of fetuses at no risk of intrapartum hypoxia. However, the configuration and application of current clinical guidelines inadvertently undermine these aims because of persistent failure to incorporate increased understanding of fetal cardiovascular physiology and adaptations to oxygen deprivation, advances in signal acquisition/processing, and related technologies. Consequently, the field on intrapartum fetal surveillance is stuck in rudimentary counts of the fetal R–R intervals and visual assessment of very common, but nonspecific fetal heart decelerations and fetal heart rate variability. The present authors argue that the time has come to move away from classifications of static morphological appearances of FHR decelerations, which do not assist the thinking clinician in understanding how the fetus defends itself and compensates for intrapartum hypoxic ischaemic insults or the patterns that suggest progressive loss of compensation. We also reappraise some of the controversial aspects of intrapartum fetal surveillance in modern obstetric practice, the current state of flux in training and certification, and contemplate the future of the field particularly in the context of the emerging role of artificial intelligence. [ABSTRACT FROM AUTHOR]

Background: There, we review the pathogenesis of gestational diabetes mellitus (GDM), its influence on fetal physiology, and neonatal outcomes, as well as the usage of antenatal corticosteroid therapy (ACST) in pregnancies complicated by GDM. Methods: MEDLINE and PubMed search was performed for the years 1990–2022, using a combination of keywords on such topics. According to the aim of the investigation, appropriate articles were identified and included in this narrative review. Results: GDM is a multifactorial disease related to unwanted pregnancy course and outcomes. Although GDM has an influence on the fetal cardiovascular and nervous system, especially in preterm neonates, the usage of ACST in pregnancy must be considered taking into account maternal and fetal characteristics. Conclusions: GDM has no influence on neonatal outcomes after ACST introduction. The ACST usage must be personalized and considered according to its gestational age-specific effects on the developing fetus. [ABSTRACT FROM AUTHOR]

Objective Despite its routine use in intrapartum care, the technique of fetal cardiotocography has some limitations. The aim of this study is to analyze the predictive capacity and interobserver agreement in the latest versions of four international cardiotocography guidelines: Federation of Gynecology and Obstetrics (FIGO), American College of Obstetrics and Gynecology (ACOG), the National Institute for Health and Care Excellence (NICE) and Chandraharan, used to predict neonatal acidemia. Study design The last 30 min of 150 cardiotocographic records were analyzed over all the pH ranges and were blindly evaluated by three independent reviewers. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated to assess the predictive capacity of each fetal cardiotocographic guideline. The degree of interobserver agreement was evaluated with the Fleiss Kappa coefficient. Results Observers found fetal cardiotocography guidelines to have a variable sensitivity and specificity. The Chandraharan classification reached the highest sensitivity (78.79%), while ACOG had the highest specificity (95.73%). On average for the three observers, Chandraharan had the highest discrimination capacity for neonatal acidemia, although this was only moderate (AUC 0.66; 95%CI, 0.55–0.77) and did not differ significantly from the remaining guidelines. The degree of agreement among the three observers, assessed according to the Fleiss Kappa coefficient, was generally acceptable or moderate for all items and classifications, being highest with the FIGO classification (ĸ = 0.35; 95%CI, 0.28–0.41) and lowest with the ACOG (ĸ = 0.23; 95%CI, 0.16–0.30). Conclusion Although all the guidelines have a moderate capacity to predict neonatal acidemia, the Chandraharan guideline has the highest capacity. This follows a different approach from the others in that it relies on interpretations of cardiotocographic traces based on fetal physiology. The degree of interobserver agreement is, in general, acceptable for the four guidelines, and is the highest for FIGO. [ABSTRACT FROM AUTHOR]

Prenatal serotonin reuptake inhibitor (SRI) antidepressant exposure is associated with newborn neurobehavioural disturbances, but it remains unclear whether this reflects a transient pharmacologic condition or an altered neurodevelopmental trajectory emerging in utero from sustained gestational SRI exposure. This study explored longitudinal relationships between third-trimester fetal physiology and newborn neurobehaviour, and determined whether early neurobehavioural continuity is shaped by prenatal SRI or depression exposure. Participants were 127 pregnant mothers and their fetal-newborn offspring. Four groups were defined based on antenatal depressive symptoms and SRI treatment: Control (n = 51), Depressed (unmedicated; n = 35), SRI-Depressed (n = 26) and SRI-Non-Depressed (n = 15). Doppler measures of fetal heart rate (fHR), motor activity and vascular hemodynamics were obtained at 36-weeks' gestation, then newborn neurobehavioural maturity was evaluated at postnatal day-7. Partial least squares analysis was used to identify latent correlations between fetal-newborn measures; associations were further studied with hierarchical regression testing group moderation. Two dimensions described 74% of the covariance between fetal physiologic and newborn neurobehavioural measures (permuted p < 0.05). Three latent fetal-newborn relationships were significantly moderated by group: (1) lower fHR variability, and (2) greater fHR decelerations, predicted lower alertness/orientation scores but only in SRI-Depressed-group newborns; and (3) lower fetal cerebrovascular resistance predicted lower motor scores in Depressed-group newborns. SRI treatment to euthymia was not associated with fetal-newborn neurobehavioural disturbances. Maternal depression, both unmedicated and SRI-treated with persistent/poorly-managed mood symptoms, differentially shaped fetal-newborn neurobehavioural continuity. These findings suggest that neurobehavioural disturbances may predate birth, and underscore the importance of effective mental health management during pregnancy. • Data-driven longitudinal study of prenatal depression/SRI effects on fetus–newborn. • Newborn neurobehavioural problems emerge in utero as altered brain/cardiac physiology. • Maternal depression, both unmedicated and SRI-treated, disrupts early neurobehaviour. • Greatest early developmental risk with exposure to persistent depressed maternal mood. [ABSTRACT FROM AUTHOR]

Umbilical artery gas results help obstetricians assess fetal well-being during labor and guide screening decisions on eligibility for therapeutic hypothermia (ie, whole-body or head cooling). The accuracy of results, especially for the base deficit on arterial cord gas analysis, in predicting brain injury is questioned. A novel biomarker specifically calculated for fetal acid-base physiology and response to asphyxia—neonatal eucapnic pH as a marker of neonatal metabolic acidosis—has the potential to be an accurate predictor of hypoxic-ischemic encephalopathy. We aimed to compare false-negative rates of hypoxic-ischemic encephalopathy for umbilical artery pH, base deficit, and neonatal eucapnic pH in assessing fetal acid-base balance as a marker of fetal well-being and predicting acute brain injury. This is a retrospective single-center cohort study of newborns ≥ 35 weeks of gestation diagnosed with hypoxic-ischemic encephalopathy. We compared false-negative rates for any grade of hypoxic-ischemic encephalopathy using unilateral paired chi-square statistical analysis based on cutoff values for umbilical artery pH ≤7.00, base deficit ≥16 mmol/L, base deficit ≥12 mmol/L and neonatal eucapnic pH ≤7.14. We performed an analysis of variance between umbilical artery pH, base deficit, and neonatal eucapnic pH for each hypoxic-ischemic encephalopathy grade. We included 113 newborns. False-negative rate for hypoxic-ischemic encephalopathy was significantly higher for base deficit <16 mmol/L (n=78/113; 69.0%) than <12 mmol/L (n=46/113; 40.7%), pH >7.00 (n=41/113; 36.3%), or neonatal eucpanic pH >7.14 (n=35/113; 31.0%) (P <.0001). All true-positive cases were identified using only umbilical artery pH and neonatal eucapnic pH. Base deficit ≥16 or ≥12 mmol/L did not add any value in identifying newborns with hypoxic-ischemic encephalopathy when using umbilical artery pH and neonatal eucapnic pH. No association emerged between any marker and hypoxic-ischemic encephalopathy severity grading. Our findings support the accuracy of neonatal eucapnic pH to assess fetal well-being during labor and to improve predictive performance for acute brain injury. Neonatal eucpanic pH, in addition to umbilical artery pH, may be a viable alternative in identifying newborns at risk for hypoxic-ischemic encephalopathy. [Display omitted] [ABSTRACT FROM AUTHOR]

The aim was to assess the association between fetal growth restriction (FGR) and fetal heart rate variability (FHRV) in relation to fetal movements. A prospective observational cohort study was performed. Non‐invasive fetal electrocardiography (NI‐FECG) allowed beat‐to‐beat assessments with <5% corrections of RR intervals. FHRV analyses included: Root mean square of successive RR interval differences (RMSSD), high frequency power (HF power), and low frequency power (LF power). Fetal movements were categorized by continuous ultrasound scanning. We enrolled 36 singleton pregnant women expecting a small fetus (< the 2.3 percentile of mean weight for gestational age) diagnosed by ultrasound, of whom 25 presented with a birthweight < the 2.3 percentile. Among these, 11 were excluded due to low quality NI‐FECG recordings, leaving 14 women with 28 recordings eligible for inclusion in the analyses. The control group consisted of 22 healthy fetuses with birthweights between the 10th and the 90th percentile (average for gestational age [AGA]). In FGR fetuses the HRV response to respiratory activity was comparable to that of AGA fetuses. RMSSD (Ratio 1.54 [95% CI: 1.33; 1.79]) and HF power (Ratio 2.88 [95% CI: 2.12; 3.91]) increased, whereas LF/HF power (Ratio: 0.44 [95% CI: 0.31;0.63]) decreased. However, during fetal quiescence, FGR fetuses differed significantly from AGA fetuses. Compared to AGA fetuses, FGR fetuses displayed lower RMSSD (Ratio 0.77 (95% CI: 0.58; 1.02)) and HF power (Ratio 0.56 (95% CI:0.32; 0.98)). This reduction was associated with the severity of the FGR. In conclusion, FGR fetuses displayed a respiratory sinus arrhythmia (RSA) comparable to AGA fetuses; however, more important, parameters representing cardiac vagal activity were impaired in FGR fetuses during quiescence. RSA may constitute an intrinsic function of the cardiovascular system, which is unaffected by fetal compromise. However, the basic cardiac outflow assessed during fetal quiescence indicates a suppressed cardiac vagal activity in the FGR fetuses. [ABSTRACT FROM AUTHOR]

Historically, fetal heart rate (FHR) decelerations were classified into "early", "late", and "variable" based on their relationship with uterine contractions. So far, three different putative etiologies were taken for granted. Recently, this belief, passed down through generations of birth attendants, has been questioned by physiologists. This narrative review aimed to assess the evidence on pathophysiology behind intrapartum FHR decelerations. This narrative review is based on information sourced from online peer-reviewed articles databases and recommendations from the major scientific societies in the field of obstetrics. Searches were performed in MEDLINE/PubMed, EMBASE, and Scopus and selection criteria included studies in animals and humans, where the physiology behind FHR decelerations was explored. The greater affinity for oxygen of fetal hemoglobin than the maternal, the unicity of fetal circulation, and the high anaerobic reserve of the myocardium, ensure adequate oxygenation to the fetus, under basal conditions. During acute hypoxic stress the efficiency of these mechanisms are increased because of the peripheral chemoreflex. This reflex, activated at each uterine contraction, is characterized by the simultaneous activation of two neural arms: the parasympathetic arm, which reduces the myocardial consumption of oxygen by decreasing the FHR and the sympathetic component, which promotes an intense peripheric vasoconstriction, thus centralizing the fetal blood volume. This review summarizes the evidence supporting the hypoxic origin of FHR decelerations, therefore archiving the historical belief that FHR decelerations have different etiologies, according to their shape and relationship with uterine contractions. The present review suggests that it is time to welcome the new scientific evidence and to update the CTG classification systems. [ABSTRACT FROM AUTHOR]

Fetal development relies on a complex circulatory network. Accurate assessment of flow distribution is important for understanding pathologies and potential therapies. In this paper, we demonstrate a method for volumetric imaging of fetal flow with magnetic resonance imaging (MRI). Fetal MRI faces challenges: small vascular structures, unpredictable motion, and inadequate traditional cardiac gating methods. Here, orthogonal multislice stacks are acquired with accelerated multidimensional radial phase contrast (PC) MRI. Slices are reconstructed into flow sensitive time-series images with motion correction and image-based cardiac gating. They are then combined into a dynamic volume using slice-to-volume reconstruction (SVR) while resolving interslice spatiotemporal coregistration. Compared to prior methods, this approach achieves higher spatiotemporal resolution ($1\times 1\times 1$ mm3, ~30 ms) with reduced scan time – important features for the quantification of flow through small fetal structures. Validation is demonstrated in adults by comparing SVR with 4D radial PCMRI (flow bias and limits of agreement: −1.1 ml/s and [−11.8 9.6] ml/s). Feasibility is demonstrated in late gestation fetuses by comparing SVR with 2D Cartesian PCMRI (flow bias and limits of agreement: −0.9 ml/min/kg and [−39.7 37.8] ml/min/kg). With SVR, we demonstrate complex flow pathways (such as parallel flow streams in the proximal inferior vena cava, preferential shunting of blood from the ductus venosus into the left atrium, and blood from the brain leaving the heart through the main pulmonary artery) for the first time in human fetal circulation. This method allows for comprehensive evaluation of the fetal circulation and enables future studies of fetal physiology. [ABSTRACT FROM AUTHOR]

Introduction: Glucocorticoid (GC) ‐induced fetal programming of the activity of the hypothalamus–pituitary–adrenal axis (HPAA) and its associated cognitive and behavioral consequences in later life have been well characterized in several animal species. However, information on humans is scarce. In this study, we examined HPAA activity markers and associated outcomes at 8 to 9 years of age among children prenatally exposed to GC for suspected preterm birth. Our hypothesis was that antenatal exposure to the betamethasone (BM) is associated with exacerbation of HPAA activity in childhood. Material and methods: Prospective observational study in 31 children whose mothers received single (n = 19) or multiple (n = 12) courses of BM for threatened preterm birth but born with normal weight appropriate for the gestational age (median 37+6 weeks of gestation) compared with 38 non‐exposed, age‐matched children. Primary end point was the activity of the HPAA in response to the Trier Social Stress Test. Secondary end points were changes in autonomic nervous system (ANS) activity, cognitive performance (IQ), attention‐deficit/hyperactivity disorder (ADHD) symptoms, and electrocortical activity (EEG). Results: There was no statistically significant difference in HPAA activity markers between antenatal BM exposed and unexposed groups. ANS activity in BM‐exposed children shifted towards a higher parasympathetic tone reflected by a higher overall high‐frequency band power of heart rate variability. IQ scores were within normal limits for both groups; however, BM‐exposed children had lower IQ scores than the unexposed group. BM‐exposed group had marginally more ADHD core symptoms and increased electrocortical activity in the occipital brain region compared with controls. A monotonic dose–response relation between BM exposure and activity of the ANS and IQ was estimated in post‐hoc analyses. Conclusions: Antenatal exposure to BM in the context of threatened preterm birth was not associated with changes in HPAA activity in childhood. However, BM exposure may be associated with changes in ANS activity. Antenatal GC prophylaxis is a valuable and often life‐saving therapy, but its prescription may warrant a well‐balanced risk–benefit assessment. [ABSTRACT FROM AUTHOR]

Abstract The aim was to assess the association between fetal growth restriction (FGR) and fetal heart rate variability (FHRV) in relation to fetal movements. A prospective observational cohort study was performed. Non‐invasive fetal electrocardiography (NI‐FECG) allowed beat‐to‐beat assessments with

Newborns show physiological differences in low- and high-altitude settings of Ecuador; those differences are especially relevant because most important cities in Ecuador are located at high altitude, above 2500 m. This study is an epidemiological, observational, and cross-sectional research performed at San Francisco Hospital in Quito (at 2850 m) and General Hospital in Manta (at 6 m) in the Manabí province. We studied 204 full-term newborns, healthy without any prenatal comorbidities, singleton pregnancy, mestizos, and born of healthy parents born. We found significant differences between the values of red blood cells (RBC), leucocytes, hematocrit, and hemoglobin. There was a difference of 27% more in RBC, 3% at hematocrit, and 0.4 g at hemoglobin in the high-altitude cohort. The leucocyte difference is 1270 cells/µl, which means a difference of 6%. At high-altitude settings, the mean pH was lower than normal values and pO2, pCO2, and HCO3. High-altitude newborns showed RBC of > 4,500,000 cells/µl; leukocytes > 19,000; pO2 ≤ 72 mm Hg; hemoglobin > 17.50 g/dl; and hematocrit > 54%. Both cohorts showed physiological changes of transition to extrauterine life. We observed higher polycythemia, respiratory acidosis, and hypoxemia among high-altitude newborns. High-altitude setting intensifies the physiological changes in hematological and arterial blood gases parameters. [ABSTRACT FROM AUTHOR]

Aim To compare the magnitude of fetuses with congenital anomalies, pregnant women identified at high risk for preterm pre-eclampsia (PE) or with preterm PE, and with early fetal growth restriction (FGR) or high risk for FGR at the second trimester assessment at 20 to 24 weeks of gestation. Methods A standardized trimester-specific protocol that included clinical and demographic details, fetal biometry, estimated fetal weight (EFW), fetal abdominal circumference (FAC), mean arterial blood pressure and fetal Doppler studies was used to identify high risk for preterm PE and FGR. The Targeted Imaging for Fetal Anomalies (TIFFA) scan was used to identify congenital anomalies. In addition, 95% confidence intervals of the point estimates were derived, and the p -value was estimated to assess the statistical significance of the difference in proportions. Results Analysis of the data of 4,572 pregnant women screened between 20 and 24 gestation weeks showed a significantly lower prevalence (p < 0.001) of congenital abnormalities (3.81%) compared to women diagnosed with early PE (2.71%) or with a high risk for PE (4.00%) and women (6.80%) with early FGR or at higher risk for fetal growth restriction with both EFW and FAC < 10th percentile. Conclusion The data on prevalence from Samrakshan show that the second-trimester assessment of pregnant women in India must expand its scope from the TIFFA scan to also focus on screening to identify women at high risk for preterm PE and FGR. [ABSTRACT FROM AUTHOR]

Polycyclic aromatic hydrocarbons (PAHs) are endocrine disruptors resulting from incomplete combustion. Pregnancy represents a particularly vulnerable period to such exposures, given the significant influence of hormone physiology on fetal growth and pregnancy outcomes. Maternal thyroid hormones play crucial roles in fetal development and pregnancy outcomes. However, limited studies have examined gestational PAH exposure and maternal thyroid hormones during pregnancy. Our study included 439 women enrolled in the LIFECODES birth cohort in Boston, aiming to explore the relationship between urinary PAH metabolites and thyroid hormones throughout pregnancy. Urine samples for PAH metabolite analysis and plasma samples for thyroid hormone were measured up to four visits throughout gestation. Single pollutant analyses employed linear mixed effect models to investigate individual associations between each PAH metabolite and thyroid hormone concentration. Sensitivity analyses were conducted to assess potential susceptibility windows and fetal-sex-specific effects of PAH exposure. Mixture analyses utilized quantile g-computation to evaluate the collective impact of eight PAH metabolites on thyroid hormone concentrations. Additionally, Bayesian kernel machine regression (BKMR) was employed to explore potential non-linear associations and interactions between PAH metabolites. Subject-specific random intercepts were incorporated to address intra-individual correlation of serial measurements over time in both single pollutant and mixture analyses. Our findings revealed positive trends in associations between PAH metabolites and thyroid hormones, both individually and collectively as a mixture. Sensitivity analyses indicated that these associations were influenced by the study visit and fetal sex. Mixture analyses suggested non-linear relationships and interactions between different PAH exposures. This comprehensive investigation underscores the critical importance of understanding the impact of PAH exposures on thyroid hormone physiology during pregnancy. The findings highlight the intricate interplay between environmental pollutants and human pregnancy physiology, emphasizing the need for targeted interventions and public health policies to mitigate adverse outcomes associated with prenatal PAH exposure. • Polycyclic aromatic hydrocarbons (PAHs) exposure and thyroid hormone levels were assessed up to four times during pregnancy. • Gestational exposure to PAHs was associated with thyroid hormone concentration during pregnancy. • Associations between PAHs and thyroid hormone concentration varied based on study visit and fetal sex. • Certain PAHs exhibited non-linear associations with thyroid hormones and interacted with other PAHs. [ABSTRACT FROM AUTHOR]

Background/Aim. The placenta is essential in pregnancy, facilitating nutrient and gas exchange between mother and fetus. However, the regulatory proteins involved in this process are not fully understood across gestation. This study aimed to identify the top 20 differentially expressed genes (DEGs) in the placenta across different pregnancy stages to elucidate the molecular mechanisms at play. Methods. Differential gene expression analysis was performed on the placental samples from the first, second, and third trimesters using microarray data from Gene Expression Omnibus and Array Express. Analysis was conducted in RStudio using the R programming language. DEGs were identified using a significance score (π-value) based on the method developed by Xiao Y et al. (2014), which combines fold change and p-value. Volcano plots were created to visualize DEGs, and the top 20 were analyzed for functional enrichment using STRING and EnrichR databases, including Gene Ontology and KEGG pathways. Results. In the transition from the first to the second trimester, significant DEGs included genes involved in steroid metabolism such as HSD11B1, HSD3B2, and HSD17B2. These genes are critical in the biosynthesis and metabolism of steroid hormones, essential for sustaining pregnancy and supporting fetal development. Enrichment analysis showed these genes were significantly associated with steroid biosynthesis and steroidogenesis pathways. For the transition from the second to the third trimester, different sets of genes were highlighted, particularly those related to endocrine regulation and pregnancy-specific functions. Key genes included CRH, INHBA, REN, and members of the pregnancy-specific glycoprotein (PSG) family. These genes are involved in hormone regulation, reproductive processes, and maintaining maternal-fetal homeostasis, with significant associations with pathways related to endocrine processes, reproductive health, and vascular function. For example, the involvement of CRH and REN in endocrine regulation suggests their role in modulating maternal and fetal physiology during the later stages of pregnancy. Also, the genes associated with vascular and hemostatic functions were identified, indicating the importance of maintaining proper blood flow and preventing bleeding complications as pregnancy progresses. Notable genes included SDC1 and HBE1, which are crucial for vascular integrity and oxygen transport. Volcano plots illustrated these shifts in gene expression, with the top 20 genes identified by π-value prominently displayed. Conclusions. This study provides an analysis of gene expression changes in the placenta throughout pregnancy, identifying key genes and pathways that regulate placental function and impact fetal development. These findings enhance the understanding of placental biology and may highlight potential targets for ensuring optimal fetal development. [ABSTRACT FROM AUTHOR]

This Special Issue intends to highlight the shaded line between the normal and pathological molecular behavior of the pre-implantation embryo and those maternal and embryonic molecular markers that can be useful to enhance the effectiveness of in vitro fertilization and predict pregnancy complications. The predicted gene targets of the sncRNA panel are proved to be decreased at the eight-cell morula-blastocyst stage and critical to early embryo development. [Extracted from the article]

Pregnancy 25-hydroxyvitamin D [25(OH)D] concentrations are associated with maternal and fetal health outcomes. Using physiological human placental perfusion and villous explants, we investigate the role of the placenta in regulating the relationships between maternal 25(OH)D and fetal physiology. We demonstrate active placental uptake of 25(OH)D3 by endocytosis, placental metabolism of 25(OH)D3 into 24,25-dihydroxyvitamin D3 and active 1,25-dihydroxyvitamin D [1,25(OH)2D3], with subsequent release of these metabolites into both the maternal and fetal circulations. Active placental transport of 25(OH)D3 and synthesis of 1,25(OH)2D3 demonstrate that fetal supply is dependent on placental function rather than simply the availability of maternal 25(OH) D3. We demonstrate that 25(OH)D3 exposure induces rapid effects on the placental transcriptome and proteome. These map to multiple pathways central to placental function and thereby fetal development, independent of vitamin D transfer. Our data suggest that the underlying epigenetic landscape helps dictate the transcriptional response to vitamin D treatment. This is the first quantitative study demonstrating vitamin D transfer and metabolism by the human placenta, with widespread effects on the placenta itself. These data demonstrate a complex interplay between vitamin D and the placenta and will inform future interventions using vitamin D to support fetal development and maternal adaptations to pregnancy. [ABSTRACT FROM AUTHOR]

A stray wild female monkey, aged 5-6 years were presented to the Referral Veterinary Polyclinics, ICAR- Indian Veterinary Research Institute, with a history of straining and discharge from the vulva since morning. A close physical examination of the external genitalia of the monkey revealed it as prominent, red and swollen implying impending labor. The vulva was open due to the internal pressure revealing foetal part visible with reduced fetal fluid. Per-vaginal examination revealed a foetal head in the birth canal, but absence of foetal responses. Per vaginal examination revealed foetal presentation to be anterior longitudinal, dorso-sacral position, but it was difficult to palpate postural condition. To relieve the condition female monkey was positioned in a left lateral recumbent position followed by ample lubrication of the birth canal with CMC (Carboxymethyl cellulose) gel using an intrauterine catheter and syringe. The traction approach was used to extract the dead foetus. Following successful delivery bleeding was prevented by administering ethamsylate injections at a dose rate of 15 mg/Kg (1 ml), and other supportive medications were administered. The macaque monkeys can postpone labour making it difficult for an observer to determine the indicators of dystocia until the condition has worsened. This makes dystocia in nonhuman primates a grave condition requiring prompt medical attention. [ABSTRACT FROM AUTHOR]

In addition to describing clinical findings and behaviour of foals (Rossdale, 1967b), he performed early work on electrocardiography (Rossdale, 1967a), blood gas analysis (Rossdale, 1968a; Rossdale & Mullen, 1970), ventilation parameters (Rossdale, 1969a) and indirect blood pressure measurement (Franco et al., 1986). He reported neurological signs in compromised neonates (Mahaffey & Rossdale, 1959; Rossdale, 1968b, 1969b) and by the 1970s, Peter proposed a classification of differential diagnosis of the collapsed neonate differentiating (1) infection, (2) non-infective behavioural disturbance, (3) failure of development and (4) immunological conditions (Rossdale, 1972). Peter led a team working on I in vivo i studies of normal and abnormal fetal development based on a pony research herd in Newmarket which advanced our understanding of prematurity and dysmaturity (Rossdale, 1993; Rossdale et al., 1985) and on induction of parturition (Leadon et al., 1986). Returning to Peter's approach to the role of Editor, he saw EVJ as serving as a conduit between clinicians in practice and those who wish to contribute new knowledge for the benefit of the horse (Rossdale et al., 2008). [Extracted from the article]

Introduction: A revised intrapartum cardiotocography (CTG) classification was introduced in Sweden in 2017. The aims of the revision were to adapt to the international guideline published in 2015 and to adjust the classification of CTG patterns to current evidence regarding intrapartum fetal physiology. This study aimed to investigate adverse neonatal outcomes before and after implementation of the revised CTG classification. Material and Methods: A before‐and‐after design was used. Cohort I (n = 160 210) included births from June 1, 2014 through May 31, 2016 using the former CTG classification, and cohort II (n = 166 558) included births from June 1, 2018 through May 31, 2020 with the revised classification. Data were collected from the Swedish Pregnancy and Neonatal Registers. The primary outcome was moderate to severe neonatal hypoxic ischemic encephalopathy (HIE 2–3). Secondary outcomes were birth acidemia (umbilical artery pH <7.05 and base excess < −12 mmol/L or pH <7.00), A‐criteria for neonatal hypothermia treatment, 5‐min Apgar scores <4 and <7, neonatal seizures, meconium aspiration, neonatal mortality and delivery mode. Logistic regression was used (period II vs period I), and results are presented as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs). Results: There were no statistically significant differences in HIE 2–3 (aOR 1.27; 95% CI 0.97–1.66), proportion of neonates meeting A‐criteria for hypothermia treatment (aOR 0.96; 95% CI 0.89–1.04) or neonatal mortality (aOR 0.68; 95% CI 0.39–1.18) between the cohorts. Birth acidemia (aOR 1.36; 95% CI 1.25–1.48), 5‐min Apgar scores <7 (aOR 1.27; 95% CI 1.18–1.36) and <4 (aOR 1.40; 95% CI 1.17–1.66) occurred more often in cohort II. The absolute risk difference for HIE 2–3 was 0.02% (95% CI 0.00–0.04). Operative delivery (vacuum or cesarean) rates were lower in cohort II (aOR 0.82; 95% CI 0.80–0.85 and aOR 0.94; 95% CI 0.91–0.97, respectively). Conclusions: Although not statistically significant, a small increase in the incidence of HIE 2–3 after implementation of the revised CTG classification cannot be excluded. Operative deliveries were fewer but incidences of acidemia and low Apgar scores were higher in the latter cohort. This warrants further in‐depth analyses before a full re‐evaluation of the revised classification can be made. [ABSTRACT FROM AUTHOR]

Objectives: To characterize, using magnetic resonance imaging (MRI), the distribution of blood flow and oxygen transport in human fetuses with subtypes of congenital heart disease (CHD) that present with neonatal cyanosis.Methods: Blood flow was measured in the major vessels of 152 late-gestation human fetuses with CHD and 40 gestational-age-matched normal fetuses, using cine phase-contrast MRI. Oxygen saturation (SaO2 ) was measured in the major vessels of 57 fetuses with CHD and 40 controls.Results: Compared with controls, we found lower combined ventricular output in fetuses with single-ventricle physiology, with the lowest being observed in fetuses with severe forms of Ebstein's anomaly. Obstructive lesions of the left or right heart were associated with increased flow across the contralateral side. Pulmonary blood flow was reduced in fetuses with Ebstein's anomaly, while those with Ebstein's anomaly and tricuspid atresia had reduced umbilical flow. Flow in the superior vena cava was elevated in fetuses with transposition of the great arteries, normal in fetuses with hypoplastic left heart, tetralogy of Fallot or tricuspid atresia and reduced in fetuses with Ebstein's anomaly. Umbilical vein SaO2 was reduced in fetuses with hypoplastic left heart or tetralogy of Fallot. Ascending aorta and superior vena cava SaO2 were reduced in nearly all CHD subtypes.Conclusions: Fetuses with cyanotic CHD exhibit profound changes in the distribution of blood flow and oxygen transport, which result in changes in cerebral, pulmonary and placental blood flow and oxygenation. These alterations of fetal circulatory physiology may influence the neonatal course and help account for abnormalities of prenatal growth and development that have been described in newborns with cyanotic CHD. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Background: Cord blood umbilical artery (Ua) pH, base deficit (BD), and pH eucapnic Blickstein/Green-50 may mislead clinicians to identify newborns at risk for hypoxic-ischemic encephalopathy. Neonatal eucapnic pH (pH euc-n Racinet-54) may be a comprehensive alternative. The goal of the study is to compare the predictive performance of these four biomarkers for the combined primary outcome of hypoxic-ischemic encephalopathy/death.Methods: This retrospective cohort study includes newborns ≥35 weeks gestational age. Receiver operating characteristics curves analysis was performed for Ua cord pH, BD, pH euc-n Racinet-54, and pH eucapnic Blickstein/Green-50 for the global cohort and for two subgroups of newborns with Ua cord pH ≤ 7.15. Cutoff values were derived for all four markers.Results: From the original cohort of 61,037 newborns born between 1 January 2007 and 31 December 2016, we excluded cases with major congenital malformations and missing/incomplete data. The global cohort includes 51,286 newborns and 60 newborns afflicted with hypoxic-ischemic encephalopathy (HIE)/death. The area under the curves (AUC) derived from the global cohort were comparable between Ua cord pH (0.95; 95%CI = 0.94-0.95), BD (0.93; 95%CI = 0.93-0.93), pH euc-n Racinet-54 (0.93; 95% CI = 0.93-0.93), and lower for pH Blickstein/Green-50 (0.78; 95% CI = 0.77-0.78) (p < .05). Within newborn with severe acidemia (pH ≤ 7.00) and moderate acidemia (7.00 ≤ pH ≤ 7.15), pH euc-n Racinet-54 had the largest AUC and best positive likelihood ratios especially for sensitivity ≥ 0.80 to minimize false negative cases.Conclusion: In this large retrospective study, predictive performance for Ua cord pH, BD, and pH euc-n Racinet-54 are comparable when applied to the global group. For newborns with Ua cord pH ≤ 7.00 and Ua cord 7.00 ≤ pH ≤ 7.15, pH euc-n Racinet-54 appears better to identify those with HIE/death, especially when the target is sensitivity > 80%. Prospective studies will confirm if pH euc-n Racinet-54 is a better alternative to Ua cord pH and BD to evaluate newborn acid-base physiology. [ABSTRACT FROM AUTHOR]