71 results on '"Nickie Andescavage"'
Search Results
2. Experience of early-life pain in premature infants is associated with atypical cerebellar development and later neurodevelopmental deficits
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Kevin M. Cook, Josepheen De Asis-Cruz, Jung-Hoon Kim, Sudeepta K. Basu, Nickie Andescavage, Jonathan Murnick, Emma Spoehr, Melissa Liggett, Adré J. du Plessis, and Catherine Limperopoulos
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Early-life pain ,fMRI ,Brain development ,Cerebellum ,Prematurity ,Neonatal intensive care unit ,Medicine - Abstract
Abstract Background Infants born very and extremely premature (V/EPT) are at a significantly elevated risk for neurodevelopmental disorders and delays even in the absence of structural brain injuries. These risks may be due to earlier-than-typical exposure to the extrauterine environment, and its bright lights, loud noises, and exposures to painful procedures. Given the relative underdeveloped pain modulatory responses in these infants, frequent pain exposures may confer risk for later deficits. Methods Resting-state fMRI scans were collected at term equivalent age from 148 (45% male) infants born V/EPT and 99 infants (56% male) born at term age. Functional connectivity analyses were performed between functional regions correlating connectivity to the number of painful skin break procedures in the NICU, including heel lances, venipunctures, and IV placements. Subsequently, preterm infants returned at 18 months, for neurodevelopmental follow-up and completed assessments for autism risk and general neurodevelopment. Results We observed that V/EPT infants exhibit pronounced hyperconnectivity within the cerebellum and between the cerebellum and both limbic and paralimbic regions correlating with the number of skin break procedures. Moreover, skin breaks were strongly associated with autism risk, motor, and language scores at 18 months. Subsample analyses revealed that the same cerebellar connections strongly correlating with breaks at term age were associated with language dysfunction at 18 months. Conclusions These results have significant implications for the clinical care of preterm infants undergoing painful exposures during routine NICU care, which typically occurs without anesthesia. Repeated pain exposures appear to have an increasingly detrimental effect on brain development during a critical period, and effects continue to be seen even 18 months later.
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- 2023
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3. Influence of maternal psychological distress during COVID-19 pandemic on placental morphometry and texture
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Haleema Saeed, Yuan-Chiao Lu, Nickie Andescavage, Kushal Kapse, Nicole R. Andersen, Catherine Lopez, Jessica Quistorff, Scott Barnett, Diedtra Henderson, Dorothy Bulas, and Catherine Limperopoulos
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Medicine ,Science - Abstract
Abstract The Coronavirus Disease 2019 (COVID-19) pandemic has been accompanied by increased prenatal maternal distress (PMD). PMD is associated with adverse pregnancy outcomes which may be mediated by the placenta. However, the potential impact of the pandemic on in vivo placental development remains unknown. To examine the impact of the pandemic and PMD on in vivo structural placental development using advanced magnetic resonance imaging (MRI), acquired anatomic images of the placenta from 63 pregnant women without known COVID-19 exposure during the pandemic and 165 pre-pandemic controls. Measures of placental morphometry and texture were extracted. PMD was determined from validated questionnaires. Generalized estimating equations were utilized to compare differences in PMD placental features between COVID-era and pre-pandemic cohorts. Maternal stress and depression scores were significantly higher in the pandemic cohort. Placental volume, thickness, gray level kurtosis, skewness and run length non-uniformity were increased in the pandemic cohort, while placental elongation, mean gray level and long run emphasis were decreased. PMD was a mediator of the association between pandemic status and placental features. Altered in vivo placental structure during the pandemic suggests an underappreciated link between disturbances in maternal environment and perturbed placental development. The long-term impact on offspring is currently under investigation.
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- 2023
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4. Examining the relationship between fetal cortical thickness, gestational age, and maternal psychological distress
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Josepheen De Asis-Cruz, Jung-Hoon Kim, Dhineshvikram Krishnamurthy, Catherine Lopez, Kushal Kapse, Nickie Andescavage, Gilbert Vezina, and Catherine Limperopoulos
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Fetal MRI ,Cortical thickness ,Maternal stress ,Maternal anxiety ,Maternal depression ,Fetal brain development ,Neurophysiology and neuropsychology ,QP351-495 - Abstract
In utero exposure to maternal stress, anxiety, and depression has been associated with reduced cortical thickness (CT), and CT changes, in turn, to adverse neuropsychiatric outcomes. Here, we investigated global and regional (G/RCT) changes associated with fetal exposure to maternal psychological distress in 265 brain MRI studies from 177 healthy fetuses of low-risk pregnant women. GCT was measured from cortical gray matter (CGM) voxels; RCT was estimated from 82 cortical regions. GCT and RCT in 87% of regions strongly correlated with GA. Fetal exposure was most strongly associated with RCT in the parahippocampal region, ventromedial prefrontal cortex, and supramarginal gyrus suggesting that cortical alterations commonly associated with prenatal exposure could emerge in-utero. However, we note that while regional fetal brain involvement conformed to patterns observed in newborns and children exposed to prenatal maternal psychological distress, the reported associations did not survive multiple comparisons correction. This could be because the effects are more subtle in this early developmental window or because majority of the pregnant women in our study did not experience high levels of maternal distress. It is our hope that the current findings will spur future hypothesis-driven studies that include a full spectrum of maternal mental health scores.
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- 2023
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5. Ex-utero third trimester developmental changes in functional brain network organization in infants born very and extremely preterm
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Kevin M. Cook, Josepheen De Asis-Cruz, Sudeepta K. Basu, Nickie Andescavage, Jonathan Murnick, Emma Spoehr, Adré J. du Plessis, and Catherine Limperopoulos
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graph theory ,resting state fMRI ,brain development ,prematurity ,stress ,brain network ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
IntroductionThe latter half of gestation is a period of rapid brain development, including the formation of fundamental functional brain network architecture. Unlike in-utero fetuses, infants born very and extremely preterm undergo these critical maturational changes in the extrauterine environment, with growing evidence suggesting this may result in altered brain networks. To date, however, the development of functional brain architecture has been unexplored.MethodsFrom a prospective cohort of preterm infants, graph parameters were calculated for fMRI scans acquired prior to reaching term equivalent age. Eight graph properties were calculated, Clustering Coefficient (C), Characteristic Path Length (L), Modularity (Q), Local Efficiency (LE), Global Efficiency (GE), Normalized Clustering (λ), Normalized Path Length (γ), and Small-Worldness (σ). Properties were first compared to values generated from random and lattice networks and cost efficiency was evaluated. Subsequently, linear mixed effect models were used to assess relationship with postmenstrual age and infant sex.ResultsA total of 111 fMRI scans were acquired from 85 preterm infants born at a mean GA 28.93 ± 2.8. Infants displayed robust small world properties as well as both locally and globally efficient networks. Regression models found that GE increased while L, Q, λ, γ, and σ decreased with increasing postmenstrual age following multiple comparison correction (r2Adj range 0.143–0.401, p
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- 2023
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6. Maternal psychological distress during the COVID-19 pandemic and structural changes of the human fetal brain
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Yuan-Chiao Lu, Nickie Andescavage, Yao Wu, Kushal Kapse, Nicole R. Andersen, Jessica Quistorff, Haleema Saeed, Catherine Lopez, Diedtra Henderson, Scott D. Barnett, Gilbert Vezina, David Wessel, Adre du Plessis, and Catherine Limperopoulos
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Medicine - Abstract
Lu, Andescavage et al. scanned fetal brains by MRI and assessed maternal distress before and during the COVID-19 pandemic. Impaired fetal brain growth, delayed cerebral cortical gyrification and increased maternal distress was seen in COVID-19 pandemic era pregnancies.
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- 2022
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7. Using Nature to Nurture: Breast Milk Analysis and Fortification to Improve Growth and Neurodevelopmental Outcomes in Preterm Infants
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Katherine Marie Ottolini, Elizabeth Vinson Schulz, Catherine Limperopoulos, and Nickie Andescavage
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preterm ,breast milk ,fortification ,neurodevelopment ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Premature infants are born prior to a critical window of rapid placental nutrient transfer and fetal growth—particularly brain development—that occurs during the third trimester of pregnancy. Subsequently, a large proportion of preterm neonates experience extrauterine growth failure and associated neurodevelopmental impairments. Human milk (maternal or donor breast milk) is the recommended source of enteral nutrition for preterm infants, but requires additional fortification of macronutrient, micronutrient, and energy content to meet the nutritional demands of the preterm infant in attempts at replicating in utero nutrient accretion and growth rates. Traditional standardized fortification practices that add a fixed amount of multicomponent fortifier based on assumed breast milk composition do not take into account the considerable variations in breast milk content or individual neonatal metabolism. Emerging methods of individualized fortification—including targeted and adjusted fortification—show promise in improving postnatal growth and neurodevelopmental outcomes in preterm infants.
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- 2021
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8. Impaired in vivo feto-placental development is associated with neonatal neurobehavioral outcomes
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Nickie, Andescavage, Theresa, Bullen, Melissa, Liggett, Scott D, Barnett, Anushree, Kapse, Kushal, Kapse, Homa, Ahmadzia, Gilbert, Vezina, Jessica, Quistorff, Catherine, Lopez, Adre, duPlessis, and Catherine, Limperopoulos
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Pediatrics, Perinatology and Child Health - Abstract
Fetal growth restriction (FGR) is a risk factor for neurodevelopmental problems, yet remains poorly understood. We sought to examine the relationship between intrauterine development and neonatal neurobehavior in pregnancies diagnosed with antenatal FGR.We recruited women with singleton pregnancies diagnosed with FGR and measured placental and fetal brain volumes using MRI. NICU Network Neurobehavioral Scale (NNNS) assessments were performed at term equivalent age. Associations between intrauterine volumes and neurobehavioral outcomes were assessed using generalized estimating equation models.We enrolled 44 women diagnosed with FGR who underwent fetal MRI and 28 infants underwent NNNS assessments. Placental volumes were associated with increased self-regulation and decreased excitability; total brain, brainstem, cortical and subcortical gray matter (SCGM) volumes were positively associated with higher self-regulation; SCGM also was positively associated with higher quality of movement; increasing cerebellar volumes were positively associated with attention, decreased lethargy, non-optimal reflexes and need for special handling; brainstem volumes also were associated with decreased lethargy and non-optimal reflexes; cerebral and cortical white matter volumes were positively associated with hypotonicity.Disrupted intrauterine growth in pregnancies complicated by antenatally diagnosed FGR is associated with altered neonatal neurobehavior. Further work to determine long-term neurodevelopmental impacts is warranted.Fetal growth restriction is a risk factor for adverse neurodevelopment, but remains difficult to accurately identify. Intrauterine brain volumes are associated with infant neurobehavior. The antenatal diagnosis of fetal growth restriction is a risk factor for abnormal infant neurobehavior.
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- 2022
9. Identification of QRS complex in non-stationary electrocardiogram of sick infants.
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Srinivas Kota, C. B. Swisher, Tareq Al-Shargabi, Nickie Andescavage, Adré du Plessis, and Rathinaswamy B. Govindan
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- 2017
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10. Severity of prematurity and age impact early postnatal development of GABA and glutamate systems
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Sudeepta K Basu, Subechhya Pradhan, Yushuf M Sharker, Kushal J Kapse, Jonathan Murnick, Taeun Chang, Catherine A Lopez, Nickie Andescavage, Adre J duPlessis, and Catherine Limperopoulos
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Cellular and Molecular Neuroscience ,Cognitive Neuroscience - Abstract
Gamma-aminobutyric acid (GABA) and glutamatergic system perturbations following premature birth may explain neurodevelopmental deficits in the absence of structural brain injury. Using GABA-edited spectroscopy (MEscher-GArwood Point Resolved Spectroscopy [MEGA-PRESS] on 3 T MRI), we have described in-vivo brain GABA+ (+macromolecules) and Glx (glutamate + glutamine) concentrations in term-born infants. We report previously unavailable comparative data on in-vivo GABA+ and Glx concentrations in the cerebellum, the right basal ganglia, and the right frontal lobe of preterm-born infants without structural brain injury. Seventy-five preterm-born (gestational age 27.8 ± 2.9 weeks) and 48 term-born (39.6 ± 0.9 weeks) infants yielded reliable MEGA-PRESS spectra acquired at post-menstrual age (PMA) of 40.2 ± 2.3 and 43.0 ± 2 weeks, respectively. GABA+ (median 2.44 institutional units [i.u.]) concentrations were highest in the cerebellum and Glx higher in the cerebellum (5.73 i.u.) and basal ganglia (5.16 i.u.), with lowest concentrations in the frontal lobe. Metabolite concentrations correlated positively with advancing PMA and postnatal age at MRI (Spearman’s rho 0.2–0.6). Basal ganglia Glx and NAA, and frontal GABA+ and NAA concentrations were lower in preterm compared with term infants. Moderate preterm infants had lower metabolite concentrations than term and extreme preterm infants. Our findings emphasize the impact of premature extra-uterine stimuli on GABA–glutamate system development and may serve as early biomarkers of neurodevelopmental deficits.
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- 2023
11. Proceedings of the 13th International Newborn Brain Conference: Fetal and/or neonatal brain development, both normal and abnormal
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Khadar Abdi, Ramy Abramsky, Nickie Andescavage, Jephté Bambi, Sudeepta Basu, Cynthia Bearer, Eric J. Benner, Thérèse Biselele, Nikolay Bliznyuk, Jeroen Breckpot, Galen Carey, Agnes Chao, Line Iadsatian Christiansen, Silvia Comani, Pierpaolo Croce, Maarten De Vos, Anneleen Dereymaeker, Laura Dubois, Amelia J. Eisch, Adrian Epstein, Neta Geva, Yael Geva, Marc Gewillig, Sheyenne Gillis, Ronald N. Goldberg, Magnus Gram, Simon Gregory, Danielle Guez-Barber, Masahiro Hayakawa, Nicole Lind Henriksen, Tim Hermans, Reli Hershkovitz, Kristine Holgersen, Bo Holmqvist, Vaibhav Jain, Katrien Jansen, Vinay Kandula, Kushal Kapse, Masahiro Kawaguchi, Abdulhafeez Khair, Mohammad Khazaei, Hiroyuki Kidokoro, Frederico C. Kiffer, Katherine Kisilewicz, Sumire Kumai, Helene Lacaille, David Ley, Catherine Limperopoulos, Sandy Ebba Hallengreen Lindholm, Prosper Lukusa, Rebecca Lundberg, Peter MacFarlane, Pavle Matak, Laetitia Mavinga, Catherine Mayer, Gloire Mbayabo, Takamasa Mitsumatsu, Gerrye Mubungu, Jonathan Murnick, Tomohiko Nakata, Hajime Narita, Parvathi Nataraj, Jun Natsume, Gunnar Naulaers, Rahul Nikam, Niklas Ortenlöf, Katherine Ottolini, Xiaoyu Pan, Stanislava Pankratova, Kelly Pegram, Anna A. Penn, Subechhya Pradhan, Khadijeh Raeisi, Nicholas Rickman, Blaire Rikard, Reut Rotem, Per Torp Sangild, Yoshiaki Sato, Fumi Sawamura, Eilon Shany, Ilan Shelef, Anna Shiraki, Laura Smets, Livia Sura, Ryosuke Suzui, Takeshi Suzuki, Bruno-Paul Tady, Gentaro Taga, Gabriella Tamburro, Liesbeth Thewissen, J. Will Thompson, Thomas Thymann, Cansu Tokat, Claire-Marie Vacher, Cyndi Valdes, Suvi Vallius, Sergei Vatolin, Hama Watanabe, Adi Yehuda Weintraub, Michael Weiss, Hiroyuki Yamamoto, Salem Shimrit Yaniv, Noelle Younge, Sanghee Yun, and Filippo Zappasodi
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Pediatrics, Perinatology and Child Health - Published
- 2022
12. Non-invasive measurement of biochemical profiles in the healthy fetal brain.
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Subechhya Pradhan, Kushal Kapse, Marni Jacobs, Nickie Andescavage, Jessica Lynn Quistorff, Catherine Lopez, Kathryn Lee Bannantine, Nicole Reinholdt Andersen, Gilbert Vezina, and Catherine Limperopoulos
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- 2020
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13. Automatic brain segmentation in preterm infants with <scp>post‐hemorrhagic</scp> hydrocephalus using <scp>3D</scp> Bayesian <scp>U‐Net</scp>
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Axel Largent, Josepheen De Asis‐Cruz, Kushal Kapse, Scott D. Barnett, Jonathan Murnick, Sudeepta Basu, Nicole Andersen, Stephanie Norman, Nickie Andescavage, and Catherine Limperopoulos
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Neurology ,Radiological and Ultrasound Technology ,Infant, Newborn ,Humans ,Infant ,Bayes Theorem ,Radiology, Nuclear Medicine and imaging ,Neurology (clinical) ,Anatomy ,Infant, Premature ,Cerebral Hemorrhage ,Cerebral Ventricles ,Hydrocephalus - Abstract
Post-hemorrhagic hydrocephalus (PHH) is a severe complication of intraventricular hemorrhage (IVH) in very preterm infants. PHH monitoring and treatment decisions rely heavily on manual and subjective two-dimensional measurements of the ventricles. Automatic and reliable three-dimensional (3D) measurements of the ventricles may provide a more accurate assessment of PHH, and lead to improved monitoring and treatment decisions. To accurately and efficiently obtain these 3D measurements, automatic segmentation of the ventricles can be explored. However, this segmentation is challenging due to the large ventricular anatomical shape variability in preterm infants diagnosed with PHH. This study aims to (a) propose a Bayesian U-Net method using 3D spatial concrete dropout for automatic brain segmentation (with uncertainty assessment) of preterm infants with PHH; and (b) compare the Bayesian method to three reference methods: DenseNet, U-Net, and ensemble learning using DenseNets and U-Nets. A total of 41 T
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- 2022
14. In Utero MRI Identifies Impaired Second Trimester Subplate Growth in Fetuses with Congenital Heart Disease
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Yao Wu, Yuan-Chiao Lu, Kushal Kapse, Marni Jacobs, Nickie Andescavage, Mary T Donofrio, Catherine Lopez, Jessica Lynn Quistorff, Gilbert Vezina, Anita Krishnan, Adré J du Plessis, and Catherine Limperopoulos
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Heart Defects, Congenital ,Cognitive Neuroscience ,Cardiovascular ,Congenital ,Cellular and Molecular Neuroscience ,Fetus ,Pregnancy ,Clinical Research ,Infant Mortality ,Humans ,Psychology ,Heart Defects ,Pediatric ,screening and diagnosis ,subplate volume ,Neurosciences ,Brain ,Experimental Psychology ,Second ,cortical sulcal depth ,Perinatal Period - Conditions Originating in Perinatal Period ,Magnetic Resonance Imaging ,Detection ,Heart Disease ,Pregnancy Trimester, Second ,embryonic structures ,subplate thickness ,Congenital Structural Anomalies ,Original Article ,Female ,Cognitive Sciences ,Pregnancy Trimester ,4.2 Evaluation of markers and technologies - Abstract
The subplate is a transient brain structure which plays a key role in the maturation of the cerebral cortex. Altered brain growth and cortical development have been suggested in fetuses with complex congenital heart disease (CHD) in the third trimester. However, at an earlier gestation, the putative role of the subplate in altered brain development in CHD fetuses is poorly understood. This study aims to examine subplate growth (i.e., volume and thickness) and its relationship to cortical sulcal development in CHD fetuses compared with healthy fetuses by using 3D reconstructed fetal magnetic resonance imaging. We studied 260 fetuses, including 100 CHD fetuses (22.3–32 gestational weeks) and 160 healthy fetuses (19.6–31.9 gestational weeks). Compared with healthy fetuses, CHD fetuses had 1) decreased global and regional subplate volumes and 2) decreased subplate thickness in the right hemisphere overall, in frontal and temporal lobes, and insula. Compared with fetuses with two-ventricle CHD, those with single-ventricle CHD had reduced subplate volume and thickness in right occipital and temporal lobes. Finally, impaired subplate growth was associated with disturbances in cortical sulcal development in CHD fetuses. These findings suggested a potential mechanistic pathway and early biomarker for the third-trimester failure of brain development in fetuses with complex CHD. Significance Statement Our findings provide an early biomarker for brain maturational failure in fetuses with congenital heart disease, which may guide the development of future prenatal interventions aimed at reducing neurological compromise of prenatal origin in this high-risk population.
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- 2021
15. Placental abnormalities in congenital heart disease
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Catherine Limperopoulos and Nickie Andescavage
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education.field_of_study ,Fetus ,Heart disease ,business.industry ,Placental Finding ,Population ,Review Article on Pre-natal Diagnosis in Congenital Heart Defects ,Placental structure ,medicine.disease ,Bioinformatics ,medicine.anatomical_structure ,In utero ,Placenta ,Pediatrics, Perinatology and Child Health ,medicine ,Gestation ,education ,business - Abstract
Congenital heart disease (CHD) remains the most common birth defect in infants, and critical CHD is associated with significant rates of morbidity and mortality. With the advent of powerful yet noninvasive advanced fetal imaging, it is becoming increasingly evident that the presence of CHD in utero disrupts typical development and contributes to the lifelong morbidity in this population. Across healthy and high-risk populations, intrauterine influences can permanently alter fetal development that may manifest in complex morbidities later in life, the so-called fetal-onset-of-adult-disease (FOAD) phenomenon. The placenta plays a critical role in not only supporting fetal development, but also by adapting to specific intrauterine conditions. The role of placental health, adaptation and dysfunction, however, in CHD is not well understood. In this article, we will review current evidence relating placental health in CHD, appraise existing knowledge-gaps in the field and highlight promising new avenues to better understand the impact of placental function on fetal well-being. We will review evidence of ex vivo human placental studies that describe abnormal placental findings in pregnancies complicated by CHD, as well evidence for in vivo assessments of the human placenta. While overall clinical in vivo assessments of placental development are rather limited, we will also review emerging evidence from advanced quantitative and functional magnetic resonance imaging that are bringing new insights into placental structure and function throughout gestation. By providing novel information about placental development, we can now explore the maternal-fetal-placental connection in greater detail, and better understand the multi-factorial mechanisms that may contribute to adverse outcomes seen in survivors of CHD.
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- 2021
16. Lipid Intake and Neurodevelopment in Preterm Infants
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Catherine Limperopoulos, Nickie Andescavage, and Katherine M. Ottolini
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Central nervous system ,Physiology ,Bayley Scales of Infant Development ,White matter ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,030212 general & internal medicine ,chemistry.chemical_classification ,Pregnancy ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Magnetic resonance imaging ,Retinopathy of prematurity ,medicine.disease ,Lipids ,White Matter ,medicine.anatomical_structure ,chemistry ,Docosahexaenoic acid ,Pediatrics, Perinatology and Child Health ,Fatty Acids, Unsaturated ,business ,Infant, Premature ,Polyunsaturated fatty acid - Abstract
Preterm infants are born before the critical period of lipid accretion and brain development that occurs during the third trimester of pregnancy. Dietary lipids serve as an important source of energy and are involved in complex processes that are essential for normal central nervous system development. In addition to traditional neurodevelopmental testing, novel quantitative magnetic resonance imaging (MRI) techniques are now available to evaluate the impact of nutritional interventions on early preterm brain development. Trials of long-chain polyunsaturated fatty acid supplementation have yielded inconsistent effects on neurodevelopmental outcomes and quantitative MRI findings. Recent studies using quantitative MRI suggest a positive impact of early lipid intake on brain volumes and white matter microstructural organization by term-equivalent age.
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- 2021
17. Prenatal origins of neuropsychiatric diseases
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Catherine Limperopoulos, Nickie Andescavage, and Ariunzaya Amgalan
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Adult ,medicine.medical_specialty ,Autism Spectrum Disorder ,Placenta ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,030225 pediatrics ,Animals ,Humans ,Medicine ,030212 general & internal medicine ,Psychiatry ,Depression (differential diagnoses) ,business.industry ,General Medicine ,medicine.disease ,Mental health ,Mental Health ,Mood disorders ,Attention Deficit Disorder with Hyperactivity ,Polysubstance dependence ,Schizophrenia ,Prenatal Exposure Delayed Effects ,Pediatrics, Perinatology and Child Health ,Anxiety ,Autism ,Female ,medicine.symptom ,business - Abstract
Aim The main objective is to review the available evidence in the literature for developmental origins of neuropsychiatric diseases and their underlying mechanisms. We also probe emerging cutting-edge prenatal MR imaging tools and their future role in advancing our understanding the prenatal footprints of neuropsychiatric disorders. Observations Both human and animal studies support early intrauterine origins of neuropsychiatric disease, particularly autism spectrum disorders, attention and hyperactivity disorders, schizophrenia, depression, anxiety and mood disorders. Specific mechanisms of intrauterine injury include infection, inflammation, hypoxia, hypo-perfusion, ischemia polysubstance use/abuse, maternal mental health and placental dysfunction. Conclusions and Relevance: There is ample evidence to suggest developmental vulnerability of the fetal brain to intrauterine exposures that increases and individual's risk for neuropsychiatric disease, especially the risk of autism spectrum disorders, depression and anxiety. Elucidating the exact timing and mechanisms of injury can be difficult, and require novel, non-invasive approaches to the study emerging structural and functional brain development of the fetus. Clinical care should both emphasize maternal health during pregnancy, as well as close, continued monitoring for at risk offspring throughout young adulthood for the early identification and treatment of neuropsychiatric diseases.
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- 2021
18. Semi-automatic segmentation of the placenta into fetal and maternal compartments using intravoxel incoherent motion MRI.
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Wonsang You, Nickie Andescavage, Zungho Zun, and Catherine Limperopoulos
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- 2017
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19. Early Lipid Intake Improves Cerebellar Growth in Very Low‐Birth‐Weight Preterm Infants
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Catherine Limperopoulos, Sudeepta K Basu, Jonathan Murnick, Mariam Said, Marni Jacobs, Kushal Kapse, Rebecca VanderVeer, Katherine M. Ottolini, and Nickie Andescavage
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Neonatal intensive care unit ,030309 nutrition & dietetics ,Medicine (miscellaneous) ,Physiology ,Reproductive health and childbirth ,Low Birth Weight and Health of the Newborn ,Medical and Health Sciences ,0302 clinical medicine ,Pregnancy ,Neonatal ,Infant Mortality ,Infant, Very Low Birth Weight ,magnetic resonance imaging ,Medicine ,Pediatric ,0303 health sciences ,Nutrition and Dietetics ,Gestational age ,Lipids ,Intensive Care Units ,Cohort ,Premature Birth ,Biomedical Imaging ,Gestation ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,Infant, Premature ,pediatrics ,parenteral nutrition ,Article ,lipids ,03 medical and health sciences ,Clinical Research ,Preterm ,Intensive Care Units, Neonatal ,Humans ,enteral nutrition ,Premature ,Nutrition ,Nutrition & Dietetics ,business.industry ,Very Low Birth Weight ,Prevention ,Infant, Newborn ,Neurosciences ,Postmenstrual Age ,Infant ,Perinatal Period - Conditions Originating in Perinatal Period ,Newborn ,neonates ,Brain Disorders ,Low birth weight ,Parenteral nutrition ,business ,Weight gain - Abstract
BACKGROUND: Despite recent advances in nutrition practice in the neonatal intensive care unit, infants remain at high risk for growth restriction following preterm birth. Additionally, optimal values for macronutrient administration, especially lipid intake, have yet to be established for preterm infants in the extrauterine environment. METHODS: We studied preterm infants born at very low-birth weight (VLBW
- Published
- 2020
20. Exploring in vivo placental microstructure in healthy and growth-restricted pregnancies through diffusion-weighted magnetic resonance imaging
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Dorothy I. Bulas, Kushal Kapse, Alexis C. Gimovsky, Marni Jacobs, Nickie Andescavage, Homa K. Ahmadzia, Wonsang You, Jessica Quistorff, Catherine Limperopoulos, and Ahmet Baschat
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Adult ,Male ,0301 basic medicine ,Pathology ,medicine.medical_specialty ,Placenta ,Pregnancy Trimester, Third ,Gestational Age ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,In vivo ,Prenatal Diagnosis ,Fetal growth ,Placental pathology ,medicine ,Humans ,Longitudinal Studies ,Intravoxel incoherent motion ,Fetal Growth Retardation ,030219 obstetrics & reproductive medicine ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Diffusion-Weighted Magnetic Resonance Imaging ,Diffusion Magnetic Resonance Imaging ,030104 developmental biology ,medicine.anatomical_structure ,Reproductive Medicine ,Case-Control Studies ,Pregnancy Trimester, Second ,Gestation ,Female ,business ,Perfusion ,Developmental Biology - Abstract
Introduction Gross and microstructural changes in placental development can influence placental function and adversely impact fetal growth and well-being; however, there is a paucity of invivo tools available to reliably interrogate in vivo placental microstructural development. The objective of this study is to characterize invivo placental microstructural diffusion and perfusion in healthy and growth-restricted pregnancies (FGR) using non-invasive diffusion-weighted imaging (DWI). Methods We prospectively enrolled healthy pregnant women and women whose pregnancies were complicated by FGR. Each woman underwent DWI-MRI between 18 and 40 weeks gestation. Placental measures of small (D) and large (D*) scale diffusion and perfusion (f) were estimated using the intra-voxel incoherent motion (IVIM) model. Results We studied 137 pregnant women (101 healthy; 36 FGR). D and D* are increased in late-onset FGR, and the placental perfusion fraction, f, is decreased (p Discussion Placental DWI revealed microstructural alterations of the invivo placenta in FGR, particularly in late-onset FGR. Early and reliable identification of placental pathology in vivo may better guide future interventions.
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- 2020
21. Cerebral venous volume changes and pressure autoregulation in critically ill infants
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Caitlin Cristante, Adre J. du Plessis, Rathinaswamy B. Govindan, Christopher B. Swisher, Tareq Al-Shargabi, An N. Massaro, Vedavalli Govindan, Yunfei Wang, Marina Metzler, Jonathan Murnick, Nickie Andescavage, Gilbert Vezina, and Dan Reich
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medicine.medical_specialty ,Mean arterial pressure ,Heart disease ,business.industry ,Encephalopathy ,Obstetrics and Gynecology ,Gestational age ,medicine.disease ,pCO2 ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Internal medicine ,Pediatrics, Perinatology and Child Health ,Cardiology ,medicine ,Breathing ,Autoregulation ,030212 general & internal medicine ,Prospective cohort study ,business - Abstract
To determine whether ventilator-related fluctuations in cerebral blood volume (CBV) are associated with cerebral pressure passivity. In a prospective study of newborns undergoing positive-pressure ventilation, we calculated coherence between continuous mean arterial pressure (MAP) and cerebral near-infrared spectroscopy hemoglobin difference (HbD). Significant HbD–MAP coherence indicated cerebral pressure passivity. CBV changes were measured as the spectral power of total hemoglobin (SHbT) at the ventilator frequency. A regression model tested whether SHbT predicts cerebral pressure passivity and/or death/brain injury, controlling for birth gestational age and other factors. We studied 68 subjects with prematurity (n = 19), congenital heart disease (n = 11), and hypoxic–ischemic encephalopathy (n = 38). SHbT, sedative use, and pCO2 were positively associated, and circulating hemoglobin negatively associated, with cerebral pressure passivity (p
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- 2020
22. Improved brain growth and microstructural development in breast milk–fed very low birth weight premature infants
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Katherine M. Ottolini, Catherine Limperopoulos, Marni Jacobs, Nickie Andescavage, and Kushal Kapse
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medicine.medical_specialty ,Internal capsule ,Breast milk ,Corpus callosum ,Article ,White matter ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,030225 pediatrics ,medicine ,Humans ,Infant, Very Low Birth Weight ,030212 general & internal medicine ,Milk, Human ,Obstetrics ,business.industry ,Infant, Newborn ,Brain ,Infant ,Gestational age ,General Medicine ,Low birth weight ,Diffusion Tensor Imaging ,Brain growth ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Female ,medicine.symptom ,business ,Infant, Premature ,Diffusion MRI - Abstract
AIM: Breast milk feeding is linked to improved neurodevelopmental outcomes in very low birth weight (VLBW) infants, though the mechanisms are not well understood. This study utilised quantitative magnetic resonance imaging (qMRI) techniques to compare brain growth and white matter development in preterm infants receiving primarily breast milk versus formula feeds. METHODS: We prospectively enrolled infants born at very low birth weight (
- Published
- 2020
23. Proceedings of the 13th International Newborn Brain Conference: Fetal and/or neonatal brain development, both normal and abnormal
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Khadar, Abdi, Ramy, Abramsky, Nickie, Andescavage, Jephté, Bambi, Sudeepta, Basu, Cynthia, Bearer, Eric J, Benner, Thérèse, Biselele, Nikolay, Bliznyuk, Jeroen, Breckpot, Galen, Carey, Agnes, Chao, Line Iadsatian, Christiansen, Silvia, Comani, Pierpaolo, Croce, Maarten, De Vos, Anneleen, Dereymaeker, Laura, Dubois, Amelia J, Eisch, Adrian, Epstein, Neta, Geva, Yael, Geva, Marc, Gewillig, Sheyenne, Gillis, Ronald N, Goldberg, Magnus, Gram, Simon, Gregory, Danielle, Guez-Barber, Masahiro, Hayakawa, Nicole Lind, Henriksen, Tim, Hermans, Reli, Hershkovitz, Kristine, Holgersen, Bo, Holmqvist, Vaibhav, Jain, Katrien, Jansen, Vinay, Kandula, Kushal, Kapse, Masahiro, Kawaguchi, Abdulhafeez, Khair, Mohammad, Khazaei, Hiroyuki, Kidokoro, Frederico C, Kiffer, Katherine, Kisilewicz, Sumire, Kumai, Helene, Lacaille, David, Ley, Catherine, Limperopoulos, Sandy Ebba Hallengreen, Lindholm, Prosper, Lukusa, Rebecca, Lundberg, Peter, MacFarlane, Pavle, Matak, Laetitia, Mavinga, Catherine, Mayer, Gloire, Mbayabo, Takamasa, Mitsumatsu, Gerrye, Mubungu, Jonathan, Murnick, Tomohiko, Nakata, Hajime, Narita, Parvathi, Nataraj, Jun, Natsume, Gunnar, Naulaers, Rahul, Nikam, Niklas, Ortenlöf, Katherine, Ottolini, Xiaoyu, Pan, Stanislava, Pankratova, Kelly, Pegram, Anna A, Penn, Subechhya, Pradhan, Khadijeh, Raeisi, Nicholas, Rickman, Blaire, Rikard, Reut, Rotem, Per Torp, Sangild, Yoshiaki, Sato, Fumi, Sawamura, Eilon, Shany, Ilan, Shelef, Anna, Shiraki, Laura, Smets, Livia, Sura, Ryosuke, Suzui, Takeshi, Suzuki, Bruno-Paul, Tady, Gentaro, Taga, Gabriella, Tamburro, Liesbeth, Thewissen, J Will, Thompson, Thomas, Thymann, Cansu, Tokat, Claire-Marie, Vacher, Cyndi, Valdes, Suvi, Vallius, Sergei, Vatolin, Hama, Watanabe, Adi Yehuda, Weintraub, Michael, Weiss, Hiroyuki, Yamamoto, Salem Shimrit, Yaniv, Noelle, Younge, Sanghee, Yun, and Filippo, Zappasodi
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Fetus ,Pregnancy ,Infant, Newborn ,Brain ,Humans ,Female ,Prenatal Care ,Head - Abstract
ispartof: J Neonatal Perinatal Med vol:15 issue:2 pages:411-426 ispartof: location:Netherlands status: published
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- 2022
24. Maternal psychological distress during the COVID-19 pandemic and structural changes of the human fetal brain
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Yuan-Chiao Lu, Nickie Andescavage, Yao Wu, Kushal Kapse, Nicole R. Andersen, Jessica Quistorff, Haleema Saeed, Catherine Lopez, Diedtra Henderson, Scott D. Barnett, Gilbert Vezina, David Wessel, Adre du Plessis, and Catherine Limperopoulos
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fetal brain ,gyrification ,maternal psychological distress ,reproductive and urinary physiology ,COVID - Abstract
Background Elevated maternal psychological distress during pregnancy is linked to adverse outcomes in offspring. The potential effects of intensified levels of maternal distress during the COVID-19 pandemic on the developing fetal brain are currently unknown. Methods We prospectively enrolled 202 pregnant women: 65 without known COVID-19 exposures during the pandemic who underwent 92 fetal MRI scans, and 137 pre-pandemic controls who had 182 MRI scans. Multi-plane, multi-phase single shot fast spin echo T2-weighted images were acquired on a GE 1.5 T MRI Scanner. Volumes of six brain tissue types were calculated. Cortical folding measures, including brain surface area, local gyrification index, and sulcal depth were determined. At each MRI scan, maternal distress was assessed using validated stress, anxiety, and depression scales. Generalized estimating equations were utilized to compare maternal distress measures, brain volume and cortical folding differences between pandemic and pre-pandemic cohorts. Results Stress and depression scores are significantly higher in the pandemic cohort, compared to the pre-pandemic cohort. Fetal white matter, hippocampal, and cerebellar volumes are decreased in the pandemic cohort. Cortical surface area and local gyrification index are also decreased in all four lobes, while sulcal depth is lower in the frontal, parietal, and occipital lobes in the pandemic cohort, indicating delayed brain gyrification. Conclusions We report impaired fetal brain growth and delayed cerebral cortical gyrification in COVID-19 pandemic era pregnancies, in the setting of heightened maternal psychological distress. The potential long-term neurodevelopmental consequences of altered fetal brain development in COVID-era pregnancies merit further study.
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- 2021
25. Maternal mental distress and cortisol levels in pregnancies with congenital heart disease
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Adre J. du Plessis, Catherine Limperopoulos, Nickie Andescavage, Mary T. Donofrio, Yao Wu, Jessica Quistorff, and Catherine Lopez
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Heart Defects, Congenital ,medicine.medical_specialty ,Heart disease ,Hydrocortisone ,Offspring ,Anxiety ,Mental distress ,Pregnancy ,Medicine ,Humans ,Generalized estimating equation ,Depression (differential diagnoses) ,business.industry ,Obstetrics ,Depression ,General Medicine ,medicine.disease ,Pregnancy Complications ,Pediatrics, Perinatology and Child Health ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Stress, Psychological ,Hormone - Abstract
Objectives:Prenatal maternal stress is associated with adverse offspring outcomes, which may be mediated by maternal stress hormones. However, evidence supporting the association between maternal stress and cortisol levels in high-risk pregnancies is limited. This study aims to determine the relationship between self-reported maternal mental distress and maternal salivary cortisol levels in pregnancies complicated by foetal CHD compared with healthy pregnancies.Methods:We recruited women with pregnancies complicated by foetal CHD and healthy pregnancies. Maternal saliva was collected between 22 and 40 gestational weeks. Standardized questionnaires measuring stress, depression, and anxiety were completed by patients. Generalized estimating equation was used to evaluate associations between maternal mental distress scales and cortisol levels.Results:We studied 165 women (55 CHD, 110 controls) and collected 504 cortisol samples (160 CHD, 344 controls). Women carrying CHD foetuses had higher stress, anxiety, and depression scores compared to women carrying healthy foetuses. However, maternal cortisol levels did not significantly differ in CHD and controls. Cortisol levels were higher in women carrying foetuses with functionally single-ventricle versus two-ventricle CHD. In both CHD and controls, there was no significant association between maternal stress, depression or anxiety scores and cortisol levels.Conclusion:Our data suggest that self-reported maternal stress, anxiety, and depression are not associated with maternal salivary cortisol levels in CHD and healthy pregnancies. The impact of maternal mental distress on foetal health may be through other mediating pathways other than maternal cortisol concentrations.
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- 2021
26. Adverse Prenatal Exposures and Fetal Brain Development: Insights From Advanced Fetal Magnetic Resonance Imaging
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Josepheen De Asis-Cruz, Catherine Limperopoulos, and Nickie Andescavage
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Autism Spectrum Disorder ,Cognitive Neuroscience ,Placenta ,Bioinformatics ,Fetal brain ,Prenatal influences ,Fetus ,Pregnancy ,Fetal mri ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Biological Psychiatry ,Depression (differential diagnoses) ,business.industry ,Brain ,medicine.disease ,Magnetic Resonance Imaging ,Functional imaging ,Schizophrenia ,Prenatal Exposure Delayed Effects ,Autism ,Female ,Neurology (clinical) ,business - Abstract
Converging evidence from clinical and preclinical studies suggests that fetal vulnerability to adverse prenatal exposures increases the risk for neuropsychiatric diseases such as autism spectrum disorder, schizophrenia, and depression. Recent advances in fetal magnetic resonance imaging have allowed us to characterize typical fetal brain growth trajectories in vivo and to interrogate structural and functional alterations associated with intrauterine exposures, such as maternal stress, environmental toxins, drugs, and obesity. Here, we review proposed mechanisms for how prenatal influences disrupt neurodevelopment, including the role played by maternal and fetal inflammatory responses. We summarize insights from magnetic resonance imaging research in fetuses, highlight recent discoveries in normative fetal development using quantitative magnetic resonance imaging techniques (i.e., three-dimensional volumetry, proton magnetic resonance spectroscopy, placental diffusion imaging, and functional imaging), and discuss how baseline trajectories are shaped by prenatal exposures.
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- 2021
27. Robust motion correction and outlier rejection of in vivo functional MR images of the fetal brain and placenta during maternal hyperoxia.
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Wonsang You, Ahmed Serag, Iordanis E. Evangelou, Nickie Andescavage, and Catherine Limperopoulos
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- 2015
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28. In vivo textural and morphometric analysis of placental development in healthy & growth-restricted pregnancies using magnetic resonance imaging
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Sayali Yewale, Nickie Andescavage, Marni Jacobs, Sara N. Iqbal, Ahmet Baschat, Catherine Limperopoulos, Dorothy I. Bulas, and Sonia Dahdouh
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Pregnancy ,Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Placental insufficiency ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Morphometric analysis ,In vivo ,030225 pediatrics ,Placenta ,Pediatrics, Perinatology and Child Health ,Fetal growth ,medicine ,Gestation ,business ,030217 neurology & neurosurgery - Abstract
The objective of this study was to characterize structural changes in the healthy in vivo placenta by applying morphometric and textural analysis using magnetic resonance imaging (MRI), and to explore features that may be able to distinguish placental insufficiency in fetal growth restriction (FGR). Women with healthy pregnancies or pregnancies complicated by FGR underwent MRI between 20 and 40 weeks gestation. Measures of placental morphometry (volume, elongation, depth) and digital texture (voxel-wise geometric and signal-intensity analysis) were calculated from T2W MR images. We studied 66 pregnant women (32 healthy controls, 34 FGR); during the study period, placentas undergo significant increases in size; signal intensity remains relatively constant, however there is increasing variation in spatial arrangements, suggestive of progressive microstructural heterogeneity. In FGR, placental size is smaller, with great homogeneity of signal intensity and spatial arrangements. We report quantitative textural and morphometric changes in the in vivo placenta in healthy controls over the second half of pregnancy. These MRI features demonstrate important differences in placental development in the setting of placental insufficiency that relate to onset and severity of FGR, as well as neonatal outcome
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- 2019
29. 938 Pregnancy and COVID-19: the impact on maternal mental health
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Catherine Lopez, Catherine Limperopoulos, Jessica Quistorff, Haleema Saeed, and Nickie Andescavage
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Pregnancy ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Obstetrics and Gynecology ,medicine.disease ,Mental health ,Saturday, January 30, 2021 • 1:00 PM - 2:00 PM ,Family medicine ,Obstetrics and Gynaecology ,Poster Session IV ,Medicine ,business - Published
- 2021
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30. 95 Elevated prenatal maternal stress during Covid-19 alters fetal biochemical profiles
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Haleema Saeed, Nickie Andescavage, Nicole Andersen, Jessica Quistorff, Kushal Kapse, Catherine Limperopoulos, Subechhya Pradhan, and Catherine Lopez
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Fetus ,Maternal stress ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Obstetrics and Gynaecology ,Obstetrics and Gynecology ,Physiology ,Medicine ,business - Published
- 2021
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31. Structural Changes of the Human Fetal Brain During the COVID-19 Pandemic
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Catherine Lopez, Catherine Limperopoulos, Yuan-Chiao Lu, Jessica Quistorff, Diedtra Henderson, Adre J. du Plessis, David L. Wessel, Nicole Andersen, Kushal Kapse, G. Vezina, Scott D. Barnett, Yao Wu, Haleema Saeed, and Nickie Andescavage
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medicine.medical_specialty ,Pregnancy ,business.industry ,Obstetrics ,Offspring ,medicine.disease ,Institutional review board ,White matter ,medicine.anatomical_structure ,Cohort ,Brain size ,Medicine ,business ,Gyrification ,Depression (differential diagnoses) - Abstract
Background: Elevated maternal psychological distress during pregnancy is linked to adverse short- and long-term outcomes in the offspring. The potential deleterious effects of intensified levels of maternal distress during the COVID-19 pandemic on the developing fetal brain are currently unknown. Methods: We prospectively enrolled 202 pregnant women: 65 with negative COVID-19 diagnoses during the pandemic who underwent 92 fetal MRI scans, and 137 pre-pandemic controls who had 182 MRI scans. Multi-plane, multi-phase single shot fast spin echo T2-weighted images were acquired on a GE 1.5T MRI Scanner. High-resolution 3D models of the fetal brains were reconstructed, and volumes of six brain tissue types were calculated: cortical gray matter (CGM), white matter (WM), cerebellum, deep gray matter (DGM), brainstem, and hippocampus. Cortical folding measures, including brain surface area, local gyrification index (LGI), and sulcal depth were determined. At each MRI scan, maternal distress was assessed using validated stress, anxiety and depression scales. Generalized estimating equations (GEEs) were utilized to compare maternal distress measures, brain volume and cortical folding differences between pandemic and pre-pandemic cohorts. Findings: Stress and depression scores were significantly higher in the pandemic cohort (14.2 vs. 10.4 for stress; 5.9 vs. 4.2 for depression; p
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- 2021
32. Abstract 17061: Impact of Maternal Anxiety on In Vivo Placental Development in Fetuses With Congenital Heart Disease
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Mary T. Donofrio, Catherine Limperopoulos, Dorothy I. Bulas, Catherine Lopez, Nicole Andersen, Nickie Andescavage, Kushal Kapse, Andrea Fry, Anita Krishnan, and Yuan-Chiao Lu
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Fetus ,Heart disease ,In vivo ,business.industry ,Physiology (medical) ,medicine ,Physiology ,Maternal anxiety ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Abstract
Introduction: Studies have shown that maternal stress and anxiety during pregnancy have been associated with a higher incidence of preterm birth and low birth weight. However, the relationship between prenatal maternal mental distress and placental development in fetuses with congenital heart disease (CHD) is unknown. Hypothesis: We tested the hypothesis that elevated maternal anxiety is associated with altered placental morphology in fetuses with CHD. Methods: A total of 141 pregnant women were recruited prospectively (control: 91; two-ventricle/2V CHD: 29; single-ventricle/SV CHD: 21), in which 228 fetal MR scans were performed (gestational age: 31.8±4.5 weeks). Single shot fast spin echo T2-weighted images were acquired on a 1.5 Tesla GE MRI scanner. Placenta tissue was manually segmented, and slice-to-volume registration was used for motion correction and 3D reconstruction. Six placental features were calculated: volume, thickness, elongation, surface area, mean diameter, and umbilical cord centricity. We completed the Spielberger State (SSAI) and Trait (SSAI) Anxiety Inventory at each study visit. Linear mixed models were utilized to analyze the placental features predicted by maternal anxiety. Results: Placental volume, surface area, and mean diameter were decreased with elevated SSAI in 2V CHD fetuses, while volume and cord centricity were increased with higher SSAI in SV CHD fetuses. Lower cord centricity was associated with elevated STAI in 2V CHD fetuses, and elongation was positively associated with STAI in SV CHD fetuses. There were no associations between anxiety measures and placental features in control fetuses. Conclusions: We report for the first time that elevated prenatal maternal anxiety is associated with altered in vivo placental structures in pregnancies complicated by fetal CHD. Our data suggest that disturbances in placental structure vary based on the type of fetal CHD (SV vs. 2V) in the setting of elevated prenatal maternal anxiety.
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- 2020
33. Association of Elevated Maternal Psychological Distress, Altered Fetal Brain, and Offspring Cognitive and Social-Emotional Outcomes at 18 Months
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Yao, Wu, Kristina M, Espinosa, Scott D, Barnett, Anushree, Kapse, Jessica Lynn, Quistorff, Catherine, Lopez, Nickie, Andescavage, Subechhya, Pradhan, Yuan-Chiao, Lu, Kushal, Kapse, Diedtra, Henderson, Gilbert, Vezina, David, Wessel, Adré J, du Plessis, and Catherine, Limperopoulos
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Cohort Studies ,Cognition ,Pregnancy ,Brain ,Humans ,Infant ,Mothers ,Female ,General Medicine ,Psychological Distress - Abstract
Prenatal maternal psychological distress is associated with disturbances in fetal brain development. However, the association between altered fetal brain development, prenatal maternal psychological distress, and long-term neurodevelopmental outcomes is unknown.To determine the association of fetal brain development using 3-dimensional magnetic resonance imaging (MRI) volumes, cortical folding, and metabolites in the setting of maternal psychological distress with infant 18-month neurodevelopment.Healthy mother-infant dyads were prospectively recruited into a longitudinal observational cohort study from January 2016 to October 2020 at Children's National Hospital in Washington, DC. Data analysis was performed from January 2016 to July 2021.Prenatal maternal stress, anxiety, and depression.Prenatal maternal stress, anxiety, and depression were measured using validated self-report questionnaires. Fetal brain volumes and cortical folding were measured from 3-dimensional, reconstructed T2-weighted MRI scans. Fetal brain creatine and choline were quantified using proton magnetic resonance spectroscopy. Infant neurodevelopment at 18 months was measured using Bayley Scales of Infant and Toddler Development III and Infant-Toddler Social and Emotional Assessment. The parenting stress in the parent-child dyad was measured using the Parenting Stress Index-Short Form at 18-month testing.The cohort consisted of 97 mother-infant dyads (mean [SD] maternal age, 34.79 [5.64] years) who underwent 184 fetal MRI visits (87 participants with 2 fetal studies each) with maternal psychological distress measures between 24 and 40 gestational weeks and completed follow-up infant neurodevelopmental testing. Prenatal maternal stress was negatively associated with infant cognitive performance (β = -0.51; 95% CI, -0.92 to -0.09; P = .01), and this association was mediated by fetal left hippocampal volume. In addition, prenatal maternal anxiety, stress, and depression were positively associated with all parenting stress measures at 18-month testing. Finally, fetal cortical local gyrification index and sulcal depth were negatively associated with infant social-emotional performance (local gyrification index: β = -54.62; 95% CI, -85.05 to -24.19; P .001; sulcal depth: β = -14.22; 95% CI, -23.59 to -4.85; P = .002) and competence scores (local gyrification index: β = -24.01; 95% CI, -40.34 to -7.69; P = .003; sulcal depth: β = -7.53; 95% CI, -11.73 to -3.32; P .001).In this cohort study of 97 mother-infant dyads, fetal cortical local gyrification index and sulcal depth were associated with infant 18-month social-emotional and competence outcomes, and fetal left hippocampal volume mediated the association between prenatal maternal stress and infant cognitive outcome. These findings suggest that altered prenatal brain development in the setting of elevated maternal distress has adverse infant sociocognitive outcomes, and identifying early biomarkers associated with long-term neurodevelopment may assist in early targeted interventions.
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- 2022
34. Feasibility of QSM in the human placenta
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Homa K. Ahmadzia, Nickie Andescavage, Alexis C. Gimovsky, Zungho Zun, Jessica Quistorff, Kushal Kapse, and Catherine Limperopoulos
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Placenta ,Physiology ,Hyperoxia ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Fetus ,business.industry ,Gestational age ,Infant ,Quantitative susceptibility mapping ,Human placenta ,Oxygenation ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,In utero ,Feasibility Studies ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
PURPOSE Quantitative susceptibility mapping (QSM) is an emerging tool for the precise characterization of human tissue, including regional oxygenation. A critical function of the human placenta is oxygen transfer to the developing fetus, which remains difficult to study in utero. The purpose of this study is to investigate the feasibility of performing QSM in the human placenta in utero. METHODS In healthy pregnant women, 3D gradient echo data of the placenta were acquired with prospective respiratory gating at 1.5 Tesla and 3 Tesla. A brief period (6-7 min) of maternal hyperoxia was induced to increase placental oxygenation in a subset of women scanned at 3 Tesla, and data were acquired before and during oxygen administration. Susceptibility and T2∗ / R2∗ maps were reconstructed from gradient echo data, and mean and SD of these measures within the whole placenta were calculated. RESULTS A total of 54 women were studied at a mean gestational age of 30.7 ± 4.2 (range: 24 5/7-38 4/7) weeks. Susceptibility and T2∗ maps demonstrated lobular contrast reflecting regional oxygenation difference at both field strengths. SD of susceptibilities, mean R2∗ , and SD of R2∗ of the placenta showed a linear relationship with gestational age (P < .01 for all). These measures were also responsive to maternal hyperoxia, and there was an increasing response with advancing gestational age (P < .01 for all). CONCLUSION This study demonstrates the feasibility of performing placental QSM in pregnant women and supports the potential for placental QSM to provide noninvasive in vivo assessment of placental oxygenation.
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- 2020
35. Emerging placental biomarkers of health and disease through advanced magnetic resonance imaging (MRI)
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Nickie Andescavage and Catherine Limperopoulos
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Fetus ,Pregnancy ,Placenta Diseases ,medicine.diagnostic_test ,business.industry ,Placenta ,Magnetic resonance imaging ,Disease ,medicine.disease ,Bioinformatics ,Placental disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Developmental Neuroscience ,Neurology ,Current management ,Maldevelopment ,medicine ,Humans ,Female ,business - Abstract
Placental dysfunction is a major cause of fetal demise, fetal growth restriction, and preterm birth, as well as significant maternal morbidity and mortality. Infant survivors of placental dysfunction are at elevatedrisk for lifelong neuropsychiatric morbidity. However, despite the significant consequences of placental disease, there are no clinical tools to directly and non-invasively assess and measure placental function in pregnancy. In this work, we will review advanced MRI techniques applied to the study of the in vivo human placenta in order to better detail placental structure, architecture, and function. We will discuss the potential of these measures to serve as optimal biomarkers of placental dysfunction and review the evidence of these tools in the discrimination of health and disease in pregnancy. Efforts to advance our understanding of in vivo placental development are necessary if we are to optimize healthy pregnancy outcomes and prevent brain injury in successive generations. Current management of many high-risk pregnancies cannot address placental maldevelopment or injury, given the standard tools available to clinicians. Once accurate biomarkers of placental development and function are constructed, the subsequent steps will be to introduce maternal and fetal therapeutics targeting at optimizing placental function. Applying these biomarkers in future studies will allow for real-time assessments of safety and efficacy of novel interventions aimed at improving maternal-fetal well-being.
- Published
- 2022
36. Neuroimaging for Neurodevelopmental Prognostication in High-Risk Neonates
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Nickie Andescavage and Elizabeth K. Sewell
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Heart Defects, Congenital ,medicine.medical_specialty ,Leukomalacia, Periventricular ,medicine.medical_treatment ,Neuroimaging ,Hypoxic Ischemic Encephalopathy ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,030225 pediatrics ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Intensive care medicine ,Cerebral Hemorrhage ,Cerebral Intraventricular Hemorrhage ,Respiratory Distress Syndrome, Newborn ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Brain ,Obstetrics and Gynecology ,Magnetic resonance imaging ,Prognosis ,Echoencephalography ,Magnetic Resonance Imaging ,White Matter ,Stroke ,Cranial ultrasound ,Hypoxia-Ischemia, Brain ,Pediatrics, Perinatology and Child Health ,Biomarker (medicine) ,business ,Outcome prediction ,Intracranial Hemorrhages ,030217 neurology & neurosurgery ,Hydrocephalus - Abstract
Predicting neurodevelopmental outcomes in high-risk neonates remains challenging despite advances in neonatal care. Early and accurate characterization of infants at risk for neurodevelopmental delays is necessary to best identify those who may benefit from existing early interventions and novel therapies that become available. Although neuroimaging is a promising biomarker in the prediction of neurodevelopmental outcomes in high-risk infants, it requires additional resources and expertise. Despite many advances in neonatal neuroimaging, there remain limitations in relating early neuroimaging findings with long-term outcomes; further studies are necessary to determine the optimal protocols to best identify high-risk patients and improve neurodevelopmental outcome prediction.
- Published
- 2018
37. Hemodynamic Responses of the Placenta and Brain to Maternal Hyperoxia in Fetuses with Congenital Heart Disease by Using Blood Oxygen–Level Dependent MRI
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Catherine Limperopoulos, Kushal Kapse, Wonsang You, Marni Jacobs, Nickie Andescavage, and Mary T. Donofrio
- Subjects
Male ,Placenta ,Hemodynamics ,Reproductive health and childbirth ,Low Birth Weight and Health of the Newborn ,Cardiovascular ,Medical and Health Sciences ,030218 nuclear medicine & medical imaging ,Congenital ,0302 clinical medicine ,Pregnancy ,Infant Mortality ,Medicine ,Prospective Studies ,reproductive and urinary physiology ,Heart Defects ,Original Research ,Hyperoxia ,Pediatric ,Gestational age ,Brain ,Magnetic Resonance Imaging ,Nuclear Medicine & Medical Imaging ,medicine.anatomical_structure ,Heart Disease ,In utero ,030220 oncology & carcinogenesis ,embryonic structures ,Cardiology ,Female ,medicine.symptom ,Adult ,Heart Defects, Congenital ,medicine.medical_specialty ,Mothers ,03 medical and health sciences ,Preterm ,Clinical Research ,Internal medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Fetus ,business.industry ,Prevention ,Oxygen Inhalation Therapy ,Oxygenation ,Perinatal Period - Conditions Originating in Perinatal Period ,Oxygen ,Good Health and Well Being ,Ventricle ,Congenital Structural Anomalies ,business - Abstract
BACKGROUND: Impaired brain development in fetuses with congenital heart disease (CHD) may result from inadequate cerebral oxygen supply in utero. PURPOSE: To test whether fetal cerebral oxygenation can be increased by maternal oxygen administration, effects of maternal hyperoxia on blood oxygenation of the placenta and fetal brain were examined by using blood oxygenation level–dependent (BOLD) functional MRI. MATERIALS AND METHODS: In this prospective study, BOLD MRI was performed in 86 fetuses (56 healthy fetuses and 30 fetuses diagnosed with CHD) between 22 and 39 weeks gestational age (GA) from May 2015 to December 2017, with the following study design: phase I, 2-minute resting state at baseline (room air); phase II, 6-minute maternal hyperoxia with 100% oxygen; and phase III, 5.6-minute return to resting state. After motion correction, the signals were averaged over the placenta and fetal brain and converted to the change in R2* (ΔR2*). Fetuses with CHD were categorized into those with a single ventricle (SV) or two ventricles (TVs) and those with aortic obstruction (AO) or non-AO. Data were analyzed by using generalized linear mixed models controlling for GA and sex. RESULTS: Placental ΔR2* increased during maternal hyperoxia in healthy fetuses and fetuses with CHD, but it was higher in SV CHD (mean ΔR2*, 1.3 sec(−1) ± 0.1 [standard error; P < .01], 1.9 sec(−1) ± 0.2 [P < .01], and 1.0 sec(−1) ± 0.3 [P < .01], respectively, for control fetuses, fetuses with SV CHD, and fetuses with TV CHD). Placental ΔR2* during maternal hyperoxia changed with GA in healthy control fetuses and fetuses with SV or AO CHD (ΔR2* per week, 0.1 sec(−1) ± 0 [P < .01], 0.2 sec(–1) ± 0 [P = .01], and 0.2 sec(−1) ± 0 [P = .01], respectively), but not in fetuses with CHD and TV or non-AO. Fetal brain ΔR2* was constant across all phases in healthy control fetuses and fetuses with TV CHD but increased during maternal hyperoxia in fetuses with SV or AO CHD (mean ΔR2*, 0.7 sec(−1) ± 0.2 [P = .01] and 0.5 sec(−1) ± 0.2 [P = .02], respectively). CONCLUSION: Six minutes of maternal hyperoxia increased placental oxygenation in healthy fetuses and fetuses with congenital heart disease, and it selectively increased cerebral blood oxygenation in fetuses with single ventricle or aortic obstruction. © RSNA, 2019 Online supplemental material is available for this article.
- Published
- 2019
38. Extending the phenotypic spectrum of Sengers syndrome: Congenital lactic acidosis with synthetic liver dysfunction
- Author
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Kristina Cusmano-Ozog, David B. Beck, Nickie Andescavage, and Eyby Leon
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0301 basic medicine ,medicine.medical_specialty ,Mitochondrial disease ,Sengers syndrome ,030105 genetics & heredity ,Congenital lactic acidosis ,Chorioamnionitis ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,AGK ,Original Research ,business.industry ,Hypertrophic cardiomyopathy ,General Medicine ,medicine.disease ,Bilateral Cataracts ,acylglycerol kinase ,Lactic acidosis ,Severe lactic acidosis ,business ,Acylglycerol kinase ,030217 neurology & neurosurgery - Abstract
Sengers syndrome is a rare autosomal recessive mitochondrial disease characterized by lactic acidosis, hypertrophic cardiomyopathy and bilateral cataracts. We present here a case of neonatal demise, within the first day of life, who initially presented with severe lactic acidosis, with evidence of both chorioamnionitis and cardiogenic shock. Initial metabolic labs demonstrated a severe lactic acidosis prompting genetic testing which revealed a homozygous pathogenic variant for Sengers syndrome in AGK, c.979A > T; p.K327*. In addition to the canonical features of Sengers syndrome, our patient is the first reported case with liver dysfunction extending the phenotypic spectrum both in terms of severity and complications. This case also highlights the importance of maintaining a broad differential for congenital lactic acidosis.
- Published
- 2018
39. Using Nature to Nurture: Breast Milk Analysis and Fortification to Improve Growth and Neurodevelopmental Outcomes in Preterm Infants
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Catherine Limperopoulos, Elizabeth V. Schulz, Katherine M. Ottolini, and Nickie Andescavage
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medicine.medical_specialty ,Fortification ,fortification ,Review ,Infant, Premature, Diseases ,Breast milk ,Nature versus nurture ,Child Development ,Humans ,Medicine ,TX341-641 ,Infant Nutritional Physiological Phenomena ,Fetus ,Pregnancy ,Nutrition and Dietetics ,neurodevelopment ,Milk, Human ,Nutrition. Foods and food supply ,business.industry ,Obstetrics ,Infant, Newborn ,medicine.disease ,Micronutrient ,Parenteral nutrition ,Neurodevelopmental Disorders ,In utero ,Food, Fortified ,breast milk ,preterm ,business ,Infant, Premature ,Food Science - Abstract
Premature infants are born prior to a critical window of rapid placental nutrient transfer and fetal growth—particularly brain development—that occurs during the third trimester of pregnancy. Subsequently, a large proportion of preterm neonates experience extrauterine growth failure and associated neurodevelopmental impairments. Human milk (maternal or donor breast milk) is the recommended source of enteral nutrition for preterm infants, but requires additional fortification of macronutrient, micronutrient, and energy content to meet the nutritional demands of the preterm infant in attempts at replicating in utero nutrient accretion and growth rates. Traditional standardized fortification practices that add a fixed amount of multicomponent fortifier based on assumed breast milk composition do not take into account the considerable variations in breast milk content or individual neonatal metabolism. Emerging methods of individualized fortification—including targeted and adjusted fortification—show promise in improving postnatal growth and neurodevelopmental outcomes in preterm infants.
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- 2021
40. 288 Assessing in vivo placental function in pregnancies complicated by maternal diabetes mellitus
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Stacey Gold, Sarah Downs, Catherine Limperopoulos, Sara N. Iqbal, Catherine Lopez, Nickie Andescavage, and Jessica Quistorff
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In vivo ,business.industry ,Obstetrics and Gynecology ,Medicine ,Maternal diabetes ,Bioinformatics ,business ,Function (biology) - Published
- 2021
41. 1116 Microstructural & functional changes in the placenta during the COVID-19 pandemic
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Catherine Limperopoulos, Nickie Andescavage, Jessica Quistorff, Haleema Saeed, Lu Yuan, Catherine Lopez, and Scott D. Barnett
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2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Obstetrics and Gynecology ,Virology ,Saturday, January 30, 2021 • 1:00 PM - 2:00 PM ,medicine.anatomical_structure ,Placenta ,Pandemic ,Obstetrics and Gynaecology ,Poster Session IV ,Medicine ,business - Published
- 2021
42. In vivo assessment of placental and brain volumes in growth-restricted fetuses with and without fetal Doppler changes using quantitative 3D MRI
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Adre J. duPlessis, C. Limperopoulos, Marina Metzler, Sara N. Iqbal, Marni Jacobs, Gilbert Vezina, Nickie Andescavage, Dorothy I. Bulas, and Ahmet Baschat
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Adult ,Male ,Pathology ,medicine.medical_specialty ,Adolescent ,Placenta ,Gestational Age ,Ultrasonography, Prenatal ,Article ,Fetal Development ,Young Adult ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Text mining ,Predictive Value of Tests ,Pregnancy ,In vivo ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,030212 general & internal medicine ,skin and connective tissue diseases ,Fetus ,Fetal Growth Retardation ,030219 obstetrics & reproductive medicine ,business.industry ,Brain ,Obstetrics and Gynecology ,Fetal doppler ,Organ Size ,Magnetic Resonance Imaging ,3. Good health ,Case-Control Studies ,embryonic structures ,Pediatrics, Perinatology and Child Health ,Female ,sense organs ,business - Abstract
Objective The relationship between placental and fetal brain growth is poorly understood, and difficult to assess. The objective of this study was to interrogate placental and fetal brain growth in healthy pregnancies and those complicated by fetal growth restriction (FGR). Study Design In a prospective, observational study, pregnant women with normal pregnancies or pregnancies complicated by FGR underwent fetal MR imaging. Placental, global and regional brain volumes were calculated. Results 114 women (79 controls and 35 FGR) underwent MR imaging (median GA 30 weeks, range 18 –39). All measured volumes increased exponentially with advancing GA. Placental, total brain, cerebral and cerebellar volumes were smaller in FGR compared to controls (p
- Published
- 2017
43. Identification of QRS complex in non-stationary electrocardiogram of sick infants
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A. du Plessis, Tareq Al-Shargabi, Nickie Andescavage, Srinivas Kota, Ramaswamy Govindan, and Christopher B. Swisher
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Adult ,medicine.medical_specialty ,Pediatrics ,Health Informatics ,030204 cardiovascular system & hematology ,Electrocardiography ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Signal strength ,030225 pediatrics ,Internal medicine ,Intensive care ,medicine ,Humans ,cardiovascular diseases ,Sensitivity (control systems) ,Retrospective Studies ,medicine.diagnostic_test ,Critically ill ,business.industry ,Infant ,Predictive value ,Computer Science Applications ,Identification (information) ,Cardiology ,business ,Infant, Premature - Abstract
Background Due to the high-frequency of routine interventions in an intensive care setting, electrocardiogram (ECG) recordings from sick infants are highly non-stationary, with recurrent changes in the baseline, alterations in the morphology of the waveform, and attenuations of the signal strength. Current methods lack reliability in identifying QRS complexes (a marker of individual cardiac cycles) in the non-stationary ECG. In the current study we address this problem by proposing a novel approach to QRS complex identification. Method Our approach employs lowpass filtering, half-wave rectification, and the use of instantaneous Hilbert phase to identify QRS complexes in the ECG. We demonstrate the application of this method using ECG recordings from eight preterm infants undergoing intensive care, as well as from 18 normal adult volunteers available via a public database. We compared our approach to the commonly used approaches including Pan and Tompkins (PT), gqrs , wavedet , and wqrs for identifying QRS complexes and then compared each with manually identified QRS complexes. Results For preterm infants, a comparison between the QRS complexes identified by our approach and those identified through manual annotations yielded sensitivity and positive predictive values of 99% and 99.91%, respectively. The comparison metrics for each method are as follows: PT (sensitivity: 84.49%, positive predictive value: 99.88%), gqrs (85.25%, 99.49%), wavedet (95.24%, 99.86%), and wqrs (96.99%, 96.55%). Thus, the sensitivity values of the four methods previously described, are lower than the sensitivity of the method we propose; however, the positive predictive values of these other approaches is comparable to those of our method, with the exception of the wqrs approach, which yielded a slightly lower value. For adult ECG, our approach yielded a sensitivity of 99.78%, whereas PT yielded 99.79%. The positive predictive value was 99.42% for both our approach as well as for PT. Conclusions We propose a novel method for identifying QRS complexes that outperforms common currently available tools for non-stationary ECG data in infants. For stationary ECG our proposed approach and the PT approach perform equally well. The ECG acquired in a clinical environment may be prone to issues related to non-stationarity, especially in critically ill patients. The approach proposed in this report offers superior reliability in these scenarios.
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- 2017
44. In vivo placental MRI shape and textural features predict fetal growth restriction and postnatal outcome
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Diane Lanham, Catherine Limperopoulos, Sayali Yewale, Adre J. du Plessis, Dorothy I. Bulas, Nickie Andescavage, Sonia Dahdouh, and Alexa Yarish
- Subjects
Fetus ,030219 obstetrics & reproductive medicine ,business.industry ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Standard error ,medicine.anatomical_structure ,In utero ,Coronal plane ,Placenta ,Immunology ,Kurtosis ,medicine ,Gestation ,Radiology, Nuclear Medicine and imaging ,business ,Nuclear medicine ,Shape analysis (digital geometry) - Abstract
Purpose To investigate the ability of three-dimensional (3D) MRI placental shape and textural features to predict fetal growth restriction (FGR) and birth weight (BW) for both healthy and FGR fetuses. Materials and Methods We recruited two groups of pregnant volunteers between 18 and 39 weeks of gestation; 46 healthy subjects and 34 FGR. Both groups underwent fetal MR imaging on a 1.5 Tesla GE scanner using an eight-channel receiver coil. We acquired T2-weighted images on either the coronal or the axial plane to obtain MR volumes with a slice thickness of either 4 or 8 mm covering the full placenta. Placental shape features (volume, thickness, elongation) were combined with textural features; first order textural features (mean, variance, kurtosis, and skewness of placental gray levels), as well as, textural features computed on the gray level co-occurrence and run-length matrices characterizing placental homogeneity, symmetry, and coarseness. The features were used in two machine learning frameworks to predict FGR and BW. Results The proposed machine-learning based method using shape and textural features identified FGR pregnancies with 86% accuracy, 77% precision and 86% recall. BW estimations were 0.3 ± 13.4% (mean percentage error ± standard error) for healthy fetuses and -2.6 ± 15.9% for FGR. Conclusion The proposed FGR identification and BW estimation methods using in utero placental shape and textural features computed on 3D MR images demonstrated high accuracy in our healthy and high-risk cohorts. Future studies to assess the evolution of each feature with regard to placental development are currently underway. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:449–458.
- Published
- 2017
45. Pattern of brain injury and depressed heart rate variability in newborns with hypoxic ischemic encephalopathy
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An N. Massaro, Gilbert Vezina, Adre J. du Plessis, Marina Metzler, Nickie Andescavage, Yunfei Wang, Rathinaswamy B. Govindan, and Tareq Al-Shargabi
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Male ,medicine.medical_specialty ,Article ,Hypoxic Ischemic Encephalopathy ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Heart Rate ,030225 pediatrics ,Internal medicine ,Heart rate ,Basal ganglia ,medicine ,Humans ,Heart rate variability ,Depression (differential diagnoses) ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,White Matter Injury ,Magnetic resonance imaging ,3. Good health ,Anesthesia ,Hypoxia-Ischemia, Brain ,Pediatrics, Perinatology and Child Health ,Cardiology ,Female ,business ,030217 neurology & neurosurgery - Abstract
BackgroundDecreased heart rate variability (HRV) is a measure of autonomic dysfunction and brain injury in newborns with hypoxic ischemic encephalopathy (HIE). This study aimed to characterize the relationship between HRV and brain injury pattern using magnetic resonance imaging (MRI) in newborns with HIE undergoing therapeutic hypothermia.MethodsHRV metrics were quantified in the time domain (αS, αL, and root mean square at short (RMSS) and long (RMSL) timescales) and frequency domain (relative low-(LF) and high-frequency (HF) power) over 24-27 h of life. The brain injury pattern shown by MRI was classified as no injury, pure cortical/white matter injury, mixed watershed/mild basal ganglia injury, predominant basal ganglia or global injury, and death. HRV metrics were compared across brain injury pattern groups using a random-effects mixed model.ResultsData from 74 infants were analyzed. Brain injury pattern was significantly associated with the degree of HRV suppression. Specifically, negative associations were observed between the pattern of brain injury and RMSS (estimate -0.224, SE 0.082, P=0.006), RMSL (estimate -0.189, SE 0.082, P=0.021), and LF power (estimate -0.044, SE 0.016, P=0.006).ConclusionDegree of HRV depression is related to the pattern of brain injury. HRV monitoring may provide insights into the pattern of brain injury at the bedside.
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- 2017
46. Assessing statistical significance of phase synchronization index — An application to study baroreflex function in critically-ill infants
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Adre J. du Plessis, Nickie Andescavage, R. B. Lenin, Tareq Al-Shargabi, Marina Metzler, and Ramaswamy Govindan
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Statistics and Probability ,Wilcoxon signed-rank test ,Computer simulation ,Bandwidth (signal processing) ,White noise ,Baroreflex ,Condensed Matter Physics ,Phase synchronization ,03 medical and health sciences ,0302 clinical medicine ,Autoregressive model ,Control theory ,Asynchronous communication ,030225 pediatrics ,030217 neurology & neurosurgery ,Mathematics - Abstract
Phase differences of two signals in perfect synchrony exhibit a narrow band distribution, whereas the phase differences of two asynchronous signals exhibit uniform distribution. We assess the statistical significance of the phase synchronization between two signals by using a signed rank test to compare the distribution of their phase differences to the theoretically expected uniform distribution for two asynchronous signals. Using numerical simulation of a second order autoregressive (AR2) process, we show that the proposed approach correctly identifies the coupling between the AR2 process and the driving white noise. We also identify the optimal p-value that distinguishes coupled scenarios from uncoupled ones. To identify the limiting cases, we study the phase synchronization between two independent white noises as a function of bandwidth of the filter in a different second simulation. We identify the frequency bandwidth below which the proposed approach fails and suggest using a data-driven approach for those scenarios. Finally, we demonstrate the application of this approach to study the coupling between beat-to-beat cardiac intervals and continuous blood pressure obtained from critically-ill infants to characterize the baroreflex function.
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- 2017
47. Fetal lung interstitial tumor: Prenatal presentation of a rare fetal malignancy
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A DiPoto Brahmbhatt, Anne Lawrence, James P. Phillips, Nickie Andescavage, Ann Blask, Andrea Badillo, and J Timofeev
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Adult ,Pathology ,medicine.medical_specialty ,Lung Neoplasms ,Gestational Age ,Malignancy ,Betamethasone ,Ultrasonography, Prenatal ,Lesion ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,030225 pediatrics ,Cystic Adenomatoid Malformation of Lung, Congenital ,Medicine ,Humans ,Cesarean Section, Repeat ,Glucocorticoids ,Fetus ,Respiratory Distress Syndrome, Newborn ,030219 obstetrics & reproductive medicine ,business.industry ,Ultrasound ,Infant, Newborn ,Congenital pulmonary airway malformation ,medicine.disease ,Magnetic Resonance Imaging ,Treatment Outcome ,Thoracotomy ,Pediatrics, Perinatology and Child Health ,Pregnancy, Twin ,Gestation ,Female ,medicine.symptom ,Presentation (obstetrics) ,business ,medicine.drug - Abstract
Fetal lung interstitial tumor (FLIT) is a rare fetal malignancy that is typically diagnosed in the postnatal period, or, if recognized prenatally can mimic a benign lesion such as congenital pulmonary airway malformation. We present the earliest case of a FLIT tumor described by ultrasound and MRI at 26 weeks of gestation. Our case highlights features suggestive of FLIT including presentation later in gestation in combination with findings on fetal MRI such as a solid appearance with radiating curved bands of high signal within and along the periphery of the lesion (not as intensely high signal as the typical CPAM), possibly detailing a radiographic signature for these tumors. The role of betamethasone for these tumors is not known.
- Published
- 2019
48. Nutrition and the developing brain: the road to optimizing early neurodevelopment: a systematic review
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Susan Keller, Nickie Andescavage, Catherine Limperopoulos, and Katherine M. Ottolini
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Pediatrics ,medicine.medical_specialty ,Brain development ,Neurogenesis ,MEDLINE ,Nutritional Status ,Gestational Age ,03 medical and health sciences ,0302 clinical medicine ,Child Development ,030225 pediatrics ,Intensive care ,Medicine ,Humans ,Significant risk ,Infant Nutritional Physiological Phenomena ,Postnatal brain ,Breast milk intake ,business.industry ,Age Factors ,Infant, Newborn ,Brain ,Magnetic Resonance Imaging ,Infant Formula ,Bottle Feeding ,Breast Feeding ,Polyunsaturated fatty acid supplementation ,Pediatrics, Perinatology and Child Health ,Brain size ,Premature Birth ,business ,030217 neurology & neurosurgery ,Infant, Premature - Abstract
Neonatal intensive care practices have resulted in marked improvements in the survival of premature infants; however, they remain at significant risk for adverse neurodevelopmental outcomes. The impact of current nutritional practices on brain development following early extra-uterine exposure in premature infants is not well known. We performed a systematic review to investigate nutritional effects on postnatal brain development in healthy term and prematurely born infants utilizing advanced magnetic resonance imaging tools. Systematic screen yielded 595 studies for appraisal. Of these, 22 total studies were selected for inclusion in the review, with findings summarized in a qualitative, descriptive fashion. Fat and energy intake are associated with improved brain volume and development in premature infants. While breast milk intake and long-chain polyunsaturated fatty acid supplementation has been proven beneficial in term infants, the impact in preterm infants is less well understood.
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- 2019
49. Association Between Socioeconomic Status and In Utero Fetal Brain Development
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G. Vezina, Nicole Andersen, Andrea Fry, Adré J. du Plessis, Nickie Andescavage, Catherine Lopez, Yuan-Chiao Lu, Kushal Kapse, Jessica Quistorff, Catherine Limperopoulos, Yao Wu, Kristina Espinosa, and Jenhao Cheng
- Subjects
Adult ,Male ,medicine.medical_specialty ,Neuroimaging ,Prenatal care ,Imaging ,Fetal Development ,Pregnancy ,Reference Values ,Interquartile range ,medicine ,Humans ,Gyrification ,Original Investigation ,Obstetrics ,business.industry ,Research ,Parietal lobe ,Brain ,Gestational age ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Online Only ,Social Class ,Frontal lobe ,Brain size ,Female ,business ,Follow-Up Studies - Abstract
This cohort study examines the association between parental socioeconomic status measures and brain volume and cortical features among fetuses., Key Points Question Is parental socioeconomic status associated with fetal brain development? Findings In this cohort study of 144 healthy pregnant women and their fetuses, low parental socioeconomic status was associated with decreased regional fetal brain tissue volume and increased brain gyrification. Meaning This cohort study found that parental socioeconomic status was associated with altered fetal brain morphology as measured by quantitative magnetic resonance imaging techniques, which may serve as an early biomarker associated with childhood neurodevelopmental disorders., Importance Children raised in settings with lower parental socioeconomic status are at increased risk for neuropsychological disorders. However, to date, the association between socioeconomic status and fetal brain development remains poorly understood. Objective To determine the association between parental socioeconomic status and in vivo fetal brain growth and cerebral cortical development using advanced, 3-dimensional fetal magnetic resonance imaging. Design, Setting, and Participants This cohort study of fetal brain development enrolled 144 healthy pregnant women from 2 low-risk community obstetrical hospitals from 2012 through 2019 in the District of Columbia. Included women had a prenatal history without complications that included recommended screening laboratory and ultrasound studies. Exclusion criteria were multiple gestation pregnancy, known or suspected congenital infection, dysmorphic features of the fetus, and documented chromosomal abnormalities. T2-weighted fetal brain magnetic resonance images were acquired. Each pregnant woman was scanned at up to 2 points in the fetal period. Data were analyzed from June through November 2020. Exposures Parental education level and occupation status were documented. Main Outcomes and Measures Regional fetal brain tissue volume (for cortical gray matter, white matter, cerebellum, deep gray matter, and brainstem) and cerebral cortical features (ie, lobe volume, local gyrification index, and sulcal depth) in the frontal, parietal, temporal, and occipital lobes were calculated. Results Fetal brain magnetic resonance imaging studies were performed among 144 pregnant women (median [interquartile range] age, 32.5 [27.0-36.1] years) with gestational age from 24.0 to 39.4 weeks; 75 fetuses (52.1%) were male, and 69 fetuses (47.9%) were female. Higher parental education level was associated with significantly increased volume in the fetal white matter (mothers: β, 2.86; 95% CI, 1.26 to 4.45; P = .001; fathers: β, 2.39; 95% CI, 0.97 to 3.81; P = .001), deep gray matter (mothers: β, 0.16; 95% CI, 0.002 to 0.32; P = .048; fathers: β, 0.16; 95% CI, 0.02 to 0.31; P = .02), and brainstem (mothers: β, 0.06; 95% CI, 0.02 to 0.10; P = .01; fathers: β, 0.04; 95% CI, 0.004 to 0.08; P = .03). Higher maternal occupation status was associated with significantly increased volume in the fetal white matter (β, 2.07; 95% CI, 0.88 to 3.26; P = .001), cerebellum (β, 0.17; 95% CI, 0.04 to 0.29; P = .01), and brainstem (β, 0.03; 95% CI, 0.001 to 0.07; P = .04), and higher paternal occupation status was associated with significantly increased white matter volume (β, 1.98; 95% CI, 0.71 to 3.25; P
- Published
- 2021
50. Association of Prenatal Maternal Anxiety With Fetal Regional Brain Connectivity
- Author
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Catherine Limperopoulos, Jessica Quistorff, Kushal Kapse, Nickie Andescavage, Catherine Lopez, Gilbert Vezina, Josepheen De Asis-Cruz, Dhineshvikram Krishnamurthy, and Li Zhao
- Subjects
Adult ,Perceived Stress Scale ,Gestational Age ,Prenatal care ,Anxiety ,Fetal Development ,Young Adult ,Pregnancy ,medicine ,Humans ,Depression (differential diagnoses) ,Psychiatric Status Rating Scales ,Resting state fMRI ,business.industry ,Brain ,Gestational age ,Prenatal Care ,General Medicine ,medicine.disease ,Pregnancy Complications ,Prenatal Exposure Delayed Effects ,Edinburgh Postnatal Depression Scale ,Female ,Pregnant Women ,medicine.symptom ,business ,Stress, Psychological ,Clinical psychology - Abstract
Importance Maternal psychological distress during pregnancy is associated with adverse obstetric outcomes and neuropsychiatric deficits in children. Currently unavailable in vivo interrogation of fetal brain function could provide critical insights into the onset and timing of altered neurodevelopmental trajectories. Objective To investigate the association between prenatal maternal stress, anxiety, and depression and in vivo fetal brain resting state functional connectivity. Design, Setting, and Participants This cohort study included pregnant women scanned between January 2016 and April 2019. A total of 50 pregnant women with healthy pregnancies were prospectively recruited from low-risk obstetric clinics in the Washington DC area and were scanned at Children’s National in Washington DC. Exposures Maternal stress, anxiety, and depression. Main Outcomes and Measures The association of prenatal maternal stress, anxiety, and depression with whole-brain connectivity was analyzed using multivariate distance matrix regression. Prenatal maternal stress, anxiety, and depression were assessed using the Perceived Stress Scale, Spielberger State Anxiety Inventory and Spielberger Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale, respectively. Whole-brain connectivity was measured from 100 functionally defined regions of interest. Results This study analyzed 59 resting-state functional connectivity magnetic resonance image data sets from the fetuses (mean [SD] gestational age, 33.52 [4 weeks]) of 50 healthy pregnant women (mean [SD] age, 33.77 [5.51]). Mean (SD) scores for the questionnaires were as follows: Spielberger State Anxiety Inventory, 26.66 (6.72) (range, 20-48); Spielberger Trait Anxiety Inventory, 28.09 (6.62) (range, 20-50); Perceived Stress Scale, 9.27 (5.13) (range, 1-25); and Edinburgh Postnatal Depression Scale 3.24 (2.84) (range, 0-14). Prenatal maternal anxiety scores measured using the Spielberger Trait and State Anxiety Inventories were associated with differences in fetal connectivity (Spielberger State Anxiety Inventory: pseudo-R2 = 0.019,P = .04; Spielberger Trait Anxiety Inventory: pseudo-R2 = 0.021,P = .007). Interhemispheric connections, such as those involving the parietofrontal and occipital association cortices, were associated with reduced maternal prenatal anxiety, and those between the brainstem and sensorimotor areas were associated with higher anxiety scores. Conclusions and Relevance In this cohort study, an association was found between prenatal maternal anxiety and disturbances in fetal brain functional connectivity, suggesting altered fetal programming. Early onset of functional deviations suggests the need for more widespread screening of pregnant women for symptoms of anxiety.
- Published
- 2020
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