G. Manten

Risk factors for cardiovascular disease in women with a history of pregnancy complicated by preeclampsia or intrauterine growth restriction.

Objective: Women with a history of preeclampsia or intrauterine growth restriction (IUGR) have an increased risk for cardiovascular disease in later life. We determined the presence of traditional and novel risk factors for cardiovascular disease in these women. Methods: We studied 256 women with a history of preeclampsia and 59 women with a history of intrauterine growth restriction. Fifty-three women with a history of uncomplicated pregnancy served as controls. We determined values for blood pressure, body mass index, concentrations of cholesterol, high-density lipoprotein cholesterol, triglycerides and lipoprotein (a), and insulin resistance. Results: Women with a history of preeclampsia exhibited more risk factors for future cardiovascular disease such as dyslipidemia, hypertension, obesity, and increased insulin resistance compared with women with a history of uncomplicated pregnancy. Women with a history of IUGR have higher concentrations of cholesterol and show a tendency to higher BMI, higher triglyceride concentrations, and increased insulin resistance as compared with women with a history of normal pregnancy. Conclusions: Preeclampsia or IUGR may represent an early marker for increased risk for early cardiovascular disease.

Grade and symmetry of normal fetal cortical development: a longitudinal two‐ and three‐dimensional ultrasound study

Recent studies have shown the capability of ultrasound to demonstrate fetal cortical development. For practical application, it would be useful to have more insight into the physiological progress of cortical folding. A longitudinal study was undertaken to grade fetal cortical development and to study physiological asymmetry by means of a simple scoring system. The reproducibility of the scoring system and the differences between two‐dimensional (2D) and three‐dimensional (3D) ultrasound were also examined.

The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation

OBJECTIVE The objective of the study was to assess in trichorionic triplet pregnancies the effectiveness of elective reduction to twins. STUDY DESIGN This was a nationwide retrospective cohort study. We compared the time to delivery and perinatal mortality in trichorionic triplet pregnancies electively reduced to twins with ongoing trichorionic triplets and primary dichorionic twins. RESULTS We identified 86 women with reduced trichorionic triplet pregnancies, 44 with ongoing trichorionic triplets, and 824 with primary twins. Reduced triplets had a median gestational age at delivery of 36.1 weeks (interquartile range [IQR], 33.3-37.5 weeks) vs 33.3 (IQR, 28.1-35.2) weeks for ongoing triplets and 37.1 (IQR, 35.3-38.1) weeks for primary twins (P < .001). The total number of surviving children in the reduced group was 155 (90%) vs 114 (86%) in the ongoing triplet group. After reduction, 75 of women (87%) had all their fetuses surviving, compared with 36 (82%) (relative risk [RR], 1.3; 95% confidence interval [CI], 0.72-2.3) for ongoing triplets and 770 (93%) (RR, 0.91; 95% CI, 0.82-1) for primary twins. There were 6 women without any surviving children (7%) after reduction vs 5 (11.4%) (RR, 0.81; 95% CI, 0.47-1.4) among women with ongoing triplets and 32 (3.9%) (RR, 1.7; 95% CI, 0.8-3.7) in women with primary twins. CONCLUSION In women with a triplet pregnancy, fetal reduction increases gestational age at birth with 3 weeks as compared with ongoing triplets. However, there the impact on neonatal survival is limited.

Detection of fetal chromosomal anomalies: does nuchal translucency measurement have added value in the era of non-invasive prenatal testing?

The objective of this study is to determine what percentage of fetal chromosomal anomalies remains undetected when first trimester combined testing is replaced by non‐invasive prenatal testing for trisomies 13, 18, and 21. We focused on the added clinical value of nuchal translucency (NT) measurement.

Changes of plasma lipoprotein(a) during and after normal pregnancy in Caucasians.

Objective: Elevated plasma concentrations of lipoprotein(a) are associated with an increased risk for development of atherosclerosis. High lipoprotein(a) concentrations may also be associated with pregnancy-induced hypertension and pre-eclampsia, but reference data on the course of lipoprotein(a) during uneventful pregnancies are limited and questionable. Methods: We studied plasma lipoprotein(a) concentrations in 19 healthy nulliparous Caucasian women during and after uncomplicated pregnancy. Blood was sampled every 4 weeks during pregnancy from 9 weeks onwards, during labor and at 2-4 weeks and 3-5 months after delivery. An apolipoprotein(a) (apo(a)) isoform-independent enzyme-linked immunosorbent assay (ELISA) was used to measure lipoprotein(a). Multilevel analysis was used to describe the data. Results: Lipoprotein(a) increased until 35 weeks, subsequently decreased slightly until delivery, and fell to values below early pregnancy concentrations thereafter. The curve is defined by the formula lipoprotein(a) (mg/l) = exp [4.789 + (0.05215 × GA) + (-0.0007371 × GA2)] where GA = gestational age in weeks. Conclusions: We constructed a curve for plasma lipoprotein(a) which may serve as the standard reference for changes in pregnancy. Its formula is helpful in predicting changes of gestational age-dependent changes of lipoprotein(a) in normal pregnancy.

The accuracy of prenatal ultrasound in determining the type of orofacial cleft

The aim of this study was to assess the accuracy of prenatal transabdominal ultrasound in determining the oral cleft type.

Fetal Heart Disease: Severity, Associated Anomalies and Parental Decision

Objective: This study describes the association between the complexity of congenital cardiac and extracardiac malformations, and the parental decision of pregnancy continuation or termination. Methods: Congenital heart defects (CHD) was diagnosed by ultrasound in 251 fetuses before the 24th week (23 + 6 weeks) of gestation during the four year period from 2007 to 2010. All fetuses from the Utrecht region were referred to our center due to a strict referral pattern. The complexity and severity of the cardiac and possible extracardiac malformations were retrospectively categorized by a pediatric cardiologist and a perinatologist who were blinded to the pregnancy outcome. The groups with and without termination of pregnancy were compared using a univariate analysis and multivariate logistic regression. Results: In 119 (47%) of the 251 fetuses, parents opted for termination of pregnancy. In 103 of these cases (87%) there was a high complex or lethal cardiac, or a major or lethal extracardiac malformation. Of the 132 continued pregnancies, 42 fetuses (32%) had a high complex or lethal cardiac, or a major or lethal extracardiac malformation. There were significantly more terminations of pregnancy in case of a high or lethal complex cardiac or extracardiac anomaly (71 vs. 15%, p <0.001). Conclusion: Parents opted for termination of pregnancy significantly more often in cases with high complex cardiac and extracardiac malformations. It was rare for parents to opt for pregnancy termination in the absence of a severe cardiac or extracardiac malformation.

Fluorinated steroids do not improve outcome of isolated atrioventricular block

INTRODUCTION Congenital atrioventricular block (CAVB) is a rare disorder with a significant morbidity and mortality. Consensus regarding the prescription and efficacy of prenatal corticosteroids is lacking. This nationwide study was initiated to evaluate the effects of prenatal treatment with corticosteroids on the outcome of CAVB in The Netherlands. METHODS All fetuses identified with isolated congenital AVB-II° or AVB-III° in any of the eight academic fetal heart centers of The Netherlands between 2003 and 2013 were included and reviewed. RESULTS Fifty-six fetuses were included. Fourteen (25%) fetuses were treated with dexamethasone. We found no differences between the steroid-treated and untreated cases regarding in utero progression of the AVB (63% vs 67% respectively), survival to birth (86% vs 84%), pacemaker implantations (74% vs 58%) or long-term dilated cardiomyopathy (13% vs 17%). Steroid treated fetuses demonstrated more in utero growth restriction (38% vs 11%). CONCLUSION No benefit from prenatal corticosteroid treatment was demonstrated for fetuses with isolated CAVB in this study. However, we found negative side effects. Our data provide no evidence to support the routine administration of corticosteroids for the treatment of fetal CAVB.

Functional outcome at school age of children born with gastroschisis

OBJECTIVE We aimed to determine motor, cognitive and behavioural outcomes of school aged children born with gastroschisis compared to matched controls. STUDY DESIGN We compared outcomes of 16 children born with gastroschisis treated at the University Medical Center Groningen, the Netherlands, between 1999 and 2006 with 32 controls matched for gender, gestational age, birth weight, and corrected for small for gestational age (SGA) and parental socioeconomic status (SES). Intelligence, auditory-verbal memory, attention, response inhibition, visual perception, motor skills, visuomotor integration, problem behaviour and executive functioning were evaluated. RESULTS Median verbal intelligence quotient and global executive functioning scores of children born with gastroschisis were poorer than of controls (95 (inter quartile range (IQR) 88-100) vs. 104 (IQR 98-113), P=0.001, and 29 (IQR 6.8-63.8) vs. 5.0 (IQR 2.8-19.8), P=0.03, respectively). Children with gastroschisis were more often classified as borderline or abnormal than controls regarding response inhibition (odds ratio (OR) 20.4; 95%-confidence interval (95%-CI); 2.4-171.5), selective visual attention (OR 40.4; 95%-CI 5.9-275.4), sustained auditory attention (OR 88.1; 95%-CI 5.8-1342.8), and fine motor skills (50% vs. 0%). Grade retention was more prevalent in gastroschisis children (OR 6.07; 95%-CI 1.42-25.9). These associations persisted after adjustment for SGA and SES. The auditory-verbal memory, visuomotor integration and behavioural problems did not significantly differ from the controls. CONCLUSIONS Gastroschisis is associated with poorer verbal intelligence, and with an increased risk for poor performance on several aspects of attention, response inhibition and fine motor skills at school age. The follow-up of children born with gastroschisis deserves attention regarding these specific domains, to improve their functional outcomes.

Outcome of isolated gastroschisis; an international study, systematic review and meta-analysis

OBJECTIVE To determine outcome of children born with isolated gastroschisis (no extra-gastrointestinal congenital abnormalities). STUDY DESIGN International cohort study and meta-analysis. PRIMARY OUTCOME time to full enteral feeding (TFEF); secondary outcomes: Duration of mechanical ventilation, length of stay (LOS), mortality and differences in outcome between simple and complex gastroschisis (complex; born with bowel atresia, volvulus, perforation or necrosis). To compare the cohort study results with literature three databases were searched. Studies were eligible for inclusion if cases were born in developed countries with isolated gastroschisis after 1990, number of cases >20 and TFEF was reported. RESULTS The cohort study included 204 liveborn cases of isolated gastroschisis. The TFEF, median duration of ventilation and LOS was, 26days (range 6-515), 2days (range 0-90) and 33days (range 11-515), respectively. Overall mortality was 10.8%. TFEF and LOS were significantly longer (P<0.0001) and mortality was fourfold higher in the complex group. Seventeen studies, amongst the current study, were included for further meta-analysis comprising a total of 1652 patients. Mean TFEF was 35.3±4.4days, length of ventilation was 5.5±2.0days, LOS was 46.4±5.2days and mortality risk was 0.06 [0.04-0.07 95%CI]. Outcome of simple and complex gastroschisis was described in five studies. TFEF, ventilation time, LOS were significant longer and mortality rate was 3.64 [1.95-6.83 95%CI] times higher in complex cases. CONCLUSIONS These results give a good indication of the expected TFEF, ventilation time and LOS and mortality risk in children born with isolated gastroschisis, although ranges remain wide. This study shows the importance of dividing gastroschisis into simple and complex for the prediction of outcome.