UOG Journal Club: Aortic and carotid arterial wall thickness in term small-for-gestational-age...
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UOG Journal Club: June 2014 Aortic and carotid arterial wall thickness in term small-for-gestational-age newborns and relationship with prenatal signs of severity I. Stergiotou, F. Crispi, B. Valenzuela-Alcaraz, M. Cruz- Lemini, B. Bijnens, E. Gratacos Volume 43, Issue 6, Date: June 2014, pages 625-631 Journal Club slides prepared by Dr Leona Poon (UOG Editor for Trainees)
UOG Journal Club: Aortic and carotid arterial wall thickness in term small-for-gestational-age newborns and relationship with prenatal signs of severity
Aortic and carotid arterial wall thickness in term small-for-gestational-age newborns and relationship with prenatal signs of severity I. Stergiotou, F. Crispi, B. Valenzuela-Alcaraz, M. Cruz-Lemini, B. Bijnens, E. Gratacos Volume 43, Issue 6, Date: June 2014, pages 625-631 http://onlinelibrary.wiley.com/doi/10.1002/uog.13245/abstract
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1. UOG Journal Club: June 2014 Aortic and carotid arterial wall
thickness in term small-for-gestational-age newborns and
relationship with prenatal signs of severity I. Stergiotou, F.
Crispi, B. Valenzuela-Alcaraz, M. Cruz-Lemini, B. Bijnens, E.
Gratacos Volume 43, Issue 6, Date: June 2014, pages 625-631 Journal
Club slides prepared by Dr Leona Poon (UOG Editor for
Trainees)
2. IUGR may be linked to adverse pregnancy outcome through
profound changes in the metabolic and cardiovascular (CV) systems
(Hattersley, 1999; Girsen, 2007; Crispi, 2008; Batalle, 2012)
Vascular intima-media thickness (IMT) is a standard diagnostic
procedure in assessing CV risk in asymptomatic adults (Stein, 2008)
There is an inverse relationship among aortic IMT (aIMT), arterial
stiffness and low birth weight (BW) (Skilton, 2005; Koklu ,2006;
Mori 2006; Tauzin 2006). Recent evidence suggests that late SGA
fetuses have worse CV and neurodevelopmental outcomes than
initially anticipated (Comas, 2011; Crispi, 2012). Hattersley AT et
al. Lancet 1999;353:1789-92. Koklu E et al. Horm Res
2006;65:269-75. Mori A et al. Pediatrics 2006;118:1034-41. Skilton
MT et al. Lancet 2005;365:1484-6. Stein et al. J Am Soc
Echocardiogr 2008;21:93-111. Tauzin L et al. Pediatr Res
2006;60:592-6. Batalle D et al. Neuroimage 2012;60:1352-66. Comas M
et al. Am J Obstet Gynecol 2011;205:57.e1-6 Crispi F et al. Am J
Obtet Gynecol 2008;199:254. Crispi F et al. Am J Obstet Gynecol
2012;207:121.e1-9. Girsen A et al. Ultrasound Obstet Gynecol
2007;29:296-303.
3. Aortic and carotid arterial wall thickness in term
small-for-gestational-age newborns and relationship with prenatal
signs of severity Stergiotou et al., UOG 2014 To assess carotid
arterial wall and aortic intima-media thickness (IMT) in term
growth-restricted newborns with and without prenatal signs of
severity Objective
4. Aortic and carotid arterial wall thickness in term
small-for-gestational-age newborns and relationship with prenatal
signs of severity Stergiotou et al., UOG 2014 Patients and Methods
Prospective cohort study of 201 newborns prenatally diagnosed as
SGA or AGA and delivered after 37 weeks, subdivided into: 1. SGA
with prenatal signs of severity defined by estimated fetal weight
(EFW) and confirmed BW < 3rd percentile or uterine artery mean
pulsatility index (mean UtAPI) > 95th percentile or
cerebroplacental ratio < 5th percentile; 2. SGA without prenatal
signs of severity defined by EFW and BW between 3rd and 10th
percentiles with normal mean UtAPI and cerebroplacental ratio; 3.
Controls defined by EFW and confirmed BW > 10th percentile, with
no pregnancy complications.
5. Patients and Methods Aortic and carotid arterial wall
thickness in term small-for-gestational-age newborns and
relationship with prenatal signs of severity Stergiotou et al., UOG
2014 Doppler examination before delivery included uterine artery
(UtA), umbilical artery (UA) and middle cerebral artery (MCA)
Controls were matched 2 to 1 with cases by gender and gestational
age at delivery ( 1 week). Exclusion criteria were chromosomal or
genetic disorders, monochorionic (MC) twin pregnancy and evidence
of infection. Fetal and neonatal weight centile were calculated
according to local reference curves. Neonatal blood pressure (BP)
was obtained using a validated ambulatory automated device; BP
centiles were calculated using local standards.
6. Patients and Methods Aortic and carotid arterial wall
thickness in term small-for-gestational-age newborns and
relationship with prenatal signs of severity Stergiotou et al., UOG
2014 Longitudinal clips of the far wall of both carotid arteries
were obtained ~1cm proximal to the bifurcation using a 13-MHz
linear-array transducer Longitudinal clips of the far wall of the
proximal abdominal aorta were obtained in the upper abdomen using a
10-MHz linear probe. Carotid artery IMT (cIMT) and aIMT
measurements were performed offline according to the standardized
trace method protocol (Figure 1). To obtain IMT, the average of 3
end-diastolic frames selected across a length of 10 mm and analyzed
for mean and maximal IMT was used Intraobserver and interobserver
variability was determined.
7. Patients and Methods Aortic and carotid arterial wall
thickness in term small-for-gestational-age newborns and
relationship with prenatal signs of severity Stergiotou et al., UOG
2014 Figure 1. Ultrasound assessment of mean cIMT (a, c, e) and
aIMT (b, d, f) in controls (a, b) and in SGA without (c, d) and
with (e, f) signs of severity
8. Statistical analysis Aortic and carotid arterial wall
thickness in term small-for-gestational-age newborns and
relationship with prenatal signs of severity Stergiotou et al., UOG
2014 Intraobserver reproducibility was assessed by intraclass
correlation coefficients (ICCs) and coefficients of variation (CV).
Interobserver reproducibility was assessed by CV for each
parameter. An estimated sample size of 32 women per group was
achieved for a power > 90% and 5% type 1 error level.
Comparisons by one-way ANOVA, based on log-transformed data
adjusted with Bonferroni post-hoc test and Pearsons chi-square
test. Models for vascular results were adjusted by multiple linear
regression by gender, gestational age at birth and age at
evaluation. Polynomial orthogonal contrasts were constructed to
test for linear trends of parameters across severity groups.
9. Aortic and carotid arterial wall thickness in term
small-for-gestational-age newborns and relationship with prenatal
signs of severity Stergiotou et al., UOG 2014 Characteristics
Controls (n=134) SGA without signs of severity (n=32) SGA with
signs of severity (n=35) P Maternal characteristics Smoking 22
(16.4) 8 (25.0) 13 (37.1)* 0.028 Prenatal ultrasound GA at scan
(wks) 34.1 (33.2 to 37.2) 37.7 (36.5 to 38.4)* 37.6 (37.1 to
38.5)*