Journal of Perinatal Medicine最新文献

Objectives: The aim was to evaluate the sensitivity and specificity of CentaFlow (CF) in a prospective multicenter study, and secondary to evaluate the safety of the CF device in a randomized multicenter study.

Methods: A sponsor-initiated multicenter randomized controlled clinical trial with termination of the randomization after enough women had been included to evaluate safety. The study proceeded as a prospective multicenter study including high-risk women (estimated fetal weight <-15 %, FGR). The first part randomized women to either standard care (SC) or SC+CF. Participants underwent CF evaluation with subsequent analysis for sensitivity and specificity for FGR at birth. Secondarily, adverse events were evaluated. Clinical assessments of fetal size conducted by midwives served as a reference. The performance of CF and SC was compared by McNemar's Test. The performance analysis of CF was done per-protocol sample.

Results: A total of 1,601 pregnant women were enrolled, with 886 undergoing CF evaluation. A total of 123 were FGR (<3rd percentile) at birth, of which 88 were evaluated by CF, and 117 had a clinical assessment of the estimated fetal weight. CF demonstrated no evidence of benefit for detecting FGR with a sensitivity of 50 % and specificity of 43 %. Adverse events associated with CF use were limited to minor skin irritation. McNemar's test showed SC was superior to CF regarding specificity as a screening tool (p=0.014).

Conclusions: While CF was safe to use, we found no evidence that CF can be used as a predictor of FGR. Further refinement of signal analysis is necessary to enhance CFs diagnostic utility.

Objectives: To evaluate the evidence linking prenatal exposure to environmental endocrine-disrupting chemicals (EDCs) - including bisphenol A (BPA), phthalates, and per- and polyfluoroalkyl substances (PFAS) - with adverse pregnancy and fetal developmental outcomes, and to assess the potential translation of this evidence into clinical perinatal risk assessment.

Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2000 and May 2025. Eligible studies included epidemiological and experimental research addressing prenatal EDC exposure and fetal-placental outcomes. After duplicate removal and screening, 52 studies met inclusion criteria and were categorized by study type (epidemiological, mechanistic, translational). Data extraction included exposure metrics, critical developmental windows, and reported effect sizes (odds ratios, risk ratios, hazard ratios).

Results: Evidence suggests that EDC exposure during early pregnancy is associated with placental dysfunction, altered fetal growth trajectories, endocrine and epigenetic modifications, and increased risk of selected neonatal outcomes. Effect sizes were variable, often modest (many<2.0), but consistently indicated biological plausibility supported by mechanistic data. Biomonitoring studies demonstrate widespread EDC exposure across populations, including higher body burdens in lower-income and racially diverse groups. Despite robust basic science evidence, clinical screening for EDC exposure remains limited, and routine risk assessment frameworks rarely incorporate environmental chemical exposures.

Conclusions: Prenatal EDC exposure is biologically linked to disrupted fetal-placental development, yet translation into clinical practice remains incomplete. Integrating environmental exposure assessment and preventive counseling into perinatal care may improve maternal-fetal health and reduce disparities.

Introduction: Maternal nutrition during pregnancy can influence fetal development through epigenetic modifications, affecting gene expression without altering DNA sequence. Nutriepigenomics - the study of nutrient-driven epigenetic regulation - provides critical insights into how prenatal nutritional exposures can shape immediate and lifelong health outcomes.

Content: This narrative review synthesizes evidence from human cohort studies and experimental animal models on how macro- and micronutrients, including folate, vitamin B12, choline, vitamin D, omega-3 fatty acids, and bioactive compounds such as polyphenols and resveratrol, modify key epigenetic processes. These include DNA methylation, histone modifications, and non-coding RNA regulation, particularly within the placenta and developing fetal tissues.

Summary: Maternal diet-induced epigenetic changes influence fetal metabolic programming, neurodevelopment, immune maturation, and organogenesis, with impacts detectable at birth and persisting into adulthood. Evidence indicates associations with altered birthweight trajectories, increased risk of childhood obesity and immune dysregulation, and potential elevation in lifelong cardiometabolic and neuropsychiatric disease risk.

Outlook: Integrating nutriepigenomic insights into perinatal care offers opportunities for early preventive strategies and personalized nutrition interventions. Translational application of epigenetic biomarkers, coupled with population-level nutritional policies, could reduce disease risk across generations and improve long-term population health outcomes.

Objectives: Hyperemesis gravidarum is a severe form of nausea and vomiting that affects approximately 0.3-2 % of pregnancies, leading to significant perinatal complications. This systematic review and meta-analysis aims to investigate the potential link between hyperemesis gravidarum and maternal serum pregnancy-associated plasma protein-A (PAPP-A) levels in the first trimester.

Methods: A thorough literature search of PubMed/MEDLINE, ScienceDirect, the Cochrane Library, and Google Scholar was conducted to identify relevant studies comparing PAPP-A levels in pregnant women diagnosed with hyperemesis gravidarum compared to healthy controls. Six studies met the inclusion criteria, with a total of 1,049 participants. Meta-analysis was performed to estimate the pooled mean difference in PAPP-A levels between hyperemesis gravidarum and control groups. A p-curve analysis and funnel plot assessment were conducted to evaluate publication bias and statistical power.

Results: The meta-analysis demonstrated a pooled mean difference of 0.16 (95 % CI: 0.07-0.25), indicating that PAPP-A levels were significantly higher in pregnancies affected by HG. The heterogeneity statistic (I²=46 %) suggested moderate variability among studies. P-curve analysis showed a right-skewed distribution of significant p-values (p=0.033), suggesting evidential value and ruling out selective reporting bias. However, the prediction interval (-0.08-0.4) indicated that some future studies might yield non-significant or even negative findings. Funnel plot analysis revealed minimal publication bias, though a slight asymmetry suggested potential underrepresentation of small, non-significant studies.

Conclusions: This study provides evidence that PAPP-A levels are elevated in pregnancies complicated by hyperemesis gravidarum, implicating potential placental dysfunction and hormonal influences in its pathogenesis. While the findings are statistically significant and robust against publication bias, moderate heterogeneity highlights the need for larger prospective studies with standardized methodologies to confirm this association and explore possible underlying mechanisms. Understanding the role of PAPP-A in hyperemesis gravidarum may contribute to improved screening and management strategies for affected pregnancies and as a result, improved perinatal care.

Fetoception refers to the maternal detection and integration of signals originating from the fetus, particularly the perception of fetal movements. This process reflects a specific form of maternal interoception, the central nervous system's capacity to process internal bodily signals. As such, fetoception offers a unique window into maternal interoceptive processing during pregnancy, a period marked by profound physiological and sensory changes. Exploring the mechanisms underlying fetoception may provide novel insights into the dynamic interactions between interoceptive systems and the maternal adaptation to pregnancy. Furthermore, potential links between fetoception, interoception, and perinatal mental health remain largely unexplored and warrant further investigation.

Objectives: Hydrops fetalis is associated with high morbidity and perinatal mortality. The aim of our study was to compare the outcomes of infants who had non-immune hydrops fetalis (NIHF) who did or did not undergo antenatal shunting.

Methods: Between January 2014 and June 2023, 20 infants with the diagnosis of NIHF were admitted to the neonatal intensive care unit (NICU) at King's College Hospital NHS Foundation Trust. The criteria for antenatal shunt placement were development of hydrops fetalis, polyhydramnios due to oesophageal compression by a pleural effusion that would likely result in preterm labour or a large pleural effusion (no hydrops at presentation) resulting in likely inferior vena cava compression and significant risk of development of hydrops.

Results: The 20 infants had a median gestational age of 34 (27-40) weeks of gestation at delivery and were diagnosed at a median gestational age of 29 (17-40) weeks. Eight infants had a shunt inserted antenatally (six pleuro amniotic and two abdominal amniotic) and they delivered at a significantly later median gestational age (36 vs. 32.5 weeks, p=0.025). After adjustment for gestational age at delivery and antenatal severity, those who had a shunt placed were not more likely to be oxygen dependent at 36 weeks post menstrual age (PMA) and had a lower length of stay (23 vs. 95 days, p=0.019).

Conclusions: Infants who had NIHF and had antenatal shunting had favourable outcomes compared to those who did not, despite a more severe antenatal presentation.

Objectives: This study compared adverse perinatal outcomes between pregnancies complicated by periviable fetal growth restriction (pFGR) that underwent weekly sonographic surveillance vs. serial growth surveillance.

Methods: In this retrospective cohort study, pFGR was defined as a 22 0/7-27 6/7-week singleton, <500 g, and ≤10 % for gestational age. The surveillance group initiated weekly Doppler surveillance while the serial growth (SG) group underwent growth assessment every 3-4 weeks between 22 and 27 6/7 weeks. Adverse perinatal outcomes were compared.

Results: Eighty-one (36.2 %) underwent weekly Doppler surveillance. Chronic hypertension (18.5 % vs. 9.1 %, p=0.04), a prior history of fetal demise (8.6 % vs. 2.1 %, p=0.02), and an estimated fetal weight <3 % (22.2 % vs. 10.5 %, p=0.02) and any abnormal umbilical artery Doppler pattern at diagnosis (25.8 % vs. 12.9 %, p=0.046) occurred more frequently in the weekly Doppler surveillance group than the SG group. Despite no difference in perinatal death, the surveillance group demonstrated a higher rate of obstetric (65.4 % vs. 42.7 %, p<0.05) and neonatal (60.8 % vs. 28.4 %, p<0.05) adverse outcome composites compared to the SG group.

Conclusions: The surveillance group experienced increased rates of obstetric and neonatal morbidity without difference in perinatal death though interpretation is limited by the observational nature of this study.

Introduction: Amniotic Fluid Embolism (AFE) is a rare but catastrophic obstetric emergency characterized by the sudden entry of amniotic fluid or fetal debris into the maternal circulation. This triggers acute cardiopulmonary collapse, disseminated intravascular coagulation (DIC), and multi-organ failure. Despite its low incidence, AFE remains a significant contributor to maternal mortality worldwide. The pathophysiology is poorly understood, involving immune-mediated anaphylactoid reactions and mechanical vascular obstruction.

Content: This review provides a comprehensive synthesis of current knowledge on AFE, examining its epidemiology, pathophysiology, risk factors, clinical manifestations, diagnostic challenges, and management strategies. A systematic literature review was conducted following PRISMA guidelines, incorporating peer-reviewed articles and clinical protocols published from 2000 to 2024. Clinical tools such as diagnostic algorithms and resuscitation frameworks were developed from aggregated evidence and thematic analysis.

Summary: AFE typically presents intrapartum or in the immediate postpartum period with sudden hypoxia, hypotension, and coagulopathy. Diagnosis is clinical, as no single confirmatory biomarker currently exists. Management is primarily supportive, focusing on rapid resuscitation, hemodynamic stabilization, and aggressive coagulopathy correction. Emerging strategies such as the A-OK regimen (Atropine, Ondansetron, Ketorolac) are discussed as investigational approaches under consideration.

Outlook: AFE continues to challenge obstetric and critical care teams due to its abrupt onset and high fatality. Future priorities include the development of validated diagnostic biomarkers, refinement of therapeutic interventions, and establishment of standardized multidisciplinary response protocols to improve maternal and neonatal outcomes.

Objectives: Congenital diaphragmatic hernia (CDH) often coexists with fetal growth restriction (FGR). The observed-to-expected (O/E) total fetal lung volume (TFLV) is used to assess CDH severity, predict outcomes, and direct fetal interventions. Expected TFLV measurements traditionally rely only on gestation age (GA). This simulation assesses how incorporating weight-adjusted GA norms affects O/E TFLV calculations in patients with isolated CDH and FGR.

Methods: A simulated dataset (n=1,005) utilized published mean fetal weight and TFLV references. Computer-generated variables included observed weights (3rd-10th %ile), O/E TFLV (10-65 %), and percent liver herniation (0-42 %). GA estimates were corrected by weight and used to calculate corrected O/E TFLV. Estimated mortality probabilities and CDH severity were compared pre- and post-adjustment.

Results: Standard vs. corrected O/E TFLV means differed significantly (36.2% vs. 43.5 %) (p<0.001), as did corrected mortality probabilities (60.2% vs. 58.6 %) (p<0.001). CDH severity shifted: severe to moderate (17.1 %) and moderate to mild (8.6 %) with corrected O/E TFLV. Two-week corrections had greater impact than 1-week. Positive correlation existed between O/E TFLV and percent difference in values, while GA showed a negative correlation with the percent differences.

Conclusions: This simulation shows how using weight-adjusted GA norms affects O/E TFLV calculations. For fetuses with isolated CDH and FGR, adjusted GA increases O/E TFLV, reduces mortality estimates, and changes CDH severity classification, possibly affecting fetal intervention eligibility. Real patient studies are needed to confirm these findings.

Objectives: The objective of this study was to examine the role of microRNA-203a-3p (miR-203a-3p) in the pathogenesis of necrotizing enterocolitis (NEC).

Methods: Quantitative real-time polymerase chain reaction (qRT-PCR) and receiver operating characteristic (ROC) curve analysis were employed to evaluate the relative abundances of miR-203a-3p as well as its diagnostic capacity. Logistic regression was applied to search for influential risk factors associated with NEC in neonates. Cell behaviors were assessed with flow cytometry and CCK-8 detection. The target genes of miR-203a-3p and its potential biological functions were analyzed via bioinformatic analysis.

Results: A significant reduction in serum levels of miR-203a-3p was observed in neonates with NEC. Notably, this miRNA exhibited exceptional diagnostic precision for differentiating NEC from non-NEC cases, as evidenced by an area under the curve (AUC) of 0.928. Furthermore, miR-203a-3p was established as an independent indicator for assessing the severity of NEC. In an NEC cell model, levels of miR-203a-3p were distinctly diminished; however, this decrease was significantly reversed following transfection with miR-203a-3p (p<0.001). Correspondingly, findings were noted regarding cell apoptosis, cell viability, inflammatory indicators, and antioxidant enzyme activities. MiR-203a-3p-related genes predominantly clustered within inflammatory-associated signaling pathways and proteins, particularly ataxia telangiectasia mutated (ATM). Notably, miR-203a-3p was found to directly target ATM. Importantly, heightened levels of ATM were detected in both neonates with NEC and LPS-triggered fetal human colon (FHC) cells (p<0.001).

Conclusions: MiR-203a-3p alleviates LPS-induced inflammatory damage in FHC cells through regulating ATM, thereby presenting a promising avenue for the development of novel therapeutic strategies for neonates with NEC.