E. Gratacós

Hospital Sant Joan de Déu, Barcino, Catalonia, Spain

Are you E. Gratacós?

Claim your profile

Publications (628)2247.2 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To evaluate in normally growing fetuses at routine 32-36 weeks scan the performance of maternal angiogenic factors, Doppler and ultrasound indices in predicting smallness for gestational age (SGA) at birth. METHODS: A cohort of 1,000 singleton pregnancies with normal estimated fetal weight (EFW, ≥10th centile) at 32-36 weeks scan was included. At inclusion, Doppler indices (mean uterine artery pulsatility index [mUtA-PI], cerebroplacental ratio and normalized umbilical vein blood flow by EFW (ml/min/kg) were evaluated, and blood samples were collected and frozen. Nested in this cohort, maternal circulating placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were assayed by enzyme-linked immunosorbent assay in all cases with a birth weight <10th centile by customized standards and in an equivalent number of controls (birth weight ≥10th centile). RESULTS: 160 cases were included (80 SGA and 80 controls). EFW (2,128 vs. 2,279 g, p < 0.001), mUtA-PI z-values (-0.25 vs. -0.65, p = 0.034) and sFlt-1/PlGF ratio (11.10 vs. 6.74, p < 0.005) were lower in SGA. The combination of sFlt-1/PlGF ratio and EFW resulted in a 66.3% detection rate for subsequent SGA, with 20% of false-positives. Fetal Doppler indices were not predictive of SGA. CONCLUSIONS: In normally growing fetuses, maternal angiogenic factors add to ultrasound parameters in predicting subsequent SGA at birth. This supports further research to investigate composite scores in order to improve the definition and identification of fetal growth restriction.
    Fetal Diagnosis and Therapy 10/2015; DOI:10.1159/000440650 · 2.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Our aim was to determine the influence of breastfeeding and postnatal nutrition on cardiovascular remodeling induced by fetal growth restriction (FGR). Methods: A cohort study including 81 children with birthweight <10 centile (FGR) and 121 with adequate fetal growth (AGA). Cardiovascular end-points were left ventricular sphericity index (LVSI), carotid intima-media thickness (cIMT) and blood pressure (BP) at 4-5 years of age. The combined effect of FGR and postnatal variables -including breastfeeding, fat dietary intake and body-mass index (BMI)- on cardiovascular end-points was assessed by linear and robust regressions. Results: FGR was the strongest predictor of cardiovascular remodeling in childhood, leading to lower LVSI and increased cIMT and BP as compared to AGA. Breastfeeding>6 months (coefficient 0.0982) and healthy-fat dietary intake (coefficient -0.0128) showed an independent beneficial effect on LVSI and cIMT respectively. Overweight/obesity induced an additional increment of 1SD on cIMT in FGR children (interaction coefficient 0.0307) when compared with its effect in AGA. BMI increased systolic BP (coefficient 0.7830) while weight catch-up increased diastolic BP (coefficient 4.8929). Conclusions: Postnatal nutrition ameliorates cardiovascular remodeling induced by FGR. Breastfeeding and healthy-fat dietary intake improved while increased BMI worsened cardiovascular end-points, which opens opportunities for targeted postnatal interventions from early life.Pediatric Research (2015); doi:10.1038/pr.2015.182.
    Pediatric Research 09/2015; DOI:10.1038/pr.2015.182 · 2.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: This study was performed to assess the role of lipopolysaccharide modulators as a marker of microbial translocation among human immunodeficiency virus (HIV)-infected women during pregnancy and to evaluate their association with preterm delivery. Methods: The study had a prospective cohort design and was performed at the Hospital Clínic in Barcelona, Spain. Thirty-six pregnant women with and 36 without HIV infection, matched on the basis of age and parity, were included. Maternal blood samples were obtained during the first trimester, during the third trimester, and at delivery. Levels of soluble CD14 (sCD14), human lipopolysaccharide-binding protein (LBP), immunoglobulin M endotoxin core antibodies to lipopolysaccharide (EndoCAb), and interleukin 6 (IL-6) were determined. Fetal cord blood levels of sCD14, LBP, and IL-6 were determined. Results were compared between groups. Results: First trimester sCD14 and LBP levels and third trimester sCD14 levels were significantly higher in the HIV-infected group. HIV-infected women with preterm births and spontaneous preterm births had significantly increased levels of sCD14 throughout pregnancy and significantly increased levels of LBP during the first trimester, compared with HIV-infected women with delivery at term or with HIV-negative women. On multivariate analysis, an independent association was observed between first trimester sCD14 levels and preterm delivery among HIV-infected women. Conclusions: This is the first study to assess inflammatory markers related to microbial translocation during pregnancy among HIV-infected women. Higher levels of sCD14 and LBP were observed in HIV-infected pregnant women and were associated with preterm delivery.
    The Journal of Infectious Diseases 09/2015; DOI:10.1093/infdis/jiv416 · 6.00 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To evaluate use of third-trimester ultrasound screening for late fetal growth restriction (FGR) on a contingency basis in an unselected population, according to the risk accrued at second trimester. METHODS: Maternal characteristics, fetal biometry and uterine Doppler at second trimester were subjected to logistic regression to estimate late FGR risk (birthweight <3rd percentile; or between 3rd and 10th percentiles, plus abnormal Doppler). Based on above second-trimester estimates, strategies for performing contingent third-trimester scans in 10%, 25%, or 50% of the cohort were tested against a strategy of routine scan at 32+0-33+6 weeks. RESULTS: The models were constructed on 1393 and validated in 1303 patients, including 73 (5.2%) and 82 late FGR (6.3%) cases, respectively. At second trimester, a posteriori first-trimester risk (baseline a priori risk and blood pressure) combined with abdominal circumference and uterine Doppler (a posteriori second-trimester risk) yielded an AUC of 0.81 (95% CI 0.74-0.87) (detection rate (DR) of 43.1% at 10% false positive rate (FPR)). Finally, the combination of a posteriori second-trimester risk plus third-trimester estimated fetal weight (full model) yielded an AUC of 0.92 (95% CI 0.88-0.96) (DR of 74% at 10% FPR). By variably subjecting 10%, 25%, or 50% of the study population to third-trimester scans, based on a posteriori second-trimester risk, AUC were 0.81 (0.75-0.88), 0.84 (0.78-0.91) and 0.89 (0.84-0.94), respectively. Only the 50% contingency model proved statistically equivalent to routinely performing third-trimester scans (AUC 0.92 (95% CI 0.88-0.96)]; p=0.11). CONCLUSION: A strategy of selecting 50% of a study population for third-trimester scans, based on accrued risk at second trimester, proved equivalent to routine third-trimester scanning in predicting late FGR.
    Ultrasound in Obstetrics and Gynecology 09/2015; DOI:10.1002/uog.15740. · 3.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To describe perinatal outcomes achieved with cord occlusion (CO) in monochorionic twins with severe selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler in the IUGR twin (types II and III). Methods: We studied a consecutive series of 90 cases of sIUGR with abnormal Doppler treated with CO of the IUGR fetus. Abnormal Doppler was defined as continuous (type II, n = 41) or intermittent (type III, n = 49) absent/reversed end-diastolic flow. All cases presented at least one of the following severity criteria: gestational age (GA) <22 weeks, inter-twin estimated weight discordance >35%, reversed end-diastolic umbilical artery flow or ductus venosus pulsatility index >95th centile. We prospectively recorded pregnancy course and perinatal outcome. Results: Median GA at surgery was 20.6 weeks and mean duration 22.4 min. Miscarriage (<24 weeks) occurred in 3.3% (3/90) and preterm delivery <32 weeks in 7.1% (6/84) of continuing pregnancies. GA at delivery was 36.4 weeks and neonatal survival of the larger twin was achieved in 93.3%. Conclusion: In a consecutive series studied by an experienced team, CO in monochorionic twins with severe sIUGR type II or III was associated with delivery >32 weeks in 92.9% and neonatal survival of the normal twin in 93.3% of pregnancies.
    Fetal Diagnosis and Therapy 09/2015; DOI:10.1159/000439023 · 2.94 Impact Factor
  • V. Borobio · M. Grande · M. Bennasar · A. Borrell · E. Gratacós
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To evaluate mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE) in fetuses with twin-to-twin transfusion syndrome (TTTS) before and after laser therapy.MethodsA prospective study in 24 fetal pairs with TTTS evaluated 24 hours before and within 48 hours after fetoscopy and 13 gestational age-matched normal monochorionic fetal pairs. MAPSE and TAPSE were measured in an apical or basal four-chamber view by placing the M-mode cursor at the lateral valve ring.ResultsMean preoperative MAPSE (controls 3.6 ± 1.3 mm vs. donors 2.7 ± 0.8 mm vs. recipients 2.8 mm ± 0.9; P<0.001) and TAPSE (controls 4.4 ± 1.5 mm vs. donors 3.3 ± 1 mm vs. recipients 3.6 mm ± 1.1 mm; P<0.001) values were significantly reduced in both TTTS fetuses. When subdividing according to TTTS stages, changes were significant in both stage I-II and III-IV subgroups, although differences were more pronounced in the latter. All observations remained unchanged 48 hours post-fetoscopy.Conclusion Both recipient and donor fetuses had decreased global longitudinal motion, even in early TTTS stages.
    Prenatal Diagnosis 08/2015; DOI:10.1002/pd.4671 · 3.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to evaluate placental 11B-hydroxysteroid dehydrogenase type 2 (11B-HSD-2) mRNA levels in intrauterine growth-restricted fetuses (IUGR) as compared with small-for-gestational-age (SGA) fetuses according to clinical criteria. Placental levels of 11B-HSD-2 mRNA levels were measured in SGA (birth weight <10th centile) and gestational-age-matched, appropriate-for-gestational-age (AGA) births. SGA was classified as IUGR (birth weight <3rd centile or <10th percentile with abnormal uterine artery Doppler or cerebroplacental ratio) or non-IUGR SGA. After RNA extraction, mRNA levels were determined by reverse transcription and quantitative PCR. A total of 38 placentas were analyzed (20 AGA and 18 SGA). Among the SGA pregnancies, 13 qualified as IUGR. The activity of 11B-HSD-2 in IUGR pregnancies [0.105 (SD 0.328)] was significantly reduced compared to non-IUGR SGA [0.304 (SD 0.261); p = 0.018] and AGA [0.294 (SD 0.328); p = 0.001]. These differences remained significant after adjusting for potential confounders (such as smoking or maternal cortisol levels). Activity levels did not significantly differ between non-IUGR SGA and AGA. IUGR fetuses had reduced 11B-HSD-2 activity in comparison with SGA and normally grown fetuses. This finding provides opportunities to develop new placental biomarkers for the phenotypic characterization of fetal smallness. © 2015 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 08/2015; DOI:10.1159/000437139 · 2.94 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Intrauterine growth restriction (IUGR) due to placental insufficiency is associated with blood-flow redistribution in order to maintain perfusion to the brain. However, some hemodynamic parameters that might be more directly related to staging of the disease cannot be measured non-invasively in clinical practice. For this, we developed a patient-specific model of the fetal circulation to estimate vascular properties of each individual. A lumped model of the fetal circulation was developed and personalized using measured echographic data from 37 normal and IUGR fetuses to automatically estimate model-based parameters. A multivariate regression analysis was performed to evaluate the association between the Doppler pulsatility indices (PI) and the model-based parameters. The correlation between model-based parameters and the placental lesions was analyzed in a set of 13 IUGR placentas. A logistic regression analysis was done to assess the added value of the model-based parameters relative to Doppler indices, for the detection of fetuses with adverse perinatal outcome. The estimated model-based placental and brain resistances were respectively increased and reduced in IUGR fetuses while placental compliance was increased in IUGR fetus. Umbilical and middle cerebral arteries PIs were most associated with both placental resistance and compliance, while uterine artery PI was more associated with the placental compliance. The logistic regression analysis showed that the model added significant information to the traditional analysis of Doppler waveforms for predicting adverse outcome in IUGR. The proposed patient-specific computational model seems to be a good approach to assess hemodynamic parameters than cannot be measured clinically. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Placenta 07/2015; 36(9). DOI:10.1016/j.placenta.2015.07.130 · 2.71 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess in vivo changes in lung and liver volume in fetuses with isolated congenital diaphragmatic hernia (CDH), either expectantly managed or treated in utero. This is a secondary analysis of prospectively collected data at 2 fetal therapy centers. We used archived magnetic resonance (MR) images of fetuses taken ≥7 days apart, creating paired observations in 20 expectantly managed cases, 41 with a second MR prior to balloon reversal and 64 after balloon removal. We measured observed to expected total fetal lung volume (O/E TFLV) and liver-to-thoracic volume ratio (LiTR). We calculated changes in volume as compared to the initial measurement and its rate as a function of gestational age (GA) at occlusion. The LiTR did not change in either group. In expectantly managed fetuses, O/E TFLV did not increase with gestation. In fetuses undergoing tracheal occlusion (TO) the measured increase in volume was 2.6-times larger with balloon in place as compared to after its removal. GA at TO was an independent predictor of the O/E TFLV. The net rate seems to initially increase and plateau at a maximum of 1.5%/week by 35-45 days after occlusion. TO induces a net increase in volume, its magnitude essentially dependent on the GA at occlusion. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Prenatal Diagnosis 07/2015; DOI:10.1002/pd.4642 · 3.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Among late-onset small fetuses, a combination of estimated fetal weight (EFW), cerebroplacental ratio (CPR) and uterine artery mean pulsatility index (UtA) discriminates a subgroup with poor perinatal outcome. The association of these criteria with fetal cardiac structure and function is unknown. A cohort of late-onset 209 small fetuses that were delivered > 34 weeks of gestation was divided in two categories: "small-for-gestational age" (SGA, n = 59) when EFW was 3-9th and CPR and UtA were normal, and "intrauterine growth restriction" (IUGR, n = 150), if EFW<3rd centile or EFW <10(th) centile together with CPR<5(th) centile and/or UtA>95(th) centile. These were compared with 150 normally grown fetuses. Fetal cardiac morphometry and function were assessed by echocardiography using 2D, M-mode, conventional and tissue Doppler. Both IUGR and SGA fetuses showed larger and more globular hearts (mean left sphericity index: controls 1.8(SD 0.3), SGA 1.5 (0.2) and IUGR 1.6(0.3), P < 0.01)) together with signs of systolic and diastolic dysfunction, including decreased tricuspid annular plane systolic excursion (controls 8.2 (1.1), SGA 7.4(1.2) and IUGR 6.9(1.1), P < 0.001) and increased myocardial performance index (controls 0.45 (0.14), SGA 0.51(0.08) and IUGR 0.57(0.1), P < 0.001). Despite near-normal perinatal outcome, the so-defined "SGA" fetuses are still associated with prenatal cardiac dysfunction. This supports that at least part of them are not "constitutionally small" and that further research is needed. This article is protected by copyright. All rights reserved.
    Ultrasound in Obstetrics and Gynecology 06/2015; DOI:10.1002/uog.14930 · 3.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To report on the accuracy of fetal echocardiography in the distinction between truncus arteriosus communis (CAT) and pulmonary atresia with ventricular septal defect (PA-VSD) and to describe the association with extracardiac and chromosomal anomalies. This was a retrospective study on 31 fetuses with a single arterial trunk overriding a VSD with a nonidentifiable right ventricle outflow tract with anterograde flow. Data on the type of cardiac defect, gestational age, characteristics of the arterial trunk valve, presence of additional vascular, chromosomal and extracardiac abnormalities and postnatal outcome were obtained. Misdiagnosed cases were reevaluated by four-dimensional spatiotemporal image correlation (4D-STIC) echocardiography. The overall diagnostic accuracy was 81% and increased to 93.5% with 4D-STIC. Chromosomal and extracardiac anomalies were detected in 40 and 27%, respectively. In the PA-VSD group, patent ductus arteriosus and major aortopulmonary collateral arteries (MAPCAs) were present in 70 and 50% of the cases, respectively, coexisting in 1 of 5 cases. MAPCAs were significantly associated with a right aortic arch and with a 22q11 microdeletion in 50% of cases. A prenatal distinction between CAT and PA-VSD can currently be achieved in most cases. MAPCAs should be actively searched for when PA-VSD is suspected, as they are associated with a higher risk of 22q11 microdeletion and potentially complicate postnatal treatment. © 2015 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 06/2015; DOI:10.1159/000433430 · 2.94 Impact Factor
  • American journal of obstetrics and gynecology 06/2015; DOI:10.1016/j.ajog.2015.06.033 · 4.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives Fetuses with congenital heart disease have evidence of abnormal brain development before birth, which is thought to contribute to adverse neurodevelopment during childhood. We evaluated whether late pregnancy brain development can be predicted at the time of diagnosis by fetal brain Doppler, head biometry and the clinical form of congenital heart disease.Methods This prospective cohort study included 58 fetuses with congenital heart disease diagnosed at 19–24 weeks of gestation and 58 controls. At the time of diagnosis, we recorded fetal head circumference, biparietal diameter, middle cerebral artery pulsatility index, cerebroplacental ratio and brain perfusion by Fractional Moving Blood Volume. We classified cases in two clinical types, i.e. with expected high or low levels of placental (well-oxygenated) blood perfusion according to the anatomical defect. All fetuses underwent 3T magnetic resonance at 36–38 weeks’ gestation.ResultsAbnormal prenatal brain development was defined by a composite score including any of the following: total brain volume <10th centile, parietoccipital or cingulate fissure's depth <10th centile, and abnormal metabolic profile in the frontal lobe. Logistic regression analysis demonstrated that middle cerebral artery pulsatility index (p<0.01, OR 12.7), cerebroplacental ratio (p<0.01, OR 8.7) and cephalic circumference (p<0.01, OR 6.2) were independent predictors of abnormal brain neurodevelopment, while the clinical type of congenital heart disease was not.Conclusions Fetal brain Doppler and cephalic biometry at the time of congenital heart disease diagnosis are independent predictors of abnormal brain development at birth, and could be used in future algorithms to improve counseling and targeted interventions.
    Ultrasound in Obstetrics and Gynecology 06/2015; DOI:10.1002/uog.14919 · 3.85 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To estimate the value of gestational age at birth and fetal Doppler in predicting the risk of neonatal cranial ultrasound abnormalities in intrauterine growth restricted fetuses born between 28 and 34 weeks.Study DesignFetal Doppler parameters, including umbilical artery, middle cerebral artery, aortic isthmus, ductus venous, and myocardial performance index, were evaluated in a cohort of 90 intrauterine growth restricted fetuses with abnormal umbilical artery Doppler delivered between 28 and 34 weeks and 90 control participants matched by gestational age. The value of gestational age and the fetal Doppler parameters to predict the risk of cranial ultrasound abnormalities, including interventricular haemorrhage, periventricular leucomalacia and basal ganglia lesions was analyzed.ResultsOverall, intrauterine growth restricted fetuses showed a significant higher incidence of cranial ultrasound abnormalities (40.0% vs. 12.2%, P < .001) than control participants. Within the group with intrauterine growth restriction, all predictive variables were individually associated with the risk of cranial ultrasound abnormalities, but fetal Doppler rather than gestational age at birth was identified as the best predictor. Middle cerebral artery Doppler distinguished two groups with different risks of cranial ultrasound abnormalities (48.5% compared with 13.6%, P < .01). In the subgroup of middle cerebral artery vasodilation, the presence of aortic isthmus retrograde net blood flow identified a subgroup of cases with the highest risk of cranial ultrasound abnormalities (66.7% compared with 38.6%, P < .05).Conclusion Evaluation of fetal Doppler parameters rather than gestational age at birth discriminates intrauterine growth restricted preterm fetuses at risk of abnormal neonatal brain scan.
    Ultrasound in Obstetrics and Gynecology 06/2015; DOI:10.1002/uog.14920 · 3.85 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We have assessed brain metabolite levels by magnetic resonance spectroscopy (MRS) in one year old infants born small at term, as compared with adequate for gestational age (AGA) born infants, and their association with neurodevelopment at two years of age. A total of 40 infants born small (birth weight <10(th) centile for GA) and 30 AGA infants underwent brain MRS at one year, on a 3 Tesla scanner. Small-born infants were subclassified as late-IUGR (intrauterine growth restriction) or as small for gestational age (SGA), based on the presence or absence of prenatal Doppler and birth weight predictors of an adverse perinatal outcome, respectively. Single-voxel PRESS (1)H-MRS data were acquired from the frontal lobe at short echo time. Neurodevelopment was evaluated at two years of age using the Bayley Scales 3rd Edition (BSID-III), assessing cognitive, language, motor, socio-emotional behavior and adaptative behavior. As compared with AGA controls, infants born small showed significantly higher levels of glutamate (Glu) and N-acetylaspartate (NAAt)/Creatine (Cr) at one year, and lower BSID-III scores at 2 years. The subgroup of late-IUGR infants further showed lower estimated glutathione (GSH) levels at one year. Significant correlations were observed for estimated GSH levels with adaptative scores, and for myo-inositol with language scores. Significant associations were also noticed for NAA/Cr with cognitive scores, and for Glu/Cr with motor scores. Infants born small show brain metabolite differences at one year of age, which are correlated with later neurodevelopment. These results support further research on MRS to develop imaging biomarkers of abnormal neurodevelopment. Copyright © 2015 Elsevier Inc. All rights reserved.
    American journal of obstetrics and gynecology 04/2015; 213(2). DOI:10.1016/j.ajog.2015.04.011 · 4.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We report the successful use of fetoscopy to treat a case of prolapsed ureterocele in a female fetus. A diagnosis of a double renal system with an intravesical ureterocele was performed at 21 weeks' gestation. Follow-up exams showed that the ureterocele was obstructing the bladder outlet causing severe megacystis, bilateral hydronephrosis and progressive oligohydramnios. Those findings suggested a poor prognosis and therefore the patient was referred to our Fetal Therapy Unit to consider prenatal treatment. The ultrasound evaluation at admission confirmed severe bilateral hydronephrosis with pelvic and caliceal dilatation, but, surprisingly, the amniotic fluid was normal and no image of ureterocele could be identified into the bladder. Instead, a cystic image between the external genitalia could be observed, leading us to the diagnosis of a prolapsed ureterocele causing intermittently severe obstruction of the urethra. Due to the unpredictable course of the malformation, parents were counselled about the uncertain fetal prognosis and therefore fetal surgery to decompress the urinary system was proposed, with the agreement of the paediatric urologist. After extensive discussion and counselling, a fetoscopic operation was designed and indicated. The procedure consisted in opening the cystic mass by means of firing with contact diode laser until the opening of the ureterocele was achieved. After the surgery, resolution of the megacystis, with reduction of the hydronephrosis, and persistent normalization of the amniotic fluid volume were observed. The pregnancy continued uneventfully and a normal female infant was born at term at her local hospital. The child is developing normally with normal renal function at 4 years old. Our report demonstrates that fetoscopic decompression of a distal urethra obstruction is feasible in the rare event of congenital prolapsed ureterocele. This article is protected by copyright. All rights reserved.
    Ultrasound in Obstetrics and Gynecology 04/2015; DOI:10.1002/uog.14876 · 3.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess maternal vascular structure and function in fetal growth restriction (FGR) pregnancies with and without preeclampsia (PE) at the time of diagnosis. We evaluated 124 pregnant women with FGR subdivided in 60 FGR with and 64 FGR without PE, together with 110 controls. The group of FGR without PE was further subdivided according to the gestational age at diagnosis into early (<32 weeks) or late-onset (≥32 weeks). Maternal carotid intima-media thickness (IMT), blood pressure (BP), carotid artery distensibility (CD), circumferential wall stress (CWS), and inferior vena cava (IVC) collapsibility were assessed by ultrasound at the time of FGR diagnosis. FGR cases with PE showed increased maternal carotid IMT (controls: mean 0.409 mm (IQR 0.386-0.439); FGR with PE: 0.425 mm (0.381-0.486); P = 0.021), BP (controls: mean BP 82 mmHg (77-89); FGR with PE: 109 mmHg (101-117); P < 0.001) and CWS, together with reduced CD and IVC collapsibility (controls: IVC collapsibility index 0.10 (0.06-0.13); FGR with PE: 0.07 (0.06-1.11); P = 0.136). FGR without PE had increased maternal IMT (0.436 mm (0.392-0.476); P = 0.001) and BP (88mmHg (81-95); P < 0.001), but similar CD and IVC collapsibility to controls. When subclassified according to gestational age, only early-onset FGR had significantly increased IMT and CWS, but both groups had increased BP. FGR without PE shares some subclinical maternal vascular features with PE, which further reinforces the notion that, at least in a proportion of cases, there is a common placental disease that influences maternal cardiovascular features. This article is protected by copyright. All rights reserved.
    Ultrasound in Obstetrics and Gynecology 02/2015; DOI:10.1002/uog.14815 · 3.85 Impact Factor

Publication Stats

6k Citations
2,247.20 Total Impact Points


  • 2014–2015
    • Hospital Sant Joan de Déu
      Barcino, Catalonia, Spain
  • 1993–2015
    • University of Barcelona
      • Department of Obstetrics and Gynecology, Pediatrics, Radiology and Anatomy
      Barcino, Catalonia, Spain
  • 2009–2014
    • Centro de Investigación Biomédica en Red de Enfermedades Raras
      Valenza, Valencia, Spain
    • Royal Prince Alfred Hospital
      Camperdown, New South Wales, Australia
  • 2008–2014
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 1994–2014
    • Hospital Clínic de Barcelona
      • Servicio de Medicina Materno Fetal
      Barcino, Catalonia, Spain
  • 2008–2012
    • Instituto de Salud Carlos III
      Madrid, Madrid, Spain
  • 2008–2010
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 2003–2009
    • Universitair Ziekenhuis Leuven
      • Department of Gynaecology and obstetrics
      Louvain, Flanders, Belgium
  • 2001–2009
    • University Hospital Vall d'Hebron
      • Department of Obstetrics
      Barcino, Catalonia, Spain
      Ayrivan, Yerevan, Armenia
  • 2002–2008
    • Autonomous University of Barcelona
      • Department of Biochemistry and Molecular Biology
      Cerdanyola del Vallès, Catalonia, Spain
  • 2006–2007
    • Southern Medical Clinic
      San Fernando, City of San Fernando, Trinidad and Tobago
  • 2004
    • University of Rochester
      Rochester, New York, United States
  • 1999–2002
    • University of Leuven
      • Faculty of Medicine
      Louvain, Flanders, Belgium