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Ultrasound in Obstetrics & Gynecology :... Mar 2020Operators performing fetal growth scans are usually aware of the gestational age of the pregnancy, which may lead to expected-value bias when performing biometric...
OBJECTIVES
Operators performing fetal growth scans are usually aware of the gestational age of the pregnancy, which may lead to expected-value bias when performing biometric measurements. We aimed to evaluate the incidence of expected-value bias in routine fetal growth scans and assess its impact on standard biometric measurements.
METHODS
We collected prospectively full-length video recordings of routine ultrasound growth scans coupled with operator eye tracking. Expected value was defined as the gestational age at the time of the scan, based on the estimated due date that was established at the dating scan. Expected-value bias was defined as occurring when the operator looked at the measurement box on the screen during the process of caliper adjustment before saving a measurement. We studied the three standard biometric planes on which measurements of head circumference (HC), abdominal circumference (AC) and femur length (FL) are obtained. We evaluated the incidence of expected-value bias and quantified the impact of biased measurements.
RESULTS
We analyzed 272 third-trimester growth scans, performed by 16 operators, during which a total of 1409 measurements (354 HC, 703 AC and 352 FL; including repeat measurements) were obtained. Expected-value bias occurred in 91.4% of the saved standard biometric plane measurements (85.0% for HC, 92.9% for AC and 94.9% for FL). The operators were more likely to adjust the measurements towards the expected value than away from it (47.7% vs 19.7% of measurements; P < 0.001). On average, measurements were corrected by 2.3 ± 5.6, 2.4 ± 10.4 and 3.2 ± 10.4 days of gestation towards the expected gestational age for the HC, AC, and FL measurements, respectively. Additionally, we noted a statistically significant reduction in measurement variance once the operator was biased (P = 0.026). Comparing the lowest and highest possible estimated fetal weight (using the smallest and largest biased HC, AC and FL measurements), we noted that the discordance, in percentage terms, was 10.1% ± 6.5%, and that in 17% (95% CI, 12-21%) of the scans, the fetus could be considered as small-for-gestational age or appropriate-for-gestational age if using the smallest or largest possible measurements, respectively. Similarly, in 13% (95% CI, 9-16%) of scans, the fetus could be considered as large-for-gestational age or appropriate-for-gestational age if using the largest or smallest possible measurements, respectively.
CONCLUSIONS
During routine third-trimester growth scans, expected-value bias frequently occurs and significantly changes standard biometric measurements obtained. © 2019 the Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Abdomen; Biometry; Female; Femur; Fetal Development; Fetus; Gestational Age; Head; Humans; Observer Variation; Pregnancy; Pregnancy Trimester, Third; Prospective Studies; Reference Values; Ultrasonography, Prenatal; Video Recording
PubMed: 31763735
DOI: 10.1002/uog.21929 -
Environmental Research Mar 2022Exposure to toxic and non-toxic metals impacts childhood growth and development, but limited data exists on exposure to metal mixtures. Here, we investigated the effects...
BACKGROUND
Exposure to toxic and non-toxic metals impacts childhood growth and development, but limited data exists on exposure to metal mixtures. Here, we investigated the effects of exposure to individual metals and a mixture of barium, cadmium, cobalt, lead, molybdenum, zinc, and arsenic on growth indicators in children 4-5 years of age.
METHODS
We used urine metal concentrations as biomarkers of exposure in 328 children enrolled in the Spanish INMA-Asturias cohort. Anthropometric measurements (arm, head, and waist circumferences, standing height, and body mass index) and parental sociodemographic variables were collected through face-to-face interviews by trained study staff. Linear regressions were used to estimate the independent effects and were adjusted for each metal in the mixture. We applied Bayesian kernel machine regression to examine non-linear associations and potential interactions.
RESULTS
In linear regression, urinary levels of cadmium were associated with reduced arm circumference (β = -0.44, 95% confidence interval [CI]: -0.73, -0.15), waist circumference (β = -1.29, 95% CI: -2.10, -0.48), and standing height (β = -1.09, 95% CI: -1.82, -0.35). Lead and cobalt concentrations were associated with reduced standing height (β = -0.64, 95% CI: -1.20, -0.07) and smaller head circumference (β = -0.29, 95% CI: -0.49, -0.09), respectively. However, molybdenum was positively associated with head circumference (β = 0.22, 95% CI: 0.01, 0.43). BKMR analyses showed strong linear negative associations of cadmium with arm and head circumference and standing height. BKMR analyses also found lead and cobalt in the metal mixture were related to reduce standing height and head circumference, and consistently found molybdenum was related to increased head circumference.
CONCLUSION
Our findings suggest that exposure to metal mixtures impacts growth indicators in children.
Topics: Arsenic; Bayes Theorem; Birth Weight; Child; Cohort Studies; Humans; Metals
PubMed: 34785205
DOI: 10.1016/j.envres.2021.112375 -
Clinical Nutrition (Edinburgh, Scotland) Jan 2022Exposure to a suboptimal environment during the fetal and early infancy period's results in long-term consequences for brain morphology and function. We investigated the...
BACKGROUND & AIMS
Exposure to a suboptimal environment during the fetal and early infancy period's results in long-term consequences for brain morphology and function. We investigated the associations of early life factors such as anthropometric neonatal data (i.e., birth length, birth weight and birth head circumference) and breastfeeding practices (i.e., exclusive and any breastfeeding) with white matter (WM) microstructure, and ii) we tested whether WM tracts related to early life factors are associated with academic performance in children with overweight/obesity.
METHODS
96 overweight/obese children (10.03 ± 1.16 years; 38.7% girls) were included from the ActiveBrains Project. WM microstructure indicators used were fractional anisotropy (FA) and mean diffusivity (MD), derived from Diffusion Tensor Imaging. Academic performance was evaluated with the Battery III Woodcock-Muñoz Tests of Achievement. Regression models were used to examine the associations of the early life factors with tract-specific FA and MD, as well as its association with academic performance.
RESULTS
Head circumference at birth was positively associated with FA of the inferior fronto-occipital fasciculus tract (0.441; p = 0.005), as well as negatively associated with MD of the cingulate gyrus part of cingulum (-0.470; p = 0.006), corticospinal (-0.457; p = 0.005) and superior thalamic radiation tract (-0.476; p = 0.001). Association of birth weight, birth length and exclusive breastfeeding with WM microstructure did not remain significant after false discovery rate correction. None tract related to birth head circumference was associated with academic performance (all p > 0.05).
CONCLUSIONS
Our results highlighted the importance of the perinatal growth in WM microstructure later in life, although its possible academic implications remain inconclusive.
Topics: Academic Performance; Anisotropy; Anthropometry; Birth Weight; Body Height; Brain; Child; Diffusion Tensor Imaging; Female; Head; Humans; Infant, Newborn; Male; Pediatric Obesity; Pregnancy; White Matter
PubMed: 34864454
DOI: 10.1016/j.clnu.2021.10.022 -
Journal of Digital Imaging Feb 2021Automatic computerized segmentation of fetal head from ultrasound images and head circumference (HC) biometric measurement is still challenging, due to the inherent...
Automatic computerized segmentation of fetal head from ultrasound images and head circumference (HC) biometric measurement is still challenging, due to the inherent characteristics of fetal ultrasound images at different semesters of pregnancy. In this paper, we proposed a new deep learning method for automatic fetal ultrasound image segmentation and HC biometry: deeply supervised attention-gated (DAG) V-Net, which incorporated the attention mechanism and deep supervision strategy into V-Net models. In addition, multi-scale loss function was introduced for deep supervision. The training set of the HC18 Challenge was expanded with data augmentation to train the DAG V-Net deep learning models. The trained models were used to automatically segment fetal head from two-dimensional ultrasound images, followed by morphological processing, edge detection, and ellipse fitting. The fitted ellipses were then used for HC biometric measurement. The proposed DAG V-Net method was evaluated on the testing set of HC18 (n = 355), in terms of four performance indices: Dice similarity coefficient (DSC), Hausdorff distance (HD), HC difference (DF), and HC absolute difference (ADF). Experimental results showed that DAG V-Net had a DSC of 97.93%, a DF of 0.09 ± 2.45 mm, an AD of 1.77 ± 1.69 mm, and an HD of 1.29 ± 0.79 mm. The proposed DAG V-Net method ranks fifth among the participants in the HC18 Challenge. By incorporating the attention mechanism and deep supervision, the proposed method yielded better segmentation performance than conventional U-Net and V-Net methods. Compared with published state-of-the-art methods, the proposed DAG V-Net had better or comparable segmentation performance. The proposed DAG V-Net may be used as a new method for fetal ultrasound image segmentation and HC biometry. The code of DAG V-Net will be made available publicly on https://github.com/xiaojinmao-code/ .
Topics: Biometry; Female; Head; Humans; Image Processing, Computer-Assisted; Pregnancy; Ultrasonography
PubMed: 33483862
DOI: 10.1007/s10278-020-00410-5 -
Ultrasound (Leeds, England) Aug 2019A variety of methods is available for the ultrasound measurement of foetal circumferences; ellipse fitting and derived measurements are often used interchangeably based...
A variety of methods is available for the ultrasound measurement of foetal circumferences; ellipse fitting and derived measurements are often used interchangeably based on an assumption of equivalence, despite evidence that results may differ. The aim of this study was to investigate the differences between ellipse fitting and derived circumferences in clinical practice. Head and abdominal circumferences originally measured using ellipse fitting were retrospectively derived from anterior-posterior and transverse diameters using a widely used formula. Where the necessary measurements were available, foetal weight was estimated. Differences between ellipse fitted and derived measurements were compared using Bland-Altman plots. Images from 65 patients (gestational age 20 to 40 weeks) were collected; four head circumference and five abdominal circumference images were excluded due to poor image quality. Data were available for estimated foetal weight calculation for 48 patients. There were small systematic differences between ellipse fitted and derived measurements. Random differences varied between 20 week scans, early growth scans and later growth scans, so were analysed in these three groups. The 95% confidence intervals were ±6 mm (±3%), ±7 mm (±2%) and ±20 mm (±6%) for head circumference at 20 weeks, earlier growth scans and later scans, respectively; the 95% confidence intervals for abdominal circumference were ±7 mm (±5%), ±11 mm (±5%) and ±17 mm (±6%) and for estimated foetal weight were ±23 g (±6%), ±69 g (±5%) and ±311 g (±12%). Foetal circumference measurement methods are not interchangeable. The derived method should be used where size, growth and estimated foetal weight charts are based on this method.
PubMed: 32549897
DOI: 10.1177/1742271X19837307 -
EBioMedicine Dec 2023Maternal lipidomic profiling offers promise for characterizing lipid metabolites during pregnancy, but longitudinal data are limited. This study aimed to examine...
BACKGROUND
Maternal lipidomic profiling offers promise for characterizing lipid metabolites during pregnancy, but longitudinal data are limited. This study aimed to examine associations of longitudinal lipidomic profiles during pregnancy with multiple neonatal anthropometry using data from a multiracial cohort.
METHODS
We measured untargeted plasma lipidome profiles among 321 pregnant women from the NICHD Fetal Growth Study-Singletons using plasma samples collected longitudinally during four study visits at gestational weeks (GW) 10-14, 15-26, 23-31, and 33-39, respectively. We evaluated individual lipidomic metabolites at each study visit in association with neonatal anthropometry. We also evaluated the associations longitudinally by constructing lipid networks using weighted correlation network analysis and common networks using consensus network analysis across four visits using linear mixed-effects models with the adjustment of false discover rate.
FINDINGS
Multiple triglycerides (TG) were positively associated with birth weight (BW), BW Z-score, length and head circumference, while some cholesteryl ester (CE), phosphatidylcholine (PC), sphingomyelines (SM), phosphatidylethanolamines (PE), and lysophosphatidylcholines (LPC 20:3) families were inversely associated with BW, length, abdominal and head circumference at different GWs. Longitudinal trajectories of TG, PC, and glucosylcermides (GlcCer) were associated with BW, and CE (18:2) with BW z-score, length, and sum of skinfolds (SS), while some PC and PE were significantly associated with abdominal and head circumference. Modules of TG at GW 10-14 and 15-26 mainly were associated with BW. At GW 33-39, two networks of LPC (20:3) and of PC, TG, and CE, showed inverse associations with abdominal circumference. Distinct trajectories within two consensus modules with changes in TG, CE, PC, and LPC showed significant differences in BW and length.
INTERPRETATION
The results demonstrated that longitudinal changes of TGs during early- and mid-pregnancy and changes of PC, LPC, and CE during late-pregnancy were significantly associated with neonatal anthropometry.
FUNDING
National Institute of Child Health and Human Development intramural funding.
Topics: Infant, Newborn; Child; Pregnancy; Humans; Female; Lipidomics; Anthropometry; Fetal Development; Birth Weight; Lipids
PubMed: 38006745
DOI: 10.1016/j.ebiom.2023.104881 -
Clinical Genetics Feb 2020The genotype-first approach has been successfully applied and has elucidated several subtypes of autism spectrum disorder (ASD). However, it requires very large cohorts...
The genotype-first approach has been successfully applied and has elucidated several subtypes of autism spectrum disorder (ASD). However, it requires very large cohorts because of the extensive genetic heterogeneity. We investigate the alternate possibility of whether phenotype-specific genes can be identified from a small group of patients with specific phenotype(s). To identify novel genes associated with ASD and abnormal head circumference using a phenotype-to-genotype approach, we performed whole-exome sequencing on 67 families with ASD and abnormal head circumference. Clinically relevant pathogenic or likely pathogenic variants account for 23.9% of patients with microcephaly or macrocephaly, and 81.25% of those variants or genes are head-size associated. Significantly, recurrent pathogenic mutations were identified in two macrocephaly genes (PTEN, CHD8) in this small cohort. De novo mutations in several candidate genes (UBN2, BIRC6, SYNE1, and KCNMA1) were detected, as well as one new candidate gene (TNPO3) implicated in ASD and related neurodevelopmental disorders. We identify genotype-phenotype correlations for head-size-associated ASD genes and novel candidate genes for further investigation. Our results also suggest a phenotype-to-genotype strategy would accelerate the elucidation of genotype-phenotype relationships for ASD by using phenotype-restricted cohorts.
Topics: Autism Spectrum Disorder; Cohort Studies; Cytoskeletal Proteins; DNA-Binding Proteins; Female; Genetic Association Studies; Genetic Predisposition to Disease; Genotype; Head; Humans; INDEL Mutation; Inhibitor of Apoptosis Proteins; Large-Conductance Calcium-Activated Potassium Channel alpha Subunits; Male; Megalencephaly; Microcephaly; Nerve Tissue Proteins; PTEN Phosphohydrolase; Phenotype; Polymorphism, Single Nucleotide; Transcription Factors; Exome Sequencing; beta Karyopherins
PubMed: 31674007
DOI: 10.1111/cge.13665 -
Developmental Medicine and Child... Mar 2010Fetal androgens influence fetal growth as well as postnatal neurocognitive ability. However, to our knowledge, no published study has prospectively examined the impact...
AIM
Fetal androgens influence fetal growth as well as postnatal neurocognitive ability. However, to our knowledge, no published study has prospectively examined the impact of early-life androgens on infant brain growth. We report the association between circulating fetal androgen levels, measured from umbilical-cord blood at birth, and a proxy measure of brain growth: head circumference.
METHOD
Participants were 82 unselected female infants from a large representative birth cohort (mean gestational age 39.4 wks, SD 1.7). Umbilical-cord blood was obtained at birth and analysed for androgen concentrations (total testosterone, androstenedione, dehyrdroepiandrosterone, and its sulphated metabolite). Head circumference and two other measures of growth - weight (mean 3311.4 g, SD 461.3) and length - were measured within 3 days of birth and again at approximately 1 year of age (mean age 13.1 mo, SD 1.1).
RESULTS
Multivariate linear regressions found an inverse association between levels of free testosterone and growth in head circumference (correlation=-.24), even when adjusting for sociodemographic/obstetric covariates and head size at birth. Growth in weight and length could not be predicted by free testosterone concentration.
INTERPRETATION
This is the first report of an association between prenatal androgen levels and postnatal growth in head circumference. These findings suggest that early-life androgens may impact brain development during infancy.
Topics: Albumins; Androstenedione; Anthropometry; Dehydroepiandrosterone; Female; Fetal Blood; Head; Humans; Infant; Male; Predictive Value of Tests; Prospective Studies
PubMed: 20002113
DOI: 10.1111/j.1469-8749.2009.03546.x -
Arquivos de Neuro-psiquiatria Jul 2020The congenital Zika syndrome involves structural brain changes, including ventriculomegaly, thin cerebral cortices, abnormal gyral pattern, cortical malformations,...
BACKGROUND
The congenital Zika syndrome involves structural brain changes, including ventriculomegaly, thin cerebral cortices, abnormal gyral pattern, cortical malformations, hypoplasia of the corpus callosum, myelination delay, subcortical diffuse calcifications, brainstem hypoplasia, and microcephaly in newborns.
OBJECTIVE
This study aimed to describe the clinical characteristics of children with congenital Zika syndrome; to compare the outcomes of infants infected in the first (1T, n=20) and second trimesters of pregnancy (2T, n=11); to investigate correlations between birth weight, birth and follow-up head circumference, birth gestational age, and gross motor scores.
METHODS
Participants were evaluated with Alberta Infant Motor Scale (AIMS) and part A of the Gross Motor Function Measure (GMFM-A). ANOVA compared head circumference, birth gestational age, birth weight, and gross motor performance of 1T and 2T.
RESULTS
The correlations were investigated by Pearson correlation coefficients. ANOVA showed differences in birth and follow-up head circumferences. Head circumference was smaller in 1T, compared to 2T. Motor performance was classified as below the fifth percentile in AIMS in all children and 1T showed lower scores in prone, sitting, and total AIMS score, compared to 2T. Children ranged from 8 to 78% on GMFM-A and there was a poorer motor performance of 1T. Nineteen children showed hypertonia, six showed normal tone and six showed hypotonia. Birth head circumference was correlated with AIMS prone postural control. Follow-up head circumference was correlated to prone, supine and total AIMS scores. Smaller head circumference at birth and follow-up denoted poorer postural control.
DISCUSSION
Children with congenital Zika syndrome showed microcephaly at birth and follow-up. Smaller head circumferences and poorer motor outcomes were observed in 1T. Infants showed poor visual and motor outcomes. Moderate positive correlations between birth and follow-up head circumference and gross motor function were found.
Topics: Brain; Cephalometry; Child; Female; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Microcephaly; Motor Skills; Pregnancy; Pregnancy Complications, Infectious; Zika Virus; Zika Virus Infection
PubMed: 32627805
DOI: 10.1590/0004-282X20200020 -
Developmental Medicine and Child... Jun 2013
Topics: Androstenedione; Anthropometry; Dehydroepiandrosterone; Female; Fetal Blood; Head; Humans; Male
PubMed: 23458387
DOI: 10.1111/dmcn.12115