First trimester fetal heart rate as a predictor of newborn sex

Objective: To predict the sex of newborns using first trimester fetal heart rate (FHR).

Methods: This was a retrospective review of medical records and ultrasounds performed between 8 and 13 weeks of gestation. Continuous variables were compared using Student’s t-tests while categorical variables were compared using Chi-square test.

Results: We found no significant differences between 332 (50.7%) female and 323 (49.3%) male FHRs during the first trimester. The mean FHR for female fetuses was 167.0?±?9.1?bpm and for male fetuses 167.3?±?10.1?bpm (p?=?0.62). There was no significant difference in crown rump length between female and male fetuses (4.01?±?1.7 versus 3.98?±?1.7?cm; p?=?0.78) or in gestational age at birth (38.01?±?2.1 versus 38.08?±?2.1 weeks; p?=?0.67). The males were significantly heavier than females (3305.3?±?568.3 versus 3127.5?±?579.8?g; p?<?0.0001) but there were no differences in the proportion of small for gestational age (SGA), average for gestational age (AGA) and large for gestational age (LGA) infants.

Conclusions: We found no significant difference between the female and male FHR during the first trimester in contrast to the prevailing lay view of females having a faster FHR. The only statistically significant difference was that males weighed more than female newborns.     

Is there a correlation between birth weights and first-trimester crown-rump length growth velocity?

Objective: To test the hypothesis that small- or large-for-gestational-age (SGA or LGA) newborns have anomalous crown-rump length (CRL) growth rates in the first trimester. Methods: Prospective observational study. Women in the first trimester presenting to the Early Pregnancy Unit, between November 2006 and December 2010, underwent transvaginal scan. Women with viable singleton pregnancies in the first trimester who had at least two CRL measurements > 5 mm, recorded at least 2 weeks apart, and also had birth weight data available were included in the final analysis. Birth weight percentiles were calculated and adjusted for gestational age and gender. SGA was equivalent to < 10th centile and LGA was equivalent to > 90th centile. Correlation analysis was performed between birthweight percentiles and first-trimester CRL growth-rate coefficients. In addition, we estimated early fetal growth rates (EFGR) by calculating the Δ CRL/Δ time (mm/day) to see if these differed according to the birth-weight percentiles. Results: A total of 107 women had complete data. The mean maternal characteristics were age 27.5 ± 6 years, weight 87 ± 29 kg and height 163 ± 8 cm. The mean birth weight and gestational age at delivery were 3405 g (SD = 597) and 269 days (SD = 13), respectively. The proportions of SGA and LGA were 7.5% and 18.7%, respectively. There were no significant correlations between birth-weight percentiles and any of the CRL growth rates. There were also no significant differences in the mean CRL velocities when comparing the SGA and LGA newborns birth weights. EFGR for SGA and LGA newborns were 1.34 mm/day (SD = 0.17) and 1.32 mm/day (SD = 0.24), respectively (p > 0.05). Conclusions: Newborns who are found to be SGA or LGA at delivery do not appear to have anomalous CRL growth patterns in the first trimester. The EFGR also did not correlate with birth-weight percentiles.     

Fetal cardiac axis in non-anomalous pregnancies: does fetal gender or maternal body mass index (BMI) matter?

Objectives: To determine if cardiac axis obtained at an early ultrasound study (11–15 weeks) differs from that obtained at a late ultrasound study (18–22 weeks) in the same fetus and to evaluate the impact of fetal gender and/or maternal body mass index (BMI).

Methods: Cardiac axes of 324 non-anomalous fetuses at 11–15 weeks gestation were measured, with follow-up measurements obtained at 18–22 weeks. Comparisons were performed based on gestational age period, fetal gender and obese/non-obese maternal status.

Results: (1) Mean fetal cardiac axis did not change between 11 and 15 weeks; p?=?0.8, (2) mean fetal cardiac axis was more levorotated at 11–15 weeks than measurements obtained at 18–22 weeks; 48.1?±?7.1° versus 43.7?±?8.9°; p?<?0.0001, (3) male fetuses had less levorotated cardiac axis than female fetuses in late ultrasound studies but there was no difference between them at early ultrasound studies; 18–22 weeks male fetus, 42.7?±?9.3° versus female fetus, 45.2?±?8.3°; p?=?0.02 and 11–15 weeks male fetus, 48.1?±?7.0° versus female fetus, 48.4?±?7.4°, p?=?0.7, respectively, and (4) similar trends with the overall study population were observed in the comparison between fetuses of obese and non-obese women.

Conclusion: Fetal cardiac axis remains stable at 11–15 weeks, becoming less levorotated at 18–22 weeks. This may be attributed to increments in fetal lung volume. The differences in cardiac axis measurements between male and female fetuses examined at 18–22 weeks may also be attributable to differences in increment of fetal lung volume during this gestational age period.     

First trimester 3D volumetry. Association of the gestational volumes with the birth weight

Objective.?To evaluate the three dimensional ultrasound (3D) in the volume assessment of the gestational contents during the 1st trimester of pregnancy. Our aim was to correlate the embryo, gestational sac, and placenta volume with the birth weight. To monitor the increase of these volumes according to the gestational age.

Method.?Prospective study of 199 singleton low risk pregnant women undergoing the 1st trimester ultrasound for fetal anomalies. In these women, gestational volumetry was performed and it was compared with the crown-rump length (CRL). Regression models were computed in order to analyze the dependence of birth weight with the volumes.

Results.?The embryo volume reveals the strongest association with the birth weight at delivery (β?=?0.24), followed by the CRL (β?=?0.20) and the gestational sac volume (β?=?0.20). The placenta volume appears the weakest association with fetal weight at delivery (β?=?0.16). All volumes increased significantly from 11⁺⁰–11⁺⁶ to 13⁺⁰–13⁺⁶ weeks of gestation (p?<?0.001). Ten cubic millimeter increase in embryo volume corresponds to a mean birth weight increase of 75?g, while 1?mm increase in the CRL corresponds to a birth weight increase of 113?g.

Conclusion.?Our results provide evidence that the embryo volume during the first trimester of pregnancy correlates better with birth weight than the CRL. This might assist in the identification of the high risk pregnancies caring macrosomic and low birth weight fetuses.     

The correlation between birth weight and insulin-like growth factor-binding protein-1 (IGFBP-1), kisspeptin-1 (KISS-1), and three-dimensional fetal volume

Purpose: This study aimed to determine the relationship between birth weight, and maternal serum insulin-like growth factor-binding protein-1 (IGFBP-1) and kisspeptin-1 (KISS-1) levels, and first-trimester fetal volume (FV) based on three-dimensional ultrasonography.

Materials and methods: The study included 142 pregnant women at gestational week 11°–13⁶. All fetuses were imaged ultrasonographically by the same physician. Maternal blood samples were collected at the time of ultrasonographic evaluation and analyzed for IGFBP-1 and KISS-1 levels via enzyme-linked immunosorbent assay (ELISA). Maternal and neonatal weights were recorded at birth. Birth weight ≤10th and the >90th percentiles was defined as small and large for gestational age (SGA and LGA), respectively.

Results: Median crown-rump length (CRL), FV, and maternal serum IGFBP-1 and KISS-1 levels were 58.2?mm (35.3–79.2?mm), 16.3?cm³ (3.8–34.4?cm³), 68.1?ng?mL^?1 (3.8–377.9?mL^?1), and 99.7?ng?L^?1 (42.1–965.3?ng?L^?1), respectively. First-trimester IGFBP-1 levels were significantly lower in the mothers with LGA neonates (p?p?>?.05). The maternal IGFBP-1 level during the first trimester was a significant independent factor for SGA and LGA neonates (Odds ratio (OR): 0.011, 95%CI: 1.005–1.018, p?p?=?.007, respectively). There was no significant relationship between SGA or LGA, and CRL, FV, or the KISS-1 level.

Conclusions: As compared to the maternal KISS-1 level, the maternal IGFBP-1 level during the first trimester might be a better biomarker of fetal growth. Additional larger scale studies are needed to further delineate the utility of IGFBP-1 as a marker of abnormal birth weight.     

Reference range for the fetal intracranial translucency measurement between 11 and 14 + 2 weeks of gestation in a Brazilian population

Objective: To establish a reference range for the fetal intracranial translucency (IT) measurement between 11 and 14?+?2 weeks in a Brazilian population.

Methods: A retrospective cross-sectional study was performed with 199 low-risk singleton pregnancies during the first trimester ultrasound exam. The IT (fourth ventricle width) measurement was performed in a mid-sagittal view of fetal profile defined by two echogenic borders – the dorsal part of the brain stem anteriorly and the choroid plexus of the fourth ventricle posteriorly. Polynomial regression was used to obtain the best fit using fetal IT measurements and crown-rump length (CRL). Percentiles 5th, 50th and 95th were determined for each gestational age.

Results: The mean of fetal IT ranged from 1.6 mm at CRL 45 to 2.0 mm at CRL 84 mm. A best fit curve was a first-degree polynomial regression: IT measurement?=?1.001?+?0.0124?×?CRL (R²=0.09).

Conclusion: Reference range for the fetal IT measurement between 11 and 14?+?2 weeks of gestation in a Brazilian population was established.     

An appropriate way to predict fetal gender at first trimester: anogenital distance

Background: Using anogenital distance to determine fetal sex is a new method. There is only one study in the literature. We predict that it will pass through the literature as a new method that can be used in determining fetal sex especially in first trimester.

Introduction: Determination of fetal gender before birth has been a matter of curiosity for both the family and the clinician. In the presence of gender-linked genetic disease, it becomes an obligation instead of an interest. The aim of this study was to determine the fetal gender accurately at first trimester with anogenital distance (AGD) and to investigate the correlations of nuchal translucency (NT), fetal heart rate (FHR), and crown-rump length (CRL) with AGD.

Materials and methods: In this prospective cross-sectional study, AGD measurement was performed in 111 patients with singleton pregnancy from 11 to 13 weeks and 6 days (CRL 45–84?mm). Measurements of AGD ≥4.8?mm were identified for males, and AGD <4.8?mm for females.

Results: Genders were demonstrated accurately for males as 76.7% and for females as 97.1%. The mean value of AGD was 3.6?mm for females and 5.1?mm for males. There were no relations between fetal gender and FHR and also NT.

Conclusions: Gender can be detected with great accuracy in gestations between 11 to 13 weeks and 6 days by using AGD. CRL and gestational week (GW) were determined as nonsignificant predictors of fetal gender by AGD measurement. In order to obtain more accurate results with AGD, consideration of further studies with larger series in different races is recommended.     

Umbilical cord diameter at 11-14 weeks of gestation: relationship to nuchal translucency, ductus venous blood flow and chromosomal defects

OBJECTIVE: To compare the umbilical cord diameter (UCD) in euploid and aneuploid fetuses at 11-14 weeks of gestation. METHODS: In 299 fetuses at 11-14 weeks of gestation the UCD, the nuchal translucency and the a-wave of the ductus venosus were measured. Reference ranges for the UCD according to the gestational age and to the crown-rump-length (CRL) were obtained by measuring the UCD by outer-to-outer border of 244 singleton pregnancies with normal karyotype. The fetal karyotype was established by chorionic villus sampling, amniocentesis or in case of suspected chromosomal abnormalities in the newborn. Linear regression was used to determine the significance of the association between the UCD and CRL or gestational age. RESULTS: Two hundred and ninety-nine fetuses were examined. The median fetal CRL was 64.5 mm (range 45-84) and the median gestational age was 13 (range 11-14) weeks. In the chromosomally normal group the UCD significantly increased with the CRL (r=0.620; p<0.001) and the gestational age (r=0.555; p<0.001). The regression equation for the mean UCD (y) according to the gestational days (x) was: y=-0.604+0.051*x. The regression equation for the mean UCD (y) according to the CRL (x) was: y=1.962+0.029*x. There were no significant differences in the mean UCD in fetuses without and with chromosomal abnormalities. The proportion of fetuses with an UCD above the 95th centile for CRL was higher in aneuploid compared to euploid fetuses (5/14 vs. 13/285, p<0.005). In 5/14 (35.7%) fetuses with chromosomal defects the NT and the UCD were above the 95th centile, whereas none of the fetuses with normal karyotype showed this combination. The proportion of fetuses with increased UCD and abnormal DV blood flow was increased in the cases with chromosomal abnormalities (33.3 vs. 1.8%, p<0.005). CONCLUSION: Umbilical cord diameter at 11-14 weeks increases with fetal CRL. Fetuses with chromosomal abnormalities are more likely to have an UCD above the 95th centile. Therefore, sonographic evaluation of the umbilical cord during first trimester ultrasound might be of additional value in the assessment of fetuses at risk for aneuploidies.     

Are the first trimester volumetric measurements with two dimensional ultrasonography satisfactory?

Objectives: Aim was to examine volumetric measurement of first trimester structures with two-dimensional ultrasonography (2D US) and evaluate necessity of three-dimensional (3D) volume measurements instead of 2D during first trimester. Methods: Using 2D transvaginal ultrasound imaging, the crown rump length (CRL), yolk sac (YS) and gestational sac (GS) diameters were recorded in 176 women with gestational age <11 weeks. Volume measurements were done by using a simplified formula for the volume of a prolate ellipsoid: V?=?0.523?×?length?×?height?×?width. Results: The mean CRL value was 19.6?±?8.8?mm. The mean YS, GS and embrionic volume (EV) varied from 0.02–0.13, 5.5–37.72, 0.024–3.31?cm³ between 6⁺⁶ and 10⁺⁶ weeks, respectively. There was moderate positive correlation between EV versus GS volume and YS volume versus EV.Conclusions: 2D US still can provide adequate information in volumetric examination of regular shaped objects. But 3D US is useful in volumetric measurements of irregular shaped structures and for screening of fetal abnormalities.     

Reference intervals of embryos/fetuses heart rate between 6 and 14 weeks of pregnancy

Abstract

Objective: To determine reference intervals for the embryos/fetuses heart rate (HR) between 6 and 14 weeks of pregnancy.

Methods: A retrospective cross-sectional study was carried in a single center with singleton pregnancies of embryos/fetuses with a crown-rump length (CRL) between 5 and 85?mm. The HR was assessed by real time M-mode or spectrum Doppler ultrasound. To evaluate the correlation between embryo/fetal HR and CRL, polynomial equations were calculated, with adjustment by the determination coefficient (R²).

Results: A total of 5867 pregnancies were assessed. The mean gestational age was 10.37?±?2.12 weeks. The mean maternal age was 26.41?±?6.78 years. The mean embryo/fetal HR (bpm) for the CRL (mm) intervals 5├15; 15├25; 25├35; 35├45; 45├55; 55├65; 65├75; 75├85 was 145.1?±?18.7; 167.2?±?10.1; 166.9?±?8.7; 165.5?±?6.9; 162.2?±?6.8; 159.2?±?6.4; 157.1?±?6.4; 154.9?±?7.3; respectively. The following third-order equation best represented the correlation between embryo/fetal HR and CRL: HR?=?119.25?+?3.596*CRL-0.07954*CRL^2?+?0.00051*CRL³ (R^2?=?0.36).

Conclusion: Reference intervals of HR in embryos/fetuses in a large sample were determined. These reference intervals can be used in high-risk early pregnancy losses.     

Assessment of free fetal DNA concentration in maternal plasma during the first trimester of pregnancy: comparative study between EDTA and PPT tubes – pilot study

Objective: To compare ethylenediamine tetraacetic acid (EDTA) tubes and plasma preparation tubes (PPT) for evaluating maternal plasma during the first trimester of pregnancy.

Methods: A cross-sectional study was conducted on 24 male fetuses in women between 6 and 14 weeks of pregnancy. Blood samples (10?mL) were collected and stored in EDTA and PPT tubes. Subsequently, the samples were centrifuged and sent for free fetal DNA extraction by means of the polymerase chain reaction (PCR) technique. The reactions were performed in a real time PCR machine for detecting the amplification products. The genome region chosen for performing the PCR reactions was a target specific for the Y chromosome, in which the DYS-14 marker was amplified only when the DNA was of male sex. The free fetal DNA concentration was given by the threshold cycle (TC). To compare the tubes, the paired Student t-test was used.

Results: The mean gestational age was 11.08?±?2.30 weeks (range: 6–14). The mean TC for PPT was 30.08?±?1.05 (range: 27.08–32.61) and for EDTA, 30.23?±?0.96 (range: 28.01–32.09), but without statistical significance (p?=?0.357).

Conclusion: We did not observe any statistically significant difference in free fetal DNA concentration between the EDTA and PPT tubes.     

First-trimester crown-rump length as a predictor of fetal LGA and SGA at term

Objective.?To determine whether first-trimester crown-rump length (CRL) is associated with birthweight extremes at term.

Methods.?Included in this study were all term, small for gestational age (SGA), and large for gestational age (LGA) neonates with no other obstetric complications and no abnormal outcomes of pregnancy. CRL at 12.0 to 12.6 weeks of estimated gestational age obtained during nuchal translucency screening was selected as an estimate of early fetal growth. Mean first-trimester CRL of the LGA noenates at term was compared via student’s t-test with mean first-trimester CRL of SGA neonates at term.

Results.?In all, 121 neonates were included in the study. Mean first-trimester CRL of the 63 LGA-term neonates was 62.7?±?6.0 mm (95% confidence interval, ±1.49 mm; range, 61.21–64.19), while that of the 58 SGA-term neonates was smaller at 58.8?±?6.9 mm (95% confidence interval, ±1.79 mm; range, 57.01–60.59 mm). This 3.9 mm difference between the means was statistically significant (P?=?0.01).

Conclusion.?We found that birthweights of LGA and SGA neonates at term were associated with their first-trimester CRL measurements, thus, indicating that fetal growth patterns apparent early in pregnancy continue through term.     

Reference ranges for the uterine arteries Doppler and cervical length measurement at 11–13(+6) weeks of gestation in a Brazilian population

Objective: To establish references ranges for the uterine arteries (UtA) Doppler and cervical length (CL) measurements at 11–13(+6) weeks of gestation in a Brazilian population.

Methods: We performed a retrospective cross-sectional study with singleton low-risk pregnant women who underwent first trimester ultrasound exams of fetuses with crown-rump length (CRL) ranging from 45 to 84?mm. The mean UtA Doppler and CL measurements were performed by transvaginal route. The mean pulsatility index (PI) of uterine arteries was obtained with color Doppler at the level of cervico-corporeal junction. The CL was obtained in a sagittal view using the cervical gland area as landmark. We determined mean?±?standard deviation (SD), ranges for mean PI of UtA and CL in each gestational age. Polynomial regression was performed to establish reference values.

Results: We have assessed 598 first-trimester pregnancies: the CL measurement was obtained from 497, while the mean PI UtA Doppler was available in 450 pregnant women. The mean CL ranged from 33.41 to 35.58?mm while the PI UtA Doppler ranged from 1.89 to 1.45. The best fit curves were: CL?=?30.790?+?0.057?×?CRL and UtA PI?=?2.411?0.011?×?CRL.

Conclusion: References ranges for the mean UtA PI Doppler and CL measurement at 11–13(+6) weeks of gestation in a Brazilian population were established.     

4D ultrasound study of fetal facial expressions in the third trimester of pregnancy

Objective: To evaluate the frequencies of fetal facial expressions in the third trimester of pregnancy, when fetal brain maturation and development are progressing in normal healthy fetuses.

Methods: Four-dimensional (4?D) ultrasound was used to examine the facial expressions of 111 healthy fetuses between 30 and 40?weeks of gestation. The frequencies of seven facial expressions (mouthing, yawning, smiling, tongue expulsion, scowling, sucking, and blinking) during 15-minute recordings were assessed. The fetuses were further divided into three gestational age groups (25 fetuses at 30–31?weeks, 43 at 32–35?weeks, and 43 at ≥36?weeks). Comparison of facial expressions among the three gestational age groups was performed to determine their changes with advancing gestation.

Results: Mouthing was the most frequent facial expression at 30–40?weeks of gestation, followed by blinking. Both facial expressions were significantly more frequent than the other expressions (p?p?=?.031). Other facial expressions did not change between 30 and 40?weeks. The frequency of yawning at 30–31?weeks was significantly higher than that at 36–40?weeks (p?Conclusions: Our results suggest that 4D ultrasound assessment of fetal facial expressions may be a useful modality for evaluating fetal brain maturation and development. The decreasing frequency of fetal yawning after 30?weeks of gestation may explain the emergence of distinct states of arousal.     

Maternal anemia effects during pregnancy on male and female fetuses: are there any differences?

Objective: Sideropenic anemia is a common pregnancy disorder. The relationship between anemia and adverse pregnancy outcome are contradictory, and it is related to the severity of the hemoglobin deficit. The aim of the study was to evaluate the relationship between maternal mild anemia at third trimester of pregnancy, fetal birth weight and fetal gender.

Study design: A retrospective study including 1131 single physiological term pregnancies was conducted. According to maternal Hb levels during the third trimester, pregnant women enrolled were divided in two groups: Group A (n?=?156) with Hb?≤?11?g/dl and Group B (n?=?975) with Hb?≥?11,1?g/dl.

Results: Maternal characteristics, gestational age at delivery, Apgar score and post-partum hemorrhage were similar between groups. However, when neonatal sex was considerate, female newborns of anemic women had a higher birth weight (p?=?0.01). Moreover, anemic women showed a significantly higher rate of emergency cesarean section (p?=?0.006), in particular when the newborn was a male (p=?0.03).

Conclusion: Maternal mild anemia in third trimester of pregnancy correlates with fetal birth weight, influencing fetal growth and delivery outcome on the basis of fetal gender. Even though the reason of this phenomenon is still unknown, these new data may represent a novel parameter to add significant prognostic information in relation to maternal mild anemia and neonatal outcome.     

Frontomaxillary facial angle at 11 + 0 to 13 + 6 weeks in Chinese population

Objectives.?To establish the normal range of frontomaxillary facial (FMF) angle in the first trimester in a Chinese population.

Methods.?In a prospective study from March 2007 to June 2007, three-dimensional (3D) volumes of the fetal profile in the mid-sagittal plane were recorded from 129 Chinese pregnant women who were screened for trisomy 21 by the combination of fetal nuchal translucency (NT) thickness, maternal serum free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 11 to 13?+?6 weeks. 3D volumes were examined using multiplanar techniques. The FMF angle of each case was measured. The relationship between the measured FMF angle with the other parameter was also examined.

Results.?The mean FMF angle decreased from 86.8° for a crown-rump length (CRL) of 45?mm to 76.0° for a CRL of 84?mm (FMF angle?=?99.49 ? 0.28×CRL, r?=^?0.377, p?<?0.0001). There was no significant association between the FMF angle with serum PAPP-A or β-hCG. The mean (SD) difference between FMF angle derived from Chinese formula and that from the published Caucasian equation was 1.47 (0.61) (95% CI 1.37–1.58) (p?<?0.0001).

Conclusions.?In the first trimester, the FMF angle decreases with fetal CRL. There was similarity in the normal value of FMF angle between the Chinese and Caucasian populations.     

Influence of gestational age and fetal heart rate on the fetal mechanical PR interval

Objective: The fetal mechanical PR interval obtained via pulsed Doppler has previously been demonstrated to correlate with electrocardiographic PR interval measured in the neonate. We sought to further analyze the influence of fetal heart rate and gestational age upon the fetal mechanical PR interval.

Methods: We searched our database for mechanical PR intervals, which were obtained during fetal echocardiography performed in our antenatal diagnostic unit. We included fetuses with a normal cardiac structural survey. The mechanical PR interval is measured from the A wave of the mitral valve to the beginning of ventricular systole corresponding to the opening of the aortic valve. Linear regression curves were generated to examine the correlation of mechanical PR interval with gestational age and fetal heart rate. Analysis of variance was used to compare the mean variation across three gestational age groups: 17–21.9 weeks (n?=?24), 22–25.9 weeks (n?=?52) and 26–38 weeks (n?=?20).

Results: Mechanical PR intervals were measured in 96 fetuses with normal fetal echocardiography. The mechanical PR interval was 123.9?±?10.3?ms (mean?±?SD), with a range of 90–150?ms. Linear regression curves correlating mechanical PR interval with fetal heart rate and gestational age demonstrated a flat slope with R²?=?0.016, p?=?0.22 and R²?=?0.0004, p?=?0.85, respectively. The mechanical PR interval measured over the three gestational ages was as follows (mean?±?SD): 122.3?±?10.5?ms for 17–21.9 weeks; 125.0?±?9.6?ms for 22–25.9 weeks; and 123.1?±?11.9?ms for 26–38 weeks. Analysis of variance revealed no difference among the mechanical PR interval means measured over the three gestational age groups (p?=?0.53).

Conclusions: Fetal mechanical PR interval ranges from 90 to 150?ms in fetuses with sonographically normal fetal cardiac structure and rate. The mechanical PR interval appears to be independent of gestational age and fetal heart rate.     

The change in sex hormone binding globulin and the influence by gestational diabetes mellitus in fetal period

Objective. To investigate the influence of gestational diabetes mellitus (GDM) on the change of SHBG in fetus.

Method. Forty-eight pregnant women with GDM and 86 women with normal pregnancy were included in the study. The following were measured in the serums of pregnant women, amniotic fluids, and umbilical cord serums: glucose, insulin, peptide-C, SHBG, and sex hormones.

Results. SHBGs in pregnant women's serums were, when compared with the control group: in male fetuses 308.06 ± 55.64 vs. 445.21 ± 50.07 (p < 0.01) and in female fetuses 312.38 ± 56.61 vs. 451.05 ± 52.87 (p < 0.01). When comparing the levels of SHBGs in amniotic fluids, inclusive of the control group, the following were in male fetuses 8.35 ± 1.07 vs. 8.41 ± 1.09 (p = NS) and in female fetuses 8.31 ± 0.97 vs. 8.39 ± 0.94 (p = NS). For the levels of SHBGs in umbilical cord serums and comparison to the control group were: in male fetuses 41.44 ± 8.83 vs. 40.24 ± 7.50 (p = NS) and in female fetuses 39.93 ± 7.04 vs. 39.69 ± 7.16 (p = NS). The concentration of SHBG in amniotic fluid had no significant relationship to glucose, dehydroepiandrosterone (DHEAS), estradiol, and total and free testosterone, but had an extremely negatively correlated to insulin and peptide-C (p < 0.01) in GDM group.

Conclusion. Although the concentration of SHBG does not change in fetus when pregnant woman is complicated with GDM, it is already influenced by the fetal regulation on hyperinsulinemia.     

Maternal obesity is not associated with increased crown-rump length in first-trimester ultrasounds of singleton gestations

Objective: To evaluate whether or not obesity affects fetal growth in the first trimester of pregnancy.

Study design: A retrospective cohort study of obese versus non-obese women in our ultrasound database was performed to compare crown-rump length (CRL), a surrogate of fetal growth, at the first-trimester genetic screening.

Results: A total of 50 obese and 50 non-obese women were included. CRL for both groups was performed at an average of 12wk5d?±?3 d. A linear regression analysis demonstrated that there was no difference between the cohorts in respect to CRL in the first trimester (p?=?.482). However, the estimated fetal weight at second-trimester anatomy ultrasound and the neonatal birth weight were increased in obese women (p?Conclusion: Maternal obesity does not significantly alter the fetal CRL. However, maternal obesity appears to be associated with increased fetal growth as early as the second trimester.