First-trimester utero-placental (vascular) development and embryonic and fetal growth: The Rotterdam periconception cohort

I F Reijnders; A G M G J Mulders; M P H Koster; A T M Kropman; E S de Vos; A H J Koning; S P Willemsen; M Rousian; E A P Steegers; R P M Steegers-Theunissen

doi:10.1016/j.placenta.2021.03.017

First-trimester utero-placental (vascular) development and embryonic and fetal growth: The Rotterdam periconception cohort

Placenta. 2021 May:108:81-90. doi: 10.1016/j.placenta.2021.03.017. Epub 2021 Mar 28.

Authors

Affiliations

¹ Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
² Department of Pathology, Clinical Bioinformatics Unit Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
³ Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
⁴ Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands. Electronic address: r.steegers@erasmusmc.nl.

PMID: 33823358
DOI: 10.1016/j.placenta.2021.03.017

Abstract

Introduction: Impaired placental development is a major cause of fetal growth restriction (FGR) and early detection will therefore improve antenatal care and birth outcomes. Here we aim to investigate serial first-trimester ultrasound markers of utero-placental (vascular) development in association with embryonic and fetal growth.

Methods: In a prospective cohort, we periconceptionally included 214 pregnant women. Three-dimensional power Doppler ultrasonography at 7, 9 and 11 weeks gestational age (GA) was used to measure placental volumes (PV) and basal plate surface area by Virtual Organ Computer-aided AnaLysis™, and utero-placental vascular volume (uPVV), crown-rump length (CRL) and embryonic volume (EV) by a V-scope volume rendering application. Estimated fetal weight (EFW) was measured by ultrasound at 22 and 32 weeks GA and birth weight percentile (BW) was recorded. Linear mixed models and regression analyses were applied and appropriately adjusted. All analyses were stratified for fetal sex.

Results: PV trajectories were positively associated with CRL (β_adj = 0.416, 95%CI:0.255; 0.576, p < 0.001), EV (β_adj = 0.220, 95%CI:0.058; 0.381, p = 0.008) and EFW (β_adj = 0.182, 95%CI:0.012; 0.352, p = 0.037). uPVV trajectories were positively associated with CRL (β_adj = 0.203, 95%CI 0.021; 0.384, p = 0.029). In girls, PV trajectories were positively associated with CRL (p < 0.001), EV (p = 0.018), EFW (p = 0.026), and uPVV trajectories were positively associated with BW (p = 0.040). In boys, positive associations were shown between PV trajectories and CRL (p = 0.002), and between uPVV trajectories and CRL (p = 0.046).

Discussion: First-trimester utero-placental (vascular) development is associated with embryonic and fetal growth, with fetal sex specific modifications. This underlines the opportunity to monitor first-trimester placental development and supports the associations with embryonic and fetal growth.

Keywords: 3D ultrasound; Birth weight; Early pregnancy; Embryo; Fetal sex; Placental vascular development; Placentation; Virtual reality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Embryonic Development / physiology*
Female
Fetal Development / physiology*
Fetal Growth Retardation / physiopathology
Humans
Placenta / blood supply*
Placentation / physiology*
Pregnancy
Pregnancy Trimester, First