Browsing by Subject "GESTATION"

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  • Kelaranta, A.; Mäkelä, T.; Kaasalainen, T.; Kortesniemi, M. (2017)
    Purpose: To determine fetal doses in different stages of pregnancy in three common computed tomography (CT) examinations: pulmonary CT angiography, abdomino-pelvic and trauma scan with Monte Carlo (MC) simulations. Methods: An adult female anthropomorphic phantom was scanned with a 64-slice CT using pulmonary angiography, abdomino-pelvic and trauma CT scan protocols. Three different sized gelatin boluses placed on the phantom's abdomen simulated different stages of pregnancy. Intrauterine dose was used as a surrogate to a dose absorbed to the fetus. MC simulations were performed to estimate uterine doses. The simulation dose levels were calibrated with volumetric CT dose index (CTDIvol) measurements and MC simulations in a cylindrical CTDI body phantom and compared with ten point doses measured with metal-oxide-semiconductor field-effect-transistor dosimeters. Intrauterine volumes and uterine walls were segmented and the respective dose volume histograms were calculated. Results: The mean intrauterine doses in different stages of pregnancy varied from 0.04 to 1.04 mGy, from 4.8 to 5.8 mGy, and from 9.8 to 12.6 mGy in the CT scans for pulmonary angiography, abdomino-pelvic and trauma CT scans, respectively. MC simulations showed good correlation with the MOSFET measurement at the measured locations. Conclusions: The three studied examinations provided highly varying fetal doses increasing from sub-mGy level in pulmonary CT angiography to notably higher levels in abdomino-pelvic and trauma scans where the fetus is in the primary exposure range. Volumetric dose distribution offered by MC simulations in an appropriate anthropomorphic phantom provides a comprehensive dose assessment when applied in adjunct to point-dose measurements.
  • Leppävirta, Jussi; Kallionpää, Roope A.; Uusitalo, Elina; Vahlberg, Tero; Pöyhönen, Minna; Peltonen, Juha; Peltonen, Sirkku (2019)
    Neurofibromatosis type 1 (NF1) is associated with reduced adult height, but there are no cohort studies on birth size. This retrospective study includes a cohort of 1,410 persons with NF1 and a matched comparison cohort from the general population. Figures for birth size were retrieved from the administrative registers of Finland, and the data were converted to standard deviation scores (SDS), defined as standard deviation difference to the reference population. The birth weight among infants with NF1 was higher than among infants without the disorder (adjusted mean difference [95% confidence interval]: 0.53 SDS [0.19-0.87]), as was the head circumference at birth (0.58 SDS [0.26-0.90]). The birth length of the NF1 infants did not differ significantly from the comparison cohort. The birth weight in the group consisting of NF1 and non-NF1 infants of NF1 mothers was lower than among infants of mothers in the comparison cohort (-0.28 SDS [-0.51 to -0.06]), as was the birth length (-0.22 SDS [-0.45 to 0.00]). In conclusion, the birth weight and head circumference of persons with NF1 are significantly higher than those of persons without the disorder. NF1 of the mother reduces birth weight and birth length of the infant.
  • Murtoniemi, Katja; Villa, Pia M.; Matomäki, Jaakko; Keikkala, Elina; Vuorela, Piia; Hämäläinen, Esa; Kajantie, Eero; Pesonen, Anu-Katriina; Räikkönen, Katri; Taipale, Pekka; Stenman, Ulf-Håkan; Laivuori, Hannele (2018)
    Background: The proportion of hyperglycosylated human chorionic gonadotropin (hCG-h) to total human chorionic gonadotropin (%hCG-h) during the first trimester is a promising biomarker for prediction of early-onset pre-eclampsia. We wanted to evaluate the performance of clinical risk factors, mean arterial pressure (MAP), %hCG-h, hCG beta, pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PIGF) and mean pulsatility index of the uterine artery (Uta-PI) in the first trimester in predicting pre-eclampsia (PE) and its subtypes early-onset, late-onset, severe and non-severe PE in a high-risk cohort. Methods: We studied a subcohort of 257 high-risk women in the prospectively collected Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) cohort Multivariate logistic regression was used to construct the prediction models. The first model included background variables and MAP. Additionally, biomarkers were included in the second model and mean Uta-PI was included in the third model. All variables that improved the model fit were included at each step. The area under the curve (AUC) was determined for all models. Results: We found that lower levels of serum PIGF concentration were associated with early-onset PE, whereas lower %hCG-h was associated with the late-onset PE. Serum PIGF was lower and hCG beta higher in severe PE, while %hCG-h and serum PAPP-A were lower in non-severe PE. By using multivariate regression analyses the best prediction for all PE was achieved with the third model: AUC was 0.66, and sensitivity 36% at 90% specificity. Third model also gave the highest prediction accuracy for late-onset, severe and non-severe PE: AUC 0.66 with 32% sensitivity, AUC 0.65, 24% sensitivity and AUC 0.60, 22% sensitivity at 90% specificity, respectively. The best prediction for early-onset PE was achieved using the second model: AUC 0.68 and 20% sensitivity at 90% specificity. Conclusions: Although the multivariate models did not meet the requirements to be clinically useful screening tools, our results indicate that the biomarker profile in women with risk factors for PE is different according to the subtype of PE. The heterogeneous nature of PE results in difficulty to find new, clinically useful biomarkers for prediction of PE in early pregnancy in high-risk cohorts.
  • Haen, Silke M.; Heinonen, Mari; Bjorkman, Stefan; Soede, Nicoline M.; Peltoniemi, Olli A.T. (2020)
    Abstract We studied luteinizing hormone (LH) pulsatility and episodic progesterone release of the corpus luteum (CL) on Day 11 and Day 21 in inseminated gilts and aimed to establish a relationship between these two hormones. Blood was collected at 15-minute intervals for 12 hours on Days 11, 16, and 21 from a vena cava caudalis catheter. At euthanasia eight gilts were pregnant and six gilts were not pregnant. Progesterone parameters (basal, mean, pulse frequency, and pulse amplitude) did not differ between pregnant and non-pregnant gilts on Day 11, LH pulse frequency and amplitude tended to differ (p = 0.07 and p = 0.079). In pregnant gilts basal and mean progesterone, progesterone pulse amplitude and frequency declined significantly from Day 11 to Day 21 (p <0.05). A significant decline was also seen in the LH pulse amplitude from Day 11 to Day 21 (p <0.05). None of the LH pulses was followed by a progesterone pulse within 1 hour on Day 21. On Day 11 and Day 21 appeared a synchronicity in the LH pulse pattern, as there were two or three LH pulses in 12 hours and these LH pulses appeared in the same time window. We conclude that on Day 11 and Day 21 of pregnancy in gilts progesterone pulses do not follow an LH pulse within one hour. Further we demonstrated that the successful or not successful formation of a CL of pregnancy is independent of progesterone release on Day 11 after insemination. We confirmed the decline of progesterone from Day 11 to Day 21 in the vena cava caudalis and could demonstrate that this decline is partly due to lower progesterone pulse amplitude and frequency and that the decline occurs simultaneously with a decline in LH pulse amplitude.
  • Lönnberg, Piia; Niutanen, Ulla; Parham, L. Diane; Wolford, Elina; Andersson, Sture; Metsäranta, Marjo; Lano, Aulikki (2018)
    Background: Children born preterm are prone to motor problems. Research on their motor performance has, however, rarely been integrated with sensory processing. Aim: To examine sensory-motor performance in children born extremely preterm (EPT). Method: In a longitudinal prospective cohort study, 49 EPT (born <28 gestational weeks; 32 boys and 17 girls) and 33 term-born (16 boys and 17 girls) children were assessed with six individual subtests from the Sensory Integration and Praxis Tests at the age of 7.0 to 7.3 years. Results: The rate of test z-scores indicating dysfunction [from - 2 standard deviations (SD) to <-1 SD for mild and <- 2 SD for moderate-to-severe] was significantly higher in EPT children than in term-born children in all the subtests. When comparing mean performance adjusted for gender and mother's education, EPT children performed worse than term-born children in Design Copying (z-score difference - 0.83; 95% confidence interval -1.32 to - 0.34), Motor Accuracy (- 0.82; -1.26 to - 0.38), Postural Praxis (- 0.95; -1.45 to - 0.45), Manual Form Perception (- 0.59; -1.12 to - 0.06), and Finger Identification (- 0.88; -1.45 to - 0.31). Additional adjustment for Full-Scale Intelligence Quotient rendered difference in Manual Form Perception non-significant. Conclusion: Seven-year-old EPT children perform worse than their term-born peers in tests for visual-motor, somatosensory, and motor planning performance.
  • Keikkala, Elina; Forsten, Janina; Ritvos, Olli; Stenman, Ulf-Håkan; Kajantie, Eero; Hämäläinen, Esa; Räikkönen, Katri; Villa, Pia M.; Laivuori, Hannele (2021)
    Objectives: Maternal serum inhibin-A , pregnancy associated plasma protein-A (PAPP-A) and PAPP-A2 together with placental growth factor (PlGF), maternal risk factors and uterine arter y pulsatility inde x (UtA PI) were analysed to study thei r ability to predict pre-eclampsia (PE). Study design: Serial serum samples for the nested case-control study were collected prospectively at 12-14, 18-20 and 26-28 weeks of gestation from 11 women who later developed early-onset PE (EO PE , diagnosis < 34 + 0 weeks of gestation), 34 women who developed late-onset PE (LO PE , diagnosis 2 34 + 0 weeks) and 89 controls. Main outcome measures: Gestational age-adjusted multiples of the median (MoM) values were calculated for biomarker concentrations. Multivariate regression analyses were performed to combine first trimester bio-markers, previously reported results on PlGF, maternal risk factors and UtA PI. Area under cu r v e (AUC) values and 95% confidence intervals (CIs) for the prediction of PE and its subtypes were calculated . Results: A high first trimester inhibin-A predicted PE (AUC 0.618, 95%CI, 0.513-0.724), whereas PAPP-A and PlGF predicted only EO PE (0.701, 0.562-0.840 and 0.798, 0.686-0.909, respectively). At 26-28 weeks PAPP-A2 and inhibin-A predicted a l l PE subtypes. In the multivariate setting inhibin-A combined with maternal pre-pregnancy body mass index, prior PE and mean UtA PI predicted PE (0.811,0.726-0.896) and LO PE (0.824, 0.733-0.914). Conclusions: At first trimester inhibin-A show potential ability to predict not only EO PE but also LO PE whereas PlGF and PAPP-A predict only EO PE. At late second trimester inhibin-A and PAPP-A2 might be usef u l for short-term prediction of PE.
  • Juhanson, Peeter; Rull, Kristiina; Kikas, Triin; Laivuori, Hannele; Vaas, Pille; Kajantie, Eero; Heinonen, Seppo; Laan, Maris (2016)
    Context and Objectives: The study represents the first comprehensive analysis of Stanniocalcin-1 (STC1) hormone in human pregnancy, assessing clinical, lifestyle, and genetic determinants of circulating STC1 at term. Design, Setting, and Participants: Participants included women with (n = 50) and without (n = 316) preeclampsia (PE) at delivery, recruited in the REPROgrammed fetal and/or maternal METAbolism (REPROMETA) study (2006-2011, Estonia). Genetic association analysis combined PE cases (n = 597) and controls (n = 623) from the REPROMETA and Finnish Genetics of Preeclampsia Consortium (2008-2011) studies. Main Outcome Measure(s): Maternal postpartum plasma STC1 was measured by ELISA (n = 366) and placental STC1 gene expression by TaqMan quantitative RT-PCR (n = 120). Genotyping was performed using Sequenom MassArray. Results: Significantly higher STC1 plasma level was measured for the PE (median, 1952 pg/mL; 1030-4284 pg/mL) compared with non-PE group (median, 1562 pg/mL; 423-3781 pg/mL; P = 3.7 = 10 = 4, Mann-Whitney U test). Statistical significance was enhanced after adjustment for cofactors (linear regression, P = 1.8 x 10(-6)). STC1 measurements were negatively correlated with maternal smoking. Prepregnancy body mass index had a positive correlation with STC1 only among PE patients (r = 0.45; P =.001). The strongest genetic association with hormone concentrations was detected for STC1 single nucleotide polymorphisms rs3758089 (C allele: minor allele frequency, 5%; linear regression: beta = 249.2 pg/mL; P =.014) and rs12678447 (G allele: minor allele frequency, 7%; beta = 147.0 pg/mL; P =.082). rs12678447 placental genotypes were significantly associated with STC1 gene expression (P =.014). The REPROMETA/Finnish Genetics of Preeclampsia Consortium metaanalysis suggested an increased risk to develop late-onset PE for the rs12678447 G allele carriers (P =.05; odds ratio = 1.38 [0.98 -1.93]). Conclusions: Increased STC1 hormone represents a hallmark of late-onset PE. STC1 gene variants modulate placental gene expression and maternal hormone levels.