FETAL BODY COMPOSITION AND VOLUMES STUDY

胎儿身体成分和体积研究

• 批准号: 9146484
• 负责人: WESLEY LEE
• 金额: $ 78.85万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-15 至 2016-09-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9146484
• 关键词: Abdomen; African American; Amniotic Sac; Area; Asians; Biometry; Birth; Blood flow; Body Composition; Brain; Budgets; Caucasians; Cerebellum; Characteristics; Chest; Chorionic Sac; Clinical; Cohort Studies; Complement; Computer software; Computers; Contractor; Data; Data Collection; Data Coordinating Center; Deposition; Dimensions; Discrimination; Documentation; Epidemiologic Studies; Ethnic Origin; Etiology; Evaluation; Face; Fatty acid glycerol esters; Fetal Growth; Fetal Growth Retardation; Fetus; Future; Gestational Age; Gestational Diabetes; Goals; Government; Growth; Head; Healthcare; Heart; Hispanics; Image; Imaging technology; Individual; Institutional Review Boards; Intervention; Kidney; Knowledge; Limb structure; Liver; Measurement; Measures; Monitor; National Institute of Child Health and Human Development; Non obese; Obesity; Organ Size; Participant; Pathologic; Patients; Pelvis; Picture Archiving and Communication System; Population; Pregnancy; Pregnancy Complications; Pregnant Women; Prenatal Diagnosis; Protocols documentation; Race; Randomized; Reading; Recruitment Activity; Relative (related person); Reporting; Research; Rest; Risk; Scanning; Schedule; Severities; Side; Signal Transduction; Site; Small for Gestational Age Infant; Specific qualifier value; Study Subject; System; Taiwan; Technology; Testing; Thigh structure; Three-Dimensional Image; Time; Twin Multiple Birth; Ultrasonography; Uterus; Visceral; Visit; Woman; Work; Writing; adverse outcome; arm; base; body volume; bone; clinical practice; cohort; cost; design; disorder control; fetal; follow-up; high risk; improved; malformation; neonatal morbidity; open label; programs; prospective; racial difference; soft tissue; subcutaneous

Identifying abnormal fetal growth as restriction or overgrowth during an ongoing pregnancy remains a pressing clinical challenge. One promising area of research suggests that changes in fetal soft tissue, including lean mass, fat mass, and organ size, may be the earliest changes that occur in pathologic growth and that soft tissue measures may complement traditional estimates that are based primarily on bone dimensions. Three-dimensional volume assessment of a portion of the arm or thigh where the borders are easier to trace, known as fractional limb volumes, may also detect abnormalities in soft tissue that result from pathologic growth earlier than conventional 2D measures. Despite the fact that most standard ultrasound machines in the U.S. have 3D/4D capability, the available technology has not been widely integrated into routine clinical practice other than for evaluation of fetal malformations. It remains to be determined whether 3D significantly improves prenatal diagnosis over 2D and is worth the extra time and cost. The Government recently completed a multi-site, prospective cohort study, the NICHD Fetal Growth Studies, which was designed to establish a standard for normal fetal growth (velocity) and size for gestational age in the U.S. population, and to improve estimation of abnormal fetal growth for four self-identified race/ethnicity backgrounds in 2,334 low-risk, non-obese gravidas: African American (n=611), Asian (n=460), Caucasian (n=614), and Hispanic (n= 649). Following a detailed sonogram at 10-13 weeks of gestation, each woman was randomized to one of 4 follow-up visit schedules. Each schedule comprised 5 additional sonograms: (16-22, 24-29, 30-33, 34-37 and 38-41 gestational weeks) for fetal biometry plus additional image and 3D volume acquisition for later analysis. An additional 486 obese women were recruited as well as 171 women with dichorionic twin gestations (where each twin has its own chorionic and amniotic sacs). The twin protocol was similar to the singleton protocol, with slight differences undertaken to allow the research ultrasounds to report to the clinical side, recognizing the high risk status of twin pregnancies, and a simplified ultrasound protocol to limit ultrasound time and patient burden. In addition to traditional biometrics, the following volumes were collected in the singleton study if they were able to be obtained: 1st trimester: fetus and gestational sac; 2nd and 3rd trimesters: head, cerebellum, face, chest, heart, abdomen, pelvis, arm and thigh. In twins, the volumes collected were 1st trimester: fetus and gestational sac and in the 2nd and 3rd trimesters the thigh. In addition to body composition, fetal cerebellar and organ sizes may differ in fetuses with growth abnormalities. Fetal cerebellar volumes have been suggested as potentially having better discrimination for fetal growth restriction than one measurement in a 2-D plane. However, there are very few studies on fetal cerebellar volumes. In addition, there may be racial differences, as cerebellar volumes were different in a Taiwan population compared to a Brazilian population. Whether cerebellar volumes vary by pregnancy complication is unknown. Kidney and liver volumes have been studied in association with pregnancy conditions such as small-for-gestational age (SGA) and gestational diabetes. In summary, there is a paucity of data on longitudinal changes in fetal body composition (subcutaneous fat, lean mass) and visceral volumes over the course of pregnancy. This data gaps contrasts sharply with available imaging technology. Knowledge of fetal body composition has the potential for practical scientific and clinical use given that current management of many pregnancy complications is limited because the degree of severity that results in adverse outcomes remains uncertain. Moreover, given reported differences in birth size characteristics by maternal race, we will be able to use data from a prospective pregnancy cohort design with longitudinal measurements (2D and 3D) to assess body composition changes and visceral measurements for the 4 maternal racial groups. Future interventions can also be tested such as increasing periods of maternal rest to increase blood flow to the uterus in instances of decreasing fetal fat deposition as an early signal for fetal growth restriction. The NICHD Fetal Growth Study is an ideal, prospective epidemiologic study well-designed to characterize fetal body composition and organ sizes. Knowledge of these associations could help increase understanding of the etiology of fetal and subsequent neonatal morbidity, and guide future interventions such as improved maternal disease control, individualized pregnancy monitoring and determining timing of delivery.

将胎儿生长异常识别为妊娠期间的限制或过度生长 仍然是一个紧迫的临床挑战。一个有希望的研究领域表明， 胎儿软组织，包括瘦肉量、脂肪量和器官大小，可能是最早发生的变化。 发生在病理生长中，软组织测量可以补充传统的 主要基于骨骼尺寸的估计。三维体积评估 手臂或大腿的一部分，其中边界更容易追踪，称为部分肢体 体积，还可以检测早期病理生长引起的软组织异常 比传统的二维测量。尽管事实上大多数标准超声波机器 美国具备3D/4D能力，但现有技术尚未广泛集成 除评估胎儿畸形外的常规临床实践。仍有待 确定 3D 是否比 2D 显着改善产前诊断并且值得 额外的时间和成本。政府最近完成了一项多地点前瞻性队列研究， NICHD 胎儿生长研究，旨在建立正常胎儿的标准 美国人口的生长（速度）和胎龄大小，并改进估计 2,334 名低风险人群中四个自认种族/民族背景的胎儿生长异常情况 非肥胖孕妇：非裔美国人 (n=611)、亚洲人 (n=460)、白种人 (n=614) 和西班牙裔 （n = 649）。在妊娠 10-13 周时进行详细的超声检查后，每位妇女 随机分配到 4 个随访计划中的一个。每个时间表包括 5 个额外的 超声检查：（16-22、24-29、30-33、34-37 和 38-41 孕周）用于胎儿生物测定以及 额外的图像和 3D 体积采集以供以后分析。另有 486 名肥胖女性 以及 171 名双绒毛膜双胞胎妊娠女性（其中每个双胞胎都有其 自己的绒毛膜囊和羊膜囊）。孪生协议与单例协议类似， 为使研究超声波能够向临床方面报告而进行的细微差别， 认识到双胎妊娠的高风险状态，并采用简化的超声方案 限制超声时间和患者负担。除了传统的生物识别技术外，还有以下技术： 如果能够获得以下数据，则在单例研究中收集体积： 第一个三个月： 胎儿和孕囊；第二和第三个三个月：头部、小脑、面部、胸部、心脏、 腹部、骨盆、手臂和大腿。在双胞胎中，收集的体积为妊娠第一个月：胎儿和 妊娠囊以及妊娠第二和第三个月的大腿。 除了身体成分外，胎儿小脑和器官的大小也可能有所不同 生长异常。胎儿小脑体积被认为可能具有 与二维平面中的一次测量相比，可以更好地辨别胎儿生长受限。 然而，关于胎儿小脑体积的研究很少。此外，还可能有 种族差异，因为台湾人口的小脑体积与台湾人口的小脑体积不同 巴西人口。小脑体积是否因妊娠并发症而变化尚不清楚。 已经研究了肾脏和肝脏体积与妊娠状况的关系，例如 小于胎龄（SGA）和妊娠期糖尿病。 总之，缺乏关于胎儿身体成分纵向变化的数据 怀孕期间的（皮下脂肪、瘦体重）和内脏体积。这个数据 差距与现有的成像技术形成鲜明对比。了解胎儿身体成分 鉴于目前对许多疾病的管理，具有实际科学和临床应用的潜力 妊娠并发症是有限的，因为导致不良后果的严重程度 结果仍不确定。此外，考虑到出生尺寸特征的报道差异 根据母亲种族，我们将能够使用前瞻性妊娠队列设计的数据 纵向测量（2D 和 3D）以评估身体成分变化和内脏变化 4 个母亲种族群体的测量值。未来的干预措施也可以进行测试，例如 在以下情况下增加产妇休息时间以增加流向子宫的血液 减少胎儿脂肪沉积作为胎儿生长受限的早期信号。 NICD 胎儿 生长研究是一项理想的前瞻性流行病学研究，旨在描述胎儿的特征 身体成分和器官大小。了解这些协会有助于提高 了解胎儿和随后的新生儿发病的病因，并指导未来 改善孕产妇疾病控制、个体化妊娠监测等干预措施 并确定交货时间。