Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Department of Pediatrics, Division of Neonatology, Sophia Children's Hospital, Rotterdam 3000 CA, The Netherlands.
Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
Hum Reprod. 2016 May;31(5):968-76. doi: 10.1093/humrep/dew043. Epub 2016 Mar 9.
Can growth trajectories of the human embryonic head be created using 3D ultrasound (3D-US) and virtual reality (VR) technology, and be associated with second trimester fetal head size and periconceptional maternal conditions?
Serial first trimester head circumference (HC) and head volume (HV) measurements were used to create reliable growth trajectories of the embryonic head, which were significantly associated with fetal head size and periconceptional maternal smoking, age and ITALIC! in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) treatment.
Fetal growth is influenced by periconceptional maternal conditions.
STUDY DESIGN, SIZE, DURATION: We selected 149 singleton pregnancies with a live born non-malformed fetus from the Rotterdam periconception cohort.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Bi-parietal diameter and occipital frontal diameter to calculate HC, HV and crown-rump length (CRL) were measured weekly between 9 + 0 and 12 + 6 weeks gestational age (GA) using 3D-US and VR. Fetal HC was obtained from second trimester structural anomaly scans. Growth trajectories of the embryonic head were created with general additive models and linear mixed models were used to estimate associations with maternal periconceptional conditions as a function of GA and CRL, respectively.
A total of 303 3D-US images of 149 pregnancies were eligible for embryonic head measurements (intra-class correlation coefficients >0.99). Associations were found between embryonic HC and fetal HC ( ITALIC! ρ = 0.617, ITALIC! P < 0.001) and between embryonic HV and fetal HC ( ITALIC! ρ = 0.660, ITALIC! P < 0.001) in ITALIC! Z-scores. Maternal periconceptional smoking was associated with decreased, and maternal age and IVF/ICSI treatment with increased growth trajectories of the embryonic head measured by HC and HV (All ITALIC! P < 0.05).
LIMITATIONS, REASONS FOR CAUTION: The consequences of the small effect sizes for neurodevelopmental outcome need further investigation. As the study population consists largely of tertiary hospital patients, external validity should be studied in the general population.
Assessment of growth trajectories of the embryonic head may be of benefit in future early antenatal care.
STUDY FUNDING/COMPETING INTERESTS: This study was funded by the Department of Obstetrics and Gynaecology, Erasmus MC University Medical Centre and Sophia Foundation for Medical Research, Rotterdam, The Netherlands (SSWO grant number 644). No competing interests are declared.
是否可以使用 3D 超声（3D-US）和虚拟现实（VR）技术创建人类胚胎头部的生长轨迹，并与中期胎儿头部大小和围孕期母亲状况相关联？
使用连续的孕早期头围（HC）和头体积（HV）测量值来创建胚胎头部的可靠生长轨迹，这些轨迹与胎儿头部大小以及围孕期母亲吸烟、年龄和 ITALIC！体外受精（IVF）/胞浆内精子注射（ICSI）治疗显著相关。
胎儿生长受围孕期母亲状况的影响。
研究设计、规模、持续时间：我们从鹿特丹围孕期队列中选择了 149 例单胎妊娠，这些妊娠均伴有活产非畸形胎儿。
参与者/材料、设置、方法：在 9+0 至 12+6 孕周妊娠（GA）期间，每周使用 3D-US 和 VR 测量两次双侧顶骨直径和枕额径以计算 HC、HV 和头臀长（CRL）。胎儿 HC 通过中期结构异常扫描获得。使用广义加性模型创建胚胎头部生长轨迹，并使用线性混合模型分别估计与 GA 和 CRL 相关的围孕期母亲状况的关联。
149 例妊娠中有 303 张 3D-US 图像符合胚胎头部测量条件（组内相关系数>0.99）。胚胎 HC 与胎儿 HC 之间存在相关性（ ITALIC！ρ=0.617，ITALIC！P<0.001），胚胎 HV 与胎儿 HC 之间也存在相关性（ ITALIC！ρ=0.660，ITALIC！P<0.001），均以 Z 分数表示。围孕期母亲吸烟与 HC 和 HV 测量的胚胎头部生长轨迹减小相关，而母亲年龄和 IVF/ICSI 治疗与胚胎头部生长轨迹增大相关（均 ITALIC！P<0.05）。
局限性、谨慎的原因：神经发育结局的小效应大小的后果需要进一步研究。由于研究人群主要为三级医院患者，因此应在一般人群中研究其外部有效性。
评估胚胎头部的生长轨迹可能对未来的早期产前保健有益。
研究资金/利益冲突：本研究由荷兰鹿特丹伊拉斯谟医学中心妇产科和索菲亚医学研究基金会（SSWO 资助号 644）资助。无利益冲突声明。
