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Published on: June 29, 2013
Human embryonic growth trajectories and associations with fetal growth and birthweight
Evelyne M van Uitert1, Niek Exalto, Graham J Burton
1Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Insights
Human embryonic growth rates accelerate between 9 and 10 weeks of gestation. This early embryonic growth is linked to fetal size in mid-pregnancy and birthweight, highlighting the importance of first-trimester development.
Area of Science:
- Reproductive Biology
- Developmental Biology
- Prenatal Medicine
Background:
- Fetal growth impacts later-life health and disease risks.
- Research has historically focused on second and third trimesters, with limited first-trimester data.
- Understanding early embryonic growth is crucial for comprehensive prenatal care.
Purpose of the Study:
- To investigate human embryonic growth trajectories during the first trimester.
- To determine the association between first-trimester embryonic growth and subsequent fetal growth and birthweight.
Main Methods:
- Prospective periconception cohort study of 201 pregnancies before 8 weeks gestation.
- Weekly 3D ultrasound scans and crown-rump length (CRL) measurements using V-Scope software.
- Correlation analysis of CRL Z-scores with mid-pregnancy estimated fetal weight (EFW) and birthweight (BW).
Main Results:
- Embryonic CRL growth rate was constant (0.99 mm/day) until 9 weeks, then increased.
- Absolute growth rate accelerated between 9 and 10 weeks gestation.
- First-trimester CRL Z-scores strongly correlated with mid-pregnancy EFW (r=0.54-0.57) and with BW (r=0.15-0.17).
Conclusions:
- Embryonic growth rates change significantly in the first trimester, particularly around 9-10 weeks.
- First-trimester embryonic growth is associated with fetal growth and birthweight.
- Findings underscore the need for further research into early pregnancy care and monitoring.
Study Question:
How do human embryonic growth trajectories evolve in the first trimester, and is first-trimester embryonic growth associated with fetal growth and birthweight (BW)?
Summary Answer:
Human embryonic growth rates increase between 9 and 10 weeks of gestation and are associated with mid-pregnancy fetal growth and BW.
What Is Known Already:
Fetal growth is associated with health and disease risks in later life. Until recently, prenatal care and research have been focused predominantly on fetal growth in the second and third trimesters of pregnancy. Longitudinal first-trimester data remain scarce.
Study Design, Size, Duration:
We recruited 201 pregnancies before 8 weeks of gestation in a prospective periconception cohort study conducted in a tertiary center.
Participants/Materials, Setting, Methods:
We performed weekly 3D ultrasound scans from enrollment up to 13 weeks of gestation. To create embryonic growth trajectories, serial crown-rump length (CRL) measurements were performed using the V-Scope software in the BARCO I-Space. Mid-pregnancy fetal growth parameters and BW were obtained from medical records. Z-scores were calculated for CRL, mid-pregnancy estimated fetal weight (EFW) and BW. Associations between embryonic and fetal growth parameters were investigated using Pearson's correlation coefficients.
Main Results And The Role Of Chance:
During the early first trimester (up to 9 weeks of gestation), we observed a constant absolute mean embryonic CRL growth rate of 0.99 mm/day (SD 0.10), while the relative growth rate decreased. Between 9 and 10 weeks of gestation, the absolute growth rate increased, and during late first trimester (from 10 weeks of gestation onward), we observed a constant mean relative growth rate of 4.1% (SD 0.006) per day. Overall, early and late first-trimester median CRL Z-scores were strongly correlated with mid-pregnancy EFW (r overall/early/late = 0.57/0.57/0.54, P < 0.001) but only overall and late CRL Z-scores were correlated with BW (r overall = 0.15, P = 0.04; r early = 0.10, P = 0.17; r late = 0.17, P = 0.02).
Limitations, Reasons For Caution:
This study was conducted in a tertiary hospital. Therefore, future studies in other populations are warranted to confirm our results.
Wider Implications Of The Findings:
This study shows differences between early and late first-trimester embryonic growth coinciding with changes in intrauterine nourishment. The established associations between first-trimester embryonic growth and fetal size in mid-pregnancy and at birth emphasize that more research is warranted to establish the importance of these results for preconceptional and early pregnancy care.
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