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

I F Reijnders¹, A G M G J Mulders¹, M P H Koster¹

¹Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.

|April 6, 2021

Insights

Early first-trimester ultrasound markers of placental development are linked to embryonic and fetal growth. Monitoring placental vascular development in early pregnancy can improve antenatal care and birth outcomes.

Area of Science:

Obstetrics and Gynecology
Fetal Medicine
Medical Imaging

Background:

Impaired placental development is a primary cause of fetal growth restriction (FGR).
Early detection of FGR can significantly improve antenatal care and birth outcomes.
Understanding early placental development is crucial for predicting fetal growth.

Purpose of the Study:

To investigate serial first-trimester ultrasound markers of utero-placental (vascular) development.
To assess the association between these early markers and embryonic and fetal growth.
To explore potential sex-specific differences in these associations.

Main Methods:

Prospective cohort study of 214 pregnant women.
Three-dimensional power Doppler ultrasonography at 7, 9, and 11 weeks gestational age.
Measurement of placental volumes (PV), utero-placental vascular volume (uPVV), crown-rump length (CRL), and embryonic volume (EV).
Analysis of estimated fetal weight (EFW) and birth weight percentile (BW), stratified by fetal sex.

Main Results:

Placental volume (PV) trajectories positively correlated with CRL, EV, and EFW.
Utero-placental vascular volume (uPVV) trajectories positively correlated with CRL.
Sex-specific associations were observed, with girls showing stronger links between PV and growth parameters, and uPVV and birth weight; boys showed associations between uPVV and CRL.

Conclusions:

First-trimester utero-placental (vascular) development is significantly associated with embryonic and fetal growth.
These associations are modified by fetal sex, highlighting the importance of sex-specific monitoring.
Monitoring early placental development offers a promising approach for improving antenatal care and predicting fetal growth outcomes.

Read full analysis

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

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