Fetal Care Research Foundation

Background & objectives The prevalence of gestational diabetes mellitus (GDM) is known to be high among South Asians. However, there is no national study on prevalence of GDM in India and few data comparing prevalence of GDM in early pregnancy (Early GDM) and late pregnancy (Late GDM). Methods This is an analysis of pregnant women who participated in the nationally representative Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. Of the 1,206 pregnant women 1,032 who underwent oral glucose tolerance test (OGTT) or had fasting blood glucose measurement and did not have overt diabetes, were included in this study. GDM was diagnosed using the NICE criteria. GDM was classified as Early GDM if diagnosed before 20 wk of gestation and Late GDM if diagnosed ≥ 20 wk of gestation, Results The weighted national prevalence of GDM in India was 22.4 per cent (95% CI: 16.7-28%) with no significant urban rural differences (24.2% vs. 21.6%, NS). The prevalence of Early GDM and Late GDM were 19.2 per cent (9.8-28.7%) and 23.4 per cent (16.7-30.2%), respectively. Central India had the highest prevalence of GDM at 32.9 per cent (17.9-48%), and West India, the lowest at 16 per cent (3.1-29.3%). High systolic blood pressure and family history of diabetes were independently associated with risk of GDM. Interpretation & conclusions Nearly one in four pregnant women in India have GDM with regional variability. The prevalence of Early GDM is also high. Thus, there is a need for screening of all pregnant women for GDM starting in early pregnancy.

Abstract Background Arterial stiffness independently predicts cardiovascular mortality and morbidity. It is shown to be increased in vascular mediated conditions, such as preeclampsia and foetal growth restriction. ARTSENS Plus device assesses arterial stiffness and is validated in older populations. The study aimed to validate its use for measuring arterial stiffness in pregnant women by comparing it with SphygmoCor XCEL as a reference standard. Methods This cross-sectional study was conducted in two centres in the south-eastern region of India, recruiting 147 pregnant women. Arterial stiffness was assessed by the carotid–femoral pulse wave velocity (cfPWV) using both devices and validated according to the ‘2024 recommendations for validation of non-invasive arterial pulse wave velocity measurement devices.’ Bland–Altman plot and coefficient of variation of the test–retest reproducibility were calculated. Results The mean age of the included women was 28 ± 4 years, and their mean gestational age was 24.6 ± 9.5 weeks. The mean difference in cfPWV values obtained from SphygmoCor XCEL and ARTSENS Plus was 0.16 ± 0.54 m/s ( p = 0.12) with a measurement error of 0.85 m/s, indicating good accuracy of the ARTSENS plus device in assessing arterial stiffness. Both devices demonstrated good intra-observer reproducibility, with coefficients of variation of 2.53% for ARTSENS Plus and 3.48% for SphygmoCor XCEL. Conclusions ARTSENS Plus assesses arterial stiffness with good accuracy and intra-observer reproducibility when validated amongst pregnant women.

The inferior colliculus (IC) is an important midbrain station of the auditory pathway, as well as an important hub of multisensory integration. The adult mammalian IC can be subdivided into three nuclei, with distinct cyto- and myeloarchitectonical profiles and distinct calcium binding proteins expression patterns. Despite several studies about its structural and functional development, the knowledge about the human fetal IC is rather limited. In this paper we first systematically describe the histological development of the human fetal IC and its subparts in five stages of the second trimester of pregnancy: 15 gestation weeks (GW), 18 GW, 21 GW, 24 GW, and 27 GW. We 3D reconstruct and calculate the volumetric growth of IC from one stage to another, which increases from 12.85 mm3 at 15 GW to 34.27 mm3 at 27 GW in the left hemisphere. The volumetric changes in the IC were further evaluated at the cellular level using serial Nissl-stained sections, as well as glial fibrillary acidic proteins (GFAP) and calretinin immunohistochemistry. We identify stellate-like and round neurons in the central nucleus of the IC (CNIC) at 24 GW and 27 GW, comparable to the adult human IC. Novel in this study, we investigate the differential calretinin expression patterns in the IC subparts, from 15 GW to 27 GW. CR labeling is identified mainly in the cortical IC rather than in the central nucleus. Furthermore, using GFAP, we describe the radial glial fibers patterns in IC, which are dominant at 18 GW and gradually taper off at later developmental stages. Finally, we describe the development of astroglia in each of the five developmental stages. All these results indicate that the human fetal IC development and cellular maturation occur in two major stages during the second trimester.

Large scale applicability of nasal bone (NB) as a screening tool for trisomy 21 (T21) has been difficult in low-risk populations. We assessed the additive value of first trimester NB assessment to detect T21 in our population. This retrospective analysis included all structurally normal fetuses where NB was assessed, nuchal translucency (NT) was <3.5mm and outcomes were available; over 5 years in a tertiary fetal medicine centre. First trimester combined screening (FTS) results were documented with a cut-off of ≥ 1:250 as high-risk. Percentage of fetuses with or without unossified nasal bone (UNB), fetuses with UNB with or without other aneuploidy markers, and T21 fetuses in each group were determined. The number of invasive procedures required to pick up one T21 fetus in the cohort with UNB was also evaluated. We included 2,620 structurally normal fetuses, of which 55 had T21. 45.7% of the total study group had UNB. The highest percentage of T21 was seen when UNB was associated with NT >3mm (33.3%) or with other aneuploidy markers (26.7%). Only 1.6% fetuses with an isolated UNB had T21. 1.9% fetuses with UNB and FTS positive result had T21, and only 0.3% of fetuses with UNB and FTS negative had T21. This percentage was no different than in the group with NB present (FTS Positive – 1.5% T21, FTS Negative – 0.3% T21). The pick up of T21 in the isolated UNB group was 1 per 61 invasives. If maternal age was <35 years, the pick-up would be 1 per 81. When isolated UNB had an FTS positive result, the pick up of T21 was 1 per 53. In isolated UNB with FTS negative result, only 1 T21 would be picked up per 290 procedures, similar to that in FTS negative fetuses with NB present and no aneuploidy markers (1 in 319). Isolated first trimester UNB does not increase T21 risk significantly in our population. This is even lesser with low risk FTS. The number of invasives needed to pick up one T21 in the isolated UNB cohort is much higher (1 per 53) than that needed for FTS positive (1 per 25).

Cellular-level anatomical data from early fetal brain are sparse yet critical to the understanding of neurodevelopmental disorders. We characterize the organization of the human cerebral cortex between 13 and 15 gestational weeks using high-resolution whole-brain histological data sets complimented with multimodal imaging. We observed the heretofore underrecognized, reproducible presence of infolds on the mesial surface of the cerebral hemispheres. Of note at this stage, when most of the cerebrum is occupied by lateral ventricles and the corpus callosum is incompletely developed, we postulate that these mesial infolds represent the primordial stage of cingulate, callosal, and calcarine sulci, features of mesial cortical development. Our observations are based on the multimodal approach and further include histological three-dimensional reconstruction that highlights the importance of the plane of sectioning. We describe the laminar organization of the developing cortical mantle, including these infolds from the marginal to ventricular zone, with Nissl, hematoxylin and eosin, and glial fibrillary acidic protein (GFAP) immunohistochemistry. Despite the absence of major sulci on the dorsal surface, the boundaries among the orbital, frontal, parietal, and occipital cortex were very well demarcated, primarily by the cytoarchitecture differences in the organization of the subplate (SP) and intermediate zone (IZ) in these locations. The parietal region has the thickest cortical plate (CP), SP, and IZ, whereas the orbital region shows the thinnest CP and reveals an extra cell-sparse layer above the bilaminar SP. The subcortical structures show intensely GFAP-immunolabeled soma, absent in the cerebral mantle. Our findings establish a normative neurodevelopment baseline at the early stage.

Abstract Fetal dural sinus malformation is a rare, congenital cerebrovascular malformation which requires proper diagnosis and follow-up. Here, we report a case of dural sinus malformation with partial thrombosis diagnosed in the second trimester by sonography and fetal magnetic resonance imaging, with subsequent spontaneous regression.

Abstract Posterior urethral valves (PUV) are the commonest cause of lower urinary tract obstruction detected during the antenatal and immediate postnatal period in male fetuses. Treatment options for PUV during the antenatal period include percutaneous vesico-amniotic shunt, fetoscopic fulguration of the valve and open fetal cystostomy. We report two cases of fetal cystoscopic laser valvotomy with fairly similar pre-operative profiles but contrasting postnatal outcomes, which re-iterates the fact that case selection in such cases continues to be a challenge. These are the first case reports on fetoscopic laser valvotomy in India to the best of our knowledge.

Abstract To evaluate the impact of discordant Crown Rump Length (CRL) noted in the first trimester on the outcome of monochorionic (MC) and dichorionic (DC) twin gestations and to establish it's role as a predictor of adverse outcomes. This was a retrospective case control study carried out at a tertiary fetal medicine centre in South India between June 2013 and May 2018. Cases were obtained from the database of the centre. All viable monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies scanned between 11 and 14 weeks gestational age after excluding fetuses with structural abnormalities were included in the study. The impact of discordant CRL ≥ 10% on the outcomes of twins was evaluated. Among 2627 twin pregnancies 2298 (87.5%) were dichorionic and 329 (12.5%) were monochorionic. Among the DC twin pregnancies CRL discordance ≥ 10% was found in 124 (5.4%) while 2174 (94.6%) were concordant. Among the MC twin pregnancies CRL discordance ≥ 10% was found in 20 (6.1%) while 309 (93.9%) were concordant. In DC twin pregnancies we found a significant association between CRL discordance of ≥ 10% and fetal loss (p = 0.001), mean GA at delivery (p = 0.002) and mean birth weight (p = 0.04). However in MC twin pregnancies we did not find any association between discordant CRL and adverse outcomes. When the CRL discordance cutoff was increased to ≥ 16% (95th centile), there was a significant increase in the aforementioned adverse outcomes in DC twin pregnancies while in MC twin pregnancies there was a significant increase in fetal loss (p = 0.027). To evaluate CRL discordance as a predictor of adverse outcomes, receiver operating curves were created for each outcome studied. But they failed to show the predictive accuracy in both CRL ≥ 10% and CRL ≥ 16% groups. CRL discordance in DC twin pregnancies are more commonly associated with adverse outcomes than MC twin pregnancies and it significantly increases when CRL C 16% (95th centile) was used as cutoff. Hence CRL discordance of ≥ 16% should be set as the cutoff to identify pregnancies at risk. However we reiterate that discordant CRL, irrespective of the cutoff used, is not a robust predictor of adverse outcomes.