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. 2023 Jan;58(1):35-45.
doi: 10.1002/ppul.26153. Epub 2022 Oct 11.

Fetal thoracic circumference in mid-pregnancy and infant lung function

Hrefna K Gudmundsdóttir  1   2 , Katarina Hilde  1   3 , Karen E S Bains  1   2 , Martin Färdig  4   5 , Guttorm Haugen  1   3 , Marissa LeBlanc  6 , Live S Nordhagen  2   7 , Björn Nordlund  4   5 , Eva M Rehbinder  1   8 , Håvard O Skjerven  1   2 , Anne C Staff  1   3 , Riyas Vettukattil  1   2 , Karin C L Carlsen  1   2
Affiliations

Fetal thoracic circumference in mid-pregnancy and infant lung function

Hrefna K Gudmundsdóttir et al. Pediatr Pulmonol. 2023 Jan.

Abstract

Background and aim: Impaired lung function in early infancy is associated with later wheeze and asthma, while fetal thoracic circumference (TC) predicts severity of neonatal lung hypoplasia. Exploring fetal origins of lung function in infancy, we aimed to determine if fetal TC in mid-pregnancy was associated with infant lung function.

Methods: From the prospective Scandinavian general population-based PreventADALL mother-child birth cohort, all 851 3-month-old infants with tidal flow-volume measurements in the awake state and ultrasound fetal size measures at 18 (min-max 16-22) weeks gestational age were included. Associations between fetal TC and time to peak tidal expiratory flow to expiratory time (tPTEF /tE ) were analyzed in linear regression models. To account for gestational age variation, we adjusted TC for simultaneously measured general fetal size, by head circumference (TC/HC), abdominal circumference (TC/AC), and femur length (TC/FL). Multivariable models were adjusted for maternal age, maternal asthma, pre-pregnancy body mass index, parity, nicotine exposure in utero, and infant sex.

Results: The infants (47.8% girls) were born at mean (SD) gestational age of 40.2 (1.30) weeks. The mean (SD) tPTEF /tE was 0.39 (0.08). The mean (SD) TC/HC was 0.75 (0.04), TC/AC 0.87 (0.04), and TC/FL 4.17 (0.26), respectively. Neither TC/HC nor TC/AC were associated with infant tPTEF /tE while a week inverse association was observed between TC/FL and tPTEF /tE ( β ^ $\hat{\beta }$ = -0.03, 95% confidence interval [-0.05, -0.007], p = 0.01).

Conclusion: Mid-pregnancy fetal TC adjusted for fetal head or abdominal size was not associated with tPTEF /tE in healthy, awake 3-month-old infants, while a weak association was observed adjusting for fetal femur length.

Keywords: PreventADALL; femur length; fetal size; infant lung function; infant sex; pregnancy; respiratory function test; tPTEF/tE; thoracic circumference; tidal breathing; tidal flow-volume loops; tidal volume; ultrasound.

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Conflict of interest statement

Marissa LeBlanc reports a speaking fee from MSD unrelated to the content of this study, Eva Maria Rehbinder has received honoraria for lectures from Sanofi Genzyme, Leo Pharma, Novartis, Norwegian Psoriasis and Eczema Association, and the Norwegian Asthma and Allergy Association and Karin C. L. Carlsen reports that her institution has received honorarium and travel costs from Thermo Fisher Scientific for international symposium participation. The remaining authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study population. From the PreventADALL mother–child birth cohort, all 851 infants from the Oslo study site with available tidal flow‐volume (TFV) measurement in the awake state at 3 months of age as well as mid‐pregnancy ultrasound measurements of fetal head circumference (HC) and/or femur length (FL) were included. To ensure independence of all participants, twin 2 was consequently excluded.
Figure 2
Figure 2
The variation in infant t PTEF/t E in relation to fetal TC/FL ratio. In the unadjusted model, the TC/FL ratio explained 1.0% of the variation in t PTEF/t E in all infants (R 2 = 0.010). R 2 for girls was 0.011 and R 2 for boys was 0.009. TC/FL, fetal thoracic circumference relative to femur length, a proxy for TC adjusted for gestational age at the time of ultrasound; t PTEF/t E, the ratio of time to peak tidal expiratory flow to expiratory time; Girls are marked with stars triangles and a whole regression line, boys are marked with dots and a broken regression line.
See this image and copyright information in PMC

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