Professional Documents
Culture Documents
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The need of a third trimester screening
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Impact on fetal programming
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Fatima Crispi, Eduard Gratacos
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www.medicinafetalbarcelona.org
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FIRST TRIMESTER ?
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screening of major
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pregnancy complications
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PE/IUGR PE/IUGR
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COMBINED 1T SCREENING
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milder disease
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heterogeneity
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DR 60-90% DR 20-60%
(PFR 10%) (FPR 10%)
Crispi UOG 2007, Poon Hypertens 209, Scazzochio AJOG 2013, Crovetto UOG 2013
prediction of PE & IUGR
EARLY-ONSET LATE-ONSET
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IMPORTANCE OF LATE PE/IUGR
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4-8 %
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PREECLAMPSIA
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1%
high prevalence
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PREECLAMPSIA + IUGR
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maternal
1% serious complications
cause of stillbirth in IUGR
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4-8 %
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fetal programming
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20 25 30 35 40
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www.fetalmedicinebarcelona.org/
Late-onset IUGR (>34w + normal UA Doppler)
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adverse perinatal outcome in 376 consecutive cases
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Figueras 2011
Biological programming and age
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IMPACT OF
ENVIRONMENT
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epigenetics
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FETAL
PROGRAMMING
1986 Barker (MRC Unit, Southampton, UK):
Coronary heart disease mortality rates
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FETAL CARDIOVASCULAR PROGRAMMING
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PRIMARY
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intrauterine CARDIOVASCULAR
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growth PROGRAMMING cardiovascular
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restriction disease in
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fetal cardiac adulthood
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dysfunction hypertension
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coronary disease
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stroke
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obesity
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diabetes
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impact of mild
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Barker BMJ 1986, Barker BMJ 1995 , Hecher Circulation 1995, Crispi AJOG 2008, Crispi Circulation 2010, Cruz FDT 2011, Crispi AJOG 2012
Exposure
Prematurity Infection
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Fetal growth restriction Genetics
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Neurocognitive disorders/Learning disabilities
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Overall ≥10%
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Estimated 2/3 of prenatal origin
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Non-specific disorders
5-8%
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Attention Deficit Hyperactivity
in Autism Spectrum Disorder
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Disorder 0.5-1%
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2-5%
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* * *
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100
w Bayley Score
impact of mild 80
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Figueras 2006-2011
Baschat 2009, 2011
20 Vohr 2004
Geva 2002-2011
Marsal 00-06
cognitive language motor socio-emot adaptive Visser 01-11
behavior
fetal programming
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placental
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coronary disease
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disease
hypertension
prematurity
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obesity
infection
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diabetes
IVF
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atention disorders
twins
autism spectrum
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IMPACT OF
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ENVIRONMENT
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OPPORTUNITY
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FOR
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CORRECTION
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•Predictive
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•Participatory
IDENTIFICATION OF RISK
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INDIVIDUAL
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BIOMARKERS
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INTERVENTION
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WINDOW OF
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OPPORTUNITY
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Fetus Child
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Functional / structural
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Problem evident
organ remodeling
screening for late PE
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32-34w
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THIRD TRIMESTER APPROACH
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maternal OR UtA Doppler OR biomarkers
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www.medicinafetalbarcelona.org/
screening for late IUGR
IMPROVING DETECTION: THE DEFINITION OF “RESTRICTION”
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screening for late IUGR
IMPROVING DETECTION: THE DEFINITION OF “RESTRICTION”
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Birthweight inverse relation with perinatal outcome AND brain-cardiac remodelling
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Mula 2012
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INTEGRATED THIRD TRIMESTER
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SCREENING FOR THE PREDICTION OF
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PERINATAL AND LONG-TERM OUTCOME
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IDENTIFICATION OF RISK
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INDIVIDUAL
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BIOMARKERS
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INTERVENTION
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WINDOW OF
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OPPORTUNITY
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Fetus Child
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Functional / structural
Problem evident
organ remodeling
thank you
fcrispi@clinic.ub.es gratacos@clinic.ub.es
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towards integrated third trimester
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screening in pregnancy
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in
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thank you
©
fcrispi@clinic.ub.es
gratacos@clinic.ub.es