Magnetic Resonance Imaging Clinical Trial
— FaPDiOfficial title:
Fetal Growth and Placental Function in Pregnancies Complicated by Diabetes
Verified date | July 2022 |
Source | Aalborg University Hospital |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational [Patient Registry] |
Diabetic pregnancies are often complicated by placental dysfunction with reduced transfer of oxygen from the mother to the fetus, which may compromise fetal growth and organ development. In diabetic pregnancies, hyperinsulinemia and hyperglycemia very often leads to fetal macrosomia. The combination of reduced placental oxygen transfer and increasing fetal demand due to fetal overgrowth may possess a particular risk of adverse pregnancy outcome. Current methods in the antenatal identification of placental dysfunction relies on estimates of fetal size and fetal wellbeing using ultrasound including Doppler flows measurements. These measurements are only indirect estimates of placental function, as no clinical method exists to assess placental function directly. In diabetic pregnancies, the estimates are further limited due to fetal overgrowth and unreliable Doppler. In addition, in diabetic pregnancies, intrauterine fetal weight estimates by ultrasound are inaccurate because of asymmetric fetal growth. Therefore, new accurate methods to assess placental function, fetal oxygenation and fetal growth in this particular group of high-risk pregnancies is highly needed. Early and precise identification of pathology in diabetes pregnancy may lead to an improved outcome in the offspring, as precise identification of pathology facilitates important obstetric decisions in regards to maternal antidiabetic treatment and timing of delivery. Resent research indicates that MRI is useful for this purpose. It is well described, that preeclampsia is associated with an increased maternal risk of cardiovascular disease later in life. Recent studies suggest, that pregestational subclinical cardiovascular dysfunction, in particular left ventricular dysfunction, may increase the risk of preeclampsia and fetal growth restriction during pregnancy. Cardiac MRI is a sensitive method to detect subclinical maternal cardiac dysfunction, which may be used in identification of high-risk pregnancies. In addition, the longitudinal design of this study allows for the investigation of cardiovascular changes during pregnancies in normal pregnancies and pregnancies complicated by diabetes. The overall aim of this study is to improve the antenatal fetal and maternal monitoring in diabetes pregnancies. Early and precise identification of pregnancy pathology provides a better basis for important obstetric decisions regarding antidiabetic treatment, monitoring intervals and timing of delivery, which leads to a better outcome for the mother and offspring. Hypothesis Project A: Placental function and fetal oxygenation in diabetic pregnancies estimated by T2* weighted placental and fetal MRI Aim: To investigate placental function and fetal oxygenation by longitudinal T2* weighted placental MRI and the association with pregnancy complications. Hypothesis: - Diabetic pregnancies are characterized by placental hypoxia (low T2* value) - Diabetic pregnancies are characterized by fetal hypoxia (low T2* value) - Fetal and placental hypoxia is a risk factor of placental related complications in pregnancy such as low birth weight, preterm delivery, acute cesarean sections and preeclampsia. Project B: Fetal growth and the growth of selected fetal organs in diabetic pregnancies estimated by longitudinal MRI volumetry Aim: To investigate growth velocity of the fetus and selected fetal organs and the correlation with pregnancy complications. Hypothesis: - Diabetic pregnancies are characterized by accelerated fetal growth in the third trimester - Diabetic pregnancies are characterized by asymmetric growth (reduced brain/liver-volume ratio) - Abnormal fetal growth is associated with dysregulated maternal diabetes. - Abnormal fetal growth is a risk factor of pregnancy complications such as; macrosomia, preterm delivery and acute cesarean sections. Project C: Maternal cardiac function in diabetic pregnancies estimated by MRI Aim: To investigate maternal cardiac function and the correlation with pregnancy complications such as preeclampsia and fetal growth restriction. Hypothesis: - Maternal cardiac function is altered in diabetes pregnancies when compared to normal pregnancies. - Impaired cardiac function (left ventricular dysfunction) is a risk factor of preeclampsia and fetal growth restriction.
Status | Enrolling by invitation |
Enrollment | 100 |
Est. completion date | October 31, 2023 |
Est. primary completion date | June 30, 2023 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | Female |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Age >18 years - Singleton pregnancy Exclusion Criteria: - Fetal malformation or abnormal karyotype - Maternal height from spine to chest > 43 cm (for technical reasons) - Sever claustrophobia or any other contradictions to MRI - Women who do not read or understand Danish |
Country | Name | City | State |
---|---|---|---|
Denmark | Aalborg University Hospital, Department of Obstetrics and Gynecology | Aalborg |
Lead Sponsor | Collaborator |
---|---|
Sidsel Linneberg Rathcke | Aarhus University Hospital, University of Nottingham |
Denmark,
Abramowicz JS, Barnett SB, Duck FA, Edmonds PD, Hynynen KH, Ziskin MC. Fetal thermal effects of diagnostic ultrasound. J Ultrasound Med. 2008 Apr;27(4):541-59; quiz 560-3. Review. — View Citation
Avni R, Neeman M, Garbow JR. Functional MRI of the placenta--From rodents to humans. Placenta. 2015 Jun;36(6):615-22. doi: 10.1016/j.placenta.2015.04.003. Epub 2015 Apr 17. Review. — View Citation
Baker PN, Johnson IR, Harvey PR, Gowland PA, Mansfield P. A three-year follow-up of children imaged in utero with echo-planar magnetic resonance. Am J Obstet Gynecol. 1994 Jan;170(1 Pt 1):32-3. — View Citation
Baschat AA. Fetal responses to placental insufficiency: an update. BJOG. 2004 Oct;111(10):1031-41. Review. — View Citation
Bouyssi-Kobar M, du Plessis AJ, Robertson RL, Limperopoulos C. Fetal magnetic resonance imaging: exposure times and functional outcomes at preschool age. Pediatr Radiol. 2015 Nov;45(12):1823-30. doi: 10.1007/s00247-015-3408-7. Epub 2015 Jul 9. — View Citation
Chavhan GB, Babyn PS, Thomas B, Shroff MM, Haacke EM. Principles, techniques, and applications of T2*-based MR imaging and its special applications. Radiographics. 2009 Sep-Oct;29(5):1433-49. doi: 10.1148/rg.295095034. Review. — View Citation
Clements H, Duncan KR, Fielding K, Gowland PA, Johnson IR, Baker PN. Infants exposed to MRI in utero have a normal paediatric assessment at 9 months of age. Br J Radiol. 2000 Feb;73(866):190-4. — View Citation
Derwig I, Lythgoe DJ, Barker GJ, Poon L, Gowland P, Yeung R, Zelaya F, Nicolaides K. Association of placental perfusion, as assessed by magnetic resonance imaging and uterine artery Doppler ultrasound, and its relationship to pregnancy outcome. Placenta. 2013 Oct;34(10):885-91. doi: 10.1016/j.placenta.2013.07.006. Epub 2013 Aug 9. — View Citation
Evers IM, de Valk HW, Mol BW, ter Braak EW, Visser GH. Macrosomia despite good glycaemic control in Type I diabetic pregnancy; results of a nationwide study in The Netherlands. Diabetologia. 2002 Nov;45(11):1484-9. Epub 2002 Sep 25. — View Citation
Evers IM, Nikkels PG, Sikkema JM, Visser GH. Placental pathology in women with type 1 diabetes and in a control group with normal and large-for-gestational-age infants. Placenta. 2003 Sep-Oct;24(8-9):819-25. — View Citation
Glover P, Hykin J, Gowland P, Wright J, Johnson I, Mansfield P. An assessment of the intrauterine sound intensity level during obstetric echo-planar magnetic resonance imaging. Br J Radiol. 1995 Oct;68(814):1090-4. — View Citation
Gortazar L, Goday A, Flores-Le Roux JA, Sarsanedas E, Payà A, Mañé L, Pedro-Botet J, Benaiges D. Trends in prevalence of pre-existing diabetes and perinatal outcomes: a large, population-based study in Catalonia, Spain, 2006-2015. BMJ Open Diabetes Res Care. 2020 Oct;8(1). pii: e001254. doi: 10.1136/bmjdrc-2020-001254. — View Citation
Gunderson EP, Chiang V, Pletcher MJ, Jacobs DR, Quesenberry CP, Sidney S, Lewis CE. History of gestational diabetes mellitus and future risk of atherosclerosis in mid-life: the Coronary Artery Risk Development in Young Adults study. J Am Heart Assoc. 2014 Mar 12;3(2):e000490. doi: 10.1161/JAHA.113.000490. — View Citation
Gyselaers W, Thilaganathan B. Preeclampsia: a gestational cardiorenal syndrome. J Physiol. 2019 Sep;597(18):4695-4714. doi: 10.1113/JP274893. Epub 2019 Aug 14. Review. — View Citation
Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements--a prospective study. Am J Obstet Gynecol. 1985 Feb 1;151(3):333-7. — View Citation
Hammoud NM, Visser GH, Peters SA, Graatsma EM, Pistorius L, de Valk HW. Fetal growth profiles of macrosomic and non-macrosomic infants of women with pregestational or gestational diabetes. Ultrasound Obstet Gynecol. 2013 Apr;41(4):390-7. doi: 10.1002/uog.11221. Epub 2013 Mar 11. — View Citation
Hand JW, Li Y, Thomas EL, Rutherford MA, Hajnal JV. Prediction of specific absorption rate in mother and fetus associated with MRI examinations during pregnancy. Magn Reson Med. 2006 Apr;55(4):883-93. — View Citation
International Commission on Non-Ionizing Radiation Protection (ICNIRP). Amendment to the ICNIRP "Statement on medical magnetic resonance (MR) procedures: protection of patients". Health Phys. 2009 Sep;97(3):259-61. doi: 10.1097/HP.0b013e3181aff9eb. — View Citation
International Commission on Non-Ionizing Radiation Protection (ICNIRP). Guidelines for limiting exposure to time-varying electric and magnetic fields (1 Hz to 100 kHz). Health Phys. 2010 Dec;99(6):818-36. doi: 10.1097/HP.0b013e3181f06c86. Erratum in: Health Phys. 2011 Jan;100(1):112. — View Citation
International Commission on Non-Ionizing Radiation Protection (ICNIRP). Medical magnetic resonance (MR) procedures: protection of patients. Health Phys. 2004 Aug;87(2):197-216. Review. — View Citation
Jensen DM, Damm P, Moelsted-Pedersen L, Ovesen P, Westergaard JG, Moeller M, Beck-Nielsen H. Outcomes in type 1 diabetic pregnancies: a nationwide, population-based study. Diabetes Care. 2004 Dec;27(12):2819-23. — View Citation
Jirkovská M, Kucera T, Dvoráková V, Jadrnícek M, Moravcová M, Žižka Z, Krejcí V. Impact of maternal diabetes type 1 on proliferative potential, differentiation and apoptotic activity in villous capillaries of term placenta. Placenta. 2016 Apr;40:1-7. doi: 10.1016/j.placenta.2016.02.003. Epub 2016 Feb 9. — View Citation
Kangarlu A, Burgess RE, Zhu H, Nakayama T, Hamlin RL, Abduljalil AM, Robitaille PM. Cognitive, cardiac, and physiological safety studies in ultra high field magnetic resonance imaging. Magn Reson Imaging. 1999 Dec;17(10):1407-16. — View Citation
Khong TY, Mooney EE, Ariel I, Balmus NC, Boyd TK, Brundler MA, Derricott H, Evans MJ, Faye-Petersen OM, Gillan JE, Heazell AE, Heller DS, Jacques SM, Keating S, Kelehan P, Maes A, McKay EM, Morgan TK, Nikkels PG, Parks WT, Redline RW, Scheimberg I, Schoots MH, Sebire NJ, Timmer A, Turowski G, van der Voorn JP, van Lijnschoten I, Gordijn SJ. Sampling and Definitions of Placental Lesions: Amsterdam Placental Workshop Group Consensus Statement. Arch Pathol Lab Med. 2016 Jul;140(7):698-713. doi: 10.5858/arpa.2015-0225-CC. Epub 2016 May 25. — View Citation
Kinsley B. Achieving better outcomes in pregnancies complicated by type 1 and type 2 diabetes mellitus. Clin Ther. 2007;29 Suppl D:S153-60. doi: 10.1016/j.clinthera.2007.12.015. Review. — View Citation
Laurini RN, Visser GH, van Ballegooie E, Schoots CJ. Morphological findings in placentae of insulin-dependent diabetic patients treated with continuous subcutaneous insulin infusion (CSII). Placenta. 1987 Mar-Apr;8(2):153-65. — View Citation
Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999-2005. Diabetes Care. 2008 May;31(5):899-904. doi: 10.2337/dc07-2345. Epub 2008 Jan 25. — View Citation
Lorenz CH, Walker ES, Morgan VL, Klein SS, Graham TP Jr. Normal human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging. J Cardiovasc Magn Reson. 1999;1(1):7-21. — View Citation
Mayhew TM, Sørensen FB, Klebe JG, Jackson MR. Growth and maturation of villi in placentae from well-controlled diabetic women. Placenta. 1994 Jan;15(1):57-65. — View Citation
Mayhew TM. Enhanced fetoplacental angiogenesis in pre-gestational diabetes mellitus: the extra growth is exclusively longitudinal and not accompanied by microvascular remodelling. Diabetologia. 2002 Oct;45(10):1434-9. Epub 2002 Sep 5. — View Citation
Michel SC, Rake A, Keller TM, Huch R, König V, Seifert B, Marincek B, Kubik-Huch RA. Original report. Fetal cardiographic monitoring during 1.5-T MR imaging. AJR Am J Roentgenol. 2003 Apr;180(4):1159-64. — View Citation
Moore RJ, Issa B, Tokarczuk P, Duncan KR, Boulby P, Baker PN, Bowtell RW, Worthington BS, Johnson IR, Gowland PA. In vivo intravoxel incoherent motion measurements in the human placenta using echo-planar imaging at 0.5 T. Magn Reson Med. 2000 Feb;43(2):295-302. — View Citation
Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: A large, population-based study. Diabetes Care. 2009 Nov;32(11):2005-9. doi: 10.2337/dc09-0656. Epub 2009 Aug 12. — View Citation
Poutamo J, Partanen K, Vanninen R, Vainio P, Kirkinen P. MRI does not change fetal cardiotocographic parameters. Prenat Diagn. 1998 Nov;18(11):1149-54. — View Citation
Price DL, De Wilde JP, Papadaki AM, Curran JS, Kitney RI. Investigation of acoustic noise on 15 MRI scanners from 0.2 T to 3 T. J Magn Reson Imaging. 2001 Feb;13(2):288-93. — View Citation
Rolnik DL, Wright D, Poon LC, O'Gorman N, Syngelaki A, de Paco Matallana C, Akolekar R, Cicero S, Janga D, Singh M, Molina FS, Persico N, Jani JC, Plasencia W, Papaioannou G, Tenenbaum-Gavish K, Meiri H, Gizurarson S, Maclagan K, Nicolaides KH. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017 Aug 17;377(7):613-622. doi: 10.1056/NEJMoa1704559. Epub 2017 Jun 28. — View Citation
Salvesen DR, Higueras MT, Mansur CA, Freeman J, Brudenell JM, Nicolaides KH. Placental and fetal Doppler velocimetry in pregnancies complicated by maternal diabetes mellitus. Am J Obstet Gynecol. 1993 Feb;168(2):645-52. — View Citation
Seraphim A, Knott KD, Augusto J, Bhuva AN, Manisty C, Moon JC. Quantitative cardiac MRI. J Magn Reson Imaging. 2020 Mar;51(3):693-711. doi: 10.1002/jmri.26789. Epub 2019 May 20. Review. — View Citation
Shah BR, Retnakaran R, Booth GL. Increased risk of cardiovascular disease in young women following gestational diabetes mellitus. Diabetes Care. 2008 Aug;31(8):1668-9. doi: 10.2337/dc08-0706. Epub 2008 May 16. — View Citation
Sheiner E, Freeman J, Abramowicz JS. Acoustic output as measured by mechanical and thermal indices during routine obstetric ultrasound examinations. J Ultrasound Med. 2005 Dec;24(12):1665-70. — View Citation
Siauve N, Chalouhi GE, Deloison B, Alison M, Clement O, Ville Y, Salomon LJ. Functional imaging of the human placenta with magnetic resonance. Am J Obstet Gynecol. 2015 Oct;213(4 Suppl):S103-14. doi: 10.1016/j.ajog.2015.06.045. Review. — View Citation
Staff AC, Redman CW, Williams D, Leeson P, Moe K, Thilaganathan B, Magnus P, Steegers EA, Tsigas EZ, Ness RB, Myatt L, Poston L, Roberts JM; Global Pregnancy Collaboration (CoLab). Pregnancy and Long-Term Maternal Cardiovascular Health: Progress Through Harmonization of Research Cohorts and Biobanks. Hypertension. 2016 Feb;67(2):251-60. doi: 10.1161/HYPERTENSIONAHA.115.06357. Epub 2015 Dec 14. Review. — View Citation
Strizek B, Jani JC, Mucyo E, De Keyzer F, Pauwels I, Ziane S, Mansbach AL, Deltenre P, Cos T, Cannie MM. Safety of MR Imaging at 1.5 T in Fetuses: A Retrospective Case-Control Study of Birth Weights and the Effects of Acoustic Noise. Radiology. 2015 May;275(2):530-7. doi: 10.1148/radiol.14141382. Epub 2015 Jan 7. — View Citation
Tee LM, Kan EY, Cheung JC, Leung WC. Magnetic resonance imaging of the fetal brain. Hong Kong Med J. 2016 Jun;22(3):270-8. doi: 10.12809/hkmj154678. Epub 2016 Apr 22. Review. — View Citation
Vonck S, Staelens AS, Bollen I, Broekx L, Gyselaers W. Why non-invasive maternal hemodynamics assessment is clinically relevant in early pregnancy: a literature review. BMC Pregnancy Childbirth. 2016 Oct 12;16(1):302. Review. — View Citation
Yu L, Zeng XL, Cheng ML, Yang GZ, Wang B, Xiao ZW, Luo X, Zhang BF, Xiao DW, Zhang S, Liu HJ, Hu YX, Lei HK, Li QF, Wang ZR. Quantitative assessment of the effect of pre-gestational diabetes and risk of adverse maternal, perinatal and neonatal outcomes. Oncotarget. 2017 May 11;8(37):61048-61056. doi: 10.18632/oncotarget.17824. eCollection 2017 Sep 22. — View Citation
* Note: There are 46 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Abnormal birth weight | Birth weight below or above normal index for gestational age (-22% - +22%) | At birth | |
Primary | Preterm delivery | Delivery before gestational age 37+0 | At birth | |
Primary | Cesarean sections | Any elective or acute cesarean section | At birth | |
Primary | Preeclampsia | Any degree of preeclamsia / eclampsia og HELLP | 30 weeks before birth or 5 weeks after birth | |
Primary | Placental pathology | Any abnormal placenta pathology | Within 1 year after birth |
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