Longitudinal adrenal gland measurements and growth trajectories as risk markers for late preterm delivery
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(2020) 20:570
RESEARCH ARTICLE
Open Access
Longitudinal adrenal gland measurements and growth trajectories as risk markers for late preterm delivery Janina Goletzke1, Mirja Pagenkemper1, Christian Wiessner2, Franziska Rüber1, Petra Arck1, Kurt Hecher1 and Anke Diemert1*
Abstract Background: The fetal adrenal gland receives rising awareness as a predictor of spontaneous preterm birth. We hereby provide longitudinal growth assessments of the fetal adrenal gland in a low risk population with an additional focus on trajectories in fetuses born preterm. Methods: Fetal adrenal gland was assessed via transabdominal ultrasound at gestational weeks (gw) 24–26, 28–30, and 34–36 in a low-risk pregnancy cohort. Longitudinal trajectories of the total gland and the mark (so called fetal zone) as well as ratio of fetal zone width/ total widths (w/W) were analyzed using repeated ANOVA analyses. To compare trajectories of the ratio w/W for preterm and term fetuses respectively, as well as women with and without clinical signs of preterm labor, the propensity score method was applied. Results: Fetal zone width increased over the course of pregnancy (p < 0.0001), while the ratio w/W decreased (p < 0.0001) (n = 327). Comparing the trajectories of the ratio w/W in fetuses born preterm (n = 11) with propensity-score matched term born fetuses (n = 22), a decrease between gw 24–26 and 28–30 was observed in both groups, which continued to decrease for the term born fetuses. However, in preterm born fetuses, the ratio increased above the term born values at gw 34–36. Conclusion: Our study provides for the first time longitudinal growth data on the fetal adrenal gland and supports the hypothesis that fetal zone enlargement is associated with preterm birth which could play an important role in risk-prediction. Keywords: Preterm labour, Adrenal gland, Fetal zone, Fetal adrenal gland, Preterm birth, HPA-axis, Fetal ultrasound
Background Preterm delivery (< 37 weeks) still remains the leading cause of perinatal morbidity and mortality in developed countries of which the majority of cases are late preterm infants (occurring between 34 and 37 weeks) [1]. Although the detailed mechanisms of the parturition process and preterm birth remains elusive, intervention * Correspondence: [email protected] 1 Department of Obstetrics and Fetal Medicine, University Medical-Centre Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany Full list of author information is available at the end of the article
strategies have recently been introduced [2–4]. Unfortunately, we still lack accurate predictors of preterm birth [5]. It is well known, that the fetal adrenal gland plays an important role in parturition [6]. As part of the fetal adrenocortical axis it is involved in the general fetal stress response [7–10]. A number of cross-sectional acquired reference ranges have been proposed for total adrenal gland size [11–13] and the distinction between the adrenal mark (called fetal zone) and the adrenal cortex [14, 15]. However, none of them was based on re
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