Second trimester fetal thymus size in association to preterm birth.
fetal diagnosis
pregnancy
prenatal ultrasonography
preterm birth
second trimester
ultrasound
Journal
Journal of perinatal medicine
ISSN: 1619-3997
Titre abrégé: J Perinat Med
Pays: Germany
ID NLM: 0361031
Informations de publication
Date de publication:
23 Feb 2022
23 Feb 2022
Historique:
received:
23
02
2021
accepted:
04
08
2021
pubmed:
29
10
2021
medline:
5
4
2022
entrez:
28
10
2021
Statut:
epublish
Résumé
The aim of this study was to compare the second trimester thymus-thorax-ratio (TTR) between fetuses born preterm (study group) and those born after 37 weeks of gestation were completed (control group). This study was conducted as a retrospective evaluation of the ultrasound images of 492 fetuses in the three vessel view. The TTR was defined as the quotient of a.p. thymus diameter and a.p. thoracic diameter. Fetuses that were preterm showed larger TTR (p<0.001) the second trimester than those born after 37 weeks of gestation were completed. The sensitivity of a binary classifier based on TTR for predicting preterm birth (PTB) was 0.792 and the specificity 0.552. In our study, fetuses affected by PTB showed enlarged thymus size. These findings led us to hypothesize, that inflammation and immunomodulatory processes are altered early in pregnancies affected by PTB. However, TTR alone is not able to predict PTB.
Identifiants
pubmed: 34710316
pii: jpm-2021-0065
doi: 10.1515/jpm-2021-0065
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
144-149Informations de copyright
© 2021 Walter de Gruyter GmbH, Berlin/Boston.
Références
Blencowe, H, Cousens, S, Oestergaard, MZ, Chou, D, Moller, A-B, Narwal, R, et al.. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012;379:2162–72. https://doi.org/10.1016/s0140-6736(12)60820-4.
MV Kinney, JLECH. March of Dimes, PMNCH, Save the Children, WHO. Born Too Soon: the global action report on preterm birth. World Heal Organ 2012;13:1–126.
Stoll, BJ, Hansen, NI, Bell, EF, Shankaran, S, Laptook, AR, Walsh, MC, et al.. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010;126:443–56. https://doi.org/10.1542/peds.2009-2959.
Markopoulou, P, Papanikolaou, E, Analytis, A, Zoumakis, E, Siahanidou, T. Preterm birth as a risk factor for metabolic syndrome and cardiovascular disease in adult life: a systematic review and meta-analysis. J Pediatr 2019;210:69–80.e5. https://doi.org/10.1016/j.jpeds.2019.02.041.
Mericq, V, Martinez-Aguayo, A, Uauy, R, Iñiguez, G, Van der Steen, M, Hokken-Koelega, A. Long-term metabolic risk among children born premature or small for gestational age. Nat Rev Endocrinol 2017;13:50–62. https://doi.org/10.1038/nrendo.2016.127.
Singer, LT, Salvator, A, Guo, S, Collin, M, Lilien, L, Baley, J. Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. JAMA 1999;281:799. https://doi.org/10.1001/jama.281.9.799.
Frey, HA, Klebanoff, MA. The epidemiology, etiology, and costs of preterm birth. Semin Fetal Neonatal Med 2016;21:68–73. https://doi.org/10.1016/j.siny.2015.12.011.
Goldenberg, RL, Culhane, JF, Iams, JD, Romero, R. Epidemiology and causes of preterm birth. Lancet 2008;371:75–84. https://doi.org/10.1016/s0140-6736(08)60074-4.
Glover, AV, Manuck, TA. Screening for spontaneous preterm birth and resultant therapies to reduce neonatal morbidity and mortality: a review. Semin Fetal Neonatal Med 2018;23:126–32. https://doi.org/10.1016/j.siny.2017.11.007.
Farley, AM, Morris, LX, Vroegindeweij, E, Depreter, MLG, Vaidya, H, Stenhouse, FH, et al.. Dynamics of thymus organogenesis and colonization in early human development. Development 2013;140:2015–26. https://doi.org/10.1242/dev.087320.
Zúñiga-Pflücker, JC. T-cell development made simple. Nat Rev Immunol 2004;4:67–72. https://doi.org/10.1038/nri1257.
Felker, RE, Cartier, MS, Emerson, DS, Brown, DL. Ultrasound of the fetal thymus. J Ultrasound Med 1989;8:669–73. https://doi.org/10.7863/jum.1989.8.12.669.
Yoo, S-J, Lee, Y-H, Kim, ES, Ryu, HM, Kim, MY, Choi, H-K, et al.. Three-vessel view of the fetal upper mediastinum: an easy means of detecting abnormalities of the ventricular outflow tracts and great arteries during obstetric screening. Ultrasound Obstet Gynecol 1997;9:173–82. https://doi.org/10.1046/j.1469-0705.1997.09030173.x.
Tangshewinsirikul, C, Panburana, P. Sonographic measurement of fetal thymus size in uncomplicated singleton pregnancies. J Clin Ultrasound 2017;45:150–9. https://doi.org/10.1002/jcu.22419.
Dörnemann, R, Koch, R, Möllmann, U, Falkenberg, MK, Möllers, M, Klockenbusch, W, et al.. Fetal thymus size in pregnant women with diabetic diseases. J Perinat Med 2017;45:595–601. https://doi.org/10.1515/jpm-2016-0400.
Gasthaus, CL, Schmitz, R, Hammer, K, Oelmeier De Murcia, K, Falkenberg, MK, Braun, J, et al.. Influence of maternal HIV infection on fetal thymus size. J Perinat Med 2019;48:67–73. https://doi.org/10.1515/jpm-2019-0060.
Warby, AC, Amler, S, Jacobi, AM, Hammer, K, Möllmann, U, Falkenberg, MK, et al.. Imaging of fetal thymus in pregnant women with rheumatic diseases. J Perinat Med 2014;42:635–9. https://doi.org/10.1515/jpm-2013-0314.
Ekin, A, Gezer, C, Taner, CE, Solmaz, U, Gezer, NS, Ozeren, M. Prognostic value of fetal thymus size in intrauterine growth restriction. J Ultrasound Med 2016;35:511–7. https://doi.org/10.7863/ultra.15.05039.
Romero, R, Dey, SK, Fisher, SJ. Preterm labor: one syndrome, many causes. Science 2014;345:760–5. https://doi.org/10.1126/science.1251816.
Cho, JY, Min, JY, Lee, Y-H, McCrindle, B, Hornberger, LK, Yoo, S-J. Diameter of the normal fetal thymus on ultrasound. Ultrasound Obstet Gynecol 2007;29:634–8. https://doi.org/10.1002/uog.3979.
Brandt, JS, Bastek, JA, Wang, E, Purisch, S, Schwartz, N. Second-trimester sonographic thymus measurements are not associated with preterm birth and other adverse obstetric outcomes. J Ultrasound Med 2016;35:989–97. https://doi.org/10.7863/ultra.15.06095.
Mohamed, N, Eviston, DP, Quinton, AE, Benzie, RJ, Kirby, AC, Peek, MJ, et al.. Smaller fetal thymuses in pre-eclampsia: a prospective cross-sectional study. Ultrasound Obstet Gynecol 2011;37:410–5. https://doi.org/10.1002/uog.8953.
Eviston, DP, Quinton, AE, Benzie, RJ, Peek, MJ, Martin, A, Nanan, RK. Impaired fetal thymic growth precedes clinical preeclampsia: a case–control study. J Reprod Immunol 2012;94:183–9. https://doi.org/10.1016/j.jri.2012.04.001.
Hu, M, Eviston, D, Hsu, P, Mariño, E, Chidgey, A, Santner-Nanan, B, et al.. Decreased maternal serum acetate and impaired fetal thymic and regulatory T cell development in preeclampsia. Nat Commun 2019;10:3031. https://doi.org/10.1038/s41467-019-10703-1.
Ghalandarpoor-Attar, SN, Borna, S, Ghalandarpoor-Attar, SM, Hantoushzadeh, S, Khezerdoost, S, Ghotbizadeh, F. Measuring fetal thymus size: a new method for diabetes screening in pregnancy. J Matern Neonatal Med 2018:1–5. https://doi.org/10.1080/14767058.2018.1517309.
Bollopragada, S, Youssef, R, Jordan, F, Greer, I, Norman, J, Nelson, S. Term labor is associated with a core inflammatory response in human fetal membranes, myometrium, and cervix. Am J Obstet Gynecol 2009;200:104.e1–e11. https://doi.org/10.1016/j.ajog.2008.08.032.
Vora, NL, Smeester, L, Boggess, K, Fry, RC. Investigating the role of fetal gene expression in preterm birth. Reprod Sci 2017;24:824–8. https://doi.org/10.1177/1933719116670038.
Kim, JY, Park, SC, Lee, JK, Choi, SJ, Hahm, KS, Park, Y. Novel antibacterial activity of β2-microglobulin in human amniotic fluid. PLoS One 2012;7. https://doi.org/10.1371/journal.pone.0047642.
El-Haieg, D, Zidan, A, El-Nemr, M. The relationship between sonographic fetal thymus size and the components of the systemic fetal inflammatory response syndrome in women with preterm prelabour rupture of membranes. BJOG An Int J Obstet Gynaecol 2008;115:836–41. https://doi.org/10.1111/j.1471-0528.2008.01715.x.
Yoon, BH, Oh, SY, Romero, R, Shim, SS, Han, SY, Park, JS, et al.. An elevated amniotic fluid matrix metalloproteinase-8 level at the time of mid-trimester genetic amniocentesis is a risk factor for spontaneous preterm delivery. Am J Obstet Gynecol 2001;185:1162–7. https://doi.org/10.1067/mob.2001.117678.
Thomakos, N, Daskalakis, G, Papapanagiotou, A, Papantoniou, N, Mesogitis, S, Antsaklis, A. Amniotic fluid interleukin-6 and tumor necrosis factor-α at mid-trimester genetic amniocentesis: relationship to intra-amniotic microbial invasion and preterm delivery. Eur J Obstet Gynecol Reprod Biol 2010;148:147–51. https://doi.org/10.1016/j.ejogrb.2009.10.027.
Goldenberg, RL, Andrews, WW, Mercer, BM, Moawad, AH, Meis, PJ, Iams, JD, et al.. The preterm prediction study: granulocyte colony-stimulating factor and spontaneous preterm birth. Am J Obstet Gynecol 2000;182:625–30. https://doi.org/10.1067/mob.2000.104210.
Li, L, Hsu, H-C, Stockard, CR, Yang, P, Zhou, J, Wu, Q, et al.. IL-12 inhibits thymic involution by enhancing IL-7- and IL-2-induced thymocyte proliferation. J Immunol 2004;172:2909–16. https://doi.org/10.4049/jimmunol.172.5.2909.
Al-Chami, E, Tormo, A, Pasquin, S, Kanjarawi, R, Ziouani, S, Rafei, M. Interleukin-21 administration to aged mice rejuvenates their peripheral T-cell pool by triggering de novo thymopoiesis. Aging Cell 2016;15:349–60. https://doi.org/10.1111/acel.12440.
Billard, MJ, Gruver, AL, Sempowski, GD. Acute endotoxin-induced thymic atrophy is characterized by intrathymic inflammatory and wound healing responses. PLoS One 2011;6:e17940. https://doi.org/10.1371/journal.pone.0017940.
Di Naro, E, Cromi, A, Ghezzi, F, Raio, L, Uccella, S, D’Addario, V, et al.. Fetal thymic involution: a sonographic marker of the fetal inflammatory response syndrome. Am J Obstet Gynecol 2006;194:153–9. https://doi.org/10.1016/j.ajog.2005.05.036.
Zalel, Y, Gamzu, R, Mashiach, S, Achiron, R. The development of the fetal thymus: an in utero sonographic evaluation. Prenat Diagn 2002;22:114–7. https://doi.org/10.1002/pd.257.
Borgelt, JMA, Möllers, M, Falkenberg, MK, Amler, S, Klockenbusch, W, Schmitz, R. Assessment of first-trimester thymus size and correlation with maternal diseases and fetal outcome. Acta Obstet Gynecol Scand 2016;95:210–6. https://doi.org/10.1111/aogs.12790.
Yildirim, M, Ipek, A, Dauletkazin, G, Cendek, BD, Gezegen, S, Desdicioglu, R, et al.. Sonographic measurement of the fetal thymus: relationship with maternal obesity. J Clin Ultrasound 2017;45:277–81. https://doi.org/10.1002/jcu.22470.