PDF(Pubmed)
Abstract：
BACKGROUND: Intrauterine growth retardation (IUGR) is a very serious prenatal condition with 3-5% incidence of all pregnancies. It results from numerous factors, including chronic placental insufficiency. IUGR is associated with an increased risk of mortality and morbidity and is considered a major cause of fetal mortality. Currently, treatment options are significantly limited and often result in preterm delivery. Postpartum, IUGR infants also have higher risks of disease and neurological abnormalities.
METHODS: The PubMed database was searched using the keywords \"IUGR\", \"fetal growth restriction\", \"treatment\", \"management\" and \"placental insufficiency\" for the period between 1975 and 2023. These terms were also combined together.
RESULTS: There were 4160 papers, reviews and articles dealing with the topic of IUGR. In total, only 15 papers directly dealt with a prepartum therapy of IUGR; 10 of these were based on an animal model. Overall, the main focus was on maternal intravenous therapy with amino acids or intraamniotic infusion. Treatment methods have been tested since the 1970s to supplement the fetuses with nutrients lacking due to chronic placental insufficiency in various ways. In some studies, pregnant women were implanted with a subcutaneous intravascular perinatal port system, thus infusing the fetuses with a continuous amino acid solution. Prolongation of pregnancy was achieved, as well as improvement in fetal growth. However, insufficient benefit was observed in infusion with commercial amino acid solution in fetuses below 28 weeks\' gestation. The authors attribute this primarily to the enormous variation in amino acid concentrations of the commercially available solutions compared with those observed in the plasma of preterm infants. These different concentrations are particularly important because differences in the fetal brain caused by metabolic changes have been demonstrated in the rabbit model. Several brain metabolites and amino acids were significantly decreased in IUGR brain tissue samples, resulting in abnormal neurodevelopment with decreased brain volume.
CONCLUSIONS: There are currently only a few studies and case reports with correspondingly low case numbers. Most of the studies refer to prenatal treatment by supplementation of amino acids and nutrients to prolong pregnancy and support fetal growth. However, there is no infusion solution that matches the amino acid concentrations found in fetal plasma. The commercially available solutions have mismatched amino acid concentrations and have not shown sufficient benefit in fetuses below 28 weeks\' gestation. More treatment avenues need to be explored and existing ones improved to better treat multifactorial IUGR fetuses.
METHODS: The PubMed database was searched using the keywords \"IUGR\", \"fetal growth restriction\", \"treatment\", \"management\" and \"placental insufficiency\" for the period between 1975 and 2023. These terms were also combined together.
RESULTS: There were 4160 papers, reviews and articles dealing with the topic of IUGR. In total, only 15 papers directly dealt with a prepartum therapy of IUGR; 10 of these were based on an animal model. Overall, the main focus was on maternal intravenous therapy with amino acids or intraamniotic infusion. Treatment methods have been tested since the 1970s to supplement the fetuses with nutrients lacking due to chronic placental insufficiency in various ways. In some studies, pregnant women were implanted with a subcutaneous intravascular perinatal port system, thus infusing the fetuses with a continuous amino acid solution. Prolongation of pregnancy was achieved, as well as improvement in fetal growth. However, insufficient benefit was observed in infusion with commercial amino acid solution in fetuses below 28 weeks\' gestation. The authors attribute this primarily to the enormous variation in amino acid concentrations of the commercially available solutions compared with those observed in the plasma of preterm infants. These different concentrations are particularly important because differences in the fetal brain caused by metabolic changes have been demonstrated in the rabbit model. Several brain metabolites and amino acids were significantly decreased in IUGR brain tissue samples, resulting in abnormal neurodevelopment with decreased brain volume.
CONCLUSIONS: There are currently only a few studies and case reports with correspondingly low case numbers. Most of the studies refer to prenatal treatment by supplementation of amino acids and nutrients to prolong pregnancy and support fetal growth. However, there is no infusion solution that matches the amino acid concentrations found in fetal plasma. The commercially available solutions have mismatched amino acid concentrations and have not shown sufficient benefit in fetuses below 28 weeks\' gestation. More treatment avenues need to be explored and existing ones improved to better treat multifactorial IUGR fetuses.
摘要：
背景：宫内发育迟缓（IUGR）是一种非常严重的产前疾病，占所有妊娠的3-5％。它是由多种因素造成的，包括慢性胎盘功能不全。IUGR与死亡率和发病率的增加相关,并且被认为是胎儿死亡率的主要原因。目前,治疗选择非常有限,通常会导致早产.产后,IUGR婴儿也有更高的疾病和神经系统异常风险。
方法：使用关键字\"IUGR\"搜索PubMed数据库，“胎儿生长受限”，\"治疗\",1975年至2023年期间的“管理”和“胎盘功能不全”。这些术语也被组合在一起。
结果：共有4160篇论文，关于IUGR主题的评论和文章。总的来说,只有15篇论文直接涉及IUGR的产前治疗;其中10篇基于动物模型。总的来说,主要关注的是使用氨基酸或羊膜腔内输注的母体静脉治疗.自1970年代以来，已经测试了治疗方法，以各种方式为胎儿补充因慢性胎盘功能不全而缺乏的营养。在一些研究中,孕妇被植入皮下血管内围产期端口系统，从而给胎儿注入连续的氨基酸溶液。延长了怀孕时间，以及改善胎儿生长。然而,在妊娠28周以下的胎儿中,用市售氨基酸溶液输注的获益不足.作者将这主要归因于与在早产儿血浆中观察到的那些相比,市售溶液的氨基酸浓度的巨大变化。这些不同的浓度尤为重要，因为在兔模型中已经证明了由代谢变化引起的胎脑差异。IUGR脑组织样本中几种脑代谢物和氨基酸显著减少，导致脑容量减少的神经发育异常。
结论：目前只有少数研究和病例报告，病例数相应较低。大多数研究涉及通过补充氨基酸和营养素来延长妊娠和支持胎儿生长的产前治疗。然而,没有与胎儿血浆中氨基酸浓度相匹配的输注溶液。市售溶液的氨基酸浓度不匹配，在妊娠28周以下的胎儿中未显示出足够的益处。需要探索更多的治疗途径，并改进现有的治疗途径，以更好地治疗多因素IUGR胎儿。
方法：使用关键字\"IUGR\"搜索PubMed数据库，“胎儿生长受限”，\"治疗\",1975年至2023年期间的“管理”和“胎盘功能不全”。这些术语也被组合在一起。
结果：共有4160篇论文，关于IUGR主题的评论和文章。总的来说,只有15篇论文直接涉及IUGR的产前治疗;其中10篇基于动物模型。总的来说,主要关注的是使用氨基酸或羊膜腔内输注的母体静脉治疗.自1970年代以来，已经测试了治疗方法，以各种方式为胎儿补充因慢性胎盘功能不全而缺乏的营养。在一些研究中,孕妇被植入皮下血管内围产期端口系统，从而给胎儿注入连续的氨基酸溶液。延长了怀孕时间，以及改善胎儿生长。然而,在妊娠28周以下的胎儿中,用市售氨基酸溶液输注的获益不足.作者将这主要归因于与在早产儿血浆中观察到的那些相比,市售溶液的氨基酸浓度的巨大变化。这些不同的浓度尤为重要，因为在兔模型中已经证明了由代谢变化引起的胎脑差异。IUGR脑组织样本中几种脑代谢物和氨基酸显著减少，导致脑容量减少的神经发育异常。
结论：目前只有少数研究和病例报告，病例数相应较低。大多数研究涉及通过补充氨基酸和营养素来延长妊娠和支持胎儿生长的产前治疗。然而,没有与胎儿血浆中氨基酸浓度相匹配的输注溶液。市售溶液的氨基酸浓度不匹配，在妊娠28周以下的胎儿中未显示出足够的益处。需要探索更多的治疗途径，并改进现有的治疗途径，以更好地治疗多因素IUGR胎儿。
