title: More than fetal urine: enteral uptake of amniotic fluid as a major predictor for fetal growth during late gestation.
abstract: The purpose of our study was to investigate the importance of amniotic fluid (AF) for fetal growth during late gestation using esophageal atresia (EA) patients as a model. In this retrospective cohort study, we compared the z-scores adapted for birth weights (BW z-scores) for each of 517 European newborns with congenital pre-gastric intestinal atresia, i.e., EA, to a European reference population. To account for the influence of the intestinal atresia on fetal growth per se, we compared adapted birth weights for each of 504 European newborns with post colonic intestinal atresia (anorectal malformation (ARM) with atresia of the anus) to the same European reference population. Analysis of the complete cohort showed (i) a significantly higher rate of small for gestational age newborns among EA compared to ARM newborns (p < 0.001) and (ii) significantly lower BW z-scores among EA compared to ARM newborns (p < 0.001). BW z-scores of EA newborns were significantly lower in term compared to preterm newborns with an inverse correlation with gestational age (GA) (Spearman correlation coefficient, r = -0.185, p < 0.001).
  
  
  CONCLUSIONS
  Enteral uptake of AF seems to play a pivotal role in fetal growth during late gestation.
  
  
  BACKGROUND
  • Peak velocity of fetal weight gain occurs at 33 weeks of gestation and continues until birth. During this period, fetal growth is mainly characterized by cellular hypertrophy. • Amniotic fluid (AF) comprises large amounts of hormones and growth regulators. What is New: • A significantly higher rate of small for gestational age and lower birth weights and z-scores are observed among newborn infants with congenital pre-gastric intestinal atresia. • These findings suggest that enteral uptake of AF is a major predictor for fetal growth during late gestation.
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany. soyhan.bagci@ukb.uni-bonn.de.
authors.forename: Soyhan
authors.initials: S
authors.lastname: Bagci
authors.affiliation: Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: Brosens
authors.affiliation: Department of Pediatric Surgery and Intensive Care, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.affiliation: Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Annelies
authors.initials: A
authors.lastname: De Klein
authors.affiliation: Department of Pediatric Surgery and Intensive Care, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Hanneke
authors.initials: H
authors.lastname: Ijsselstijn
authors.affiliation: Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands.
authors.forename: Charlotte H W
authors.initials: CH
authors.lastname: Wijers
authors.affiliation: Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands.
authors.forename: Nel
authors.initials: N
authors.lastname: Roeleveld
authors.affiliation: Department of Surgery-Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands.
authors.forename: Ivo
authors.initials: I
authors.lastname: de Blaauw
authors.affiliation: Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Broens
authors.affiliation: Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands.
authors.forename: Iris A L M
authors.initials: IA
authors.lastname: van Rooij
authors.affiliation: Department of Pediatric Surgery and Urology, University Hospital Cologne, Cologne, Germany.
authors.forename: Alice
authors.initials: A
authors.lastname: Hölscher
authors.affiliation: Department of Pediatric Surgery and Urology, University Hospital Cologne, Cologne, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Boemers
authors.affiliation: Department of Pediatric Surgery, Asklepios Children's Hospital St. Augustin, St. Augustin, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Pauly
authors.affiliation: Department of Pediatric Surgery, University Medicine of Mainz, Mainz, Germany.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Münsterer
authors.affiliation: Department of Pediatric Surgery and Urology, Center for Child and Youth Health, Klinikum Bremen-Mitte, Bremen, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Schmiedeke
authors.affiliation: Department of Pediatric Surgery and Urology, Cnopf'sche Kinderklinik, Nürnberg, Germany.
authors.forename: Mattias
authors.initials: M
authors.lastname: Schäfer
authors.affiliation: Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital, Hannover, Germany.
authors.forename: Benno E
authors.initials: BE
authors.lastname: Ure
authors.affiliation: Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital, Hannover, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Lacher
authors.affiliation: Institute of Human Genetics, University of Bonn, Bonn, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: Choinitzki
authors.affiliation: Institute of Human Genetics, University of Bonn, Bonn, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Schumacher
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Zwink
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.|Department of Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg University, Mainz, Germany.
authors.forename: Ekkehart
authors.initials: E
authors.lastname: Jenetzky
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Katzer
authors.affiliation: Department of Neonatology, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Arand
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Bartmann
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany.|Institute of Human Genetics, University of Bonn, Bonn, Germany.
authors.forename: Heiko M
authors.initials: HM
authors.lastname: Reutter
mesh_terms: D000653:Amniotic Fluid / Q000502:physiology*; D000071056:Anorectal Malformations / Q000503:physiopathology; D001724:Birth Weight / Q000502:physiology*; D016022:Case-Control Studies; D003106:Colon / Q000002:abnormalities*; D004933:Esophageal Atresia / Q000503:physiopathology*; D005260:Female; D047109:Fetal Development; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age / Q000502:physiology*; D007409:Intestinal Atresia / Q000503:physiopathology*; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D017678:Sex Distribution; D018709:Statistics, Nonparametric
keywords: Amniotic fluid; Esophageal atresia; Fetal growth; Fetal nutrition; Small for gestational age