Novas abordagens para a restrição de crescimento fetal: é chegada a hora da metabolômica

Leite, Debora Farias Batista; Cecatti, Jose Guilherme

doi:10.1055/s-0039-1692126

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ginecologia e Obstetrícia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Review Article • Rev. Bras. Ginecol. Obstet. 41 (07) • Jul 2019 • https://doi.org/10.1055/s-0039-1692126 copiar

Novas abordagens para a restrição de crescimento fetal: é chegada a hora da metabolômica

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

O diagnóstico da restrição do crescimento fetal (RCF) é frequentemente feito por medidas biométricas ultrassonográficas ou por avaliação pela Dopplervelocimetria, mas, na maioria dos casos, o diagnóstico é apenas pós-natal, usando o peso ao nascimento como um marcador para o desenvolvimento intrauterino. Riscos maiores de atraso do neurodesenvolvimento, síndrome metabólica e doenças cardiovasculares associadas com a RCF impõem uma mudança no foco durante a gestação. Novas abordagens metodológicas, como a metabolômica, podem fornecer novos biomarcadores para o desenvolvimento fetal intrauterino. As evidências recentes sobre os metabolitos envolvidos com o crescimento e peso fetalmostram um papel consistente desempenhado pelos lipídios (especialmente os ácidos graxos), aminoácidos, vitamina

Palavras-chave:
restrição do crescimento fetal; pequeno para a idade gestacional; previsão metabolômica

Authors	Country	Type of sample	Time of sampling	Technique	Targeted metabolites	Definition for FGR/ SGA	Participants	Increased metabolites	Decreased metabolites
Untargeted evaluations
Dessì et al (2011)¹⁰10 Dessì A, Atzori L, Noto A, et al. Metabolomics in newborns with intrauterine growth retardation (IUGR): urine reveals markers of metabolic syndrome. J Matern Fetal Neonatal Med 2011;24 (Suppl 2):35-39. Doi: 10.3109/14767058.2011.605868 https://doi.org/10.3109/14767058.2011.60...	Italy	Urine	< 24h after birth (before any nutrition)/ again 96h after birth	H-NMR		IUGR: < 10^th centile of BW by populational curves suspected in pregnancy	26 IUGR^b30 AGA, preterm births	Creatinine and myo-inositol
Horgan et al (2011)¹⁵15 Horgan RP, Broadhurst DI, Walsh SK, et al. Metabolic profiling uncovers a phenotypic signature of small for gestational age in early pregnancy. J Proteome Res 2011;10(08):3660-3673. Doi: 10.1021/pr2002897 https://doi.org/10.1021/pr2002897...	Australia	Blood	20' after birth	UPLC-MS		< 10^th centile customized birth weight	8 SGA6 AGA	DG (32:0)	Phenylacetylglutamin, leucyl-leucyl-norleucine, cervonyl-carnitine, (15Z)-tetra-cosenoic acid, hexacosanedioic acid, pentacosenoic acid, cycloheptanecarboxylic acid, hydroxybutyrate, lysoPC (18:2), PC-more than 20 hits, PC, lyso-PC, acetylleucyl-leucyl-norleucinal, lysoPC(16:1), pregnanediol-3-glucuronide, sphinganine 1-phosphate, sphingosine 1-phosphate, pregnanediol-3-glucuronide, 6-hydroxysphingosine
Favretto et al (2012)¹¹11 Favretto D, Cosmi E, Ragazzi E, et al. Cord blood metabolomic profiling in intrauterine growth restriction. Anal Bioanal Chem 2012;402(03):1109-1121. Doi: 10.1007/s00216-011-5540-z https://doi.org/10.1007/s00216-011-5540-...	Italy	Venous cord blood	Immediately after birth	Metabolic profiling/LC-HRMS		IUGR^a: EFW < 10^thcentile AGA: EFW 10-90^th centile – both confirmed after birth by populational curves	22 IUGR21 AGA; antepartum C-section.	Tryptophan, phenylalanine, glutamate, valine, isoleucine, histidine, proline,methionine, dopamine, uric acid, 5-methylundecenoic acid, L-thyronine, hexadecanedioic acid, (OH)VitD3-3-D-glucopyranoside
Sanz-Cortés et al (2013)¹²12 Sanz-Cortés M, Carbajo RJ, Crispi F, Figueras F, Pineda-Lucena A, Gratacós E. Metabolomic profile of umbilical cord blood plasma from early and late intrauterine growth restricted (IUGR) neonates with and without signs of brain vasodilation. PLoS One2013;8(12):e80121. Doi: 10.1371/journal.pone.0080121 https://doi.org/10.1371/journal.pone.008...		Venous cord blood	At delivery	H-NMR		IUGR: < 10^th centile of BW and Doppler abnormalities	76 IUGR^a55 AGA^d	Unsaturated lipids, creatine, glutamine	Choline
Dessì et al (2014)³⁸38 Dessì A, Marincola FC, Pattumelli MG, et al. Investigation of the 1H-NMR based urine metabolomic profiles of IUGR, LGA and AGA newborns on the first day of life. J Matern Fetal Neonatal Med 2014;27(Suppl 2):13-19. Doi: 10.3109/14767058.2014.955674 https://doi.org/10.3109/14767058.2014.95...	Italy	Urine	1^st urine after birth	H-NMR		IUGR: < 10^th centile of BW by populational curves suspected in pregnancy	12 IUGR^b17 AGA	Citrate, creatinine, creatine, myo-inositol, betaine/TMAO, glycine	Urea, aromatic, compounds, branched-chain amino acids
Miranda et al (2018)¹³13 Miranda J, Simões RV, Paules C, et al. Metabolic profiling and targeted lipidomics reveals a disturbed lipid profile in mothers and fetuses with intrauterine growth restriction. Sci Rep 2018;8 (01):13614. Doi: 10.1038/s41598-018-31832-5 https://doi.org/10.1038/s41598-018-31832...	Spain	Blood	After birth	H-NRM	FGR: EFW <3^rd centile or <10^th+ Doppler abnormalitiesSGA: EFW and BW <10^th without Doppler abnormalities			Fatty acids, formate (SGAxAGA/FGRxAGA)Acetate (FGRxAGA)
Targeted evaluations
Liu et al (2016)³⁹39 Liu J, Chen XX, Li XW, Fu W, Zhang WQ. Metabolomic research on newborn infants with intrauterine growth restriction. Medicine (Baltimore) 2016;95(17):e3564. Doi: 10.1097/MD.0000000000003564 https://doi.org/10.1097/MD.0000000000003...	China	Blood	3-7 days of birth	HPLC-MS	21 amino acids and 55 acylcarnitines	IUGR: < 10^th percentile of BW by populational curves	60 IUGR^a60 AGA		Alanine, homocysteine, methionine, ornithine, serine, tyrosine^c
Visentin et al (2017)¹⁴14 Visentin S, Crotti S, Donazzolo E, et al. Medium chain fatty acids in intrauterine growth restricted and small for gestational age pregnancies. Metabolomics 2017;13(05):1-9. Doi: 10.1007/s11306-017-1197-8 https://doi.org/10.1007/s11306-017-1197-...	Italy	Venous cord blood	At birth	GC-MS	Medium chain fatty acids	IUGR: EFW < 3^rd centile or <10^th centile + Doppler abnormalitiesSGA: EFW and BW < 10^th without Doppler abnormalities	11 IUGR12 AGA10 SGA	Decanoic and dodecanoic acids (SGA x IUGR)octanoic, decanoic and dodecanoic acids (SGA x AGA)

Authors	Country	Type of sample	Time of sampling	Approach	Targeted metabolites	Definition for FGR/ SGA	Participants	Increased metabolites	Decreased metabolites
Visentin et al (2017)¹⁴14 Visentin S, Crotti S, Donazzolo E, et al. Medium chain fatty acids in intrauterine growth restricted and small for gestational age pregnancies. Metabolomics 2017;13(05):1-9. Doi: 10.1007/s11306-017-1197-8 https://doi.org/10.1007/s11306-017-1197-...	Italy	Blood	After birth	GC-MS	Medium-chain fatty acids	IUGR: EFW < 3^rd centile or < 10^th centile + Doppler abnormalities.SGA: EFW and BW < 10^th centile without Doppler abnormalities	11 IUGR12 AGA10 SGA	Hexanoic, octanoic, decanoic and dodecanoic acids (SGA x IUGR)octanoic, decanoic and dodecanoic acids (SGA x AGA)
Miranda et al (2018)¹³13 Miranda J, Simões RV, Paules C, et al. Metabolic profiling and targeted lipidomics reveals a disturbed lipid profile in mothers and fetuses with intrauterine growth restriction. Sci Rep 2018;8 (01):13614. Doi: 10.1038/s41598-018-31832-5 https://doi.org/10.1038/s41598-018-31832...	Spain	Blood	After birth	H-NRM		FGR: EFW < 3^rd centile or < 10^th centile + Doppler abnormalitiesSGA: EFW and BW < 10^th centile without Doppler abnormalities	27 FGR25 SGA28 AGA		Fatty acids, 2-oxoisovaleric acid, citrate (SGA x AGA/ FGR x AGA),alanine (FGR x AGA)

Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Av. Brigadeiro Luís Antônio, 3421, sala 903 - Jardim Paulista, 01401-001 São Paulo SP - Brasil, Tel. (55 11) 5573-4919 - Rio de Janeiro - RJ - Brazil
E-mail: editorial.office@febrasgo.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence
José Guilherme Cecatti, PhD, Rua Alexander Fleming 101, Cidade Universitária Zeferino Vaz, 13083- 889, Campinas, SP, Brazil (e-mail: cecatti@unicamp.br).