Placental Imaging Project (PIP)

Simple Summary

The purpose of this study is to use magnetic resonance imaging (MRI) to measure blood flow to the placenta during pregnancy. Maternal blood carries the oxygen and nutrients that the baby needs to grow and develop. This blood goes to the placenta which controls the exchange of nutrients to the baby and removal of waste products from the baby. The ability to look at blood flow while a baby is still in the womb may help obstetricians find women who have poor blood flow (known as placental insufficiency) during pregnancy. Finding these potential problems during pregnancy, rather than after delivery, may in the future allow medical staff to intervene and give the best possible outcome for the baby.

Inclusion Criteria

Chart review to identify potential study participants who meet eligibility criteria for each group as described below:  

Pregnant women will be recruited based on inclusion criteria for 3 subject groups:

            1) Non-smokers with low risk for placental insufficiency

            2) Smokers

            3) Non-smokers who are at a high risk for adverse outcomes based on prior clinical history

Ancillary IUGR Arm:  This study arm will comprise 2 groups:

          1) Confirmed cases of IUGR in the current pregnancy

          2) Non-smokers with no complications in their current pregnancy

Inclusion criteria: Pregnant women fulfilling inclusion criteria, and not meeting exclusion criteria, will be invited to participate in this study.

Inclusion criteria for all groups:

1. Maternal age over 18 years and able to give informed consent

Inclusion criteria for low risk group:

1. Pregnant patient, as defined by positive pregnancy test for elevated β-HCG and certain menstrual history, or early ultrasound, identified prior to 18 weeks gestational age

2. No history of a second or third trimester loss

3. No history of fetal growth restriction

Inclusion criteria for high risk group

1.  Pregnant patient, as defined by positive pregnancy test for elevated β-HCG and certain menstrual history, or early ultrasound and are able to consent with reasonable certainty that they can complete 1-2 MRI's prior to delivery

2. History of pregnancy complicated by placental insufficiency in a previous singleton pregnancy

• Severe preeclampsia requiring preterm delivery
• Preterm delivery due to placental insufficiency (e.g. FGR, oligohydramnios, abnormal umbilical artery Doppler’s, abnormal antenatal testing)
• FGR <10 % delivered at term
• Stillbirth attributed to placental cause, regardless of gestational age

3.  Not currently a smoker

4.  Pregnancy at risk for placental insufficiency due to clinical concerns (e.g., chronic hypertension)

5.  Spontaneous preterm birth <34 weeks

Inclusion criteria for smokers/marijuana group:

1.  Perturbation during current pregnancy 

2.  Pregnant patient, as defined by positive pregnancy test for elevated β-HCG and certain menstrual history, or early ultrasound, and are able to consent with reasonable certainty that they can complete 1-2 MRI's prior to delivery

Inclusion criteria for IUGR group and this control sub-group:

1. Intrauterine growth restriction (estimated fetal weight <10^th percentile) confirmed by clinical diagnosis in the current pregnancy.
2. Non-smokers with no complications in their current pregnancy

Exclusion Criteria

These criteria will exclude women whose medications, personality traits or obstetric conditions could confound their ability to complete a 1 hour MRI scan.

1. Individuals with intellectual disability or who are incarcerated

2. Major fetal anomalies known to be associated with abnormal growth (i.e. major congenital heart defect, gastroschisis)

3. Current maternal history of alcohol abuse

4. Current medical problems requiring chronic on going treatment:

   • Cancer

   • Active liver disease (acute hepatitis, chronic active hepatitis, persistently abnormal liver enzymes)

   • Chronic pulmonary disease requiring regular use of medication (exercise asthma or seasonal allergies are allowable

5. Prior history of claustrophobia

6. Metal implants. Inclusion of participants with a metal implant will be determined after discussion with each site’s MRI team and will be reviewed on a case-by-case basis, based on type of implant and where the implant is located in the body.

7. Increased aneuploidy risk based on ultrasound findings or genetic testing

Participant Reimbursement

$75 for each MRI completed (12-16 weeks, 26-28 weeks, 32-34 weeks)$50 for delivery samples collected