Prenatal Diagnosis and Intervention: Shaping the Future of Maternal–Fetal Medicine

Background: Increased placental thickness has been associated with adverse perinatal outcomes and fetal functional and structural abnormalities. However, whether marked third-trimester placental thickening is associated with a distinct maternal clinical profile compared with pregnancies with normal placental thickness remains insufficiently characterized. This study aimed to compare maternal characteristics, comorbidities, medication exposure, infection history, and fetal findings between pregnancies with marked placental thickening, defined as placental thickness ≥70 mm, and gestational-age-matched control pregnancies with a placental thickness <70 mm and no documented maternal or fetal abnormalities. Methods: This retrospective matched case–control study included singleton pregnancies referred for fetal echocardiography to a tertiary referral center in Łódź, Poland, between 1 January 2022 and 14 March 2025. Placental thickness was measured sonographically in a perpendicular plane from the chorionic plate to the basal plate, excluding the umbilical cord insertion site. Only anterior and/or fundal placentas assessed at ≥28 weeks of gestation were included. Among pregnancies with recorded third-trimester placental thickness measurements, 99 cases with placental thickness ≥70 mm were identified as the thick-placenta group. A control group of 99 pregnancies with placental thickness <70 mm was selected and matched for gestational age. Control pregnancies had no documented maternal disease, no fetal structural or functional abnormalities, and no exposure to the medications analyzed in this study. Maternal demographic characteristics, body mass index, comorbidities, infection history, obstetric history, and medication use were compared between groups. Continuous variables were compared using Welch’s t-test and the Mann–Whitney U test, and categorical variables were compared using Fisher’s exact test. Results: The study included 99 pregnancies with marked placental thickening and 99 control pregnancies with normal placental thickness. Gestational age at examination was comparable between groups, with a mean of 35.5 weeks in controls and 35.0 weeks in the thick-placenta group (p = 0.662, Welch’s t-test). Median gestational age was also not significantly different between groups (35.4 vs. 36.43 weeks; p = 0.340, Mann–Whitney U test). Mean placental thickness was significantly greater in the thick-placenta group than in controls (81.4 mm vs. 46.9 mm; p < 0.0001). Maternal age and anthropometric characteristics were comparable between groups, whereas BMI > 25 kg/m² was more common in the thick-placenta group. In contrast to the clinically healthy control group, maternal infection was documented in 100.0% of thick-placenta cases, hormonal treatment in 97.0%, history of COVID-19 in 52.5%, hypothyroidism in 44.4%, prior miscarriage in 37.4%, aspirin or anticoagulant use in 32.3%, gestational diabetes mellitus in 25.3%, and pregnancy-induced hypertension in 7.1%. All evaluated maternal clinical factors were significantly more common in the thick-placenta group than in controls. Fetal cardiac or extracardiac dysfunction was present in 68.7% of thick-placenta pregnancies. Conclusions: In this gestational-age-matched case–control study, pregnancies with marked third-trimester placental thickening showed a distinct maternal profile compared with healthy controls with normal placental thickness. Despite comparable gestational age, maternal age, and maternal anthropometric characteristics, the thick-placenta group demonstrated a significantly higher infectious, hormonal, metabolic, and endocrine burden. These findings indicate that, in this selected tertiary referral cohort, placental thickness ≥70 mm was associated with a higher burden of maternal clinical abnormalities and fetal functional findings. Rather than representing an independent marker of placental maladaptation or maternal-fetal risk, marked placental thickening should be interpreted as a clinically relevant ultrasound finding that may prompt careful review of maternal history and targeted fetal assessment. Prospective studies are needed to determine which maternal factors are independently associated with placental thickening and to clarify their relationship with fetal function and perinatal outcomes. Full article

Objective: To assess correlations between maternal obesity and fetal interventricular septum (IVS) volume measured by means of spatiotemporal image correlation and Virtual Organ Computer-Aided Analysis (STIC-VOCAL), after adjustment for gestational age. Methods: This cross-sectional observational study included 88 consecutive singleton pregnancies undergoing routine obstetric ultrasound at our center between January 2024 and December 2025. Fetal IVS volume was assessed using STIC-VOCAL, and its association with maternal characteristics was evaluated by means of univariate and multivariable regression analyses adjusted for gestational age. Results: Fetal IVS volume increased with estimated fetal weight (r = 0.860, p < 0.0001) and gestational age (r = 0.891, p < 0.0001), which represented the main determinant of absolute fetal cardiac volume. The association between maternal obesity and fetal IVS volume was not evident on univariate analysis (U = 987.5, p = 0.874) but became significant after adjustment for gestational age in multivariable regression models (β = +89.1 mm³, p < 0.0001). At comparable gestational ages, maternal obesity was associated with an adjusted increase in fetal IVS volume of approximately 22.6 mm³. Conclusions: Maternal obesity was independently associated with a modest increase in fetal IVS volume after adjustment for gestational age. STIC-VOCAL volumetry may provide a sensitive tool for detecting subtle fetal cardiac structural changes, although these findings remain exploratory. Full article

Objectives: To evaluate perinatal, obstetric, and early functional outcomes following totally percutaneous fetoscopic repair of open spina bifida (OSB) using the skin-over-biocellulose for antenatal fetoscopic repair (SAFER) technique. Methods: This retrospective cohort study included all fetuses who underwent totally percutaneous fetoscopic repair of OSB at a single tertiary referral center between September 2018 and March 2026. Eligibility was based on predefined clinical criteria. Data on maternal, fetal, operative, and neonatal outcomes were collected. The primary outcomes included perinatal and obstetric results, need for cerebrospinal fluid (CSF) diversion within the first year of life, and early functional outcomes, including motor improvement and ambulation. Exploratory analyses were performed to assess associations between procedural factors and obstetric outcomes. Results: Twenty-two fetuses underwent fetoscopic repair. The procedure was completed in 95% of cases. Median gestational age at surgery was 28.2 weeks. Preterm prelabor rupture of membranes (PPROM) occurred in 68% of cases, and the median gestational age at delivery was 32.7 weeks. All fetuses were live-born, with no neonatal deaths. Maternal outcomes were favorable, with no maternal mortality and no ICU admissions. Vaginal delivery was achieved in 50% of cases, with no uterine rupture or dehiscence. The rate of CSF diversion within the first year was 31.8%. Reversal of hindbrain herniation was observed in 95% of cases. A motor improvement of ≥2 levels was achieved in 68% of patients, with no cases of functional deterioration. Community ambulation at ≥24 months was observed in 53% of cases with available follow-up. Conclusions: Totally percutaneous fetoscopic repair of OSB using the SAFER technique was associated with favorable perinatal, obstetric, and early functional outcomes in this single-center cohort. The high incidence of PPROM and subsequent preterm delivery remains an obstetrical challenge. Maternal safety profile, including the preservation of uterine integrity for vaginal delivery, and the early neurological benefits were encouraging. Our results support the feasibility of this approach and highlight the absolute necessity of multidisciplinary expertise and structured training. Full article

Objectives: Autism spectrum disorder (ASD) is increasingly conceptualized as a neurodevelopmental condition with prenatal origins. Advances in fetal magnetic resonance imaging (MRI), including high-resolution structural imaging and resting-state functional connectivity analysis, now enable in vivo characterization of the developing human brain before birth. This review examines whether fetal MRI biomarkers are associated with later ASD diagnosis or autistic traits. Methods: We conducted a PRISMA-informed narrative review of human studies identified through MEDLINE, EMBASE, SCOPUS, and Web of Science. Eligible studies included original human investigations using fetal MRI to assess brain structure and/or function, with postnatal ASD diagnosis or standardized autistic-trait outcomes. Results: Eight eligible studies provide converging evidence that neurodevelopmental divergence associated with ASD may be detectable in utero. Structural analyses consistently report prenatal volumetric alterations, particularly enlargement of the insular cortex between the second and third trimesters. Additional findings of regional overgrowth and hemispheric asymmetries suggest distributed deviations in cortical maturation. Functional fetal MRI studies further demonstrate atypical large-scale network organization prior to birth. Altered connectivity within cingulate, prefrontal, temporal, and cerebellar circuits has been prospectively associated with later autistic traits, indicating that network-level integration may diverge before behavioral symptoms emerge. Evidence from high-risk conditions, including isolated ventriculomegaly and tuberous sclerosis complex, reinforces the association between prenatal structural abnormalities and increased ASD risk. Conclusions: Current evidence suggests that structural and functional brain alterations identifiable by fetal MRI may precede the clinical manifestation of ASD. These findings support a model of ASD as a condition potentially rooted in prenatal neurodevelopmental divergence. However, larger, standardized, multicenter studies are required before fetal MRI biomarkers can be translated into predictive or clinical applications. Full article