An enlarged fetal thymus may be the initial response to intrauterine inflammation in pregnant women at risk for preterm birth

Hamamoto, Tatiana Emy Nishimoto Kawanami; Hatanaka, Alan Roberto; França, Marcelo Santucci; Sarmento, Stéphanno Gomes Pereira; Helfer, Talita Micheletti; Nomura, Roseli Mieko Yamamoto; Araujo Júnior, Edward; Moron, Antonio Fernandes

doi:10.1590/1806-9282.20221678

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Brasil

Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 69 (5) • 2023 • https://doi.org/10.1590/1806-9282.20221678 copy

An enlarged fetal thymus may be the initial response to intrauterine inflammation in pregnant women at risk for preterm birth

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Fetal thymus involvement in prematurity has been studied, and this study aimed to evaluate its relationship with short cervix and amniotic fluid sludge in the second trimester of pregnancy.

METHODS:

In this prospective cross-sectional study, 79 pregnant women (19+0 to 24+6 weeks) were included, and cervical length and the presence or absence of amniotic fluid sludge were evaluated. In the three-vessel view of the fetal thorax, the thymus was identified, and its perimeter and transverse diameter were measured and transformed to a zeta score based on gestational age.

RESULTS:

Data from 22 women with short cervix (<25 mm) and 57 patients with normal cervix (≥25 mm) were analyzed. The transverse diameter of the fetal thymus was significantly greater in the short cervix group compared to that of the normal cervix group (z-score 2.708 vs. −0.043, p=0.003). There were no significant differences in the perimeter (z-score −0.039 vs. −0.071, p=0.890) or the transverse diameter (z-score 1.297 vs. −0.004, p=0.091) of the fetal thymus associated with the presence (n=21) or absence of sludge (n=58).

CONCLUSION:

A short cervix is associated with an increased transverse diameter of the fetal thymus during the second trimester of gestation.

KEYWORDS:
Thymus gland; Fetus; Premature birth; Cervix uteri

Characteristics	NC (n=57)	SC (n=22)	p-value	AAFS (n=58)	PAFS (n=21)	p-value
Maternal age, years	28.8 (6.1)	26.2 (8.8)	0.136	27.0 (7.2)	31.1 (5.6)	0.020
White	28 (49.1%)	8 (36.4%)	0.311	23 (39.7%)	13 (61.9%)	0.080
Nulliparous	24 (42.1%)	11 (50.0%)	0.970	31 (53.4%)	4 (19.1%)	0.02
BMI (kg/m²)	26.3 (4.5)	26.7 (6.0)	0.739	26.3 (4.6)	26.6 (5.9)	0.781
Tobacco use	9 (15.8%)	3 (13.6%)	0.812	9 (15.5%)	3 (14.3%)	0.894
High-risk pregnancy	11 (19.3%)	2 (9.1%)	0.276	10 (17.2%)	3 (14.3%)	0.756
GA, weeks	22.2 (1.3)	22.7 (1.5)	0.204	22.6 (1.3)	21.8 (1.4)	0.035
CL, mm	33.0 (31.4–34.7)	21.1 (17.0–22.4)	<0.001	29.9 (26.8–31.9)	33.0 (27.0–36.5)	0.220
CL<25 mm	–	–	–	16 (27.6%)	6 (28.6%)	0.931
Absence of cervical gland area	0 (0.0%)	1 (4.5%)	0.279	1 (1.7%)	0 (0.0%)	1.0
Funneling presence	0 (0.0%)	8 (36.4%)	<0.001	5 (8.6%)	3 (14.3%)	0.432
Amniotic fluid sludge	1 (1.8%)	6 (27.3%)	0.932	–	–	–

		NC (n=57)	SC (n=22)	p-value	AAFS (n=58)	PAFS (n=21)	p-value
Perimeter
	P (Z-score)	−0.090 (−0.351 to −0.004)	0.056 (y0.119 to 0.248)	0.199	−0.071 (−0.268 to −0.058)	−0.039 (−0.371 to 0.254)	0.890
	P/CC	0.235 (0.226 to 0.244)	0.244 (0.238 to 0.255)	0.238	0.239 (0.227 to 0.245)	0.235 (0.226 to 0.255)	0.965
	P/FL	1.251 (1.178 to 1.314)	1.286 (1.180 to 1.334)	0.956	1.267 (1.183 to 1.313)	1.261 (1.136 to 1.386)	0.773
	P/HL	1.322 (1.229 to 1.371)	1.371 (1.271 to 1.410)	0.638	1.334 (1.253 to 1.377)	1.325 (1.185 to 1.416)	0.641
Transverse diameter
	TD (Z-score)	−0.043 (−0.194 to 0.194)	2.708 (0.024 to 3.481)	0.003	−0.004 (−0.114 to 0.255)	1.297 (−0.135 to 3.060)	0.091
	TD/CC	0.087 (0.084 to 0.092)	0.136 (0.089 to 0.155)	0.005	0.089 (0.084 to 0.094)	0.114 (0.085 to 0.155)	0.042
	TD/FL	0.472 (0.444 to 0.501)	0.691 (0.459 to 0.795)	0.021	0.474 (0.446 to 0.507)	0.660 (0.443 to 0.834)	0.042
	TD/HL	0.485 (0.469 to 0.539)	0.762 (0.505 to 0.862)	0.024	0.500 (0.475 to 0.543)	0.666 (0.464 to 0.865)	0.126

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[1] *Corresponding author: araujojred@terra.com.br