{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T22:05:01Z","timestamp":1747173901287,"version":"3.40.5"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T00:00:00Z","timestamp":1711065600000},"content-version":"unspecified","delay-in-days":50,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Twin Res Hum Genet"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Fetuses undergo major surgical stress as well as fluid shifts secondary to both twin-twin transfusion (TTTS) as well as the fetoscopic surgery for treatment of TTTS. While the pathophysiology of TTTS is understood, the acute metabolic changes that fetuses experience from fetoscopic surgery are not. We sought to evaluate the changes in recipient metabolomic profile secondary to TTTS surgery. Amniotic fluid was collected at the beginning and end of four TTTS surgical cases performed from 12\/2022\u22122\/2023. Samples were immediately processed and evaluated via NMR-based Metabolomics Facility protocol. In univariate analysis, 12 metabolites (glucose, lactate, and 10 key amino acids) showed statistically significant changes between the beginning and end of the surgery. Among these, 11 metabolites decreased at the end, while only lactate increased. Supervised oPLS-DA modeling revealed pyruvate and lactate as the two metabolites most impact on the variance between cases, and that 40% of metabolomic changes could be attributed directly to the timing that the sample was taken (i.e., if pre- or postoperatively). These results indicate significant metabolic changes in the recipient twin during fetoscopic surgery for TTTS. These findings of decreased glucose, increased lactate, and decreased amnio acids would indicate increased catabolism during surgery. This study raises questions regarding optimal maternal and fetal nutrition during surgery and if nutritional status could be optimized to further improve twin survival during fetoscopic surgery.<\/jats:p>","DOI":"10.1017\/thg.2024.10","type":"journal-article","created":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T06:23:15Z","timestamp":1711088595000},"page":"56-63","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Acute Fetal Metabolomic Changes in Twins Undergoing Fetoscopic Surgery for Twin-Twin Transfusion Syndrome"],"prefix":"10.1017","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8001-1444","authenticated-orcid":false,"given":"Braxton","family":"Forde","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Martin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miki","family":"Watanabe-Chailland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Foong-Yen","family":"Lim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2024,3,22]]},"reference":[{"key":"S1832427424000100_ref14","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1093\/nar\/gkab382","article-title":"MetaboAnalyst 5.0: Narrowing the gap between raw spectra and functional insights","volume":"49","author":"Pang","year":"2021","journal-title":"Nucleic Acids Research"},{"key":"S1832427424000100_ref18","doi-asserted-by":"crossref","first-page":"65","DOI":"10.2337\/db11-1727","article-title":"Increased hepatic glucose production in fetal sheep with intrauterine growth restriction is not suppressed by insulin","volume":"62,","author":"Thorn","year":"2013","journal-title":"Diabetes"},{"key":"S1832427424000100_ref17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ajog.2012.10.880","article-title":"Twin-twin transfusion syndrome","volume":"208","author":"Simpson","year":"2013","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"S1832427424000100_ref22","doi-asserted-by":"crossref","first-page":"3644","DOI":"10.3390\/nu13103644","article-title":"Serum and amniotic fluid metabolic profile changes in response to gestational diabetes mellitus and the association with maternal-fetal outcomes","volume":"13","author":"Zhou","year":"2021","journal-title":"Nutrients"},{"key":"S1832427424000100_ref1","doi-asserted-by":"crossref","first-page":"e164","DOI":"10.1097\/AOG.0000000000003074","article-title":"Approaches to limit intervention during labor and birth","volume":"133","year":"2019","journal-title":"Obstetrics and Gynecology"},{"key":"S1832427424000100_ref2","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1152\/ajpendo.00458.2009","article-title":"Lactate distribution in culture medium of human myometrial biopsies incubated under different conditions","volume":"297,","author":"Akerud","year":"2009","journal-title":"American Journal of Physiology\u2014Endocrinology and Metabolism"},{"key":"S1832427424000100_ref6","doi-asserted-by":"crossref","first-page":"761","DOI":"10.3390\/metabo13060761","article-title":"Non-targeted metabolomic study of fetal growth restriction","volume":"13,","author":"Chen","year":"2023","journal-title":"Metabolites"},{"key":"S1832427424000100_ref12","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/978-1-0716-2624-5_11","article-title":"Metabolomics: Going deeper, going broader, going further","volume":"2554","author":"Moco","year":"2023","journal-title":"Methods in Molecular Biology"},{"key":"S1832427424000100_ref20","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1093\/nar\/gkl923","article-title":"HMDB: The Human Metabolome Database","volume":"35","author":"Wishart","year":"2007","journal-title":"Nucleic Acids Research"},{"key":"S1832427424000100_ref21","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1056\/NEJM199501263320404","article-title":"Preliminary experience with endoscopic laser surgery for severe twin-twin transfusion syndrome","volume":"332,","author":"Ville","year":"1995","journal-title":"The New England Journal of Medicine"},{"key":"S1832427424000100_ref13","doi-asserted-by":"crossref","first-page":"2965","DOI":"10.3390\/ijms22062965","article-title":"Diabetes during pregnancy: A maternal disease complicating the course of pregnancy with long-term deleterious effects on the offspring. A clinical review","volume":"22,","author":"Ornoy","year":"2021","journal-title":"International Journal of Molecular Sciences"},{"key":"S1832427424000100_ref19","doi-asserted-by":"crossref","first-page":"7306","DOI":"10.1080\/14767058.2021.1946790","article-title":"Amniotic fluid lactate (AFL): A new predictor of labor outcome in dystocic deliveries","volume":"35","author":"Wiberg-Itzel","year":"2022","journal-title":"The Journal of Maternal-Fetal and Neonatal Medicine"},{"key":"S1832427424000100_ref8","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1053\/ejpn.2001.0400","article-title":"Neurodevelopmental risks in twin-to-twin transfusion syndrome: preliminary findings","volume":"5","author":"Haverkamp","year":"2001","journal-title":"European Journal of Paediatric Neurology"},{"key":"S1832427424000100_ref3","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1007\/s43032-021-00750-9","article-title":"Fetal sex does not impact placental blood flow or placental amino acid transfer in late gestation pregnant sheep with or without placental insufficiency","volume":"29","author":"Brown","year":"2022","journal-title":"Reproductive Sciences"},{"key":"S1832427424000100_ref5","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1203\/00006450-197604000-00006","article-title":"Lactate and pyruvate as fetal metabolic substrates","volume":"10","author":"Char","year":"1976","journal-title":"Pediatric Research"},{"key":"S1832427424000100_ref10","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1152\/ajpendo.00046.2023","article-title":"Adaptive responses in uteroplacental metabolism and fetoplacental nutrient shuttling and sensing during placental insufficiency","volume":"324","author":"Kyllo","year":"2023","journal-title":"American Journal of Physiology\u2014Endocrinology and Metabolism"},{"key":"S1832427424000100_ref11","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1097\/AOG.0b013e318195873e","article-title":"Risk factors for neurodevelopment impairment in twin-twin transfusion syndrome treated with fetoscopic laser surgery","volume":"113,","author":"Lopriore","year":"2009","journal-title":"Obstetrics and Gynecology"},{"key":"S1832427424000100_ref4","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1161\/HYPERTENSIONAHA.119.13727","article-title":"Fetal oxygen and glucose consumption in human pregnancy complicated by fetal growth restriction","volume":"75","author":"Cetin","year":"2020","journal-title":"Hypertension"},{"key":"S1832427424000100_ref15","doi-asserted-by":"crossref","first-page":"107424","DOI":"10.1016\/j.isci.2023.107424","article-title":"Fetal metabolic adaptations to cardiovascular stress in twin-twin transfusion syndrome","volume":"26,","author":"Parchem","year":"2023","journal-title":"iScience"},{"key":"S1832427424000100_ref16","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1056\/NEJMoa032597","article-title":"Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome","volume":"351","author":"Senat","year":"2004","journal-title":"The New England Journal of Medicine"},{"key":"S1832427424000100_ref7","first-page":"101055","article-title":"Creation of a novel synthetic amniotic fluid for use in fetal therapy with in vitro testing on human amniotic membranes","volume":"5,","author":"Forde","year":"2023","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"S1832427424000100_ref9","doi-asserted-by":"crossref","first-page":"e15033","DOI":"10.14814\/phy2.15033","article-title":"Uteroplacental nutrient flux and evidence for metabolic reprogramming during sustained hypoxemia","volume":"9,","author":"Jones","year":"2021","journal-title":"Physiological Reports"}],"container-title":["Twin Research and Human Genetics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1832427424000100","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T11:36:34Z","timestamp":1716982594000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1832427424000100\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["S1832427424000100"],"URL":"https:\/\/doi.org\/10.1017\/thg.2024.10","relation":{},"ISSN":["1832-4274","1839-2628"],"issn-type":[{"type":"print","value":"1832-4274"},{"type":"electronic","value":"1839-2628"}],"subject":[],"published":{"date-parts":[[2024,2]]},"assertion":[{"value":"\u00a9 The Author(s), 2024. Published by Cambridge University Press on behalf of International Society for Twin Studies","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}