The measurement of fetal liver T(*)(2) in utero before and after maternal oxygen breathing: progress towards a non-invasive measurement of fetal oxygenation and placental function

Utero-placental insufficiency is thought to be a major cause of growth retardation in utero and an important risk factor in the perinatal period. The purpose of this study was to investigate whether MRI could detect changes of fetal oxygenation, based on the blood oxygenation level dependence (BOLD) of the MRI tissue signal. Nine third trimester women (34-38 weeks) with normal pregnancies underwent abdominal MRI examinations. Following localization of the fetal liver using T(2)-weighted single-shot HASTE scans, up to 7 breath-held transaxial single-slice gradient-echo image sets were obtained through the fetal liver. The mother then commenced oxygen breathing with the imaging procedure repeated after 20 minutes of O(2) breathing. For each image set, T(*)(2) values are calculated using linear regression of log (signal) versus TE for a region of interest within the fetal liver selected by the attending radiologist. Fetal liver T(*)(2) values were calculated before and after O(2) breathing for each multi-echo image acquisition set. A signed rank test was used to test for a significant change in fetal liver T(*)(2) between the pre-O(2) and post-O(2) image sets. A significant increase in T*(2) (alpha < 0.05) was seen in 5 of the 9 fetal livers, a smaller increase (of borderline statistical significance, alpha = 0.057) in 2 livers, and no significant change (alpha > 0.05) in 2 livers. Our study indicates that T(*)(2) measurement of the fetal liver may detect alteration in fetal oxygen level following maternal oxygenation using the BOLD effect. This technique may potentially be applied to the identification and understanding of placental dysfunction in intra-uterine growth retardation.

Growth-restricted premature infants are at increased risk for low thyroxine

OBJECTIVE

To evaluate, in extremely premature infants, the relationship between growth restriction and early total thyroxine levels, and to determine how maternal, prenatal, perinatal and neonatal variables influence the relationship.

STUDY DESIGN

719 infants born at four medical centers in Massachusetts, New York and New Jersey between 1991 and 1993 were studied. Entry criteria included: gestational age 23--30 weeks, birth weight 500--1500 g, and a serum thyroxine level obtained in the first week of life. Infants born to mothers with a history of thyroid disease were excluded. Birth weight and total thyroxine level are expressed as z-scores (standard deviation units) to adjust for their relationship to gestational age.

RESULTS

In linear regression analysis, there was a 0.18 decrease in the total thyroxine z-score for each 1.0 (1 standard deviation unit) decrease in birth weight z-score (p=0.0001). Adjustment for multiple potential maternal, prenatal, perinatal and neonatal confounders failed to identify a factor or factors that could account for the observed association.

CONCLUSIONS

The early total thyroxine level in extremely preterm infants was significantly associated with birth weight z-score. This relationship persisted even after adjustment for maternal, prenatal, perinatal and neonatal confounders suggesting antenatal influences. Of clinical importance, growth-restricted infants are at increased risk for early hypothyroxinemia and, possibly, to its related morbidities.

Circadian rhythm of ANP, aldosterone and PRA in normotensive IUGR

OBJECTIVE

Atrial natriuretic peptide (ANP) increases are reported during normal pregnancy, but the relation to arterial pressure and the renin-angiotensin system is debatable. We assessed whether normotensive pregnancies with intrauterine growth retardation (IUGR) present an alteration of maternal ANP levels.

DESIGN

A total of 11 pregnant women with IUGR, in the absence of any other maternal or fetal pathology, entered the study during the third trimester. They were compared with 12 healthy pregnant women of similar age and characteristics. We monitored all subjects for blood pressure (BP), ANP, aldosterone and plasma renin activity (PRA), under the same conditions for 24 h. All subjects were submitted to the same regimen of life; with homogeneous dark : light periods, salt intake and meal times.

METHODS

BP was monitored at 20 min intervals for 24 h and blood tests performed at six time points during the 24 h. EDTA plasma samples were immediately centrifuged. Hormone assays were performed by radioimmunoassay. Koch's nonparametric two-way analysis of variance (ANOVA) was used to compare the hormone time-dependent profiles in the two groups. Circadian rhythms were assessed by cosinor analysis.

RESULTS

The IUGR group was characterized by higher ANP values compared to normal pregnancy, (205 +/- 24 versus 146 +/- 21 pg/ml: P < 0.05) but not significant differences were shown for PRA, aldosterone and BP circadian rhythms.

CONCLUSIONS

This study shows higher ANP values in human pregnancy complicated by IUGR, with presence of normal BP, aldosterone and PRA profiles.

Fetal serum levels of insulin, growth hormone and insulin-like growth factor-I in concordant and discordant twin gestations

OBJECTIVE

To examine the role of insulin, growth hormone and insulin-like growth factor (IGF)-I in concordant and discordant twin pairs.

METHODS

Umbilical cord serum samples were obtained from 20 twin pairs with weight discordancy (intertwin birth weight difference > 20%) and from 20 concordant twins (intertwin birth weight difference < 20%), both groups of similar gestational age, gravidity, and parity. The serum samples were analyzed for the levels of IGF-I, growth hormone and insulin in both maternal and fetal compartments.

RESULTS

Among the group of discordant twins, the normally grown twin, in all cases, had significantly higher cord serum IGF-I levels than their growth-restricted co-twin (108 +/- 73 ng/ml vs. 39 +/- 24 ng/ml; p < 0.01). There were no significant intertwin differences in the cord blood IGF-I levels in the concordant twin pairs (87 +/- 44 vs. 88 +/- 48 ng/ml; p = 0.986). Insulin and growth hormone levels did not correlate with intertwin birth weight differences.

CONCLUSION

These data demonstrate that IGF-I is important in the regulation of both normal and restricted fetal growth in utero, and its action appears to be, at least in part, through an endocrine action. The precise role of growth hormone and insulin in fetal growth restriction remains uncertain.

Umbilical cord plasma interleukin-6 and fetal growth restriction in preeclampsia: a prospective study in Norway

OBJECTIVE

To study the association between umbilical plasma levels of interleukin-6 (IL-6) in relation to fetal growth in subgroups of preeclampsia, and in control pregnancies.

METHODS

Umbilical cord plasma was collected from 12,804 consecutive births. A total of 271 singleton cases of preeclampsia were identified, and classified as mild or severe, and as disease with early or late onset. As controls, 611 singleton pregnancies without preeclampsia were selected, and the ratio between observed and expected birth weight was used as a measure of fetal growth. In the analysis, we also included maternal smoking during pregnancy. Umbilical cord plasma IL-6 concentration was measured with an IL-6 bioassay. Comparing controls with subgroups of preeclampsia (severe and early onset), this study had a statistical power of 90% to detect a difference in cord IL-6 of 10 pg/mL.

RESULTS

In severe preeclampsia, cord plasma IL-6 concentration was lower than among controls (P <.001), and there was a sharp decrease in cord plasma IL-6 with decreasing birth weight ratio (P trend <.001). By further dividing the preeclampsia group into early or late onset, the strong association between low IL-6 levels and low birth weight ratio appeared to be present mainly in early-onset disease. These results were not confounded by maternal smoking.

CONCLUSION

Restricted fetal growth related to preeclampsia is associated with reduced umbilical cord plasma IL-6 concentration in cases with early-onset disease. In these cases, fetal growth restriction could be mediated by impaired trophoblast function.

Serum lipid peroxidation levels in small-for-gestational-age babies

The levels of lipid peroxidation in sera of asymmetric small-for-gestational-age (SGA) babies at the second hour of life were investigated. Lipid peroxidation levels, measured as malondialdehyde (MDA), were 3.3 +/- 1.1 and 3.9 +/- 1.2 mmol/L in SGA and appropriate-for-gestational age (AGA) groups, respectively. The difference was not significant (p>0.05). This result may indicate that free radical scavengers are sufficient in SGA babies.

The association of abnormal alpha-fetoprotein and adverse pregnancy outcome: does increased fetal surveillance affect pregnancy outcome?

OBJECTIVE

Our purpose was to investigate whether adverse outcomes associated with elevated maternal serum alpha-fetoprotein levels may be prevented by intensive antenatal monitoring.

STUDY DESIGN

Records of patients with elevated maternal serum alpha-fetoprotein values of > or =2.0 multiples of the median between 1995 and 1999 were reviewed. Pregnancy histories were analyzed to determine whether intensive antenatal monitoring (twice-weekly nonstress tests and determinations of the amniotic fluid index) would have detected the adverse outcomes when routine obstetric care would have missed them. Women with elevations explained by multiple gestations, structural abnormalities, or a fetal death were excluded.

RESULTS

The study enrolled 136 patients. Twenty-three patients were excluded because of multiple gestations, structural or chromosomal abnormalities, or fetal death or for lack of available follow-up. Seventy-eight patients had no perinatal complications, but 12 of these patients underwent heightened surveillance. One of these patients was subjected to an induction of labor. Thirty-five pregnancies had complications (21 with preterm labor, 7 with pregnancy-induced hypertension, 6 with growth restriction or oligohydramnios, 1 with abruptio placentae, and 1 with vasa previa). Of these 35 pregnancies, 22 were followed up with routine obstetric care and 13 with heightened surveillance. Heightened surveillance did not achieve earlier or improved detection in this group. These results suggest that routine pregnancy management is an adequate strategy for providing care to pregnant patients with unexplained elevated maternal serum alpha-fetoprotein levels. Adverse outcomes were detected with routine pregnancy management or were undetectable even with intensive management.

CONCLUSION

Increased risks of pregnancy-induced hypertension, preterm delivery, intrauterine growth restriction, intrauterine fetal death, oligohydramnios, and abruptio placentae are associated with elevated maternal serum alpha-fetoprotein levels. However, in our study, routine pregnancy management was an acceptable method of detecting these adverse outcomes when they were detectable.

[Effectiveness of high-frequency oscillatory ventilation in the treatment of lung hypoplasia in connection with intrauterine growth retardation and maternal pre-eclampsia]

The authors examine in a retrospective study the effectivity of high frequency oscillatory ventilation in group of intrauterine retardated babies with clinical signs of lung hypoplasia. During one year period they treated 12 intrauterine retarded patients with high frequency oscillatory ventilation because of failure of conventional ventilation. The indications were in seven cases the high pCO2 level and in five ones low saturation in spite of surfactant administration. The birth weight of babies were between 770 grams and 2150 grams, and theirs gestational age between 29 and 35 weeks. Four patients died. The causes of death were in two cases severe cardiomyopathy and at two patients intraventricular haemorrhage. Two survivors are suffering of bronchopulmonary dysplasia. They suggest that immediate high frequency ventilation reduces the period of mechanical ventilation and the number of residual picture. They suggest, that lung hypoplasia is an underestimated diagnosis in intrauterine retardated babies. If the cause of respiratory failure in cases complicated with maternal preeclampsia is not only hyaline membrane disease it is necessary to look for signs of lung hypoplasia and to follow the treatment with high frequency oscillatory ventilation.

Familial thrombophilia and the occurrence of fetal growth restriction

BACKGROUND AND OBJECTIVES

To evaluate the association between unexplained or gestational-hypertension-associated fetal growth restriction (FGR) and factor V Leiden, prothrombin A20210 mutations, and methylenetetrahydrofolate reductase (MTHFR) TT 677 genotype.

DESIGN AND METHODS

Sixty-one women with a previous history of FGR and 93 parous women with uneventful pregnancies from the same ethnic background were investigated for the presence of factor V (FV) Leiden, prothrombin A20210 mutations, and MTHFR TT 677 genotype. Moreover, antiphospholipid antibodies, antithrombin, protein C, and total and free protein S antigen were determined in all patients.

RESULTS

Among the controls, 2 (2.2%) carried the FV Leiden mutation, 19 (20.4%) were TT MTHFR homozygotes and 1 (1.6%) carried the prothrombin A20210 allele. The FV Leiden mutation was present in 8 women with FGR (13.1%, OR: 6.9, 95%CI 1.4-33.5), the TT MTHFR homozygosity in 17 (27.8%, OR: 1.5, 95%CI 0.7-3.2) and the A20210 prothrombin allele in 7 (11.5%, OR: 5.9, 95%CI 1.2-29.4). In six cases (9.8%) there was coexistence of more than one mutation (2 had the FV Leiden and the TT MTHFR genotype and 4 carried the A20210 prothrombin allele and TT MTHFR genotype). A logistic regression analysis showed that FV Leiden and A20210 prothrombin mutations were independently associated with the occurrence of FGR.

INTERPRETATION AND CONCLUSIONS

Present data indicate an association between prothrombotic genetic factors and FGR.

Relatively low serum leptin levels in adults born with intra-uterine growth retardation

BACKGROUND

In-utero under-nutrition dramatically alters the development of adipose tissue, during the fetal and the neonatal period.

THE AIM OF THE STUDY

To investigate whether adults born with intra-uterine growth retardation (IUGR) show evidence of impaired adipose tissue development and leptin regulation.

DESIGN

Serum leptin concentrations were measured in 26 healthy adults born with IUGR and 25 controls aged 24 y who have been studied previously, 3 y ago.

RESULTS

The IUGR group demonstrated a significant increase of body mass index (BMI) in comparison to controls between 21 and 24 y of age (4.8+/-7.7%, P=0.004 vs 0.8+/-6.7%, P=0.70). Percentage of total body fat mass was significantly higher in IUGR-born subjects than in controls (27.2+/-7.6 vs 22.0+/-7.3%, P=0.02). Fasting insulin was significantly higher in the IUGR group (7.5+/-3.8 vs 5.3+/-2.3 miccroU/ml, P=0.03). Surprisingly, crude serum leptin concentrations did not significantly differ between the two groups. Moreover, adjusted means of serum leptin levels were significantly lower in IUGR-born subjects than in controls when corrected for body fat mass, gender and fasting insulin (11.3 vs 13.8 ng/ml, P=0.02).

SUMMARY

Adults born with IUGR developed an excess of adipose tissue associated with relatively low serum leptin levels suggestive of an altered adipocyte function. Considering the close relationship between adipose tissue and insulin-sensitivity, these observations point to the potential implication of abnormal adipose tissue development in the long-term metabolic consequences associated with in-utero undernutrition.

Nucleated red blood cell count and doppler ultrasound in low- and high-risk pregnancies

OBJECTIVE

The aim of this study was to evaluate the influence of circulatory deterioration in small-for-gestational-age fetuses (SGA) on the nucleated red blood cell count (NRBC).

PATIENTS AND METHODS

During a 12-month period 194 patients with a complete NRBC count post-partum were enrolled in the study. Using pulsed wave colour Doppler ultrasound we recorded blood flow velocity waveforms from both uterine arteries and from the umbilical artery and/or from the fetal aorta. Patients were assigned to seven groups according to the results of the Doppler examination. Mean outcome measures were birthweight, gestational age at delivery, NRBC count, incidence of preeclampsia or SGA and need of neonatal intensive care.

RESULTS

Significantly higher nucleated red blood cell counts than in all other groups were found in cases with abnormal Doppler findings in both uterine arteries and the umbilical artery and/or fetal aorta (p<0.001). These newborns had significantly lower birth weights (p<0.01, p<0.001), lower gestational age (p<0.001), an increased likelihood of caesarean section for clinical signs of fetal distress (p<0.001) and had to be transfered more frequently to the neonatal intensive care unit (p<0.01, p<0.001).

CONCLUSION

Patients with abnormal Doppler velocimetry waveforms of the uterine arteries in the presence of an abnormal umbilical artery or fetal aorta Doppler findings have a high risk of prematurity, preeclampsia or delivering a small-for-gestational-age newborn. Fetal response to uteroplacental insufficiency may lead to elevated nucleated red blood cells in the fetal blood. This fact might help to discriminate the small-for-gestational-age fetus who is growth-retarded and suffers from chronic placental insufficiency from the small but healthy fetus.

Correlations between serum assays of human chorionic gonadotrophin (hCG) and human placental lactogen (hPL) and pre-eclampsia or intrauterine growth restriction (IUGR) among nulliparas younger than 38 years

OBJECTIVE

To study the relation between serum human chorionic gonadotrophin (hCG) levels measured at 15-18 weeks and gestational disorders, assess their correlation with the artery uteroplacental Doppler (AUD) at 24 weeks among nulliparas, and assess the predictivity of the hCG/hPL (human placental lactogen) ratio for pre-eclampsia.

STUDY DESIGN

Retrospective study of two groups of women younger than 38 years old: one with an elevated serum hCG level (2 MoM (multiples of the median) or more) and a normal fetal karyotype (group A), and the other with a lower hCG level (group B). Within each group, we studied the nulliparas separately (respectively groups AO and BO). We analyzed the double screening, elevated hCG levels with abnormal AUD, for the predicting of hypertensive disorders.

RESULTS

Elevated hCG levels were significantly (p<0.05) more prevalent among women who developed gestational diabetes (groups A and AO) and among nulliparas with pregnancy-induced hypertension and pre-eclampsia (AO). Among nulliparas, the combination of the hCG assay and a subsequent Doppler increased the positive predictive value (PPV) of the assay from 19 to 75%, without reducing its negative predictive value (NPV) for gestational vascular disorders. The hCG/hPL ratio did not improve the predictivity of the hCG assay alone for pre-eclampsia.

CONCLUSIONS

An hCG level of 2 MoM or more at 15-18 weeks identifies a group of women at risk of gestational vascular disorders; it therefore ought to lead to an AUD at 24 weeks. This double screening should be able to define a population of women at risk of developing a hypertensive disorder, who could thus benefit from a preventive treatment, as aspirin.

Expression of vascular endothelial growth factor receptors 1, 2 and 3 in placentas from normal and complicated pregnancies

Extensive angiogenesis and invasion of the maternal decidua by trophoblasts are essential for the development and function of the placenta. Vascular endothelial growth factors (VEGF), placenta growth factor (PlGF) and their receptors VEGFR-1/Flt-1, VEGFR-2/KDR and VEGFR-3/Flt4 have important roles in vasculogenesis and angiogenesis. We have studied the localization of these proteins by immunohistochemistry and Western blotting in the placenta and of PlGF in maternal serum, and their association with diabetes, pre-eclampsia, fetal growth restriction (FGR) and fetal alcohol syndrome (FAS). VEGFR-1 and VEGFR-3 were detected mainly in the syncytiotrophoblastic layer whereas VEGFR-2 was detected in the vascular endothelial cells of the placenta. VEGFR-1, but not the other receptors, showed increased expression in placental syncytiotrophoblasts from 50% of patients with severe pre-eclampsia and FGR when compared with normal placentas. PlGF was undetectable in 38 of 44 samples of amniotic fluid of mothers with normal and complicated pregnancies. However, maternal serum PlGF concentrations were significantly lower in pre-eclamptic patients and in those with FGR when compared to diabetic women or healthy controls. These results suggest that low maternal serum PlGF and increased placental expression of its receptor VEGFR-1 are associated with pre-eclampsia and FGR.

The relation between newborn hemoglobin F fractions and risk factors for sudden infant death syndrome

OBJECTIVES

The aims of this study were to determine and compare fetal hemoglobin (HbF) fractions at birth in newborns exposed and not exposed to selected factors that have been reported to increase the risk of sudden infant death syndrome (SIDS). Previous studies have implicated HbF in the etiology of SIDS by finding higher fractions in infants dying from SIDS compared to age-matched control infants.

DESIGN

We performed a cross-sectional study using high-performance liquid chromatography to measure HbF fractions in newborn cord blood samples. Exposure to selected risk factors for SIDS was assessed through review of medical records.

PARTICIPANTS

Six hundred thirty-three infants born at Via Christi Regional Medical Center-St Francis Campus, Wichita, Kan, from February 28 through August 5, 1997.

MAIN OUTCOME MEASURE

Hemoglobin F fractions at birth were compared in newborns exposed and not exposed to selected risk factors associated with increased incidence of SIDS.

RESULTS

Mean HbF fractions were significantly higher in preterm newborns of mothers who smoked and in term newborns with intrauterine growth restriction, pregnancy weight gain less than or equal to 9 kg, and pregnancy complications associated with reduced placental blood flow. An elevated newborn HbF fraction, defined as 77% or greater, was significantly associated with maternal smoking, maternal anemia, intrauterine growth restriction, and pregnancy complications associated with reduced placental blood flow.

CONCLUSION

This study suggests a possible mechanism (HbF) by which previously identified factors may increase the risk of SIDS.

Elevation in erythroblast count in maternal blood before the onset of preeclampsia

OBJECTIVE

We recently showed that both maternal and fetal erythroblast counts are elevated in the peripheral blood of pregnant women with preeclampsia. The purpose of this study was to examine whether this elevation actually occurs before the clinical onset of the disorder.

STUDY DESIGN

Erythroblasts were enriched and enumerated in 97 maternal blood samples obtained in the second trimester, and results were subsequently correlated with pregnancy outcomes.

RESULTS

Significantly higher quantities of erythroblasts (mean, 6041.7 vs 928.9; P =.008) were detected in blood samples obtained from women who later acquired preeclampsia (n = 15) than in blood samples from the control cohort (n = 72). Intrauterine growth restriction (n = 10) was not accompanied by a similar rise in erythroblast count.

CONCLUSION

Because a large proportion of the erythroblasts in maternal blood are fetal, our data suggest that fetal-maternal cell traffic is affected early in pregnancies that are later complicated by preeclampsia but not in those affected only by intrauterine growth restriction.

Fetal hemoglobin-expressing nucleated red blood cell frequencies in pregnancies with intrauterine growth restriction

The objective of this study was to examine whether there is a difference in the frequency of fetal erythroblasts in maternal blood in pregnancies with intrauterine growth restriction (IUGR) as compared with normal pregnancies. Nucleated red blood cells (NRBC) were isolated from nine pregnant women with ultrasonically diagnosed IUGR (estimated fetal weight less than the 10th percentile for gestational age) and 11 women with appropriately grown fetuses. The frequency of fetal hemoglobin-expressing NRBC (FHE-NRBC) in maternal blood was evaluated by triple density centrifugation and anti-CD71+ magnetic cell sorting, followed by indirect immunocytochemistry for the detection of gamma-chain fetal hemoglobin. The number of FHE-NRBC in 10 ml maternal blood in the IUGR group was higher than in the control group (454.5 vs 56.7, p<0.05). This difference was even more pronounced when FHE-NRBC frequency was calculated relative to the total CD71+ population of cells. There were 118.9 FHE-NRBC per 10(5) CD71+ cells in IUGR pregnancies as compared with 11.5 cells in the control group (p<0.01). There was no difference in the total mean number of CD71+ mononuclear cells between the two groups. The observed increase in the frequency of fetal cells in the maternal circulation found in IUGR pregnancies may be a result of an increase in total NRBC in the fetal circulation or rather of abnormalities in placental structure. This phenomenon may assist in identifying pregnancies at risk for this complication early in the course of the pregnancy, even before actual growth restriction presents itself ultrasonically.

Changes of serum melatonin level and its relationship to feto-placental unit during pregnancy

Serum melatonin concentrations were studied in normal pregnant women and in women with several types of pathologic pregnancies, e.g., twins, preeclampsia or intrauterine growth retardation (IUGR). Blood samples were collected from the maternal antecubital vein at 14:00 hr (daytime) and 02:00 hr (nighttime) during pregnancy, and also from the umbilical vein and artery immediately after delivery. Serum melatonin concentrations were measured by radioimmunoassay. Daytime serum melatonin levels in normal (single fetus; singleton) pregnancies were low. While the levels showed an increasing tendency toward the end of pregnancy, no statistically significant changes occurred. On the other hand, the nighttime serum melatonin levels increased after 24 weeks of gestation, with significantly (P < 0.01) high levels after 32 weeks; these values decreased to non-pregnant levels on the 2nd day of puerperium. Nighttime serum melatonin levels were significantly (P < 0.05) higher in twin pregnancies after 28 weeks of gestation than in singleton pregnancies, whereas the patients with severe preeclampsia showed significantly (P < 0.05) lower serum melatonin levels than the mild preeclampsia or the normal pregnant women after 32 weeks of gestation. Melatonin concentrations in umbilical vessels showed a higher tendency in neonates who were born during at night compared with the other neonates; moreover, those in the umbilical artery were generally higher than those in the umbilical vein. The present results indicate that in humans, the maternal serum melatonin levels show a diurnal rhythm, which increases until the end of pregnancy, reflecting some pathologic states of the feto-placental unit. Fetuses may produce melatonin with a circadian rhythm.

[Changes of maternal and umbilical serum nitric oxide in patients with the intrauterine growth retardation]

OBJECTIVE

To determine whether the levels of maternal and umbilical serum nitric oxide (NO) were changed in cases of intrauterine growth retardation (IUGR).

METHODS

Fifteen pregnant women with fetuses of IUGR (IUGR group) and 25 normal pregnant women in late trimester (normal control group) were studied. Maternal and fetal umbilical venous blood were collected from all the cases. Serum NO2-/NO3-, the end products of NO, were measured with the Griess reaction after reduction with nitrate reductase.

RESULTS

Mean NO2-/NO3- values in maternal serum were (74.22 +/- 28.99) mumol/L in IUGR group and (56.71 +/- 22.81) mumol/L in the control. Umbilical serum NO2-/NO3- values were (39.73 +/- 24.65) mumol/L in IUGR group and (21.49 +/- 6.69) mumol/L in the control. Compared with the control, maternal as well as umbilical serum NO2-/NO3- in IUGR group were significantly higher (P < 0.05 and P < 0.001, respectively). The total nitrite levels in fetal circulation were lower than in maternal circulation in both groups (P < 0.05).

CONCLUSIONS

Changes of NO in the pregnant women and their fetuses were due to the result of secondary complementary response in the patients with IUGR. The metabolic disorder of nitric oxide in maternal and fetal circulation may play an important role in pathogenesis of IUGR.

Folate and intrauterine growth retardation

The objectives of this case-control study were to compare the levels of folate in cord and maternal blood of 315 mothers who had intrauterine growth-retarded (IUGR) babies and 321 mothers who had appropriate-for-gestational-age (AGA) babies, to evaluate the correlation between cord and maternal folate and to assess the prevalence of folate deficiency. Mothers were recruited from the four largest hospitals in Campinas city, south-east Brazil. The gestational ages of the newborns were evaluated by the Capurro method. They were classified as being IUGR according to the Lubchenco birthweight-for-gestational-age standard. Red blood cell (RBC) folate was measured by radio-immunoassay. Slightly more IUGR (25.7%) than AGA babies (19.9%) had cord folate levels < or = 226.5 nmol/l (100 ng/ml) (p = 0.05) and similar percentages of IUGR (32.1%) and AGA (29.9%) mothers had folate levels < or = 226.5 nmol/l. Mean cord folate levels in IUGR and AGA babies were 10% higher than mean folate levels in the two groups of mothers (p < 0.001). There were weak correlations between maternal and cord folate in IUGR (r = 0.31) and AGA (r = 0.35) (p < 0.001) mother/baby groups. In this population, 35% of mothers were folate-deficient although it was not associated with IUGR. Nevertheless, it would be important to give Brazilian women folate tablets during pregnancy and to investigate the effect on concentrations of homocysteine and on the prevalence of birth defects.

Neutrophil activation in preeclampsia and isolated intrauterine growth restriction

OBJECTIVE

Neutrophils have been implicated in the pathogenesis of preeclampsia. Because preeclampsia and intrauterine growth restriction result from similar placental lesions, the aim of this study was to investigate neutrophil activation in isolated intrauterine growth restriction relative to preeclampsia and uncomplicated pregnancy. Polymorphonuclear neutrophil activation was analyzed by measuring cell surface and soluble cell adhesion molecule expressions.

STUDY DESIGN

L -Selectin (CD62L ) and CD11b surface expressions on polymorphonuclear neutrophils were analyzed in 13 women with preeclampsia, 11 women with isolated intrauterine growth restriction, and 17 age- and gestation-matched control women by means of a standardized quantitative flow cytometry assay. Serum levels of soluble L -selectin were measured by enzyme-linked immunosorbent assay.

RESULTS

Neutrophils from women with isolated intrauterine growth restriction and women with preeclampsia displayed higher levels of CD11b and lower levels of CD62L than did neutrophils from healthy pregnant women. Soluble L -selectin serum levels were significantly increased in the preeclampsia and intrauterine growth restriction groups relative to normal values. No significant difference in the levels of CD11b, CD62L, and soluble L -selectin were observed between women with isolated intrauterine growth restriction and those with preeclampsia. Leukocyte activation was not correlated with disease severity.

CONCLUSION

The observed alteration in polymorphonuclear neutrophil adhesion molecule expressions and increased serum soluble L -selectin levels are consistent with activation of peripheral blood neutrophils occurring in isolated intrauterine growth restriction in a manner similar to that seen in preeclampsia. This evidence of neutrophil activation may help to advance our understanding of the disease process in isolated intrauterine growth restriction.

The concentration of alpha 1-antitrypsin in the maternal serum after delivery of normal and small for gestational age infants

BACKGROUND

alpha 1-antitrypsin (A-1-AT) is an acute-phase protein. It is present in plasma and other extracellular fluids and in human trophoblastic tissue. It accounts for 80 to 90 per cent of antiprotease reactions occurring in plasma. It has the ability to greatly affect enzyme activity and plays an important role in immunomodulatory processes.

MATERIALS AND METHODS

The purpose of the study was to determine the plasma concentration of A-1-AT in mothers giving birth to hypotrophic (small for gestational age, SGA), and eutrophic (appropriate for gestational age, AGA) infants. 33 women who gave birth to SGA infants and 36 women who gave birth to AGA infants participated in the study. The control group consisted of 30 non-pregnant women who were of reproductive age. All women gave birth at term. To measure A-1-AT concentration, we used the diffusion method described by Mancini et al.

RESULTS

The highest concentration of A-1-AT (379 mg/dl) was found in women giving birth to SGA infants, compared with 345 mg/dl for women giving birth to AGA infants. In the control group, the concentration was found to be 270 mg/dl.

CONCLUSIONS

Statistical analysis of the results showed a significant difference between the two groups of women gave birth and between each parturient compared with control subjects. Increasing concentration of A-1-AT in the plasma of women in labor may be the result of an acute phase reaction triggered by the stress during parturition. Additionally, increased concentrations of A-1-AT in women who gave birth to SGA rather than AGA infants suggest that it may play a role in the processes of intrauterine growth retardation (IUGR).

Serial measurements of serum human placental lactogen (hPL) and serial ultrasound examinations in the evaluation of fetal growth

Serial serum hPL measurements and serial ultrasound fetometry were compared in the evaluation of fetal growth by relating these two parameters to size at birth and to clinical factors known to influence size at birth. The data were from a prospective study of 1000 consecutive pregnant women considered to be at risk for fetal growth retardation with retrospective analysis. Serum hPL was measured by radioimmunoassay and fetal weight estimated by ultrasound every 3 weeks during the last trimester. hPL values were expressed as multiples of the median (MoM) and linear regression analysis of the hPL MoM values was carried out for each pregnancy to find the slope of the line (hPL-slope); at least 3 serum hPL values were required. The estimated fetal weight and weight-for-age at birth was expressed in Z-scores. The individual intrauterine growth velocity was calculated by regression analysis and expressed as change in Z-score for 12 weeks. At least two ultrasound measurements over an interval of at least 42 days were used to estimate the fetal growth velocity. In 588 women the file was complete. The main outcome measures were the individual mean hPL, hPL-slope, fetal growth velocity, birth weight deviation, smoking in pregnancy and diagnosis of preeclampsia. A significant correlation was found between the hPL-slope and the intrauterine fetal growth velocity (r=0.34), and between hPL-slope and birth weight deviation (r=0.32). Mean hPL was correlated to birth weight deviation (r=0.27), but only very weakly to intrauterine growth velocity (r=0.08). hPL-slope and intrauterine growth velocity independently predicted birth weight deviation. Heavy smoking which was stopped before the third trimester was not associated with low intrauterine growth velocity, but with a low hPL-slope. Preeclampsia was associated with a trend towards low and decreasing hPL and with an increasing intrauterine growth velocity and birth weight deviation. In conclusion the rate of change of serial hPL measurements correlated well to intrauterine fetal growth velocity in the third trimester as estimated by ultrasound and to the deviation in birth weight, but hPL seems to have a separate physiological significance, since it did not pick up when smoking was stopped and growth velocity was normalised and it did not at all detect the increased growth associated with preeclampsia.