Fetal plasma erythropoietin in pregnancies complicated by maternal diabetes mellitus

Salvesen, Douglas R.; Brudenell, J. M.; Snijders, R. J. M.; Ireland, Robin; Nicolaïdes, K. H.

doi:10.1016/0020-7292(93)90290-d

Cited by 19 publications

(25 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ventricular dysfunction might also be due to metabolic acidosis. As previous studies have shown [16,17], diabetic pregnancies were complicated with fetal acidemia, especially when the diabetes was poorly controlled. Future study assessing the right ventricular compliance directly, i.e.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Function in Fetuses of Poorly-Controlled Pre-Gestational Diabetic Pregnancies – A Pilot Study

Wong

Chan

Cincotta

et al. 2003

Gynecol Obstet Invest

View full text Add to dashboard Cite

Objective: Cardiac impairment is frequently found in babies of diabetic mothers. It is still controversial whether this is due to poor glucose control. The aim of this study is to compare the cardiac function in fetuses of well- and poorly-controlled pre-gestational diabetic pregnancy in third trimester. Methods: Women with type 1 pre-gestational diabetes were enrolled at 30–32 weeks. Cardiac size and interventricular septal wall thickness were measured by M-mode at end-diastolic phase. The right and left ventricular ejection fractions were calculated. At the mitral and tricuspid valves inflow, the ratio between early ventricular filling and active atrial filling (E/A) at both atrioventricular valves were measured by Doppler echocardiography. Peak velocities of ascending aorta and pulmonary artery were assessed. The angle of isonation was kept at <20°. Women with poorly-controlled diabetes (HbA1c >6.5%) were compared with those with satisfactorily controlled diabetes (HbA1c ≤6.5%). Results: A total of 21 women with pre-gestational diabetes were recruited for this study. Eight women with well-controlled diabetes were compared with 9 women who had poorly-controlled diabetes. HbA1c in the poorly-controlled group was 7.3% and in the well-controlled group it was 5.4% (p < 0.001). There was no difference between the two groups in cardiac size, interventricular septal wall thickness, ejection fraction, aorta and pulmonary artery peak flow velocities. The right atrioventricular E/A ratio was significantly lower among the poorly-controlled diabetic pregnancies (0.71 vs. 0.54; p < 0.05). Conclusion: Fetuses of poorly-controlled diabetic mothers had a lower right atrioventricular E/A ratio. This may be due to metabolic acidosis, non-hypertrophic cardiac dysfunction or fetal polycythemia.

show abstract

Section: Discussionmentioning

confidence: 99%

Cardiac Function in Fetuses of Poorly-Controlled Pre-Gestational Diabetic Pregnancies – A Pilot Study

Wong

Chan

Cincotta

et al. 2003

Gynecol Obstet Invest

View full text Add to dashboard Cite

show abstract

“…It is thus conceivable that cardiac dysfunction could be a cause of stillbirths in pregnancies complicated by diabetes. During fetal life, infants of women with diabetes often have hyperglycemia, hyperinsulinemia (5 ), and increased concentrations of markers of hypoxic stress, e.g., plasma erythropoietin (6,7 ). These factors could all have negative effects on the fetal heart in utero (8 ).…”

confidence: 99%

Increased Plasma Pro-B-Type Natriuretic Peptide in Infants of Women with Type 1 Diabetes

Halse¹,

Lindegaard²,

Goetze³

et al. 2005

Clinical Chemistry

View full text Add to dashboard Cite

“…This needs to be investigated in other studies. Infants of women with gestational diabetes tend to be large for gestational age and have higher levels of EPO (20). None of the women in this study had gestational diabetes, so we cannot exclude the possibility that the association between birth weight SDS and EPO is U-shaped.…”

Section: Discussionmentioning

confidence: 81%

Association between Erythropoietin in Cord Blood of Twins and Size at Birth: Does It Relate to Gestational Factors or to Factors during Labor or Delivery?

et al. 2005

View full text Add to dashboard Cite

We hypothesized that cord blood erythropoietin (EPO), a marker of fetal hypoxia, relates to gestational factors and not solely those associated with delivery. We investigated the association between birth weight SD score (SDS) and cord blood EPO in 290 twins (145 pairs), assessing the influence of gestational versus perinatal factors by comparing the association in those who were delivered by elective cesarean (CS) with that in other delivery modes. Blood EPO values were skewed, so geometric means are presented and log EPO values were used in statistical models. The birth size-EPO association was estimated in mixed-effects models that included terms that represented difference in log EPO and mean log EPO for each twin pair. Within-pair estimates of the association were unconfounded by maternal factors (because these were perfectly controlled). Geometric mean EPO was higher in boys versus girls (24.4 versus 17.0 IU/L; p ϭ 0.0001) and increased with gestational age (p ϭ 0.0003) but was similar after elective CS versus other delivery modes. The negative birth size-EPO association was stronger in infants who were delivered by elective CS than by other delivery modes [␤ for log 2 EPO: Ϫ0.56 (95% CI, Ϫ0.77 to Ϫ0.36) versus Ϫ0.27 (Ϫ0.42 to Ϫ0.12), respectively; p ϭ 0.02 for interaction). Because the association was seen after elective CS delivery, cord blood EPO must relate to factors during gestation, not just perinatal factors. There was no evidence of an association between birth weight SDS and pair mean log EPO, indicating that the association is entirely due to fetus-specific rather than pairspecific factors. Size at birth (standardized for sex and gestational age) reflects intrauterine growth. This is determined substantially by maternal acquisition of oxygen and nutrients and their transfer to the fetus via the placenta (1). It is difficult to study the contributions of and interactions between maternal and placental factors, especially in large cohorts, but twin pregnancies may offer such an opportunity, because maternal factors are shared, whereas placental factors can be discordant (2,3).As an indicator of fetal oxygenation (4), cord blood erythropoietin (EPO) reflects adequacy of oxygen delivery to the fetus. It is of fetal origin because maternal EPO does not cross the human placenta (5-7). Raised cord blood EPO indicates fetal hypoxemia and impaired oxygen transfer to the fetus, an impairment that may extend to delivery of other substrates that are essential for fetal growth (8).A number of studies have demonstrated a relationship between EPO in cord blood and size at birth, including studies of twins (4,9 -12). However, there is evidence that EPO level rises within~4 h of an episode of hypoxia, (13) and neonates who are small for gestation may be more likely to sustain perinatal asphyxia (14). Thus, the observed negative association between birth weight and cord blood EPO could primarily

show abstract

Fetal plasma erythropoietin in pregnancies complicated by maternal diabetes mellitus

Cited by 19 publications

References 0 publications

Cardiac Function in Fetuses of Poorly-Controlled Pre-Gestational Diabetic Pregnancies – A Pilot Study

Cardiac Function in Fetuses of Poorly-Controlled Pre-Gestational Diabetic Pregnancies – A Pilot Study

Increased Plasma Pro-B-Type Natriuretic Peptide in Infants of Women with Type 1 Diabetes

Association between Erythropoietin in Cord Blood of Twins and Size at Birth: Does It Relate to Gestational Factors or to Factors during Labor or Delivery?

Contact Info

Product

Resources

About