Serum Erythropoietin in Small for Gestational Age Fetuses

Lémery, D.; Santolaya, Joaquín; Serre, Anaïs; Denoix, Stephanie; Besse, G; Vanlieferinghen, Philippe C.; Bezou, Marie J.; Gaillard, G; Jacquetin, B.

doi:10.1159/000244033

Cited by 25 publications

(21 citation statements)

References 13 publications

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“…In particular, it remains to be determined whether these changes have an impact on oxygen transport. Importantly, the long-term effects of prenatal glucocorticoid excess on RBC in humans are unknown, but conditions associated with prenatal stress, such as intrauterine growth retardation or maternal diabetes, increase fetal/ infant EPO concentrations and erythroblastosis (34,35). Our data indicate that RBC mass can be permanently programmed by prenatal stress and provide a novel mechanism for fetal origins of polycythemia and its associated complications, notably thromboemolic disease.…”

Section: Discussionmentioning

confidence: 82%

Prenatal Glucocorticoid Overexposure Causes Permanent Increases in Renal Erythropoietin Expression and Red Blood Cell Mass in the Rat Offspring

Tang

Nyirenda

2011

Endocrinology

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Glucocorticoids promote maturation of fetal systems, including erythropoiesis, in preparation for extrauterine life. However, recent studies have shown that prenatal glucocorticoid excess can cause long-term deleterious cardiometabolic and other consequences to the offspring. Here, we examined the effect of prenatal treatment with the synthetic glucocorticoid dexamethasone (DEX) during the last week of gestation on red blood cell (RBC) mass in the rat offspring. DEX-treated offspring at 9 months of age had significantly higher RBC count (9.4 Ϯ 0.1 vs. 235.7 Ϯ 5.6 ϫ 10 9 liter; P ϭ 0.04), compared with offspring of vehicletreated control pregnancies. White blood cells and platelets were unaltered. Renal mRNA expression and plasma concentrations of erythropoietin, the main regulator of erythropoiesis, were increased by nearly 100% in both newborn and adult DEX-treated rats (P Ͻ 0.01). This increase was accompanied by marked elevation in renal expression of hepatocyte nuclear factor 4␣ mRNA, whereas other erythropoietin-regulating transcription factors, such as hypoxia-inducible factor 1, hypoxia-inducible factor 2, and GATA2 were unchanged. These data indicate that RBC mass can be programmed by prenatal glucocorticoid excess, and if extrapolatable to humans, provide a novel mechanism for fetal origins of polycythemia and its associated complications. (Endocrinology 152: 2716 -2721, 2011)

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Section: Discussionmentioning

confidence: 82%

Prenatal Glucocorticoid Overexposure Causes Permanent Increases in Renal Erythropoietin Expression and Red Blood Cell Mass in the Rat Offspring

Tang

Nyirenda

2011

Endocrinology

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“…Erythropoietin, which also regulates fetal erythropoiesis [29], is elevated in cord blood at birth in a variety of conditions associated with impaired oxygen supply to the fetus: intrauterine growth restriction, maternal diabetes, and fetal anemia [17,[30][31][32][33]. Because hypoxia causes an increased production of erythropoietin, its concentration can serve as a marker of chronic fetal hypoxia [17].…”

Section: Discussionmentioning

confidence: 99%

Vascular Endothelial Growth Factor and Angiogenin Levels during Fetal Development and in Maternal Diabetes

Lassus

Teramo²,

Nupponen³

et al. 2003

Neonatology

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We evaluated the concentrations of vascular endothelial growth factor (VEGF) and angiogenin in the umbilical cord blood from 14 fetuses with erythroblastosis or alloimmune thrombocytopenia and at birth from 28 preterm fetuses, from 42 healthy term fetuses, and from 24 term fetuses born to mothers with insulin-treated diabetes. A correlation appeared between VEGF and angiogenin levels (r = 0.44, p = 0.038). The gestational age correlated with both VEGF (r = 0.38, p = 0.0008) and angiogenin levels (r = 0.80, p = 0.0001). The concentration of VEGF was lower in fetuses born to mothers with insulin-treated diabetes than in the healthy term fetuses (p = 0.0028), but this difference was absent for angiogenin (p > 0.05). In conclusion, in umbilical cord plasma, a developmental increase was evident in concentrations of VEGF and angiogenin during the last trimester of gestation. That the umbilical cord VEGF level was lower in term fetuses born to mothers with diabetes than in term fetuses of healthy mothers may be associated with an aberrant fetal vascular development in diabetic pregnancies.

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“…In a group of 75 children with cerebral palsy, Sheilds and Schifrin 14 reported that cord blood acidosis was absent in newborns with chronic hypoxia who did not have intrapartum evidence of fetal distress. Among these children, only half had a low 5-minute Apgar score.…”

Section: Discussionmentioning

confidence: 99%

“…12 The presence of EPO in fetal blood has been documented as early as the 16th week of gestation. 13 Elevated EPO has been associated with uteroplacental insufficiency, like fetal growth restriction (FGR) 14 and intrauterine fetal hypoxia. 15,16 A strong correlation between EPO and cord blood gases has also been reported.…”

mentioning

confidence: 99%

Fetal Erythropoietin Levels in Growth-Restricted and Appropriately Grown Neonates With and Without Abnormal Fetal Heart Rate Tracings: A Comparison With Cord Blood Gases and Apgar Scores

1999

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OBJECTIVE:To determine if umbilical cord plasma erythropoietin (EPO) levels in combination with cord blood gases and Apgar scores can distinguish between subacute and chronic uteroplacental insufficiency. METHODS:A total of 184 neonates delivered between 1993 and 1997 at Tampa General Hospital were studied. Cord plasma EPO levels, cord blood gases, and Apgar scores were determined prospectively and compared in four subgroups that were defined based on the presence or absence of fetal growth restriction (FGR; chronic fetal hypoxia), abnormal fetal heart rate tracings during labor (FHR; subacute/acute fetal hypoxia), or both. RESULTS:Both growth-restricted and appropriately grown newborns with abnormal intrapartum FHR tracing had elevated umbilical cord plasma EPO (183.5 and 135.2 mIU/ml, respectively; normal ϭ 20.7 mIU/ml) and base deficit, whereas pH, PO 2 , and 1-minute and 5-minute Apgar scores were significantly lower, compared with appropriately grown newborns with a normal intrapartum course. Among newborns with normal heart rate tracings and FGR, the mean plasma EPO levels were elevated (89.5 mIU/ml), whereas the other parameters were not different from normal. CONCLUSION:Our findings suggest that, although cord blood gases and Apgar scores may reflect subacute and acute events, they are not good predictors of chronic uteroplacental insufficiency. The supplemental use of umbilical cord plasma EPO levels may improve our ability to identify chronic uteroplacental insufficiency.Intrauterine fetal well being has been traditionally assessed by ultrasound studies and fetal heart rate monitoring.1-3 These surveillance methods, however, have not helped decrease the incidence of cerebral palsy.4,5 It has been suggested that chronic, rather than subacute or acute, fetal hypoxia is a better predictor of neurologic deficits in the newborn.6 -11 To improve pregnancy outcomes, investigators have searched for better markers of chronic fetal hypoxia.Erythropoietin (EPO) is a glycoprotein produced by the fetal kidney and liver, and its production increases only in response to fetal hypoxia. 12 The presence of EPO in fetal blood has been documented as early as the 16th week of gestation. 13 Elevated EPO has been associated with uteroplacental insufficiency, like fetal growth restriction (FGR) 14 and intrauterine fetal hypoxia. 15,16 A strong correlation between EPO and cord blood gases has also been reported. [17][18][19] As an indicator of chronic hypoxia, EPO may prove useful in identifying fetuses at risk for long-term irreversible end organ damage such as cerebral palsy. The purpose of this study was to determine if fetal EPO could provide a better method for identifying infants with chronic uteroplacental insufficiency than cord blood gases and Apgar scores alone. METHODSThe study protocol was approved by the Institutional Review Board of the University of South Florida College of Medicine. The estimated gestational age of the infants at delivery was 24 to 40 completed weeks, based on menstrual history, early ultraso...

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Serum Erythropoietin in Small for Gestational Age Fetuses

Cited by 25 publications

References 13 publications

Prenatal Glucocorticoid Overexposure Causes Permanent Increases in Renal Erythropoietin Expression and Red Blood Cell Mass in the Rat Offspring

Prenatal Glucocorticoid Overexposure Causes Permanent Increases in Renal Erythropoietin Expression and Red Blood Cell Mass in the Rat Offspring

Vascular Endothelial Growth Factor and Angiogenin Levels during Fetal Development and in Maternal Diabetes

Fetal Erythropoietin Levels in Growth-Restricted and Appropriately Grown Neonates With and Without Abnormal Fetal Heart Rate Tracings: A Comparison With Cord Blood Gases and Apgar Scores

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