Insulinlike growth factor 1 in controls and growth-retarded fetuses.
OBJECTIVE
To establish a reference range of insulinlike growth factor 1 (IGF-1) values in normal fetuses and to assess whether intrauterine growth retardation is associated with increased or decreased IGF-1 levels.


METHODS
Retrospective analysis of blood samples collected from 64 fetuses who underwent blood sampling at 18-38 weeks' gestation was performed: 40 fetuses, who were considered controls, were appropriately grown for gestational age and were found unaffected by the condition for which they were tested; the remainder (n = 24) underwent fetal blood sampling to assess fetal karyotype and acid-base balance following ultrasonic diagnosis of intrauterine growth retardation. (In this group, 8 survived, and 16 died during the perinatal period). IGF-1 was measured using a radioimmunoassay after acid-ethanol extraction in order to avoid interference by the binding proteins. All samples from controls and growth-retarded fetuses were measured using the same batch, and the intra-assay coefficient of variation of the test ranged from 4.1 to 6.1%.


RESULTS
In control fetuses, IGF-1 serum levels increased linearly with gestational age. In growth-retarded fetuses, IGF-1 levels were not significantly different from the reference range (median Z-score -0.3; range -4.4 to 291) and did not correlate with fetal size, hematocrit, and acid-base balance values. There was a significant difference in IGF-1 and pH values when the fetuses were divided into two groups based on the perinatal outcome: those who survived had values of IGF-1 mostly within the normal range, whereas the fetuses who died in utero or postnatally had significantly decreased pH and elevated IGF-1 values (median Z-score 2.1; 95% confidence interval 0.4-13.9; p = 0.04).


CONCLUSIONS
This study confirms previous observations that IGF-1 levels parallel the increase in fetal size which occurs with advancing gestation. Increased levels of IGF-1 may indicate a terminal process in the fetal adaptation to placental failure.
1st Department of Obstetrics and Gynecology, University of Milan, Italy.
L
L
Bocconi
F
F
Mauro
S E
SE
Maddalena
C
C
De Iulio
A S
AS
Tirelli
E
E
Pace
U
U
Nicolini
D016022:Case-Control Studies; D005312:Fetal Blood / Q000737:chemistry*; D005313:Fetal Death / Q000097:blood; D005317:Fetal Growth Retardation / Q000097:blood*; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D012016:Reference Values; D012189:Retrospective Studies
D007334:Insulin-Like Growth Factor I