Discordant fetal leptin levels in monochorionic twins with chronic midtrimester twin-twin transfusion syndrome.
The objective of this study was to determine the plasma leptin concentrations in monochorionic twin fetuses with and without twin-twin transfusion syndrome (TTTS). Paired maternal and fetal blood samples were obtained at birth from monochorionic twin pregnancies complicated with (n=12) or without TTTS (n=12). Amniotic fluid samples were also collected from twin pairs at amnioreduction and/or fetal blood sampling in utero. Plasma and amniotic fluid leptin concentrations were measured by radio-immunoassay. Fetal leptin levels in the growth-restricted donor were lower than the recipient twin of the TTTS group (Delta mean 3.7; CI 2.6 to 4.7 ng/ml; P< 0.001). Fetal leptin levels were comparable between non-TTTS twin pairs (Delta mean 0.9; CI 0.1 to 1.4 ng/ml; P=0.10) and recipient twins of TTTS (P=NS). Maternal plasma concentrations of leptin were comparable between the two groups and were higher than the fetal levels. There was a positive association between cord leptin levels and birthweight of twin pairs (y=0.002x-0.37; r=0.58; P< 0.01; n=48). A significant positive relation was also found between delta leptin levels and percentage discordance in birthweight in the TTTS group (y=0.25x-2.21; r=0.82; P< 0.001, n=12). In conclusion, leptin levels in the recipient twins were three times higher than their growth restricted donor twins. However further studies are warranted to elucidate the underlying mechanism.
Sooranna
S R
SR
Imperial College School of Medicine, Department of Maternal and Fetal Medicine, Chelsea and Westminster Hospital, London, UK.
Ward
S
S
Bajoria
R
R
D000653:Amniotic Fluid / Q000737:chemistry*; D001724:Birth Weight; D002823:Chorion; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D005330:Fetofetal Transfusion / Q000097:blood / Q000378:metabolism*; D005865:Gestational Age; D006801:Humans; D020738:Leptin / Q000032:analysis*; D008431:Maternal-Fetal Exchange; D011247:Pregnancy
D020738:Leptin