Activin A, hypoxia and the prediction of obstetric outcomes.
On the back of sheep experiments showing that uterine hypoxia induces a rapid and sustained elevation of fetal activin A levels, we undertook two prospective studies to explore whether this novel observation could be exploited clinically. The first was a prospective labour ward study investigating whether umbilical arterial activin A levels at delivery correlated with either neonatal hypoxic ischaemic encephalopathy or pH. Unfortunately, we were unable to demonstrate a link with either, but found that levels were significantly depressed among those who had an emergency Caesarean section, suggesting a possible role in active labour. Second, we investigated the link between activin A and intrauterine growth restriction (IUGR), a condition of fetoplacental hypoxia, by measuring levels in women presenting for antenatal ultrasound biometry with clinical suspicion of a small baby. We found that, compared to pregnancies with a baby that was small for gestational age (SGA) but otherwise healthy, levels were 2.4 and 8 times higher, respectively, in pregnancies complicated by IUGR, and those complicated by both IUGR and preeclampsia. However, a single blood sample of activin A was unable to distinguish between IUGR and SGA pregnancies with sufficient sensitivity to be clinically useful. Our studies were unable to demonstrate clinical utility for the experimental observation linking activin A and hypoxia.
Tong
Stephen
S
Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia. stong@unimelb.edu.au
D028341:Activins / Q000097:blood / Q000378:metabolism*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis*; D005311:Fetal Hypoxia / Q000175:diagnosis*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D028322:Inhibin-beta Subunits / Q000097:blood / Q000378:metabolism*; D008423:Maternal Age; D007744:Obstetric Labor Complications / Q000175:diagnosis; D010298:Parity; D011225:Pre-Eclampsia / Q000175:diagnosis; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014471:Umbilical Veins / Q000737:chemistry
D015415:Biomarkers; C422405:activin A; D028341:Activins; D028322:Inhibin-beta Subunits