Cardiovascular hemodynamics and umbilical artery N-terminal peptide of proB-type natriuretic peptide in human fetuses with growth restriction.
OBJECTIVE
To test our hypothesis that human fetal N-terminal peptide of proB-type natriuretic peptide (NT-proBNP) secretion is increased in proportion to the severity of fetal cardiovascular compromise in intrauterine growth restriction.


METHODS
This prospective cross-sectional study consisted of 42 growth-restricted fetuses who underwent Doppler ultrasonographic examination of cardiovascular hemodynamics within 7 days before delivery. Group 1 fetuses (n = 13) had normal umbilical artery (UA) velocimetry. Group 2 fetuses (n = 15) had abnormal UA and normal ductus venosus (DV) velocimetry. In Group 3 fetuses (n = 14), both UA and DV velocimetries were abnormal. At delivery, an UA blood sample was obtained for assessment of NT-proBNP. Normal values for UA NT-proBNP were determined in 49 neonates (control group) with uncomplicated pregnancy and delivery.


RESULTS
Group 3 fetuses demonstrated greater (P < 0.05) UA and descending aorta pulsatility indices (PIs) and greater DV, left hepatic vein (LHV) and inferior vena cava PIs for veins (PIVs) than fetuses in Groups 1 and 2. Weight-indexed cardiac outputs and ventricular ejection forces were similar among the groups. Group 3 fetuses had higher (P < 0.05) UA NT-proBNP concentration than fetuses in Groups 1 and 2. In the control group, the 95(th) percentile value of UA NT-proBNP was 518 pmol/L. In Group 3, 13/14 neonates demonstrated abnormal UA NT-proBNP levels. The corresponding incidences were 4/13 and 7/15 in Groups 1 and 2. Significant positive correlations were found between UA, DV and LHV PIVs and UA NT-proBNP concentrations.


CONCLUSIONS
In human fetal growth restriction, increased cardiac afterload and pulsatility in DV blood velocity waveform pattern are associated with elevated UA NT-proBNP concentrations.
Girsen
A
A
Department of Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Ala-Kopsala
M
M
Mäkikallio
K
K
Vuolteenaho
O
O
Räsänen
J
J
D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003627:Data Interpretation, Statistical; D015150:Echocardiography, Doppler / Q000379:methods; D016021:Epidemiologic Studies; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005317:Fetal Growth Retardation / Q000097:blood*; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000378:metabolism*; D010446:Peptide Fragments / Q000097:blood / Q000378:metabolism*; D021041:Placental Circulation / Q000502:physiology; D010927:Placental Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011247:Pregnancy; D014469:Umbilical Arteries / Q000378:metabolism*
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain