title: First trimester maternal serum ischaemia-modified albumin: a marker of hypoxia-ischaemia-driven early trophoblast development.
abstract: BACKGROUND
  A hypoxic intrauterine environment is believed to play a pivotal role in physiological trophoblast development. Ischaemia-modified albumin (IMA) is used in the measurement of cardiac ischaemia. We aimed to test the hypothesis that maternal serum IMA may be elevated in early pregnancy as a measurable manifestation of intrauterine ischaemia.
  
  
  METHODS
  Prospective observational study in healthy women with singleton pregnancies (n=66) and non-pregnant controls (n=26). Maternal serum IMA levels were measured at 11-13 weeks of gestation and in non-pregnant women.
  
  
  RESULTS
  The median IMA level in the pregnant group [115.14 kU/l; interquartile range (IQR) 102.33-124.71 kU/l] was significantly higher (P<0.001) than in non-pregnant controls (73.71 kU/l; IQR 60.38-82.78 kU/l). During pregnancy, absolute values of IMA were higher than the concentration used for the diagnosis of myocardial ischaemia (>95 kU/l) in 86% of women.
  
  
  CONCLUSIONS
  In early pregnancy, IMA levels were above the concentration used for the diagnosis of myocardial ischaemia in most women, and should therefore not be used as a marker for cardiac ischaemia in pregnancy. Maternal serum IMA is elevated to supra-physiological levels in early normal pregnancy supporting the hypothesis that normal trophoblast development is associated with a hypoxic intrauterine environment, although other mechanisms leading to an IMA increase cannot be excluded.
authors: Fetal Medicine Unit, Division of Obstetrics and Gynaecology, St. George's University of London, and Department of Clinical Biochemistry, St. George's Hospital NHS Trust, London SW17 0RE, UK.
authors: Federico
authors: F
authors: Prefumo
authors: David C
authors: DC
authors: Gaze
authors: Aris T
authors: AT
authors: Papageorghiou
authors: Paul O
authors: PO
authors: Collinson
authors: Baskaran
authors: B
authors: Thilaganathan
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism*; D005260:Female; D005865:Gestational Age; D006801:Humans; D000860:Hypoxia; D007511:Ischemia / Q000175:diagnosis / Q000378:metabolism*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012709:Serum Albumin / Q000096:biosynthesis*; D014327:Trophoblasts / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D012709:Serum Albumin