Lung maturation in small for gestational age fetuses from pregnancies complicated by placental insufficiency or maternal hypertension.
BACKGROUND
Clinical studies suggest that respiratory outcome of infants born preterm may be influenced by placental insufficiency and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. If so, one could expect to see differences in lung maturation indices (lecithin/sphingomyelin (L/S) ratio and lamellar body count (LBC)) in the amniotic fluid. The present study investigates lung maturation indices of preterm small for gestational age (SGA) fetuses with or without abnormal Doppler ultrasound examination and with or without maternal hypertension/HELLP syndrome.


METHODS
Retrospective cohort study of 76 neonates born in our center between 1997 and 2003 with gestational age (GA) <34 weeks, birth weight <p10 for GA and available results from amniocentesis. All analyses were corrected for potential confounders.


RESULTS
The L/S ratio was significantly higher in the abnormal Doppler group as compared to the normal Doppler group (p=0.02). The L/S ratio was significantly lower in hypertensive pregnancies as compared to normotensive pregnancies (p=0.02). Subdivision of the maternal hypertension group showed a significantly lower L/S ratio in the HELLP syndrome group as compared to the normotension group (p=0.04).


CONCLUSIONS
The L/S ratio of SGA fetuses is significantly higher in cases with presumed placental insufficiency and significantly lower when pregnancies are complicated by HELLP syndrome. These observations are in line with the hypothesis that placental insufficiency accelerates lung maturation and with recent reports of poorer respiratory outcome in infants from mothers with HELLP syndrome.
Torrance
H L
HL
Perinatal Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands. H.Torrance@umcutrecht.nl
Voorbij
H A M
HA
Wijnberger
L D
LD
van Bel
F
F
Visser
G H A
GH
D000293:Adolescent; D000328:Adult; D000653:Amniotic Fluid / Q000737:chemistry / Q000166:cytology; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis / Q000503:physiopathology*; D005325:Fetal Organ Maturity / Q000502:physiology*; D005865:Gestational Age; D017359:HELLP Syndrome / Q000503:physiopathology; D006305:Health Status Indicators; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D054709:Lecithins / Q000032:analysis; D008168:Lung / Q000196:embryology* / Q000502:physiology; D010927:Placental Insufficiency / Q000503:physiopathology; D011247:Pregnancy; D011663:Pulmonary Surfactants / Q000032:analysis; D012189:Retrospective Studies; D013109:Sphingomyelins / Q000032:analysis
D054709:Lecithins; D011663:Pulmonary Surfactants; D013109:Sphingomyelins