title: Defective endovascular trophoblast invasion in the first trimester is associated with increased maternal serum ischemia-modified albumin.
abstract: BACKGROUND
  Ischemia-modified albumin (IMA), a protein elevated in cardiac ischemia, is also increased to supra-physiological levels in early normal pregnancy. This finding supports the hypothesis that normal trophoblast development is stimulated by a hypoxic intrauterine environment. The aim of this study was to examine whether first trimester IMA levels are further elevated with defective trophoblast development.
  
  
  METHODS
  Prospective study of healthy women with singleton pregnancies undergoing nuchal translucency assessment at 11-14 weeks. First trimester maternal serum IMA concentrations in those subsequently developing pre-term pre-eclampsia (n = 19) were compared to randomly chosen controls with normal pregnancy outcome (n = 69).
  
  
  RESULTS
  Median first trimester serum IMA concentrations were significantly higher in women who subsequently developed pre-eclampsia (median 126.5 kU/L, interquartile range (IQR) 114.33-134.36 kU/L) when compared to those with normal pregnancy outcome (median 115.01 kU/L, IQR 102.29-124.81 kU/L, P = 0.02).
  
  
  CONCLUSIONS
  Maternal serum IMA levels are elevated in the first trimester in women with pre-eclampsia, a clinical manifestation of defective endovascular trophoblast development. This suggests that abnormally high intrauterine hypoxia and subsequent reperfusion oxidative damage may be associated with defective trophoblast development. First trimester serum IMA may be a potential biomarker for abnormal placental development.
authors.affiliation: Fetal Medicine Unit, Academic Department of Clinical Developmental Sciences, 4th Floor, Lanesborough Wing, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
authors.forename: Aris T
authors.initials: AT
authors.lastname: Papageorghiou
authors.forename: Federico
authors.initials: F
authors.lastname: Prefumo
authors.forename: Karin
authors.initials: K
authors.lastname: Leslie
authors.forename: David C
authors.initials: DC
authors.lastname: Gaze
authors.forename: Paul O
authors.initials: PO
authors.lastname: Collinson
authors.forename: Baskaran
authors.initials: B
authors.lastname: Thilaganathan
mesh_terms: D000328:Adult; D000418:Albumins / Q000032:analysis*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005865:Gestational Age; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology; D010920:Placenta / Q000098:blood supply* / Q000503:physiopathology*; D010929:Placentation / Q000502:physiology; D011225:Pre-Eclampsia / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000378:metabolism*; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000503:physiopathology; D014327:Trophoblasts / Q000378:metabolism*
chemical_list: D000418:Albumins; D015415:Biomarkers