title: The effect of intrauterine growth restriction on circulating surfactant protein D concentrations in the perinatal period.
abstract: The aim of this study was to investigate possible alterations in circulating concentrations of surfactant protein D (SP-D)-an important component of the innate immune system that is upregulated in pulmonary diseases-in appropriate for gestational age (AGA) and intrauterine growth-restricted (IUGR) pregnancies, because the latter are characterized by structural lung immaturity, impaired immunocompetence, and increased risk of respiratory infections and chronic obstructive lung disease in later life. Serum SP-D concentrations were determined in 40 mothers and their 20 IUGR and 20 AGA full-term fetuses-neonates on postnatal day 1 (N1) and 4 (N4). Fetal SP-D concentrations were higher in the IUGR group (b = 18.16, 95% CI: 6.86-29.47, P = .002) and negatively correlated with infants' customized centiles and gestational age (r = -.326, P = .04, and r = -.446, P = .004, respectively). In both groups, fetal SP-D concentrations were lower than N1 and N4 ones (P <or= .015 in all cases). In the IUGR group, N1 SP-D concentrations were higher in vaginal deliveries (P = .032). Higher SP-D concentrations in IUGR fetuses may reflect structural lung immaturity, leading to increased alveolar-vascular permeability and protein leakage into the circulation. Alternatively, SP-D production may be increased due to intrauterine glucocorticoid exposure, leading to accelerated lung maturation. Surfactant protein D concentrations postnatally increase and are higher in neonates born vaginally, probably as a consequence of lung liquid reabsorption, concomitant with initiation of breathing and delivery stress. A progressive decrease in placental function may result in downregulated SP-D production, accounting for the negative correlation between fetal SP-D concentrations and gestational age.
authors.affiliation: Second Department of Obstetrics and Gynecology, Athens University Medical School, Athens, Greece.
authors.forename: Despina D
authors.initials: DD
authors.lastname: Briana
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Gourgiotis
authors.forename: Stavroula
authors.initials: S
authors.lastname: Baka
authors.forename: Maria
authors.initials: M
authors.lastname: Boutsikou
authors.forename: Venetia-Maria
authors.initials: VM
authors.lastname: Vraila
authors.forename: Theodora
authors.initials: T
authors.lastname: Boutsikou
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Hassiakos
authors.forename: Ariadne
authors.initials: A
authors.lastname: Malamitsi-Puchner
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D018743:Perinatal Care; D011247:Pregnancy; D037663:Pulmonary Surfactant-Associated Protein D / Q000097:blood*
chemical_list: D015415:Biomarkers; D037663:Pulmonary Surfactant-Associated Protein D