title: Altered amniotic fluid leptin levels in twin-twin transfusion syndrome with concurrent placental insufficiency.
abstract: OBJECTIVE
  To measure amniotic fluid leptin levels in fetuses with twin-twin transfusion syndrome (TTTS) with and without placental insufficiency (PI) and determine its usefulness as a biomarker of PI.
  
  
  METHODS
  A retrospective case control study of TTTS stage III patients from 2009 to 2011 was conducted. Cases were pregnancies with PI (TTTS-PI, n = 18) matched by stage, gestational age, and degree of cardiomyopathy to controls without PI (TTTS, n = 26). PI was strictly defined using biometric parameters. Amniotic fluid from recipient twins (RT) was taken during second trimester fetoscopic laser therapy. Leptin concentrations were determined and compared to growth parameters and birth weight.
  
  
  RESULTS
  RT-adjusted leptin was 66% higher in TTTS-PI (p = 0.016) compared to TTTS controls. Cases had significantly higher growth discordance (p = 0.004) and lower RT birth weight (p = 0.041) compared to controls. Significantly higher adjusted leptin levels were observed at birth in the TTTS-PI group when comparing those with SGA donor twins to those of normal weight (p = 0.016).
  
  
  CONCLUSIONS
  These data suggest a role for leptin in pregnancies complicated by TTTS with placental insufficiency. However, further studies are needed to define its mechanism and potential role as a biomarker in amniotic fluid for placental pathophysiology.
authors.affiliation: a Cincinnati Fetal Center, Center for Fetal Cellular and Molecular Therapy, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA and.
authors.forename: Alan
authors.initials: A
authors.lastname: Coleman
authors.forename: Mounira
authors.initials: M
authors.lastname: Habli
authors.forename: Robert B
authors.initials: RB
authors.lastname: Hinton
authors.forename: William
authors.initials: W
authors.lastname: Polzin
authors.forename: Foong-Yen
authors.initials: FY
authors.lastname: Lim
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications* / Q000378:metabolism; D006801:Humans; D020738:Leptin / Q000378:metabolism*; D010927:Placental Insufficiency / Q000175:diagnosis* / Q000378:metabolism; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D020738:Leptin
keywords: Amniotic fluid; fetal growth restriction; leptin; placental insufficiency; twin–twin transfusion syndrome