title: Increased Fetal Plasma Erythropoietin in Monochorionic Twin Pregnancies With Selective Intrauterine Growth Restriction and Abnormal Umbilical Artery Doppler.
abstract: Hypoxia is the primary stimulus for the production of erythropoietin (EPO) in both fetal and adult life. Here, we investigated fetal plasma EPO concentrations in monochorionic (MC) twin pregnancies with selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery (UA) Doppler. We diagnosed sIUGR in presence of (1) birth-weight discordance >20% and (2) either twin with a birth weight <10th percentile. An abnormal UA Doppler was defined as a persistent absent-reverse end diastolic flow (AREDF). The intertwin EPO ratio was calculated as the plasma EPO level of the smaller (or small-for-gestational-age) twin divided by the EPO concentration of the larger (or appropriate-for-gestational-age (AGA)) twin. Thirty-two MC twin pairs were included. Of these, 17 pairs were normal twins (Group 1), seven pairs were twins with sIUGR without UA Doppler abnormalities (Group 2), and eight pairs were twins with sIUGR and UA Doppler abnormalities (Group 3). The highest EPO ratio was identified in Group 3 (p < .001) but no significant differences were observed between Groups 1 and 2. Fetal hemoglobin levels did not differ significantly in the three groups, and fetal EPO concentration did not correlate with gestational age at birth. We conclude that fetal plasma EPO concentrations are selectively increased in MC twin pregnancies with sIUGR and abnormal UA Doppler, possibly as a result of uncompensated hypoxia.
authors.affiliation: Department of Obstetrics and Gynecology,Chang Gung Memorial Hospital,Linkou,College of Medicine,Chang Gung University,Taoyuan,Taiwan.
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology,Chang Gung Memorial Hospital,Linkou,College of Medicine,Chang Gung University,Taoyuan,Taiwan.
authors.forename: An-Shine
authors.initials: AS
authors.lastname: Chao
authors.affiliation: Department of Obstetrics and Gynecology,Chang Gung Memorial Hospital,Linkou,College of Medicine,Chang Gung University,Taoyuan,Taiwan.
authors.forename: Hsiu-Huei
authors.initials: HH
authors.lastname: Peng
authors.affiliation: Department of Obstetrics and Gynecology,Chang Gung Memorial Hospital,Linkou,College of Medicine,Chang Gung University,Taoyuan,Taiwan.
authors.forename: Shuenn-Dyh
authors.initials: SD
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology,Chang Gung Memorial Hospital,Linkou,College of Medicine,Chang Gung University,Taoyuan,Taiwan.
authors.forename: Sheng-Yuan
authors.initials: SY
authors.lastname: Su
authors.affiliation: Department of Obstetrics and Gynecology,Chang Gung Memorial Hospital,Linkou,College of Medicine,Chang Gung University,Taoyuan,Taiwan.
authors.forename: Kuan-Ju
authors.initials: KJ
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynecology,Chang Gung Memorial Hospital,Linkou,College of Medicine,Chang Gung University,Taoyuan,Taiwan.
authors.forename: Po-Jen
authors.initials: PJ
authors.lastname: Cheng
authors.affiliation: Department of Obstetrics and Gynecology,Chang Gung Memorial Hospital,Linkou,College of Medicine,Chang Gung University,Taoyuan,Taiwan.
authors.forename: Tzu-Hao
authors.initials: TH
authors.lastname: Wang
mesh_terms: D002823:Chorion; D004200:Diseases in Twins / Q000097:blood / Q000175:diagnosis; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D005317:Fetal Growth Retardation / Q000097:blood / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000097:blood*; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000002:abnormalities / Q000000981:diagnostic imaging*
chemical_list: D004921:Erythropoietin
keywords: erythropoietin; intrauterine growth restriction; monochorionic twin pregnancy; placenta