Poster Session 3
Amrita Roy, MD (she/her/hers)
Maternal Fetal Medicine
Bridgeport Hospital / Yale New Haven Health
Bridgeport, Connecticut, United States
Hannah Spector, BSc
University of Rochester Medical Center
Rochester, New York, United States
Sarah Crimmins, DO
University of Rochester
Rochester, New York, United States
Ponnila S. Marinescu, MD
Assistant Professor, Department of Obstetrics and Gynecology
University of Rochester Medical Center
Rochester, New York, United States
Fetal growth restriction is a major contributor to fetal and neonatal morbidity/mortality. Early onset FGR [eFGR, diagnosed < 32 weeks] has a strong association with catabolism, and markers of chronic hypoxia are proportionally increased in this state, likely in amniotic fluid (AF). However, comparisons of AF analytes between eFGR and appropriately grown for gestational age (AGA) pregnancies are limited. We analyzed concentrations of AF lactate, endothelin-1 (ET-1), soluble fms-like tyrosine kinase 1 (sFlt-1), erythropoietin (EPO), and indoleamine-2,3-dioxygenase (IDO) in eFGR vs AGA control groups.
Retrospective case control study using cryopreserved AF samples; eFGR (cases) and AGA (control) pregnancies were identified via EMR. Analyses of lactate, ET-1, EPO, IDO-1, and sFlt-1 were performed using ELISA. Primary outcome was concentration of AF analytes in eFGR versus control groups. Subgroup analyses assessed concentrations of AF analytes in eFGR, eFGR with brain sparing (eFGR+BS) and control groups.
44 AF samples were evaluated, 11 with eFGR [7 of which were eFGR+BS], 33 with AGA. AF concentrations of EPO and sFlt-1 were higher in the eFGR group (EPO eFGR 4.41mIU/mL vs. control 1.54 mIU/mL p=0.005; sFlt-1 eFGR 0.51 ng/mL vs. control 0.27 ng/mL p=0.002). AF lactate concentrations were lower in the eFGR group (eFGR 4.99 mmol/L vs. control 5.37 mmol/L p=0.034). There were no statistically significant differences in ET-1 or IDO-1 between groups. AF concentrations of EPO and sFlt-1 were higher in the eFGR and eFGR+BS cohorts when compared to control (EPO eFGR 7.82 mIU/mL, eFGR+BS 4.41 mIU/mL vs. control 1.54 mIU/mL p=0.005; sFlt-1 eFGR 0.56 ng/mL, eFGR+BS 0.40 ng/mL vs. control 0.27 ng/mL p=0.002).
Our novel characterization of AF analytes shows that EPO and sFLt-1 are significantly elevated in pregnancies with eFGR and eFGR+BS. Ability to identify at risk pregnancies has the potential to meaningfully impact management, particularly in identifying time frame for intervention. Further studies will assess predictability of eFGR by AF analyte combinations.
