期刊
ARCHIVES OF GYNECOLOGY AND OBSTETRICS
卷 -, 期 -, 页码 -出版社
SPRINGER HEIDELBERG
DOI: 10.1007/s00404-023-07006-8
关键词
Fetal anemia; Hydrops fetalis; NT-proBNP; Fetal heart; Cardiac failure; Intrauterine transfusion
The purpose of this study was to investigate the effect of anemia and intrauterine transfusion (IUT) on NT-proBNP concentrations in fetuses with anemia and establish gestational age-dependent reference values of a control group. NT-proBNP levels in non-anemic fetuses are higher than in postnatal life, decreasing with ongoing pregnancy. Anemia severity correlates with circulating NT-proBNP levels. Highest concentrations occur in fetuses with hydrops and with PVB19 infection, respectively. Treatment by IUT leads to a normalization of NT-proBNP concentrations, so the measurement of its levels may be useful in therapy monitoring.
PurposeIn adults and fetuses, N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a marker of cardiac failure and myocardial remodelling. We examined the effect of anemia and intrauterine transfusion (IUT) on NT-proBNP concentrations in fetuses with anemia and established gestational age-dependent reference values of a control group.MethodsWe analyzed NT-proBNP levels in anemic fetuses that underwent serial intrauterine transfusions (IUT), focusing on different causes and severity of anemia and comparing the results to a non-anemic control group.ResultsIn the control group, the average NT-proBNP concentration was 1339 +/- 639 pg/ml, decreasing significantly with increasing gestational age (R = - 74.04, T = - 3.65, p = 0.001). Subjects had significantly higher NT-proBNP concentrations before initiation of IUT therapy (p < 0.001), showing fetuses with parvovirus B19 (PVB19) infection having the highest concentrations. Hydropic fetuses also showed an increased NT-proBNP concentration compared to non-hydropic fetuses (p < 0.001). During the course of therapy, NT-proBNP concentration before subsequent IUT decreased significantly from pathologically high levels, while MoM-Hb and MoM-MCA-PSV remained pathological.ConclusionNT-pro BNP levels in non-anemic fetuses are higher than in postnatal life, decreasing with ongoing pregnancy. Anemia is a hyperdynamic state and its severity correlates with circulating NT-proBNP levels. Highest concentrations occur in fetuses with hydrops and with PVB19 infection, respectively. Treatment by IUT leads to a normalisation of NT-proBNP concentrations, so the measurement of its levels may be useful in therapy monitoring.
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