Is increased maternal endothelin-1 concentration associated with neonatal asphyxia and preterm delivery in intrahepatic cholestasis of pregnancy?

Arch Gynecol Obstet. 2010 Dec;282(6):617-21. doi: 10.1007/s00404-009-1261-3. Epub 2009 Oct 28.

Abstract

Objectives: To evaluate plasma endothelin-1 (ET-1) and fetuin-A concentrations in women with intrahepatic cholestasis of pregnancy (ICP) and to determine whether there is any association between these parameters and fetal asphyxia.

Methods: We carried out a prospective case-control study consisting of 32 women with ICP at third trimester of pregnancy and 32 pregnant women without ICP. Blood samples from maternal peripheral venous circulation were collected and ET-1 and fetuin-A levels were determined from the plasma samples. Pulse-wave Doppler and Apgar scores were also recorded.

Results: ET-1 concentrations were significantly higher in ICP patients. No difference was observed in fetuin-A levels between the two groups. Six newborns were declared as asphyctic (APGAR score at the 5 min <7). Maternal ET-1 levels did not correlate with the APGAR score at 5 min, total bile acid (TBA) and umbilical artery systolic/diastolic ratio with ICP patients. TBA levels were positively correlated with umbilical artery systolic/diastolic ratio negatively correlated with APGAR score at the 1' and 5'-Apgar score in all subjects. Plasma ET-1 concentration was higher in the preterm neonates of mothers with ICP compared with normal term neonates of mothers.

Conclusions: Although these data did not show evidence that maternal ET-1 would be associated with fetal distress, we can speculate that maternal ET-1 may be playing a role in the underlying pathology regarding microvascular dysfunction especially in the preterm neonates of mothers with ICP. Elevated TBA levels may increase the risk of asphyxia whereas fetuin-a (as an anti-inflammation marker) does not seem to have effect in women with ICP.

MeSH terms

  • Adolescent
  • Adult
  • Apgar Score
  • Asphyxia Neonatorum / blood*
  • Asphyxia Neonatorum / etiology
  • Blood Proteins / metabolism*
  • Case-Control Studies
  • Cholestasis, Intrahepatic / blood*
  • Cholestasis, Intrahepatic / complications
  • Endothelin-1 / blood*
  • Female
  • Fetal Distress / blood
  • Fetal Distress / etiology
  • Humans
  • Infant, Newborn
  • Laser-Doppler Flowmetry
  • Pregnancy
  • Pregnancy Complications / blood*
  • Premature Birth / blood
  • Premature Birth / etiology
  • Prospective Studies
  • Umbilical Arteries / blood supply
  • Young Adult
  • alpha-2-HS-Glycoprotein

Substances

  • AHSG protein, human
  • Blood Proteins
  • Endothelin-1
  • alpha-2-HS-Glycoprotein