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Hum. Reprod. Advance Access originally published online on April 16, 2007
Human Reproduction 2007 22(7):2029-2032; doi:10.1093/humrep/dem095
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

First trimester maternal serum ischaemia-modified albumin: a marker of hypoxia-ischaemia-driven early trophoblast development

Federico Prefumo1, David C Gaze2, Aris T Papageorghiou1, Paul O Collinson2 and Baskaran Thilaganathan1,3

1 Fetal Medicine Unit, Division of Obstetrics and Gynaecology, St. George's University of London, London SW17 0RE, UK 2 Department of Clinical Biochemistry, St George's Hospital NHS Trust, London SW17 0QT, UK

3 Correspondence address. Tel: +44 20 8725 0071; Fax: +44 20 8715 0079; E-mail: basky{at}pobox.com

BACKGROUND: A hypoxic intrauterine environment is believed to play a pivotal role in physiological trophoblast development. Ischaemia-modified albumin (IMA) is used in the measurement of cardiac ischaemia. We aimed to test the hypothesis that maternal serum IMA may be elevated in early pregnancy as a measurable manifestation of intrauterine ischaemia.

METHODS: Prospective observational study in healthy women with singleton pregnancies (n = 66) and non-pregnant controls (n = 26). Maternal serum IMA levels were measured at 11–13 weeks of gestation and in non-pregnant women.

RESULTS: The median IMA level in the pregnant group [115.14 kU/l; interquartile range (IQR) 102.33–124.71 kU/l] was significantly higher (P < 0.001) than in non-pregnant controls (73.71 kU/l; IQR 60.38–82.78 kU/l). During pregnancy, absolute values of IMA were higher than the concentration used for the diagnosis of myocardial ischaemia (>95 kU/l) in 86% of women.

CONCLUSIONS: In early pregnancy, IMA levels were above the concentration used for the diagnosis of myocardial ischaemia in most women, and should therefore not be used as a marker for cardiac ischaemia in pregnancy. Maternal serum IMA is elevated to supra-physiological levels in early normal pregnancy supporting the hypothesis that normal trophoblast development is associated with a hypoxic intrauterine environment, although other mechanisms leading to an IMA increase cannot be excluded.

Key words: first trimester/hypoxia/serum/ischaemia-modified albumin/trophoblast

Submitted on October 16, 2006; resubmitted on December 20, 2006; accepted on January 26, 2007.


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