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Hum. Reprod. Advance Access published online on February 16, 2008
Human Reproduction, doi:10.1093/humrep/den029
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© The Author 2008. 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

Defective endovascular trophoblast invasion in the first trimester is associated with increased maternal serum ischemia-modified albumin

Aris T. Papageorghiou1, Federico Prefumo1, Karin Leslie1, David C. Gaze2, Paul O. Collinson2 and Baskaran Thilaganathan1,3

1 Fetal Medicine Unit, Academic Department of Clinical Developmental Sciences, 4th Floor, Lanesborough Wing, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK 2 Department of Clinical Biochemistry, St George's Hospital NHS Trust, London, UK

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

BACKGROUND: Ischemia-modified albumin (IMA), a protein elevated in cardiac ischemia, is also increased to supra-physiological levels in early normal pregnancy. This finding supports the hypothesis that normal trophoblast development is stimulated by a hypoxic intrauterine environment. The aim of this study was to examine whether first trimester IMA levels are further elevated with defective trophoblast development.

METHODS: Prospective study of healthy women with singleton pregnancies undergoing nuchal translucency assessment at 11–14 weeks. First trimester maternal serum IMA concentrations in those subsequently developing pre-term pre-eclampsia (n = 19) were compared to randomly chosen controls with normal pregnancy outcome (n = 69).

RESULTS: Median first trimester serum IMA concentrations were significantly higher in women who subsequently developed pre-eclampsia (median 126.5 kU/L, interquartile range (IQR) 114.33–134.36 kU/L) when compared to those with normal pregnancy outcome (median 115.01 kU/L, IQR 102.29–124.81 kU/L, P = 0.02).

CONCLUSIONS: Maternal serum IMA levels are elevated in the first trimester in women with pre-eclampsia, a clinical manifestation of defective endovascular trophoblast development. This suggests that abnormally high intrauterine hypoxia and subsequent reperfusion oxidative damage may be associated with defective trophoblast development. First trimester serum IMA may be a potential biomarker for abnormal placental development.

Key words: ischemia-modified albumin/trophoblast development/pre-eclampsia

Submitted on August 9, 2007; resubmitted on December 1, 2007; accepted on January 14, 2008.


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