Fetal NT-proBNP levels and their course in severe anemia during intrauterine treatment.
Cardiac failure
Fetal anemia
Fetal heart
Hydrops fetalis
Intrauterine transfusion
NT-proBNP
Journal
Archives of gynecology and obstetrics
ISSN: 1432-0711
Titre abrégé: Arch Gynecol Obstet
Pays: Germany
ID NLM: 8710213
Informations de publication
Date de publication:
26 Mar 2023
26 Mar 2023
Historique:
received:
10
12
2022
accepted:
07
03
2023
entrez:
26
3
2023
pubmed:
27
3
2023
medline:
27
3
2023
Statut:
aheadofprint
Résumé
In 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. We 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. In 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. NT-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.
Identifiants
pubmed: 36966429
doi: 10.1007/s00404-023-07006-8
pii: 10.1007/s00404-023-07006-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s).
Références
Nicolaides KH, Clewell WH, Mibashan RS et al (1988) Fetal haemoglobin measurement in the assessment of red cell isoimmunisation. Lancet 331:1073–1075. https://doi.org/10.1016/S0140-6736(88)91896-X
doi: 10.1016/S0140-6736(88)91896-X
Prefumo F, Fichera A, Fratelli N, Sartori E (2019) Fetal anemia: diagnosis and management. Best Pract Res Clin Obstet Gynaecol 58:2–14. https://doi.org/10.1016/j.bpobgyn.2019.01.001
doi: 10.1016/j.bpobgyn.2019.01.001
pubmed: 30718211
Baschat AA, Muench MV, Gembruch U (2003) Coronary artery blood flow velocities in various fetal conditions: fetal coronary blood flow. Ultrasound Obstet Gynecol 21:426–429. https://doi.org/10.1002/uog.82
doi: 10.1002/uog.82
pubmed: 12768550
Sohan K, Carroll SG, De La Fuente S et al (2001) Analysis of outcome in hydrops fetalis in relation to gestational age at diagnosis, cause and treatment: Hydrops fetalis. Acta Obstet Gynecol Scand 80:726–730. https://doi.org/10.1034/j.1600-0412.2001.080008726.x
doi: 10.1034/j.1600-0412.2001.080008726.x
pubmed: 11531615
Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200. https://doi.org/10.1093/eurheartj/ehw128
doi: 10.1093/eurheartj/ehw128
pubmed: 27206819
Merz WM, Kübler K, Fimmers R et al (2012) Circulating N-terminal pro-B-type natriuretic peptide in fetal anemia before and after treatment. Pediatr Res 72:174–178. https://doi.org/10.1038/pr.2012.53
doi: 10.1038/pr.2012.53
pubmed: 22546865
Miyoshi T, Hosoda H, Minamino N (2021) Significance of atrial and brain natriuretic peptide measurements in fetuses with heart failure. Front Physiol 12:654356. https://doi.org/10.3389/fphys.2021.654356
doi: 10.3389/fphys.2021.654356
pubmed: 33815155
pmcid: 8012666
Cameron VA, Ellmers LJ (2003) Minireview: natriuretic peptides during development of the fetal heart and circulation. Endocrinology 144:2191–2194. https://doi.org/10.1210/en.2003-0127
doi: 10.1210/en.2003-0127
pubmed: 12746273
Nir A, Lindinger A, Rauh M et al (2009) NT-Pro-B-type natriuretic peptide in infants and children: reference values based on combined data from four studies. Pediatr Cardiol 30:3–8. https://doi.org/10.1007/s00246-008-9258-4
doi: 10.1007/s00246-008-9258-4
pubmed: 18600369
Merz WM, Kübler K, Albers E et al (2010) Reference values for N-terminal pro-B-type natriuretic peptide in fetal circulation between 20 and 34 weeks of gestation. Clin Biochem 43:519–521. https://doi.org/10.1016/j.clinbiochem.2009.11.012
doi: 10.1016/j.clinbiochem.2009.11.012
pubmed: 19968983
Merz WM, Kübler K, Albers E et al (2012) N-terminal pro-B-type natriuretic peptide in the circulation of fetuses with cardiac malformations. Clin Res Cardiol 101:73–79. https://doi.org/10.1007/s00392-011-0366-4
doi: 10.1007/s00392-011-0366-4
pubmed: 21960417
Merz WM, Kübler K, Fimmers R et al (2013) Cardiorenal syndrome is present in human fetuses with severe, isolated urinary tract malformations. PLoS ONE 8:e63664. https://doi.org/10.1371/journal.pone.0063664
doi: 10.1371/journal.pone.0063664
pubmed: 23717461
pmcid: 3661568
Bahlmann F, Krummenauer F, Spahn S et al (2011) Natriuretic peptide levels in intrauterine growth-restricted fetuses with absent and reversed end-diastolic flow of the umbilical artery in relation to ductus venosus flow velocities. J Perinat Med 39:529–537. https://doi.org/10.1515/jpm.2011.065
doi: 10.1515/jpm.2011.065
pubmed: 21892902
Luterek K, Szymusik I, Bartkowiak R et al (2011) N-terminal pro-B-type natriuretic peptide: a potential marker of fetal heart failure in hemolytic disease. Neuro Endocrinol Lett 32:657–662
pubmed: 22167142
Merz WM, Gembruch U (2014) Old tool—new application: NT-proBNP in fetal medicine. Ultrasound Obstet Gynecol 44:377–385. https://doi.org/10.1002/uog.13443
doi: 10.1002/uog.13443
pubmed: 24919683
Lechner E, Wiesinger-Eidenberger G, Wagner O et al (2009) Amino terminal pro B-type natriuretic peptide levels are elevated in the cord blood of neonates with congenital heart defect. Pediatr Res 66:466–469. https://doi.org/10.1203/PDR.0b013e3181b3aee4
doi: 10.1203/PDR.0b013e3181b3aee4
pubmed: 19581836
Leufgen C, Gembruch U, Stoffel-Wagner B et al (2017) N-terminal pro-B-type natriuretic peptide in amniotic fluid of fetuses with known or suspected cardiac load. PLoS ONE 12:e0177253. https://doi.org/10.1371/journal.pone.0177253
doi: 10.1371/journal.pone.0177253
pubmed: 28545116
pmcid: 5436674
Oepkes D, Seaward PG, Vandenbussche FPHA et al (2006) Doppler ultrasonography versus amniocentesis to predict fetal anemia. N Engl J Med 355:156–164. https://doi.org/10.1056/NEJMoa052855
doi: 10.1056/NEJMoa052855
pubmed: 16837679
Detti L, Oz U, Guney I et al (2001) Doppler ultrasound velocimetry for timing the second intrauterine transfusion in fetuses with anemia from red cell alloimmunization. Am J Obstet Gynecol 185:1048–1051. https://doi.org/10.1067/mob.2001.118161
doi: 10.1067/mob.2001.118161
pubmed: 11717631
Vonzun L, Ochsenbein-Kölble N, Balsyte D et al (2022) Second systolic peak in fetal middle cerebral artery Doppler after intrauterine transfusion. Arch Gynecol Obstet 307:241–248. https://doi.org/10.1007/s00404-022-06517-0
doi: 10.1007/s00404-022-06517-0
pubmed: 35348831
pmcid: 9837016
Bar-Oz B, Lev-Sagie A, Arad I et al (2005) N-terminal pro-B-type natriuretic peptide concentrations in mothers just before delivery, in cord blood, and in newborns. Clin Chem 51:926–927. https://doi.org/10.1373/clinchem.2005.048892
doi: 10.1373/clinchem.2005.048892
pubmed: 15855678
Fortunato G, CarandenteGiarrusso P, Martinelli P et al (2006) Cardiac troponin T and amino-terminal pro-natriuretic peptide concentrations in fetuses in the second trimester and in healthy neonates. Clin Chem Lab Med (CCLM). https://doi.org/10.1515/CCLM.2006.144
doi: 10.1515/CCLM.2006.144
pubmed: 16776629
Walther T, Stepan H, Faber R (2001) Dual natriuretic peptide response to volume load in the fetal circulation. Cardiovasc Res 49:817–819. https://doi.org/10.1016/s0008-6363(00)00303-5
doi: 10.1016/s0008-6363(00)00303-5
pubmed: 11230981
Seong WJ, Yoon DH, Chong GO et al (2010) Umbilical cord blood amino-terminal pro-brain natriuretic peptide levels according to the mode of delivery. Arch Gynecol Obstet 281:907–912. https://doi.org/10.1007/s00404-009-1253-3
doi: 10.1007/s00404-009-1253-3
pubmed: 19844734
Bakker J, Gies I, Slavenburg B et al (2004) Reference values for N-terminal pro-B-type natriuretic peptide in umbilical cord blood. Clin Chem 50:2465. https://doi.org/10.1373/clinchem.2004.040253
doi: 10.1373/clinchem.2004.040253
pubmed: 15563504
Swynghedauw B (1999) Molecular mechanisms of myocardial remodeling. Physiol Rev 79:215–262. https://doi.org/10.1152/physrev.1999.79.1.215
doi: 10.1152/physrev.1999.79.1.215
pubmed: 9922372
Schwachtgen L, Herrmann M, Georg T et al (2005) Reference values of NT-proBNP serum concentrations in the umbilical cord blood and in healthy neonates and children. Z Kardiol 94:399–404. https://doi.org/10.1007/s00392-005-0246-x
doi: 10.1007/s00392-005-0246-x
pubmed: 15940440
Kocylowski RD, Dubiel M, Gudmundsson S et al (2009) Biochemical tissue-specific injury markers of the heart and brain in postpartum cord blood. Am J Obstet Gynecol 200:273.e1-273.e25. https://doi.org/10.1016/j.ajog.2008.10.009
doi: 10.1016/j.ajog.2008.10.009
pubmed: 19167692
Yadav V, Deka D, Aparna S, Dadhwal V (2019) NT-proBNP: a useful biochemical marker for prognosis in Rh-isoimmunized pregnancies. J Obstet Gynaecol India 69:128–132. https://doi.org/10.1007/s13224-018-1180-y
doi: 10.1007/s13224-018-1180-y
pubmed: 31686745
Porter HJ, Quantrill AM, Fleming KA (1988) B19 parvovirus infection of myocardial cells. Lancet 1:535–536. https://doi.org/10.1016/s0140-6736(88)91332-3
doi: 10.1016/s0140-6736(88)91332-3
pubmed: 2893953
Young NS, Brown KE (2004) Parvovirus B19. N Engl J Med 350:586–597. https://doi.org/10.1056/NEJMra030840
doi: 10.1056/NEJMra030840
pubmed: 14762186
Girsen A, Ala-Kopsala M, Mäkikallio K et al (2007) Cardiovascular hemodynamics and umbilical artery N-terminal peptide of proB-type natriuretic peptide in human fetuses with growth restriction. Ultrasound Obstet Gynecol 29:296–303. https://doi.org/10.1002/uog.3934
doi: 10.1002/uog.3934
pubmed: 17323307
Heegaard ED, Brown KE (2002) Human parvovirus B19. Clin Microbiol Rev 15:485–505. https://doi.org/10.1128/CMR.15.3.485-505.2002
doi: 10.1128/CMR.15.3.485-505.2002
pubmed: 12097253
pmcid: 118081
Kosian P, Hellmund A, Geipel A et al (2022) Intrauterine transfusion in 103 fetuses with severe anemia caused by parvovirus infection. A multicenter retrospective study. Arch Gynecol Obstet. https://doi.org/10.1007/s00404-022-06712-z
doi: 10.1007/s00404-022-06712-z
pubmed: 35916962
Enders M, Klingel K, Weidner A et al (2010) Risk of fetal hydrops and non-hydropic late intrauterine fetal death after gestational parvovirus B19 infection. J Clin Virol 49:163–168. https://doi.org/10.1016/j.jcv.2010.07.014
doi: 10.1016/j.jcv.2010.07.014
pubmed: 20729141
Morey AL, Nicolini U, Welch CR et al (1991) Parvovirus B19 infection and transient fetal hydrops. Lancet 337:496. https://doi.org/10.1016/0140-6736(91)93435-c
doi: 10.1016/0140-6736(91)93435-c
pubmed: 1671501
Forestier F, Tissot JD, Vial Y et al (1999) Haematological parameters of parvovirus B19 infection in 13 fetuses with hydrops foetalis. Br J Haematol 104:925–927. https://doi.org/10.1046/j.1365-2141.1999.01241.x
doi: 10.1046/j.1365-2141.1999.01241.x
pubmed: 10192461
Cosmi E, Mari G, DelleChiaie L et al (2002) Noninvasive diagnosis by Doppler ultrasonography of fetal anemia resulting from parvovirus infection. Am J Obstet Gynecol 187:1290–1293. https://doi.org/10.1067/mob.2002.128024
doi: 10.1067/mob.2002.128024
pubmed: 12439522
Pasman SA, van den Brink CPB, Kamping MA et al (2009) Total blood volume is maintained in nonhydropic fetuses with severe hemolytic anemia. Fetal Diagn Ther 26:10–15. https://doi.org/10.1159/000236353
doi: 10.1159/000236353
pubmed: 19816024
van Kamp IL, Klumper FJ, Bakkum RS et al (2001) The severity of immune fetal hydrops is predictive of fetal outcome after intrauterine treatment. Am J Obstet Gynecol 185:668–673. https://doi.org/10.1067/mob.2001.116690
doi: 10.1067/mob.2001.116690
pubmed: 11568796
Zwiers C, Lindenburg ITM, Klumper FJ et al (2017) Complications of intrauterine intravascular blood transfusion: lessons learned after 1678 procedures. Ultrasound Obstet Gynecol 50:180–186. https://doi.org/10.1002/uog.17319
doi: 10.1002/uog.17319
pubmed: 27706858
pmcid: 5601196
Jonker SS, Giraud MK, Giraud GD et al (2010) Cardiomyocyte enlargement, proliferation and maturation during chronic fetal anaemia in sheep. Exp Physiol 95:131–139. https://doi.org/10.1113/expphysiol.2009.049379
doi: 10.1113/expphysiol.2009.049379
pubmed: 19700519