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Antithrombin improves the maternal and neonatal outcomes but not the angiogenic factors in extremely growth-restricted fetuses at <28 weeks of gestation

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Published/Copyright: December 3, 2016
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 45 Issue 7

Abstract

Aims:

Severe preterm fetal growth restriction (FGR) remote from term is problematic. We aimed to investigate the effect of maternally-administered antithrombin on maternal and neonatal outcomes. A prospective, one-arm, pilot study was performed in 14 women with severe FGR (≤5th centile) at <28 weeks of gestation, without hypertensive disorders. Maternal plasma concentrations of soluble Feline McDonough Sarcoma (FMS)-like trypsin kinase-1 (sFlt-1) and placental growth factor (PlGF) were measured and categorized into three groups: group 1; low sFlt-1 and high PlGF, group 2; moderate sFlt-1 and low PlGF, and group 3; high sFlt-1 and low PlGF. Antithrombin was administered for 3 days. The incidence of perinatal mortality, infant morbidity, and the period of pregnancy prolongation were compared.

Results:

In group 1 (n=4), their pregnancies were extended for longer periods and the maternal and infant outcomes were good. The prolongation periods were shorter in groups 2 (n=3) and 3 (n=7), which resulted in poor maternal [severe preeclampsia or hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome] and infant outcomes.

Conclusions:

The evaluation of the maternal sFlt-1 and PlGF at 21–27 weeks of gestation is useful in the managements of severe FGR. Antithrombin treatment could prolong the pregnancies with low sFlt-1 and high PlGF without negatively affecting maternal or fetal health.

Keywords: Antithrombin; fetal growth restriction; perinatal mortality; placenta
Correspondence author: Hiroshi Sameshima, MD, Department of Obstetrics and Gynecology and Center for Perinatal Medicine, Faculty of Medicine, University of Miyazaki, 5200, Kihara, Kiyotake, Miyazaki 889-1692, Japan, Tel.: +81-985-85-0988, Fax: +81-985-85-6149

Acknowledgements

We are grateful to Dr. Yuichiro Sato of the Department of Diagnostic Pathology, Faculty of Medicine, University of Miyazaki, for his assistance. This study was supported by a Grant (#79-258) from the Ministry of Education, Culture, Sports, Science and Technology, Japan, a grant from the JAOG Ogyaa Donation Foundation (2014), and a research grant from CSL Behring, Tokyo, Japan.

Author’s statement

  1. Conflict of interest: The corresponding author (HS) received a research grant from CSL Behring, Tokyo, Japan (a total of 20,000 USD for research related to this study during 2013–2014). Except this, all authors declare no conflict of interest.

  2. Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.

  3. Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

References

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Received: 2016-6-1
Accepted: 2016-10-12
Published Online: 2016-12-3
Published in Print: 2017-10-26

©2017 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Preeclampsia and intrauterine growth restriction: placental disorders still not fully understood
  4. Review article
  5. Hepar uterinum: a history of ideas on fetal nutrition
  6. Original articles
  7. Twin pregnancy in women above the age of 45 years: maternal and neonatal outcomes
  8. Maternal endothelial damage as a disorder shared by early preeclampsia, late preeclampsia and intrauterine growth restriction
  9. Maternal venous SHARP1 levels in preeclampsia
  10. Second-trimester maternal serum markers in the prediction of preeclampsia
  11. Pregnancy outcomes regarding maternal serum AFP value in second trimester screening
  12. Quantification of mechanical dyssynchrony in growth restricted fetuses and normal controls using speckle tracking echocardiography (STE)
  13. Serum cholesterol acceptor capacity in intrauterine growth restricted fetuses
  14. Antithrombin improves the maternal and neonatal outcomes but not the angiogenic factors in extremely growth-restricted fetuses at <28 weeks of gestation
  15. Simple approach based on maternal characteristics and mean arterial pressure for the prediction of preeclampsia in the first trimester of pregnancy
  16. Fetal death: an extreme manifestation of maternal anti-fetal rejection
  17. Intrauterine growth restriction and placental gene expression in severe preeclampsia, comparing early-onset and late-onset forms
  18. The relationship between maternal and umbilical cord adropin levels with the presence and severity of preeclampsia
  19. Expression of placental regulatory genes is associated with fetal growth
  20. Circulating soluble fms-like tyrosine kinase-1 and placental growth factor from 10 to 40 weeks’ pregnancy in normotensive women
  21. A one year review of eclampsia in an Ethiopian Tertiary Care Center (Saint Paul’s Hospital Millennium Medical College, SPHMMC)
  22. Congress Calendar
  23. Congress Calendar
https://doi.org/10.1515/jpm-2016-0190
Keywords for this article
Antithrombin; fetal growth restriction; perinatal mortality; placenta

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Preeclampsia and intrauterine growth restriction: placental disorders still not fully understood
  4. Review article
  5. Hepar uterinum: a history of ideas on fetal nutrition
  6. Original articles
  7. Twin pregnancy in women above the age of 45 years: maternal and neonatal outcomes
  8. Maternal endothelial damage as a disorder shared by early preeclampsia, late preeclampsia and intrauterine growth restriction
  9. Maternal venous SHARP1 levels in preeclampsia
  10. Second-trimester maternal serum markers in the prediction of preeclampsia
  11. Pregnancy outcomes regarding maternal serum AFP value in second trimester screening
  12. Quantification of mechanical dyssynchrony in growth restricted fetuses and normal controls using speckle tracking echocardiography (STE)
  13. Serum cholesterol acceptor capacity in intrauterine growth restricted fetuses
  14. Antithrombin improves the maternal and neonatal outcomes but not the angiogenic factors in extremely growth-restricted fetuses at <28 weeks of gestation
  15. Simple approach based on maternal characteristics and mean arterial pressure for the prediction of preeclampsia in the first trimester of pregnancy
  16. Fetal death: an extreme manifestation of maternal anti-fetal rejection
  17. Intrauterine growth restriction and placental gene expression in severe preeclampsia, comparing early-onset and late-onset forms
  18. The relationship between maternal and umbilical cord adropin levels with the presence and severity of preeclampsia
  19. Expression of placental regulatory genes is associated with fetal growth
  20. Circulating soluble fms-like tyrosine kinase-1 and placental growth factor from 10 to 40 weeks’ pregnancy in normotensive women
  21. A one year review of eclampsia in an Ethiopian Tertiary Care Center (Saint Paul’s Hospital Millennium Medical College, SPHMMC)
  22. Congress Calendar
  23. Congress Calendar
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