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

• Published in: Human reproduction (Oxford) Vol. 22; no. 7; pp. 2029 - 2032
• Main Authors: Prefumo, Federico, Gaze, David C, Papageorghiou, Aris T, Collinson, Paul O, Thilaganathan, Baskaran
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-07-2007; Oxford Publishing Limited (England)
• Subjects: Adult; Biological and medical sciences; Biomarkers - metabolism; Female; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Hypoxia; Ischemia - diagnosis; Ischemia - metabolism; Medical sciences; Pregnancy; Pregnancy Trimester, First; Serum Albumin - biosynthesis; Trophoblasts - metabolism; hypoxia; ischaemia-modified albumin; first trimester; serum; trophoblast; Trophoblaste; Oxygen; Fetal membrane; Albumin; Cardiovascular disease; First trimester; Early stage; Serum albumin; Marker; Pregnancy; Vertebrata; Mammalia; Ischemia; Mother; Hypoxia; Serum
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/humrep/dem095

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.