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High amniotic fluid erythropoietin levels are associated with an increased frequency of fetal and neonatal morbidity in type 1 diabetic pregnancies.
MedLine Citation:
PMID:  15502930     Owner:  NLM     Status:  MEDLINE    
AIMS/HYPOTHESIS: In this study we investigated whether chronic fetal hypoxia, as indicated by amniotic fluid erythropoietin levels, is associated with perinatal morbidity in type 1 diabetic pregnancies. METHODS: A total of 331 women with type 1 diabetes had at least one childbirth between 1995 and 2000. The amniotic fluid erythropoietin concentration was measured in 156 diabetic singleton pregnancies at a median time of 1 day before Caesarean section without labour contractions and in 19 healthy control subjects at Caesarean section. RESULTS: The median amniotic fluid erythropoietin level was 14.0 mU/ml (range 2.0-1975.0) in diabetic pregnancies and 6.3 mU/ml (range 1.7-13.7) in controls (p<0.0001). Of the 156 diabetic patients, 21 (13.5%) had amniotic fluid erythropoietin levels higher than 63.0 mU/ml. Amniotic fluid erythropoietin levels correlated negatively with umbilical artery pH (r=-0.49, p<0.0001) and pO2 (r=-0.62, p<0.0001) at birth and neonatal lowest blood glucose level (r=-0.47, p<0.0001). Positive correlations were found between amniotic fluid erythropoietin levels and umbilical artery pCO2 (r=0.49, p<0.0001) and last maternal HbA1c (r=0.43, p<0.0001). Furthermore, a U-shaped correlation was demonstrated between amniotic fluid erythropoietin levels and birthweight z score (z score below -0.6 SD units: r=-0.63, p=0.0007; z score above +1.0 SD units: r=0.32, p=0.0014). Neonatal hypoglycaemia, hypertrophic cardiomyopathy and admission to the neonatal intensive care unit occurred significantly more often in cases with high amniotic fluid erythropoietin levels (>63.0 mU/ml) than in those with normal levels. Multivariate logistic regression analysis revealed that amniotic fluid erythropoietin was the only variable independently related to low umbilical artery pH (<7.21; p<0.0001) and neonatal hypoglycaemia (p=0.002). Low umbilical artery pO2 (<15.0 mm Hg) was explained by amniotic fluid erythropoietin (p<0.0001) and birthweight z score (p=0.004). CONCLUSIONS/INTERPRETATION: Antenatal high amniotic fluid erythropoietin levels can identify type 1 diabetic pregnancies at increased risk of severe perinatal complications.
K Teramo; M A Kari; M Eronen; H Markkanen; V Hiilesmaa
Publication Detail:
Type:  Journal Article     Date:  2004-10-22
Journal Detail:
Title:  Diabetologia     Volume:  47     ISSN:  0012-186X     ISO Abbreviation:  Diabetologia     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-11-19     Completed Date:  2005-04-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0006777     Medline TA:  Diabetologia     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1695-703     Citation Subset:  IM    
Department of Obstetrics and Gynaecology, University Central Hospital, Helsinki, Finland.
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MeSH Terms
Amniotic Fluid / chemistry*
Biological Markers
Birth Weight
Blood Glucose / metabolism
Cesarean Section
Erythropoietin / analysis*
Fetal Diseases / epidemiology*
Gestational Age
Infant, Newborn
Infant, Newborn, Diseases / epidemiology
Maternal Age
Pregnancy in Diabetics / physiopathology*
Umbilical Arteries / physiopathology
Reg. No./Substance:
0/Biological Markers; 0/Blood Glucose; 11096-26-7/Erythropoietin

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