203: Placenta growth factor in pregnancies conceived by assisted reproductive technology
1
203 Placenta growth factor in pregnancies conceived by assisted reproductive technology Hayley Quant 1 , Samuel Parry 1 , Rita Leite 1 , Nadav Schwartz 1 1 University of Pennsylvania Perelman School of Medicine, Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Philadelphia, PA OBJECTIVE: Assisted reproductive technology (ART) is associated with an increased risk of placenta-mediated adverse pregnancy outcomes. We sought to compare first trimester serum levels of Placental Protein 13 (PP13) and Placenta Growth Factor (PlGF) as well as uterine artery Doppler pulsatility index (UPI) in ART-conceived and spontaneous pregnancies. STUDY DESIGN: This cohort was part of a larger prospective study in- vestigating early predictors of adverse pregnancy outcomes. Unse- lected patients with singleton gestations were enrolled between 11 and 14 weeks. Dopplers were performed and serum assayed for PlGF and PP13. Medical records were reviewed to identify ART patients. Pa- tients who conceived via in vitro fertilization (IVF), controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI), or ovula- tion induction (OI) were compared with spontaneous conceptions. Lo- gistic regression was used to control for potential confounders. RESULTS: ART was used in 42 (9.3%) of 534 pregnancies: 16 IVF, 5 COH, 28 OI, 1 natural cycle IUI. Significant differences in mean ma- ternal age (35.6 vs 30.2, p0.0005), black race (9.5% vs 44.3%, p0.0005) and nulliparity (78.6% vs 52.2%, p0.001) were found between ART and spontaneous groups. PlGF was significantly lower in the ART group compared to the spontaneous group (0.92 vs 1.20 MoM; P0.008) (Figure). This association remained significant after controlling for maternal age, race, parity, BMI, screening blood pres- sure and chronic hypertension. There were no differences in PP13 or in UPI between ART and spontaneous groups. CONCLUSION: Low levels of serum PlGF, a proangiogenic protein, have been linked to adverse pregnancy outcomes. Our study suggests that despite normal placental perfusion as demonstrated by uterine artery Doppler, angiogenic derangements early in gestation may contribute to placenta-mediated adverse outcomes in ART pregnancies. These findings may guide future research into the mechanisms by which ART leads to an increased risk of adverse pregnancy outcomes. 204 Maternal microchimerism in cord blood Hilary Gammill 1 , Christine Luu 2 , Rebecca Resnick 2 , Suzanne Peterson 3 , J. Nelson 4 1 University of Washington, Obstetrics and Gynecology, Seattle, WA, 2 Fred Hutchinson Cancer Research Center, Clinical Research, Seattle, WA, 3 Swedish Medical Center, Obstetrics and Gynecology, Seattle, WA, 4 University of Washington, Rheumatology, Seattle, WA OBJECTIVE: Transplacental exchange of cells occurs bidirectionally be- tween mother and fetus during pregnancy, establishing microchimerism (Mc). Reports of maternal Mc (MMc) in umbilical cord blood (CB) at delivery have varied in approach and estimates. Sensitive and accurate assessment of MMc in CB can yield important information about the physiology of cell exchange and is particularly relevant in the context of increasing use of CB for hematopoietic cell transplant. We sought to quantify cellular MMc in CB in normal term deliveries, at midgestation, and in pregnancies complicated by preeclampsia (PE), using a well-es- tablished and sensitive quantitative PCR approach. STUDY DESIGN: For women with uncomplicated term deliveries or PE, maternal blood was collected prior to delivery, and CB was collected by sterile venipuncture from a double-clamped cord segment. For women undergoing midtrimester pregnancy termination, CB was collected at the time of clinical cordocentesis. DNA was extracted from Ficoll-purified blood mononuclear cells. Maternal and fetal HLA genotyping was conducted, and MMc was quantified with Q- PCR assays targeting maternal-specific HLA alleles. Prevalence and concentration of MMc was compared. RESULTS: Overall detection of MMc was common (20/28 samples, 71%). Preliminary analysis suggested a trend toward higher detection rates and concentrations by groups (Table), p0.08. CONCLUSION: Our data demonstrate frequent detection of MMc in CB. In addition, we saw a trend toward increasing detection at later gestational ages and in pregnancies complicated by PE. These findings prompt the question whether differences in MMc according to pregnancy outcome may contribute to fetal origins of disease. In addition, MMc in CB may have important implications for transplantation, including effects on graft-versus-tumor and graft-versus-host outcomes. Poster Session I Clinical Obstetrics, Epidemiology, Fetus, Medical-Surgical Complications, Neonatology, Physiology/Endocrinology, Prematurity www.AJOG.org S96 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2013
Transcript of 203: Placenta growth factor in pregnancies conceived by assisted reproductive technology
203 Placenta growth factor in pregnancies conceived byassisted reproductive technologyHayley Quant1, Samuel Parry1, Rita Leite1, Nadav Schwartz1
1University of Pennsylvania Perelman School of Medicine, Maternal andChild Health Research Program, Department of Obstetrics and Gynecology,Philadelphia, PAOBJECTIVE: Assisted reproductive technology (ART) is associated withan increased risk of placenta-mediated adverse pregnancy outcomes.We sought to compare first trimester serum levels of Placental Protein13 (PP13) and Placenta Growth Factor (PlGF) as well as uterine arteryDoppler pulsatility index (UPI) in ART-conceived and spontaneouspregnancies.STUDY DESIGN: This cohort was part of a larger prospective study in-vestigating early predictors of adverse pregnancy outcomes. Unse-lected patients with singleton gestations were enrolled between 11 and14 weeks. Dopplers were performed and serum assayed for PlGF andPP13. Medical records were reviewed to identify ART patients. Pa-tients who conceived via in vitro fertilization (IVF), controlled ovarianhyperstimulation (COH) and intrauterine insemination (IUI), or ovula-tion induction (OI) were compared with spontaneous conceptions. Lo-gistic regression was used to control for potential confounders.RESULTS: ART was used in 42 (9.3%) of 534 pregnancies: 16 IVF, 5COH, 28 OI, 1 natural cycle IUI. Significant differences in mean ma-ternal age (35.6 vs 30.2, p�0.0005), black race (9.5% vs 44.3%,p�0.0005) and nulliparity (78.6% vs 52.2%, p�0.001) were foundbetween ART and spontaneous groups. PlGF was significantly lowerin the ART group compared to the spontaneous group (0.92 vs 1.20MoM; P�0.008) (Figure). This association remained significant aftercontrolling for maternal age, race, parity, BMI, screening blood pres-sure and chronic hypertension. There were no differences in PP13 orin UPI between ART and spontaneous groups.CONCLUSION: Low levels of serum PlGF, a proangiogenic protein, havebeen linked to adverse pregnancy outcomes. Our study suggests thatdespite normal placental perfusion as demonstrated by uterine arteryDoppler, angiogenic derangements early in gestation may contributeto placenta-mediated adverse outcomes in ART pregnancies. Thesefindings may guide future research into the mechanisms by whichART leads to an increased risk of adverse pregnancy outcomes.
204 Maternal microchimerism in cord bloodHilary Gammill1, Christine Luu2, Rebecca Resnick2,Suzanne Peterson3, J. Nelson4
1University of Washington, Obstetrics and Gynecology, Seattle, WA, 2FredHutchinson Cancer Research Center, Clinical Research, Seattle, WA,3Swedish Medical Center, Obstetrics and Gynecology, Seattle, WA,4University of Washington, Rheumatology, Seattle, WAOBJECTIVE: Transplacental exchange of cells occurs bidirectionally be-tween mother and fetus during pregnancy, establishing microchimerism(Mc). Reports of maternal Mc (MMc) in umbilical cord blood (CB) atdelivery have varied in approach and estimates. Sensitive and accurateassessment of MMc in CB can yield important information about thephysiology of cell exchange and is particularly relevant in the context ofincreasing use of CB for hematopoietic cell transplant. We sought toquantify cellular MMc in CB in normal term deliveries, at midgestation,and in pregnancies complicated by preeclampsia (PE), using a well-es-tablished and sensitive quantitative PCR approach.STUDY DESIGN: For women with uncomplicated term deliveries or PE,maternal blood was collected prior to delivery, and CB was collectedby sterile venipuncture from a double-clamped cord segment. Forwomen undergoing midtrimester pregnancy termination, CB wascollected at the time of clinical cordocentesis. DNA was extractedfrom Ficoll-purified blood mononuclear cells. Maternal and fetalHLA genotyping was conducted, and MMc was quantified with Q-PCR assays targeting maternal-specific HLA alleles. Prevalence andconcentration of MMc was compared.RESULTS: Overall detection of MMc was common (20/28 samples,71%). Preliminary analysis suggested a trend toward higher detectionrates and concentrations by groups (Table), p�0.08.CONCLUSION: Our data demonstrate frequent detection of MMc in CB. Inaddition, we saw a trend toward increasing detection at later gestationalages and in pregnancies complicated by PE. These findings prompt thequestion whether differences in MMc according to pregnancy outcomemay contribute to fetal origins of disease. In addition, MMc in CB mayhave important implications for transplantation, including effects ongraft-versus-tumor and graft-versus-host outcomes.
Poster Session I Clinical Obstetrics, Epidemiology, Fetus, Medical-Surgical Complications, Neonatology, Physiology/Endocrinology, Prematurity www.AJOG.org
S96 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2013
