COMPARATIVE STUDY OF SERUM LEVELS

OF INHIBIN A, ACTIVIN A AND LEPTIN IN

INTRAUTRINE GROWTH RESTRICTED AND

APPROPRIATE FOR GESTATIONAL AGE

PREGNANCY

COMPARATIVE STUDY OF SERUM LEVELS

OF INHIBIN A, ACTIVIN A AND LEPTIN IN

INTRAUTRINE GROWTH RESTRICTED AND

APPROPRIATE FOR GESTATIONAL AGE

PREGNANCY

P.G. STUDENT

Dr. Jograjiya G.R.

SUPERVISOR

Dr. Pratiksha Gupta

CO-SUPERVISOR

DR. Sarika Arora

P.G. STUDENT

Dr. Jograjiya G.R.

SUPERVISOR

Dr. Pratiksha Gupta

CO-SUPERVISOR

DR. Sarika Arora

INTRODUCTIONINTRODUCTION

Intrauterine growth restriction (IUGR)-

estimated fetal weight <10th percentile for

gestational age.

Small for gestational age (SGA)- estimated

fetal weight or abdominal circumference

(AC) <10th percentile.

Intrauterine growth restriction (IUGR)-

estimated fetal weight <10th percentile for

gestational age.

Small for gestational age (SGA)- estimated

fetal weight or abdominal circumference

(AC) <10th percentile.

TYPE OF IUGRTYPE OF IUGR Symmetrical IUGR (type 1) - 20-30%

Early in pregnancy Intrauterine infection Chromosomal disorders Congenital malformation Normal ponderal index

Asymmetrical IUGR (type 2)- 70-80% After 28 weeks Uteroplacental insufficiency The ponderal index is low with low birth weight and

abdominal circumference.

Symmetrical IUGR (type 1) - 20-30% Early in pregnancy Intrauterine infection Chromosomal disorders Congenital malformation Normal ponderal index

Asymmetrical IUGR (type 2)- 70-80% After 28 weeks Uteroplacental insufficiency The ponderal index is low with low birth weight and

abdominal circumference.

INHIBIN AINHIBIN A

A dimeric glycoprotein produced during pregnancy.

It inhibits FSH by directly acting on the pituitary. It is first produced by the corpus luteum and

later by the placenta. It regulates cell growth and differentiation. Elevated levels of inhibin A (>2.0 MoM) in

pregnancy have been linked to adverse pregnancy outcomes, including pre-eclampsia, IUGR, preterm birth, and stillbirth.

A dimeric glycoprotein produced during pregnancy.

It inhibits FSH by directly acting on the pituitary. It is first produced by the corpus luteum and

later by the placenta. It regulates cell growth and differentiation. Elevated levels of inhibin A (>2.0 MoM) in

pregnancy have been linked to adverse pregnancy outcomes, including pre-eclampsia, IUGR, preterm birth, and stillbirth.

ACTIVIN A ACTIVIN A

It is a dimeric glycoprotein belong to transforming growth factor β superfamily.

It antagonizes inhibin A by stimulate FSH. During pregnancy, the fetoplacental unit is the

major source of activin A. It progressively increases throughout pregnancy. Animal studies show that after stimulating the

secretion of activin A leads to acute fetoplacental hypoxia.

It is a dimeric glycoprotein belong to transforming growth factor β superfamily.

It antagonizes inhibin A by stimulate FSH. During pregnancy, the fetoplacental unit is the

major source of activin A. It progressively increases throughout pregnancy. Animal studies show that after stimulating the

secretion of activin A leads to acute fetoplacental hypoxia.

LEPTINLEPTINIt is a 16 kDa protein hormone.

It is an adipose derived hormones.

It regulates energy intake and energy expenditure,

including appetite and metabolism.

It implicates implantation, embryo development and

continuation of pregnancy.

It has been related to pre-eclampsia and IUGR.

It is a 16 kDa protein hormone.

It is an adipose derived hormones.

It regulates energy intake and energy expenditure,

including appetite and metabolism.

It implicates implantation, embryo development and

continuation of pregnancy.

It has been related to pre-eclampsia and IUGR.

ULTRASOUND IN IUGRULTRASOUND IN IUGR

Ultrasound biometry-AC,HC,FL,BPD. Ultrasonography in Biophysical Profile

1. The nonstress test (NST)2. Ultrasonographic measurement of the amniotic fluid

volume (AFV)3. Observation of the presence or absence of fetal

breathing movements4. Gross body movements5. Tone

Ultrasound color Doppler- umbilical artery, uterine artery, middle cerebral artery.

Ultrasound biometry-AC,HC,FL,BPD. Ultrasonography in Biophysical Profile

1. The nonstress test (NST)2. Ultrasonographic measurement of the amniotic fluid

volume (AFV)3. Observation of the presence or absence of fetal

breathing movements4. Gross body movements5. Tone

Ultrasound color Doppler- umbilical artery, uterine artery, middle cerebral artery.

LACUNAE IN EXISTING KNOWLEDGE

LACUNAE IN EXISTING KNOWLEDGE

Limited studies on correlation of inhibin A

and activin A levels in IUGR in Indian.

Limited studies on levels of leptin correlation

with IUGR in Indian scenario.

AIMS & OBJECTIVESAIMS & OBJECTIVES

To estimate serum levels of inhibin A, activin A and leptin in maternal blood and umbilical vein blood in intrauterine growth restricted and appropriate for gestational age pregnancy in women during labor.

To study ultrasound finding of intrauterine growth restricted and appropriate for gestational age pregnancy in pregnant women.

To estimate serum levels of inhibin A, activin A and leptin in maternal blood and umbilical vein blood in intrauterine growth restricted and appropriate for gestational age pregnancy in women during labor.

To study ultrasound finding of intrauterine growth restricted and appropriate for gestational age pregnancy in pregnant women.

MATERIALS AND METHOD MATERIALS AND METHOD

STUDY DESIGN: Comparative prospective, non-interventional.

STUDY SITE: OPD, Ward and labor room of the department of Obstetrics and Gynecology, ESI PGIMSR, Basaidarapur, New Delhi-110015.

DURATION OF THE STUDY: Over period of 15 months.

 SAMPLE SIZE: 100

STUDY DESIGN: Comparative prospective, non-interventional.

STUDY SITE: OPD, Ward and labor room of the department of Obstetrics and Gynecology, ESI PGIMSR, Basaidarapur, New Delhi-110015.

DURATION OF THE STUDY: Over period of 15 months.

 SAMPLE SIZE: 100

SELECTION CRITERIA

Inclusion Criteria: The study group will be selected women, age range between 21 and 40 years, BMI range 20–30 kg/m2. Singleton pregnancies with the gestational age above 28

weeks. Clinically suspected IUGR confirmed by Ultrasound.

The control group will be selected women, age range between 21 and 40 years; BMI range 20–30 kg/m2. Singleton appropriate for gestational age pregnant

women.

Umbilicalvessels Chorionic

vesselsChorionicplate

Spiralartery

Placentalseptum

Basalplate

Uteroplacentalveins

Exclusion Criteria:

Multiple gestations

Severe anemia, Hb < 7 g/dl

Severe malnutrition

Severe respiratory disease

Cardiac disease

Smoking

Alcohol ingestion

Thyroid disorders

IN BOTH THE GROUPS

Maternal blood 5 milliliters will be collected before

delivery during labor in plain tube and assayed for :

Levels of Inhibin A, activin A and leptin by enzyme-linked

immunosorbent assay (ELISA).

After delivery umbilical vein blood 5 milliliters will be

collected in plain tube and assayed for:

Levels of Inhibin A, activin A and leptin by enzyme-linked

immunosorbent assay (ELISA).

Maternal blood 5 milliliters will be collected before

delivery during labor in plain tube and assayed for :

Levels of Inhibin A, activin A and leptin by enzyme-linked

immunosorbent assay (ELISA).

After delivery umbilical vein blood 5 milliliters will be

collected in plain tube and assayed for:

Levels of Inhibin A, activin A and leptin by enzyme-linked

immunosorbent assay (ELISA).

STUDY OUTCOMESTUDY OUTCOME

Primary To compare and correlate serum levels of inhibin A,

activin A and leptin in maternal blood and umbilical vein blood in intrauterine growth restricted and appropriate for gestational age pregnancy.

Secondary To compare and correlate ultrasound finding between

intrauterine growth restricted and appropriate for gestational age pregnancy.

To correlate birth weight with serum levels of inhibin A, activin A and leptin in intrauterine growth restricted and appropriate for gestational age pregnancy.

Primary To compare and correlate serum levels of inhibin A,

activin A and leptin in maternal blood and umbilical vein blood in intrauterine growth restricted and appropriate for gestational age pregnancy.

Secondary To compare and correlate ultrasound finding between

intrauterine growth restricted and appropriate for gestational age pregnancy.

To correlate birth weight with serum levels of inhibin A, activin A and leptin in intrauterine growth restricted and appropriate for gestational age pregnancy.

THANK YOUTHANK YOU