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      Increased Fetal Plasma Erythropoietin in Monochorionic Twin Pregnancies With Selective Intrauterine Growth Restriction and Abnormal Umbilical Artery Doppler.

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          Abstract

          Hypoxia is the primary stimulus for the production of erythropoietin (EPO) in both fetal and adult life. Here, we investigated fetal plasma EPO concentrations in monochorionic (MC) twin pregnancies with selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery (UA) Doppler. We diagnosed sIUGR in presence of (1) birth-weight discordance >20% and (2) either twin with a birth weight <10th percentile. An abnormal UA Doppler was defined as a persistent absent-reverse end diastolic flow (AREDF). The intertwin EPO ratio was calculated as the plasma EPO level of the smaller (or small-for-gestational-age) twin divided by the EPO concentration of the larger (or appropriate-for-gestational-age (AGA)) twin. Thirty-two MC twin pairs were included. Of these, 17 pairs were normal twins (Group 1), seven pairs were twins with sIUGR without UA Doppler abnormalities (Group 2), and eight pairs were twins with sIUGR and UA Doppler abnormalities (Group 3). The highest EPO ratio was identified in Group 3 (p < .001) but no significant differences were observed between Groups 1 and 2. Fetal hemoglobin levels did not differ significantly in the three groups, and fetal EPO concentration did not correlate with gestational age at birth. We conclude that fetal plasma EPO concentrations are selectively increased in MC twin pregnancies with sIUGR and abnormal UA Doppler, possibly as a result of uncompensated hypoxia.

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          Author and article information

          Journal
          Twin Res Hum Genet
          Twin research and human genetics : the official journal of the International Society for Twin Studies
          Cambridge University Press (CUP)
          1832-4274
          1832-4274
          August 2016
          : 19
          : 4
          Affiliations
          [1 ] Department of Obstetrics and Gynecology,Chang Gung Memorial Hospital,Linkou,College of Medicine,Chang Gung University,Taoyuan,Taiwan.
          Article
          S1832427416000384
          10.1017/thg.2016.38
          27161360
          f6fd9f34-9b10-4d9e-863b-41ba5ff143de
          History

          intrauterine growth restriction,erythropoietin,placenta,monochorionic twin pregnancy

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