Am J Perinatol 2020; 37(11): 1084-1093
DOI: 10.1055/s-0040-1701504
SMFM Fellowship Series Article

Maternal Amino Acid Profiles to Distinguish Constitutionally Small versus Growth-Restricted Fetuses Defined by Doppler Ultrasound: A Pilot Study

Anne C. Porter
1  Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Diane L. Gumina
1  Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
2  Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Michael Armstrong
3  Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Kenneth N. Maclean
4  Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Nichole Reisdorph
3  Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Henry L. Galan
1  Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Sally P. Stabler
5  Division of Hematology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Beth A. Bailey
1  Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
John C. Hobbins
1  Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
1  Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
2  Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
› Author Affiliations
Funding This work was supported by an SMFM/AAOGF Scholar Award (K.J.H.), the Perelman Study for Fetal Growth Restriction (D.L.G., H.L.G., and J.H.), the William R Hummel Homocystinuria Research Fund (K.N.M.), and the Ehst-Hummel-Kaufmann Family Endowed Chair in Inherited Metabolic Disease (K.N.M.).

Abstract

Objective Fetuses measuring below the 10th percentile for gestational age may be either constitutionally small for gestational age (SGA) or have pathologic fetal growth restriction (FGR). FGR is associated with adverse outcomes; however, identification of low-risk SGA cases is difficult. We performed a pilot study evaluating maternal markers of pathologic FGR, hypothesizing there are distinct amino acid signatures that might be used for diagnosis and development of new interventions.

Study Design This was a cohort study of healthy women with sonographic fetal estimated fetal weight <5th percentile divided into two groups based upon umbilical artery (UmA) Doppler studies or uterine artery (UtA) Doppler studies. We collected maternal blood samples prior to delivery and used ion pair reverse phase liquid chromatography-mass spectrometry or gas chromatography-mass spectrometry to assess 44 amino acids.

Results Among 14 women included, five had abnormal UmA, and three had abnormal UtA Doppler results. Those with abnormal UmA showed elevated ornithine. Those with abnormal UtA had lower dimethylglycine, isoleucine, methionine, phenylalanine, and 1-methylhistidine.

Conclusion We found several amino acids that might identify pregnancies affected by pathologic FGR. These findings support the feasibility of future larger studies to identify maternal metabolic approaches to accurately stratify risk for small fetuses.

Note

This work was presented in part at the Society for Reproductive Investigation meeting 2018 in San Diego, CA.




Publication History

Received: 28 December 2019

Accepted: 30 December 2019

Publication Date:
02 March 2020 (online)

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