Steroid Hormone Levels in Recipient Amniotic Fluid in Twin–Twin Transfusion Syndrome and Their Association with Preterm Delivery

Mallory Hoffman; Lovepreet K. Mann; Jong H. Won; Eric P. Bergh; Roopali Donepudi; Anthony Johnson; Kenneth J. Moise; Cora Macpherson; Elizabeth Thom; Sam Mesiano; Ramesha Papanna

doi:10.1055/s-0039-1700862

American Journal of Perinatology, Table of Contents

Am J Perinatol 2020; 37(06): 562-569
DOI: 10.1055/s-0039-1700862

SMFM Fellowship Series Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Steroid Hormone Levels in Recipient Amniotic Fluid in Twin–Twin Transfusion Syndrome and Their Association with Preterm Delivery

Mallory Hoffman

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, UTHealth, The University of Texas Health Science Center at Houston, Houston, Texas

,

Lovepreet K. Mann

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, UTHealth, The University of Texas Health Science Center at Houston, Houston, Texas

²The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas

,

Jong H. Won

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, UTHealth, The University of Texas Health Science Center at Houston, Houston, Texas

²The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas

,

Eric P. Bergh

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, UTHealth, The University of Texas Health Science Center at Houston, Houston, Texas

²The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas

,

Roopali Donepudi

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, UTHealth, The University of Texas Health Science Center at Houston, Houston, Texas

²The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas

,

Anthony Johnson

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, UTHealth, The University of Texas Health Science Center at Houston, Houston, Texas

²The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas

,

Kenneth J. Moise

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, UTHealth, The University of Texas Health Science Center at Houston, Houston, Texas

²The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas

,

Cora Macpherson

³Department of Epidemiology and Biostatistics, The George Washington University Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, Maryland

,

Elizabeth Thom

³Department of Epidemiology and Biostatistics, The George Washington University Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, Maryland

,

Sam Mesiano

⁴Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio

,

Ramesha Papanna

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, UTHealth, The University of Texas Health Science Center at Houston, Houston, Texas

²The Fetal Center, Children's Memorial Hermann Hospital, Houston, Texas

› Author Affiliations

Abstract

Objective Preterm delivery following fetoscopic laser surgery (FLS) of twin–twin transfusion syndrome (TTTS) is associated with severe perinatal morbidity and mortality. The role of steroid hormones in amniotic fluid (AF) after FLS remains unknown.

Study Design A prospective cohort study of consecutive case series of FLS for TTTS was performed from April 2012 to February 2017. Cases were divided into early (≤27 weeks) spontaneous preterm delivery (ED) and late delivery (LD; ≥34 weeks) following FLS and compared. AF supernatants were assessed for protein, estradiol, progesterone and cortisol levels (using the ELISA kit), and normalized to total protein levels to adjust for dilution.

Results A total of 294 consecutive cases of FLS for TTTS in monochorionic–diamniotic twins were performed during the study period. AF was available in 44 ED patients and 50 LD patients. On logistic regression, ED was associated with higher normalized progesterone levels (odds ratio [OR]: 1.25; 95% confidence interval [CI]: 1.12–1.41), lower normalized cortisol (OR: 0.78; 95% CI: 0.64–0.96), and higher estradiol levels (OR: 1.3; 95% CI: 1.03–1.63).

Conclusion Elevated AF normalized progesterone and estradiol, and lower normalized cortisol levels were associated with ED. This novel finding requires further exploration to establish the molecular mechanism operational in pregnancies complicated by TTTS to potentially prevent early preterm birth after fetal surgery.

Keywords

amniotic fluid - twin–twin transfusion syndrome - steroid hormones - progesterone - estradiol - cortisol - preterm birth - risk assessment

Full Text

References

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