Fetal survivin
concentrations in normal
and complicated
pregnancies at term
Ariadne Malamitsi-Puchner 1 , Maria Boutsikou ...
Apoptosis
•
•
•

Programmed cell death
regulates cell proliferation
contributes to tissue and organ
homeostasis
• importan...
Disturbances in feto-placental
apoptosis seem to be associated
with abnormal pregnancy outcome
• fetal macrosomia, due to ...
IUGR/ Fetal macrosomia
• IUGR

is correlated with
-increased incidence of apoptosis in IUGR-affected fetal
membranes
-abno...
Survivin
• 16.5 kD protein
• member of the inhibitors of apoptosis (IAP)
family

• prominently expressed in fetal tissues ...
HYPOTHESIS OF THE STUDY
• Umbilical cord blood concentrations of survivin in
IUGR and large-for-gestational-age (LGA-due t...
AIM OF THE STUDY
•

Investigate cord blood survivin concentrations
in IUGR, LGA and AGA pregnancies at birth

•

Correlate...
SUBJECTS OF THE STUDY
• 160 healthy, singleton full-term

pregnancies
- 101 AGA (placental weight: 480-621 g)
- 48 asymmet...
Gestation Related Optimal
Weight (GROW) computergenerated programme
www.gestation.net

d
6
5
P
p
E
x
S
c
l
M
n
k
o
G
)
h
g...
CAUSES OF INTRAUTERINE
GROWTH RESTRICTION
• Preeclampsia ( n=19 )
• Hypertensive disease of pregnancy
(n=16 )

• Various d...
DEMOGRAPHIC DATA OF THE
STUDY POPULATION
•
•
•
•
•
•

IUGR
Gestational age (weeks)
38 .4 ±1 .4 *
BW (g)
256 6 ±34 3 *
BW c...
Methods
•
•

•

Blood collected from:
Doubly-clamped umbilical cords (m ixed
arteriovenous blood ) – reflecting fetal
stat...
Fig. 1. Cord blood survivin concentrations
in AGA, IUGR and LGA pregnancies .
400

Survivin concentrations (pg/ml)

300

2...
Results
• No statistically significant differences in
cord blood survivin concentrations
between IUGR, LGA and AGA groups.
Results
• In the three groups

• The effect of group (IUGR, LGA, AGA) (Fig.1),

birthweight, customized centile, gestation...
Conclusions 1
• Cord blood survivin concentrations in full-term
pregnancies are independent of intrauterine
growth

• Cord...
Conclusions 2
• Parity, gender and mode of delivery

(vaginal or elective cesarean section) do
not seem to have any impact...
Conclusions 3

• Reference values (median) for

cord blood survivin concentrations
at term were 138.49 pg/mL
Survivin
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Survivin

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Survivin

  1. 1. Fetal survivin concentrations in normal and complicated pregnancies at term Ariadne Malamitsi-Puchner 1 , Maria Boutsikou 1 , Sophia Liosi 1 , Dimitrios Gourgiotis 2 , Venetia-Maria Vraila 2 , Dimitrios Hassiakos 1 , Stavroula Baka 1 , Despina D. Briana 1 1. Neonatal Division, 2nd Department of Obstetrics and Gynecology, Athens University Medical School, Athens, Greece 2.Research Laboratories, 2nd Department of Pediatrics, Athens University Medical School, Athens, Greece
  2. 2. Apoptosis • • • Programmed cell death regulates cell proliferation contributes to tissue and organ homeostasis • important for the development of normal human placenta
  3. 3. Disturbances in feto-placental apoptosis seem to be associated with abnormal pregnancy outcome • fetal macrosomia, due to maternal diabetes mellitus (DM) • intrauterine growth restriction (IUGR)
  4. 4. IUGR/ Fetal macrosomia • IUGR is correlated with -increased incidence of apoptosis in IUGR-affected fetal membranes -abnormal expression of proteins involved in apoptosis and cell turnover • Fetal macrosomia is correlated with -decreased apoptosis in placental cells
  5. 5. Survivin • 16.5 kD protein • member of the inhibitors of apoptosis (IAP) family • prominently expressed in fetal tissues and overexpressed in cancer cells • • important for normal fetal development plays critical roles in placental cell survival and cytotrophoblast cell differentiation
  6. 6. HYPOTHESIS OF THE STUDY • Umbilical cord blood concentrations of survivin in IUGR and large-for-gestational-age (LGA-due to gestational DM) cases may differ from respective concentrations in appropriate-forgestational-age (AGA) controls, since the former are associated with excessive and reduced feto-placental apoptosis, respectively.
  7. 7. AIM OF THE STUDY • Investigate cord blood survivin concentrations in IUGR, LGA and AGA pregnancies at birth • Correlate determined concentrations with gestational age, gender and mode of delivery .
  8. 8. SUBJECTS OF THE STUDY • 160 healthy, singleton full-term pregnancies - 101 AGA (placental weight: 480-621 g) - 48 asymmetric IUGR ( placental weight 230-420 g) - 11 LGA (placental weight: 650-810 g) • Apgar scores:>8 in 1st and 5th minute
  9. 9. Gestation Related Optimal Weight (GROW) computergenerated programme www.gestation.net d 6 5 P p E x S c l M n k o G ) h g w r i B y D e a m t s u C ( b : = W
  10. 10. CAUSES OF INTRAUTERINE GROWTH RESTRICTION • Preeclampsia ( n=19 ) • Hypertensive disease of pregnancy (n=16 ) • Various diseases : severe type I DM • ( n=2) ,iron deficiency anemia (n=4), hypothyroidism (n=4) Maternal smoking ( n=10 )
  11. 11. DEMOGRAPHIC DATA OF THE STUDY POPULATION • • • • • • IUGR Gestational age (weeks) 38 .4 ±1 .4 * BW (g) 256 6 ±34 3 * BW centile 5. 33±3 .8 * Gender (male/female) 23/25 Mode of delivery (VD/ECS)** 24/24 Parity (1st /other) 31 / 17 * values are mean ± SD **VD: vaginal delivery/ ECS: elective cesarian section LGA 38 . 4±0 .9* 3781±173 * 94 . 1 ±3 .1 * 9/2 6/5 7/4 AGA 39 .0 ± 1.0 * 319 7 ±29 6* 39 . 3±23 .4* 60/41 77/24 70/31
  12. 12. Methods • • • Blood collected from: Doubly-clamped umbilical cords (m ixed arteriovenous blood ) – reflecting fetal state Determination of plasma survivin concentrations by enzyme immunoassay ( Human Total Survivin EIA , Assay Designs, 5777 Hines Drive, Ann Arbor, MI 48108, U.S.A ) Statistical analysis (non-parametric tests)
  13. 13. Fig. 1. Cord blood survivin concentrations in AGA, IUGR and LGA pregnancies . 400 Survivin concentrations (pg/ml) 300 200 100 0 AGA IUGR LGA
  14. 14. Results • No statistically significant differences in cord blood survivin concentrations between IUGR, LGA and AGA groups.
  15. 15. Results • In the three groups • The effect of group (IUGR, LGA, AGA) (Fig.1), birthweight, customized centile, gestational age, gender, mode of delivery and parity on circulating survivin concentrations was not significant • Reference survivin values (median, range): 138.49 pg/mL and 71.54 - 349.89 pg/mL, respectively
  16. 16. Conclusions 1 • Cord blood survivin concentrations in full-term pregnancies are independent of intrauterine growth • Cord blood survivin concentrations probably do not reflect the disturbances of feto-placental apoptosis expected in IUGR and fetal macrosomia, due to gestational DM
  17. 17. Conclusions 2 • Parity, gender and mode of delivery (vaginal or elective cesarean section) do not seem to have any impact on umbilical cord blood survivin concentrations
  18. 18. Conclusions 3 • Reference values (median) for cord blood survivin concentrations at term were 138.49 pg/mL

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