Endoglin in Pregnancy Complicated by Fetal Intrauterine Growth Restriction

Abstract

SUMMARY Introduction: I ntrauterine growth restriction (IUGR) is defined as a failure of the fetus to achieve its optimal growth potential (ACOG Practice Bulletin, 2001) and constitutes a major clinical and public health problem, mainly in the developing world (de Onis et al., 1998). It is considered a heterogeneous syndrome associated with hypertensive disorders of pregnancy, smoking, infection, under nutrition and un explained factors (Villar et al., 2006). IUGR fetuses are at greater risk of perinatal death, birth hypoxia, neonatal complications, impaired neuro development and manifestations of the metabolic syndrome in adult life such as type 2 diabetes, coronary heart disease and hypertension (Kady and Gardosi, 2004). It is widely accepted that, next to infections, maternal disease and chromosomal abnormalities, a lack of nutrients and oxygen and impaired fetal-placental angiogenesis could lead to IUGR (Ruebner et al., 2006). Endothelial dysfunction may lead to impaired uteroplacental function or nutrient deficiency (riaBna et al., 2009). The regulation of vascular growth and remodeling is considered to be central to normal placental and fetal growth and development (Chaiworapongsa et al., 2008). Endoglin, also known as CD105, is one of the key proteins that iso synthesized and released by the placenta. It is highly expressed on the vascular endothelium and syncytiotrophoblast and is known to play a role in angiogenesis and in the regulation of the vascular tone through its interaction with endothelial nitric oxide synthase (eNOS) (Robinson and Johnson, 2007). Endoglin, is a 180 KDa homodimeric transmembrane glycoprotein expressed mainly in endothelial cells, but also in many other cell types (Jose et al., 2007). Levine et al. demonstrated that the levels of soluble maternal endoglin in small-for-gestational-age (SGA) fetuses in normotensive pregnancies increased in the second trimester, with a large increase after the 37th week, Patients and methods: The objective of the study was to evaluate the maternal serum endoglin level (26th_30th gestational weeks) in the measuring of Intra-uterine growth restriction in high risk groups. This study was carried out at Ain Shams Maternity Hospital. 117 pregnant women in their 26th_ 30th week of gestation (at 1st visit) were included in the study and informed clearly about the aim of the study, the required procedure and the follow-up plan, they accepted and were assigned to 2 groups. The first group: (group A) were included 69 pregnant women without IUGR. The second group: (group B) were included 48 patients which develops IUGR. The first group sups divided into 12 Patients with diagnosis of chronic hypertension, 30 patients with diagnosis of preeclampsia. 27 pregnant women normotensive without IUGR (with high rick for IUGR cyanotic heart disease, pregestional diabetes, Systemic lupus erythematosus). The second group: (group B) sup divided into 12 patients with of preeclampsia complicated by IUGR, 26 patients with diagnosis of chronic hypertension complicated by IUGR. 10 Normotensive with IUGR (with high rick for IUGR cyanotic heart disease, pregestional diabetes, Systemic lupus erythematosus).

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