Maternal plasma syndecan-1: a biomarker for fetal growth restriction. (31st December 2023)

• Record Type: Journal Article
• Authors: Juusela, Alexander; Jung, Eunjung; Gallo, Dahiana M.; Bosco, Mariachiara; Suksai, Manaphat; Diaz-Primera, Ramiro; Tarca, Adi L.; Than, Nandor Gabor; Gotsch, Francesca; Romero, Roberto; Chaiworapongsa, Tinnakorn
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 36:Number 1(2023)
• Publication Date: 2023-12-31
• Subjects: Diagnosis -- Doppler velocimetry -- endothelium -- glycocalyx -- inflammation -- intrauterine growth restriction -- placenta -- prediction -- pregnancy -- small for gestational age (SGA) -- syncytiotrophoblast -- ultrasound -- umbilical artery -- uterine artery; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2022.2150074
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Objective: The identification of fetal growth disorders is an important clinical priority given that they increase the risk of perinatal morbidity and mortality as well as long-term diseases. A subset of small-for-gestational-age (SGA) infants are growth-restricted, and this condition is often attributed to placental insufficiency. Syndecan-1, a product of the degradation of the endothelial glycocalyx, has been proposed as a biomarker of endothelial damage in different pathologies. During pregnancy, a "specialized" form of the glycocalyx—the "syncytiotrophoblast glycocalyx"—covers the placental villi. The purpose of this study was to determine whether the concentration of maternal plasma syndecan-1 can be proposed as a biomarker for fetal growth restriction. Study design: A cross-sectional study was designed to include women with normal pregnancy ( n = 130) and pregnant women who delivered an SGA neonate ( n = 50). Doppler velocimetry of the uterine and umbilical arteries was performed in women with an SGA fetus at the time of diagnosis. Venipuncture was performed within 48 h of Doppler velocimetry and plasma concentrations of syndecan-1 were determined by a specific and sensitive immunoassay. Results: (1) Plasma syndecan-1 concentration followed a nonlinear increase with gestational age in uncomplicated pregnancies (R 2 = 0.27, p < .001); (2) women with a pregnancy complicated with an SGA fetus had a significantly lower mean plasma concentration of syndecan-1 than those with an appropriate-for-gestational-age fetus ( p = .0001); (3) this difference can be attributed to fetal growth restriction, as the mean plasma syndecan-1 concentration was significantly lower only in the group of women with an SGA fetus who had abnormal umbilical and uterine artery Doppler velocimetry compared to controls ( p = .00071; adjusted p = .0028). A trend toward lower syndecan-1 concentrations was also noted for SGA with abnormal uterine but normal umbilical artery Doppler velocimetry ( p = .0505; adjusted p = .067); 4) among women with an SGA fetus, those with abnormal umbilical and uterine artery Doppler findings had a lower mean plasma syndecan-1 concentration than women with normal Doppler velocimetry ( p = .02; adjusted p = .04); 5) an inverse relationship was found between the maternal plasma syndecan-1 concentration and the umbilical artery pulsatility index ( r = −0.5; p = .003); and 6) a plasma syndecan-1 concentration ≤ 850 ng/mL had a positive likelihood ratio of 4.4 and a negative likelihood ratio of 0.24 for the identification of a mother with an SGA fetus who had abnormal umbilical artery Doppler velocimetry (area under the ROC curve 0.83; p < .001). Conclusion: Low maternal plasma syndecan-1 may reflect placental diseases and this protein could be a biomarker for fetal growth restriction. However, as a sole biomarker for this condition, its accuracy is low.