Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark.
Biomark Med. 2013 Feb;7(1):139-46. doi: 10.2217/bmm.12.79.
To examine concentrations of three cardiovascular propeptides in umbilical cord plasma of neonates born to mothers with Type 1, Type 2 and gestational diabetes. Measurement of cardiovascular markers in umbilical cord plasma may potentially help identify neonates at risk of postnatal complications. Neonates born to mothers with diabetes have an increased risk of neonatal morbidity and mortality, and measurement of these new biomarkers may potentially help identify neonates at risk of these complications.
SUBJECTS & METHODS: Copeptin, midregional proadrenomedullin (MR-proADM) and mid-regional pro-A-type natriuretic peptide (MR-proANP) were measured in cord plasma of neonates (n = 63) born to mothers with the three types of diabetes. Associations with maternal glycemic control, mode of delivery and neonatal metabolic acidosis were examined.
Umbilical cord plasma copeptin concentrations were lowest in neonates after elective cesarean sections (6.1 pmol/l; interquartile range [IQR]: 4.5-9.1) compared with emergency cesarean sections (156 pmol/l; IQR: 9.6-311; p = 0.019) and vaginal delivery (831 pmol/l; IQR: 107-2407; p < 0.0001). MR-proADM was also affected by mode of delivery; however, this seemed more likely to be caused by an inverse association with the acid-base balance. In this population, only MR-proANP plasma concentrations were related to type of diabetes. Neonates born to mothers with Type 1 diabetes had higher concentrations (median 260 pmol/l; IQR: 222-318) compared with Type 2 diabetes (175 pmol/l; IQR: 169-200; p = 0.003) and gestational diabetes (200 pmol/l; IQR: 149-276; p = 0.009).
Umbilical cord plasma copeptin and MR-proADM concentrations primarily reflect perinatal stress associated with mode of delivery and the degree of fetal acidosis, whereas MR-proANP concentrations are higher in neonates born to mothers with Type 1 diabetes.
检测 1 型、2 型和妊娠期糖尿病母亲所生新生儿脐带血浆中三种心血管前肽的浓度。检测脐带血浆中的心血管标志物可能有助于发现有产后并发症风险的新生儿。患有糖尿病的母亲所生的新生儿有更高的新生儿发病率和死亡率风险，而这些新生物标志物的检测可能有助于发现有这些并发症风险的新生儿。
检测了 63 例母亲患有三种类型糖尿病的新生儿脐带血浆中的 copeptin、中区域前肾上腺髓质素 (MR-proADM) 和中区域 A 型利钠肽前肽 (MR-proANP)。检查了与母体血糖控制、分娩方式和新生儿代谢性酸中毒的关系。
与急诊剖宫产（156pmol/L；IQR：9.6-311；p=0.019）和阴道分娩（831pmol/L；IQR：107-2407；p<0.0001）相比，择期剖宫产新生儿的脐带血浆 copeptin 浓度最低（6.1pmol/L；IQR：4.5-9.1）。MR-proADM 也受到分娩方式的影响，但这似乎更可能是由于与酸碱平衡的反比关系。在该人群中，只有 MR-proANP 血浆浓度与糖尿病类型有关。与 2 型糖尿病（175pmol/L；IQR：169-200；p=0.003）和妊娠期糖尿病（200pmol/L；IQR：149-276；p=0.009）相比，1 型糖尿病母亲所生的新生儿的浓度更高（中位数 260pmol/L；IQR：222-318）。
脐带血浆 copeptin 和 MR-proADM 浓度主要反映与分娩方式和胎儿酸中毒程度相关的围产期应激，而 1 型糖尿病母亲所生的新生儿的 MR-proANP 浓度更高。
