Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, 3084, Victoria, Australia.
Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia.
Nat Commun. 2020 May 15;11(1):2411. doi: 10.1038/s41467-020-16346-x.
Placental insufficiency can cause fetal growth restriction and stillbirth. There are no reliable screening tests for placental insufficiency, especially near-term gestation when the risk of stillbirth rises. Here we show a strong association between low circulating plasma serine peptidase inhibitor Kunitz type-1 (SPINT1) concentrations at 36 weeks' gestation and low birthweight, an indicator of placental insufficiency. We generate a 4-tier risk model based on SPINT1 concentrations, where the highest risk tier has approximately a 2-5 fold risk of birthing neonates with birthweights under the 3, 5, 10 and 20 centiles, whereas the lowest risk tier has a 0-0.3 fold risk. Low SPINT1 is associated with antenatal ultrasound and neonatal anthropomorphic indicators of placental insufficiency. We validate the association between low circulating SPINT1 and placental insufficiency in two other cohorts. Low circulating SPINT1 is a marker of placental insufficiency and may identify pregnancies with an elevated risk of stillbirth.
胎盘功能不全可导致胎儿生长受限和死胎。目前尚无可靠的胎盘功能不全筛查试验，尤其是在妊娠晚期，死胎风险增加。本研究显示，妊娠 36 周时循环血浆丝氨酸蛋白酶抑制剂 Kunitz 型 1（SPINT1）浓度较低与低出生体重（胎盘功能不全的一个指标）密切相关。我们根据 SPINT1 浓度生成了一个 4 级风险模型，其中风险最高的一级出生体重低于第 3、5、10 和 20 百分位的新生儿的风险约为 2-5 倍，而风险最低的一级的风险为 0-0.3 倍。低 SPINT1 与产前超声和新生儿形态学指标均提示胎盘功能不全。我们在另外两个队列中验证了低循环 SPINT1 与胎盘功能不全之间的关联。低循环 SPINT1 是胎盘功能不全的标志物，可能识别出具有死胎风险增加的妊娠。
