Reference Intervals for N-Terminal Pro-B-Type Natriuretic Peptide in Amniotic Fluid between 10 and 34 Weeks of Gestation

Merz, Waltraut M.; Leufgen, Christina; Fimmers, Rolf; Stoffel‐Wagner, Birgit; Gembruch, Ulrich

doi:10.1371/journal.pone.0114416

Cited by 9 publications

(13 citation statements)

References 43 publications

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“…Although AF-ntproBNP is of fetal origin [35] we assume that these factors exert an influence on the plasma to AF ratio, act as confounders and interfere with AF analysis [30–34]. …”

Section: Discussionmentioning

confidence: 99%

“…Maternal exclusion criteria were the presence of cardiac or renal diseases. Inclusion and exclusion criteria for controls have been described in detail [ 35 , 36 ].…”

Section: Methodsmentioning

confidence: 99%

“…To adjust for a potential dilutional effect, the AF-nt-proBNP / AF-TP ratio was calculated and used for analysis. The previously established reference curve was extended to incorporate samples from 34 to 40 weeks of gestation [ 35 , 37 ]. Non-parametric tests were used for between group analysis of quantitative variables; Pearson’s coefficient was calculated to analyze correlations.…”

Section: Methodsmentioning

confidence: 99%

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N-terminal pro-B-type natriuretic peptide in amniotic fluid of fetuses with known or suspected cardiac load

et al. 2017

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BackgroundMyocardial dysfunction occurs in a variety of fetal disorders. Findings from adult cardiology, where n-terminal pro-B-type natriuretic peptide (nt-proBNP) is an established biomarker of left ventricular dysfunction have been extended to fetal life. Since fetal blood sampling is technically challenging we investigated amniotic fluid nt-proBNP for its suitability to diagnose fetal myocardial dysfunction.MethodsUltrasound, Doppler examination and echocardiography was applied to classify cases and controls. Amniotic fluid nt-proBNP to amniotic fluid total protein ratio was calculated and compared to the gestational age-dependent reference intervals. In a subset of cases, fetal and maternal plasma nt-proBNP levels were determined.ResultsSpecimen from 391 fetuses could be analyzed (171 cases, 220 controls). There was a high correlation between amniotic fluid and fetal blood nt-proBNP levels (r = 0.441 for cases; r = 0.515 for controls), whereas no correlation could be detected between maternal and fetal (blood and amniotic fluid) nt-proBNP concentrations. Specificity and positive likelihood ratio of amniotic fluid nt-proBNP to amniotic fluid total protein ratio were high (0.97 and 4.3, respectively).ConclusionAmniotic fluid nt-proBNP measurement allows diagnostic confirmation of fetal myocardial dysfunction. It may serve as a useful adjunct in addition and correlation to existing tests of myocardial function, particularly in the context of invasive fetal therapy, where access to the amniotic cavity is part of the procedure.

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“…Although AF-ntproBNP is of fetal origin [35] we assume that these factors exert an influence on the plasma to AF ratio, act as confounders and interfere with AF analysis [30–34]. …”

Section: Discussionmentioning

confidence: 99%

“…Maternal exclusion criteria were the presence of cardiac or renal diseases. Inclusion and exclusion criteria for controls have been described in detail [ 35 , 36 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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N-terminal pro-B-type natriuretic peptide in amniotic fluid of fetuses with known or suspected cardiac load

et al. 2017

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“…In addition, we excluded patients who were diagnosed with IUGR because the levels of NT-proBNP can be altered by this condition. 24 In a study by Merz et al, 25 it was demonstrated that amniotic fluid levels of NT-proBNP are of fetal origin. They attributed it predominantly to fetal renal functions, but the exact origin in the fetal body remained to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

“…They attributed it predominantly to fetal renal functions, but the exact origin in the fetal body remained to be elucidated. 25 NT-proBNP levels were demonstrated to accurately reflect renal function when the cardiac and circulatory status are normal. 5,26 It's been demonstrated that these levels were also superior to BNP, likely because the clearance of NT-proBNP is more dependent on kidney function, while the clearance of BNP can be performed by other pathways.…”

Section: Discussionmentioning

confidence: 99%

The Association between N-terminal Pro-Brain Natriuretic Peptide Levels in the Umbilical Vein and Amniotic Fluid Volume Abnormalities

Ersoy

Özler

Öztaş

et al. 2016

Rev Bras Ginecol Obstet

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Purpose The amniotic fluid volume (AFV) is known as a predictor for the wellness of a fetus. We aimed to investigate whether N-terminal pro-brain natriuretic peptide (NTproBNP) levels reflect AFV abnormalities in otherwise normal fetuses. Methods We recruited 24 women with isolated oligohydramnios, 23 women with isolated polyhydramnios, and 36 women with normal AFV at a tertiary referral center. NT-proBNP levels in umbilical venous samples and the individual characteristics of the three groups were compared. One-way ANOVA and Kruskal-Wallis analysis of variance were used for multi-group comparisons of continuous variables. When a significant difference was detected, the Scheffe test was performed as a post-hoc analysis. Proportions were compared using the Chi-square (2) test. Results Maternal age, body mass indices, weight gained in pregnancy and NT-proBNP levels were similar among the three groups. Apgar scores at 1 and 5 minutes significantly correlated with NT-proBNP levels in all newborns (Spearman's r ¼ 0.23; p ¼ 0.03 and Spearman's r ¼ 0.24; p ¼ 0.02, respectively). The umbilical venous NTproBNP levels did not differ between newborns who needed mechanical ventilation and those who didn't (p ¼ 0.595). Conclusions NT-proBNP is a biomolecule that may provide insights into the pathogenesis of fetal circulatory problems and subsequent renal failure. Further investigations are warranted.

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Different expressions of cardiac biomarkers between different types of acquired right ventricular outflow tract abnormality in monochorionic twins

et al. 2022

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Objective: To investigate the differences in amniotic fluid cardiac biomarkers and clinical features among types of right ventricular outflow tract (RVOT) abnormality in monochorionic (MC) twins.Method: This prospective study included MC twins that underwent laser surgery.Recipient or larger twins (group A) and donor or smaller twins (group B) were assessed and divided into those with a normal right ventricular outflow tract (normal RVOT), functional pulmonary atresia (fPA), or pulmonary stenosis (PS). Amniotic fluid levels of NT-proBNP (afNT-proBNP) and cardiac troponin T (afTnT) were examined during surgery.Results: Of 190 fetuses in group A, there were 14 RVOT abnormality cases (including 7 fPA and 7 PS). No group B fetuses showed RVOT abnormality findings.In group A, later and earlier gestational age at surgery were observed in fPA (25.1 � 2.8 weeks) and PS groups (17.8 � 0.9 weeks). All survived PS cases demonstrated progressive pulmonary valve obstruction, not observed in fPA groups. AfNT-proBNP were significantly higher in fPA and PS than in the normal RVOT group (p < 0.05). AfTnT was significantly higher in group A with PS than fPA and normal RVOT groups (p < 0.05). Conclusion:Among RVOT abnormality types in group A, amniotic fluid cardiac biomarkers were differently expressed, and clinical features were also differentiated. These findings provide insight into the pathophysiological influence on RVOT in MC twins. Clinical trial registration:This study was registered with the Japanese Clinical Trial Registry "UMIN-CTR" (http://www.umin.ac.jp/ctr/index-j.htm; trial ID numbers UMIN000024486 and 000037702). Key pointsWhat's already known about this topic? � Right ventricular outflow tract (RVOT) abnormality in monochorionic (MC) twins with complications, such as twin-to-twin transfusion syndrome and selective intrauterine growth restriction, is much more frequent than in singleton fetuses and is a clinically important

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Reference Intervals for N-Terminal Pro-B-Type Natriuretic Peptide in Amniotic Fluid between 10 and 34 Weeks of Gestation

Cited by 9 publications

References 43 publications

N-terminal pro-B-type natriuretic peptide in amniotic fluid of fetuses with known or suspected cardiac load

N-terminal pro-B-type natriuretic peptide in amniotic fluid of fetuses with known or suspected cardiac load

The Association between N-terminal Pro-Brain Natriuretic Peptide Levels in the Umbilical Vein and Amniotic Fluid Volume Abnormalities

Different expressions of cardiac biomarkers between different types of acquired right ventricular outflow tract abnormality in monochorionic twins

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