Serum immunoglobulins in multiple pregnancy.

Abstract

(1976). Archives The three cases of fetofetal transfusion syndrome were exceptional in the large difference between IgG concentrations in recipient and donor twins. The discrepancy was much greater than that found between the levels of proteins produced by the fetus, suggesting a disturbance in maternofetal placental transfer.IgM was detected in all cord sera, with one exception, and the level was not related to order of birth. IgA was detected in 16% of cord sera, 13% in sera from first borns. IgE was detected in only 8% of cord sera and there was no evidence of placental transfer.For several centuries it has been recognized that the human infant has a surprising resistance to some infections during the first months of life. That this is due to the transfer of immunity from mother to fetus was first shown by Fischl and Wundcheim (1895) when they isolated diphtheria antitoxin from human umbilical cord blood. Since then the subject of maternofetal transfer of immunity has been extensively studied and it is now well known that it is the immunoglobulin G (IgG) antibodies which cross the placenta and that, in the human newborn, IgG is almost entirely of maternal origin. Much is still unknown about the regulation of maternofetal transfer of IgG and we hoped that further light might be shed on the subject by studying the pattern of immunoglobulins in multiple pregnancy. Our interest was further stimulated on finding a large intrapair difference in cord serum IgG concentration in 2 male infants suffering from the fetofetal transfusion syndrome (Bryan and Slavin, 1974).

Transplacental Total IgG Transfer in Twin Pregnancies

“…observed a significantly higher level of IgG in cord than in maternal serum. This difference was not observed in our study, possibly because the earlier mean gestational age at delivery in our population (36.3 weeks) compared to their study (>37 weeks, observing the plotting data) . Bryan et al.…”

“…A positive correlation between total serum IgG concentration and umbilical cord IgG concentrations has been demonstrated both in singleton and twin pregnancies . Bryan et al.…”

“…To the best of our knowledge, only one study, carried out more than three decades ago, investigated IgG concentrations in 50 twin pregnancies and showed that mean IgG levels were also higher in the umbilical cord than maternal sera. No differences were observed according to zygosity; however, data were not analyzed according to chorionicity …”

Serum Alphafetoprotein in Multiple Pregnancy

“…Nor was a higher level found in the cord sera of the second-born infants, who in general are more prone to acute fetal distress than the preceding twin. On the other hand, one case of the fetofetal transfusion was of interest in this respect -the donor's serum AFP was slightly higher than that of the recipient, whereas all other proteins measured, total protein, albu min, transferrin and immunoglobulin G were considerably lower, as would be expected in this condition (3). The donor twin could be in a uniquely stressful situation over a period of weeks or months, and this relative increase in AFP production could possibly be a reflection of this.…”

Discordant Amino Acid Profiles in Monochorionic Twins with Twin-Twin Transfusion Syndrome

“…Alternatively, increased alanine levels in the donor twin may be a result of decreased protein synthesis because of hepatic dysfunction. Total plasma protein concentration in the donor twin is known to be less than that of the recipient twin (43).…”