Free Foetal Haemoglobin in Severe Early-Onset Foetal Growth Restriction : A Prospective Multi-Centre Study
(2025) In BJOG: An International Journal of Obstetrics and Gynaecology- Abstract
Objective: To assess foetal circulating free foetal haemoglobin (fHbF) levels and heme defences, correlated to foetal circulatory biometry and foetal sex in severe early-onset foetal growth restriction (FGR). Design, Setting and Population: A prospective study severe early-onset foetal growth restriction pregnancies with close clinical management (estimated foetal weight (EFW) < 3rd centile and < 600 g at 20–26 + 6 weeks; N = 20). Method & Main Outcome Measures: Temporal foetal vascular obstetric biometry was recorded. Cord blood fHbF and key heme-scavenger defences were measured and compared with normal term births (N = 26) and births with late-onset FGR (N = 12). Results: fHbF was elevated in early-onset FGR compared with... (More)
Objective: To assess foetal circulating free foetal haemoglobin (fHbF) levels and heme defences, correlated to foetal circulatory biometry and foetal sex in severe early-onset foetal growth restriction (FGR). Design, Setting and Population: A prospective study severe early-onset foetal growth restriction pregnancies with close clinical management (estimated foetal weight (EFW) < 3rd centile and < 600 g at 20–26 + 6 weeks; N = 20). Method & Main Outcome Measures: Temporal foetal vascular obstetric biometry was recorded. Cord blood fHbF and key heme-scavenger defences were measured and compared with normal term births (N = 26) and births with late-onset FGR (N = 12). Results: fHbF was elevated in early-onset FGR compared with normal pregnancy: 0.437(0.337/0.753) mg/mL; and 0.098 (0.045/0.264) mg/mL, respectively (p < 0.0001); whilst hemopexin was downregulated in early- (p < 0.001) and late-onset FGR (p < 0.0001), compared to normal pregnancy: 36(14/81) μg/mL, 25(19/40) μg/mL, and 155(132/219) μg/mL, respectively; median (interquartile ranges). Early-onset FGR male foetuses had higher HbF compared with the normal males: 0.710(0.433/0.857) mg/mL; (p < 0.001); 0.099(0.043/0.246) mg/mL, respectively; median (interquartile ranges). In early-onset FGR, ratios of mid-cerebral artery and umbilical artery pulsatility indices correlated positively with heme-scavenger levels (hemopexin and a heme-handling composite measure: p < 0.05, r = 0.672; and p < 0.01, r = 0.620; respectively), indicating lower levels are associated with cerebral vascular redistribution. These heme handling measures also positively correlated with gestational age at delivery (r = 0.713 and r = 0.642, respectively, p < 0.01, both) and birthweight (r = 0.742, p < 0.001; and r = 0.523, p < 0.05; respectively). Conclusion: Overproduction of fHbF and an inadequate heme defence may contribute to foetal distress and poor umbilical arterial Dopplers in early onset FGR due to elevated placental vascular resistance and vascular inflammation.
(Less)
- author
- Brook, Adam
; Baynes, Georgia
; Scargill, Jonathan
; Evangelinos, Angelos
; Brennan-Richardson, Charlotte
; Dow, Freya
; Ginsberg, Yuval
; Weissbach, Tal
; Brodszki, Jana
LU
; Hansson, Eva
; Diemert, Anke
; Hecher, Kurt
; Maksym, Katarzyna
; Marlow, Neil
; Spencer, Rebecca N.
; David, Anna L.
; Hansson, Stefan R.
LU
and Brownbill, Paul
(Less) - organization
- publishing date
- 2025
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- alpha 1 microglobulin, fetal growth restriction, haemoglobin, hemopexin
- in
- BJOG: An International Journal of Obstetrics and Gynaecology
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:39971745
- scopus:85219670163
- ISSN
- 1470-0328
- DOI
- 10.1111/1471-0528.18104
- language
- English
- LU publication?
- yes
- id
- 9f7d8f87-9330-4dad-aadb-3ccb0f0e3725
- date added to LUP
- 2025-06-27 11:44:10
- date last changed
- 2025-07-11 12:16:26
@article{9f7d8f87-9330-4dad-aadb-3ccb0f0e3725,
abstract = {{<p>Objective: To assess foetal circulating free foetal haemoglobin (fHbF) levels and heme defences, correlated to foetal circulatory biometry and foetal sex in severe early-onset foetal growth restriction (FGR). Design, Setting and Population: A prospective study severe early-onset foetal growth restriction pregnancies with close clinical management (estimated foetal weight (EFW) < 3rd centile and < 600 g at 20–26 + 6 weeks; N = 20). Method & Main Outcome Measures: Temporal foetal vascular obstetric biometry was recorded. Cord blood fHbF and key heme-scavenger defences were measured and compared with normal term births (N = 26) and births with late-onset FGR (N = 12). Results: fHbF was elevated in early-onset FGR compared with normal pregnancy: 0.437(0.337/0.753) mg/mL; and 0.098 (0.045/0.264) mg/mL, respectively (p < 0.0001); whilst hemopexin was downregulated in early- (p < 0.001) and late-onset FGR (p < 0.0001), compared to normal pregnancy: 36(14/81) μg/mL, 25(19/40) μg/mL, and 155(132/219) μg/mL, respectively; median (interquartile ranges). Early-onset FGR male foetuses had higher HbF compared with the normal males: 0.710(0.433/0.857) mg/mL; (p < 0.001); 0.099(0.043/0.246) mg/mL, respectively; median (interquartile ranges). In early-onset FGR, ratios of mid-cerebral artery and umbilical artery pulsatility indices correlated positively with heme-scavenger levels (hemopexin and a heme-handling composite measure: p < 0.05, r = 0.672; and p < 0.01, r = 0.620; respectively), indicating lower levels are associated with cerebral vascular redistribution. These heme handling measures also positively correlated with gestational age at delivery (r = 0.713 and r = 0.642, respectively, p < 0.01, both) and birthweight (r = 0.742, p < 0.001; and r = 0.523, p < 0.05; respectively). Conclusion: Overproduction of fHbF and an inadequate heme defence may contribute to foetal distress and poor umbilical arterial Dopplers in early onset FGR due to elevated placental vascular resistance and vascular inflammation.</p>}},
author = {{Brook, Adam and Baynes, Georgia and Scargill, Jonathan and Evangelinos, Angelos and Brennan-Richardson, Charlotte and Dow, Freya and Ginsberg, Yuval and Weissbach, Tal and Brodszki, Jana and Hansson, Eva and Diemert, Anke and Hecher, Kurt and Maksym, Katarzyna and Marlow, Neil and Spencer, Rebecca N. and David, Anna L. and Hansson, Stefan R. and Brownbill, Paul}},
issn = {{1470-0328}},
keywords = {{alpha 1 microglobulin; fetal growth restriction; haemoglobin; hemopexin}},
language = {{eng}},
publisher = {{Wiley-Blackwell}},
series = {{BJOG: An International Journal of Obstetrics and Gynaecology}},
title = {{Free Foetal Haemoglobin in Severe Early-Onset Foetal Growth Restriction : A Prospective Multi-Centre Study}},
url = {{http://dx.doi.org/10.1111/1471-0528.18104}},
doi = {{10.1111/1471-0528.18104}},
year = {{2025}},
}