Fetal NT-proBNP levels and their course in severe anemia during intrauterine treatment

• Published in: Archives of gynecology and obstetrics Vol. 309; no. 4; pp. 1341 - 1351
• Main Authors: Siebers, Pauline, Gembruch, Ulrich, Merz, Waltraut Maria, Recker, Florian, Müller, Andreas, Strizek, Brigitte, Geipel, Annegret, Berg, Christoph, Weber, Eva Christin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2024; Springer Nature B.V
• Subjects: Adult; Anemia; Anemia - therapy; Blood Transfusion, Intrauterine - methods; Endocrinology; Female; Fetal Diseases - therapy; Fetus; Fetuses; Gestational age; Gynecology; Human Genetics; Humans; Maternal-Fetal Medicine; Medicine; Medicine & Public Health; Natriuretic Peptide, Brain; Obstetrics/Perinatology/Midwifery; Peptide Fragments; Pregnancy; Fetal anemia; Cardiac failure; Intrauterine transfusion; NT-proBNP; Hydrops fetalis; Fetal heart
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-023-07006-8

Purpose In adults and fetuses, N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a marker of cardiac failure and myocardial remodelling. We examined the effect of anemia and intrauterine transfusion (IUT) on NT-proBNP concentrations in fetuses with anemia and established gestational age-dependent reference values of a control group. Methods We analyzed NT-proBNP levels in anemic fetuses that underwent serial intrauterine transfusions (IUT), focusing on different causes and severity of anemia and comparing the results to a non-anemic control group. Results In the control group, the average NT-proBNP concentration was 1339 ± 639 pg/ml, decreasing significantly with increasing gestational age ( R  = − 74.04, T  = − 3.65, p  = 0.001). Subjects had significantly higher NT-proBNP concentrations before initiation of IUT therapy ( p  < 0.001), showing fetuses with parvovirus B19 (PVB19) infection having the highest concentrations. Hydropic fetuses also showed an increased NT-proBNP concentration compared to non-hydropic fetuses ( p  < 0.001). During the course of therapy, NT-proBNP concentration before subsequent IUT decreased significantly from pathologically high levels, while MoM-Hb and MoM-MCA-PSV remained pathological. Conclusion NT-pro BNP levels in non-anemic fetuses are higher than in postnatal life, decreasing with ongoing pregnancy. Anemia is a hyperdynamic state and its severity correlates with circulating NT-proBNP levels. Highest concentrations occur in fetuses with hydrops and with PVB19 infection, respectively. Treatment by IUT leads to a normalisation of NT-proBNP concentrations, so the measurement of its levels may be useful in therapy monitoring.