359: Fetal growth restriction and markers of metabolic dysfunction and inflammation

Assess the relationship between fetal growth restriction (FGR) with abnormal umbilical artery (UA) Doppler indices and cord blood concentrations of renin, leptin and c-reactive protein (CRP). This prospective study enrolled control subjects with normal fetal growth indices and cases with FGR (< 10%) and abnormal UA Doppler indices. At delivery umbilical artery and venous cord blood was collected, placed in EDTA, centrifuged and plasma stored at -80˚C. Cord blood concentrations of renin, leptin and CRP were determined with ELISA. Recruitment (n=16): 3 singletons with FGR + abnormal UA Dopplers, 5 singletons with normal growth and normal UA Dopplers, 4 multiple pregnancies (three sets of twins, one set of triplets) each with an FGR fetus with abnormal UA Dopplers and one or more normally-grown fetuses. Renin concentrations were greater in FGR singletons compared to controls (164.9 ± 23.9 pg/mL vs 39.1 ± 11.4 pg/mL, P<0.01) but not different in multiple pregnancies (53.6 ± 5.5 pg/mL vs 98.9 ± 41.9 pg/mL). Leptin concentrations were lower in singleton FGR compared to controls (9.4 ± 1.6 ng/mL vs 1.1 ± 0.3 ng/mL, P<0.05). Leptin concentrations were similar between FGR and control in multiple pregnancies (2.6 ± 2.5 ng/mL vs 0.9 ± 0.5 ng/mL) but lower (P<0.01) than singleton controls. There were no differences in CRP between groups. However, 2 of the 3 fetuses with reversed end-diastolic flow had the greatest CRP concentrations in the cohort. Singleton fetuses with FGR and abnormal UA Dopplers had greater concentrations of renin and lower concentrations of leptin when compared to controls. This is consistent with in-utero metabolic dysfunction. In multiple pregnancies, FGR fetuses with abnormal UA Dopplers and control fetuses exhibited different concentrations of leptin and renin compared to control fetuses from singleton pregnancies. This suggests that both the FGR fetus and the normal fetus in a multiple pregnancy have abnormal metabolic signaling.