Maternal serum ischemia-modified albumin as an oxidative stress biomarker in preterm pre-labor rupture of membranes
Abstract
Objectives: To evaluate the maternal serum ischemia-modified albumin (IMA) concentration as an oxidative stress biomarker in pregnancies complicated by preterm pre-labor rupture of membranes (PPROM) without maternal clinical infection and compare these results with healthy pregnancies.
Material and methods: The present cohort study included 40 pregnancies complicated by PPROM and 49 similar gestational age healthy pregnancies in the third trimester of gestation. Maternal venous blood specimens were obtained at the day of first diagnosis. Maternal serum IMA level was assayed with an Albumin Cobalt Binding test. The subjects were followed up until delivery and perinatal outcomes were recorded.
Results: The maternal serum IMA concentrations were significantly higher in the study group (0.56 ± 0.05 absorbance units) as compared to controls (0.54 ± 0.03 absorbance units) (p = 0.020). The maternal serum IMA concentrations were not significantly correlated with the initial maternal white blood cell count (r: 0.118, p = 0.269) and C-reactive protein levels (r: 0.066, p = 0.541). The maternal serum IMA concentrations were negatively correlated with gestational age at delivery (r: –0.248, p = 0.019), birthweight (r: –0.247, p = 0.020) and Apgar scores (r: –0.200, p = 0.049; r: –0.245, p = 0.020). The threshold value of maternal serum IMA concentration above 0.55 absorbance units indicated the pregnancy complicated by PPROM by 57.5% sensitivity and 57.1% specificity (Area under curve 0.613, confidence interval 0.50–0.73).
Conclusions: The current study supported for the first time that there is an association between increased maternal serum IMA levels and the development of PPROM in the third trimester of gestation without maternal clinical infection. Elevated maternal serum IMA levels may alert the obstetrician about poor ongoing perinatal outcomes in the early phase of PPROM before increased maternal C-reactive protein and white blood cell count.
Keywords: pregnancyischemia-modified albuminpreterm pre-labor rupture of membranesperinatal outcome
References
- Mercer BM, Crouse DT, Goldenberg RL, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The antibiotic treatment of PPROM study: systemic maternal and fetal markers and perinatal outcomes. Am J Obstet Gynecol. 2012; 206(2): 145.e1–145.e9.
- Parry S, Strauss JF. Mechanisms of disease – premature rupture of the fetal membranes. New Engl J Med. 1998; 338(10): 663–670.
- Cobo T, Kacerovsky M, Palacio M, et al. A prediction model of histological chorioamnionitis and funisitis in preterm prelabor rupture of membranes: analyses of multiple proteins in the amniotic fluid . J Matern Fetal Neonatal Med. 2012; 25(10): 1995–2001.
- Tsiartas P, Kacerovsky M, Musilova I, et al. The association between histological chorioamnionitis, funisitis and neonatal outcome in women with preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med. 2013; 26(13): 1332–1336.
- Hjortshøj S, Kristensen SR, Ravkilde J. Diagnostic value of ischemia-modified albumin in patients with suspected acute coronary syndrome. Am J Emerg Med. 2010; 28(2): 170–176.
- Apple FS, Wu AHB, Mair J, et al. Committee on Standardization of Markers of Cardiac Damage of the IFCC. Future biomarkers for detection of ischemia and risk stratification in acute coronary syndrome. Clin Chem. 2005; 51(5): 810–824.
- Halliwell B. Antioxidants in human health and disease. Annu Rev Nutr. 1996; 16: 33–50.
- Simon HU, Haj-Yehia A, Levi-Schaffer F. Role of reactive oxygen species (ROS) in apoptosis induction. Apoptosis. 2000; 5(5): 415–418.
- Anwaruddin S, Januzzi JL, Baggish AL, et al. Ischemia modified albumin improves the usefulness of standard cardiac biomarkers for the diagnosis of myocardial ischemia in the emergency department setting. Am J Clin Pathol. 2005; 123(1): 140–145.
- Guven S, Alver A, Mentese A, et al. The novel ischemia marker 'ischemia-modified albumin' is increased in normal pregnancies. Acta Obstet Gynecol Scand. 2009; 88(4): 479–482.
- Prefumo F, Gaze DC, Papageorghiou AT, et al. First trimester maternal serum ischaemia-modified albumin: a marker of hypoxia-ischaemia-driven early trophoblast development. Hum Reprod. 2007; 22(7): 2029–2032.
- Menon R, Boldogh I, Urrabaz-Garza R, et al. Senescence of primary amniotic cells via oxidative DNA damage. PLoS One. 2013; 8(12): e83416.
- Menon R, Polettini J, Syed TA, et al. Expression of 8-oxoguanine glycosylase in human fetal membranes. Am J Reprod Immunol. 2014; 72(1): 75–84.
- Menon R, Yu J, Basanta-Henry P, et al. Short fetal leukocyte telomere length and preterm prelabor rupture of the membranes. PLoS One. 2012; 7(2): e31136.
- Ustün Y, Engin-Ustün Y, Oztürk O, et al. Ischemia-modified albumin as an oxidative stress marker in preeclampsia. J Matern Fetal Neonatal Med. 2011; 24(3): 418–421.
- Iacovidou N, Briana DD, Boutsikou M, et al. Cord blood ischemia-modified albumin levels in normal and intrauterine growth restricted pregnancies. Mediators Inflamm. 2008; 2008: 523081.
- Cengiz H, Dagdeviren H, Kanawati A, et al. Ischemia-modified albumin as an oxidative stress biomarker in early pregnancy loss. J Matern Fetal Neonatal Med. 2016; 29(11): 1754–1757.
- Ma Sg, Yu Wn, Jin Y, et al. Evaluation of serum ischemia-modified albumin levels in pregnant women with and without gestational diabetes mellitus. Gynecol Endocrinol. 2012; 28(11): 837–840.
- Goldenberg R, Culhane J, Iams J, et al. Epidemiology and causes of preterm birth. Lancet. 2008; 371(9606): 75–84.
- Longini M, Perrone S, Vezzosi P, et al. Association between oxidative stress in pregnancy and preterm premature rupture of membranes. Clin Biochem. 2007; 40(11): 793–797.
- Woods JR. Reactive oxygen species and preterm premature rupture of membranes-a review. Placenta. 2001; 22 Suppl A: S38–S44.
- Kacerovsky M, Tothova L, Menon R, et al. Amniotic fluid markers of oxidative stress in pregnancies complicated by preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med. 2015; 28(11): 1250–1259.
- Gaze DC. Ischemia modified albumin: a novel biomarker for the detection of cardiac ischemia. Drug Metab Pharmacokinet. 2009; 24(4): 333–341.
- Dursun A, Okumus N, Zenciroglu A. Ischemia-modified albumin (IMA): could it be useful to predict perinatal asphyxia? J Matern Fetal Neonatal Med. 2012; 25(11): 2401–2405.
- Özdemir S, Kıyıcı A, Balci O, et al. Assessment of ischemia-modified albumin level in patients with recurrent pregnancy loss during the first trimester. Eur J Obstet Gynecol Reprod Biol. 2011; 155(2): 209–212.
