Placenta · 2026
Maternal cardiovascular, endothelial and inflammatory biomarker dysregulation in twin-twin transfusion syndrome: insights into shared mechanisms with pre-eclampsia.
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Reilly Kelly, Ruddock Mark, Kurth Mary Jo, Watt Joanne, Mackie Fiona, Morris R Katie, Kilby Mark D, Fitzgerald Peter, Watson Chris, Mone Fionnuala
Аннотация
BACKGROUND: While pre-eclampsia incidence is increased in twin pregnancy, this risk reduces following fetoscopic laser ablation (FLA) for twin-twin transfusion syndrome (TTTS). We evaluated maternal cardiovascular, inflammatory and angiogenic biomarkers in TTTS compared with gestation and maternal characteristic matched uncomplicated monochorionic diamniotic (MCDA) twin pregnancies and examined biomarker changes following laser ablation.
METHODS: Maternal serum biomarkers assessed before and after FLA included heart-type fatty acid-binding protein (H-FABP), midkine, soluble tumour necrosis factor receptors (sTNFR1/2), leucine-rich alpha-2 glycoprotein-1 (LRG-1), placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A) and soluble fms-like tyrosine kinase-1 (sFlt-1).
RESULTS: Compared with matched uncomplicated MCDA pregnancies (n = 16), TTTS pregnancies prior to FLA (n = 35) demonstrated significantly higher concentrations of H-FABP (3.4 vs 2.0 ng/mL), midkine (3278.5 vs 2504.4 pg/mL), sTNFR2 (.4 vs .2 ng/mL), LRG1 (101.4 vs 74.9 μg/mL), PAPP-A (83,220 vs 33,240 mIU/L) and sFlt-1 (4301 vs 3366 pg/mL), together with an elevated sFlt-1/PlGF ratio (27.3 vs 9.2), all p < 0.05). In paired pre/post FLA TTTS pregnancies (n = 35) H-FABP increased from 3.4 to 4.7 ng/mL, midkine from 3278.5 to 4055.4 pg/mL and sFlt-1 from 4301 to 5219.5 pg/mL, while LRG1 decreased from 101.4 to 88.9 μg/mL (all p < 0.05).
CONCLUSION: Twin-twin transfusion syndrome is associated with biomarkers of maternal cardiovascular stress, inflammatory activation and angiogenic dysregulation. These biomarker profiles are altered following fetoscopic laser ablation and involve those linked to the prediction of pre-eclampsia.
METHODS: Maternal serum biomarkers assessed before and after FLA included heart-type fatty acid-binding protein (H-FABP), midkine, soluble tumour necrosis factor receptors (sTNFR1/2), leucine-rich alpha-2 glycoprotein-1 (LRG-1), placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A) and soluble fms-like tyrosine kinase-1 (sFlt-1).
RESULTS: Compared with matched uncomplicated MCDA pregnancies (n = 16), TTTS pregnancies prior to FLA (n = 35) demonstrated significantly higher concentrations of H-FABP (3.4 vs 2.0 ng/mL), midkine (3278.5 vs 2504.4 pg/mL), sTNFR2 (.4 vs .2 ng/mL), LRG1 (101.4 vs 74.9 μg/mL), PAPP-A (83,220 vs 33,240 mIU/L) and sFlt-1 (4301 vs 3366 pg/mL), together with an elevated sFlt-1/PlGF ratio (27.3 vs 9.2), all p < 0.05). In paired pre/post FLA TTTS pregnancies (n = 35) H-FABP increased from 3.4 to 4.7 ng/mL, midkine from 3278.5 to 4055.4 pg/mL and sFlt-1 from 4301 to 5219.5 pg/mL, while LRG1 decreased from 101.4 to 88.9 μg/mL (all p < 0.05).
CONCLUSION: Twin-twin transfusion syndrome is associated with biomarkers of maternal cardiovascular stress, inflammatory activation and angiogenic dysregulation. These biomarker profiles are altered following fetoscopic laser ablation and involve those linked to the prediction of pre-eclampsia.