Key result
Severe fetal anemia was associated with significantly higher NT-proBNP concentrations compared to non-anemic controls (37,452 vs 1,339 pg/ml, p<0.001), which subsequently decreased during intrauterine transfusion therapy.
Why the study?
NT-proBNP is a marker of cardiac failure and myocardial remodelling, but the effect of anemia and intrauterine transfusion on its levels in fetuses and gestational age-dependent reference values required investigation.
Does intrauterine transfusion reduce NT-proBNP concentrations in fetuses with severe anemia?
Observational (n=193)
No
Does intrauterine transfusion reduce NT-proBNP concentrations in fetuses with severe anemia?
NT-proBNP is elevated in anemic fetuses, particularly those with hydrops or parvovirus B19 infection, and normalizes following intrauterine transfusion, suggesting its utility in therapy monitoring.
Answers are grounded in this paper and cite their sources.
NT-proBNP may aid monitoring of intrauterine transfusion response in fetal anemia; hypothesis-generating and needs prospective validation before practice change.
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.
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Siebers et al. (2023) conducted an observational in Fetal anemia (n=193). Severe fetal anemia vs. Non-anemic fetuses was evaluated on Fetal NT-proBNP concentration (p=<0.001). Severe fetal anemia was associated with significantly higher NT-proBNP concentrations compared to non-anemic controls (37,452 vs 1,339 pg/ml, p<0.001), which subsequently decreased during intrauterine transfusion therapy.
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