295: Angiogenic factors as biomarkers for fetal wellbeing during delivery

Abstract

Four million newborns die at delivery, and the main factor associated with neonatal death or long term neuro-developmental disabilities is hypoxia. Available predictors of hypoxia during labor such as CTG and fetal scalp blood are rather poor, with a low positive predictive value. Levels of angiogenic factors such as VEGF (Vascular Endothelial Growth Factor), PlGF (Placental Growth Factor), Ang-1 (Angiopetin-1) and Ang-2 (Angiopoetin-2) are known to be regulated by hypoxia and affected by an insufficiently working placenta. If they differ during delivery in relation to acute fetal asphyxia, is unknown. Aim of the study: To investigate if different angiogenic factors during the delivery and if these factors might be predictors of fetal wellbeing. 100 newborns, delivered at Soder Hospital in Stockholm, were included. They were classified as not healthy if one or more of the following criteria were present: 1) pH ≤7, 10, 2) Apgar < 7, at 5 minutes, 3) BE >-12 and 4) transfer to NICU. CB (Cord Blood) and AF (Amniotic Fluid) was collected and immediately frozen at -70°C. Gene expression and the level of the factors in CB and AF were analyzed by qPCR. A correlation between the gene expressions of both Ang-2 and PlGF in CB and non-healthy newborns was found (Folder change nonhealthy /healthy was 2, 03 for Ang-2 and 1, 44 for PlGF in CB). No significant correlation was seen between gene expression of Ang-1 and VEGF. When analyzing the protein level of angiogenic factors in CB and AF, the level of VEGF in AF showed a significant correlation with a non-healthy newborn. Our results show an upregulation of the gene expression of Ang-2 and PlGF in the not-healthy newborns. A correlation between the protein level of VEGF in AF and hypoxia at delivery was found. Future projects will evaluate if these angiogenic factors could be used as predictors of fetal hypoxia during labor.