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The relationship of maternal erythrocyte oxygen transport parameters to intrauterine growth retardation
E G Brown1, G J Mendoza, F A Chervenak
1Department of Pediatrics, Mt. Sinai Medical Center, New York, New York.
Insights
Maternal red blood cell oxygen transport, specifically 2,3-diphosphoglycerate/hemoglobin ratio and oxygen affinity, is linked to fetal growth. The 2,3-diphosphoglycerate/hemoglobin ratio is the main factor regulating this affinity.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Physiology
Background:
- Fetal growth is influenced by maternal physiological factors.
- Maternal oxygen transport is crucial for fetal development.
- Red blood cell 2,3-diphosphoglycerate (2,3-DPG) and hemoglobin oxygen affinity are key parameters of oxygen transport.
Purpose of the Study:
- To evaluate the relationship between fetal growth and maternal oxygen transport parameters.
- To assess the role of 2,3-diphosphoglycerate/hemoglobin molar ratio and hemoglobin oxygen affinity in fetal growth retardation.
- To determine the primary regulator of hemoglobin oxygen affinity in pregnant women.
Main Methods:
- Studied 21 pregnant women in their third trimester with sonographic evidence of fetal growth retardation.
- Assessed maternal red blood cell 2,3-diphosphoglycerate, hemoglobin oxygen affinity, hemoglobin, pH, and PCO2.
- Correlated maternal parameters with birth weight (gestational age)-normalized Z scores and ponderal index-normalized Z scores.
Main Results:
- Decreased maternal 2,3-diphosphoglycerate/hemoglobin molar ratio and hemoglobin oxygen affinity correlated significantly with reduced birth weight Z scores (r=0.71, p<0.001; r=0.67, p<0.001).
- The 2,3-diphosphoglycerate/hemoglobin molar ratio was the principal regulator of hemoglobin oxygen affinity (p<0.001).
- pH had minimal significance (p<0.025), while PCO2 showed little effect on oxygen affinity regulation.
Conclusions:
- Maternal red blood cell oxygen transport parameters, specifically the 2,3-diphosphoglycerate/hemoglobin molar ratio and hemoglobin oxygen affinity, are related to fetal growth.
- The 2,3-diphosphoglycerate/hemoglobin molar ratio is the primary regulator of maternal hemoglobin oxygen affinity.
- These findings highlight the importance of maternal oxygen transport in ensuring adequate fetal growth.
Abstract:
The relation of fetal growth and maternal oxygen transport as assessed by red blood cell 2,3-diphosphoglycerate, hemoglobin oxygen affinity, hemoglobin, pH, and PCO2 was evaluated in 21 pregnant women. The study was performed in the third trimester and each subject evaluated had sonographic evidence of fetal growth retardation without other obvious abnormalities. Decreased maternal 2,3-diphosphoglycerate/hemoglobin molar ratio and hemoglobin oxygen affinity were related linearly to the birth weight normalized for the expected sea level values of gestational age expressed as a birth weight (gestational age-normalized) Z score. The correlation coefficients and p values were r = 0.71, p less than 0.001 and r = 0.67, p less than 0.001, respectively. The ponderal index-normalized Z score correlated with the 2,3-diphosphoglycerate/hemoglobin molar ratio (r = 0.46, p less than 0.04), but the relation was not as strong as the birth weight-normalized Z score. The crown-heel length/head circumference ratio did not correlate with the 2,3-diphosphoglycerate/hemoglobin molar ratio (r = 0.29, NS). The birth weight (gestational age)-normalized Z score did not correlate with hemoglobin, PCO2, or pH. In the regulation of hemoglobin oxygen affinity, calculations indicated that the 2,3-diphosphoglycerate/hemoglobin molar ratio played a highly significant role (p less than 0.001), pH was minimally significant (p less than 0.025), but PCO2 had little or no significant effects in this study. It appears that fetal growth is related to the maternal red blood cell oxygen transport parameters 2,3-diphosphoglycerate/hemoglobin molar ratio and hemoglobin oxygen affinity. Moreover, the 2,3-diphosphoglycerate/hemoglobin molar ratio is the principal regulator of hemoglobin oxygen affinity.