From the 2nd Institute of Obstetrics and Gynecology (R. Di I., E.M.,
B.V., E.V.C.), the Department of Internal Medicine (C.L.), and the Department
of Pathology and Experimental Medicine (P.A.), University "La
Sapienza," Rome, Italy.
Correspondence to Romolo Di Iorio, MD, PhD, Laboratory of Perinatal Medicine and Molecular Biology, 2nd Institute of Obstetrics and Gynecology, University "La Sapienza," Viale Regina Elena, 324, I-00161 Rome, Italy. E-mail perinat{at}flashnet.it
Abstract—Adrenomedullin is a
novel peptide that elicits a long-lasting vasorelaxant activity.
Recently, we found high concentrations of adrenomedullin in maternal
and umbilical cord plasma and in amniotic fluid in full-term
human pregnancy, indicating a role of this peptide during gestation. To
investigate the possibility that adrenomedullin is involved in the
pathophysiology of preeclampsia, we measured its concentration in
maternal and fetoplacental compartments. We studied 12 normotensive
nonpregnant women, 13 hypertensive nonpregnant subjects, 29 patients
with preeclampsia, and 30 normotensive pregnant women. In all patients,
plasma was collected from the cubital vein, and amniotic fluid samples
were obtained by transabdominal amniocentesis or at elective cesarean
section. Plasma samples from umbilical vein and placental tissues were
collected at delivery. Adrenomedullin was assayed on plasma and
amniotic fluid samples using a specific radioimmunoassay, and its
localization and distribution on placental sections was determined by
immunohistochemistry. Adrenomedullin concentrations were higher in
hypertensive than in normotensive nonpregnant patients. Pregnant women
had higher adrenomedullin levels than nonpregnant subjects, although
maternal plasma adrenomedullin concentrations did not differ between
normal pregnant and preeclamptic women. Preeclamptic patients showed
higher concentrations (P<0.01) than normotensive
pregnant women of adrenomedullin in amniotic fluid (252±29 versus
112±10 fmol/µmol creatinine) and umbilical vein plasma
(18.1±2.1 versus 8.5±1.1 fmol/mL). Increased local production
of adrenomedullin is associated with preeclampsia. The fetus seems to
be responsible for the higher levels of this hormone. Increased
adrenomedullin concentrations may be necessary to maintain placental
vascular resistance and/or fetal circulation at a physiological
level.
© 1998 American Heart Association, Inc.
Scientific Contributions
Adrenomedullin, a New Vasoactive Peptide, Is Increased in Preeclampsia
Key Words: adrenomedullin • preeclampsia • placenta • amniotic fluid • plasma
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