An investigation of the umbilical artery N-terminal proBrain natriuretic peptide levels of fetuses due to fetal distress in term pregnancies

Erturk, Derya; Birsen, Meryem Busra; Onder, Durmus; Kaba, Metin; Ellidag, Hamit Yasar; Inal, Zeynep Ozturk

doi:10.1590/1806-9282.20240446

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 70 (8) • 2024 • https://doi.org/10.1590/1806-9282.20240446 copy

An investigation of the umbilical artery N-terminal proBrain natriuretic peptide levels of fetuses due to fetal distress in term pregnancies

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

This study aimed to investigate umbilical artery N-terminal proBrain natriuretic peptide (NT-proBNP) in fetuses delivered by cesarean section due to fetal distress in term pregnancies.

METHODS:

This prospective case-control study was conducted at the Antalya Training and Research Hospital Obstetric Department, Turkiye. A total of 140 pregnant women, 70 underwent elective cesarean sections between weeks 37 and 40 of gestation (Group 1, the control group) and 70 underwent cesarean sections due to fetal distress (Group 2, the study group), were included. The participants’ sociodemographic and obstetric data and fetal umbilical blood NT-proBNP levels were recorded in a database.

RESULTS:

Age, body mass index, gestational age, prenatal diagnostic tests, fetal anatomical scanning, and baby gender ratios were comparable between the groups (p>0.05), while statistically significant differences were observed in terms of gravidity (3.0 vs. 1.0, p≤0.001) and parity numbers (2 vs. 0, p≤0.001), baby height (50.36±0.88 vs. 49.80±0.86, p≤0.001) and weight (3422.43±409.16 vs. 3239.86±293.74, p=0.003), 1-min Apgar (9.0±0.1 vs. 8.5±1.3, p≤0.001) and 5-min Apgar (10.0±0.1 vs. 9.8±0.4, p=0.026) scores, umbilical artery pH (7.32±0.05 vs. 7.25±0.07, p≤0.001), umbilical artery base deficit (-2.48±1.23 vs. −4.36±1.09. p≤0.001), and NT-proBNP levels [8.77 (7.72–9.39) vs. 12.35 (9.69–12.92), p<0.001].

CONCLUSION:

This study showed that NT-proBNP can be used as an important marker in the diagnosis of fetal distress. Prospective studies with more participants are now needed to confirm the accuracy of our results.

KEYWORDS:
Fetal distress; Hypoxia; NT-proBNP; Pregnancy

			Control group (n=70)	Study group (n=70)	p
Age (years)			29.47±6.36	27.47±6.21	0.335
BMI (kg/m²)			30.73±4.09	31.02±3.12	0.645
Gravidity			3.0 (2.0–4.0)	1.0 (1.0–2.0)	<0.001^* * Statistically significant.
Parity			2.0 (1.0–2.0)	0 (0–1.0)	<0.001^* * Statistically significant.
Number of cesarean deliveries			1.0 (0–1.0)	–
Gestational age (weeks)			39.1±1.1	39.2±1.3	0.512
Indication (n, %)	CPD		6 (8.6%)	0 (0%)	<0.001^* * Statistically significant.
	Before cesarean delivery		21 (30.0%)	0 (0%)
	PROM		0 (0%)	29 (41.4%)
	Macrosomia		6 (8.6%)	0 (0%)
	Recurrent cesarean delivery		34 (48.6%)	0 (0%)
	Term pregnancy		0 (0%)	27 (38.6%)
	Presentation abnormality		3 (4.3%)	0 (0%)
	Surmaturity		0 (0%)	14 (20.0%)
Double screening test (n, %)	Normal		36 (51.4%)	27 (38.6%)	0.126
Triple screening test (n, %)	Normal		29 (41.4%)	25 (35.7%)	0.487
Fetal anatomical screening (n, %)	Normal		41 (58.6%)	34 (48.6%)	0.236
OGTT (n, %)	Normal		31 (44.3%)	25 (35.71%)	0.301
Fetal height (cm)			50.36±0.88	49.80±0.86	<0.001^* * Statistically significant.
Birth weight (g)			3422.43±409.16	3239.86±293.74	0.003^* * Statistically significant.
Sex (n, %)		Female	37 (52.9%)	36 (51.4%)	0.866
Sex (n, %)		Male	33 (47.1%)	34 (48.6%)	0.866
Apgar score		1-min	9.0±0.1	8.5±1.3	<0.001^* * Statistically significant.
Apgar score		5-min	10.0±0.1	9.8±0.4	0.026^* * Statistically significant.
NICU admission (n, %)			0 (0%)	4 (5.7%)	0.120
NICU duration (days)			–	0 (0–0)	–

		Control (n=70)	Study (n=70)	p
MATERNAL	Hb (10³/mm³)	11.3±1.2	11.5±1.5	0.321
	Htc (10³/mm³)	34.17±3.33	35.67±4.20	0.021^* * Statistically significant.
	WBC (10³/mm³)	9.84±2.13	11.31±2.77	0.002^* * Statistically significant.
	PLT (10³/mm³)	228.64±59.60	251.23±75.31	0.051
	Glucose (mg/dL)	80.57±13.64	79.91±11.26	0.75
	Creatinine (mg/dL)	0.65±0.09	0.64±0.09	0.58
	ALT (U/L)	14.0 (10.0–17.0)	12.0 (9.0–16.0)	0.206
	AST (U/L)	15.0 (12.0–18.25)	16.5 (13.0–21.0)	0.142
	CRP (mg/L)	5.9 (3.5–9.3)	9.2 (3.3–6.4)	0.001^* * Statistically significant.
	Leucocyte in urine	0 (0–2.75)	0 (0–4.0)	0.118
	Leucocyte esterase in urine	0 (0–0)	0 (0–0)	0.118
	Bacteria in urine	0 (0–0)	0 (0–0)	0.629
	Protein in urine	0 (0–0)	0 (0–0)	0.247
FETAL	Umbilical artery pH	7.32±0.05	7.25±0.07	<0.001^* * Statistically significant.
	Umbilical artery base deficiency	-2.48±1.23	-4.36±1.09	<0.001^* * Statistically significant.
	Umbilical artery SatO₂	58.09±11.34	58.10	0.995
	Umbilical artery pCO₂	41.87±6.81	42.95±8.93	0.423
	Umbilical artery pO₂	27.83±6.56	25.42±6.29	0.029^* * Statistically significant.
	Umbilical artery NT-proBNP (μg/mL)	8.77 (7.72–9.39)	12.35 (9.69–12.92)	<0.001^* * Statistically significant.

	AUC	Cut-off value	95%CI	Sensitivity	Specificity	PPD	NPD	p
Umbilical artery NT-proBNP	0.894	8.54	0.800–0.927	86%	57%	67%	83%	<0.001 ^* * Statistically significant.

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[1] *Corresponding author: zeynephafiza@gmail.com