Adrenomedullin is a novel peptide that elicits a long-lasting vasorela
xant activity. Recently, we found high concentrations of adrenomedulli
n in maternal and umbilical cord plasma and in amniotic fluid in full-
term human pregnancy, indicating a role of this peptide during gestati
on. 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 no
npregnant women, 13 hypertensive nonpregnant subjects, 29 patients wit
h preeclampsia, and 30 normotensive pregnant women. In all patients, p
lasma 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 amnio
tic fluid samples using a specific radioimmunoassay, and its localizat
ion and distribution on placental sections was determined by immunohis
tochemistry. Adrenomedullin concentrations were higher in hypertensive
than in normotensive nonpregnant patients. Pregnant women had higher
adrenomedullin levels than nonpregnant subjects, although maternal pla
sma adrenomedullin concentrations did not differ between normal pregna
nt and preeclamptic women. Preeclamptic patients showed higher concent
rations (P<0.01) than normotensive pregnant women of adrenomedullin in
amniotic fluid (252+/-29 versus 112+/-10 fmol/mu mol 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, T
he 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 physiolog
ical level.