Is an atherogenic lipoprotein profile in the fetus a prerequisite for placental vascular disease?

Objective To measure the blood apolipoprotein A-1 and apolipoprotein B in t he fetal circulation in normal pregnancy and in pregnancy with evidence of vascular disease in the fetal umbilical placental circulation defined in th e antenatal period by Doppler ultrasound study. Design An observational study to compare fetal plasma apolipoprotein levels in normal and complicated pregnancy. Setting A university hospital tertiary referral obstetric unit. Samples Umbilical vein blood was collected at delivery from 22 normal fetus es delivered by elective caesarean section for non fetal reasons and 30 fet uses with evidence of umbilical placental vascular disease identified anten atally by Doppler ultrasound study. Methods Plasma apolipoprotein A-1 and B were determined using an enzyme-lin ked immunosorbent assay (ELISA) methods. Main outcome measures Fetal plasma levels of apolipoprotein A-1 and B were measured. Results There was a significantly lower level of fetal plasma apolipoprotei n A-1 in placental insufficiency [placental insufficiency vs normal pregnan cy, median 0.30 g/L (interquartile range 0.24, 0.39 g/L) vs 0.35 g/L (0.31, 0.42 g/L), P = 0.045]. In contrast, the levels of fetal plasma apolipoprot ein B in placental insufficiency [0.20 g/L (0.17, 0.26 g/L)] were significa ntly increased compared with normal pregnancy [0.16 g/L (0.14, 0.20 g/L), P = 0.03]. The ratio of fetal plasma apolipoprotcin B to A-1 was also substa ntially higher in placental insufficiency [0.68 (0.55, 0.83)] than in norma l pregnancy [0.45 (0.36, 0.60), P = 0.0003]. Conclusions Our study has demonstrated that levels of fetal plasma apolipop rotein A-1, apolipoprotein B and the ratio of apolipoprotein B to A-1 were altered in the fetuses who are victims of umbilical pla cental insufficienc y in the same direction as in adults associated with a high risk of atherog enesis.