First trimester material serum ischaemia-modified albumin: a marker of hypoxia-ischaemia-driven early trophoblast development

BACKGROUND A hypoxic intrauterine environment is believed to play a pivotal role in physiological trophoblast development. Ischaemia-modified albumin (IMA) is used in the measurement of cardiac ischaemia. We aimed to test the hypothesis that maternal serum IMA may be elevated in early pregnancy as a measurable manifestation of intrauterine ischaemia. METHODS Prospective observational study in healthy women with singleton pregnancies ( n = 66) and non-pregnant controls ( n = 26). Maternal serum IMA levels were measured at 11–13 weeks of gestation and in non-pregnant women. RESULTS The median IMA level in the pregnant group [115.14 kU/l; interquartile range (IQR) 102.33–124.71 kU/l] was significantly higher ( P 95 kU/l) in 86% of women. CONCLUSIONS In early pregnancy, IMA levels were above the concentration used for the diagnosis of myocardial ischaemia in most women, and should therefore not be used as a marker for cardiac ischaemia in pregnancy. Maternal serum IMA is elevated to supra-physiological levels in early normal pregnancy supporting the hypothesis that normal trophoblast development is associated with a hypoxic intrauterine environment, although other mechanisms leading to an IMA increase cannot be excluded