Review

Does the Physiological Acromegaly of Pregnancy Benefit the Fetus?
Johan Verhaeghe

Department of Obstetrics and Gynecology, U.Z. Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium

Address of Corresponding Author

Gynecol Obstet Invest 2008;66:217-226 (DOI: 10.1159/000147167)

  Key Words

• Growth hormone
• Insulin-like growth factor
• Placenta

  Abstract

Pregnancy is accompanied by notable changes in the secretion of growth hormone (GH) and the insulin-like growth factors (IGFs). A GH variant produced by the placenta is discernible in maternal plasma from early pregnancy, rising exponentially until 37 weeks. Meanwhile, pituitary GH gradually drops to near-undetectable levels. While there might be a modest reduction in circulating IGF-I in early pregnancy, IGF-I increases 2- to 3-fold in the second half, again with a peak at around 37 weeks. Thus, placental GH is believed to replace pituitary GH as the primary stimulus for IGF-I secretion in pregnancy. Several IGF-binding proteins (IGFBPs) including IGFBP-3 are proteolyzed, leading to an elevated free (bioavailable) IGF-I fraction. IGF-II concentrations also appear to show a modest (20-25%) increase in the course of pregnancy. The possible clinical manifestations include edema of face and forearms and carpal tunnel symptoms, reminiscent of the symptoms of acromegaly and the side effects of GH/IGF-I treatment. Neither placental GH nor the maternal IGFs cross the placental barrier, yet evidence from preclinical models is accumulating that they promote trophoblast invasion, placenta growth and maturation, transplacental nutrient transport and, ultimately, fetal growth. The ensemble data strongly suggest that 'gestational acromegaly' develops in order to foster fetoplacental growth.

Copyright © 2008 S. Karger AG, Basel

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  Author Contacts

Dr. Johan Verhaeghe
Department of Obstetrics and Gynecology, U.Z. Gasthuisberg
Herestraat 49
BE-3000 Leuven (Belgium)
Tel. +32 16 3 44 212, Fax +32 16 3 44 205, E-Mail johan.verhaeghe@uz.kuleuven.be

  Article Information

Published online: July 22, 2008
Number of Print Pages : 10
Number of Figures : 3, Number of Tables : 1, Number of References : 118

  Publication Details

Gynecologic and Obstetric Investigation

Vol. 66, No. 4, Year 2008 (Cover Date: November 2008)

Journal Editor: D'Hooghe T. (Leuven)
ISSN: 0378-7346 (Print), eISSN: 1423-002X (Online)

For additional information: http://www.karger.com/GOI

  Drug Dosage / Copyright

Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.