Twin-to-twin transfusion syndrome: an antiangiogenic state?

Juan Pedro Kusanovic, Roberto Romero, Jimmy Espinoza, Jyh Kae Nien, Chong Jai Kim, Pooja Mittal, Sam Edwin, Offer Erez, Francesca Gotsch, Shali Mazaki-Tovi, Nandor G. Than, Eleazar Soto, Natalia Camacho, Ricardo Gomez, Ruben Quintero, Sonia S. Hassan

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


Objective: An imbalanced chronic blood flow between the donor and recipient twin through placental vascular anastomoses is the accepted pathophysiology of twin-to-twin transfusion syndrome (TTTS). Vascular endothelial growth factor receptor-1 (VEGFR-1) mRNA is overexpressed only in the syncytiotrophoblast of the donor twin in some cases of TTTS. This study was conducted to determine maternal plasma concentrations of placental growth factor (PlGF), soluble VEGFR-1, and soluble endoglin (s-Eng) in monochorionic-diamniotic pregnancies with and without TTTS. Study Design: This case-control study included monochorionic-diamniotic pregnancies between 16-26 weeks with and without TTTS. Maternal plasma concentrations of PlGF, sVEGFR-1, and s-Eng were determined with ELISA. A P value < .05 was considered statistically significant. Results: Patients with TTTS had higher median plasma concentrations of s-Eng (14.8 ng/mL vs 7.8 ng/mL; P < .001) and sVEGFR-1 (6383.1 pg/mL vs 3220.1 pg/mL; P < .001]; and lower median plasma concentrations of PlGF (115.5 pg/mL vs 359.3 pg/mL; P = .002) than those without TTTS. Conclusion: We propose that an antiangiogenic state may be present in some cases of TTTS.

Original languageEnglish (US)
Pages (from-to)382.e1-382.e8
JournalAmerican journal of obstetrics and gynecology
Issue number4
StatePublished - Apr 2008
Externally publishedYes


  • angiogenesis
  • angiogenic factors
  • birthweight discordancy
  • endoglin
  • monochorionic
  • placental growth factor
  • PlGF
  • sFlt1
  • sVEGFR-1
  • TTTS
  • twin pregnancy

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology


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