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Disease Markers
Volume 2016, Article ID 7124186, 13 pages
Research Article

Increased Umbilical Cord PAI-1 Levels in Placental Insufficiency Are Associated with Fetal Hypoxia and Angiogenesis

1Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
2Children’s Health Research Institute, Departments of Biochemistry and Pediatrics, University of Western Ontario, London, ON, Canada N6C 2V5

Received 22 September 2015; Revised 12 December 2015; Accepted 16 December 2015

Academic Editor: Irene Rebelo

Copyright © 2016 Maxim D. Seferovic and Madhulika B. Gupta. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


In intrauterine growth restriction (IUGR), a subset of pregnancies undergoes placental vascular dysregulation resulting in restricted blood flow and fetal hypoxemia. Altered transcription of hypoxic regulated plasminogen activator inhibitor 1 (PAI-1) has been associated with pregnancy complications and angiogenic regulation. Here we assessed circulating PAI-1 as an indicator of placental insufficiency. Venous umbilical PAI-1 of hypoxemic (VpO2 20 versus 35 mmHg, ) placental insufficient pregnancies (resistance index 0.9 versus 0.63, ) () was compared to controls (). PAI-1 was increased (~10-fold, ) and had a positive predictive ratio of 6.7. Further, PAI-1 levels correlated to blood oxygen (, ). The plasma’s angiogenic potency measured in vitro was associated with umbilical cord blood PAI-1 levels (, ). This association was attenuated by PAI-1 inhibiting antibody (). The results demonstrate PAI-1 as a potential marker of placental insufficiency and identify its close association with pathological hypoxia and angiogenesis in a subset of growth restricted pregnancies.