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Fetal Growth Restriction: Pathogenic Mechanisms

MAULIK, DEV MD, PhD*; FRANCES EVANS, JODI MS; RAGOLIA, LOUIS PhD

Clinical Obstetrics & Gynecology: June 2006 - Volume 49 - Issue 2 - pp 219-227
Fetal Growth Restriction

Complex genetic and environmental mechanisms of maternal, fetal and placental origin regulate fetal growth and may contribute to fetal growth restriction (FGR). The somatotrophic regulatory factors include IGF-I, IGF-II, the IGF binding proteins (IGFBP) 1-6, IGF receptors 1 and 2, and the IGFBP specific proteases. Abnormal remodeling of utero-placental arteries and abnormal fetal-placental angiogenesis has also been implicated in FGR. The underlying molecular mediators include vascular endothelial growth factor (VEGF), placental growth factor (PlGF), VEGF receptors, VEGF binding proteins, and numerous other agents working through multiple pathways many of which still remain unknown. Expression of these major angiogenic factors appears to be regulated by local oxygen partial pressure. Future investigations may resolve many of these issues not only adding to the clarity of our understanding of the mechanisms of growth restriction but also improving clinical management.

*Department of Obstetrics and Gynecology

Vascular Biology Institute, Winthrop University Hospital, Mineola, NY 11501

Correspondance: Dev Maulik, MD, PhD, Professor and Chairman, Department of Obstetrics and Gynecology, Winthrop University Hospital, 259 First Street, Mineola, NY 11501. E-mail: wirving@winthrop.org

© 2006 Lippincott Williams & Wilkins, Inc.