Oxidative stress biomarkers in fetal growth restriction: a systematic review and meta-analysis

Purpose

Fetal growth restriction (FGR) affects about 10% of pregnancies and is linked to higher risks of perinatal mortality and long-term health issues, largely due to placental insufficiency and oxidative stress caused by hypoxia and inflammation. This study examines key oxidative stress biomarkers to assess significant differences in FGR versus appropriate for gestational age (AGA) neonates.

Methods

This meta-analysis reviewed studies up to December analyzing oxidative stress biomarkers in cord blood from FGR versus AGA newborns. Key markers analyzed included malondialdehyde (MDA), superoxide dismutase (SOD), catalase, ischemia-modified albumin (IMA), homocysteine, nitric oxide (NO), and nucleated red blood cells (NRBCs). Standardized mean differences (Cohen’s d) and 95% confidence intervals (CIs) were calculated.

Results

A total of 48 studies involving 4684 participants were included. MDA levels were significantly higher in FGR infants (d = 0.37, p = 0.01), especially in those with intrauterine growth restriction (IUGR) (d = 0.58, p = 0.02). SOD activity was markedly lower in FGR (d = − 1.98, p < 0.001), most notably in mixed FGR cases (d = − 4.95). Catalase was also reduced (d = − 2.64, p < 0.001), while NRBC (d = 2.24, p < 0.001) and IMA (d = 0.74, p < 0.001) were elevated. Homocysteine and NO levels showed no significant differences.

Conclusion

FGR is associated with distinct oxidative stress patterns in cord blood. These biomarkers, especially MDA, SOD, catalase, NRBC, and IMA, may hold promise for improving FGR diagnosis.