Background: To estimate the normal level of adrenomedullin (AM) during multiple pregnancy. Methods: The study population consisted of 5 women with normal cycles, 130 women with normal pregnancy between 6 and 40 weeks of gestation, 93 women with twin pregnancy and 42 women with triplet pregnancy. Results: Total AM concentration in the first trimester (13.7 ± 0.58 fmol/ml), second trimester (26.8 ± 1.13 fmol/ml) and third trimester (37.8 ± 1.32 fmol/ml) in pregnant women was significantly higher than that in nonpregnant women (8.0 ± 0.71 fmol/ml). In each trimester, the maternal plasma concentrations of triplet-pregnant women were significantly higher than in twin and singleton-pregnant women. Umbilical venous AM levels (29.9 ± 2.63 fmol/ml) were higher than umbilical arterial AM (20.2 ± 2.04 fmol/ml). Conclusion: Since alterations in the AM concentration in maternal plasma may mediate compensatory vascular responses in the uterine circulation, it might be useful to know the normal level of AM during multiple pregnancy in order to detect abnormalities during multiple pregnancy.

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