GDF-15 is a member of the transforming growth factor beta cytokine superfamily that is expressed in inflammatory state, under oxidative stress and reflects cardiac remodeling.6,7 A meta-analysis of 8 clinical studies in patients with HF showed that elevated levels of GDF-15 were associated with increased mortality.8 However, these studies relied on a single, baseline measurement of GDF-15, which fails to take into account disease progression and the dynamic pattern of biomarkers during follow-up. Here, GDF15 is linked to hydrops fetalis.