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Masserdotti A, Gasik M, Grillari-Voglauer R, Grillari J, Cargnoni A, Chiodelli P, Papait A, Magatti M, Romoli J, Ficai S, Di Pietro L, Lattanzi W, Silini AR, Parolini O. Unveiling the human fetal-maternal interface during the first trimester: biophysical knowledge and gaps. Front Cell Dev Biol 2024; 12:1411582. [PMID: 39144254 PMCID: PMC11322133 DOI: 10.3389/fcell.2024.1411582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/11/2024] [Indexed: 08/16/2024] Open
Abstract
The intricate interplay between the developing placenta and fetal-maternal interactions is critical for pregnancy outcomes. Despite advancements, gaps persist in understanding biomechanics, transport processes, and blood circulation parameters, all of which are crucial for safe pregnancies. Moreover, the complexity of fetal-maternal interactions led to conflicting data and methodological variations. This review presents a comprehensive overview of current knowledge on fetal-maternal interface structures, with a particular focus on the first trimester. More in detail, the embryological development, structural characteristics, and physiological functions of placental chorionic plate and villi, fetal membranes and umbilical cord are discussed. Furthermore, a description of the main structures and features of maternal and fetal fluid dynamic exchanges is provided. However, ethical constraints and technological limitations pose still challenges to studying early placental development directly, which calls for sophisticated in vitro, microfluidic organotypic models for advancing our understanding. For this, knowledge about key in vivo parameters are necessary for their design. In this scenario, the integration of data from later gestational stages and mathematical/computational simulations have proven to be useful tools. Notwithstanding, further research into cellular and molecular mechanisms at the fetal-maternal interface is essential for enhancing prenatal care and improving maternal and fetal health outcomes.
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Affiliation(s)
- Alice Masserdotti
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Johannes Grillari
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria
- Institute of Molecular Biotechnology, BOKU University, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Austria
| | - Anna Cargnoni
- Centro di Ricerca E. Menni, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Paola Chiodelli
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Papait
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Marta Magatti
- Centro di Ricerca E. Menni, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Jacopo Romoli
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Ficai
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorena Di Pietro
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Wanda Lattanzi
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Antonietta Rosa Silini
- Centro di Ricerca E. Menni, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Ornella Parolini
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
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Trilla Solà C, Parra Roca J, Llurba Olivé E. Reference Ranges of 2-Dimensional Placental Biometry and 3-Dimensional Placental Volume between 11 and 14 Weeks of Gestation. Diagnostics (Basel) 2024; 14:1556. [PMID: 39061694 PMCID: PMC11276113 DOI: 10.3390/diagnostics14141556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/13/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE The purpose of this study was to provide gestational age (GA) specific reference ranges for 2-dimensional (2D) placental biometry and 3-dimensional (3D) placental volume between 11 and 14 weeks of gestation. METHODS Placental biometry including 2D and 3D variables was calculated in 1142 first-trimester singleton pregnancies with non-complicated outcome between September 2016 and February 2020. Ultrasound datasets were obtained at the time of the first-trimester ultrasound, and 2D basal plate (BP), chorionic plate (CP), placental thickness (PT), and 3D placental volume (PV) were measured following a standardized methodology. Reference ranges for each variable were calculated according to GA and crown-rump-length (CRL). RESULTS A total of 1142 uncomplicated pregnancies were considered for analysis. All placental measurements increased significantly between 11 and 14 weeks, especially for PT (39.64%) and PV (64.4%). Reference ranges were constructed for each 2D and 3D first-trimester placental variable using the best-fit regression model for the predicted mean and SD as a function of GA and CRL. CONCLUSIONS Reference ranges of 2D placental biometry and 3D placental volume between 11 and 14 weeks of gestation were constructed, generating reference values. Placental biometry showed a progressive increase during the first trimester. This highlights the importance of using reference range charts according to GA.
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Affiliation(s)
- Cristina Trilla Solà
- Department of Obstetrics and Gynecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28040 Madrid, Spain
| | - Juan Parra Roca
- Department of Obstetrics and Gynecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
| | - Elisa Llurba Olivé
- Department of Obstetrics and Gynecology, Institut d’Investigació Biomèdica Sant Pau-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS, RD21/0012/0001), Instituto de Salud Carlos III, 28040 Madrid, Spain
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Umapathy A, Clark A, Sehgal A, Karanam V, Rajaraman G, Kalionis B, Jones H, James J, Murthi P. Molecular regulators of defective placental and cardiovascular development in fetal growth restriction. Clin Sci (Lond) 2024; 138:761-775. [PMID: 38904187 PMCID: PMC11193155 DOI: 10.1042/cs20220428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/12/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024]
Abstract
Placental insufficiency is one of the major causes of fetal growth restriction (FGR), a significant pregnancy disorder in which the fetus fails to achieve its full growth potential in utero. As well as the acute consequences of being born too small, affected offspring are at increased risk of cardiovascular disease, diabetes and other chronic diseases in later life. The placenta and heart develop concurrently, therefore placental maldevelopment and function in FGR may have profound effect on the growth and differentiation of many organ systems, including the heart. Hence, understanding the key molecular players that are synergistically linked in the development of the placenta and heart is critical. This review highlights the key growth factors, angiogenic molecules and transcription factors that are common causes of defective placental and cardiovascular development.
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Affiliation(s)
- Anandita Umapathy
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Alys Clark
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Auckland Bioengineering Institute, Bioengineering Institute, New Zealand
| | - Arvind Sehgal
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia and Monash Newborn, Monash Children’s Hospital, Melbourne, VIC, Australia
| | - Vijaya Karanam
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Royal Women’s Hospital, Victoria, Australia
| | - Gayathri Rajaraman
- First year college, Victoria University, St Albans, Victoria 3021, Australia
| | - Bill Kalionis
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Royal Women’s Hospital, Victoria, Australia
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, Royal Women’s Hospital, Victoria, Australia
| | - Helen N. Jones
- Department of Physiology and Aging, University of Florida College of Medicine, Gainesville, FL, U.S.A
- Center for Research in Perinatal Outcomes, University of Florida College of Medicine, Gainesville, FL, U.S.A
| | - Jo James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Auckland Bioengineering Institute, Bioengineering Institute, New Zealand
| | - Padma Murthi
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and Royal Women’s Hospital, Victoria, Australia
- Department of Maternal Fetal Medicine, Pregnancy Research Centre, Royal Women’s Hospital, Victoria, Australia
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
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Rawal S, Ray S, Sharma N. Correlation Between Ultrasonographic Placental Thickness and Adverse Fetal and Neonatal Outcomes. Cureus 2024; 16:e56410. [PMID: 38638712 PMCID: PMC11023942 DOI: 10.7759/cureus.56410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction The placenta is often overlooked in the routine evaluation of normal gestations, receiving attention only when abnormalities are detected. Placental thickness can serve as a good predictor of fetal growth and birth weight, especially in the second trimester.In this prospective study, we measured placental thickness in the second and third trimesters of singleton pregnancies and identified an association between placental thickness and adverse outcomes such as congenital anomalies, fetal growth restriction (FGR), prematurity, low birth weight, stillbirth, and hydrops fetalis. Methodology A total of 298 patients aged 20 to 33 years with a singleton pregnancy and regular cycles, who were sure of the date of their last menstrual period, were observed. Placental thickness was measured by ultrasound at 18-20 and 30-32 weeks, and patients were divided into three groups. Group A consisted of patients with normal placental thickness. Group B included patients with a thin placenta (below the 10th percentile). Group C consisted of patients with a thick placenta (above the 95th percentile). The correlation between placental thickness and the fetal and neonatal outcome was observed. Results Out of 298 patients, 82 (27.5%) were primigravida and 216 (72.4%) were multigravida. At 18-20 weeks, premature birth was observed in one patient (7.69%) in Group C and six patients (20%) in Group B, compared with eight patients (3.14%) in Group A. At 30-32 weeks, premature birth was seen in two patients (16.67%) in Group C and 11 patients (36.67%) in Group B, compared with two patients (0.78%) in Group A. At 18-20 weeks of gestation, low birth weight was observed for three patients (23.08%) in Group C and 16 patients (53.33%) in Group B, compared with 15 patients (5.88%) in Group A. At 30-32 weeks, low birth weight was observed for four patients (33.33%) in Group C and 19 patients (63.33%) in Group B compared with 11 patients (4.30%) in Group A. A significant association was found between a thin placenta and low birth weight and prematurity at both 18-20 and 30-32 weeks of gestation. Two patients (13.33%) had major congenital abnormalities and a thick placenta at 18-20 weeks. In Group C, hydrops were observed in two patients (15.38%) at 18-20 weeks and two patients (16.67%) at 30-32 weeks. A significant association was found between a thick placenta and hydrops. At 30-32 weeks, 13 patients (43.33%) in Group B had developed FGR compared with six patients (2.34%) with a normal placenta. A significant association was found between a thin placenta and FGR. One patient (7.69%) with a thick placenta had a stillbirth, indicating a nonsignificant association. Conclusions A positive correlation was observed between congenital anomalies and hydrops and a thick placenta, whereas FGR, preterm labor, prematurity, and low birth weight were associated with a thin placenta. Subnormal placental thickness for a particular gestational age may be the earliest sign of FGR. A sonographically identified abnormal placenta should alert clinicians to the possibility of a compromised perinatal outcome and the need for evaluation and close follow-up.
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Affiliation(s)
- Seema Rawal
- Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, IND
| | - Smriti Ray
- Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, IND
- Reproductive Medicine, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, IND
| | - Neeraj Sharma
- Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, IND
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Ashley RL, Trigo EM, Ervin JM. Placental insufficiency and heavier placentas in sheep after suppressing CXCL12/CXCR4 signaling during implantation†. Biol Reprod 2023; 109:982-993. [PMID: 37724932 PMCID: PMC10724462 DOI: 10.1093/biolre/ioad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/28/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023] Open
Abstract
During implantation, trophoblast cell invasion and differentiation is predominantly important to achieving proper placental formation and embryonic development. The chemokine, C-X-C motif chemokine ligand 12 (CXCL12) working through its receptor C-X-C motif chemokine receptor 4 (CXCR4) is implicated in implantation and placentation but precise roles of this axis are unclear. Suppressing CXCL12/CXCR4 signaling at the fetal-maternal interface in sheep reduces trophoblast invasion, disrupts uterine remodeling, and diminishes placental vascularization. We hypothesize these negative impacts during implantation will manifest as compromised fetal and placental growth at midgestation. To test, on day 12 postbreeding, osmotic pumps were surgically installed in 30 ewes and delivered intrauterine CXCR4 inhibitor or saline for 7 or 14 days. On day 90, fetal/maternal tissues were collected, measured, weighed, and maternal (caruncle) and fetal (cotyledon) placenta components separated and analyzed. The objectives were to determine if (i) suppressing CXCL12/CXCR4 during implantation results in reduced fetal and placental growth and development and (ii) if varying the amount of time CXCL12/CXCR4 is suppressed impacts fetal/placental development. Fetal weights were similar; however greater placental weight and placentome numbers occurred when CXCL12/CXCR4 was suppressed for 14 days. In caruncles, greater abundance of fibroblast growth factor 2, vascular endothelial growth factor A, vascular endothelial growth factor A receptor 1 (FLT-1), and placental growth factor were observed after suppressing CXCL12/CXCR4. Similar results occurred in cotyledons except less vascular endothelial growth factor in 7 day group and less fibroblast growth factor in 14 day group. Our data underscore the importance of CXCL12/CXCR4 signaling during placentation and provide strong evidence that altering CXCL12-mediated signaling induces enduring placental effects manifesting later in gestation.
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Affiliation(s)
- Ryan L Ashley
- Department of Animal and Range Sciences, New Mexico State University, Las Cruces, NM, USA
| | - Elisa M Trigo
- Department of Animal and Range Sciences, New Mexico State University, Las Cruces, NM, USA
| | - Jacqueline M Ervin
- Department of Animal and Range Sciences, New Mexico State University, Las Cruces, NM, USA
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Williams A, Saizy S, Mendola P, Grobman W, Subramaniam A, Stevens DR, Mumford SL, Larson K, Chen Z, Messer LC, Duncan V, Faye-Petersen O, Kumar R. Prenatal exposure to perceived stress, maternal asthma, and placental size. Placenta 2023; 139:127-133. [PMID: 37390516 PMCID: PMC10529282 DOI: 10.1016/j.placenta.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION Prenatal exposure to stress has been associated with poor pregnancy outcomes, yet evidence linking stress and placental size is limited. Asthma is associated with worse pregnancy outcomes and women with asthma may be more susceptible to stress. Using the asthma-enriched B-WELL-Mom cohort, we examined the association between perceived stress and placental size. METHODS Placental measures of weight, length, width, and thickness were available for 345 women (262 with asthma) via placental pathology report. Perceived Stress Scale (PSS) scores were obtained in each trimester of pregnancy and categorized into quartiles (low quartile as reference). For associations between PSS and placental size, generalized estimating equations adjusted for maternal and infant factors were used to estimate regression coefficients (β) and 95% confidence intervals (95% CI). Full models and models stratified by asthma status were run. RESULTS Compared to Quartile 1, high levels of stress (Quartile 4) were associated with smaller placental weight (-20.63 95% CI: -37.01,-4.26) and length (-0.55 95% CI: -0.96,-0.15), but not width or thickness. Results by asthma status show a stronger association between perceived stress and shorter placental length in those with asthma and a stronger association between perceived stress and smaller placental thickness in those without asthma. Findings were robust to sensitivity analyses DISCUSSION: Higher levels of perceived stress were associated with smaller placental size. Additional research is warranted to understand the relationship between stress and placental size.
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Affiliation(s)
- Andrew Williams
- Public Health Program, Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, 1301 N Columbia Rd, Grand Forks, ND, 58202, USA.
| | - Sadia Saizy
- Public Health Program, Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, 1301 N Columbia Rd, Grand Forks, ND, 58202, USA
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 270 Farber Hall, Buffalo, NY, 14214, USA
| | - William Grobman
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Akila Subramaniam
- University of Alabama at Birmingham, Heersink School of Medicine, 1670 University Blvd, Birmingham, AL, 35233, USA
| | - Danielle R Stevens
- Epidemiology Branch, National Institute of Environmental Health Sciences, PO Box 12233, Mail Drop A3-05, Durham, NC, 27709, USA
| | - Sunni L Mumford
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Kate Larson
- USDA Agricultural Research Service, Grand Forks Human Nutrition Research Center, United States Department of Agriculture, 2420 2nd Ave N, Grand Forks, ND, 58203, USA
| | - Zhen Chen
- Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20892, USA
| | - Lynne C Messer
- OHSU-PSU School of Public Health, 1805 SW 4th Ave, Portland, OR, 97201, USA
| | - Virginia Duncan
- University of Alabama at Birmingham, Heersink School of Medicine, 1670 University Blvd, Birmingham, AL, 35233, USA
| | - Ona Faye-Petersen
- University of Alabama at Birmingham, Heersink School of Medicine, 1670 University Blvd, Birmingham, AL, 35233, USA
| | - Rajesh Kumar
- Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL, 60611, USA
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Zhang Y, Zeng HH. Placental morphological features of small for gestational age preterm neonates born to mothers with pregnancy-induced hypertension. Front Pediatr 2023; 11:1093622. [PMID: 37025291 PMCID: PMC10070738 DOI: 10.3389/fped.2023.1093622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/20/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction Small for gestational age (SGA) neonates are often born to mothers with pregnancy-induced hypertension (PIH). Here, we aimed to explore the morphometric characteristics of the placenta during the perinatal period associated with SGA risk in mothers with PIH and identify the risk factors related to SGA. Methods The medical records of 134 neonates born between 28- and 32-weeks' gestation to PIH mothers were retrospectively analyzed. Placental morphology and umbilical cord (UC) length were compared between the SGA and appropriate for gestational age (AGA) groups. Results The placenta of the SGA group had a shorter major (15.00 vs. 18.00 cm; z = -6.04, p < 0.01) and minor placenta axes (13.00 vs. 15.00 cm; z = -4.59, p < 0.01), lower weight (300.00 vs. 420.00 g; z = -7.21, p < 0.01), smaller volume (282.00 vs. 396.00 cm3; z = -5.00, p < 0.01), and smaller area (141.00 vs. 212.00 cm2; z = -5.96, p < 0.01) than the AGA group. The UC was significantly shorter (39.00 vs. 44.00 cm; z = -3.68, p < 0.01). Short placental major axis [p = 0.03; odds ratio (OR): 2.16; 95% confidence interval (CI): 1.84 - 2.63] and low placental weight (p < 0.01; OR: 2.68; 95% CI: 2.66 - 2.70) were independent risk factors for SGA in premature newborns of PIH mothers. Discussion A major axis shorter than 15.5 cm or placental weight lower than 347.50 g at birth was related to a greater risk of SGA infants born to PIH mothers. As a predictor in prenatal ultrasound, the major axis is more helpful for precise prenatal pre-evaluation of vulnerable SGA preterm neonates with PIH mothers.
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Contribution of Second Trimester Sonographic Placental Morphology to Uterine Artery Doppler in the Prediction of Placenta-Mediated Pregnancy Complications. J Clin Med 2022; 11:jcm11226759. [PMID: 36431236 PMCID: PMC9697802 DOI: 10.3390/jcm11226759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Second-trimester uterine artery Doppler is a well-established tool for the prediction of preeclampsia and fetal growth restriction. At delivery, placentas from affected pregnancies may have gross pathologic findings. Some of these features are detectable by ultrasound, but the relative importance of placental morphologic assessment and uterine artery Doppler in mid-pregnancy is presently unclear. Objective: To characterize the association of second-trimester sonographic placental morphology markers with placenta-mediated complications and determine whether these markers are predictive of placental dysfunction independent of uterine artery Doppler. Methods: This was a retrospective cohort study of patients with a singleton pregnancy at high risk of placental complications who underwent a sonographic placental study at mid-gestation (160/7−246/7 weeks’ gestation) in a single tertiary referral center between 2016−2019. The sonographic placental study included assessment of placental dimensions (length, width, and thickness), placental texture appearance, umbilical cord anatomy, and uterine artery Doppler (mean pulsatility index and early diastolic notching). Placental area and volume were calculated based on placental length, width, and thickness. Continuous placental markers were converted to multiples on medians (MoM). The primary outcome was a composite of early-onset preeclampsia and birthweight < 3rd centile. Results: A total of 429 eligible patients were identified during the study period, of whom 45 (10.5%) experienced the primary outcome. The rate of the primary outcome increased progressively with decreasing placental length, width, and area, and increased progressively with increasing mean uterine artery pulsatility index (PI). By contrast, placental thickness followed a U-shaped relationship with the primary outcome. Placental length, width, and area, mean uterine artery PI and bilateral uterine artery notching were all associated with the primary outcome. However, in the adjusted analysis, the association persisted only for placenta area (adjusted odds ratio [aOR] 0.21, 95%-confidence interval [CI] 0.06−0.73) and mean uterine artery PI (aOR 11.71, 95%-CI 3.84−35.72). The area under the ROC curve was highest for mean uterine artery PI (0.80, 95%-CI 0.71−0.89) and was significantly higher than that of placental area (0.67, 95%-CI 0.57−0.76, p = 0.44). A model that included both mean uterine artery PI and placental area did not significantly increase the area under the curve (0.82, 95%-CI 0.74−0.90, p = 0.255), and was associated with a relatively minor increase in specificity for the primary outcome compared with mean uterine artery PI alone (63% [95%-CI 58−68%] vs. 52% [95%-CI 47−57%]). Conclusion: Placental area is independently associated with the risk of placenta-mediated complications yet, when combined with uterine artery Doppler, did not further improve the prediction of such complications compared with uterine artery Doppler alone.
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Abstract
Importance A thickened placenta is easily identified on ultrasound and provides insight into maternal and fetal wellbeing as well as underlying structural and physiologic anomalies. Objectives The aim of this study was to review the literature to clarify what classifies a placenta as "thickened" and to review the associated incidence, maternal and fetal comorbidities, and management during pregnancy. Evidence Acquisition Electronic databases (PubMed and Web of Science) were searched from 2000 to 2020 in the English language. Studies were selected that examined associations between placental thickness, potential etiologies, and obstetric outcomes. Results There were 140 abstracts identified. After reviewing the articles, 60 were used in this review. Routine assessment of the placenta in the prenatal period is an easy and inexpensive way to assess the maternal and fetal patients. The criteria for a "thickened placenta" vary between studies based on gestational age, placental location, measurement technique, and maternal or fetal factors. Whereas most suggest thickness exceeding 4 cm is pathologic, a review had a threshold of 6 cm in the third trimester to classify placentomegaly. Several maternal and fetal conditions have been associated with a thickened placenta, such as obesity, parity, anemia, diabetes, preeclampsia, cardiac dysfunction, infection, assisted reproductive technology, multiple pregnancy, sacrococcygeal teratomas, and Beckwith-Wiedemann syndrome. A thickened placenta in pregnancy is associated with a higher incidence of adverse pregnancy outcomes and neonatal morbidity and mortality. Conclusions The literature is clear that early evaluation of the placenta using ultrasound should be a standard practice. A thickened placenta found on routine imaging should prompt a more thorough investigation to determine the etiology of the placentomegaly. At the time of this literature review, there are no recommendations regarding modality or frequency of antenatal surveillance in pregnancies complicated by a thickened placenta. However, serial ultrasounds and weekly antenatal testing in the third trimester should be considered. Relevance A thickened placenta has been associated with a variety of maternal and fetal conditions and increases the risk of adverse pregnancy outcomes and neonatal morbidity and mortality.
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Srinivasan V, Melbourne A, Oyston C, James JL, Clark AR. Multiscale and multimodal imaging of utero-placental anatomy and function in pregnancy. Placenta 2021; 112:111-122. [PMID: 34329969 DOI: 10.1016/j.placenta.2021.07.290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022]
Abstract
Placental structures at the nano-, micro-, and macro scale each play important roles in contributing to its function. As such, quantifying the dynamic way in which placental structure evolves during pregnancy is critical to both clinical diagnosis of pregnancy disorders, and mechanistic understanding of their pathophysiology. Imaging the placenta, both exvivo and invivo, can provide a wealth of structural and/or functional information. This review outlines how imaging across modalities and spatial scales can ultimately come together to improve our understanding of normal and pathological pregnancies. We discuss how imaging technologies are evolving to provide new insights into placental physiology across disciplines, and how advanced computational algorithms can be used alongside state-of-the-art imaging to obtain a holistic view of placental structure and its associated functions to improve our understanding of placental function in health and disease.
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Affiliation(s)
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, Kings College London, UK
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, New Zealand
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Sun X, Shen J, Wang L. Insights into the role of placenta thickness as a predictive marker of perinatal outcome. J Int Med Res 2021; 49:300060521990969. [PMID: 33583234 PMCID: PMC7890726 DOI: 10.1177/0300060521990969] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The placenta is a transitory organ indispensable for normal fetal maturation and growth. Recognition of abnormal placental variants is important in clinical practice, and a broader understanding of the significance of placental variants would help clinicians better manage affected pregnancies. Increased thickness of the placenta is reported to be a nonspecific finding but it is associated with many maternal and fetal abnormalities, including preeclampsia and abnormal fetal growth. In this review, we address the questions regarding the characteristics of placenta thickness and the relationship between thickened placenta and poor pregnancy outcomes.
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Affiliation(s)
| | | | - Liquan Wang
- Liquan Wang, Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University, School of Medicine, No. 88, Jiefang Road, Shangcheng District, Hangzhou, Zhejiang Province, 310000, People’s Republic of China.
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12
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Schiffer V, van Haren A, De Cubber L, Bons J, Coumans A, van Kuijk SM, Spaanderman M, Al-Nasiry S. Ultrasound evaluation of the placenta in healthy and placental syndrome pregnancies: A systematic review. Eur J Obstet Gynecol Reprod Biol 2021; 262:45-56. [PMID: 33984727 DOI: 10.1016/j.ejogrb.2021.04.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION An antepartum screening method to determine normal and abnormal placental function is desirable in the prevention of maternal and fetal pregnancy complications. Placental appearance can easily be obtained and evaluated using 2D ultrasonography, but surprisingly little is known about the change in placental appearance during gestation. Aim of this systematic review was to describe the antepartum placental appearance in placenta syndrome (PS) pregnancies, and to compare this to the appearance in healthy pregnancies. METHODS A systematic review investigating placental thickness, -lakes and/or -calcifications by ultrasound examination in both uncomplicated (reference group) and PS pregnancies in relation to gestational age was performed. English literature was searched using PubMed (NCBI), EMBASE (Ovid) and the Cochrane Library, from database inception until September 2020. Data on placental thickness was presented as a continuous variable or as the proportion of abnormal placental thickness. Data on placental lakes and -calcifications was presented as prevalence (%). There was no restriction applied on the definition of placental lakes or -calcifications. Due to heterogeneity, pooling of the results was not performed. RESULTS A total of 28 studies were included describing 1719 PS cases; consisting of 370 (21 %) cases with preeclampsia or pregnancy induced hypertension, 1341 (78 %) cases with fetal growth restriction (FGR) or small for gestational age (SGA), and 8 (1%) cases with combined clinical expressions. In addition, the reference group comprised 3315 pregnant women. Placental thickness showed an increase between the first and second trimester, which was higher in PS- compared to uncomplicated pregnancies. Placental lakes were frequently observed in FGR and SGA pregnancies, especially in the second trimester. Grade 3 calcifications were most prominent in the PS pregnancies, specifically in the late second and third trimester. Moreover, in the reference group, no grade 3 calcifications were reported before 35 weeks of gestation. CONCLUSION Placental appearance in PS-pregnancies shows higher placental thickness and greater presence of placental lakes and -calcifications compared to uncomplicated pregnancies. Standardized definitions of (ab-)normal placental appearance and longitudinal research in both healthy and complicated pregnancies are needed to improve personalized obstetric care.
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Affiliation(s)
- Veronique Schiffer
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands.
| | - Ashlee van Haren
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - Lisa De Cubber
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - Judith Bons
- Central Diagnostic Laboratory, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Audrey Coumans
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - Sander Mj van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - Marc Spaanderman
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - Salwan Al-Nasiry
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands
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13
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Sun C, Groom KM, Oyston C, Chamley LW, Clark AR, James JL. The placenta in fetal growth restriction: What is going wrong? Placenta 2020; 96:10-18. [PMID: 32421528 DOI: 10.1016/j.placenta.2020.05.003] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/17/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
The placenta is essential for the efficient delivery of nutrients and oxygen from mother to fetus to maintain normal fetal growth. Dysfunctional placental development underpins many pregnancy complications, including fetal growth restriction (FGR) a condition in which the fetus does not reach its growth potential. The FGR placenta is smaller than normal placentae throughout gestation and displays maldevelopment of both the placental villi and the fetal vasculature within these villi. Specialized epithelial cells called trophoblasts exhibit abnormal function and development in FGR placentae. This includes an altered balance between proliferation and apoptotic death, premature cellular senescence, and reduced colonisation of the maternal decidual tissue. Thus, the placenta undergoes aberrant changes at the macroscopic to cellular level in FGR, which can limit exchange capacity and downstream fetal growth. This review aims to compile stereological, in vitro, and imaging data to create a holistic overview of the FGR placenta and its pathophysiology, with a focus on the contribution of trophoblasts.
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Affiliation(s)
- Cherry Sun
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Katie M Groom
- Liggins Institute, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Lawrence W Chamley
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, The University of Auckland, Auckland Bioengineering, House, Level 6/70 Symonds Street, Grafton, Auckland, 1010, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
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14
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Ismail KI, Hannigan A, O'Donoghue K, Cotter A. Role of 2-Dimensional Ultrasound Imaging in Placental and Umbilical Cord Morphometry: Literature and Pictorial Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3131-3140. [PMID: 31144344 DOI: 10.1002/jum.15024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 04/23/2019] [Indexed: 06/09/2023]
Abstract
Abnormalities of the placenta and umbilical cord have been associated with adverse pregnancy outcomes. Antenatal detection of placental and umbilical cord abnormalities using ultrasound (US) imaging is now gaining popularity with the advancements in obstetric US. This article reviews the use of 2-dimensional obstetric US as a tool to measure and assess placental and umbilical cord morphometry. It highlights the potential role of placental and umbilical cord morphometry as a valuable component of the screening tool for high risk pregnancies and identifies the need for further research to examine its feasibility.
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Affiliation(s)
- Khadijah I Ismail
- Departments of Obstetrics and Gynecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Ailish Hannigan
- Departments of Biostatistics, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
| | - Amanda Cotter
- Departments of Obstetrics and Gynecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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15
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The volume of villi with γ-sm-actin positive perivascular cells correlates with placental weight and thickness. Placenta 2019; 85:24-31. [PMID: 31434032 DOI: 10.1016/j.placenta.2019.08.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/30/2019] [Accepted: 08/12/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The classification of histologically stained villous cross sections in villous types (terminal, intermediate and stem villi) by stromal peculiarities is known to be observer predicated. Therefore, quantitative histology of villous trees has not become a routine endpoint of studies on the role of the placenta in prenatal programming, as opposed to the gross placental parameters weight and thickness. The classification of villous cross sections in central (stem) and peripheral (terminal) parts based on the presence or absence, respectively, of immunohistochemical detection of myofibroblasts in perivascular position is less observer dependent. We hypothesized that it will, possibly, identify microscopic correlates of placental weight and thickness within the villous tree. METHODS 50 placentas from clinically normal pregnancies were processed for the present study. Thin villous cross sections, obtained in a systematic random manner, were stained immunohistochemically to detect γ-smooth muscle (sm) actin and to classify them subsequently as part of central or peripheral villous tree. The volume fractions of histological structures visible in villous cross sections (stroma, lumen, endothelium and syncytium) were estimated by design-based stereology. RESULTS The present study reveals a significant correlation of placental weight and thickness with the volume estimate of stroma that have myofibroblasts in perivascular position. DISCUSSION The positive linear correlation between the volume of central parts of villous trees and the placental weight and thickness is new. Surprisingly, the volume of more peripheral parts of villous trees, which is the main site of materno-fetal exchange does not correlate with placental weight and thickness.
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16
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Nogueira R, Sousa S, Braga AC, Azevedo A, Pereira N, Carmo O, Tavares MP, Pinto JC. Measurements in First-Trimester Abortion Products: A Pathologic Study. Arch Pathol Lab Med 2019; 144:207-214. [PMID: 31173530 DOI: 10.5858/arpa.2018-0181-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Related to the advances in prenatal diagnosis and the emergence of medically challenging situations, there has been an increased interest in conducting a pathologic study of first-trimester abortion products. OBJECTIVE.— To evaluate measurements across a large group of first-trimester spontaneous abortion specimens. Potential goals include a validation of prenatal embryo and gestational-sac measurements as a function of gestational age (GA). DESIGN.— A retrospective case study of first-trimester spontaneous abortions between June 2015 and April 2017 in Centro de Genética Clínica Embryo-Fetal Pathology Laboratory, Porto, Portugal. Considering the inclusion criteria, 585 complete gestational sacs, 182 embryos, and 116 umbilical cords were selected. We recorded the weight of the gestational sacs and embryos and measurements of gestational sacs, umbilical cords, and embryo crown-rump length. Models were computed using regression techniques. RESULTS.— Gestational-sac diameter percentiles 5, 25, 50, 75 and 95 were calculated according to GA, and at each 1-week interval the diameter increased an average of 3 mm. Umbilical cord length percentiles 5, 25, 50, 75 and 95 were calculated according to GA, and at each 1-week interval, the length increased an average of 1.35 mm. Embryo crown-rump length estimated mean ± SD values were GA 6 weeks, 5.3 ± 2.3 mm; GA 7 weeks, 9.4 ± 4.8 mm; GA 8 weeks, 13.7 ± 8.2 mm; GA 9 weeks, 20.8 ± 9.1 mm; GA 10 weeks, 22.6 ± 13.4 mm; GA 11 weeks, 29.4 ± 12.9 mm; and GA 12 weeks, 52 mm. CONCLUSIONS.— Pathologic measurements obtained should be compared to expected measurements and correlated with ultrasound findings, clinical information, and microscopic findings. Deviations from expected values could lead to an understanding of early pregnancy loss.
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Affiliation(s)
- Rosete Nogueira
- From the Surgical Sciences Domain, Medicine School (Drs Nogueira and Pinto) and the Engineering School, Department of Production and Systems (Dr Braga), Minho University, Campus de Gualtar, Braga, Portugal; the Life and Health Sciences Research Institute (ICVS), ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal (Drs Nogueira and Pinto); the Embryo-fetal Pathology Laboratory (Dr Nogueira and Mss Sousa and Azevedo) and the Prenatal Clinical Department (Dr Tavares), CGC Genetics, Porto, Portugal; the Prenatal Diagnosis Department, Hospital S Teotónio, Viseu, Portugal (Dr Pereira); the Prenatal Diagnosis Department, Hospital Tâmega Sousa, Penafiel, Portugal (Dr Carmo); and the Department of Pediatric Surgery, Hospital de S. Marcos, Braga, Portugal (Dr Pinto)
| | - Sara Sousa
- From the Surgical Sciences Domain, Medicine School (Drs Nogueira and Pinto) and the Engineering School, Department of Production and Systems (Dr Braga), Minho University, Campus de Gualtar, Braga, Portugal; the Life and Health Sciences Research Institute (ICVS), ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal (Drs Nogueira and Pinto); the Embryo-fetal Pathology Laboratory (Dr Nogueira and Mss Sousa and Azevedo) and the Prenatal Clinical Department (Dr Tavares), CGC Genetics, Porto, Portugal; the Prenatal Diagnosis Department, Hospital S Teotónio, Viseu, Portugal (Dr Pereira); the Prenatal Diagnosis Department, Hospital Tâmega Sousa, Penafiel, Portugal (Dr Carmo); and the Department of Pediatric Surgery, Hospital de S. Marcos, Braga, Portugal (Dr Pinto)
| | - Ana Cristina Braga
- From the Surgical Sciences Domain, Medicine School (Drs Nogueira and Pinto) and the Engineering School, Department of Production and Systems (Dr Braga), Minho University, Campus de Gualtar, Braga, Portugal; the Life and Health Sciences Research Institute (ICVS), ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal (Drs Nogueira and Pinto); the Embryo-fetal Pathology Laboratory (Dr Nogueira and Mss Sousa and Azevedo) and the Prenatal Clinical Department (Dr Tavares), CGC Genetics, Porto, Portugal; the Prenatal Diagnosis Department, Hospital S Teotónio, Viseu, Portugal (Dr Pereira); the Prenatal Diagnosis Department, Hospital Tâmega Sousa, Penafiel, Portugal (Dr Carmo); and the Department of Pediatric Surgery, Hospital de S. Marcos, Braga, Portugal (Dr Pinto)
| | - Ana Azevedo
- From the Surgical Sciences Domain, Medicine School (Drs Nogueira and Pinto) and the Engineering School, Department of Production and Systems (Dr Braga), Minho University, Campus de Gualtar, Braga, Portugal; the Life and Health Sciences Research Institute (ICVS), ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal (Drs Nogueira and Pinto); the Embryo-fetal Pathology Laboratory (Dr Nogueira and Mss Sousa and Azevedo) and the Prenatal Clinical Department (Dr Tavares), CGC Genetics, Porto, Portugal; the Prenatal Diagnosis Department, Hospital S Teotónio, Viseu, Portugal (Dr Pereira); the Prenatal Diagnosis Department, Hospital Tâmega Sousa, Penafiel, Portugal (Dr Carmo); and the Department of Pediatric Surgery, Hospital de S. Marcos, Braga, Portugal (Dr Pinto)
| | - Nuno Pereira
- From the Surgical Sciences Domain, Medicine School (Drs Nogueira and Pinto) and the Engineering School, Department of Production and Systems (Dr Braga), Minho University, Campus de Gualtar, Braga, Portugal; the Life and Health Sciences Research Institute (ICVS), ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal (Drs Nogueira and Pinto); the Embryo-fetal Pathology Laboratory (Dr Nogueira and Mss Sousa and Azevedo) and the Prenatal Clinical Department (Dr Tavares), CGC Genetics, Porto, Portugal; the Prenatal Diagnosis Department, Hospital S Teotónio, Viseu, Portugal (Dr Pereira); the Prenatal Diagnosis Department, Hospital Tâmega Sousa, Penafiel, Portugal (Dr Carmo); and the Department of Pediatric Surgery, Hospital de S. Marcos, Braga, Portugal (Dr Pinto)
| | - Olímpia Carmo
- From the Surgical Sciences Domain, Medicine School (Drs Nogueira and Pinto) and the Engineering School, Department of Production and Systems (Dr Braga), Minho University, Campus de Gualtar, Braga, Portugal; the Life and Health Sciences Research Institute (ICVS), ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal (Drs Nogueira and Pinto); the Embryo-fetal Pathology Laboratory (Dr Nogueira and Mss Sousa and Azevedo) and the Prenatal Clinical Department (Dr Tavares), CGC Genetics, Porto, Portugal; the Prenatal Diagnosis Department, Hospital S Teotónio, Viseu, Portugal (Dr Pereira); the Prenatal Diagnosis Department, Hospital Tâmega Sousa, Penafiel, Portugal (Dr Carmo); and the Department of Pediatric Surgery, Hospital de S. Marcos, Braga, Portugal (Dr Pinto)
| | - Maria Purificação Tavares
- From the Surgical Sciences Domain, Medicine School (Drs Nogueira and Pinto) and the Engineering School, Department of Production and Systems (Dr Braga), Minho University, Campus de Gualtar, Braga, Portugal; the Life and Health Sciences Research Institute (ICVS), ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal (Drs Nogueira and Pinto); the Embryo-fetal Pathology Laboratory (Dr Nogueira and Mss Sousa and Azevedo) and the Prenatal Clinical Department (Dr Tavares), CGC Genetics, Porto, Portugal; the Prenatal Diagnosis Department, Hospital S Teotónio, Viseu, Portugal (Dr Pereira); the Prenatal Diagnosis Department, Hospital Tâmega Sousa, Penafiel, Portugal (Dr Carmo); and the Department of Pediatric Surgery, Hospital de S. Marcos, Braga, Portugal (Dr Pinto)
| | - Jorge Correia Pinto
- From the Surgical Sciences Domain, Medicine School (Drs Nogueira and Pinto) and the Engineering School, Department of Production and Systems (Dr Braga), Minho University, Campus de Gualtar, Braga, Portugal; the Life and Health Sciences Research Institute (ICVS), ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal (Drs Nogueira and Pinto); the Embryo-fetal Pathology Laboratory (Dr Nogueira and Mss Sousa and Azevedo) and the Prenatal Clinical Department (Dr Tavares), CGC Genetics, Porto, Portugal; the Prenatal Diagnosis Department, Hospital S Teotónio, Viseu, Portugal (Dr Pereira); the Prenatal Diagnosis Department, Hospital Tâmega Sousa, Penafiel, Portugal (Dr Carmo); and the Department of Pediatric Surgery, Hospital de S. Marcos, Braga, Portugal (Dr Pinto)
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Bernard N, Forest JC, Tarabulsy GM, Bujold E, Bouvier D, Giguère Y. Use of antidepressants and anxiolytics in early pregnancy and the risk of preeclampsia and gestational hypertension: a prospective study. BMC Pregnancy Childbirth 2019; 19:146. [PMID: 31039756 PMCID: PMC6492434 DOI: 10.1186/s12884-019-2285-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/11/2019] [Indexed: 12/14/2022] Open
Abstract
Background We investigated the association between antidepressant and anxiolytic exposure during the first and early second trimester of pregnancy (< 16 weeks), and hypertensive disorders of pregnancy (including preeclampsia and gestational hypertension) in women with singleton pregnancy. Methods This study is based on a large prospective cohort of 7866 pregnant women. We included pregnant women aged 18 years or older without chronic hepatic or renal disease at the time of recruitment. Participants lost to the follow-up, with multiple pregnancies and pregnancy terminations, miscarriages or fetal deaths before 20 weeks of gestation were excluded from the study, as well as women with no data on the antidepressant/anxiolytic medication use during pregnancy. Information concerning antidepressant or anxiolytic medication use was extracted from hospital records after delivery. The associations between their use and the risk of gestational hypertension or preeclampsia were calculated. Results The final sample for analysis included 6761 participants including 218 (3.2%) women who were exposed to antidepressant and/or anxiolytic medication before the 16th week of gestation. Forty-one women had a non-medicated depression or anxiety during the pregnancy. Moreover, 195 (2.9%) and 122 (1.8%) women developed gestational hypertension and preeclampsia respectively. When compared to women unexposed to antidepressant/anxiolytic medication, depression and anxiety, those using antidepressant and/or anxiolytic drugs before the 16th week of gestation were at increased risk of preeclampsia (adjusted odd ratio (aOR) 3.09 [CI95% 1.56–6.12]), especially if they continued their medication after the 16th week (aOR 3.41 [CI95% 1.66–7.02]) compared to those who did not (1.60 [CI95% 0.21–12.34]). Conclusions Women exposed to antidepressant and/or anxiolytic medication before the 16th week of pregnancy have a 3-fold increased risk for preeclampsia when compared to women unexposed to antidepressant/anxiolytic medication, depression and anxiety. Also, our results suggested that women who stopped their medication before the 16th week of pregnancy could be benefit from reduced preeclampsia risk.
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Affiliation(s)
- Nathalie Bernard
- Centre de recherche du CHU de Québec-Université Laval, 10 rue de L'Espinay, Québec City, Québec, G1L 3L5, Canada
| | - Jean-Claude Forest
- Centre de recherche du CHU de Québec-Université Laval, 10 rue de L'Espinay, Québec City, Québec, G1L 3L5, Canada.,Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec City, Canada
| | | | - Emmanuel Bujold
- Centre de recherche du CHU de Québec-Université Laval, 10 rue de L'Espinay, Québec City, Québec, G1L 3L5, Canada.,Department of Reproduction, Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Damien Bouvier
- Centre de recherche du CHU de Québec-Université Laval, 10 rue de L'Espinay, Québec City, Québec, G1L 3L5, Canada.,Department of Biochemistry and Molecular Genetics, CHU Clermont-Ferrand, and UCA, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - Yves Giguère
- Centre de recherche du CHU de Québec-Université Laval, 10 rue de L'Espinay, Québec City, Québec, G1L 3L5, Canada. .,Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec City, Canada.
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18
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Hamidi OP, Hameroff A, Kunselman A, Curtin WM, Sinha R, Ural SH. Placental thickness on ultrasound and neonatal birthweight. J Perinat Med 2019; 47:331-334. [PMID: 30504523 DOI: 10.1515/jpm-2018-0100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 11/05/2018] [Indexed: 11/15/2022]
Abstract
Objective To investigate the relationship between maximal placental thickness during routine anatomy scan and birthweight at delivery. Methods This retrospective descriptive study analyzed 200 term, singleton deliveries in 2016 at Penn State Hershey Medical Center. We measured maximal placental thickness in the sagittal plane from the ultrasound images of the placenta obtained at the 18-21-week fetal anatomy screen. The relationship between placental thickness and neonatal birthweight was assessed using Pearson's correlation coefficient (r) with 95% confidence interval (CI). Logistic regression was used to assess the association between placental thickness and secondary binary outcomes of neonatal intensive care unit (NICU) admission and poor Apgar scores. Two-sample t-tests, or exact Wilcoxon rank-sum test for non-normally distributed data, were used to assess for differences attributable to medical comorbidities (pre-gestational diabetes, gestational diabetes, chronic hypertension, gestational hypertension, preeclampsia and eclampsia). Results Placental thickness had a positive correlation with neonatal birthweight [r=0.18, 95% CI=(0.05, 0.32)]. The mean placental thickness measured 34.2±9.7 mm. The strength of the correlation remained similar when adjusting for gestational age (r=0.20) or excluding medical comorbidities (r=0.19). There was no association between placental thickness and NICU admission, Apgar scores <7 or medical comorbidities. Conclusion Our study demonstrated a positive correlation between sonographic placental thickness and birthweight. Future prospective studies are warranted in order to further investigate whether a clinically significant correlation exists while adjusting for more covariates.
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Affiliation(s)
- Odessa P Hamidi
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, 500 University Dr., Hershey, PA, USA
| | - Avi Hameroff
- Penn State Hershey Medical Center, Division of Maternal Fetal Medicine, Hershey, PA, USA
| | - Allen Kunselman
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, USA
| | - William M Curtin
- Penn State Hershey Medical Center, Division of Maternal Fetal Medicine, Hershey, PA, USA
| | - Risha Sinha
- Penn State Hershey College of Medicine, Hershey, PA, USA
| | - Serdar H Ural
- Penn State Hershey Medical Center, Division of Maternal Fetal Medicine, Hershey, PA, USA
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19
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Keshavarz E, Motevasselian M, Amirnazeri B, Bahramzadeh S, Mohammadkhani H, Mehrjardi Z, Razzaz M, Bakhtiyari M. Gestational age-specific reference values of placental thickness in normal pregnant women. Women Health 2019; 59:718-729. [PMID: 30786837 DOI: 10.1080/03630242.2018.1553816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The aim of this study was to determine the reference values of the placental thickness in 400 normal pregnant women during weeks 16-41 of gestation who were referred to the Mahdiyeh hospital during January 2014-February 2015. The placental thickness at the junction of the umbilical artery was measured using ultrasonography. Multivariable linear regression was used to model the mean placental thickness and assess associations with measured covariates, including gestational age (GA). Centiles for placental thickness distribution were estimated according to the modulus exponential-normal model. The mean and standard deviation of the age of the participants was 31.4 ± 5.7 years. The Pearson correlation coefficient indicated a very strong positive linear correlation between GA and placental thickness (p <.001; r = 0.93). A nonlinear increase of placental thickness with estimated fetal weights was observed. GA-specific placental thicknesses for the 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97.5th percentiles of placental thickness were calculated. By making use of the provided nomogram in this study, neonatal outcomes associated with the placental thickness, such as Hemoglobin Bart's disease, can be diagnosed early to improve maternal and newborn health.
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Affiliation(s)
- E Keshavarz
- a Department of Radiology , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - M Motevasselian
- b Department of Gynecology & Obstetric , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - B Amirnazeri
- b Department of Gynecology & Obstetric , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - S Bahramzadeh
- b Department of Gynecology & Obstetric , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - H Mohammadkhani
- b Department of Gynecology & Obstetric , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Z Mehrjardi
- b Department of Gynecology & Obstetric , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - M Razzaz
- c Department of Radiology , Kerman University of Medical Sciences , Kerman , Iran
| | - M Bakhtiyari
- d Non-Communicable Diseases Research Center , Alborz University of Medical Sciences , Karaj , Iran.,e Department of Community Medicine , Alborz University of Medical Sciences , Karaj , Iran
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