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Abstract
Preeclampsia is a major, frequent and potentially severe condition of pregnancy, characterized by severe hypertension and proteinuria. In this review, we describe recent advances in understanding the pathology, and discuss the long-term impacts on maternal vascular health. Next, we describe the genetic, epigenetic and immunological basis of preeclampsia. We describe the links between preeclampsia and oxidative stress in placental (trophoblast) and endothelial cells. We mention cellular and animal models commonly used to decipher modified pathophysiological pathways in a preeclamptic pregnancy compared to a normal pregnancy. Finally, we discuss the therapeutic options, readily available or in development, to improve the monitoring of pregnancies, the health of patients and that of children born from preeclamptic pregnancies.
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Affiliation(s)
- Céline Méhats
- Inserm U1016, CNRS UMR8104, Institut Cochin, équipe FGTB, 24, rue du faubourg Saint-Jacques, 75014 Paris, France
| | - Francisco Miralles
- Inserm U1016, CNRS UMR8104, Institut Cochin, équipe FGTB, 24, rue du faubourg Saint-Jacques, 75014 Paris, France
| | - Daniel Vaiman
- Inserm U1016, CNRS UMR8104, Institut Cochin, équipe FGTB, 24, rue du faubourg Saint-Jacques, 75014 Paris, France
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Berkane N, Liere P, Oudinet JP, Hertig A, Lefèvre G, Pluchino N, Schumacher M, Chabbert-Buffet N. From Pregnancy to Preeclampsia: A Key Role for Estrogens. Endocr Rev 2017; 38:123-144. [PMID: 28323944 DOI: 10.1210/er.2016-1065] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 02/28/2017] [Indexed: 02/08/2023]
Abstract
Preeclampsia (PE) results in placental dysfunction and is one of the primary causes of maternal and fetal mortality and morbidity. During pregnancy, estrogen is produced primarily in the placenta by conversion of androgen precursors originating from maternal and fetal adrenal glands. These processes lead to increased plasma estrogen concentrations compared with levels in nonpregnant women. Aberrant production of estrogens could play a key role in PE symptoms because they are exclusively produced by the placenta and they promote angiogenesis and vasodilation. Previous assessments of estrogen synthesis during PE yielded conflicting results, possibly because of the lack of specificity of the assays. However, with the introduction of reliable analytical protocols using liquid chromatography/mass spectrometry or gas chromatography/mass spectrometry, more recent studies suggest a marked decrease in estradiol levels in PE. The aim of this review is to summarize current knowledge of estrogen synthesis, regulation in the placenta, and biological effects during pregnancy and PE. Moreover, this review highlights the links among the occurrence of PE, estrogen biosynthesis, angiogenic factors, and cardiovascular risk factors. A close link between estrogen dysregulation and PE occurrence might validate estrogen levels as a biomarker but could also reveal a potential approach for prevention or cure of PE.
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Affiliation(s)
- Nadia Berkane
- Department of Gynecology and Obstetrics of University Hospital of Geneva, 1205, Genève, Switzerland.,U1195, INSERM and University Paris Sud, 94276 Kremlin Bicêtre, France
| | - Philippe Liere
- U1195, INSERM and University Paris Sud, 94276 Kremlin Bicêtre, France
| | - Jean-Paul Oudinet
- U1195, INSERM and University Paris Sud, 94276 Kremlin Bicêtre, France
| | - Alexandre Hertig
- Department of Nephrology, Tenon Hospital, APHP, 75020 Paris, France.,University of Pierre and Marie Curie, Sorbonne University, Paris 06, 75005 Paris, France.,Unité Mixte de Recherche Scientifique 1155, F-75020 Paris, France
| | - Guillaume Lefèvre
- University of Pierre and Marie Curie, Sorbonne University, Paris 06, 75005 Paris, France.,Department of Biochemistry and Hormonology, Tenon Hospital, APHP, F-75020 Paris, France
| | - Nicola Pluchino
- Department of Gynecology and Obstetrics of University Hospital of Geneva, 1205, Genève, Switzerland
| | | | - Nathalie Chabbert-Buffet
- University of Pierre and Marie Curie, Sorbonne University, Paris 06, 75005 Paris, France.,Department of Obstetrics, Gynecology and Reproductive Medicine, Tenon Hospital, APHP, F-75020 Paris, France.,INSERM, UMR-S938, Centre de Recherche Saint-Antoine, F-75012 Paris, France
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Gabory A, Chavatte-Palmer P, Vambergue A, Tarrade A. [Impact of maternal obesity and diabetes on placental function]. Med Sci (Paris) 2016; 32:66-73. [PMID: 26850609 DOI: 10.1051/medsci/20163201011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Located at the feto-maternal interface, the placenta is involved in exchange, endocrine and immune functions, which impact fetal development. In contact with the maternal environment, this organ is sensitive to metabolic disorders as over-nutrition, obesity or diabetes. The alteration of blood parameters associated with these pathologies affects placental histology, vascularization and nutrient transfers and, according to the types of troubles, induces local inflammation or hypoxia. These placental changes lead to disturbance of development and fetal growth, which increase the risk of pathologies in offspring in adulthood. The placenta thus appears as a crucial player in the fetal programming.
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Affiliation(s)
- Anne Gabory
- Inra, UMR 1198 biologie du développement et reproduction, Domaine de Vilvert, F-78350 Jouy-en-Josas, France
| | - Pascale Chavatte-Palmer
- Inra, UMR 1198 biologie du développement et reproduction, Domaine de Vilvert, F-78350 Jouy-en-Josas, France - Fondation PremUp, 4, avenue de l'Observatoire, F-75006 Paris, France
| | - Anne Vambergue
- Hôpital Claude Huriez, CHRU Lille, université Lille2, EA 4489 environnement périnatal et croissance, Faculté de médecine, place de Verdun, F-59000 Lille, France
| | - Anne Tarrade
- Inra, UMR 1198 biologie du développement et reproduction, Domaine de Vilvert, F-78350 Jouy-en-Josas, France - Fondation PremUp, 4, avenue de l'Observatoire, F-75006 Paris, France
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Serov AS, Salafia CM, Filoche M, Grebenkov DS. Analytical theory of oxygen transport in the human placenta. J Theor Biol 2015; 368:133-44. [PMID: 25580015 DOI: 10.1016/j.jtbi.2014.12.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/23/2014] [Indexed: 11/18/2022]
Abstract
We propose an analytical approach to solving the diffusion-convection equations governing oxygen transport in the human placenta. We show that only two geometrical characteristics of a placental cross-section, villi density and the effective villi radius, are needed to predict fetal oxygen uptake. We also identify two combinations of physiological parameters that determine oxygen uptake in a given placenta: (i) the maximal oxygen inflow of a placentone if there were no tissue blocking the flow and (ii) the ratio of transit time of maternal blood through the intervillous space to oxygen extraction time. We derive analytical formulas for fast and simple calculation of oxygen uptake and provide two diagrams of efficiency of oxygen transport in an arbitrary placental cross-section. We finally show that artificial perfusion experiments with no-hemoglobin blood tend to give a two-orders-of-magnitude underestimation of the in vivo oxygen uptake and that the optimal geometry for such setup alters significantly. The theory allows one to adjust the results of artificial placenta perfusion experiments to account for oxygen-hemoglobin dissociation. Combined with image analysis techniques, the presented model can give an easy-to-use tool for prediction of the human placenta efficiency.
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Affiliation(s)
- A S Serov
- Laboratoire de Physique de la Matière Condensée, Ecole Polytechnique, CNRS, 91128 Palaiseau Cedex, France.
| | - C M Salafia
- Placental Analytics LLC, 93 Colonial Avenue, Larchmont, New York 10538, USA
| | - M Filoche
- Laboratoire de Physique de la Matière Condensée, Ecole Polytechnique, CNRS, 91128 Palaiseau Cedex, France
| | - D S Grebenkov
- Laboratoire de Physique de la Matière Condensée, Ecole Polytechnique, CNRS, 91128 Palaiseau Cedex, France
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Optimal villi density for maximal oxygen uptake in the human placenta. J Theor Biol 2015; 364:383-96. [DOI: 10.1016/j.jtbi.2014.09.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/31/2014] [Accepted: 09/16/2014] [Indexed: 11/22/2022]
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Adam I, Elhassan EM, Mohmmed AA, Salih MM, Elbashir MI. Malaria and pre-eclampsia in an area with unstable malaria transmission in Central Sudan. Malar J 2011; 10:258. [PMID: 21899731 PMCID: PMC3224261 DOI: 10.1186/1475-2875-10-258] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 09/07/2011] [Indexed: 11/17/2022] Open
Abstract
Background Placental malaria and pre-eclampsia occur frequently in women in tropics and are leading causes of maternal and perinatal morbidities and mortality. Few data exist concerning the interaction between placental malaria and pre-eclampsia. Methods A case control study was conducted in Medani Hospital, which locates in an area of unstable malaria transmission in Central Sudan. Case (N = 143) were women with pre-eclampsia, which was defined as systolic blood presure≥140 mm Hg or diastolic blood pressure ≥ 90 mm Hg and proteinuria. Controls were parturient women (N = 143) without any blood pressure values > 139/89 mm Hg or proteinuria. Obstetrical and medical characteristics were gathered from both groups through structured questionnaires. Placental histopathology examinations for malaria were performed. Results Twenty-eight (19.6%) vs. 16 (11.2%); P = 0.04 of the cases vs. controls, had placental malaria infections. Five (2%), 1 (2%) and 22 (28.0%) vs. 1, 2 and 13 of the placentae showed acute, chronic and past infection on histopathology examination in the two groups respectively, while 115 (80.4%) vs.127 (88.8%) of them showed no infection, P = 0.04. In multivariate analysis, while there were no associations between age, parity, educational level, lack of antenatal care, blood groups and body mass index and pre-eclampsia; family history of hypertension and placental malaria (OR = 2.3, 95% CI = 1.0-5.2; P = 0.04) were significantly associated with pre-eclampsia. Conclusion Placental malaria was associated with pre-eclampsia. Further research is needed.
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Affiliation(s)
- Ishag Adam
- Faculty of Medicine, University of Khartoum, PO Box 102, Khartoum, Sudan.
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Mayeur S, Lukaszewski MA, Breton C, Storme L, Junien C, Vieau D, Lesage J. Le BDNF. Med Sci (Paris) 2011; 27:251-2. [DOI: 10.1051/medsci/2011273251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Tranquilli AL, Landi B. The origin of pre-eclampsia: from decidual "hyperoxia" to late hypoxia. Med Hypotheses 2010; 75:38-46. [PMID: 20171021 DOI: 10.1016/j.mehy.2010.01.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 01/20/2010] [Indexed: 11/24/2022]
Abstract
Normal gestation implants on a relatively hypoxic deciduas so that trophoblast deeply invades endometrium and angiogenesis seeks for oxygen supply. If implantation occurs before those hypoxic conditions occur, trophoblast invasion is defective, due to the relatively high oxygen tension in the decidual environment, laying the foundations for subsequent pre-eclampsia.
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Affiliation(s)
- Andrea L Tranquilli
- Department of Clinical Sciences, Section of Women's Health Sciences, Università Politecnica Marche, Ancona, Italy.
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Gheorghe CP, Goyal R, Mittal A, Longo LD. Gene expression in the placenta: maternal stress and epigenetic responses. THE INTERNATIONAL JOURNAL OF DEVELOPMENTAL BIOLOGY 2010; 54:507-23. [PMID: 19876832 PMCID: PMC2830734 DOI: 10.1387/ijdb.082770cg] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Successful placental development is crucial for optimal growth, development, maturation and survival of the embryo/fetus into adulthood. Numerous epidemiologic and experimental studies have demonstrated the profound influence of intrauterine environment on life, and the diseases to which one is subject as an adult. For the most part, these invidious influences, whether maternal hypoxia, protein or caloric deficiency or excess, and others, represent types of maternal stress. In the present review, we examine certain aspects of gene expression in the placenta as a consequence of maternal stressors. To examine these issues in a controlled manner, and in a species in which the genome has been sequenced, most of these reported studies have been performed in the mouse. Although each individual maternal stress is characterized by up- or down-regulation of specific genes in the placenta, functional analysis reveals some patterns of gene expression common to the several forms of stress. Of critical importance, these genes include those involved in DNA methylation and histone modification, cell cycle regulation, and related global pathways of great relevance to epigenesis and the developmental origins of adult health and disease.
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Affiliation(s)
- Ciprian P Gheorghe
- Center for Perinatal Biology, Department of Physiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Ndao CT, Dumont A, Fievet N, Doucoure S, Gaye A, Lehesran JY. Placental malarial infection as a risk factor for hypertensive disorders during pregnancy in Africa: a case-control study in an urban area of Senegal, West Africa. Am J Epidemiol 2009; 170:847-53. [PMID: 19679749 DOI: 10.1093/aje/kwp207] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In tropical countries, malaria and hypertension are common diseases of pregnancy. They have physiopathologic similarities such as placental ischemia, endothelial dysfunction, and production of proinflammatory cytokines. Recent findings suggested their possible link. The authors conducted a case-control study to explore the relation between malaria and hypertension at Guediawaye, a hypoendemic malarial setting in Senegal. Cases were pregnant women admitted to the delivery unit for hypertension. Controls were pregnant women admitted for normal delivery, without any history of hypertension or proteinuria during the present pregnancy. Malarial infection was determined by placental tissue examination. From January to December 2002, 77 cases of gestational hypertension, 113 cases of preeclampsia, 59 cases of eclampsia, and 241 controls were enrolled. Placental malarial infection (PMI) was present in 14 cases (6.3%) and in 15 controls (6.2%). The prevalence of PMI was 4.6% for eclampsia, 4.0% for preeclampsia, and 11.6% for gestational hypertension. In multivariate analysis, PMI appeared to be an independent risk factor for gestational hypertension (adjusted odds ratio = 2.7, 95% confidence interval: 1.0, 7.6). The authors found an association between PMI and nonproteinuric hypertension in women living in a malaria-hypoendemic area. The exact significance of such relation should be clarified in further studies in different settings of malarial endemicity.
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Affiliation(s)
- C T Ndao
- Santé de la mere et de l'enfant en milieu tropical, Institut de Recherche pour le Développement, Dakar, Senegal.
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Infection palustre placentaire et issue de l’accouchement dans une zone péri-urbaine au Sénégal. Rev Epidemiol Sante Publique 2006. [DOI: 10.1016/s0398-7620(06)76708-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vaiman D, Mondon F, Garcès-Duran A, Mignot TM, Robert B, Rebourcet R, Jammes H, Chelbi ST, Quetin F, Marceau G, Sapin V, Piumi F, Danan JL, Rigourd V, Carbonne B, Ferré F. Hypoxia-activated genes from early placenta are elevated in preeclampsia, but not in Intra-Uterine Growth Retardation. BMC Genomics 2005; 6:111. [PMID: 16129025 PMCID: PMC1236921 DOI: 10.1186/1471-2164-6-111] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 08/29/2005] [Indexed: 11/25/2022] Open
Abstract
Background As a first step to explore the possible relationships existing between the effects of low oxygen pressure in the first trimester placenta and placental pathologies developing from mid-gestation, two subtracted libraries totaling 2304 cDNA clones were constructed. For achieving this, two reciprocal suppressive/subtractive hybridization procedures (SSH) were applied to early (11 weeks) human placental villi after incubation either in normoxic or in hypoxic conditions. The clones from both libraries (1440 hypoxia-specific and 864 normoxia-specific) were spotted on nylon macroarrays. Complex cDNAs probes prepared from placental villi (either from early pregnancy, after hypoxic or normoxic culture conditions, or near term for controls or pathological placentas) were hybridized to the membranes. Results Three hundred and fifty nine clones presenting a hybridization signal above the background were sequenced and shown to correspond to 276 different genes. Nine of these genes are mitochondrial, while 267 are nuclear. Specific expression profiles characteristic of preeclampsia (PE) could be identified, as well as profiles specific of intra-uterine growth retardation (IUGR). Focusing on the chromosomal distribution of the fraction of genes that responded in at least one hybridization experiment, we could observe a highly significant chromosomal clustering of 54 genes into 8 chromosomal regions, four of which containing imprinted genes. Comparative mapping data indicate that these imprinted clusters are maintained in synteny in mice, and apparently in cattle and pigs, suggesting that the maintenance of such syntenies is requested for achieving a normal placental physiology in eutherian mammals. Conclusion We could demonstrate that genes induced in PE were also genes highly expressed under hypoxic conditions (P = 5.10-5), which was not the case for isolated IUGR. Highly expressed placental genes may be in syntenies conserved interspecifically, suggesting that the maintenance of such clusters is requested for achieving a normal placental physiology in eutherian mammals.
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Affiliation(s)
- Daniel Vaiman
- Génétique et Epigénétique des Pathologies Placentaires, GEPP, U709 INSERM-Université René Descartes-Institut Alfred Jost, Pavillon Baudelocque, Hôpital Cochin, 123 Boulevard de Port-Royal, 75014, Paris, France
- Département de Génétique Animale, INRA, 78352, Jouy-en-Josas,, France
| | - Françoise Mondon
- Génétique et Epigénétique des Pathologies Placentaires, GEPP, U709 INSERM-Université René Descartes-Institut Alfred Jost, Pavillon Baudelocque, Hôpital Cochin, 123 Boulevard de Port-Royal, 75014, Paris, France
| | - Alexandra Garcès-Duran
- Génétique et Epigénétique des Pathologies Placentaires, GEPP, U709 INSERM-Université René Descartes-Institut Alfred Jost, Pavillon Baudelocque, Hôpital Cochin, 123 Boulevard de Port-Royal, 75014, Paris, France
| | - Thérèse-Marie Mignot
- Génétique et Epigénétique des Pathologies Placentaires, GEPP, U709 INSERM-Université René Descartes-Institut Alfred Jost, Pavillon Baudelocque, Hôpital Cochin, 123 Boulevard de Port-Royal, 75014, Paris, France
| | - Brigitte Robert
- Génétique et Epigénétique des Pathologies Placentaires, GEPP, U709 INSERM-Université René Descartes-Institut Alfred Jost, Pavillon Baudelocque, Hôpital Cochin, 123 Boulevard de Port-Royal, 75014, Paris, France
| | - Régis Rebourcet
- Génétique et Epigénétique des Pathologies Placentaires, GEPP, U709 INSERM-Université René Descartes-Institut Alfred Jost, Pavillon Baudelocque, Hôpital Cochin, 123 Boulevard de Port-Royal, 75014, Paris, France
| | - Hélène Jammes
- Génétique et Epigénétique des Pathologies Placentaires, GEPP, U709 INSERM-Université René Descartes-Institut Alfred Jost, Pavillon Baudelocque, Hôpital Cochin, 123 Boulevard de Port-Royal, 75014, Paris, France
| | - Sonia T Chelbi
- Génétique et Epigénétique des Pathologies Placentaires, GEPP, U709 INSERM-Université René Descartes-Institut Alfred Jost, Pavillon Baudelocque, Hôpital Cochin, 123 Boulevard de Port-Royal, 75014, Paris, France
| | - Frédérique Quetin
- Génétique et Epigénétique des Pathologies Placentaires, GEPP, U709 INSERM-Université René Descartes-Institut Alfred Jost, Pavillon Baudelocque, Hôpital Cochin, 123 Boulevard de Port-Royal, 75014, Paris, France
| | - Geoffrey Marceau
- Laboratoire de Biochimie Medicale, Faculte de Medecine et de Pharmacie, UMR INSERM U.384 UA, 28 Place Henri Dunant, BP. 38, 63000 Clermont-Ferrand, France
| | - Vincent Sapin
- Laboratoire de Biochimie Medicale, Faculte de Medecine et de Pharmacie, UMR INSERM U.384 UA, 28 Place Henri Dunant, BP. 38, 63000 Clermont-Ferrand, France
| | - François Piumi
- Centre de Ressources Biologiques, Laboratoire de Radiobiologie et d'Etudes des Génomes, Centre de Recherches INRA de Jouy-en-Josas, INRA, CRJJ, 78352 Jouy-en-Josas, France
| | - Jean-Louis Danan
- UPR CNRS 9078, Université René Descartes ParisV, Site Necker, 156 rue de Vaugirard, 75015 Paris, France
| | - Virginie Rigourd
- Génétique et Epigénétique des Pathologies Placentaires, GEPP, U709 INSERM-Université René Descartes-Institut Alfred Jost, Pavillon Baudelocque, Hôpital Cochin, 123 Boulevard de Port-Royal, 75014, Paris, France
- Service de Réanimation Néonatale, Institut de Puériculture et de Périnatalogie, 26, boulevard Brune, 75014 Paris, France
| | - Bruno Carbonne
- Génétique et Epigénétique des Pathologies Placentaires, GEPP, U709 INSERM-Université René Descartes-Institut Alfred Jost, Pavillon Baudelocque, Hôpital Cochin, 123 Boulevard de Port-Royal, 75014, Paris, France
- Service de Gynecologie-Obstetrique, Hopital Saint Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris, France
| | - Françoise Ferré
- Génétique et Epigénétique des Pathologies Placentaires, GEPP, U709 INSERM-Université René Descartes-Institut Alfred Jost, Pavillon Baudelocque, Hôpital Cochin, 123 Boulevard de Port-Royal, 75014, Paris, France
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Suárez Obando F, Zarante Montoya I, Céspedes Salazar C. [Development of endocrinological systemic diseases in the adult, the fetal programming hypothesis]. Med Clin (Barc) 2005; 124:423-6. [PMID: 15799850 DOI: 10.1157/13072856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Fernando Suárez Obando
- Servicio de Genética Médica, Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá, Colombia.
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