1
|
Mir IN, White SP, Steven Brown L, Heyne R, Rosenfeld CR, Chalak LF. Autism spectrum disorders in extremely preterm infants and placental pathology findings: a matched case-control study. Pediatr Res 2021; 89:1825-1831. [PMID: 32950030 DOI: 10.1038/s41390-020-01160-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The prevalence of autism spectrum disorders (ASD) is 5-fold higher in preterm (PT) infants born ≤28 weeks gestational age (GA) as compared to the general population. The relationship between placental pathologic lesions and ASD in PT infants has not been studied. OBJECTIVES The objective of this study was to determine the association of placental pathology with the occurrence of ASD in PT infants born ≤28 weeks GA. STUDY DESIGN A matched case-control study to identify confirmed ASD cases (n = 16) and matched controls (n = 48) born at Parkland Hospital between January 2012 and December 2015. Patients were matched using known variables associated with increased risk of ASD in PT infants. Placental histology from all births was reviewed. RESULTS Children with ASD had 2-fold greater incidence of multiple placental pathologic lesions vs. matched controls [11/16 (69%) vs.16/48 (33%), respectively; P = 0.01]. In contrast, single placental pathologic lesions were not associated with ASD [5/16 (31%) vs. 21/48 (43%), respectively; P = 0.1]. CONCLUSIONS In this study, we have demonstrated an association between the increasing complexity of histologic placental lesions and the later risk for ASD in infants born ≤28 weeks GA. Thus, placental pathology findings may be valuable in further understanding the prenatal pathologic processes underlying ASD in PT infants. IMPACT PT infants with ASD have a 2-fold greater incidence of multiple placental pathologies. This is the first study to report an association between the complexity of histologic placental lesions and later risk of ASD in infant born extremely PT (i.e., ≤28 weeks GA). This study reiterates the importance of examining placental pathologic lesions, since placental evidence of antenatal insults correlates with postnatal morbidities and mortality in PT infants.
Collapse
Affiliation(s)
- Imran N Mir
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA.
| | - Stormi P White
- Department of Pediatrics, Division of Autism and Related Disorders, Emory University School of Medicine and Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Roy Heyne
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Charles R Rosenfeld
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Lina F Chalak
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
| |
Collapse
|
2
|
Placental origins of neonatal diseases: toward a precision medicine approach. Pediatr Res 2021; 89:377-383. [PMID: 33288874 DOI: 10.1038/s41390-020-01293-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 01/30/2023]
Abstract
The placenta is the single most reliable source for precise information on intrauterine environment, as well as maternal and fetal health. It mediates the physiology of two distinct yet highly interconnected individuals. The pathology that develops in the placenta, and the adaptations the placenta undergoes to mitigate this pathology, may influence the later life health of the mother and baby. Pathological placental examination provides a unique opportunity to explore and understand the intrauterine environment, as well as providing a record of events that may be associated with adverse pregnancy outcomes. A number of placental lesions have been described in association with various neonatal morbidities. The purpose of this review is to summarize the evidence for the association of placental pathologic lesions with neurodevelopmental outcomes infants with specific neonatal morbidities, including (1) neonatal encephalopathy, (2) bronchopulmonary dysplasia, (3) congenital heart diseases, and (4) autism spectrum disorders. For each of these disease processes, we will also propose specific research priorities in future studies. We conclude with a hospital-specific protocol for triaging which placentas should receive histological evaluation as a fundamental first step for the field of neuroplacentology to guide precision-based therapeutic approaches in the affected newborns. IMPACT: The purpose of this review is to summarize the evidence for placental origins of neonatal diseases. We propose specific research priorities in the field of neuroplacentology in future studies. We also present a targeted hospital-based approach for triaging which placentas should receive histological evaluation.
Collapse
|
3
|
Mir IN, Chalak LF, Brown LS, Johnson-Welch S, Heyne R, Rosenfeld CR, Kapadia VS. Impact of multiple placental pathologies on neonatal death, bronchopulmonary dysplasia, and neurodevelopmental impairment in preterm infants. Pediatr Res 2020; 87:885-891. [PMID: 31812153 PMCID: PMC7223700 DOI: 10.1038/s41390-019-0715-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND To determine the association of placental pathology, including multiple placental lesions, with the occurrence and severity of bronchopulmonary dysplasia (BPD), death, and neurodevelopmental impairment (NDI) in preterm infants. METHOD A retrospective cohort study of neonates <29 weeks gestational age (GA) born at Parkland Hospital from 08/2009 to 08/2012. Infants were stratified as follows: Group 1: no significant placental pathology; Group 2: single significant placental lesion; and Group 3: ≥2 placental lesions (multiple lesions). Primary outcome was death and/or BPD. Two-year neurodevelopmental follow-up was compared. RESULTS In all, 42% (100/241) of infants had one placental lesion, and 34% (82/241) ≥2 lesions. As the number of the pathologic lesions increased (no lesions vs. 1 vs. ≥2), the occurrence of death or BPD increased (25%, 37%, and 52%, respectively; P = 0.004). Moreover, infants with multiple pathologic lesions were more likely to have NDI (29%, 29%, and 46%, respectively; P = 0.03). After logistic regression, infants with multiple pathologic lesions were more likely to develop moderate-to-severe BPD [P < 0.01; OR 3.9 (1.5-10.1)] but not NDI. CONCLUSION(S) Neonates <29 weeks GA with multiple placental pathologic lesions have an increased risk for developing BPD, suggesting an interaction between placental inflammation and vascular pathology and the pathogenesis of BPD; however, the risk of NDI is not increased.
Collapse
Affiliation(s)
- Imran N. Mir
- 0000 0000 9482 7121grid.267313.2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, TX 75390 USA
| | - Lina F. Chalak
- 0000 0000 9482 7121grid.267313.2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, TX 75390 USA
| | - L. Steven Brown
- 0000 0000 9482 7121grid.267313.2Parkland Health and Hospital Systems, UT Southwestern Medical School, Dallas, TX 75390 USA
| | - Sarah Johnson-Welch
- 0000 0000 9482 7121grid.267313.2Department of Pathology, UT Southwestern Medical School, Dallas, TX 75390 USA
| | - Roy Heyne
- 0000 0000 9482 7121grid.267313.2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, TX 75390 USA
| | - Charles R. Rosenfeld
- 0000 0000 9482 7121grid.267313.2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, TX 75390 USA
| | - Vishal S. Kapadia
- 0000 0000 9482 7121grid.267313.2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, TX 75390 USA
| |
Collapse
|
4
|
Ogawa J, Suzuki S. Clinical characteristics of pregnancies complicated by both fetal growth restriction and placenta previa or low-lying placenta. HYPERTENSION RESEARCH IN PREGNANCY 2019. [DOI: 10.14390/jsshp.hrp2019-009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jun Ogawa
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital
| |
Collapse
|
5
|
Nicotine protects fetus against LPS-induced fetal growth restriction through ameliorating placental inflammation and vascular development in late pregnancy in rats. Biosci Rep 2019; 39:BSR20190386. [PMID: 31209145 PMCID: PMC6603276 DOI: 10.1042/bsr20190386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/14/2019] [Accepted: 06/12/2019] [Indexed: 01/19/2023] Open
Abstract
Our previous work has shown that nicotine suppressed lipopolysaccharide (LPS)-induced placental inflammation by inhibiting cytokine release as well as infiltration of leukocytes into the placenta through the cholinergic anti-inflammatory pathway. Nicotine also increased fetal survival and restored pup weight. In the present study, we aim to further investigate if fetal growth restriction (FGR) occurs with LPS treatment, and evaluate the protective effects of nicotine on fetuses in late gestation of rats. Pregnant Sprague–Dawley rats were divided into control group, nicotine group, LPS group and LPS + nicotine group. Rats were first pretreated with nicotine or vehicle by subcutaneous injection on gestation day (GD)14 and GD15, followed by LPS or vehicle intraperitoneal injection on GD16, and were killed on GD18. Loss of fetuses, number and weights of live fetuses and weights of placentas were recorded. Placentas were collected to evaluate placental pathology and determine inflammatory cytokines and vascular endothelial growth factor (VEGF) levels. We found that LPS treatment increased levels of placental inflammatory cytokines and placental pathological damage, decreased levels of VEGF, reduced number of live fetuses and induced FGR. Pretreatment with nicotine reversed LPS-induced high levels of placental inflammatory cytokines, low levels of placental VEGF and placental pathological damage, then rescued the number and weights of live fetuses. These data demonstrated that activation of the cholinergic anti-inflammatory pathway by nicotine protected fetus against LPS-induced FGR through ameliorating placental inflammation and vascular development in late pregnancy in rats. It may be an alternative therapeutic strategy for inflammation- induced FGR in late pregnancy.
Collapse
|
6
|
Maged AM, Waly M, AbdelHak A, Eissa TS, Osman NK. Correlation of Doppler Velocimetry of Uterine and Umbilical Arteries with Placental Pathology in Pregnancy Associated with Intrauterine Growth Restriction. JOURNAL OF FETAL MEDICINE 2019. [DOI: 10.1007/s40556-019-00191-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
7
|
Taylor T, Quinton A, Hyett J. The developmental origins of placental function. Australas J Ultrasound Med 2017; 20:141-146. [PMID: 34760487 DOI: 10.1002/ajum.12071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The placenta is the link between mother and fetus and its function is central to a successful pregnancy. The predominant theory within the literature is that the development of placental dysfunction is a result of abnormal trophoblast invasion early in pregnancy. Knowledge of the development of the early placenta and the establishment of the fetomaternal circulation assists in understanding the origins of placental dysfunction which manifest later in pregnancy. Perinatally, chronic placental dysfunction may result in a growth-restricted fetus, maternal problems such as gestational hypertension, pre-eclampsia, eclampsia and pregnancy complications such as placental abruption, preterm labour and delivery. In addition, the growth-restricted fetus and the mother are at an increased risk of a myriad of disorders later in life. The role of ultrasound in the assessment of first trimester pregnancy is evolving with the potential for value in the prediction of placental function in later pregnancy. This review will address two aims, first to describe the development of the placenta from fertilisation to 12 weeks' gestation, correlating this with first trimester ultrasound findings. Second, to describe the link between placental development and function later in pregnancy. Understanding the link between early placental development and later placental function is essential in directing the focus of new research addressing the role of ultrasound in the first trimester in the prediction of adverse obstetric outcomes.
Collapse
Affiliation(s)
- Tracey Taylor
- South Coast Ultrasound for Women 10/363 Crown Street Wollongong New South Wales 2500 Australia.,Discipline of Obstetrics, Gynaecology and Neonatology Central Clinical School Faculty of Medicine University of Sydney Camperdown New South Wales 2006 Australia
| | - Ann Quinton
- School of Health, Medical and Applied Science Central Queensland University 400 Kent Street Sydney New South Wales 2000 Australia.,Discipline of Obstetrics, Gynaecology and Neonatology Nepean School Faculty of Medicine University of Sydney Camperdown New South Wales 2006 Australia
| | - Jonathan Hyett
- Discipline of Obstetrics, Gynaecology and Neonatology Central Clinical School Faculty of Medicine University of Sydney Camperdown New South Wales 2006 Australia.,RPA Women and Babies Royal Prince Alfred Hospital 50 Missenden Road Camperdown New South Wales 2050 Australia
| |
Collapse
|
8
|
High rate of chronic villitis in placentas of pregnancies complicated by influenza A/H1N1 infection. Infect Dis Obstet Gynecol 2014; 2014:768380. [PMID: 24693211 PMCID: PMC3947755 DOI: 10.1155/2014/768380] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/30/2013] [Accepted: 01/02/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Pandemic influenza A/H1N1 infection during pregnancy has a negative impact on several aspects of pregnancy outcome. As yet, no elucidating mechanism has been revealed for these effects. We investigated whether placentas of pregnancies complicated by 2009 influenza A/H1N1 infection demonstrated an increased rate of chronic villitis and whether this villitis was caused by influenza virus. METHODS We performed a cohort study on 145 pregnant outpatients during the 2009-2010 influenza A H1N1 pandemic. The placentas of patients with influenza infection were examined for histologic signs of chronic villitis. In case of villitis, polymerase chain reaction (PCR) on influenza virus was performed on placental tissue. RESULTS 29 patients had influenza infection. Placentas of 15 of these patients were collected and examined. In 7 cases (47%) chronic villitis was detected. Placental weight and birth weight of the neonates did not differ between cases with and without chronic villitis. In all cases PCR was negative for influenza. CONCLUSION In our series, chronic villitis was present in a high proportion of placentas of pregnancies complicated by 2009 influenza A/H1N1 infection. We could not demonstrate the presence of influenza virus in placental tissue.
Collapse
|
9
|
Janzen C, Lei MYY, Cho J, Sullivan P, Shin BC, Devaskar SU. Placental glucose transporter 3 (GLUT3) is up-regulated in human pregnancies complicated by late-onset intrauterine growth restriction. Placenta 2013; 34:1072-8. [PMID: 24011442 DOI: 10.1016/j.placenta.2013.08.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 08/10/2013] [Accepted: 08/14/2013] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Transport of glucose from maternal blood across the placental trophoblastic tissue barrier is critical to sustain fetal growth. The mechanism by which GLUTs are regulated in trophoblasts in response to ischemic hypoxia encountered with intrauterine growth restriction (IUGR) has not been suitably investigated. OBJECTIVE To investigate placental expression of GLUT1, GLUT3 and GLUT4 and possible mechanisms of GLUT regulation in idiopathic IUGR. METHODS We analyzed clinical, biochemical and histological data from placentas collected from women affected by idiopathic full-term IUGR (n = 10) and gestational age-matched healthy controls (n = 10). RESULTS We found increased GLUT3 protein expression in the trophoblast (cytotrophoblast greater than syncytiotrophoblast) on the maternal aspect of the placenta in IUGR compared to normal placenta, but no differences in GLUT1 or GLUT4 were found. No differential methylation of the GLUT3 promoter between normal and IUGR placentas was observed. Increased GLUT3 expression was associated with an increased nuclear concentration of HIF-1α, suggesting hypoxia may play a role in the up-regulation of GLUT3. DISCUSSION Further studies are needed to elucidate whether increased GLUT3 expression in IUGR is a marker for defective villous maturation or an adaptive response of the trophoblast in response to chronic hypoxia. CONCLUSIONS Patients with IUGR have increased trophoblast expression of GLUT3, as found under the low-oxygen conditions of the first trimester.
Collapse
Affiliation(s)
- C Janzen
- Department of Obstetrics and Gynecology, Division of Perinatology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
| | | | | | | | | | | |
Collapse
|
10
|
Saben J, Zhong Y, Gomez-Acevedo H, Thakali KM, Borengasser SJ, Andres A, Shankar K. Early growth response protein-1 mediates lipotoxicity-associated placental inflammation: role in maternal obesity. Am J Physiol Endocrinol Metab 2013; 305:E1-14. [PMID: 23632636 PMCID: PMC4116409 DOI: 10.1152/ajpendo.00076.2013] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obesity is associated with low-grade chronic inflammation, which contributes to cellular dysfunction promoting metabolic disease. Obesity during pregnancy leads to a proinflammatory milieu in the placenta; however, the underlying causes for obesity-induced placental inflammation remain unclear. Here, we examine the mechanisms by which saturated fatty acids and inflammatory cytokines induce inflammation in placental trophoblasts. We conducted global transcriptomic profiling in BeWo cells following palmitate and/or TNFα treatment and gene/protein expression analyses of MAPK pathways and characterized downstream transcription factors directly regulating inflammatory cytokines. Microarray analysis revealed increased expression of genes regulating inflammation, stress response, and immediate early response in cytotrophoblasts in response to palmitic acid (PA), TNFα, or a combination of both (PA + TNFα). Both gene ontology and gene set enrichment analysis revealed MAPK and EGR-1 signaling to be upregulated in BeWo cells, which was confirmed via immunoblotting. Importantly, activation of JNK signaling was necessary for increased proinflammatory cytokine (IL-6, TNFα, and IL-8) and EGR1 mRNA. Consistent with the requirement of JNK signaling, ChIP analysis confirmed the recruitment of c-Jun and other MAPK-responsive immediate early factors on the EGR1 promoter. Moreover, recruitment of EGR-1 on cytokine promoters (IL-6, TNFα, and IL-8) and an impaired proinflammatory response following knockdown of EGR-1 suggested it as a central component of the mechanism facilitating inflammatory gene expression. Finally, akin to in vitro findings, term placenta from obese women also had both increased JNK and p38 signaling and greater EGR-1 protein relative to lean women. Our results demonstrate that lipotoxic insults induce inflammation in placental cells via activation of JNK/EGR-1 signaling.
Collapse
Affiliation(s)
- Jessica Saben
- Arkansas Children's Nutrition Center, Little Rock, AR 72202, USA
| | | | | | | | | | | | | |
Collapse
|