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Rahman S, Islam MS, Roy AK, Hasan T, Chowdhury NH, Ahmed S, Raqib R, Baqui AH, Khanam R. Maternal serum biomarkers of placental insufficiency at 24-28 weeks of pregnancy in relation to the risk of delivering small-for-gestational-age infant in Sylhet, Bangladesh: a prospective cohort study. BMC Pregnancy Childbirth 2024; 24:418. [PMID: 38858611 PMCID: PMC11163798 DOI: 10.1186/s12884-024-06588-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/15/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Small-for-gestational-age (SGA), commonly caused by poor placentation, is a major contributor to global perinatal mortality and morbidity. Maternal serum levels of placental protein and angiogenic factors are changed in SGA. Using data from a population-based pregnancy cohort, we estimated the relationships between levels of second-trimester pregnancy-associated plasma protein-A (PAPP-A), placental growth factor (PlGF), and serum soluble fms-like tyrosine kinase-1 (sFlt-1) with SGA. METHODS Three thousand pregnant women were enrolled. Trained health workers prospectively collected data at home visits. Maternal blood samples were collected, serum aliquots were prepared and stored at -80℃. Included in the analysis were 1,718 women who delivered a singleton live birth baby and provided a blood sample at 24-28 weeks of gestation. We used Mann-Whitney U test to examine differences of the median biomarker concentrations between SGA (< 10th centile birthweight for gestational age) and appropriate-for-gestational-age (AGA). We created biomarker concentration quartiles and estimated the risk ratios (RRs) and 95% confidence intervals (CIs) for SGA by quartiles separately for each biomarker. A modified Poisson regression was used to determine the association of the placental biomarkers with SGA, adjusting for potential confounders. RESULTS The median PlGF level was lower in SGA pregnancies (934 pg/mL, IQR 613-1411 pg/mL) than in the AGA (1050 pg/mL, IQR 679-1642 pg/mL; p < 0.001). The median sFlt-1/PlGF ratio was higher in SGA pregnancies (2.00, IQR 1.18-3.24) compared to AGA pregnancies (1.77, IQR 1.06-2.90; p = 0.006). In multivariate regression analysis, women in the lowest quartile of PAPP-A showed 25% higher risk of SGA (95% CI 1.09-1.44; p = 0.002). For PlGF, SGA risk was higher in women in the lowest (aRR 1.40, 95% CI 1.21-1.62; p < 0.001) and 2nd quartiles (aRR 1.30, 95% CI 1.12-1.51; p = 0.001). Women in the highest and 3rd quartiles of sFlt-1 were at reduced risk of SGA delivery (aRR 0.80, 95% CI 0.70-0.92; p = 0.002, and aRR 0.86, 95% CI 0.75-0.98; p = 0.028, respectively). Women in the highest quartile of sFlt-1/PlGF ratio showed 18% higher risk of SGA delivery (95% CI 1.02-1.36; p = 0.025). CONCLUSIONS This study provides evidence that PAPP-A, PlGF, and sFlt-1/PlGF ratio measurements may be useful second-trimester biomarkers for SGA.
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Affiliation(s)
- Sayedur Rahman
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, Uppsala, SE- 751 85, Sweden.
| | | | - Anjan Kumar Roy
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tarik Hasan
- Projahnmo Research Foundation, Banani, Dhaka, 1213, Bangladesh
| | | | | | - Rubhana Raqib
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
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Palmrich P, Kalafat E, Pateisky P, Schirwani-Hartl N, Haberl C, Herrmann C, Khalil A, Binder J. Prognostic value of angiogenic markers in pregnancy with fetal growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:619-626. [PMID: 37774098 DOI: 10.1002/uog.27509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/01/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE Pregnancies with fetal growth restriction (FGR) are at increased risk for pre-eclampsia. Angiogenic markers including soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are altered in pregnancies complicated by FGR, but their utility for predicting pre-eclampsia in growth-restricted pregnancies is uncertain. This study aimed to evaluate the prognostic value of angiogenic markers for predicting the development of pre-eclampsia in pregnancies with FGR and suspected pre-eclampsia. METHODS This was a retrospective study of singleton pregnancies with FGR, defined according to Delphi consensus criteria, which underwent sampling of sFlt-1 and PlGF for suspicion of pre-eclampsia at the Medical University of Vienna, Vienna, Austria, between 2013 and 2020. Women with an established diagnosis of pre-eclampsia at sampling were excluded. Cox regression analysis and logistic regression analysis were performed to evaluate the association of angiogenic markers with the development of pre-eclampsia at various timepoints. RESULTS In this cohort of 93 women, pre-eclampsia was diagnosed in 14 (15.1%) women within 1 week after sampling, 21 (22.6%) within 2 weeks after sampling and 38 (40.9%) at any time after assessment. The sFlt-1/PlGF ratio consistently showed a stronger association with the development of pre-eclampsia compared to sFlt-1 or PlGF alone (pre-eclampsia within 1 week: area under the receiver-operating-characteristics curve, 0.87 vs 0.82 vs 0.72). Models including the sFlt-1/PlGF ratio were associated more strongly with pre-eclampsia hazard compared to models including sFlt-1 or PlGF alone (concordance index, 0.790 vs 0.759 vs 0.755). The risk classification capability of the sFlt-1/PlGF ratio decreased after the 2-week timepoint. The established cut-off value for the sFlt-1/PlGF ratio of < 38 was effective for ruling out pre-eclampsia within 2 weeks, with a negative predictive value of 0.933 and sensitivity of 0.952. CONCLUSIONS Use of the sFlt-1/PlGF ratio is preferrable to the use of PlGF alone for the prediction of pre-eclampsia in pregnancies with FGR. Established cut-offs for ruling out the development of pre-eclampsia in the short term seem to be effective in these patients. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- P Palmrich
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - E Kalafat
- Department of Obstetrics and Gynecology, School of Medicine, Koc University, Istanbul, Turkey
| | - P Pateisky
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - N Schirwani-Hartl
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - C Haberl
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - C Herrmann
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - J Binder
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
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Grundeken M, Gustin K, Vahter M, Delaval M, Barman M, Sandin A, Sandberg AS, Wold AE, Broberg K, Kippler M. Toxic metals and essential trace elements in placenta and their relation to placental function. ENVIRONMENTAL RESEARCH 2024; 248:118355. [PMID: 38295973 DOI: 10.1016/j.envres.2024.118355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Placental function is essential for fetal development, but it may be susceptible to malnutrition and environmental stressors. OBJECTIVE To assess the impact of toxic and essential trace elements in placenta on placental function. METHODS Toxic metals (cadmium, lead, mercury, cobalt) and essential elements (copper, manganese, zinc, selenium) were measured in placenta of 406 pregnant women in northern Sweden using ICP-MS. Placental weight and birth weight were obtained from hospital records and fetoplacental weight ratio was used to estimate placental efficiency. Placental relative telomere length (TL) and mitochondrial DNA copy number (mtDNAcn) were determined by quantitative PCR (n = 285). Single exposure-outcome associations were evaluated using linear or spline regression, and joint associations and interactions with Bayesian kernel machine regression (BKMR), all adjusted for sex, maternal smoking, and age or BMI. RESULTS Median cadmium, mercury, lead, cobalt, copper, manganese, zinc, and selenium concentrations in placenta were 3.2, 1.8, 4.3, 2.3, 1058, 66, 10626, and 166 μg/kg, respectively. In the adjusted regression, selenium (>147 μg/kg) was inversely associated with placental weight (B: -158; 95 % CI: -246, -71, per doubling), as was lead at low selenium (B: -23.6; 95 % CI: -43.2, -4.0, per doubling). Manganese was positively associated with placental weight (B: 41; 95 % CI: 5.9, 77, per doubling) and inversely associated with placental efficiency (B: -0.01; 95 % CI: -0.019, -0.004, per doubling). Cobalt was inversely associated with mtDNAcn (B: -11; 95 % CI: -20, -0.018, per doubling), whereas all essential elements were positively associated with mtDNAcn, individually and joint. CONCLUSION Among the toxic metals, lead appeared to negatively impact placental weight and cobalt decreased placental mtDNAcn. Joint essential element concentrations increased placental mtDNAcn. Manganese also appeared to increase placental weight, but not birth weight. The inverse association of selenium with placental weight may reflect increased transport of selenium to the fetus in late gestation.
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Affiliation(s)
- Marijke Grundeken
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Klara Gustin
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Marie Vahter
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mathilde Delaval
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Joint Mass Spectrometry Centre (JMSC), Cooperation Group Comprehensive Molecular Analytics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Malin Barman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Anna Sandin
- Department of Clinical Science, Pediatrics, Sunderby Research Unit, Umeå University, Sweden
| | - Ann-Sofie Sandberg
- Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Agnes E Wold
- Institute of Biomedicine, Dept, Of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Broberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Waldheim F, Sirotkina M, Pettersson K, Kublickas M, Papadogiannakis N. Reference Values for Placental Weight and Placental:Fetal Weight Ratio in a Swedish Population. Pediatr Dev Pathol 2024:10935266241239505. [PMID: 38576404 DOI: 10.1177/10935266241239505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
INTRODUCTION There is important clinical information from placental weight and its ratio to the fetal weight. The aim with this study was to establish reference values for the placental weight and the placental:fetal weight ratio for gestational weeks 13-43 in a Swedish population. MATERIALS AND METHODS Cases were retrospectively collected from the database used at the Pathology Department at Karolinska University Hospital and information about the placental weight, fetal weight, and gestational age was retrieved. Conditions, which could affect the placental- or fetal weight were excluded. Thereafter percentile curves were calculated for the placental weight and the placental:fetal weight ratio for gestational weeks. RESULTS A total of 730 cases were included and percentile curves for the placental weight for gestational week 13-43 and placental:fetal weight ratio for gestational week 18-43 are presented. CONCLUSIONS Reference values for post fixation placental weight and its ratio to fetal weight for a Swedish population are presented. The reference values are lower than the current reference values used in our institution, and this will be of importance when interpreting findings after placental examination.
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Affiliation(s)
- Frida Waldheim
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Meeli Sirotkina
- Department of Pathology and Karolinska Institute, Division of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Pettersson
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Marius Kublickas
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Department of Pathology and Karolinska Institute, Division of Pathology, Karolinska University Hospital, Stockholm, Sweden
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Chowdhury SF, Prout N, Rivera-Núñez Z, Barrett E, Brunner J, Duberstein Z, Kannan K, Salafia CM, Shah R, Miller RK, O'Connor TG. PFAS alters placental arterial vasculature in term human placentae: A prospective pregnancy cohort study. Placenta 2024; 149:54-63. [PMID: 38518389 PMCID: PMC10997442 DOI: 10.1016/j.placenta.2024.03.002] [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: 11/06/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Perfluoroalkyl substances (PFAS) are synthetic chemicals used in industrial and consumer goods that are widely detected in human populations and are associated with adverse health outcomes, including perinatal health risks and child health. One mechanism of influence may be the impact of PFAS exposure on placental structure and function. OBJECTIVES The objective of this study is to investigate the relationship between maternal prenatal exposure to PFAS and measures of placental vascularization, and to assess whether changes in vascularization play a role in mediating the impact of PFAS on birth outcomes. METHODS Using data from a prospective cohort study, we examined associations between second trimester PFAS (individually and as mixtures using Bayesian kernel machine regression) and placental arterial vasculature in term placentae (N = 158); secondarily we evaluated the degree to which alterations in placental arterial vasculature explained associations between PFAS exposure and birth outcomes. Placental arterial vasculature features were collected from arterial tracings of each placental image. RESULTS In both linear regression and mixture models, natural log-transformed perfluorooctanoic acid concentrations were negatively associated with surface vasculature, indexed by the mean distance from arterial end point to perimeter (β = -0.23, 95% CI: -0.41, -0.041); additionally, maximum arterial tortuosity was negatively associated with placental weight (β = -0.19, 95% CI: -0.34, -0.051). There were no reliable differences in effect by fetal sex. DISCUSSION The findings provide some of the first evidence of PFAS exposure shaping a key measure of placental vascular function, which may underlie the impact of PFAS on perinatal and child health risks.
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Affiliation(s)
- Sadia Firoza Chowdhury
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Avenue., Rochester, NY, 14642, USA; Translational Biomedical Sciences Program, University of Rochester, 601 Elmwood Avenue., Rochester, NY, 14642, USA.
| | - Nashae Prout
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Avenue., Rochester, NY, 14642, USA; Toxicology Graduate Program, University of Rochester, 601 Elmwood Avenue., Rochester, NY, 14642, USA.
| | - Zorimar Rivera-Núñez
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA; Environmental and Occupational Health Sciences Institute, Rutgers University, 170 Frelinghuysen Rd., Piscataway, NJ, 08854, USA.
| | - Emily Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA; Environmental and Occupational Health Sciences Institute, Rutgers University, 170 Frelinghuysen Rd., Piscataway, NJ, 08854, USA; Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, USA.
| | - Jessica Brunner
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, USA.
| | - Zoe Duberstein
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Avenue., Rochester, NY, 14642, USA; Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, NY, 14627, USA.
| | - Kurunthachalam Kannan
- Department of Pediatrics and Department of Environmental Medicine, New York University Grossman School of Medicine, 550 1st Ave., New York, NY, 10016, USA.
| | - Carolyn M Salafia
- Placental Analytics LLC, 187 Overlook Circle, New Rochelle, NY, 10804, USA; Institute for Basic Research, 1550 Forest Hill Road, Staten Island, NY 10314, USA; New York Presbyterian- Brooklyn Methodist Hospital, 550 6th Street, Brooklyn, NY, 11215, USA; Queens Hospital Center, 82-68 164th Street, Queens, New York, 11432, USA.
| | - Ruchit Shah
- Placental Analytics LLC, 187 Overlook Circle, New Rochelle, NY, 10804, USA.
| | - Richard K Miller
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, USA.
| | - Thomas G O'Connor
- Wynne Center for Family Research, University of Rochester, 601 Elmwood Avenue., Rochester, NY, 14642, USA; Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, USA; Psychology, University of Rochester, Meliora Hall, P.O. Box 270266, Rochester, NY, 14627, USA; Department of Psychiatry, University of Rochester, 300 Crittenden Blvd., Rochester, NY, 14642, USA; Department of Neuroscience, University of Rochester, 601 Elmwood Avenue., Rochester, NY, 14642, USA.
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Ovadia M, Gluska H, Cohen G, Schreiber H, Biron-Shental T, Kovo M, Shechter-Maor G. Does decreased fetal growth estimation in the appropriate for gestational age range affect delivery outcomes? Arch Gynecol Obstet 2024:10.1007/s00404-024-07432-2. [PMID: 38411630 DOI: 10.1007/s00404-024-07432-2] [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: 10/30/2023] [Accepted: 02/12/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To study the effect of decreased estimated fetal weight (EFW) percentiles in appropriate for gestational age fetuses. METHODS This retrospective cohort study included women who had second and third trimester ultrasound examinations. Delivery and neonatal outcomes of pregnancies with decreased EFW of ≥ 30 percentiles in EFW between ultrasound examinations (decreased growth group) and those without such a decrease (control group) were compared. Deliveries with EFW or birthweight below the 10th percentile were excluded. RESULTS Among 1610 deliveries, 57 were in the decreased growth group and 1553 in the control group. Maternal characteristics did not differ between the groups except for higher rate of nulliparity in the decreased growth group. We found similar rates of Category II/III monitoring, cesarean deliveries due to non-reassuring fetal heart rate and adverse neonatal outcomes. Neonatal birthweight was lower in the decreased growth group as compared to controls. CONCLUSIONS This study did not find association between the group of appropriate for gestational age fetuses with decreased growth, with adverse outcomes.
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Affiliation(s)
- Michal Ovadia
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Affiliated with School of Medicine, Tel Aviv University, 59 Tchernichovsky St, 44281, Kfar Saba, Israel
| | - Hadar Gluska
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Affiliated with School of Medicine, Tel Aviv University, 59 Tchernichovsky St, 44281, Kfar Saba, Israel
| | - Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Affiliated with School of Medicine, Tel Aviv University, 59 Tchernichovsky St, 44281, Kfar Saba, Israel
| | - Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Affiliated with School of Medicine, Tel Aviv University, 59 Tchernichovsky St, 44281, Kfar Saba, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Affiliated with School of Medicine, Tel Aviv University, 59 Tchernichovsky St, 44281, Kfar Saba, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Affiliated with School of Medicine, Tel Aviv University, 59 Tchernichovsky St, 44281, Kfar Saba, Israel
| | - Gil Shechter-Maor
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Affiliated with School of Medicine, Tel Aviv University, 59 Tchernichovsky St, 44281, Kfar Saba, Israel.
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Penteado MP, Grandi C, Rodrigues LDS, Cardoso VC. Association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from the 2010/2011 BRISA birth cohort. J Pediatr (Rio J) 2024:S0021-7557(24)00007-X. [PMID: 38346677 DOI: 10.1016/j.jped.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE To study the association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from a birth cohort. METHOD This was a secondary cross-sectional analysis of data obtained in a cohort study (Brazilian RibeirãoPreto and São Luís Birth Cohort Studies - BRISA), whose deliveries were performed between 2010 and 2011. Standardized questionnaires were applied to mothers, and placentas and newborns were evaluated shortly after delivery. Placental efficiency was assessed using the ratio between birth weight and placental weight (BW/PW ratio); values below the lower quartile (25th percentile for gestational age) were considered to have low placental efficiency. Newborn phenotypes were small and large for gestational age, stunted and wasted, evaluated using the INTERGROWTH-21 growth standard. To identify the confounding variables theoretical model was constructed using Directed Acyclic Graphs, and unadjusted and adjusted logistic regression were performed. Placental measurements were obtained blindly from pregnancy and delivery data. RESULTS 723 mother-placenta-child triads were studied. 3.2 % of newborns were small-for-gestational-age (SGA), 6.5 %large-for-gestational-age (LGA), 5.7 %had stunting, and 0.27 % wasting. A significantly higher risk was found between low placental efficiency and SGA (OR 2.82;95 % CI 1.05-7.57), stunting (OR 2.23; 95 % CI 1.07-4.65), and wasting (OR 8.22; 95 % CI 1.96-34.37). No relationship was found between LGA and placental efficiency. CONCLUSIONS Low placental efficiency was associated with increased risk for small-for-gestational-age, stunting, and wasting. Placental morphometry can provide valuable information on intrauterine conditions and neonatal health, helping to identify newborns at higher risk of future comorbidities.
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Affiliation(s)
- Marina Papa Penteado
- Universidade de São Paulo (USP), Hospital das Clínicas de Ribeirão Preto (HCRP), HC Criança, Ribeirão Preto, SP, Brazil.
| | - Carlos Grandi
- Sociedade Argentina de Pediatria, Comissão de Pesquisa, Buenos Aires, Argentina
| | | | - Viviane Cunha Cardoso
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Puericultura e Pediatria, Ribeirão Preto, SP, Brazil
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Gomes J, Begum M, Kumarathasan P. Polybrominated diphenyl ether (PBDE) exposure and adverse maternal and infant health outcomes: Systematic review. CHEMOSPHERE 2024; 347:140367. [PMID: 37890790 DOI: 10.1016/j.chemosphere.2023.140367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023]
Abstract
Polybrominated diphenyl ethers (PBDEs) are flame retardants found in ambient environment and are measured in humans. There are reports on general PBDE toxicity, including endocrine disrupting properties. Studies on adverse maternal and infant outcomes and underlying toxicity mechanisms needs to be understood. The objective of this study was to conduct a systematic review to examine the state of science on the relationship between PBDE and adverse maternal/infant health outcomes and related maternal biomarker changes. This literature review was conducted using PubMed, Scopus, Embase and Web of Science for published articles from January 2005-February 2022. Article quality was assessed using Newcastle-Ottawa Scale. Of the 1518 articles, only 54 human observational studies were screened in for this review. A second reviewer examined the validity of these articles. Reports on associations between PBDE and maternal health outcomes included gestational hypertension/preeclampsia (N = 2) and gestational diabetes mellitus/glycemic index (N = 6). Meanwhile, reports on PBDE and infant outcomes (N=32) included effects on infant birth weight, birth length and cephalic perimeter, preterm birth, fetal growth restriction and APGAR scores. Although findings on PBDE exposure and adverse infant outcomes showed inconsistencies across studies, in general, negative correlations between maternal PBDEs and infant birth weight, birth length and cephalic perimeter were seen, in few cases, after stratification by sex. Association between maternal PBDE and maternal biomarkers (N=18) suggested negative impact of PBDE exposure on markers relevant to neuro-endocrine system and inflammatory processes. The review findings identified potential associations between maternal PBDE and adverse maternal/infant health outcomes. Furthermore, PBDE-related biomarker changes suggest disturbances in maternal mechanisms relevant to endocrine disrupting properties of PBDEs. The observed study heterogeneity can be attributed to factors namely, sample size, study design and statistical analysis. Overall review findings imply the necessity for further research to validate PBDE exposure-related adverse maternal/infant health effects and to validate underlying toxicity mechanisms.
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Affiliation(s)
- J Gomes
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
| | - M Begum
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - P Kumarathasan
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Environmental Health Science and Research Bureau, HECS, Health Canada, Ottawa, ON, Canada.
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Atasoy Karakas L, Esin S, Sahin Uysal N, Tohma YA, Onalan G, Zeyneloglu HB. Granulocyte colony-stimulating factor in assisted reproductive technology treatment does not increase the risk of adverse perinatal outcomes in twin pregnancies. J OBSTET GYNAECOL 2023; 43:2186776. [PMID: 36899463 DOI: 10.1080/01443615.2023.2186776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
The aim of the study is to compare the perinatal outcomes of twin pregnancies resulting from assisted reproductive technology (ART) treatment in which granulocyte colony-stimulating factor (G-CSF) was used with those in which it was not. In this retrospective study, the clinical data of 122 dichorionic diamniotic twin pregnancies were reviewed. Pregnancies were divided into two groups, G-CSF-treated and non-G-CSF treated. Maternal age, gestational week at birth, oligohydramnios, gestational hypertension, pre-eclampsia, preterm birth, first-trimester bleeding, gestational diabetes, rupture of membrane, foetal congenital anomalies, admission to the neonatal intensive care unit, birth weight (BW), small for gestational age, BW discordance, Apgar score and placental weight were compared between the groups.IMPACT STATEMENTWhat is already known on this subject? Granulocyte colony-stimulating factor (G-CSF) administrations increase pregnancy outcomes and do not have a negative effect on perinatal outcomes in singleton pregnancies.What the results of this study add? This study showed that the perinatal outcome of dichorionic diamniotic twin pregnancies conceived after assisted reproductive technology (ART) treatment was similar in the GSF administrated and non-GSF administrated groups.What the implications are of these findings for clinical practice and/or further research? Using G-CSF to increase the success of ART does not seem to have an adverse outcome in the dichorionic diamniotic twin pregnancies.
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Affiliation(s)
- Latife Atasoy Karakas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Sertac Esin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Nihal Sahin Uysal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Yusuf Aytac Tohma
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Gogsen Onalan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Hulusi Bulent Zeyneloglu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
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10
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Tankala M, Rao MK, Senapati S, Behera SS. Morphometric Evaluation of Human Placental and Umbilical Cord for Neonatal Indices: A Cross-Sectional Study. Cureus 2023; 15:e48959. [PMID: 38106776 PMCID: PMC10725719 DOI: 10.7759/cureus.48959] [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] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND In India, there is only limited data on studies related to umbilical cord and placental indices in newborn infants. The present study was undertaken to evaluate the morphometric analysis of placental and umbilical cord indices and their association with length, weight, and head size in newborns. MATERIALS AND METHODS This was a longitudinal cross-sectional study conducted on placentas and fetal measures from 245 women who gave birth during the study period. The placental variables, umbilical cord indices, and neonatal indices were measured. The association between the parameters was done using Pearson's correlation, and p<0.05 was considered statistically significant. Results: The placental weight (p=0.01) and placental volume (p=0.01) showed a significant positive correlation with newborn weight. The mean placental diameter was 16.32 ± 1.54 cm, and there was no significant correlation between placental diameter and infant weight (p=0.232), length (p=0.658), or head circumference (0.842). In addition, there was a significant association between placental diameter, placental volume (p=0.000), and placental weight (p=0.000). There was a significant positive correlation (p<0.05) between ponderable index and birth weight, length, and head circumference. CONCLUSION Placental weight and newborn weight were significantly associated in this study. The length of the umbilical cord was found to be related to placental weight. So, placental measurements are reliable indicators for the assessment of fetal wellbeing.
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Affiliation(s)
- Madhavi Tankala
- Department of Anatomy, Kalinga Institute of Medical Sciences (KIMS) Hospital, Bhubaneswar, IND
| | - Mohini K Rao
- Department of Pathology, Kar Clinic and Hospitals Pvt. Ltd., Bhubaneswar, IND
| | - Susmita Senapati
- Department of Anatomy, Kalinga Institute of Medical Sciences (KIMS) Hospital, Bhubaneswar, IND
| | - Shashi Shankar Behera
- Department of Obstetrics and Gynecology, Advanced Medicare & Research Institute Ltd. (AMRI) Hospitals, Bhubaneswar, IND
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, IND
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11
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Dankó I, Kelemen E, Tankó A, Cserni G. Placental Pathology and Its Associations With Clinical Signs in Different Subtypes of Fetal Growth Restriction. Pediatr Dev Pathol 2023; 26:437-446. [PMID: 37334814 DOI: 10.1177/10935266231179587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE We evaluated placental alterations in different subtypes of fetal growth restriction (FGR) to determine any clinical associations. METHODS FGR placentas classified according to the Amsterdam criteria were correlated with clinical findings. Percentage of intact terminal villi and villous capillarization ratio were calculated in each specimen. Correlations of placental histopathology and perinatal outcomes were studied. 61 FGR cases were studied. RESULTS Early-onset-FGR was more often associated with preeclampsia and recurrence than late-onset-FGR; placentas from early-onset-FGR often had diffuse maternal (or fetal) vascular malperfusion and villitis of unknown etiology. Decreased percentage of intact terminal villi was associated with pathologic CTG. Decreased villous capillarization was associated with early-onset-FGR and birth weight below the second percentile. Avascular villi and infarction were more common when femoral length/abdominal circumference ratio was >0.26, and perinatal outcome was poor in this group. CONCLUSION In early-onset-FGR and preeclamptic FGR, altered vascularization of villi may have a key role in pathogenesis, and recurrent FGR is associated with villitis of unknown etiology. There is an association between femoral length/abdominal circumference ratio >0.26 and histopathological alterations of placenta in FGR pregnancies. There are no significant differences in the percentage of intact terminal villi between different FGR subtypes by onset or recurrency.
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Affiliation(s)
- István Dankó
- Department of Obstetrics and Gynecology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Edit Kelemen
- Perinatal Intensive Centre, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - András Tankó
- Department of Obstetrics and Gynecology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
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12
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Hoirisch-Clapauch S. Silicone breast implants may contribute to early-onset fetal growth restriction. Clin Rheumatol 2023; 42:2445-2452. [PMID: 37271772 PMCID: PMC10239713 DOI: 10.1007/s10067-023-06650-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION There are many studies showing that silicone breast implants may affect lactation, but few analyzed whether these implants affect placentation. We observed that many mothers with growth-restricted pregnancies had inflammatory conditions, such as silicone breast implants or giardiasis. METHODS This single-center cohort study assessed the prevalence of inflammatory conditions in normotensive growth-restricted singleton pregnancies. Next, we stratified the patients according to the presence or absence of silicone breast implants, to determine whether these implants influence fetal growth restriction onset or severity. RESULTS Twelve (32%) of the 38 participants underwent cosmetic breast augmentation 4-18 years before pregnancy. Half of the patients with and 38% without silicone breast implants had giardiasis. Half of the mothers with and 35% without silicone breast implants had autoantibodies. Silicone breast implants were associated with a 70% increased risk of fetal growth restriction before 32 weeks' gestation (95% confidence interval [CI], 1.2-2.5). Fetal growth restriction was diagnosed significantly earlier in mothers with than in those without silicone breast implants, respectively at 27 (95% CI, 25-30) and 30 weeks' gestation (95% CI, 29-32). Silicone breast implants also tripled the risk of fetuses being below the third percentile, but the difference was not significant. CONCLUSION Our results suggest that the association of inflammatory conditions, such as silicone breast implants, giardiasis, and autoantibodies may contribute to placental insufficiency. Silicone breast implants older than four years increased the risk of early-onset fetal growth restriction. Studies with large samples are needed to validate our findings and define whether silicone-related fetal growth restriction should be included in autoimmune/inflammatory syndrome induced by adjuvants (ASIA) criteria. Key Points • Fetal growth restriction (FGR), responsible for 30% of stillbirths, is the most common cause of prematurity and intrapartum asphyxia. • In this study, including 38 mothers with normotensive FGR, all participants had 2-4 inflammatory conditions, such as giardiasis, sinusitis, candidiasis, dysbiosis, extreme fear or autoantibodies. • Silicone breast implants were associated with a 70% increased risk of fetal growth restriction before 32 weeks' gestation. • FGR was diagnosed at 27 weeks' gestation (95% CI, 25-30) in mothers with and at 30 weeks' gestation (95% CI, 29-32) in mothers without silicone breast implants.
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13
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Leal-Silva T, Souza MR, Cruz LL, Moraes-Souza RQ, Paula VG, Soares TS, Dela Justina V, Giachini FR, Damasceno DC, Américo MF, Volpato GT. Toxicological effects of the Morinda citrifolia L. fruit extract on maternal reproduction and fetal development in rats. Drug Chem Toxicol 2023; 46:609-615. [PMID: 35502509 DOI: 10.1080/01480545.2022.2070197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Morinda citrifolia L., also known as Noni, is widely used plant in folk medicine for various therapeutic purposes. However, reports on its effects during pregnancy are limited. Therefore, the objective of this study was to evaluate the effects of the M. citrifolia fruit extract on maternal performance and fetal development during pregnancy in rats. Pregnant Wistar rats (n = 12/group) were treated from gestational days (GD) 0-21 with water (control group) or the aqueous extract of M. citrifolia fruit at doses of 200, 400, or 750 mg/kg, orally. During pregnancy, clinical signs of toxicity, maternal weight, feed intake, and water consumption were noted. On GD 21, the rats were anesthetized and blood was collected to evaluate various biochemical parameters. During laparotomy, reproductive performance parameters were recorded, and fetuses were weighed and the anomalies analyzed. Reduced placental efficiency and fetal growth restriction were observed in the group treated with 400 mg/kg of M. citrifolia extract. The highest dose (750 mg/kg) augmented aspartate aminotransferase concentration and preimplantation losses, while reducing the number of live fetuses. Furthermore, both doses (400 and 750 mg/kg) of the plant extract caused fetal anomalies. In conclusion, consumption of high doses of the M. citrifolia aqueous extrac during pregnancy leads to maternal hepatotoxicity, anti-implantation effects, intrauterine growth restriction and fetal abnormalities, indicating that the plant fruit extract can be harmful to both the mother and the fetus.
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Affiliation(s)
- Thaís Leal-Silva
- Laboratory of System Physiology and Reproductive Toxicology, Institute of Biological and Health Sciences, Federal University of Mato Grosso (UFMT), Barra do Garças, Brazil
| | - Maysa Rocha Souza
- Laboratory of System Physiology and Reproductive Toxicology, Institute of Biological and Health Sciences, Federal University of Mato Grosso (UFMT), Barra do Garças, Brazil
- Laboratory of Experimental Research on Gynecology and Obstetrics, Graduate Program on Gynecology Obstetrics and Mastology, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Larissa Lopes Cruz
- Laboratory of System Physiology and Reproductive Toxicology, Institute of Biological and Health Sciences, Federal University of Mato Grosso (UFMT), Barra do Garças, Brazil
- Laboratory of Experimental Research on Gynecology and Obstetrics, Graduate Program on Gynecology Obstetrics and Mastology, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Rafaianne Queiroz Moraes-Souza
- Laboratory of System Physiology and Reproductive Toxicology, Institute of Biological and Health Sciences, Federal University of Mato Grosso (UFMT), Barra do Garças, Brazil
- Laboratory of Experimental Research on Gynecology and Obstetrics, Graduate Program on Gynecology Obstetrics and Mastology, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Verônyca Gonçalves Paula
- Laboratory of System Physiology and Reproductive Toxicology, Institute of Biological and Health Sciences, Federal University of Mato Grosso (UFMT), Barra do Garças, Brazil
- Laboratory of Experimental Research on Gynecology and Obstetrics, Graduate Program on Gynecology Obstetrics and Mastology, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Thaigra Sousa Soares
- Laboratory of System Physiology and Reproductive Toxicology, Institute of Biological and Health Sciences, Federal University of Mato Grosso (UFMT), Barra do Garças, Brazil
| | - Vanessa Dela Justina
- Federal University of Mato Grosso, Institute of Health Sciences and Health, Barra do Garças, Brazil
| | - Fernanda Regina Giachini
- Federal University of Mato Grosso, Institute of Health Sciences and Health, Barra do Garças, Brazil
| | - Débora Cristina Damasceno
- Laboratory of Experimental Research on Gynecology and Obstetrics, Graduate Program on Gynecology Obstetrics and Mastology, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Madileine Francely Américo
- Laboratory of System Physiology and Reproductive Toxicology, Institute of Biological and Health Sciences, Federal University of Mato Grosso (UFMT), Barra do Garças, Brazil
| | - Gustavo Tadeu Volpato
- Laboratory of System Physiology and Reproductive Toxicology, Institute of Biological and Health Sciences, Federal University of Mato Grosso (UFMT), Barra do Garças, Brazil
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14
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Springer S, Worda K, Franz M, Karner E, Krampl-Bettelheim E, Worda C. Fetal Growth Restriction Is Associated with Pregnancy Associated Plasma Protein A and Uterine Artery Doppler in First Trimester. J Clin Med 2023; 12:jcm12072502. [PMID: 37048586 PMCID: PMC10095370 DOI: 10.3390/jcm12072502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Fetal growth restriction (FGR) is a major cause of stillbirth and poor neurodevelopmental outcomes. The early prediction may be important to establish treatment options and improve neonatal outcomes. The aim of this study was to assess the association of parameters used in first-trimester screening, uterine artery Doppler pulsatility index and the development of FGR. In this retrospective cohort study, 1930 singleton pregnancies prenatally diagnosed with an estimated fetal weight under the third percentile were included. All women underwent first-trimester screening assessing maternal serum pregnancy-associated plasma protein A (PAPP-A), free beta-human chorionic gonadotrophin levels, fetal nuchal translucency and uterine artery Doppler pulsatility index (PI). We constructed a Receiver Operating Characteristics curve to calculate the sensitivity and specificity of early diagnosis of FGR. In pregnancies with FGR, PAPP-A was significantly lower, and uterine artery Doppler pulsatility index was significantly higher compared with the normal birth weight group (0.79 ± 0.38 vs. 1.15 ± 0.59, p < 0.001 and 1.82 ± 0.7 vs. 1.55 ± 0.47, p = 0.01). Multivariate logistic regression analyses demonstrated that PAPP-A levels and uterine artery Doppler pulsatility index were significantly associated with FGR (p = 0.009 and p = 0.01, respectively). To conclude, these two parameters can predict FGR < 3rd percentile.
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Affiliation(s)
- Stephanie Springer
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | - Katharina Worda
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-140-400-28210
| | - Marie Franz
- Department of Gynecology and Obstetrics, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Eva Karner
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Christof Worda
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria
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15
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da Cruz LL, Barco VS, Paula VG, Gallego FQ, Souza MR, Corrente JE, Zambrano E, Volpato GT, Damasceno DC. Severe Diabetes Induction as a Generational Model for Growth Restriction of Rat. Reprod Sci 2023:10.1007/s43032-023-01198-9. [PMID: 36849856 DOI: 10.1007/s43032-023-01198-9] [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: 09/12/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023]
Abstract
We used uncontrolled maternal diabetes as a model to provoke fetal growth restriction in the female in the first generation (F1) and to evaluate reproductive outcomes and the possible changes in metabolic systems during pregnancy, as well as the repercussions at birth in the second generation (F2). For this, nondiabetic and streptozotocin-induced severely diabetic Sprague-Dawley rats were mated to obtain female pups (F1), which were classified as adequate (AGA) or small (SGA) for gestational weight. Afterward, we composed two groups: F1 AGA from nondiabetic dams (Control) and F1 SGA from severely diabetic dams (Restricted) (n minimum = 10 animals/groups). At adulthood, these rats were submitted to the oral glucose tolerance test, mated, and at day 17 of pregnancy, blood samples were collected to determine glucose and insulin levels for assessment of insulin resistance. At the end of the pregnancy, the blood and liver samples were collected to evaluate redox status markers, and reproductive, fetal, and placental outcomes were analyzed. Maternal diabetes was responsible for increased SGA rates and a lower percentage of AGA fetuses (F1 generation). The restricted female pups from severely diabetic dams presented rapid neonatal catch-up growth, glucose intolerance, and insulin resistance status before and during pregnancy. At term pregnancy of F1 generation, oxidative stress status was observed in the maternal liver and blood samples. In addition, their offspring (F2 generation) had lower fetal weight and placental efficiency, regardless of gender, which caused fetal growth restriction and confirmed the fetal programming influence.
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Affiliation(s)
- Larissa Lopes da Cruz
- Postgraduate Course on Tocogynecology, Laboratory of Experimental Research on Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
- Institute of Biological and Health Sciences, Laboratory of System Physiology and Reproductive Toxicology, Federal University of Mato Grosso (UFMT), Barra do Garças, Mato Grosso State, Brazil
| | - Vinícius Soares Barco
- Postgraduate Course on Tocogynecology, Laboratory of Experimental Research on Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Verônyca Gonçalves Paula
- Postgraduate Course on Tocogynecology, Laboratory of Experimental Research on Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
- Institute of Biological and Health Sciences, Laboratory of System Physiology and Reproductive Toxicology, Federal University of Mato Grosso (UFMT), Barra do Garças, Mato Grosso State, Brazil
| | - Franciane Quintanilha Gallego
- Postgraduate Course on Tocogynecology, Laboratory of Experimental Research on Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Maysa Rocha Souza
- Postgraduate Course on Tocogynecology, Laboratory of Experimental Research on Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
- Institute of Biological and Health Sciences, Laboratory of System Physiology and Reproductive Toxicology, Federal University of Mato Grosso (UFMT), Barra do Garças, Mato Grosso State, Brazil
| | - José Eduardo Corrente
- Research Support Office, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Elena Zambrano
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Reproductive Biology, Mexico City, Mexico
| | - Gustavo Tadeu Volpato
- Institute of Biological and Health Sciences, Laboratory of System Physiology and Reproductive Toxicology, Federal University of Mato Grosso (UFMT), Barra do Garças, Mato Grosso State, Brazil
| | - Débora Cristina Damasceno
- Postgraduate Course on Tocogynecology, Laboratory of Experimental Research on Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil.
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16
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Andreasen LA, Feragen A, Christensen AN, Thybo JK, Svendsen MBS, Zepf K, Lekadir K, Tolsgaard MG. Multi-centre deep learning for placenta segmentation in obstetric ultrasound with multi-observer and cross-country generalization. Sci Rep 2023; 13:2221. [PMID: 36755050 PMCID: PMC9908915 DOI: 10.1038/s41598-023-29105-x] [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: 02/12/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
The placenta is crucial to fetal well-being and it plays a significant role in the pathogenesis of hypertensive pregnancy disorders. Moreover, a timely diagnosis of placenta previa may save lives. Ultrasound is the primary imaging modality in pregnancy, but high-quality imaging depends on the access to equipment and staff, which is not possible in all settings. Convolutional neural networks may help standardize the acquisition of images for fetal diagnostics. Our aim was to develop a deep learning based model for classification and segmentation of the placenta in ultrasound images. We trained a model based on manual annotations of 7,500 ultrasound images to identify and segment the placenta. The model's performance was compared to annotations made by 25 clinicians (experts, trainees, midwives). The overall image classification accuracy was 81%. The average intersection over union score (IoU) reached 0.78. The model's accuracy was lower than experts' and trainees', but it outperformed all clinicians at delineating the placenta, IoU = 0.75 vs 0.69, 0.66, 0.59. The model was cross validated on 100 2nd trimester images from Barcelona, yielding an accuracy of 76%, IoU 0.68. In conclusion, we developed a model for automatic classification and segmentation of the placenta with consistent performance across different patient populations. It may be used for automated detection of placenta previa and enable future deep learning research in placental dysfunction.
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Affiliation(s)
- Lisbeth Anita Andreasen
- Copenhagen Academy for Medical Education and Simulation (CAMES) Rigshospitalet, Copenhagen, Denmark.
| | - Aasa Feragen
- Technical University of Denmark (DTU) Compute, Lyngby, Denmark
| | | | | | - Morten Bo S Svendsen
- Copenhagen Academy for Medical Education and Simulation (CAMES) Rigshospitalet, Copenhagen, Denmark
| | - Kilian Zepf
- Technical University of Denmark (DTU) Compute, Lyngby, Denmark
| | - Karim Lekadir
- Artificial Intelligence in Medicine Lab (BCN-AIM), Universitat de Barcelona, Barcelona, Spain
| | - Martin Grønnebæk Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES) Rigshospitalet, Copenhagen, Denmark.,Department of Fetal Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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17
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Doctory N, Romano A, Navon I, Barbash-Hazan S, Bardin R, Hadar E. Placental location and obstetrical-neonatal outcomes: A retrospective study. Int J Gynaecol Obstet 2023; 160:641-645. [PMID: 35749141 DOI: 10.1002/ijgo.14316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/11/2022] [Accepted: 06/20/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To explore the potential association of lateral placentation with pregnancy outcome. METHODS The database of a tertiary medical center was searched for women who gave birth to a singleton neonate from 2012 to 2020 for whom placental location was documented during antepartum sonographic examination. Clinical data were compared between patients with a central (anterior/posterior/fundal) or lateral placenta using standard statistics. The primary outcome measure was neonatal birthweight, and secondary outcome measures were pregnancy complications and mode of delivery. RESULTS The cohort included 12 306 women: 11 608 (94%) with a central placenta and 698 (5.6%) with a lateral placenta. The lateral placenta group had higher rates (P < 0.05) of prior and current cesarean delivery, assisted delivery, and preterm birth. On multivariate regression analyses, placental location (adjusted odds ratio [aOR], 1.36; 95% confidence interval [CI], 1.11-1.66) and maternal age (aOR, 1.02; 95% CI, 1.01-1.03) were associated with risk of preterm birth. Lateral placenta (aOR, 1.22; 95% CI, 1.02-1.47), maternal age (aOR, 1.07; 95% CI, 1.06-1.08), parity (aOR, 0.32; 95% CI, 0.28-0.35), and prior cesarean delivery (aOR, 12.00; 95% CI, 10.60-13.60) were associated with risk of current cesarean delivery. CONCLUSION The findings suggest that lateral placentation may pose a risk of preterm birth and cesarean delivery compared with central placentation.
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Affiliation(s)
- Neta Doctory
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Romano
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Navon
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiri Barbash-Hazan
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Bardin
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Salmeri N, Carbone IF, Cavoretto PI, Farina A, Morano D. Epigenetics Beyond Fetal Growth Restriction: A Comprehensive Overview. Mol Diagn Ther 2022; 26:607-626. [PMID: 36028645 DOI: 10.1007/s40291-022-00611-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 12/30/2022]
Abstract
Fetal growth restriction is a pathological condition occurring when the fetus does not reach the genetically determined growth potential. The etiology of fetal growth restriction is expected to be multifactorial and include fetal, maternal, and placental factors, the latter being the most frequent cause of isolated fetal growth restriction. Severe fetal growth restriction has been related to both an increased risk of perinatal morbidity and mortality, and also a greater susceptibility to developing diseases (especially cardio-metabolic and neurological disorders) later in life. In the last decade, emerging evidence has supported the hypothesis of the Developmental Origin of Health and Disease, which states that individual developmental 'programming' takes place via a delicate fine tuning of fetal genetic and epigenetic marks in response to a large variety of 'stressor' exposures during pregnancy. As the placenta is the maternal-fetal interface, it has a crucial role in fetal programming, such that any perturbation altering placental function interferes with both in-utero fetal growth and also with the adult life phenotype. Several epigenetic mechanisms have been highlighted in modulating the dynamic placental epigenome, including alterations in DNA methylation status, post-translational modification of histones, and non-coding RNAs. This review aims to provide a comprehensive and critical overview of the available literature on the epigenetic background of fetal growth restriction. A targeted research strategy was performed using PubMed, MEDLINE, Embase, and The Cochrane Library up to January 2022. A detailed and fully referenced synthesis of available literature following the Scale for the Assessment of Narrative Review Articles guidelines is provided. A variety of epigenetic marks predominantly interfering with placental development, function, and metabolism were found to be potentially associated with fetal growth restriction. Available evidence on the role of environmental exposures in shaping the placental epigenome and the fetal phenotype were also critically discussed. Because of the highly dynamic crosstalk between epigenetic mechanisms and the extra level of complexity in interpreting the final placental transcriptome, a full comprehension of these phenomenon is still lacking and advances in multi-omics approaches are urgently needed. Elucidating the role of epigenetics in the developmental origins of health and disease represents a new challenge for the coming years, with the goal of providing early interventions and prevention strategies and, hopefully, new treatment opportunities.
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Affiliation(s)
- Noemi Salmeri
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Ilma Floriana Carbone
- Unit of Obstetrics, Department of Woman, Child and Neonate, Mangiagalli Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Ivo Cavoretto
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, 40138, Bologna, Italy.
| | - Danila Morano
- Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria S. Anna, University of Ferrara, Cona, Ferrara, Italy
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19
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Free Cortisol Mediates Associations of Maternal Urinary Heavy Metals with Neonatal Anthropometric Measures: A Cross-Sectional Study. TOXICS 2022; 10:toxics10040167. [PMID: 35448428 PMCID: PMC9032588 DOI: 10.3390/toxics10040167] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/07/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022]
Abstract
Prenatal exposure to heavy metals is known to be associated with adverse birth outcomes and oxidative stress biomarkers. In this study, we examined whether maternal free cortisol or 8-Hydroxy-2-Deoxyguanosine (8-OHdG) could mediate associations between maternal heavy metal exposure and birth outcomes. A total of 182 healthy pregnant women were recruited. Heavy metals (including Pb, Hg, and Cd), free-cortisol, and 8-OHdG were analyzed in urine at delivery. Birth outcomes including birth weight, length, Ponderal index, and head circumference were measured. To examine associations of maternal urinary heavy metals with biomarkers and birth outcomes, generalized linear models were employed. Birth length was positively associated with Pb (β = 0.78, 95% CI: 0.09−1.46) and Hg (β = 0.84, 95% CI: 0.23−1.45) (both p < 0.05). The Ponderal index, a measure of a newborn’s leanness, was negatively associated with maternal urinary Pb (β = −0.23, 95% CI: −0.46−−0.07) and Hg (β = −0.26, 95% CI: −0.44−−0.08) (both p < 0.05). No association between maternal Cd and birth outcomes was observed. Most heavy metals showed positive associations with free cortisol and 8-OHdG. Free cortisol was identified as a mediator underlying the observed relationship between Hg and birth length or Ponderal index. This study observed adverse birth outcomes from maternal exposures to Pb and Hg. Increased free cortisol related to Hg exposure was suggested as a possible causal pathway from Hg exposure to birth outcomes such as the Ponderal index.
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Soullane S, Spence AR, Abenhaim HA. Association of placental pathology and gross morphology with autism spectrum disorders. Autism Res 2021; 15:531-538. [DOI: 10.1002/aur.2658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Safiya Soullane
- Faculty of Medicine McGill University Montreal Quebec Canada
| | - Andrea R. Spence
- Centre for Clinical Epidemiology and Community Studies Jewish General Hospital Montreal Quebec Canada
| | - Haim A. Abenhaim
- Centre for Clinical Epidemiology and Community Studies Jewish General Hospital Montreal Quebec Canada
- Department of Obstetrics and Gynecology Jewish General Hospital, McGill University Montreal Quebec Canada
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21
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Sun S, Meng Q, Bai Y, Cao C, Li J, Cheng B, Shi B, Shan A. Lycopene improves maternal reproductive performance by modulating milk composition and placental antioxidative and immune status. Food Funct 2021; 12:12448-12467. [PMID: 34792070 DOI: 10.1039/d1fo01595h] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Placental health and milk quality are important for maternal reproductive performance during pregnancy and lactation. Lycopene plays an important role in antioxidation, anti-inflammation and regulating lipid metabolism. The goal of the present study was to investigate the effects of dietary lycopene supplementation in the pig model on reproductive performance, placental health and milk composition during maternal gestation and lactation. In the present study, the litter size of live piglets was increased and the litter size of dead piglets was decreased by lycopene supplementation of the diet of sows. The litter weight at birth and weaning were increased in the lycopene group. Through placental proteomics, we enriched differentially expressed proteins (DEPs), gene ontology (GO) terms, and Kyoto encyclopedia of proteins and genomes (KEGG) pathways involved in immunity, anti-inflammation, antioxidants, and lipid metabolism and transport. Furthermore, in terms of placental health, we analyzed the levels of related enzymes, metabolites and mRNA expression in the placenta. Lycopene was shown to reduce mRNA expression and the levels of placental inflammatory factors, increase the content of immunoglobulin, improve the antioxidant capacity, and improve lipid metabolism and lipid transport in the placenta. In terms of sow milk composition, lycopene increased the levels of immunoglobulins in colostrum and lactose in colostrum and milk. Overall, the results of the present study demonstrate that dietary lycopene supplementation of sows during gestation and lactation improves the reproductive performance to a certain extent; this may be due to lycopene improving the placental health and milk composition of sows.
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Affiliation(s)
- Shishuai Sun
- Institute of Animal Nutrition, Northeast Agricultural University, Harbin, 150030, P. R. China.
| | - Qingwei Meng
- Institute of Animal Nutrition, Northeast Agricultural University, Harbin, 150030, P. R. China.
| | - Yongsong Bai
- Institute of Animal Nutrition, Northeast Agricultural University, Harbin, 150030, P. R. China.
| | - Chunyu Cao
- Institute of Animal Nutrition, Northeast Agricultural University, Harbin, 150030, P. R. China.
| | - Jibo Li
- Institute of Animal Nutrition, Northeast Agricultural University, Harbin, 150030, P. R. China.
| | - Baojing Cheng
- Institute of Animal Nutrition, Northeast Agricultural University, Harbin, 150030, P. R. China.
| | - Baoming Shi
- Institute of Animal Nutrition, Northeast Agricultural University, Harbin, 150030, P. R. China.
| | - Anshan Shan
- Institute of Animal Nutrition, Northeast Agricultural University, Harbin, 150030, P. R. China.
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22
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Peng X, Cai X, Li J, Huang Y, Liu H, He J, Fang Z, Feng B, Tang J, Lin Y, Jiang X, Hu L, Xu S, Zhuo Y, Che L, Wu D. Effects of Melatonin Supplementation during Pregnancy on Reproductive Performance, Maternal-Placental-Fetal Redox Status, and Placental Mitochondrial Function in a Sow Model. Antioxidants (Basel) 2021; 10:1867. [PMID: 34942970 PMCID: PMC8698367 DOI: 10.3390/antiox10121867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/09/2021] [Accepted: 11/18/2021] [Indexed: 12/25/2022] Open
Abstract
Melatonin (MT) is a bio-antioxidant that has been widely used to prevent pregnancy complications, such as pre-eclampsia and IUGR during gestation. This experiment evaluated the impacts of dietary MT supplementation during pregnancy on reproductive performance, maternal-placental-fetal redox status, placental inflammatory response, and mitochondrial function, and sought a possible underlying mechanism in the placenta. Sixteen fifth parity sows were divided into two groups and fed each day of the gestation period either a control diet or a diet that was the same but for 36 mg of MT. The results showed that dietary supplementation with MT increased placental weight, while the percentage of piglets born with weight < 900 g decreased. Meanwhile, serum and placental MT levels, maternal-placental-fetal redox status, and placental inflammatory response were increased by MT. In addition, dietary MT markedly increased the mRNA levels of nutrient transporters and antioxidant-related genes involved in the Nrf2/ARE pathway in the placenta. Furthermore, dietary MT significantly increased ATP and NAD+ levels, relative mtDNA content, and the protein expression of Sirt1 in the placenta. These results suggested that MT supplementation during gestation could improve maternal-placental-fetal redox status and reproductive performance by ameliorating placental antioxidant status, inflammatory response, and mitochondrial dysfunction.
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Affiliation(s)
- Xie Peng
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - Xuelin Cai
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - Jian Li
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - Yingyan Huang
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - Hao Liu
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - Jiaqi He
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - Zhengfeng Fang
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - Bin Feng
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - Jiayong Tang
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - Yan Lin
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - Xuemei Jiang
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - Liang Hu
- College of Food Science, Sichuan Agricultural University, Ya’an 625014, China;
| | - Shengyu Xu
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - Yong Zhuo
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - Lianqiang Che
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
| | - De Wu
- Key Laboratory for Animal Disease Resistant Nutrition of the Ministry of Education, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu 611130, China; (X.P.); (X.C.); (J.L.); (Y.H.); (H.L.); (J.H.); (Z.F.); (B.F.); (J.T.); (Y.L.); (X.J.); (S.X.); (Y.Z.); (L.C.)
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23
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Ouidir M, Tekola-Ayele F, Canty T, Grantz KL, Sciscione A, Tong D, Jones RR, Sundaram R, Williams A, Stevens D, Mendola P. Acute ambient air pollution exposure and placental Doppler results in the NICHD fetal growth studies - Singleton cohort. ENVIRONMENTAL RESEARCH 2021; 202:111728. [PMID: 34297937 PMCID: PMC8578287 DOI: 10.1016/j.envres.2021.111728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/21/2021] [Accepted: 07/16/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Increased placental vascular resistance is a proposed mechanism by which air pollution exposure during pregnancy lowers birth weight and increases pregnancy-induced hypertensive disorders. OBJECTIVE To examine the impact of acute air pollution exposure during pregnancy on uterine and umbilical artery Doppler indicators of placental vascular resistance. METHODS After a first ultrasound to confirm gestational age, 2562 pregnant women recruited in 12 clinics throughout the United States underwent up to five standardized ultrasounds with Doppler measurements. Exposures to 11 air pollutants were estimated for the hour of ultrasound and each of the 2 h prior to ultrasound at the clinics using the National Air Quality Forecast Capability reanalysis products. We used mixed logistic regression to study the longitudinal odds ratio (OR) of any, uni- or bi-lateral systolic and diastolic uterine artery notching compared to no notching and the longitudinal OR of abnormal end diastolic flow of the umbilical artery compared to forward flow. Uterine and umbilical artery resistance indexes were studied using linear mixed models. RESULTS Each inter-quartile range (IQR) increase of particulate matter < 2.5 μm, nitrate, ammonium, primary organic matter (POM) and nitrogen dioxide during the hour of ultrasound was associated with a decreased risk of unilateral systolic notch and with increased resistance index of the left uterine artery. For the umbilical artery, each IQR increase in ozone was associated with decreased resistance index (b: -0.26, 95 % CI: -0.52, -0.01) and with a decreased risk of abnormal end diastolic flow (OR: 0.36, 95 % CI: 0.14, 0.94); while each IQR increase of elemental carbon and POM was associated with increased risk of abnormal end diastolic flow (OR: 1.47, 95 % CI: 1.02, 2.13 and OR: 1.67, 95 % CI: 1.17, 2.39, respectively). DISCUSSION Our results suggest acute air pollution exposure may influence placental vascular resistance.
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Affiliation(s)
- Marion Ouidir
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Timothy Canty
- Department of Atmospheric and Oceanic Science, University of Maryland, College Park, MD, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA
| | - Daniel Tong
- Center for Spatial Science and Systems, George Mason University, Fairfax, VA, USA
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Andrew Williams
- University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND, USA
| | - Danielle Stevens
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
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Hwa Im D, Kim YN, Cho HJ, Park YH, Kim DH, Byun JM, Jeong DH, Lee KB, Sung MS. Placental Pathologic Changes Associated with Fetal Growth Restriction and Consequent Neonatal Outcomes. Fetal Pediatr Pathol 2021; 40:430-441. [PMID: 32056478 DOI: 10.1080/15513815.2020.1723147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To evaluate the pathological changes of the placenta to determine the mechanism underlying placenta-derived fetal growth restriction (FGR) and investigate its influence on neonatal outcomes. Study design: This retrospective case-control study included 120 singleton pregnancies with FGR as well as 120 gestational age-matched controls. We compared the placental pathological findings and neonatal outcomes according to the presence of placental malperfusion. Results: The FGR group demonstrated lower placental weight (350.8 ± 118.8 vs. 436.1 ± 109.7g, P < .0001), smaller chorionic plate area (157.7 ± 48.0 vs. 201.5 ± 53.4 cm2, P < .0001), and higher rate of villous change lesions (84.2% vs. 52.5%, P < .0001) than the control group. FGR neonates with placental malperfusion had a higher rate of adverse neonatal outcomes (87.1% vs. 63.2%, P = .0175). Conclusion: Small placentas and placental malperfusion reflected in villous changes are associated with FGR. FGR neonates with placental malperfusion are more susceptible to adverse neonatal outcomes.
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Affiliation(s)
- Do Hwa Im
- Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital, Busan, Korea (the Republic of)
| | - Young Nam Kim
- Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital, Busan, Korea (the Republic of).,Paik Inje Memorial Institute for Clinical Medicine Research, Pusan, Korea (the Republic of)
| | - Hwa Jin Cho
- Department of Pathology, Inje University Busan Paik Hospital, Busan, Korea (the Republic of)
| | - Yong Hee Park
- Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital, Busan, Korea (the Republic of)
| | - Da Hyun Kim
- Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital, Busan, Korea (the Republic of)
| | - Jung Mi Byun
- Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital, Busan, Korea (the Republic of).,Paik Inje Memorial Institute for Clinical Medicine Research, Pusan, Korea (the Republic of)
| | - Dae Hoon Jeong
- Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital, Busan, Korea (the Republic of).,Paik Inje Memorial Institute for Clinical Medicine Research, Pusan, Korea (the Republic of)
| | - Kyung Bok Lee
- Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital, Busan, Korea (the Republic of).,Paik Inje Memorial Institute for Clinical Medicine Research, Pusan, Korea (the Republic of)
| | - Moon Su Sung
- Department of Obstetrics and Gynecology, Inje University Busan Paik Hospital, Busan, Korea (the Republic of)
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Takeda Y, Michikawa T, Morokuma S, Yamazaki S, Nakahara K, Yoshino A, Sugata S, Takami A, Saito S, Hoshi J, Kato K, Nitta H, Nishiwaki Y. Trimester-Specific Association of Maternal Exposure to Fine Particulate Matter and its Components With Birth and Placental Weight in Japan. J Occup Environ Med 2021; 63:771-778. [PMID: 34491964 DOI: 10.1097/jom.0000000000002254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We investigated which trimester of exposure to PM2.5 and its components was associated with birth and placental weight, and the fetoplacental weight ratio. METHODS The study included 63,990 women who delivered singleton term births within 23 Tokyo wards between 2013 and 2015. Each day, we collected fine particles on a filter, and analyzed their chemical constituents, including carbons and ions. Trimester-specific exposure to each pollutant was estimated based on the average daily concentrations. RESULTS Over the third trimester, sulfate exposure tended to be inversely associated with birth weight, and decreased placental weight (difference for highest vs lowest quintile groups = -6.7 g, 95% confidence interval = -12.5 to -0.9). For fetoplacental weight ratio, there was no relationship. CONCLUSIONS Sulfate exposure over the third trimester may reduce birth weight, particularly placental weight.
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Affiliation(s)
- Yuki Takeda
- Department of Environmental and Occupational Health, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143-8540, Japan (Dr Takeda, Dr Michikawa, and Dr Nishiwaki); Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143-8540, Japan (Dr Michikawa and Dr Nishiwaki); Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan (Dr Morokuma); Health and Environmental Risk Division, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan (Dr Yamazaki and Dr Nitta); Department of Obstetrics and Gynaecology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan (Dr Nakahara and Dr Kato); Regional Environment Conservation Division, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan (Dr Yoshino, Dr Sugata, and Dr Takami); Tokyo Metropolitan Research Institute for Environmental Protection, 1-7-5 Shinsuna, Koto-ku, Tokyo 136-0075, Japan (Dr Saito and Dr Hoshi)
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Circulating syndecan-1 is reduced in pregnancies with poor fetal growth and its secretion regulated by matrix metalloproteinases and the mitochondria. Sci Rep 2021; 11:16595. [PMID: 34400721 PMCID: PMC8367987 DOI: 10.1038/s41598-021-96077-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/30/2021] [Indexed: 11/08/2022] Open
Abstract
Fetal growth restriction is a leading cause of stillbirth that often remains undetected during pregnancy. Identifying novel biomarkers may improve detection of pregnancies at risk. This study aimed to assess syndecan-1 as a biomarker for small for gestational age (SGA) or fetal growth restricted (FGR) pregnancies and determine its molecular regulation. Circulating maternal syndecan-1 was measured in several cohorts; a large prospective cohort collected around 36 weeks’ gestation (n = 1206), a case control study from the Manchester Antenatal Vascular service (285 women sampled at 24–34 weeks’ gestation); two prospective cohorts collected on the day of delivery (36 + 3–41 + 3 weeks’ gestation, n = 562 and n = 405 respectively) and a cohort who delivered for preterm FGR (< 34 weeks). Circulating syndecan-1 was consistently reduced in women destined to deliver growth restricted infants and those delivering for preterm disease. Syndecan-1 secretion was reduced by hypoxia, and its loss impaired proliferation. Matrix metalloproteinases and mitochondrial electron transport chain inhibitors significantly reduced syndecan-1 secretion, an effect that was rescued by coadministration of succinate, a mitochondrial electron transport chain activator. In conclusion, circulating syndecan-1 is reduced among cases of term and preterm growth restriction and has potential for inclusion in multi-marker algorithms to improve detection of poorly grown fetuses.
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Zhou H, Sun X, Wang Y, Ye Y, Chen H, Chen Q, He G, Wang J, Liu X, Dong M, Chen D, Chen G, Yuan L, Xiao J, Hu J, Zeng W, Rong Z, Zhang Q, Zhou M, Guo L, Lv Y, Fan J, Pu Y, Ma W, Zhang B, Liu T. The Mediating Role of Placental Weight Change in the Association Between Prenatal Exposure to Thallium and Birth Weight: A Prospective Birth Cohort Study. Front Public Health 2021; 9:679406. [PMID: 34277546 PMCID: PMC8283527 DOI: 10.3389/fpubh.2021.679406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Previous studies have demonstrated the embryotoxicity and fetotoxicity of thallium (Tl). However, the effects of prenatal exposure to Tl on birth weight and placental weight and the mediating role of placental weight in the association of Tl with birth weight remain unclear. Methods: We recruited 2,748 participants from the ongoing Prenatal Environment and Offspring Health Cohort (PEOH Cohort) study, which was initiated in 2016 in Guangzhou, China. The Tl concentrations in maternal urine samples collected during the first and third trimester were determined by inductively coupled plasma mass spectrometry. Birth weight and placental weight were extracted from maternal medical records. Results: Pregnant women exposed to the highest tertile of Tl in the first trimester (β = −42.7 g, 95% CI: −82.3, −3.1 g) and third trimester (β = −50.6 g, 95% CI: −99.0, −2.3 g) had babies with lower birth weights than those exposed to the lowest tertile. We also found significant negative associations of exposure to Tl concentrations in the first and third trimester with placental weight. Mediation analyses showed that 50.3% (95% CI: 15.9, 79.2%) and 33.5% (95% CI: 1.3, 80.3%) of the effects of Tl exposure in the first and third trimester on birth weight were mediated by decreased placental weight. Conclusion: Our results suggest that prenatal exposure to Tl is negatively associated with birth weight and that this association may be mediated by decreased placental weight.
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Affiliation(s)
- He Zhou
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.,Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xiaoli Sun
- Gynecology Department, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yiding Wang
- Food Safety and Health Research Center, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yufeng Ye
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Hanwei Chen
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Qingsong Chen
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Guanhao He
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jiaqi Wang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.,Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xin Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Moran Dong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.,School of Public Health, Southern Medical University, Guangzhou, China
| | - Dengzhou Chen
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.,Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Guimin Chen
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.,School of Public Health, Southern Medical University, Guangzhou, China
| | - Lixia Yuan
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.,School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jianxiong Hu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Zuhua Rong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Qianqian Zhang
- Food Safety and Health Research Center, School of Public Health, Southern Medical University, Guangzhou, China
| | - Mengya Zhou
- Food Safety and Health Research Center, School of Public Health, Southern Medical University, Guangzhou, China
| | - Lingchuan Guo
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, China
| | - Yanyun Lv
- Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, China
| | - Jingjie Fan
- Department of Prevention and Health Care, Shenzhen Maternity & Child Health Care Hospital, Southern Medical University, Shenzhen, China
| | - Yudong Pu
- Songshan Lake Central Hospital of Dongguan City, Dongguan, China
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Bo Zhang
- Food Safety and Health Research Center, School of Public Health, Southern Medical University, Guangzhou, China.,School of Public Health, Southern Medical University, Guangzhou, China
| | - Tao Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.,Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.,School of Medicine, Jinan University, Guangzhou, China
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Nguyen T, Khaksari K, Khare SM, Park S, Anderson AA, Bieda J, Jung E, Hsu CD, Romero R, Gandjbakhche AH. Non-invasive transabdominal measurement of placental oxygenation: a step toward continuous monitoring. BIOMEDICAL OPTICS EXPRESS 2021; 12:4119-4130. [PMID: 34457403 PMCID: PMC8367252 DOI: 10.1364/boe.424969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to assess transabdominal placental oxygenation levels non-invasively. A wearable device was designed and tested in 12 pregnant women with an anterior placenta, 5 of whom had maternal pregnancy complications. Preliminary results revealed that the placental oxygenation level is closely related to pregnancy complications and placental pathology. Women with maternal pregnancy complications were found to have a lower placental oxygenation level (69.4% ± 6.7%) than those with uncomplicated pregnancy (75.0% ± 5.8%). This device is a step in the development of a point-of-care method designed to continuously monitor placental oxygenation and to assess maternal and fetal health.
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Affiliation(s)
- Thien Nguyen
- National Institute of Child Health and Human Development, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
| | - Kosar Khaksari
- National Institute of Child Health and Human Development, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
| | - Siddharth M. Khare
- National Institute of Child Health and Human Development, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
| | - Soongho Park
- National Institute of Child Health and Human Development, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
| | - Afrouz A. Anderson
- National Institute of Child Health and Human Development, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
| | - Janine Bieda
- Department of Obstetrics and Gynecology, Wayne State University, 3990 John R. Street, Box 158, Detroit, MI 48201, USA
| | - Eunjung Jung
- Department of Obstetrics and Gynecology, Wayne State University, 3990 John R. Street, Box 158, Detroit, MI 48201, USA
| | - Chaur-Dong Hsu
- Department of Obstetrics and Gynecology, Wayne State University, 3990 John R. Street, Box 158, Detroit, MI 48201, USA
| | - Roberto Romero
- Department of Obstetrics and Gynecology, Wayne State University, 3990 John R. Street, Box 158, Detroit, MI 48201, USA
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, 20814 and Detroit, Michigan 48201, USA
| | - Amir H. Gandjbakhche
- National Institute of Child Health and Human Development, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20814, USA
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29
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García-Jiménez R, Arroyo E, Borrero C, Garcia-Mejido JA, Sosa F, Fernández-Palacín A, Sainz JA. Evaluation of Placental Micro-vascularization by Superb Micro-vascular Imaging Doppler in Cases of Intra-uterine Growth Restriction: A First Step. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1631-1636. [PMID: 33653625 DOI: 10.1016/j.ultrasmedbio.2021.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/07/2021] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
Superb micro-vascular imaging (SMI) Doppler has proven to be a valid method to assess normal placental micro-vascularization. In this study, we present the application of SMI Doppler to assess placental micro-vascularization in cases of placental insufficiency. We observed fewer secondary and tertiary villi in cases of intra-uterine growth restriction, as well as a lower pulsatile index of secondary villi. The observations made in our study stress the diagnostic potential of SMI Doppler in placental insufficiency.
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Affiliation(s)
- Rocío García-Jiménez
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | - Eva Arroyo
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | - Carlota Borrero
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain; Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
| | - José Antonio Garcia-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain; Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
| | - Francisco Sosa
- Department of Pathology. Valme University Hospital, Seville, Spain
| | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - José Antonio Sainz
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain; Department of Obstetrics and Gynecology, University of Seville, Seville, Spain.
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30
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Beune IM, Damhuis SE, Ganzevoort W, Hutchinson JC, Khong TY, Mooney EE, Sebire NJ, Gordijn SJ. Consensus Definition of Fetal Growth Restriction in Intrauterine Fetal Death: A Delphi Procedure. Arch Pathol Lab Med 2021; 145:428-436. [PMID: 32882006 DOI: 10.5858/arpa.2020-0027-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Fetal growth restriction is a risk factor for intrauterine fetal death. Currently, definitions of fetal growth restriction in stillborns are heterogeneous. OBJECTIVES.— To develop a consensus definition for fetal growth restriction retrospectively diagnosed at fetal autopsy in intrauterine fetal death. DESIGN.— A modified online Delphi survey in an international panel of experts in perinatal pathology, with feedback at group level and exclusion of nonresponders. The survey scoped all possible variables with an open question. Variables suggested by 2 or more experts were scored on a 5-point Likert scale. In subsequent rounds, inclusion of variables and thresholds were determined with a 70% level of agreement. In the final rounds, participants selected the consensus algorithm. RESULTS.— Fifty-two experts participated in the first round; 88% (46 of 52) completed all rounds. The consensus definition included antenatal clinical diagnosis of fetal growth restriction OR a birth weight lower than third percentile OR at least 5 of 10 contributory variables (risk factors in the clinical antenatal history: birth weight lower than 10th percentile, body weight at time of autopsy lower than 10th percentile, brain weight lower than 10th percentile, foot length lower than 10th percentile, liver weight lower than 10th percentile, placental weight lower than 10th percentile, brain weight to liver weight ratio higher than 4, placental weight to birth weight ratio higher than 90th percentile, histologic or gross features of placental insufficiency/malperfusion). There was no consensus on some aspects, including how to correct for interval between fetal death and delivery. CONCLUSIONS.— A consensus-based definition of fetal growth restriction in fetal death was determined with utility to improve management and outcomes of subsequent pregnancies.
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Affiliation(s)
- Irene Maria Beune
- From the Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Beune, Damhuis, Gordijn)
| | - Stefanie Elisabeth Damhuis
- From the Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Beune, Damhuis, Gordijn).,the Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands (Damhuis, Ganzevoort)
| | - Wessel Ganzevoort
- the Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands (Damhuis, Ganzevoort)
| | - John Ciaran Hutchinson
- The Department of Histopathology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom (Hutchinson).,The UCL Great Ormond Street Institute of Child Health, London, United Kingdom (Hutchinson)
| | - Teck Yee Khong
- The Department of Anatomical Pathology, Women's and Children's Hospital, North Adelaide, Australia (Khong)
| | - Eoghan E Mooney
- The Department of Pathology & Laboratory Medicine, National Maternity Hospital, Dublin, Ireland (Mooney)
| | - Neil James Sebire
- The Department of Pathology, Great Ormond Street Hospital for Children and UCL Institute of Child Health, London, United Kingdom (Sebire)
| | - Sanne Jehanne Gordijn
- From the Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Beune, Damhuis, Gordijn)
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Placental weight in first generation migrant mothers in Germany. Do the length of stay, acculturation or migrant status play a role? Placenta 2021; 108:103-108. [PMID: 33857818 DOI: 10.1016/j.placenta.2021.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Migration status affects perinatal outcomes. A small placenta is associated with placental dysfunction and poor outcomes. Placental weight and perinatal outcomes are influenced by migrant status, the length of stay and the level of acculturation in the host country. Our aim was to compare placental weight in first generation immigrants to native non-immigrants in a teaching hospital in Berlin. The influence of migrant status, the length of stay and the level of acculturation on placental weight was also ascertained. METHODS At the Charité University Hospital in Berlin Germany between January 2011 and January 2012, 1373 non-migrant and 1243 first generation migrants were included. Data collection was by means of a standardized questionnaire. The level of acculturation was based on the Frankfurter Acculturation Questionnaire (Frankfurter Akkulturationsfragebogen-FRAKK). Demographic parameters such as age, maternal weight, country of origin, parity, anemia, diabetes, hypertension, smoking and neonatal outcomes including neonatal weight, placental weight were measured. RESULTS We found no difference in mean placenta weight when comparing first generation women with a migration background to women of the native population (608 g vs 597 g, p-value 0.41). There was also no difference in placental weight when assessed by the length of stay and degree of acculturation in the host country. DISCUSSION While first generation migrant women have increased perinatal complications, there is no influence of migrant status, length of stay and the degree of acculturation on placenta weight. Pregnancy outcomes maybe be more dependent on factors such as the access to adequate maternal care.
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Todros T, Paulesu L, Cardaropoli S, Rolfo A, Masturzo B, Ermini L, Romagnoli R, Ietta F. Role of the Macrophage Migration Inhibitory Factor in the Pathophysiology of Pre-Eclampsia. Int J Mol Sci 2021; 22:1823. [PMID: 33673075 PMCID: PMC7917653 DOI: 10.3390/ijms22041823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/13/2022] Open
Abstract
Proinflammatory cytokines are produced in pregnancy in response to the invading pathogens and/or nonmicrobial causes such as damage-associated molecules and embryonic semi-allogenic antigens. While inflammation is essential for a successful pregnancy, an excessive inflammatory response is implicated in several pathologies including pre-eclampsia (PE). This review focuses on the proinflammatory cytokine macrophage migration inhibitory factor (MIF), a critical regulator of the innate immune response and a major player of processes allowing normal placental development. PE is a severe pregnancy-related syndrome characterized by exaggerated inflammatory response and generalized endothelial damage. In some cases, usually of early onset, it originates from a maldevelopment of the placenta, and is associated with intrauterine growth restriction (IUGR) (placental PE). In other cases, usually of late onset, pre-pregnancy maternal diseases represent risk factors for the development of the disease (maternal PE). Available data suggest that low MIF production in early pregnancy could contribute to the abnormal placentation. The resulting placental hypoxia in later pregnancy could produce high release of MIF in maternal serum typical of placental PE. More studies are needed to understand the role of MIF, if any, in maternal PE.
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Affiliation(s)
- Tullia Todros
- Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy; (T.T.); (A.R.)
| | - Luana Paulesu
- Department of Life Sciences, University of Siena, 53100 Siena, Italy; (L.E.); (R.R.); (F.I.)
| | - Simona Cardaropoli
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy;
| | - Alessandro Rolfo
- Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy; (T.T.); (A.R.)
| | | | - Leonardo Ermini
- Department of Life Sciences, University of Siena, 53100 Siena, Italy; (L.E.); (R.R.); (F.I.)
| | - Roberta Romagnoli
- Department of Life Sciences, University of Siena, 53100 Siena, Italy; (L.E.); (R.R.); (F.I.)
| | - Francesca Ietta
- Department of Life Sciences, University of Siena, 53100 Siena, Italy; (L.E.); (R.R.); (F.I.)
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Alfaidy N, Brouillet S, Rajaraman G, Kalionis B, Hoffmann P, Barjat T, Benharouga M, Murthi P. The Emerging Role of the Prokineticins and Homeobox Genes in the Vascularization of the Placenta: Physiological and Pathological Aspects. Front Physiol 2020; 11:591850. [PMID: 33281622 PMCID: PMC7689260 DOI: 10.3389/fphys.2020.591850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/13/2020] [Indexed: 01/25/2023] Open
Abstract
Vasculogenesis and angiogenesis are key processes of placental development, which occur throughout pregnancy. Placental vasculogenesis occurs during the first trimester of pregnancy culminating in the formation of hemangioblasts from intra-villous stem cells. Placental angiogenesis occurs subsequently, forming new blood vessels from existing ones. Angiogenesis also takes place at the fetomaternal interface, allowing essential spiral arteriole remodeling to establish the fetomaternal circulation. Vasculogenesis and angiogenesis in animal models and in humans have been studied in a wide variety of in vitro, physiological and pathological conditions, with a focus on the pro- and anti-angiogenic factors that control these processes. Recent studies revealed roles for new families of proteins, including direct participants such as the prokineticin family, and regulators of these processes such as the homeobox genes. This review summarizes recent advances in understanding the molecular mechanisms of actions of these families of proteins. Over the past decade, evidence suggests increased production of placental anti-angiogenic factors, as well as angiogenic factors are associated with fetal growth restriction (FGR) and preeclampsia (PE): the most threatening pathologies of human pregnancy with systemic vascular dysfunction. This review also reports novel clinical strategies targeting members of these family of proteins to treat PE and its consequent effects on the maternal vascular system.
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Affiliation(s)
- Nadia Alfaidy
- Unité 1036, Institut National de la Santé et de la Recherche Médicale, Grenoble, France.,Department of Biology, University of Grenoble Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France
| | - Sophie Brouillet
- INSERM U1203, Department of Reproductive Biology, University of Montpellier, Montpellier, France
| | - Gayathri Rajaraman
- Faculty of Health and Biomedicine, First Year College, Victoria University, St. Albans, VIC, Australia
| | - Bill Kalionis
- Department of Maternal-Fetal Medicine, Obstetrics and Gynaecology, Pregnancy Research Centre, Royal Women's Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Pascale Hoffmann
- Unité 1036, Institut National de la Santé et de la Recherche Médicale, Grenoble, France.,Department of Biology, University of Grenoble Alpes, Grenoble, France.,Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France
| | - Tiphaine Barjat
- Unité 1059, Saint-Etienne Hospital, Institut National de la Santé et de la Recherche Médicale, Saint-Étienne, France
| | - Mohamed Benharouga
- Unité Mixte de Recherche 5249, Laboratoire de Chimie et Biologie des Métaux, Centre National de la Recherche Scientifique (CNRS), Grenoble, France
| | - Padma Murthi
- Department of Maternal-Fetal Medicine, Obstetrics and Gynaecology, Pregnancy Research Centre, Royal Women's Hospital, The University of Melbourne, Parkville, VIC, Australia.,Department of Pharmacology, The Ritchie Centre, Monash Biomedicine Discovery Institute, Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
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34
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Comparison of Decidual Vasculopathy in Central and Peripheral Regions of Placenta with Implication of Lateral Growth and Spiral Artery Remodeling. REPRODUCTIVE MEDICINE 2020. [DOI: 10.3390/reprodmed1030012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Decidual vasculopathy at late gestation was shown to be associated with spiral artery remodeling at implantation. Dramatic decidual vascular transformation from early to late stage pregnancy suggests a dynamic spatiotemporal relationship between the various vascular components in spiral artery remodeling and decidual vasculopathy. The central and peripheral portions of 105 placentas with decidual vasculopathy at term were examined with or without preeclampsia to see if temporal vascular regeneration was present. Central and peripheral vasculopathy and central and peripheral regeneration were compared. The peripheral portion showed more decidual vasculopathy (88 of total 105, 83.8%) than central portion (72 of total 105, 68.6%, p < 0.0001). However, central portion showed more vascular regeneration (51 of total 105, 48.6%) than the peripheral portion (23 of total 105, 21.9%, p < 0.0001). There was no difference in vasculopathy or regeneration with or without preeclampsia. Spiral artery remodeling is non-synchronous during placental growth and vascular regeneration. This spatiotemporal sequence may help interpretation of morphologic changes of decidual vasculopathy.
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35
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Blake BE, Fenton SE. Early life exposure to per- and polyfluoroalkyl substances (PFAS) and latent health outcomes: A review including the placenta as a target tissue and possible driver of peri- and postnatal effects. Toxicology 2020; 443:152565. [PMID: 32861749 PMCID: PMC7530144 DOI: 10.1016/j.tox.2020.152565] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/14/2020] [Accepted: 08/22/2020] [Indexed: 01/09/2023]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are ubiquitous drinking water contaminants of concern due to mounting evidence implicating adverse health outcomes associated with exposure, including reduced kidney function, metabolic syndrome, thyroid disruption, and adverse pregnancy outcomes. PFAS have been produced in the U.S. since the 1940s and now encompass a growing chemical family comprised of diverse chemical moieties, yet the toxicological effects have been studied for relatively few compounds. Critically, exposures to some PFAS in utero are associated with adverse outcomes for both mother and offspring, such as hypertensive disorders of pregnancy (HDP), including preeclampsia, and low birth weight. Given the relationship between HDP, placental dysfunction, adverse health outcomes, and increased risk for chronic diseases in adulthood, the role of both developmental and lifelong exposure to PFAS likely contributes to disease risk in complex ways. Here, evidence for the role of some PFAS in disrupted thyroid function, kidney disease, and metabolic syndrome is synthesized with an emphasis on the placenta as a critical yet understudied target of PFAS and programming agent of adult disease. Future research efforts must continue to fill the knowledge gap between placental susceptibility to environmental exposures like PFAS, subsequent perinatal health risks for both mother and child, and latent health effects in adult offspring.
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Affiliation(s)
- Bevin E Blake
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of the National Toxicology Program (DNTP), NTP Laboratory, National Institute of Environmental Health Sciences (NIEHS), National Institute of Health (NIH), Research Triangle Park, NC, USA.
| | - Suzanne E Fenton
- Division of the National Toxicology Program (DNTP), NTP Laboratory, National Institute of Environmental Health Sciences (NIEHS), National Institute of Health (NIH), Research Triangle Park, NC, USA
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36
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Clark AR, Lee TC, James JL. Computational modeling of the interactions between the maternal and fetal circulations in human pregnancy. WIREs Mech Dis 2020; 13:e1502. [PMID: 32744412 DOI: 10.1002/wsbm.1502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022]
Abstract
In pregnancy, fetal growth is supported by its placenta. In turn, the placenta is nourished by maternal blood, delivered from the uterus, in which the vasculature is dramatically transformed to deliver this blood an ever increasing volume throughout gestation. A healthy pregnancy is thus dependent on the development of both the placental and maternal circulations, but also the interface where these physically separate circulations come in close proximity to exchange gases and nutrients between mum and baby. As the system continually evolves during pregnancy, our understanding of normal vascular anatomy, and how this impacts placental exchange function is limited. Understanding this is key to improve our ability to understand, predict, and detect pregnancy pathologies, but presents a number of challenges, due to the inaccessibility of the pregnant uterus to invasive measurements, and limitations in the resolution of imaging modalities safe for use in pregnancy. Computational approaches provide an opportunity to gain new insights into normal and abnormal pregnancy, by connecting observed anatomical changes from high-resolution imaging to function, and providing metrics that can be observed by routine clinical ultrasound. Such advanced modeling brings with it challenges to scale detailed anatomical models to reflect organ level function. This suggests pathways for future research to provide models that provide both physiological insights into pregnancy health, but also are simple enough to guide clinical focus. We the review evolution of computational approaches to understanding the physiology and pathophysiology of pregnancy in the uterus, placenta, and beyond focusing on both opportunities and challenges. This article is categorized under: Reproductive System Diseases >Computational Models.
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Affiliation(s)
- Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Tet Chuan Lee
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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37
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Kiran N, Aslam N, Tabassum T, Kanwal S, Zia T. MORPHOLOGICAL FINDINGS IN INTRAUTERINE GROWTH RESTRICTION (IUGR) PLACENTAS VERSUS NORMAL PLACENTAS IN PREGNANT WOMEN OF DISTRICT RAWALPINDI, PAKISTAN. GOMAL JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.46903/gjms/17.03.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: Intrauterine growth restriction (IUGR) is a principal cause of fetal and neonatal morbidity and mortality. The placenta, as a vector for maternal-fetal nutrient and oxygen exchange has major influence on birthweight. The objectives of this study were to compare the placental weight (grams), number of syncytial knots and number of blood vessels in villi of IUGR placentas versus normal placentas. Materials & Methods: This cross-sectional study was carried out at Rai Medical College, Sargodha, Pakistan in collaboration with Zainab Memorial Hospital, Rawalpindi, Pakistan from December 2016 to November 2018. Study group included 45 IUGR placentas and control group included 25 normal placentas. Placental weight in grams, number of syncytial knots and number of blood vessels in villi of placentas were three research variables. These were described by mean, minimum, maximum, range and standard deviation for each group separately and were compared between the two groups through independent-samples t-test. Results: Descriptively the mean placental weight in grams in IUGR group (423.35±64.13g) was lower than control group placentas (535.92±44.57g). The number of syncytial knots in IUGR group placentas (22.04±5.21) was more than control group placentas (13.84±4.41). The number of blood vessels in IUGR placentas was lower than control group placentas. All three null hypothesis for research variables between the two groups were rejected (p=
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38
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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: 75] [Impact Index Per Article: 18.8] [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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dos Reis HLB, Boldrini NAT, Rangel AFR, Barros VF, Merçon de Vargas PR, Miranda AE. Placental growth disorders and perinatal adverse outcomes in Brazilian HIV-infected pregnant women. PLoS One 2020; 15:e0231938. [PMID: 32352999 PMCID: PMC7192492 DOI: 10.1371/journal.pone.0231938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 04/03/2020] [Indexed: 12/18/2022] Open
Abstract
Fetal and placental growth disorders are common in maternal human immunodeficiency virus (HIV) infection and can be attributed to both the infection and comorbidities not associated with HIV. We describe placental growth disorders and adverse reproductive outcomes in HIV-infected pregnant women whose delivery occurred between 2001-2014 in Vitoria, Brazil. Cases with gestational age (GA) ≥ than 22 weeks validated by ultrasonography, with placental and fetal weight dimensions at birth, were studied. Outcomes were summarized as proportions of small (SGA), appropriate (AGA), and large (LGA) for GA when the z-score values were below -1.28, between -1.28 and +1.28, or above +1.28, respectively. Of 187 fetal attachment requisitions, 122(65.2%) women and their newborns participated in the study. The median maternal age was 28 years and 81(66.4%) underwent ≥ 6 prenatal visits. A total of 81(66.4%) were diagnosed before current pregnancy; 68(55.7%) exhibited criteria for acquired immunodeficiency syndrome (AIDS); 64(52.4%) had detectable viral load; 25(20.5%) cases presented SGA placental weight and 6(4.9%) SGA placental thickness. SGA placental area was observed in 41(33.6%) cases, and among the SGA placental weight cases 12(48%) were also SGA fetal weight. Preterm birth (PTB) occurred in 15.6%(19/122) of cases; perinatal death in 4.1%(5/122) and HIV vertical transmission in 6 of 122 (4.9%). Women, ≥36 years old, were 5.7 times more likely to have PTB than those under 36. Also, patients with AIDS-defining criteria were 3.7 times more likely to have PTB. Prenatal care was inversely associated with PTB. Statistically significant associations were observed between AGA placental area and Protease Inhibitor usage and between SGA placental weight and SGA area. We found a prevalence of placental growth disorders in HIV-infected pregnant women and values higher than international reference values. The restriction of placental growth was a common disorder, possibly attributed to virus effects or a combination of antiretroviral regimens.
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Affiliation(s)
- Helena Lucia Barroso dos Reis
- Post-Graduate Program of Infectious Diseases, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
- * E-mail:
| | | | - Ana Fernanda Ribeiro Rangel
- Department of Pathology, Pathology Laboratory of Cassiano Antonio Moraes University Hospital, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
| | - Vinicius Felipe Barros
- Department of Pathology, Pathology Laboratory of Cassiano Antonio Moraes University Hospital, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
| | - Paulo Roberto Merçon de Vargas
- Department of Pathology, Pathology Laboratory of Cassiano Antonio Moraes University Hospital, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
| | - Angélica Espinosa Miranda
- Post-Graduate Program of Infectious Diseases, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
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Najpaverova S, Kovarik M, Kacerovsky M, Zadak Z, Hronek M. The Relationship of Nutritional Energy and Macronutrient Intake with Pregnancy Outcomes in Czech Pregnant Women. Nutrients 2020; 12:nu12041152. [PMID: 32325979 PMCID: PMC7230203 DOI: 10.3390/nu12041152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 11/16/2022] Open
Abstract
Maternal nutrition and metabolism play important roles for the well-being of both mother and fetus during pregnancy. This longitudinal study brings an original evaluation of the relationship between the nutritional energy and macronutrients intake (NEMI) and pregnancy outcomes and an assessment of the changes in such intake over the previous ten years. Sixty-five healthy Czech pregnant women were examined in three pregnancy periods (1st: 17th-27th; 2nd: 28th-35th; 3rd: 36th-38th gestational weeks). Results of 7-day dietary records were analyzed using NutriDan software. Energy intake decreased from 30.0 kcal/kg to 25.0 kcal/kg during pregnancy. The data also showed a decrease in macronutrients intake (p < 0.0001) with the advancing stage of pregnancy. Positive correlations were demonstrated between NEMI and birth weight (r = 0.410, p < 0.001). In the second pregnancy period, NEMI (excluding carbohydrates) positively associated with neonatal birth length (p < 0.01) and negatively with duration of birth (p < 0.05). An increased NEMI in the last period of pregnancy shortened the length of pregnancy.
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Affiliation(s)
- Simona Najpaverova
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic; (S.N.); (M.K.)
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic;
| | - Miroslav Kovarik
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic; (S.N.); (M.K.)
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic;
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic;
| | - Zdenek Zadak
- Department of Research and Development, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic;
| | - Miloslav Hronek
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic; (S.N.); (M.K.)
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic;
- Correspondence: ; Tel.: +420-495-067-254
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Impact of Physical Activity During Pregnancy on Gestational Hypertension. PHYSICAL ACTIVITY AND HEALTH 2020. [DOI: 10.5334/paah.49] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Blake BE, Cope HA, Hall SM, Keys RD, Mahler BW, McCord J, Scott B, Stapleton HM, Strynar MJ, Elmore SA, Fenton SE. Evaluation of Maternal, Embryo, and Placental Effects in CD-1 Mice following Gestational Exposure to Perfluorooctanoic Acid (PFOA) or Hexafluoropropylene Oxide Dimer Acid (HFPO-DA or GenX). ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:27006. [PMID: 32074459 PMCID: PMC7064328 DOI: 10.1289/ehp6233] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 05/18/2023]
Abstract
BACKGROUND Perfluorooctanoic acid (PFOA) is a poly- and perfluoroalkyl substance (PFAS) associated with adverse pregnancy outcomes in mice and humans, but little is known regarding one of its replacements, hexafluoropropylene oxide dimer acid (HFPO-DA, referred to here as GenX), both of which have been reported as contaminants in drinking water. OBJECTIVES We compared the toxicity of PFOA and GenX in pregnant mice and their developing embryo-placenta units, with a specific focus on the placenta as a hypothesized target. METHODS Pregnant CD-1 mice were exposed daily to PFOA (0, 1, or 5mg/kg) or GenX (0, 2, or 10mg/kg) via oral gavage from embryonic day (E) 1.5 to 11.5 or 17.5 to evaluate exposure effects on the dam and embryo-placenta unit. Gestational weight gain (GWG), maternal clinical chemistry, maternal liver histopathology, placental histopathology, embryo weight, placental weight, internal chemical dosimetry, and placental thyroid hormone levels were determined. RESULTS Exposure to GenX or PFOA resulted in increased GWG, with increase in weight most prominent and of shortest latency with 10mg/kg/d GenX exposure. Embryo weight was significantly lower after exposure to 5mg/kg/d PFOA (9.4% decrease relative to controls). Effect sizes were similar for higher doses (5mg/kg/d PFOA and 10mg/kg/d GenX) and lower doses (1mg/kg/d PFOA and 2mg/kg/d GenX), including higher maternal liver weights, changes in liver histopathology, higher placental weights and embryo-placenta weight ratios, and greater incidence of placental abnormalities relative to controls. Histopathological features in placentas suggested that PFOA and GenX may exhibit divergent mechanisms of toxicity in the embryo-placenta unit, whereas PFOA- and GenX-exposed livers shared a similar constellation of adverse pathological features. CONCLUSIONS Gestational exposure to GenX recapitulated many documented effects of PFOA in CD-1 mice, regardless of its much shorter reported half-life; however, adverse effects toward the placenta appear to have compound-specific signatures. https://doi.org/10.1289/EHP6233.
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Affiliation(s)
- Bevin E. Blake
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of the National Toxicology Program (DNTP), NTP Laboratory, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Research Triangle Park, North Carolina, USA
| | - Harlie A. Cope
- Division of the National Toxicology Program (DNTP), NTP Laboratory, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Research Triangle Park, North Carolina, USA
| | - Samantha M. Hall
- Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
| | - Robert D. Keys
- Cellular and Molecular Pathology Branch, National Toxicology Program (NTP), National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Beth W. Mahler
- Cellular and Molecular Pathology Branch, National Toxicology Program (NTP), National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - James McCord
- Exposure Methods and Measurements Division, National Exposure Research Laboratory, Office of Research and Development (ORD), U.S. EPA, Research Triangle Park, North Carolina, USA
| | - Brittany Scott
- Cellular and Molecular Pathology Branch, National Toxicology Program (NTP), National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Heather M. Stapleton
- Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
| | - Mark J. Strynar
- Exposure Methods and Measurements Division, National Exposure Research Laboratory, Office of Research and Development (ORD), U.S. EPA, Research Triangle Park, North Carolina, USA
| | - Susan A. Elmore
- Cellular and Molecular Pathology Branch, National Toxicology Program (NTP), National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Suzanne E. Fenton
- Division of the National Toxicology Program (DNTP), NTP Laboratory, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Research Triangle Park, North Carolina, USA
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Eskild A, Sommerfelt S, Skau I, Grytten J. Offspring birthweight and placental weight in immigrant women from conflict-zone countries; does length of residence in the host country matter? A population study in Norway. Acta Obstet Gynecol Scand 2019; 99:615-622. [PMID: 31774545 DOI: 10.1111/aogs.13777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/18/2019] [Accepted: 11/25/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION We aimed to estimate differences in offspring birthweight and placental weight between Norwegian women and immigrants in Norway from countries with armed conflicts. We also studied whether length of residence in Norway was associated with offspring birthweight and placental weight. MATERIAL AND METHODS We included in our study all singleton births in Norway at gestational week 28 or beyond during the years 1999-2014, to mothers who were born in Somalia, Afghanistan, Iraq (total immigrants n = 18 817), or Norway (n = 668 439). Data were obtained from The Medical Birth Registry of Norway and the Central Person Registry of Norway. We estimated the differences between Norwegian and immigrant women in mean offspring birthweight and mean placental weight by applying linear regression analyses. Adjustments were made for maternal age, parity, year of delivery, gestational age at delivery, preeclampsia, and diabetes. RESULTS The immigrant women had 206 g (95% CI 199 to 213 g) lower mean offspring birthweight and 16 g (95% CI 14 to 18 g) lower mean placental weight than Norwegian women. Immigrant women with ≥5 years of residence in Norway had higher offspring birthweight (40 g) and higher placental weight (17 g) than immigrant women with <5 years of residence. CONCLUSIONS Immigrant mothers from Somalia, Afghanistan, and Iraq gave birth to infants and placentas with lower weight than Norwegian women. However, the difference between Norwegian women and immigrant women was reduced by length of residence in Norway.
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Affiliation(s)
- Anne Eskild
- Division of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silje Sommerfelt
- Division of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Irene Skau
- Department of Community Dentistry, University of Oslo, Oslo, Norway
| | - Jostein Grytten
- Division of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.,Department of Community Dentistry, University of Oslo, Oslo, Norway
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Dudley DM, Aliota MT, Mohr EL, Newman CM, Golos TG, Friedrich TC, O'Connor DH. Using Macaques to Address Critical Questions in Zika Virus Research. Annu Rev Virol 2019; 6:481-500. [PMID: 31180813 PMCID: PMC7323203 DOI: 10.1146/annurev-virology-092818-015732] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Zika virus (ZIKV) and nonhuman primates have been inextricably linked since the virus was first discovered in a sentinel rhesus macaque in Uganda in 1947. Soon after ZIKV was epidemiologically associated with birth defects in Brazil late in 2015, researchers capitalized on the fact that rhesus macaques are commonly used to model viral immunity and pathogenesis, quickly establishing macaque models for ZIKV infection. Within months, the susceptibility of pregnant macaques to experimental ZIKV challenge and ZIKV-associated abnormalities in fetuses was confirmed. This review discusses key unanswered questions in ZIKV immunity and in the pathogenesis of thecongenital Zika virus syndrome. We focus on those questions that can be best addressed in pregnant nonhuman primates and lessons learned from developing macaque models for ZIKV amid an active epidemic.
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Affiliation(s)
- Dawn M Dudley
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA; , ,
| | - Matthew T Aliota
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, Saint Paul, Minnesota 55108, USA;
| | - Emma L Mohr
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin 53792, USA;
| | - Christina M Newman
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA; , ,
| | - Thaddeus G Golos
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin 53715, USA; ,
- Departments of Comparative Biosciences and Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - Thomas C Friedrich
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin 53715, USA; ,
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - David H O'Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA; , ,
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin 53715, USA; ,
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Mathewlynn S, Collins SL. Volume and vascularity: Using ultrasound to unlock the secrets of the first trimester placenta. Placenta 2019; 84:32-36. [PMID: 31279487 DOI: 10.1016/j.placenta.2019.06.379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 11/19/2022]
Abstract
Fetal growth restriction (FGR) is a major cause of perinatal morbidity and mortality. Identifying which pregnancies are at risk of FGR facilitates enhanced surveillance and early delivery before fetal demise can ensue. However, existing risk stratification strategies yield an unacceptably low detection rate. A robust and reliable first trimester screening test for FGR would not only enable high-risk women to be appropriately monitored but would facilitate future trials for possible interventions to enhance fetal growth. Both the volume and vascularity of the first trimester placenta has been demonstrated to be linked to adverse pregnancy outcomes including FGR and pre-eclampsia. The investigation of novel ultrasound markers for FGR are discussed along with the development of methods for fully automatic placental volume estimation which has the potential for use as part of a multi-variable population-based screening test.
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Affiliation(s)
- S Mathewlynn
- Department of Obstetrics and Gynaecology, Milton Keynes University Hospital, Milton Keynes, UK
| | - S L Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, UK; Fetal Medicine Unit, The Women's Centre, John Radcliffe Hospital, Oxford, UK.
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Punshon T, Li Z, Jackson BP, Parks WT, Romano M, Conway D, Baker ER, Karagas MR. Placental metal concentrations in relation to placental growth, efficiency and birth weight. ENVIRONMENT INTERNATIONAL 2019; 126:533-542. [PMID: 30851484 PMCID: PMC6475117 DOI: 10.1016/j.envint.2019.01.063] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 05/19/2023]
Abstract
The quality of the intrauterine environment, in which the placenta plays a critical role, affects birth outcomes and lifelong health. The effect of metal contaminants on the growth and functioning of the placenta have not been widely reported but may provide insights into how metal exposures lead to these outcomes. We examined relationships between placental concentrations of cadmium (Cd), arsenic (As), mercury (Hg) and lead (Pb) and measures of placental growth and functioning (placental weight, placental efficiency (the log ratio of placental weight and birth weight), chorionic disc area and disc eccentricity) as part of the New Hampshire Birth Cohort Study (N = 1159). We additionally examined whether these associations were modified by placental concentrations of essential elements zinc (Zn) and selenium (Se). Associations were evaluated using generalized linear models. Multivariable-adjusted differences in placental weight were - 7.81 g (95% CI: -15.42, -2.48) with every ng/g increase in the Cd concentration of placenta (p-Value = 0.0009). Greater decrements in placental weight and efficiency associated with placental Cd were observed for females. For placentae with below median Zn and Se concentrations, decrements in placental weight were - 8.81 g (95% CI: -16.85, -0.76) and - 13.20 g (95% CI: -20.70, -5.70) respectively. The Cd concentration of placenta was also associated with reductions in placental efficiency both overall, and in Zn- and Se-stratified models. No appreciable differences were observed with other elements (As, Hg or Pb) and with other placental measures (chorionic disc area and disc eccentricity). In structural equation models, placental weight was a mediator in the relation between placental Cd concentration and reduced birth weight. Our findings suggest a role of interacting essential and contaminant elements on birth weight that may be mediated by changes in the growth and function of the placenta.
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Affiliation(s)
- Tracy Punshon
- Dartmouth College, Department of Biology, 78 College Street, Hanover, NH 03755, USA.
| | - Zhigang Li
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Brian P Jackson
- Dartmouth College, Department of Earth Sciences, 6105 Sherman Fairchild Hall, Hanover, NH 03755, USA
| | - W Tony Parks
- Dartmouth College, Department of Biology, 78 College Street, Hanover, NH 03755, USA; Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, USA
| | - Megan Romano
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | | | - Emily R Baker
- Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, USA
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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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Vascular changes in fetal growth restriction: clinical relevance and future therapeutics. J Perinatol 2019; 39:366-374. [PMID: 30518801 DOI: 10.1038/s41372-018-0287-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 01/08/2023]
Abstract
Fetal growth restriction (FGR) affects about 5-10% pregnancies and is associated with poorer outcomes in the perinatal period. Additionally, long standing epidemiological data support its association with chronic diseases such as hypertension and diabetes. Cardiac and vascular adaptations in response to chronic hypoxemia due to utero-placental insufficiency are hallmarks of fetal adaptations. Investigators have attempted to identify these changes in the placenta at the microscopic and molecular level. The ex vivo dual perfusion model of the placenta enables the study of placental haemodynamics in growth-restricted pregnancies. Persistent arterial abnormalities (thickness and stiffness) noted on vascular ultrasound during fetal life through to the young-adult age group for those affected by FGR, seem to be a plausible link between in utero events and chronic circulatory diseases. Using these, this review reflects current thought on vascular maladaptive changes in the FGR cohorts and the role in investigating current and future therapeutics.
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Nobles CJ, Grantz KL, Liu D, Williams A, Ouidir M, Seeni I, Sherman S, Mendola P. Ambient air pollution and fetal growth restriction: Physician diagnosis of fetal growth restriction versus population-based small-for-gestational age. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 650:2641-2647. [PMID: 30296771 PMCID: PMC6203640 DOI: 10.1016/j.scitotenv.2018.09.362] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/24/2018] [Accepted: 09/28/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND Ambient air pollution may affect fetal growth restriction (FGR) through several mechanisms. However, prior studies of air pollution and small-for-gestational age (SGA), a common proxy for FGR, have reported inconsistent findings. OBJECTIVE We assessed air pollution in relation to physician-diagnosed FGR and population-based SGA in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Consecutive Pregnancy Study (2002-2010). METHODS Among 50,005 women (112,203 singleton births), FGR was captured from medical records and ICD-9 codes, and SGA determined by population standards for birthweight <10th, <5th and <3rd percentile. Community Multiscale Air Quality models estimated ambient levels of seven criteria pollutants for whole pregnancy, 3-months preconception, and 1st, 2nd and 3rd trimesters. Generalized estimating equations with robust standard errors accounted for interdependency of pregnancies within participant. Models adjusted for maternal age, race/ethnicity, pre-pregnancy body mass index, smoking, alcohol, parity, insurance, marital status, asthma and temperature. RESULTS FGR was diagnosed in 1.5% of infants, and 6.7% were <10th, 2.7% <5th and 1.5% <3rd percentile for SGA. Positive associations of SO2, NO2 and PM10 and negative associations of O3 with FGR were observed throughout preconception and pregnancy. For example, an interquartile increase in whole pregnancy SO2 was associated with 16% (95% CI 8%, 25%) increased FGR risk, 17% for NO2 (95% CI 9%, 26%) and 12% for PM10 (95% CI 6%, 19%). Associations with SGA were less clear. CONCLUSIONS Chronic exposure to air pollution may be associated with FGR but not SGA in this low-risk population.
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Affiliation(s)
- Carrie J Nobles
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Danping Liu
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Andrew Williams
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Marion Ouidir
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Indulaxmi Seeni
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
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Mustieles V, Mínguez-Alarcón L, Christou G, Ford JB, Dimitriadis I, Hauser R, Souter I, Messerlian C. Placental weight in relation to maternal and paternal preconception and prenatal urinary phthalate metabolite concentrations among subfertile couples. ENVIRONMENTAL RESEARCH 2019; 169:272-279. [PMID: 30497002 PMCID: PMC6347561 DOI: 10.1016/j.envres.2018.11.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Phthalates are known reproductive toxicants that reduce placental and fetal weight in experimental animal studies. Although phthalate exposure has been associated with reduced birth weight in humans, there is limited epidemiologic evidence on whether the placenta is also affected. OBJECTIVE To assess whether maternal and paternal preconception and prenatal urinary phthalate metabolite concentrations are associated with placental weight, and the birth weight: placental weight (BW:PW) ratio among singletons conceived by subfertile couples. METHODS The present analysis included 132 mothers and 68 fathers, and their corresponding 132 singletons recruited in an academic hospital fertility center in Boston, Massachusetts. Urinary concentrations of eleven phthalate metabolites were measured and averaged in multiple paternal (n = 196) and maternal (n = 596) preconception, and maternal prenatal (n = 328) samples. Placental weight and birth weight (grams) were abstracted from delivery records, and the BW:PW was calculated. We estimated the association of natural log-phthalate metabolite concentrations across windows of exposure with placental weight and the BW:PW ratio using multivariable linear regression models, adjusting for a priori covariates. RESULTS In adjusted models, each log-unit increase in paternal urinary concentrations of the sum of di-(2-ethylhexyl) phthalate (ΣDEHP) metabolites was associated with a 24 g (95% CI: -48, -1) decrease in placental weight. We also observed a significant negative association between maternal preconception monoethyl phthalate (MEP) metabolite concentrations and the BW:PW ratio (β = -0.26; 95%CI: -0.49, -0.04). Additionally, each log-unit increase in prenatal MEP metabolite concentrations was associated with a 24 g (95% CI: -41, -7) decrease in placental weight. CONCLUSIONS Our results suggest that certain paternal and maternal urinary phthalate metabolites may affect placental weight and the BW:PW ratio. However, given the small sample size within a subfertile cohort and the novelty of these findings, more studies are needed to confirm the present results.
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Affiliation(s)
- Vicente Mustieles
- Biosanitary Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada, Spain; Center for Biomedical Research (CIBM), University of Granada, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), 18100, Spain
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - George Christou
- Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology, Boston, MA 02114, USA
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Irene Dimitriadis
- Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology, Boston, MA 02114, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology, Boston, MA 02114, USA
| | - Carmen Messerlian
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
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