1
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Vogtmann R, Riedel A, Sassmannshausen I, Langer S, Kühnel-Terjung E, Kimmig R, Schorle H, Winterhager E, Gellhaus A. Overexpression of Human sFLT1 in the Spongiotrophoblast Is Sufficient to Induce Placental Dysfunction and Fetal Growth Restriction in Transgenic Mice. Int J Mol Sci 2024; 25:2040. [PMID: 38396719 PMCID: PMC10888837 DOI: 10.3390/ijms25042040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Preeclampsia (PE) is characterized by maternal hypertension and placental dysfunction, often leading to fetal growth restriction (FGR). It is associated with an overexpression of the anti-angiogenic sFLT1 protein, which originates from the placenta and serves as a clinical biomarker to predict PE. To analyze the impact of sFLT1 on placental function and fetal growth, we generated transgenic mice with placenta-specific human sFLT1 (hsFLT1) overexpression. Immunohistochemical, morphometrical, and molecular analyses of the placentas on 14.5 dpc and 18.5 dpc were performed with a focus on angiogenesis, nutrient transport, and inflammation. Additionally, fetal development upon placental hsFLT1 overexpression was investigated. Dams exhibited a mild increase in serum hsFLT1 levels upon placental hsFLT1 expression and revealed growth restriction of the fetuses in a sex-specific manner. Male FGR fetuses expressed higher amounts of placental hsFLT1 mRNA compared to females. FGR placentas displayed an altered morphology, hallmarked by an increase in the spongiotrophoblast layer and changes in labyrinthine vascularization. Further, FGR placentas showed a significant reduction in placental glycogen storage and nutrient transporter expression. Moreover, signs of hypoxia and inflammation were observed in FGR placentas. The transgenic spongiotrophoblast-specific hsFLT1 mouse line demonstrates that low hsFLT1 serum levels are sufficient to induce significant alterations in fetal and placental development in a sex-specific manner.
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Affiliation(s)
- Rebekka Vogtmann
- Department of Gynecology and Obstetrics, University Hospital, 45147 Essen, Germany (A.R.); (R.K.)
| | - Alina Riedel
- Department of Gynecology and Obstetrics, University Hospital, 45147 Essen, Germany (A.R.); (R.K.)
| | - Ivanka Sassmannshausen
- Department of Gynecology and Obstetrics, University Hospital, 45147 Essen, Germany (A.R.); (R.K.)
| | - Sarah Langer
- Department of Gynecology and Obstetrics, University Hospital, 45147 Essen, Germany (A.R.); (R.K.)
| | - Elisabeth Kühnel-Terjung
- Department of Gynecology and Obstetrics, University Hospital, 45147 Essen, Germany (A.R.); (R.K.)
| | - Rainer Kimmig
- Department of Gynecology and Obstetrics, University Hospital, 45147 Essen, Germany (A.R.); (R.K.)
| | - Hubert Schorle
- Department of Developmental Pathology, Institute of Pathology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Elke Winterhager
- EM Unit, Imaging Center Essen, University Hospital, 45147 Essen, Germany;
| | - Alexandra Gellhaus
- Department of Gynecology and Obstetrics, University Hospital, 45147 Essen, Germany (A.R.); (R.K.)
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2
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Stroganov S, Harris T, Fellus-Alyagor L, Ben Moyal L, Plitman Mayo R, Golani O, Hirsch D, Ben-Dor S, Brandis A, Mehlman T, Kovo M, Biron-Shental T, Dekel N, Neeman M. The differential regulation of placenta trophoblast bisphosphoglycerate mutase in fetal growth restriction: preclinical study in mice and observational histological study of human placenta. eLife 2024; 13:e82631. [PMID: 38314803 PMCID: PMC10883672 DOI: 10.7554/elife.82631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/25/2024] [Indexed: 02/07/2024] Open
Abstract
Background Fetal growth restriction (FGR) is a pregnancy complication in which a newborn fails to achieve its growth potential, increasing the risk of perinatal morbidity and mortality. Chronic maternal gestational hypoxia, as well as placental insufficiency are associated with increased FGR incidence; however, the molecular mechanisms underlying FGR remain unknown. Methods Pregnant mice were subjected to acute or chronic hypoxia (12.5% O2) resulting in reduced fetal weight. Placenta oxygen transport was assessed by blood oxygenation level dependent (BOLD) contrast magnetic resonance imaging (MRI). The placentae were analyzed via immunohistochemistry and in situ hybridization. Human placentae were selected from FGR and matched controls and analyzed by immunohistochemistry (IHC). Maternal and cord sera were analyzed by mass spectrometry. Results We show that murine acute and chronic gestational hypoxia recapitulates FGR phenotype and affects placental structure and morphology. Gestational hypoxia decreased labyrinth area, increased the incidence of red blood cells (RBCs) in the labyrinth while expanding the placental spiral arteries (SpA) diameter. Hypoxic placentae exhibited higher hemoglobin-oxygen affinity compared to the control. Placental abundance of Bisphosphoglycerate mutase (BPGM) was upregulated in the syncytiotrophoblast and spiral artery trophoblast cells (SpA TGCs) in the murine gestational hypoxia groups compared to the control. Hif1α levels were higher in the acute hypoxia group compared to the control. In contrast, human FGR placentae exhibited reduced BPGM levels in the syncytiotrophoblast layer compared to placentae from healthy uncomplicated pregnancies. Levels of 2,3 BPG, the product of BPGM, were lower in cord serum of human FGR placentae compared to control. Polar expression of BPGM was found in both human and mouse placentae syncytiotrophoblast, with higher expression facing the maternal circulation. Moreover, in the murine SpA TGCs expression of BPGM was concentrated exclusively in the apical cell side, in direct proximity to the maternal circulation. Conclusions This study suggests a possible involvement of placental BPGM in maternal-fetal oxygen transfer, and in the pathophysiology of FGR. Funding This work was supported by the Weizmann Krenter Foundation and the Weizmann - Ichilov (Tel Aviv Sourasky Medical Center) Collaborative Grant in Biomedical Research, by the Minerva Foundation, by the ISF KillCorona grant 3777/19.
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Affiliation(s)
- Sima Stroganov
- Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Talia Harris
- Chemical Research Support Weizmann Institute of Science, Rehovot, Israel
| | | | - Lital Ben Moyal
- Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Romina Plitman Mayo
- Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Ofra Golani
- Life Science Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Dana Hirsch
- Life Science Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Shifra Ben-Dor
- Life Science Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Alexander Brandis
- Life Science Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Tevie Mehlman
- Life Science Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Michal Kovo
- OBGYN, Meir Medical Center, Kfar Saba, Israel
- Tel Aviv University, School of Medicine, Tel Aviv, Israel
| | - Tal Biron-Shental
- OBGYN, Meir Medical Center, Kfar Saba, Israel
- Tel Aviv University, School of Medicine, Tel Aviv, Israel
| | - Nava Dekel
- Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Michal Neeman
- Immunology and Regenerative Biology, Weizmann Institute of Science, Rehovot, Israel
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3
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Greghi JR, Favaron PO, Trautwein LGC, Silva CGBD, Lemos GAAD, Martins MIM. Emergency cesarean section in dogs: Usefulness of amniotic fluid biochemical parameters and placental morphology as indicators of neonatal viability. Theriogenology 2023; 211:115-124. [PMID: 37607467 DOI: 10.1016/j.theriogenology.2023.08.011] [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: 05/18/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/24/2023]
Abstract
In recent years, special attention has been paid to the analysis of fetal fluids and placental histopathology to identify parameters that can be used as indicators of maternal reproductive quality, embryonic viability, and fetal and neonatal health. Newborn health reflects the functioning of the fetal adnexa and its relationship with maternal tissues. Therefore, evaluating these components is promising for the early detection of newborns at risk. This study aimed to detect the biochemical characteristics of the amniotic fluid (AF) and histopathological characteristics of the placenta for comparison between canine neonates born by elective (EL) and emergency (EM) cesarean sections (CSs) and associate the results with neonatal viability in the first 24 h. A total of 38 neonates born by ELCS (n = 19) and EMCS (n = 19) were selected. AF was collected to analyze the concentration of its biochemical components [alanine aminotransferase (ALT), alkaline phosphatase (ALP), creatinine, urea, total protein, albumin, total and direct bilirubin, lactate, glucose, potassium, chloride, calcium, and sodium]. Histopathological processing of the placenta was used to describe the lesions and identify the arrangement of collagen fibers using hematoxylin-eosin and picrosirius staining. There was an increase in ALP activity (P = 0.035) and the concentrations of lactate (P < 0.001) and potassium (P = 0.031), and a decrease in chlorides (P < 0.001) in the AF of neonates in the EMCS group. The comparisons between the groups did not show differences between the presence and extent of lesions in the placenta; however, a difference was observed in the arrangement of collagen fibers in the placental structure. A comparison between AF and histopathological findings showed a negative correlation (r = -0.609, P = 0.003) between glucose concentration and the presence of necrosis in the placental labyrinth. It was observed that the composition of the AF changed owing to the influence of the type of cesarean, possibly caused by prolonged hypoxia in cases of dystocia. ALP activity and lactate, potassium, and chloride concentrations in the AF might be explored as markers of neonatal health in EMCS. Under the conditions of this study, no correlations were found between the placenta's histopathological characteristics and the neonates' viability.
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Affiliation(s)
- Julia Rodrigues Greghi
- Department of Veterinary Clinics, State University of Londrina (UEL), Rod Celso Garcia Cid, PR 445 Km 380, CEP 86057-970, Londrina, PR, Brazil.
| | - Phelipe Oliveira Favaron
- Department of General Biology, State University of Londrina (UEL), Rod Celso Garcia Cid, PR 445 Km 380, CEP 86057-970, Londrina, PR, Brazil.
| | - Luiz Guilherme Corsi Trautwein
- Department of Veterinary Clinics, State University of Londrina (UEL), Rod Celso Garcia Cid, PR 445 Km 380, CEP 86057-970, Londrina, PR, Brazil.
| | - Caio Garcia Barbosa da Silva
- Department of Veterinary Clinics, State University of Londrina (UEL), Rod Celso Garcia Cid, PR 445 Km 380, CEP 86057-970, Londrina, PR, Brazil.
| | - Gisele Augusta Amorim de Lemos
- Department of Preventive Veterinary Medicine, State University of Londrina (UEL), Rod Celso Garcia Cid, PR 445 Km 380, CEP 86057-970, Londrina, PR, Brazil.
| | - Maria Isabel Mello Martins
- Department of Veterinary Clinics, State University of Londrina (UEL), Rod Celso Garcia Cid, PR 445 Km 380, CEP 86057-970, Londrina, PR, Brazil.
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4
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Portela Dias J, Guedes-Martins L. Fetal Pulmonary Venous Return: From Basic Research to the Clinical Value of Doppler Assessment. Pediatr Cardiol 2023; 44:1419-1437. [PMID: 37505268 PMCID: PMC10435640 DOI: 10.1007/s00246-023-03244-4] [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: 05/18/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
The fetal pulmonary circulation represents less than 25% of the fetal cardiac output. In comparison with the pulmonary arteries, studies on pulmonary veins are few and limited, and many questions remain to be answered. The literature reports that pulmonary veins play an important role in regulating vascular flow, forming an active segment of the pulmonary circulation. The development of more sophisticated ultrasonography technology has allowed the investigation of the extraparenchymal pulmonary veins and their waveform. The recognition of the pulmonary vein anatomy in echocardiography is important for the diagnosis of anomalous pulmonary venous connections, with a significant impact on prognosis. On the other hand, the identification of the normal pulmonary vein waveform seems to be a reliable way to study left heart function, with potential applicability in fetal and maternal pathology. Thus, the goal of this narrative review was to provide a clinically oriented perspective of the available literature on this topic.
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Affiliation(s)
- J Portela Dias
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313, Porto, Portugal.
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar e Universitário de Santo António, Largo da Maternidade Júlio Dinis 45, 4050-651, Porto, Portugal.
- Unidade de Investigação e Formação - Centro Materno Infantil do Norte, 4050-651, Porto, Portugal.
| | - L Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313, Porto, Portugal
- Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte, Centro Hospitalar e Universitário de Santo António, Largo da Maternidade Júlio Dinis 45, 4050-651, Porto, Portugal
- Unidade de Investigação e Formação - Centro Materno Infantil do Norte, 4050-651, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal
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5
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Stevens RP, Lee JY, Bauer N, Stevens T. Got Oxygen? Studies on Mesenchymal Cell Hypoxia Inducible Factor-1α in Lung Development. Am J Respir Cell Mol Biol 2023; 69:380-382. [PMID: 37478332 PMCID: PMC10557915 DOI: 10.1165/rcmb.2023-0247ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 07/23/2023] Open
Affiliation(s)
- Reece P Stevens
- Department of Physiology and Cell Biology and Center for Lung Biology University of South Alabama Mobile, Alabama
| | - Ji Young Lee
- Department of Physiology and Cell Biology Center for Lung Biology and Department of Internal Medicine University of South Alabama Mobile, Alabama
| | - Natalie Bauer
- Center for Lung Biology and Department of Pharmacology University of South Alabama Mobile, Alabama
| | - Troy Stevens
- Department of Physiology and Cell Biology Center for Lung Biology and Department of Internal Medicine University of South Alabama Mobile, Alabama
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6
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Filippi L, Pascarella F, Pini A, Cammalleri M, Bagnoli P, Morganti R, Innocenti F, Castagnini N, Melosi A, Scaramuzzo RT. Fetal Oxygenation from the 23rd to the 36th Week of Gestation Evaluated through the Umbilical Cord Blood Gas Analysis. Int J Mol Sci 2023; 24:12487. [PMID: 37569862 PMCID: PMC10419490 DOI: 10.3390/ijms241512487] [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: 07/04/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
The embryo and fetus grow in a hypoxic environment. Intrauterine oxygen levels fluctuate throughout the pregnancy, allowing the oxygen to modulate apparently contradictory functions, such as the expansion of stemness but also differentiation. We have recently demonstrated that in the last weeks of pregnancy, oxygenation progressively increases, but the trend of oxygen levels during the previous weeks remains to be clarified. In the present retrospective study, umbilical venous and arterial oxygen levels, fetal oxygen extraction, oxygen content, CO2, and lactate were evaluated in a cohort of healthy newborns with gestational age < 37 weeks. A progressive decrease in pO2 levels associated with a concomitant increase in pCO2 and reduction in pH has been observed starting from the 23rd week until approximately the 33-34th week of gestation. Over this period, despite the increased hypoxemia, oxygen content remains stable thanks to increasing hemoglobin concentration, which allows the fetus to become more hypoxemic but not more hypoxic. Starting from the 33-34th week, fetal oxygenation increases and ideally continues following the trend recently described in term fetuses. The present study confirms that oxygenation during intrauterine life continues to vary even after placenta development, showing a clear biphasic trend. Fetuses, in fact, from mid-gestation to near-term, become progressively more hypoxemic. However, starting from the 33-34th week, oxygenation progressively increases until birth. In this regard, our data suggest that the placenta is the hub that ensures this variable oxygen availability to the fetus, and we speculate that this biphasic trend is functional for the promotion, in specific tissues and at specific times, of stemness and intrauterine differentiation.
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Affiliation(s)
- Luca Filippi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Neonatology Unit, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy; (F.P.); (F.I.); (N.C.); (A.M.); (R.T.S.)
| | - Francesca Pascarella
- Neonatology Unit, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy; (F.P.); (F.I.); (N.C.); (A.M.); (R.T.S.)
| | - Alessandro Pini
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Maurizio Cammalleri
- Unit of General Physiology, Department of Biology, University of Pisa, 56126 Pisa, Italy; (M.C.); (P.B.)
| | - Paola Bagnoli
- Unit of General Physiology, Department of Biology, University of Pisa, 56126 Pisa, Italy; (M.C.); (P.B.)
| | - Riccardo Morganti
- Section of Statistics, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy;
| | - Francesca Innocenti
- Neonatology Unit, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy; (F.P.); (F.I.); (N.C.); (A.M.); (R.T.S.)
| | - Nicola Castagnini
- Neonatology Unit, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy; (F.P.); (F.I.); (N.C.); (A.M.); (R.T.S.)
| | - Alice Melosi
- Neonatology Unit, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy; (F.P.); (F.I.); (N.C.); (A.M.); (R.T.S.)
| | - Rosa Teresa Scaramuzzo
- Neonatology Unit, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy; (F.P.); (F.I.); (N.C.); (A.M.); (R.T.S.)
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7
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Baena-García L, de la Flor-Alemany M, Coll-Risco I, Reoyo OR, Aranda P, Aparicio VA. A concurrent prenatal exercise program increases neonatal and placental weight and shortens labor: The GESTAFIT project. Scand J Med Sci Sports 2023; 33:465-474. [PMID: 36578199 DOI: 10.1111/sms.14298] [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: 01/18/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore the influence of a supervised concurrent exercise-training program during pregnancy on maternal and neonatal birth-related outcomes and type of birth. METHODS One hundred and fifty-nine Caucasian pregnant women from the GESTAFIT project participated in this quasi-experimental study and were allocated into control [(n = 86), (age 33.1 ± 4.8 years old, BMI 24.8 ± 4.1 kg/m2 )] or exercise group [(n = 50) (age 33.1 ± 4.1 years old, BMI: 24.7 ± 4.1 kg/m2 )]. The exercise group followed a 60-min 3 days/week concurrent (aerobic and strength) training program from the 17th gestational week until birth. Maternal and neonatal birth-related outcomes (i.e., gestational age at birth, duration of labor, placental and neonatal weight and type of birth) were collected from obstetric medical records. Umbilical arterial and venous blood gas analysis were assessed after birth. RESULTS The exercise group increased average duration of the first stage of labor [between-group differences (B): 80.8 min, 95% confidence interval (CI), 4.18, 157.31, p = 0.03] and decreased duration of the second stage of labor [between-group differences (B): 29.8 min, 95% CI: -55.5, -4.17, p = 0.02] compared to the control group. The exercise group showed greater placental [between-group differences (B): 53.3 g (95% CI: 9.99, 96.7, p = 0.01)] and neonatal [between-group differences (B): 161.8 g (95% CI: 9.81, 313.8, p = 0.033)] weight compared to the control group. No differences between groups were found regarding type of birth (p > 0.05). CONCLUSIONS A concurrent and supervised physical exercise program during pregnancy is safe and could promote better maternal and neonatal birth-related outcomes. More studies are needed to clarify the mechanisms by which physical exercise increases neonatal and placenta weight.
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Affiliation(s)
- Laura Baena-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), Granada, Spain
| | - Marta de la Flor-Alemany
- Sport and Health University Research Institute (iMUDS), Granada, Spain.,Department of Physiology, University of Granada, Granada, Spain.,Institute of Nutrition and Food Technology, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Irene Coll-Risco
- Sport and Health University Research Institute (iMUDS), Granada, Spain
| | - Olga Roldán Reoyo
- Department of Sport Sciences, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - Pilar Aranda
- Department of Physiology, University of Granada, Granada, Spain.,Institute of Nutrition and Food Technology, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Virginia A Aparicio
- Sport and Health University Research Institute (iMUDS), Granada, Spain.,Department of Physiology, University of Granada, Granada, Spain.,Institute of Nutrition and Food Technology, Biomedical Research Centre, University of Granada, Granada, Spain
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8
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Zheng B, Lyu L, Wang X, Wen H, Li Y, Li J, Yao Y, Zuo C, Yan S, Xie S, Qi X. Comparative transcriptomic analysis and genome-wide characterization of the Semaphorin family reveal the potential mechanism of angiogenesis around embryo in ovoviviparous black rockfish (Sebastes schlegelii). Gen Comp Endocrinol 2023; 338:114275. [PMID: 36940835 DOI: 10.1016/j.ygcen.2023.114275] [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: 01/10/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/23/2023]
Abstract
To guarantee the quality and survival rate of their offspring, ovoviviparous teleost evolved special characteristics of in vivo fertilization and embryo development. Maternal black rockfish, having over 50 thousand embryos developing within the ovary simultaneously, provided around 40% nutrition throughout oocyte development, while the capillaries around each embryo contributed the rest 60% during pregnancy. Since fertilization, capillaries started to proliferate and developed into a placenta-like structure that covered over half of each embryo. Aimed to characterize the potential mechanism behind, comparative transcriptome analysis of samples collected according to the process of pregnancy. Three important time point in the process, including mature oocyte stage, fertilization and sarcomere period, were chosen for the transcriptome sequencing. Our study identified key pathways and genes involved in the cell cycle as well as DNA replication and repair, cell migration and adhesion, immune, and metabolic functions. Notably, several of the semaphoring gene family members were differently expressed. To confirm the accuracy of these genes, total of 32 sema genes were identified from the whole genome and distinct expression pattern of sema genes was observed in different pregnant stages. Our results revealed a novel insight for further investigating the functions of sema genes in reproduction physiology and embryo processes in ovoviviparous teleost.
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Affiliation(s)
- Bingyan Zheng
- Key Laboratory of Mariculture, Ministry of Education, Ocean University of China, Qingdao, China
| | - Likang Lyu
- Key Laboratory of Mariculture, Ministry of Education, Ocean University of China, Qingdao, China
| | - Xiaojie Wang
- Key Laboratory of Mariculture, Ministry of Education, Ocean University of China, Qingdao, China
| | - Haishen Wen
- Key Laboratory of Mariculture, Ministry of Education, Ocean University of China, Qingdao, China
| | - Yun Li
- Key Laboratory of Mariculture, Ministry of Education, Ocean University of China, Qingdao, China
| | - Jianshuang Li
- Key Laboratory of Mariculture, Ministry of Education, Ocean University of China, Qingdao, China
| | - Yijia Yao
- Key Laboratory of Mariculture, Ministry of Education, Ocean University of China, Qingdao, China
| | - Chenpeng Zuo
- Key Laboratory of Mariculture, Ministry of Education, Ocean University of China, Qingdao, China
| | - Shaojing Yan
- Key Laboratory of Mariculture, Ministry of Education, Ocean University of China, Qingdao, China
| | - Songyang Xie
- Key Laboratory of Mariculture, Ministry of Education, Ocean University of China, Qingdao, China
| | - Xin Qi
- Key Laboratory of Mariculture, Ministry of Education, Ocean University of China, Qingdao, China.
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9
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Wongkitikamjorn W, Wada E, Hosomichi J, Maeda H, Satrawaha S, Hong H, Yoshida KI, Ono T, Hayashi YK. Metabolic dysregulation and decreased capillarization in skeletal muscles of male adolescent offspring rats exposed to gestational intermittent hypoxia. Front Physiol 2023; 14:1067683. [PMID: 36711021 PMCID: PMC9878705 DOI: 10.3389/fphys.2023.1067683] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023] Open
Abstract
Gestational intermittent hypoxia (IH) is a hallmark of obstructive sleep apnea that occurs frequently during pregnancy, and effects caused by this environmental change during pregnancy may be transmitted to the offspring. In this study, we aimed to clarify the effects of IH in pregnant rats on the skeletal muscle of adolescent offspring rats. Mother rats underwent IH from gestation day 7-21, and their 5-weeks-old male offspring were analyzed. All male offspring rats were born and raised under normoxia conditions. Although no general growth retardation was observed, we found that exposure to gestational IH reduces endurance running capacity of adolescent offspring rats. Both a respiratory muscle (diaphragm; DIA) and a limb muscle (tibialis anterior; TA) showed no histological abnormalities, including fiber size and fiber type distribution. To identify the possible mechanism underlying the reduced running capacity, regulatory factors associated with energy metabolism were analyzed in different parts of skeletal muscles. Compared with rats born under conditions of gestational normoxia, gestational IH offspring rats showed significantly lower expression of genes associated with glucose and lipid metabolism, and lower protein levels of phosphorylated AMPK and AKT. Furthermore, gene expression of adiponectin receptors one and two was significantly decreased in the DIA and TA muscles. In addition, the DIA muscle from adolescent rats had significantly decreased capillary density as a result of gestational IH. However, these changes were not observed in a sucking muscle (geniohyoid) and a masticating muscle (masseter) of these rats. These results suggest that respiratory and limb muscles are vulnerable to gestational IH, which induces altered energy metabolism with decreased aerobic motor function. These changes were partially owing to the decreased expression of adiponectin receptors and decreased capillary density in adolescent offspring rats.
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Affiliation(s)
- Wirongrong Wongkitikamjorn
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan,Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Eiji Wada
- Department of Pathophysiology, Tokyo Medical University, Tokyo, Japan
| | - Jun Hosomichi
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hideyuki Maeda
- Department of Forensic Medicine, Tokyo Medical University, Tokyo, Japan
| | - Sirichom Satrawaha
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Haixin Hong
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan,Department of Stomatology, Shenzhen University General Hospital, Shenzhen, China
| | - Ken-ichi Yoshida
- Department of Forensic Medicine, Tokyo Medical University, Tokyo, Japan
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yukiko K. Hayashi
- Department of Pathophysiology, Tokyo Medical University, Tokyo, Japan,*Correspondence: Yukiko K. Hayashi,
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Filippi L, Scaramuzzo RT, Pascarella F, Pini A, Morganti R, Cammalleri M, Bagnoli P, Ciantelli M. Fetal oxygenation in the last weeks of pregnancy evaluated through the umbilical cord blood gas analysis. Front Pediatr 2023; 11:1140021. [PMID: 37152310 PMCID: PMC10160648 DOI: 10.3389/fped.2023.1140021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Embryo and fetus grow and mature over the first trimester of pregnancy in a dynamic hypoxic environment, where placenta development assures an increased oxygen availability. However, it is unclear whether and how oxygenation changes in the later trimesters and, more specifically, in the last weeks of pregnancy. Methods Observational study that evaluated the gas analysis of the umbilical cord blood collected from a cohort of healthy newborns with gestational age ≥37 weeks. Umbilical venous and arterial oxygen levels as well as fetal oxygen extraction were calculated to establish whether oxygenation level changes over the last weeks of pregnancy. In addition, fetal lactate, and carbon dioxide production were analyzed to establish whether oxygen oscillations may induce metabolic effects in utero. Results This study demonstrates a progressive increase in fetal oxygenation levels from the 37th to the 41st weeks of gestation (mean venous PaO2 approximately from 20 to 25 mmHg; p < 0.001). This increase is largely attributable to growing umbilical venous PaO2, regardless of delivery modalities. In neonates born by vaginal delivery, the increased oxygen availability is associated with a modest increase in oxygen extraction, while in neonates born by cesarean section, it is associated with reduced lactate production. Independently from the type of delivery, carbon dioxide production moderately increased. These findings suggest a progressive shift from a prevalent anaerobic metabolism (Warburg effect) towards a growing aerobic metabolism. Conclusion This study confirms that fetuses grow in a hypoxic environment that becomes progressively less hypoxic in the last weeks of gestation. The increased oxygen availability seems to favor aerobic metabolic shift during the last weeks of intrauterine life; we hypothesize that this environmental change may have implications for fetal maturation during intrauterine life.
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Affiliation(s)
- Luca Filippi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Neonatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Correspondence: Luca Filippi
| | | | | | - Alessandro Pini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Morganti
- Section of Statistics, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Maurizio Cammalleri
- Unit of General Physiology, Department of Biology, University of Pisa, Pisa, Italy
| | - Paola Bagnoli
- Unit of General Physiology, Department of Biology, University of Pisa, Pisa, Italy
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11
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Whittington CM, Buddle AL, Griffith OW, Carter AM. Embryonic specializations for vertebrate placentation. Philos Trans R Soc Lond B Biol Sci 2022; 377:20210261. [PMID: 36252220 PMCID: PMC9574634 DOI: 10.1098/rstb.2021.0261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/28/2022] [Indexed: 12/20/2022] Open
Abstract
The vertebrate placenta, a close association of fetal and parental tissue for physiological exchange, has evolved independently in sharks, teleost fishes, coelacanths, amphibians, squamate reptiles and mammals. This transient organ forms during pregnancy and is an important contributor to embryonic development in both viviparous and oviparous, brooding species. Placentae may be involved in transport of respiratory gases, wastes, immune molecules, hormones and nutrients. Depending on the taxon, the embryonic portion of the placenta is comprised of either extraembryonic membranes (yolk sac or chorioallantois) or temporary embryonic tissues derived via hypertrophy of pericardium, gill epithelium, gut, tails or fins. These membranes and tissues have been recruited convergently into placentae in several lineages. Here, we highlight the diversity and common features of embryonic tissues involved in vertebrate placentation and suggest future studies that will provide new knowledge about the evolution of pregnancy. This article is part of the theme issue 'Extraembryonic tissues: exploring concepts, definitions and functions across the animal kingdom'.
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Affiliation(s)
- Camilla M. Whittington
- School of Life and Environmental Sciences, The University of Sydney, Heydon-Laurence A08, New South Wales 2006, Australia
| | - Alice L. Buddle
- School of Life and Environmental Sciences, The University of Sydney, Heydon-Laurence A08, New South Wales 2006, Australia
| | - Oliver W. Griffith
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales 2109, Australia
| | - Anthony M. Carter
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, J. B. Winsloews Vej 21, 5000 Odense, Denmark
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12
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Prioreschi A, Aronoff DM, Koethe J, Norris SA, Goldstein JA. Interactions between maternal health and placental morphology on neonate body composition. GLOBAL PEDIATRICS 2022; 3. [PMID: 37073307 PMCID: PMC10107011 DOI: 10.1016/j.gpeds.2022.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background We aimed to examine maternal metabolic correlates of neonate body composition, and the potential mediating effect of the placenta. Methods Data were collected throughout pregnancy and at delivery. An oral glucose tolerance test (OGTT) was conducted in order to diagnose or rule out gestational diabetes mellitus (GDM). Maternal weight and blood pressure were taken and hypertension and gestational weight gain (GWG) were defined. Gestational age, birth weight (BW) and weight to length ration (WLR) were recorded. Photographs were taken of the placenta, and the widths and lengths were measured digitally. Body composition was analysed via air displacement plethysmography or dual-energy x-ray absorptiometry. Mediation models were conducted to determine the mediation effect of the placental variables on the relationships between maternal health variables and neonate outcomes. Next, interaction terms were added to models to determine how maternal and placental variables interacted in their effect on neonate outcomes. Results A total of n = 280 women were included in the analysis. Majority were overweight or obese. Fourteen percent of women developed GDM during pregnancy, 5% had hypertension during pregnancy, 32% were HIV positive, and 32% had anemia. For the birth weight outcome, coefficients of BMI were attenuated by the addition of placental variables (Model 1 β=18.66 vs Model 2 β=16.40). Similar patterns were evident for GWG and hypertension, and for the WLR outcome. In all cases the addition of the placental variables attenuated associations between maternal exposures and neonatal outcomes, yet the level of significance did not change. Inclusion of interaction terms reversed the direction of the relationships between hypertension and BW and WLR, and between GWG and WLR. Conclusion The placenta buffers some harmful effects of obesity, GWG, and hypertension on neonate size, and placental efficiency interacted with most maternal risk factors to either counteract, or attenuate relationships with neonate size at birth. However the placenta was unable to completely counteract the negative effect of excess nutrient supply on in utero growth.
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Affiliation(s)
- Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Corresponding author at: Chris Hani Baragwanath Academic Hospital, Corner College and Clinic Roads, Soweto, South Africa. (A. Prioreschi)
| | - David M Aronoff
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232
| | - John Koethe
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeffrey A Goldstein
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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13
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Desoye G, Carter AM. Fetoplacental oxygen homeostasis in pregnancies with maternal diabetes mellitus and obesity. Nat Rev Endocrinol 2022; 18:593-607. [PMID: 35902735 DOI: 10.1038/s41574-022-00717-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/09/2022]
Abstract
Despite improvements in clinical management, pregnancies complicated by pre-existing diabetes mellitus, gestational diabetes mellitus or obesity carry substantial risks for parent and offspring. Some of the endocrine and metabolic changes in parent and fetus in diabetes mellitus and obesity lead to fetal oxygen deficit, mostly due to insulin-induced accelerated fetal metabolism. The human fetus deals with reduced oxygenation through a wide range of adaptive responses that act at various levels in the placenta as well as the fetus. These responses ensure adequate oxygen delivery to the fetus, increase the oxygen transport capacity of fetal blood and redistribute oxygen-rich blood to vital organs such as the brain and heart. The liver has a central role in adapting to reduced oxygenation by increasing its oxygen extraction and stimulating erythropoietin synthesis to increase haematocrit. The type of adaptive response depends on the onset and duration of hypoxia and the severity of the metabolic disturbance. In pregnancies characterized by diabetes mellitus or obesity, these adaptive systems come under additional strain owing to the increased maternal supply of glucose and resultant fetal hyperinsulinaemia, both of which stimulate oxidative metabolism. In the rare situation that the adaptive responses are overwhelmed, stillbirth can ensue.
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Affiliation(s)
- Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria.
- Center for Pregnant Women with Diabetes, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Anthony M Carter
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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14
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Prenatal Hypoxia Affects Foetal Cardiovascular Regulatory Mechanisms in a Sex- and Circadian-Dependent Manner: A Review. Int J Mol Sci 2022; 23:ijms23052885. [PMID: 35270026 PMCID: PMC8910900 DOI: 10.3390/ijms23052885] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/17/2022] Open
Abstract
Prenatal hypoxia during the prenatal period can interfere with the developmental trajectory and lead to developing hypertension in adulthood. Prenatal hypoxia is often associated with intrauterine growth restriction that interferes with metabolism and can lead to multilevel changes. Therefore, we analysed the effects of prenatal hypoxia predominantly not associated with intrauterine growth restriction using publications up to September 2021. We focused on: (1) The response of cardiovascular regulatory mechanisms, such as the chemoreflex, adenosine, nitric oxide, and angiotensin II on prenatal hypoxia. (2) The role of the placenta in causing and attenuating the effects of hypoxia. (3) Environmental conditions and the mother's health contribution to the development of prenatal hypoxia. (4) The sex-dependent effects of prenatal hypoxia on cardiovascular regulatory mechanisms and the connection between hypoxia-inducible factors and circadian variability. We identified that the possible relationship between the effects of prenatal hypoxia on the cardiovascular regulatory mechanism may vary depending on circadian variability and phase of the days. In summary, even short-term prenatal hypoxia significantly affects cardiovascular regulatory mechanisms and programs hypertension in adulthood, while prenatal programming effects are not only dependent on the critical period, and sensitivity can change within circadian oscillations.
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15
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Ortega MA, Fraile-Martínez O, García-Montero C, Sáez MA, Álvarez-Mon MA, Torres-Carranza D, Álvarez-Mon M, Bujan J, García-Honduvilla N, Bravo C, Guijarro LG, De León-Luis JA. The Pivotal Role of the Placenta in Normal and Pathological Pregnancies: A Focus on Preeclampsia, Fetal Growth Restriction, and Maternal Chronic Venous Disease. Cells 2022; 11:cells11030568. [PMID: 35159377 PMCID: PMC8833914 DOI: 10.3390/cells11030568] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/02/2022] [Accepted: 02/05/2022] [Indexed: 12/01/2022] Open
Abstract
The placenta is a central structure in pregnancy and has pleiotropic functions. This organ grows incredibly rapidly during this period, acting as a mastermind behind different fetal and maternal processes. The relevance of the placenta extends far beyond the pregnancy, being crucial for fetal programming before birth. Having integrative knowledge of this maternofetal structure helps significantly in understanding the development of pregnancy either in a proper or pathophysiological context. Thus, the aim of this review is to summarize the main features of the placenta, with a special focus on its early development, cytoarchitecture, immunology, and functions in non-pathological conditions. In contraposition, the role of the placenta is examined in preeclampsia, a worrisome hypertensive disorder of pregnancy, in order to describe the pathophysiological implications of the placenta in this disease. Likewise, dysfunction of the placenta in fetal growth restriction, a major consequence of preeclampsia, is also discussed, emphasizing the potential clinical strategies derived. Finally, the emerging role of the placenta in maternal chronic venous disease either as a causative agent or as a consequence of the disease is equally treated.
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Affiliation(s)
- Miguel A. Ortega
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (D.T.-C.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain;
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28801 Alcalá de Henares, Madrid, Spain
- Correspondence: ; Tel.: +34-91-885-4540; Fax: +34-91-885-4885
| | - Oscar Fraile-Martínez
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (D.T.-C.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain;
| | - Cielo García-Montero
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (D.T.-C.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain;
| | - Miguel A. Sáez
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (D.T.-C.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain;
- Pathological Anatomy Service, Central University Hospital of Defence-UAH, 28047 Madrid, Spain
| | - Miguel Angel Álvarez-Mon
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (D.T.-C.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain;
| | - Diego Torres-Carranza
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (D.T.-C.); (M.Á.-M.); (J.B.); (N.G.-H.)
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (D.T.-C.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain;
- Immune System Diseases-Rheumatology and Oncology Service, University Hospital Príncipe de Asturias, CIBEREHD, 28801 Alcalá de Henares, Madrid, Spain
| | - Julia Bujan
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (D.T.-C.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain;
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.S.); (M.A.Á.-M.); (D.T.-C.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain;
| | - Coral Bravo
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (C.B.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Luis G. Guijarro
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain;
- Unit of Biochemistry and Molecular Biology (CIBEREHD), Department of System Biology, University of Alcalá, 28801 Alcalá de Henares, Madrid, Spain
| | - Juan A. De León-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (C.B.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
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16
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Blood Flow and Respiratory Gas Exchange in the Human Placenta at Term: A Data Update. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1395:379-384. [PMID: 36527666 DOI: 10.1007/978-3-031-14190-4_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Reliable measurements using modern techniques and consensus in experimental design have enabled the assessment of novel data sets for normal maternal and foetal respiratory physiology at term. These data sets include (a) principal factors affecting placental gas transfer, e.g., maternal blood flow through the intervillous space (IVS) (500 mL/min) and foeto-placental blood flow (480 mL/min), and (b) O2, CO2 and pH levels in the materno-placental and foeto-placental circulation. According to these data, the foetus is adapted to hypoxaemic hypoxia. Despite flat oxygen partial pressure (pO2) gradients between the blood of the IVS and the umbilical arteries of the foetus, adequate O2 delivery to the foetus is maintained by the higher O2 affinity of the foetal blood, high foetal haemoglobin (HbF) concentrations, the Bohr effect, the double-Bohr effect, and high foeto-placental (=umbilical) blood flow. Again, despite flat gradients, adequate CO2 removal from the foetus is maintained by a high diffusion capacity, high foeto-placental blood flow, the Haldane effect, and the double-Haldane effect. Placental respiratory gas exchange is perfusion-limited, rather than diffusion-limited, i.e., O2 uptake depends on O2 delivery.
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Taggarsi DA, Krishna B. Placenta in the Critically Ill Mother. Indian J Crit Care Med 2021; 25:S200-S205. [PMID: 35615604 PMCID: PMC9108785 DOI: 10.5005/jp-journals-10071-24024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The placenta is a temporary, multifunctional organ composed of both maternal and fetal components. It maintains homeostasis to ensure the growth of the fetus and well-being of the mother. Abnormalities in placental development have been known to be responsible for several disorders of pregnancy. Conditions coincident with pregnancy can upset the homeostasis and result in critical illness, which can greatly impact placental function and in turn affect the fetus. Decreased blood flow, acidemia, hypercarbia, and hypoxia seen in critically ill pregnant mothers can result in fetal death. Understanding the physiological changes and functioning of the maternal-fetal-placental unit will aid in better management of critically ill mothers. How to cite this article Taggarsi DA, Krishna B. Placenta in the Critically Ill Mother. Indian J Crit Care Med 2021;25(Suppl 3):S200-S205.
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Affiliation(s)
- Dipali Anand Taggarsi
- Department of Critical Care Medicine, St John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St John's Medical College and Hospital, Bengaluru, Karnataka, India
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18
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Martinez VD, Lam WL. Health Effects Associated With Pre- and Perinatal Exposure to Arsenic. Front Genet 2021; 12:664717. [PMID: 34659330 PMCID: PMC8511415 DOI: 10.3389/fgene.2021.664717] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/26/2021] [Indexed: 12/11/2022] Open
Abstract
Inorganic arsenic is a well-established human carcinogen, able to induce genetic and epigenetic alterations. More than 200 million people worldwide are exposed to arsenic concentrations in drinking water exceeding the recommended WHO threshold (10μg/l). Additionally, chronic exposure to levels below this threshold is known to result in long-term health effects in humans. The arsenic-related health effects in humans are associated with its biotransformation process, whereby the resulting metabolites can induce molecular damage that accumulates over time. The effects derived from these alterations include genomic instability associated with oxidative damage, alteration of gene expression (including coding and non-coding RNAs), global and localized epigenetic reprogramming, and histone posttranslational modifications. These alterations directly affect molecular pathways involved in the onset and progression of many conditions that can arise even decades after the exposure occurs. Importantly, arsenic metabolites generated during its biotransformation can also pass through the placental barrier, resulting in fetal exposure to this carcinogen at similar levels to those of the mother. As such, more immediate effects of the arsenic-induced molecular damage can be observed as detrimental effects on fetal development, pregnancy, and birth outcomes. In this review, we focus on the genetic and epigenetic damage associated with exposure to low levels of arsenic, particularly those affecting early developmental stages. We also present how these alterations occurring during early life can impact the development of certain diseases in adult life.
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Affiliation(s)
- Victor D. Martinez
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
- Department of Pathology and Laboratory Medicine, IWK Health Centre, Halifax, NS, Canada
- Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada
- The Canadian Environmental Exposures in Cancer (CE2C) Network, Halifax, NS, Canada
| | - Wan L. Lam
- The Canadian Environmental Exposures in Cancer (CE2C) Network, Halifax, NS, Canada
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
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19
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Dudley JS, Hannaford P, Dowland SN, Lindsay LA, Thompson MB, Murphy CR, Van Dyke JU, Whittington CM. Structural changes to the brood pouch of male pregnant seahorses (Hippocampus abdominalis) facilitate exchange between father and embryos. Placenta 2021; 114:115-123. [PMID: 34517263 DOI: 10.1016/j.placenta.2021.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/10/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Embryonic growth and development require efficient respiratory gas exchange. Internal incubation of developing young thus presents a significant physiological challenge, because respiratory gas diffusion to embryos is impeded by the additional barrier of parental tissue between the embryo and the environment. Therefore, live-bearing species exhibit a variety of adaptations facilitating respiratory gas exchange between the parent (usually the mother) and embryos. Syngnathid fishes are the only vertebrates to exhibit male pregnancy, allowing comparative studies of the biology and evolution of internal incubation of embryos, independent of the female reproductive tract. Here, we examine the fleshy, sealed, seahorse brood pouch, and provide the first quantification of structural changes to this gestational organ across pregnancy. METHODS We used histological analysis and morphometrics to quantify the surface area for exchange across the brood pouch epithelium, and the structure of the vascular bed of the brood pouch. RESULTS We show dramatic remodelling of gestational tissues as pregnancy progresses, including an increase in tortuosity of the gestational epithelium, an increase in capillary density, and a decrease in diffusion distance between capillaries and the pouch lumen. DISCUSSION These changes produce an increased surface area and expansion of the vascular bed of the placenta that likely facilitates respiratory gas exchange. These changes mirror the remodelling of gestational tissue in viviparous amniotes and elasmobranchs, and provide further evidence of the convergence of adaptations to support pregnancy in live-bearing animals.
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Affiliation(s)
- J S Dudley
- The University of Sydney, School of Life and Environmental Sciences, Sydney, NSW, Australia; Macquarie University, Department of Biological Sciences, Faculty of Science and Engineering, Macquarie Park, NSW, Australia
| | - P Hannaford
- The University of Sydney, School of Life and Environmental Sciences, Sydney, NSW, Australia
| | - S N Dowland
- The University of Sydney, School of Medical Sciences (Anatomy and Histology), Sydney, NSW, Australia
| | - L A Lindsay
- The University of Sydney, School of Medical Sciences (Anatomy and Histology), Sydney, NSW, Australia
| | - M B Thompson
- The University of Sydney, School of Life and Environmental Sciences, Sydney, NSW, Australia
| | - C R Murphy
- The University of Sydney, School of Life and Environmental Sciences, Sydney, NSW, Australia; The University of Sydney, School of Medical Sciences (Anatomy and Histology), Sydney, NSW, Australia
| | - J U Van Dyke
- La Trobe University, Department of Pharmacy and Biomedical Sciences, School of Molecular Sciences, Wodonga, Victoria, Australia
| | - C M Whittington
- The University of Sydney, School of Life and Environmental Sciences, Sydney, NSW, Australia.
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20
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Carter AM. Unique Aspects of Human Placentation. Int J Mol Sci 2021; 22:8099. [PMID: 34360862 PMCID: PMC8347521 DOI: 10.3390/ijms22158099] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 12/22/2022] Open
Abstract
Human placentation differs from that of other mammals. A suite of characteristics is shared with haplorrhine primates, including early development of the embryonic membranes and placental hormones such as chorionic gonadotrophin and placental lactogen. A comparable architecture of the intervillous space is found only in Old World monkeys and apes. The routes of trophoblast invasion and the precise role of extravillous trophoblast in uterine artery transformation is similar in chimpanzee and gorilla. Extended parental care is shared with the great apes, and though human babies are rather helpless at birth, they are well developed (precocial) in other respects. Primates and rodents last shared a common ancestor in the Cretaceous period, and their placentation has evolved independently for some 80 million years. This is reflected in many aspects of their placentation. Some apparent resemblances such as interstitial implantation and placental lactogens are the result of convergent evolution. For rodent models such as the mouse, the differences are compounded by short gestations leading to the delivery of poorly developed (altricial) young.
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Affiliation(s)
- Anthony M Carter
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, DK-5230 Odense, Denmark
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Martinez VD, Sage AP, Minatel BC, Marshall EA, Price EM, Becker-Santos DD, Robinson WP, Lam WL. Human placental piwi-interacting RNA transcriptome is characterized by expression from the DLK1-DIO3 imprinted region. Sci Rep 2021; 11:14981. [PMID: 34294738 PMCID: PMC8298716 DOI: 10.1038/s41598-021-93885-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 06/17/2021] [Indexed: 01/07/2023] Open
Abstract
The placenta is vital to embryonic development and requires a finely-tuned pattern of gene expression, achieved in part by its unique epigenetic landscape. Piwi-interacting RNAs (piRNAs) are a class of small-non-coding RNA with established roles as epigenetic regulators of gene expression, largely via methylation of targeted DNA sequences. The expression of piRNAs have mainly been described in germ cells, but a fraction have been shown to retain expression in adult somatic tissues. To aid in understanding the contribution of these regulators in the placenta, we provide the first description of the piRNA transcriptome in human placentas. We find 297 piRNAs to be preferentially expressed in the human placenta, a subset of which are expressed at higher levels relative to testes samples. We also observed a large proportion of placental piRNAs to be expressed from a single locus, as distinct from canonical cluster locations associated with transposable element silencing. Finally, we find that 15 of the highest-expressed placental piRNAs maps to the DLK1-DIO3 locus, suggesting a link to placental biology. Our findings suggest that piRNAs could contribute to the molecular networks defining placental function in humans, and a biological impact of piRNA expression beyond germ cells.
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Affiliation(s)
- Victor D Martinez
- British Columbia Cancer Research Centre, 675 West 10th Ave, Vancouver, BC, Canada. .,IWK Health Centre, Halifax, NS, Canada. .,Department of Pathology, Faculty of Medicine, Dalhousie University, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada.
| | - Adam P Sage
- British Columbia Cancer Research Centre, 675 West 10th Ave, Vancouver, BC, Canada
| | - Brenda C Minatel
- British Columbia Cancer Research Centre, 675 West 10th Ave, Vancouver, BC, Canada
| | - Erin A Marshall
- British Columbia Cancer Research Centre, 675 West 10th Ave, Vancouver, BC, Canada
| | - E Magda Price
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | | | - Wendy P Robinson
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Wan L Lam
- British Columbia Cancer Research Centre, 675 West 10th Ave, Vancouver, BC, Canada
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22
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Mouradian GC, Lakshminrusimha S, Konduri GG. Perinatal Hypoxemia and Oxygen Sensing. Compr Physiol 2021; 11:1653-1677. [PMID: 33792908 DOI: 10.1002/cphy.c190046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The development of the control of breathing begins in utero and continues postnatally. Fetal breathing movements are needed for establishing connectivity between the lungs and central mechanisms controlling breathing. Maturation of the control of breathing, including the increase of hypoxia chemosensitivity, continues postnatally. Insufficient oxygenation, or hypoxia, is a major stressor that can manifest for different reasons in the fetus and neonate. Though the fetus and neonate have different hypoxia sensing mechanisms and respond differently to acute hypoxia, both responses prevent deviations to respiratory and other developmental processes. Intermittent and chronic hypoxia pose much greater threats to the normal developmental respiratory processes. Gestational intermittent hypoxia, due to maternal sleep-disordered breathing and sleep apnea, increases eupneic breathing and decreases the hypoxic ventilatory response associated with impaired gasping and autoresuscitation postnatally. Chronic fetal hypoxia, due to biologic or environmental (i.e. high-altitude) factors, is implicated in fetal growth restriction and preterm birth causing a decrease in the postnatal hypoxic ventilatory responses with increases in irregular eupneic breathing. Mechanisms driving these changes include delayed chemoreceptor development, catecholaminergic activity, abnormal myelination, increased astrocyte proliferation in the dorsal respiratory group, among others. Long-term high-altitude residents demonstrate favorable adaptations to chronic hypoxia as do their offspring. Neonatal intermittent hypoxia is common among preterm infants due to immature respiratory systems and thus, display a reduced drive to breathe and apneas due to insufficient hypoxic sensitivity. However, ongoing intermittent hypoxia can enhance hypoxic sensitivity causing ventilatory overshoots followed by apnea; the number of apneas is positively correlated with degree of hypoxic sensitivity in preterm infants. Chronic neonatal hypoxia may arise from fetal complications like maternal smoking or from postnatal cardiovascular problems, causing blunting of the hypoxic ventilatory responses throughout at least adolescence due to attenuation of carotid body fibers responses to hypoxia with potential roles of brainstem serotonin, microglia, and inflammation, though these effects depend on the age in which chronic hypoxia initiates. Fetal and neonatal intermittent and chronic hypoxia are implicated in preterm birth and complicate the respiratory system through their direct effects on hypoxia sensing mechanisms and interruptions to the normal developmental processes. Thus, precise regulation of oxygen homeostasis is crucial for normal development of the respiratory control network. © 2021 American Physiological Society. Compr Physiol 11:1653-1677, 2021.
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Affiliation(s)
- Gary C Mouradian
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Satyan Lakshminrusimha
- Department of Pediatrics, UC Davis Children's Hospital, UC Davis Health, UC Davis, Davis, California, USA
| | - Girija G Konduri
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Children's Research Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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23
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Amberg BJ, DeKoninck PLJ, Kashyap AJ, Skinner SM, Rodgers KA, McGillick EV, Deprest JA, Hooper SB, Crossley KJ, Hodges RJ. Placental gas exchange during amniotic carbon dioxide insufflation in sheep. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:305-313. [PMID: 31765050 DOI: 10.1002/uog.21933] [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: 08/13/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Insufflation of the amniotic cavity with carbon dioxide (CO2 ) is used clinically to improve visibility during complex fetoscopic surgery. Insufflation with heated, humidified CO2 has recently been shown to reduce fetal hypercapnia and acidosis in sheep, compared with use of cold and dry CO2 , but the underlying mechanisms are unclear. The aim of this study was to investigate whether differences in placental CO2 and oxygen (O2 ) exchange during insufflation with heated and humidified vs cold and dry CO2 could explain these findings. METHODS Thirteen fetal lambs at 105 days of gestation (term, 146 days) were exteriorized partially, via a midline laparotomy and hysterotomy, and instrumented with an umbilical artery catheter, an umbilical vein catheter and a common umbilical vein flow probe. Arterial and venous catheters and flow probes were also inserted into the maternal uterine circulation. Six ewes were insufflated with cold, dry CO2 (22°C; 0-5% humidity) and seven with heated, humidified CO2 (40°C; 95-100% humidity) at 15 mmHg for 180 min. Blood-flow recordings and paired arterial and venous blood gases were sampled from uterine and umbilical vessels. Rates of placental CO2 and O2 exchange were calculated. RESULTS After 180 min of insufflation, fetal survival was 33% (2/6) using cold, dry CO2 and 71% (5/7) using heated, humidified CO2 . By 120 min, fetuses insufflated with heated, humidified CO2 had lower arterial CO2 levels and higher arterial pH compared to those insufflated with cold, dry gas. Insufflation decreased significantly placental gas exchange in both groups, as measured by rates of both (i) fetal CO2 clearance and O2 uptake and (ii) maternal O2 delivery and CO2 uptake from the fetal compartment. CONCLUSIONS Lower arterial CO2 and higher pH levels in fetuses insufflated with heated and humidified, compared to cold and dry, CO2 could not be explained by differences in placental gas exchange. Instead, heated and humidified insufflation appeared to reduce fetal CO2 absorption from the uterus, supporting its use in preference to cold, dry CO2 . © 2019 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B J Amberg
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - P L J DeKoninck
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - A J Kashyap
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - S M Skinner
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - K A Rodgers
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - E V McGillick
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - J A Deprest
- Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - S B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - K J Crossley
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - R J Hodges
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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24
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Watkins VY, Frolova AI, Stout MJ, Carter EB, Macones GA, Cahill AG, Raghuraman N. The relationship between maternal anemia and umbilical cord oxygen content at delivery. Am J Obstet Gynecol MFM 2021; 3:100270. [PMID: 33451626 PMCID: PMC7811574 DOI: 10.1016/j.ajogmf.2020.100270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Anemia is one of the most commonly diagnosed comorbidities in pregnancy and is known to increase the risk of obstetrical complications. However, little is known about the effect of anemia on placental oxygen transfer and fetal oxygenation. OBJECTIVE This study examined the relationship between maternal anemia and fetal oxygenation status at delivery as measured by umbilical cord partial pressure of oxygen. STUDY DESIGN This is a secondary analysis of a prospective cohort study of singleton term deliveries with universal admission complete blood count and umbilical cord gases between 2010 and 2014. Maternal anemia was defined as hemoglobin of ≤10 g/dL on admission. The primary outcomes were umbilical artery and vein partial pressure of oxygen; the secondary outcomes were acidemia (umbilical artery pH of <7.1), hypoxemia (umbilical artery or umbilical vein partial pressure of oxygen at the <5th percentile), and hyperoxemia (umbilical artery/umbilical vein partial pressure of oxygen at the >90th percentile). Outcomes were compared between patients with and without anemia. RESULTS Maternal anemia was associated with a significantly higher umbilical artery partial pressure of oxygen (median [interquartile range], 20 [16-24] vs 19 [15-24] mm Hg; P=.01) and umbilical vein partial pressure of oxygen (median [interquartile range], 30 [25-36] vs 29 [23-34] mm Hg; P<.01). Neonates born to anemic mothers were more likely to have umbilical vein hyperoxemia (15.7% vs 10.9%; adjusted odds ratio, 1.51; 95% confidence interval, 1.26-1.81) with no difference in umbilical artery hyperoxemia. There was no difference in the rates of umbilical artery or umbilical vein hypoxemia. Although maternal anemia was associated with a significant difference in umbilical artery pH (7.28±0.060 vs 7.27±0.065; P<.01), there was no difference in the rate of neonatal acidemia between groups (1.6% vs 1.9%; adjusted odds ratio, 0.93; 95% confidence interval, 0.55-1.55). CONCLUSION Umbilical cord oxygen content is higher in anemic mothers. Maternal anemia may lead to adaptations in maternal, placental, and fetal physiology, allowing for easier unloading of oxygen to the placenta and increased oxygen transfer to the fetus.
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Affiliation(s)
- Virginia Y Watkins
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO.
| | - Antonina I Frolova
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
| | - Molly J Stout
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Ebony B Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
| | - George A Macones
- Department of Obstetrics and Gynecology, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Nandini Raghuraman
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
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25
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OʼBrien-Abel N. Clinical Implications of Fetal Heart Rate Interpretation Based on Underlying Physiology. MCN Am J Matern Child Nurs 2020; 45:82-91. [PMID: 31714283 DOI: 10.1097/nmc.0000000000000596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Understanding the physiology of fetal oxygenation and various influences on fetal heart rate control supports nurses, midwives, and physicians in interpreting and managing electronic fetal heart rate tracings during labor and birth. Maternal oxygenation, placental circulation and exchange, umbilical blood flow and fetal circulation affect fetal oxygenation, which is reflected in observed fetal heart rate patterns. Fetal heart control is further influenced by the central and autonomic nervous systems, baroreceptors, chemoreceptors, humoral factors, sleep-wake patterns, breathing movements, medications, painful stimuli, sound and vibrations, and temperature. Knowledge of the physiologic basis for fetal heart rate pattern characteristics guides interventions to improve fetal oxygenation when indicated. A review and update on clinical implications of fetal heart rate pattern interpretation based on underlying physiology is presented.
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Affiliation(s)
- Nancy OʼBrien-Abel
- Nancy O'Brien-Abel is a Perinatal Clinical Nurse Specialist, Perinatal Consulting, LLC, Affiliate Instructor, School of Nursing, University of Washington, Seattle, WA. The author can be reached via e-mail at
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26
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Carter AM. The role of mammalian foetal membranes in early embryogenesis: Lessons from marsupials. J Morphol 2020; 282:940-952. [PMID: 32374455 DOI: 10.1002/jmor.21140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/20/2020] [Accepted: 04/25/2020] [Indexed: 12/16/2022]
Abstract
Across mammals, early embryonic development is supported by uterine secretions taken up through the yolk sac and other foetal membranes (histotrophic nutrition). The marsupial conceptus is enclosed in a shell coat for the first two-thirds of gestation and nutrients pass to the embryo through the shell and the avascular bilaminar yolk sac. At around the time of shell rupture, part of the yolk sac is trilaminar and supplied with blood vessels. It attaches to the uterus and forms a choriovitelline placenta. Rapid growth of the embryo ensues, still supported by histotrophe as well as exchange of oxygen and nutrients between maternal and foetal blood vessels (haemotrophic nutrition). Few marsupials have a chorioallantoic placenta and the highly altricial newborn is delivered after a short gestation. Eutherian embryos pass through a similar sequence before there is a fully functional chorioallantoic placenta. In most orders, there is transient yolk sac placentation, but even before this, nutrients are transferred through an avascular yolk sac. Yolk sac placentation does not occur in rodents or catarrhine primates. Early embryonic development in the mouse is nonetheless dependent on histotrophic nutrition. In the first trimester of human pregnancy, uterine glands open to the intervillous space and secretion products are taken up by the trophoblast. Transfer of nutrients to the early human embryo also involves the yolk sac, which floats free in the exocoelom. Marsupials can therefore inform us about the role of foetal membranes and histotrophic nutrition in early embryogenesis, knowledge that can translate to eutherians.
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Affiliation(s)
- Anthony M Carter
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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27
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Malinowski AK, Dziegielewski C, Keating S, Parks T, Kingdom J, Shehata N, Rizov E, D'Souza R. Placental histopathology in sickle cell disease: A descriptive and hypothesis-generating study. Placenta 2020; 95:9-17. [PMID: 32452407 DOI: 10.1016/j.placenta.2020.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/23/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Abnormal placental development is a unifying factor amongst many adverse pregnancy outcomes (APOs) in Sickle Cell Disease (SCD). Our aim was to describe placental histopathologic findings in women with SCD and their relationship with APOs, and to explore the association between antenatal sonographic findings and placental pathology. METHODS Retrospective single-centre case series of all pregnant women with SCD (January 2000-December 2017), pregnancy beyond 20 weeks' gestation, and available placenta histopathology. APOs included intrauterine fetal death, early neonatal death, preterm birth, small for gestational age, and hypertensive disorders of pregnancy. Review of images for mid-pregnancy ultrasound and one proximal to delivery was completed, blinded to clinical outcomes and histopathology results. Gross and histopathologic findings were reviewed and characterized per published classification. RESULTS Of 72 placentas, abnormalities were present in 69%, with Maternal Vascular Malperfusion (MVM) noted in 40%. APOs were encountered in 61% overall and in 79% of those with MVM. Neither SCD genotype nor severe maternal anemia had an influence on histopathologic placental features. Presence of high-resistance uterine artery waveforms at mid-trimester ultrasound was strongly associated with APOs and with abnormal findings on placental histopathology, most notably MVM. MVM was strongly associated with small for gestational age infants, preterm birth, and stillbirth. DISCUSSION MVM is the predominant lesion in placentas of women with SCD and is strongly associated with APOs. Mid-trimester ultrasound can identify a subset of women at risk. Future research into advanced imaging modalities to aid in antenatal diagnosis alongside investigations of potentially beneficial therapies is needed.
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Affiliation(s)
- Ann Kinga Malinowski
- Mount Sinai Hospital, Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Toronto, Canada; University of Toronto, Department of Medicine, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.
| | - Claudia Dziegielewski
- Mount Sinai Hospital, Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Toronto, Canada; University of Toronto, Department of Medicine, Toronto, Canada
| | - Sarah Keating
- University of Toronto, Department of Medicine, Toronto, Canada; Mount Sinai Hospital, Department of Pathology, Toronto, Canada
| | - Tony Parks
- Mount Sinai Hospital, Department of Pathology, Toronto, Canada; University of Toronto, Department of Laboratory Medicine and Pathobiology, Canada
| | - John Kingdom
- Mount Sinai Hospital, Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Toronto, Canada; University of Toronto, Department of Medicine, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Nadine Shehata
- University of Toronto, Department of Medicine, Toronto, Canada; University of Toronto, Institute of Health Policy, Management, and Evaluation, Toronto, Canada; Mount Sinai Hospital, Department of Medicine, Division of Haematology, Toronto, Canada; University Health Network, Department of Medicine, Division of Medical Oncology and Haematology, Toronto, Canada
| | - Elyssa Rizov
- Mount Sinai Hospital, Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Toronto, Canada; University of Toronto, Department of Medicine, Toronto, Canada
| | - Rohan D'Souza
- Mount Sinai Hospital, Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Toronto, Canada; University of Toronto, Department of Medicine, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
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28
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Excessive umbilical cord coiling confers risk of elevated nocturnal blood pressure and severe/early-onset preeclampsia. J Hypertens 2020; 37:187-196. [PMID: 30015757 DOI: 10.1097/hjh.0000000000001849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The associations between umbilical cord coiling, feto-placental vascular resistance and maternal blood pressure (BP) are not well understood. METHOD We retrospectively analyzed 502 pregnant women suspected of hypertensive disorders in the third trimester from a hospital-based cohort, who underwent ambulatory BP monitoring and umbilical artery Doppler velocimetry examinations within 14 days before delivery. By applying quantile regression, a significant quantile-dependent positive association between umbilical cord coiling index and umbilical artery pulsatility index (UAPIMOM; converted to multiples of median) was observed from above 0.75th quantiles for each parameter. RESULTS Using the cutoffs both at the 0.75th quantile to define high umbilical cord coiling (≥0.28 coils/cm) and high UAPIMOM (≥1.30), respectively, a graded increase in BP level was observed from patients with both low, either high and both high categories. Multivariate linear and quantile regression revealed that the high umbilical cord coiling/high UAPIMOM interaction was significantly correlated with night-time mean DBP level. Moreover, umbilical cord hypercoiling (≥0.3 coils/cm) was significantly correlated with night-time DBP with an average increase of ∼5 mmHg from the 0.05th to 0.70th quantiles and independently predicted the occurrence of severe (odds ratio 2.32, 95% confidence interval: 1.22-4.41) and early-onset (odds ratio 2.43, 95% confidence interval: 1.18-4.97) preeclampsia after adjusting for covariates. Further mediation analysis showed that elevated high UAPIMOM (≥1.30) could explain 11.4% of the umbilical cord hypercoiling → high night-time DBP association. CONCLUSION Therefore, this retrospective study identifies excessive umbilical cord coiling, and its interaction with increased feto-placental vascular resistance, as novel risk factors for nocturnal BP elevation and preeclampsia.
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Burggren W, Bautista N. Invited review: Development of acid-base regulation in vertebrates. Comp Biochem Physiol A Mol Integr Physiol 2019; 236:110518. [DOI: 10.1016/j.cbpa.2019.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/26/2022]
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30
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Almendros I, Martínez-Ros P, Farré N, Rubio-Zaragoza M, Torres M, Gutiérrez-Bautista ÁJ, Carrillo-Poveda JM, Sopena-Juncosa JJ, Gozal D, Gonzalez-Bulnes A, Farré R. Placental oxygen transfer reduces hypoxia-reoxygenation swings in fetal blood in a sheep model of gestational sleep apnea. J Appl Physiol (1985) 2019; 127:745-752. [PMID: 31369330 DOI: 10.1152/japplphysiol.00303.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Obstructive sleep apnea (OSA), characterized by events of hypoxia-reoxygenation, is highly prevalent in pregnancy, negatively affecting the gestation process and particularly the fetus. Whether the consequences of OSA for the fetus and offspring are mainly caused by systemic alterations in the mother or by a direct effect of intermittent hypoxia in the fetus is unknown. In fact, how apnea-induced hypoxemic swings in OSA are transmitted across the placenta remains to be investigated. The aim of this study was to test the hypothesis, based on a theoretical background on the damping effect of oxygen transfer in the placenta, that oxygen partial pressure (Po2) swings resulting from obstructive apneas mimicking OSA are mitigated in the fetal circulation. To this end, four anesthetized ewes close to term pregnancy were subjected to obstructive apneas consisting of 25-s airway obstructions. Real-time Po2 was measured in the maternal carotid artery and in the umbilical vein with fast-response fiber-optic oxygen sensors. The amplitudes of Po2 swings in the umbilical vein were considerably smaller [3.1 ± 1.0 vs. 21.0 ± 6.1 mmHg (mean ± SE); P < 0.05]. Corresponding estimated swings in fetal and maternal oxyhemoglobin saturation tracked Po2 swings. This study provides novel insights into fetal oxygenation in a model of gestational OSA and highlights the importance of further understanding the impact of sleep-disordered breathing on fetal and offspring development.NEW & NOTEWORTHY This study in an airway obstruction sheep model of gestational sleep apnea provides novel data on how swings in oxygen partial pressure (Po2) translate from maternal to fetal blood. Real-time simultaneous measurement of Po2 in maternal artery and in umbilical vein shows that placenta transfer attenuates the magnitude of oxygenation swings. These data prompt further investigation of the extent to which maternal apneas could induce similar direct oxidative stress in fetal and maternal tissues.
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Affiliation(s)
- Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain.,Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, Spain
| | - Paula Martínez-Ros
- Animal Production and Health Department, Veterinary Faculty, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain
| | - Nuria Farré
- Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Heart Diseases Biomedical Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mónica Rubio-Zaragoza
- Bioregenerative Medicine and Applied Surgery Research Group, Animal Medicine and Surgery Department, Veterinary Faculty, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain.,García Cugat Foundation for Biomedical Research, Barcelona, Spain
| | - Marta Torres
- CIBER de Enfermedades Respiratorias, Madrid, Spain.,Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
| | - Álvaro J Gutiérrez-Bautista
- Anaesthesia Unit, Veterinary Teaching Hospital, Animal Medicine and Surgery Department, Veterinary Faculty, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain
| | - José M Carrillo-Poveda
- Bioregenerative Medicine and Applied Surgery Research Group, Animal Medicine and Surgery Department, Veterinary Faculty, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain.,García Cugat Foundation for Biomedical Research, Barcelona, Spain
| | - Joaquín J Sopena-Juncosa
- Bioregenerative Medicine and Applied Surgery Research Group, Animal Medicine and Surgery Department, Veterinary Faculty, Universidad Cardenal Herrera-CEU Universities, Valencia, Spain.,García Cugat Foundation for Biomedical Research, Barcelona, Spain
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri
| | - Antonio Gonzalez-Bulnes
- Department of Animal Reproduction, Deputy Directorate General of Research and Technology-Spanish National Institute for Agricultural and Food Research and Technology, Madrid, Spain
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Madrid, Spain.,Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, Spain
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31
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Wood CE, Keller-Wood M. Current paradigms and new perspectives on fetal hypoxia: implications for fetal brain development in late gestation. Am J Physiol Regul Integr Comp Physiol 2019; 317:R1-R13. [PMID: 31017808 DOI: 10.1152/ajpregu.00008.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The availability of oxygen to the fetus is limited by the route taken by oxygen from the atmosphere to fetal tissues, aided or diminished by pregnancy-associated changes in maternal physiology and, ultimately, a function of atmospheric pressure and composition of the mother's inspired gas. Much of our understanding of the fetal physiological response to hypoxia comes from experiments designed to elucidate the cardiovascular and endocrine responses to transient hypoxia. Complementing this work is equally impactful research into the origins of intrauterine growth restriction in which animal models designed to restrict the transfer of oxygen from the maternal to the fetal circulation were used. A common assumption has been that outcomes measured after a period of hypoxia are related to cellular deprivation of oxygen and reoxygenation: an assumption based on a focus on what we can see "under the streetlights." Recent studies demonstrate that availability of oxygen may not tell the whole story. Transient hypoxia in the fetal sheep stimulates transcriptomics responses that mirror inflammation. This response is accompanied by the appearance of bacteria in the fetal brain and other tissues, likely resulting from a hypoxia-stimulated release of bacteria from the placenta. The appearance of bacteria in the fetus after transient hypoxia complements the recent discovery of bacterial DNA in the normal human placenta and in the tissues of fetal sheep. An understanding of the mechanism of the physiological, cellular, and molecular responses to hypoxia requires an appreciation of stimuli other than cellular oxygen deprivation: stimuli that we would have never known about without looking "between the streetlights," illuminating direct responses to the manipulated variables.
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Affiliation(s)
- Charles E Wood
- Department of Physiology and Functional Genomics, University of Florida College of Medicine , Gainesville, Florida
| | - Maureen Keller-Wood
- Department of Pharmacodynamics, University of Florida College of Pharmacy , Gainesville, Florida
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Tchirikov M, Saling E, Bapayeva G, Bucher M, Thews O, Seliger G. Hyperbaric oxygenation and glucose/amino acids substitution in human severe placental insufficiency. Physiol Rep 2019. [PMID: 29536649 PMCID: PMC5849598 DOI: 10.14814/phy2.13589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In the first case, the AA and glucose were infused through a perinatal port system into the umbilical vein at 30 weeks' gestation due to severe IUGR. The patient received daily hyperbaric oxygenation (HBO, 100% O2) with 1.4 atmospheres absolute for 50 min for 7 days. At 31+4 weeks' gestation, the patient gave birth spontaneously to a newborn weighing 1378 g, pH 7.33, APGAR score 4/6/intubation. In follow‐up examinations at 5 years of age, the boy was doing well without any neurological disturbance or developmental delay. In the second case, the patient presented at 25/5 weeks' gestation suffering from severe IUGR received HBO and maternal AA infusions. The cardiotocography was monitored continuously during HBO treatment. The short‐time variations improved during HBO from 2.9 to 9 msec. The patient developed pathologic CTG and uterine contractions 1 day later and gave birth to a hypotrophic newborn weighing 420 g. After initial adequate stabilization, the extremely preterm newborn unfortunately died 6 days later. Fetal nutrition combined with HBO is technically possible and may allow the prolongation of the pregnancy. Fetal‐specific amino‐acid composition would facilitate the treatment options of IUGR fetuses and extremely preterm newborn.
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Affiliation(s)
- Michael Tchirikov
- Center of Fetal Surgery, University Clinic of Obstetrics and Fetal Medicine, University Medical Center Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Erich Saling
- Saling Institute of Perinatal Medicine, Berlin, Germany
| | - Gauri Bapayeva
- National Research Center for Mother and Child Health, Nazarbayev University, Astana, Republic of Kazakhstan
| | - Michael Bucher
- Center of HBO, University Clinic of Anesthesiology, University Medical Center Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Oliver Thews
- Institute of Physiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Gregor Seliger
- Center of Fetal Surgery, University Clinic of Obstetrics and Fetal Medicine, University Medical Center Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
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Lawrence DJ, Escott ME, Myers L, Intapad S, Lindsey SH, Bayer CL. Spectral photoacoustic imaging to estimate in vivo placental oxygenation during preeclampsia. Sci Rep 2019; 9:558. [PMID: 30679723 PMCID: PMC6345947 DOI: 10.1038/s41598-018-37310-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/05/2018] [Indexed: 11/09/2022] Open
Abstract
Preeclampsia is a pregnancy-related hypertensive disorder accounting for 14% of global maternal deaths annually. Preeclampsia - maternal hypertension and proteinuria - is promoted by placental ischemia resulting from reduced uteroplacental perfusion. Here, we assess longitudinal changes in placental oxygenation during preeclampsia using spectral photoacoustic imaging. Spectral photoacoustic images were acquired of the placenta of normal pregnant (NP) and preeclamptic reduced uterine perfusion pressure (RUPP) Sprague Dawley rats on gestational days (GD) 14, 16, and 18, corresponding to mid- to late gestation (n = 10 per cohort). Two days after implementation of the RUPP surgical model, placental oxygen saturation decreased 12% in comparison with NP. Proteinuria was determined from a 24-hour urine collection prior to imaging on GD18. Blood pressure measurements were obtained on GD18 after imaging. Placental hypoxia in the RUPP was confirmed with histological staining for hypoxia-inducible factor (HIF)-1α, a cellular transcription regulator which responds to local oxygen levels. Using in vivo, longitudinal imaging methods we determined that the placenta in the reduced uterine perfusion pressure rat model of preeclampsia is hypoxic, and that this hypoxia is maintained through late gestation. Future work will utilize these methods to assess the impact of novel therapeutics on placental ischemia and the progression of preeclampsia.
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Affiliation(s)
- Dylan J Lawrence
- Department of Biomedical Engineering, Tulane University, 500 Lindy Boggs Center, New Orleans, LA, 70118, USA
| | - Megan E Escott
- Department of Biomedical Engineering, Tulane University, 500 Lindy Boggs Center, New Orleans, LA, 70118, USA
| | - Leann Myers
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St #2400, New Orleans, LA, 70112, USA
| | - Suttira Intapad
- School of Medicine, Tulane University, 1430 Tulane Ave, New Orleans, LA, 70112, USA
| | - Sarah H Lindsey
- School of Medicine, Tulane University, 1430 Tulane Ave, New Orleans, LA, 70112, USA
| | - Carolyn L Bayer
- Department of Biomedical Engineering, Tulane University, 500 Lindy Boggs Center, New Orleans, LA, 70118, USA.
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Ritchie HE, Oakes DJ, Kennedy D, Polson JW. Early Gestational Hypoxia and Adverse Developmental Outcomes. Birth Defects Res 2018; 109:1358-1376. [PMID: 29105381 DOI: 10.1002/bdr2.1136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/01/2017] [Indexed: 12/14/2022]
Abstract
Hypoxia is a normal and essential part of embryonic development. However, this state may leave the embryo vulnerable to damage when oxygen supply is disturbed. Embryofetal response to hypoxia is dependent on duration and depth of hypoxia, as well as developmental stage. Early postimplantation rat embryos were resilient to hypoxia, with many surviving up to 1.5 hr of uterine clamping, while most mid-gestation embryos were dead after 1 hour of clamping. Survivors were small and many had a range of defects, principally terminal transverse limb reduction defects. Similar patterns of malformations occurred when embryonic hypoxia was induced by maternal hypoxia, interruption of uteroplacental flow, or perfusion and embryonic bradycardia. There is good evidence that high altitude pregnancies are associated with smaller babies and increased risk of some malformations, but these results are complicated by increased risk of pre-eclampsia. Early onset pre-eclampsia itself is associated with small for dates and increased risk of atrio-ventricular septal defects. Limb defects have clearly been associated with chorionic villus sampling, cocaine, and misoprostol use. Similar defects are also observed with increased frequency among fetuses who are homozygous for thalassemia. Drugs that block the potassium current, whether as the prime site of action or as a side effect, are highly teratogenic in experimental animals. They induce embryonic bradycardia, hypoxia, hemorrhage, and blisters, leading to transverse limb defects as well as craniofacial and cardiovascular defects. While evidence linking these drugs to birth defects in humans is not compelling, the reason may methodological rather than biological. Birth Defects Research 109:1358-1376, 2017.© 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Helen E Ritchie
- Discipline of Biomedical Science, Sydney Medical School, University of Sydney, Sydney, NSW
| | - Diana J Oakes
- Discipline of Biomedical Science, Sydney Medical School, University of Sydney, Sydney, NSW
| | | | - Jaimie W Polson
- Discipline of Biomedical Science, Sydney Medical School, University of Sydney, Sydney, NSW
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Malinowski AK, Cheung P, Yang J, D'Souza R, Shehata N, Ward R, Kuo KHM, Murphy K. Cord gas parameters in infants born to women with sickle cell disease: a retrospective matched cohort study. Br J Haematol 2018; 184:653-657. [DOI: 10.1111/bjh.15142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ann K. Malinowski
- Division of Maternal‐Fetal Medicine Department of Obstetrics & Gynaecology Mount Sinai Hospital Toronto Ontario Canada
- Department of Medicine University of Toronto Toronto Ontario Canada
- Lunenfeld‐Tanenbaum Research Institute Mount Sinai Hospital Toronto Ontario Canada
| | - Patrina Cheung
- Division of Maternal‐Fetal Medicine Department of Obstetrics & Gynaecology Mount Sinai Hospital Toronto Ontario Canada
- Department of Medicine University of Toronto Toronto Ontario Canada
| | - Junmin Yang
- Maternal‐Infant Care (MiCare) Research Centre Department of Pediatrics Mount Sinai Hospital Toronto Ontario Canada
| | - Rohan D'Souza
- Division of Maternal‐Fetal Medicine Department of Obstetrics & Gynaecology Mount Sinai Hospital Toronto Ontario Canada
- Department of Medicine University of Toronto Toronto Ontario Canada
- Lunenfeld‐Tanenbaum Research Institute Mount Sinai Hospital Toronto Ontario Canada
| | - Nadine Shehata
- Department of Medicine University of Toronto Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
- Division of Haematology Department of Medicine Mount Sinai Hospital Toronto Ontario Canada
- Division of Medical Oncology and Haematology Department of Medicine University Health Network Toronto Ontario Canada
- Department of Laboratory Medicine and Pathobiology Mount Sinai Hospital Toronto Ontario Canada
| | - Richard Ward
- Department of Medicine University of Toronto Toronto Ontario Canada
- Department of Medicine Division of Haematology University Health Network Toronto Ontario Canada
| | - Kevin H. M. Kuo
- Department of Medicine University of Toronto Toronto Ontario Canada
- Department of Medicine Division of Haematology University Health Network Toronto Ontario Canada
| | - Kellie Murphy
- Division of Maternal‐Fetal Medicine Department of Obstetrics & Gynaecology Mount Sinai Hospital Toronto Ontario Canada
- Department of Medicine University of Toronto Toronto Ontario Canada
- Lunenfeld‐Tanenbaum Research Institute Mount Sinai Hospital Toronto Ontario Canada
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Abstract
The mammalian placenta shows an extraordinary degree of variation in gross and fine structure, but this has been difficult to interpret in physiological terms. Transcriptomics offers a path to understanding how structure relates to function. This essay examines how studies of gene transcription can inform us about placental evolution in eutherian and marsupial mammals and more broadly about convergent evolution of viviparity and placentation in vertebrates. Thus far, the focus has been on the chorioallantoic placenta of eutherians at term, the reproductive strategies of eutherians and marsupials, and the decidual response of the uterus at implantation. Future work should address gene expression during early stages of placental development and endeavor to cover all major groups of mammals. Comparative studies across oviparous and viviparous vertebrates have centered on the chorioallantoic membrane and yolk sac. They point to the possibility of defining a set of genes that can be recruited to support commonalities in reproductive strategies. Further advances can be anticipated from single-cell transcriptomics if those techniques are applied to a range of placental structures and in species other than humans and mice.
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Affiliation(s)
- Anthony M Carter
- Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, J. B. Winsloews Vej 21, DK-5000 Odense, Denmark
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Salavati N, Gordijn SJ, Sovio U, Zill-E-Huma R, Gebril A, Charnock-Jones DS, Scherjon SA, Smith GCS. Birth weight to placenta weight ratio and its relationship to ultrasonic measurements, maternal and neonatal morbidity: A prospective cohort study of nulliparous women. Placenta 2017; 63:45-52. [PMID: 29183631 DOI: 10.1016/j.placenta.2017.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/12/2017] [Accepted: 11/13/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Birth weight to placenta weight (BWPW)-ratio is an indicator of the ability of the placenta to maintain adequate nutrient supply to the fetus. We sought to investigate the relationship between BWPW-ratio with fetal growth, utero-placental Doppler and neonatal and maternal morbidity. METHODS We studied a group of 3311 women recruited to a prospective cohort study of nulliparous women (Rosie Hospital, Cambridge, UK) who delivered a live born infant at term and whose placental weight and birth weight were known. Ultrasonic indices and BWPW ratio were converted to gestational age adjusted z scores. Analysis of continuous variables was by multivariable linear regression. BWPW ratio was also categorized (lowest or highest quintile, both referent to quintiles 2 to 4) and associations with adverse outcomes analyzed using multivariable logistic regression. RESULTS Lowest quintile of BWPW-ratio was associated (adjusted odds ratio [95% CI], P) with both neonatal morbidity (1.55 [1.12-2.14], 0.007) and maternal diabetes (1.75 [1.18-2.59], 0.005). Highest quintile of BWPW ratio was associated with a reduced risk of maternal obesity (0.71 [0.53 to 0.95], 0.02) and preeclampsia (0.51 [0.31 to 0.84], 0.008), but higher (adjusted z score [95% CI], P) uterine artery Doppler mean pulsatility index (PI) at 20 weeks of gestation (0.09 [0.01-0.18], 0.04) and umbilical artery Doppler PI at 36 weeks of gestation (0.16 [0.07-0.25], <0.001). CONCLUSION BWPW-ratio is related to ultrasonic measurements and both neonatal and maternal morbidity. Therefore, this ratio may be an indicative marker of immediate and longer term health risks for an individual.
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Affiliation(s)
- N Salavati
- Department of Obstetrics and Gynaecology, University Medical Centre of Groningen, University of Groningen, The Netherlands.
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Centre of Groningen, University of Groningen, The Netherlands.
| | - U Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK; Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
| | - R Zill-E-Huma
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK.
| | - A Gebril
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK.
| | - D S Charnock-Jones
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK; Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
| | - S A Scherjon
- Department of Obstetrics and Gynaecology, University Medical Centre of Groningen, University of Groningen, The Netherlands.
| | - G C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK; Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
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Oths KS, Smith HN, Stein MJ, Lazo Landivar RJ. A decade of rapid change: Biocultural influences on child growth in highland Peru. Am J Hum Biol 2017; 30. [PMID: 29083078 DOI: 10.1002/ajhb.23072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/25/2017] [Accepted: 10/08/2017] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES In the past decade many areas of Peru have been undergoing extreme environmental, economic, and cultural change. In the highland hamlet of Chugurpampa, La Libertad, climate change has ruined harvests and led to frequent periods of migration to the coast in search of livelihood. This biocultural research examines how the changes could be affecting the growth of children who maintain residence in the highlands. METHODS Clinical records from the early 2000s were compared to those from the early 2010s. Charts were randomly selected to record anthropometric data, netting a sample of 75 children ages 0-60 months of age. Analysis of covariance was run to compare mean stature, weight, and BMI between cohorts. Percentage of children who fall below the -2 threshold for z-scores for height and weight were compared by age and cohort. RESULTS A significant secular trend in growth was found, with children born more recently larger than those born a decade before. The effect is most notable in the first year of life, with the growth advantage attenuated by the age of 3 for height and age 4 for weight. While children were unlikely to be stunted from 0 to 3 years of age, 44% of the later cohort were stunted and 11% were underweight from 4 to 5 years of age. CONCLUSIONS Three possible explanations for the rapid shift are entertained: more time spent on the coast during gestation and early childhood, which may attenuate the effect of hypoxia on child growth; dietary change; and increased use of biomedicine.
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Affiliation(s)
- Kathryn S Oths
- Department of Anthropology, University of Alabama, Tuscaloosa, Alabama 35487
| | - Hannah N Smith
- Department of Anthropology, University of Alabama, Tuscaloosa, Alabama 35487
| | - Max J Stein
- Department of Anthropology, University of Alabama, Tuscaloosa, Alabama 35487
| | - Rodrigo J Lazo Landivar
- Department of Anthropology, University of Massachusetts-Amherst, Amherst, Massachusetts 01003
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The relationship between birth and placental weights changes with placental size. Early Hum Dev 2017; 111:56-59. [PMID: 28618274 DOI: 10.1016/j.earlhumdev.2017.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/14/2017] [Accepted: 05/26/2017] [Indexed: 02/01/2023]
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Luo J, Abaci Turk E, Bibbo C, Gagoski B, Roberts DJ, Vangel M, Tempany-Afdhal CM, Barnewolt C, Estroff J, Palanisamy A, Barth WH, Zera C, Malpica N, Golland P, Adalsteinsson E, Robinson JN, Grant PE. In Vivo Quantification of Placental Insufficiency by BOLD MRI: A Human Study. Sci Rep 2017. [PMID: 28623277 PMCID: PMC5473907 DOI: 10.1038/s41598-017-03450-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Fetal health is critically dependent on placental function, especially placental transport of oxygen from mother to fetus. When fetal growth is compromised, placental insufficiency must be distinguished from modest genetic growth potential. If placental insufficiency is present, the physician must trade off the risk of prolonged fetal exposure to placental insufficiency against the risks of preterm delivery. Current ultrasound methods to evaluate the placenta are indirect and insensitive. We propose to use Blood-Oxygenation-Level-Dependent (BOLD) MRI with maternal hyperoxia to quantitatively assess mismatch in placental function in seven monozygotic twin pairs naturally matched for genetic growth potential. In-utero BOLD MRI time series were acquired at 29 to 34 weeks gestational age. Maps of oxygen Time-To-Plateau (TTP) were obtained in the placentas by voxel-wise fitting of the time series. Fetal brain and liver volumes were measured based on structural MR images. After delivery, birth weights were obtained and placental pathological evaluations were performed. Mean placental TTP negatively correlated with fetal liver and brain volumes at the time of MRI as well as with birth weights. Mean placental TTP positively correlated with placental pathology. This study demonstrates the potential of BOLD MRI with maternal hyperoxia to quantify regional placental function in vivo.
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Affiliation(s)
- Jie Luo
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, 02115, USA.,Madrid-MIT M+Vision Consortium, RLE, Massachusetts Institute of Technology, Cambridge, 02139, USA
| | - Esra Abaci Turk
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, 02115, USA.,Madrid-MIT M+Vision Consortium, RLE, Massachusetts Institute of Technology, Cambridge, 02139, USA
| | - Carolina Bibbo
- Maternal Fetal Medicine, Brigham and Women's Hospital, Boston, 02115, USA
| | - Borjan Gagoski
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, 02115, USA
| | | | - Mark Vangel
- Radiology, Massachusetts General Hospital, Boston, 02114, USA
| | | | | | - Judy Estroff
- Radiology, Boston Children's Hospital, Boston, 02115, USA
| | | | - William H Barth
- Obstetrics and Gynecology, Massachusetts General Hospital, Boston, 02114, USA
| | - Chloe Zera
- Maternal Fetal Medicine, Brigham and Women's Hospital, Boston, 02115, USA
| | - Norberto Malpica
- Madrid-MIT M+Vision Consortium, RLE, Massachusetts Institute of Technology, Cambridge, 02139, USA.,Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, 28933, Spain
| | - Polina Golland
- Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, 02139, USA.,Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, 02139, USA
| | - Elfar Adalsteinsson
- Madrid-MIT M+Vision Consortium, RLE, Massachusetts Institute of Technology, Cambridge, 02139, USA.,Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, 02139, USA.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, 02139, USA
| | - Julian N Robinson
- Maternal Fetal Medicine, Brigham and Women's Hospital, Boston, 02115, USA
| | - Patricia Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, 02115, USA.
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Bhide A, Rasanen J, Huhta H, Junno J, Erkinaro T, Ohtonen P, Haapsamo M, Acharya G. Effect of Hypoxemia on Fetal Ventricular Deformation in a Chronically Instrumented Sheep Model. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:967-973. [PMID: 28268036 DOI: 10.1016/j.ultrasmedbio.2017.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/01/2016] [Accepted: 01/19/2017] [Indexed: 06/06/2023]
Abstract
We hypothesized that in near-term sheep fetuses, hypoxemia changes myocardial function as reflected in altered ventricular deformation on speckle-tracking echocardiography. Fetuses in 21 pregnant sheep were instrumented. After 4 d of recovery, fetal cardiac function was assessed by echocardiography at baseline, after 30 and 120 min of induced fetal hypoxemia and after its reversal. Left (LV) and right (RV) ventricular cardiac output and myocardial strain were measured. Baseline mean (standard deviation [SD]) LV and RV global longitudinal strains were -18.7% (3.8) and -14.3% (5.3). Baseline RV global longitudinal and circumferential deformations were less compared with those of the left ventricle (p = 0.016 and p < 0.005). LV, but not RV, global longitudinal strain was decreased (p = 0.003) compared with baseline with hypoxemia. Circumferential and radial strains did not exhibit significant changes. In the near-term sheep fetus, LV global longitudinal and circumferential strains are more negative than RV strains. Acute hypoxemia leads to LV rather than RV dysfunction as reflected by decreased deformation.
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Affiliation(s)
- Amarnath Bhide
- Women's Health & Perinatal Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.
| | - Juha Rasanen
- Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland; Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Heikki Huhta
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Juulia Junno
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Tiina Erkinaro
- Department of Anaesthesiology, Oulu University Hospital, Oulu, Finland
| | - Pasi Ohtonen
- Department of Statistics, Oulu University Hospital, Oulu, Finland
| | - Mervi Haapsamo
- Department of Obstetrics and Gynecology, Lapland Central Hospital, Rovaniemi, Finland
| | - Ganesh Acharya
- Women's Health & Perinatal Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway; Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Acharya G, Sonesson SE, Flo K, Räsänen J, Odibo A. Hemodynamic aspects of normal human feto-placental (umbilical) circulation. Acta Obstet Gynecol Scand 2016; 95:672-82. [DOI: 10.1111/aogs.12919] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/26/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Ganesh Acharya
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; UiT - The Arctic University of Norway; Tromsø Norway
- Department of Clinical Sciences, Intervention and Technology; Karolinska Institute; Stockholm Sweden
- Department of Women′s and Children's Health; Karolinska Institute; Stockholm Sweden
| | - Sven-Erik Sonesson
- Department of Women′s and Children's Health; Karolinska Institute; Stockholm Sweden
| | - Kari Flo
- Women's Health and Perinatology Research Group; Department of Clinical Medicine; Faculty of Health Sciences; UiT - The Arctic University of Norway; Tromsø Norway
| | - Juha Räsänen
- Department of Obstetrics and Gynecology; Kuopio University Hospital and University of Eastern Finland; Kuopio Finland
| | - Anthony Odibo
- Division of Maternal Fetal Medicine; Department of Obstetrics and Gynecology; University of South Florida; Tampa FL USA
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Korzeniewski SJ, Romero R, Chaiworapongsa T, Chaemsaithong P, Kim CJ, Kim YM, Kim JS, Yoon BH, Hassan SS, Yeo L. Maternal plasma angiogenic index-1 (placental growth factor/soluble vascular endothelial growth factor receptor-1) is a biomarker for the burden of placental lesions consistent with uteroplacental underperfusion: a longitudinal case-cohort study. Am J Obstet Gynecol 2016; 214:629.e1-629.e17. [PMID: 26688491 DOI: 10.1016/j.ajog.2015.11.015] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/21/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Placental lesions consistent with maternal vascular underperfusion (MVU) are thought to be pathogenically linked to preeclampsia, small-for-gestational-age newborns, fetal death, and spontaneous preterm labor and delivery; yet, these lesions cannot be diagnosed antenatally. We previously reported that patients with such conditions and lesions have an abnormal profile of the angiogenic placental growth factor (PlGF) and antiangiogenic factors (eg, soluble vascular endothelial growth factor receptor [sVEGFR]-1). OBJECTIVE The objectives of this study were to: (1) examine the relationship between the maternal plasma PlGF/sVEGFR-1 concentration ratio (referred to herein as angiogenic index-1) and the burden of histologic placental features consistent with MVU; and (2) test the hypothesis that angiogenic index-1 can identify patients in the midtrimester who are destined to deliver before 34 weeks of gestation with multiple (ie, ≥3) histologic placental features consistent with MVU. STUDY DESIGN A 2-stage case-cohort sampling strategy was used to select participants from among 4006 women with singleton gestations enrolled from 2006 through 2010 in a longitudinal study. Maternal plasma angiogenic index-1 ratios were determined using enzyme-linked immunosorbent assays. Placentas underwent histologic examination according to standardized protocols by experienced pediatric pathologists who were blinded to clinical diagnoses and pregnancy outcomes. The diagnosis of lesions consistent with MVU was made using criteria proposed by the Perinatal Section of the Society for Pediatric Pathology. Weighted analyses were performed to reflect the parent cohort; "n*" is used to reflect weighted frequencies. RESULTS (1) Angiogenic index-1 (PlGF/sVEGFR-1) concentration ratios were determined in 7560 plasma samples collected from 1499 study participants; (2) the prevalence of lesions consistent with MVU was 21% (n* = 833.9/3904) and 27% (n* = 11.4/42.7) of women with ≥3 MVU lesions delivered before 34 weeks of gestation; (3) a low angiogenic index-1 (<2.5th quantile for gestational age) in maternal plasma samples obtained within 48 hours of delivery had a sensitivity of 73% (n* = 8.3/11.4; 95% confidence interval [CI], 47-98%), a specificity of 94% (n* = 3130.9/3316.2; 95% CI, 94-95%), a positive likelihood ratio of 12.2, and a negative likelihood ratio of 0.29 in the identification of patients who delivered placentas with ≥3 MVU lesions at <34 weeks; (4) prospectively, at 20-23 weeks of gestation, a maternal plasma concentration of angiogenic index-1 <2.5th quantile identified 70% (n* = 7.2/10.3; 95% CI, 42-98%) of patients who delivered placentas with ≥3 MVU lesions before 34 weeks (specificity, 97% [n* = 2831.3/2918; 95% CI, 96-98%]; positive likelihood ratio, 23; negative likelihood ratio, 0.31); and (5) among women without obstetrical complications who delivered at term, angiogenic index-1 was lower in women with than without placental lesions consistent with MVU (P < .05). CONCLUSION Maternal plasma angiogenic index-1 (PlGF/sVEGFR-1) is the first biomarker for the burden of placental lesions consistent with MVU. We propose that an accumulation of these lesions in placentas delivered before 34 weeks is a histologic counterpart of an antiangiogenic profile.
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