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Minor KC, Liu J, Druzin ML, El-Sayed YY, Hintz SR, Bonifacio SL, Leonard SA, Lee HC, Profit J, Karakash SD. Magnesium sulfate and risk of hypoxic-ischemic encephalopathy in a high-risk cohort. Am J Obstet Gynecol 2024; 231:647.e1-647.e12. [PMID: 38580044 PMCID: PMC11508778 DOI: 10.1016/j.ajog.2024.04.001] [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: 10/25/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy contributes to morbidity and mortality among neonates ≥36 weeks of gestation. Evidence of preventative antenatal treatment is limited. Magnesium sulfate has neuroprotective properties among preterm fetuses. Hypertensive disorders of pregnancy are a risk factor for hypoxic-ischemic encephalopathy, and magnesium sulfate is recommended for maternal seizure prophylaxis among patients with preeclampsia with severe features. OBJECTIVE (1) Determine trends in the incidence of hypertensive disorders of pregnancy, antenatal magnesium sulfate, and hypoxic-ischemic encephalopathy; (2) evaluate the association between hypertensive disorders of pregnancy and hypoxic-ischemic encephalopathy; and (3) evaluate if, among patients with hypertensive disorders of pregnancy, the odds of hypoxic-ischemic encephalopathy is mitigated by receipt of antenatal magnesium sulfate. STUDY DESIGN We analyzed a prospective cohort of live births ≥36 weeks of gestation between 2012 and 2018 within the California Perinatal Quality Care Collaborative registry, linked with the California Department of Health Care Access and Information files. We used Cochran-Armitage tests to assess trends in hypertensive disorders, encephalopathy diagnoses, and magnesium sulfate utilization and compared demographic factors between patients with or without hypertensive disorders of pregnancy or treatment with magnesium sulfate. Hierarchical logistic regression models were built to explore if hypertensive disorders of pregnancy were associated with any severity and moderate/severe hypoxic-ischemic encephalopathy. Separate hierarchical logistic regression models were built among those with hypertensive disorders of pregnancy to evaluate the association of magnesium sulfate with hypoxic-ischemic encephalopathy. RESULTS Among 44,314 unique infants, the diagnosis of hypoxic-ischemic encephalopathy, maternal hypertensive disorders of pregnancy, and the use of magnesium sulfate increased over time. Compared with patients with hypertensive disorders of pregnancy alone, patients with hypertensive disorders treated with magnesium sulfate represented a high-risk population. They were more likely to be publicly insured, born between 36 and 38 weeks of gestation, be small for gestational age, have lower Apgar scores, require a higher level of resuscitation at delivery, have prolonged rupture of membranes, experience preterm labor and fetal distress, and undergo operative delivery (all P<.002). Hypertensive disorders of pregnancy were associated with hypoxic-ischemic encephalopathy (adjusted odds ratio, 1.26 [95% confidence interval, 1.13-1.40]; P<.001) and specifically moderate/severe hypoxic-ischemic encephalopathy (adjusted odds ratio, 1.26 [95% confidence interval, 1.11-1.42]; P<.001). Among patients with hypertensive disorders of pregnancy, treatment with magnesium sulfate was associated with 29% reduction in the odds of neonatal hypoxic-ischemic encephalopathy (adjusted odds ratio, 0.71 [95% confidence interval, 0.52-0.97]; P=.03) and a 37% reduction in the odds of moderate/severe neonatal hypoxic-ischemic encephalopathy (adjusted odds ratio, 0.63 [95% confidence interval, 0.42-0.94]; P=.03). CONCLUSION Hypertensive disorders of pregnancy are associated with hypoxic-ischemic encephalopathy and, specifically, moderate/severe disease. Among people with hypertensive disorders, receipt of antenatal magnesium sulfate is associated with a significant reduction in the odds of hypoxic-ischemic encephalopathy and moderate/severe disease in a neonatal cohort admitted to neonatal intensive care unit at ≥36 weeks of gestation. The findings of this observational study cannot prove causality and are intended to generate hypotheses for future clinical trials on magnesium sulfate in term infants.
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Affiliation(s)
- Kathleen C Minor
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA.
| | - Jessica Liu
- Division of Neonatology, Department of Pediatrics, Stanford University, Stanford, CA; California Perinatal Quality Care Collaborative, Stanford, CA
| | - Maurice L Druzin
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
| | - Yasser Y El-Sayed
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
| | - Susan R Hintz
- Division of Neonatology, Department of Pediatrics, Stanford University, Stanford, CA; California Perinatal Quality Care Collaborative, Stanford, CA
| | - Sonia L Bonifacio
- Division of Neonatology, Department of Pediatrics, Stanford University, Stanford, CA
| | - Stephanie A Leonard
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
| | - Henry C Lee
- Division of Neonatology, Department of Pediatrics, Stanford University, Stanford, CA; California Perinatal Quality Care Collaborative, Stanford, CA
| | - Jochen Profit
- Division of Neonatology, Department of Pediatrics, Stanford University, Stanford, CA; California Perinatal Quality Care Collaborative, Stanford, CA
| | - Scarlett D Karakash
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
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Borowczak J, Gąsiorek-Kwiatkowska A, Szczerbowski K, Maniewski M, Zdrenka M, Szadurska-Noga M, Gostomczyk K, Rutkiewicz P, Olejnik K, Cnota W, Karpów-Greiner M, Knypiński W, Sekielska-Domanowska M, Ludwikowski G, Dubiel M, Szylberg Ł, Bodnar M. SARS-CoV-2 Infection during Delivery Causes Histopathological Changes in the Placenta. Diseases 2024; 12:142. [PMID: 39057113 PMCID: PMC11276080 DOI: 10.3390/diseases12070142] [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: 05/29/2024] [Revised: 06/27/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND SARS-CoV-2 can damage human placentas, leading to pregnancy complications, such as preeclampsia and premature birth. This study investigates the histopathological changes found in COVID-19-affected placentas. MATERIALS AND METHODS This study included 23 placentas from patients with active COVID-19 during delivery and 22 samples from patients without COVID-19 infection in their medical history. The samples underwent histopathological examination for pathology, such as trophoblast necrosis, signs of vessel damage, or fetal vascular malperfusion. RESULTS Newborns from the research group have lower weights and Apgar scores than healthy newborns. In the COVID-19 group, calcifications and collapsed intervillous space were more frequent, and inflammation was more severe than in the healthy group. At the same time, the placenta of SARS-CoV-2-positive patients showed signs of accelerated vascular maturation. Trophoblast necrosis was found only in the placentas of the research group. The expression of CD68+ was elevated in the COVID-19 cohort, suggesting that macrophages constituted a significant part of the inflammatory infiltrate. The increase in lymphocyte B markers was associated with placental infarctions, while high levels of CD3+, specific for cytotoxic T lymphocytes, correlated with vascular injury. CONCLUSIONS SARS-CoV-2 is associated with pathological changes in the placenta, including trophoblast necrosis, calcification, and accelerated villous maturation. Those changes appear to be driven by T cells and macrophages, whose increased expression reflects ongoing histiocytic intervillositis in the placenta.
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Affiliation(s)
- Jędrzej Borowczak
- Department of Tumor Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (K.G.)
| | - Agnieszka Gąsiorek-Kwiatkowska
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Krzysztof Szczerbowski
- Department of Tumor Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (K.G.)
| | - Mateusz Maniewski
- Department of Tumor Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (K.G.)
- Doctoral School of Medical and Health Sciences, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland
| | - Marek Zdrenka
- Department of Tumor Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (K.G.)
| | - Marta Szadurska-Noga
- Department of Pathomorphology and Forensic Medicine, Faculty of Medical Sciences, University of Warmia and Mazury, 10-561 Olsztyn, Poland;
| | - Karol Gostomczyk
- Department of Tumor Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (K.G.)
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Paula Rutkiewicz
- Chair of Pathology, Jan Biziel University Hospital No. 2, 85-168 Bydgoszcz, Poland (K.O.)
| | - Katarzyna Olejnik
- Chair of Pathology, Jan Biziel University Hospital No. 2, 85-168 Bydgoszcz, Poland (K.O.)
| | - Wojciech Cnota
- Chair and Department of Gynaecology and Obstetrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, 41-703 Ruda Śląska, Poland
| | - Magdalena Karpów-Greiner
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Wojciech Knypiński
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Marta Sekielska-Domanowska
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Grzegorz Ludwikowski
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Mariusz Dubiel
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Łukasz Szylberg
- Department of Tumor Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (K.G.)
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
- Chair of Pathology, Jan Biziel University Hospital No. 2, 85-168 Bydgoszcz, Poland (K.O.)
| | - Magdalena Bodnar
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
- Chair of Pathology, Jan Biziel University Hospital No. 2, 85-168 Bydgoszcz, Poland (K.O.)
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Barber E, Ram M, Mor L, Ganor Paz Y, Shmueli A, Bornstein S, Barda G, Schreiber L, Weiner E, Levy M. Pregnancy and placental outcomes according to maternal BMI in women with preeclampsia: a retrospective cohort study. Arch Gynecol Obstet 2024; 309:2521-2528. [PMID: 37466689 DOI: 10.1007/s00404-023-07148-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Obesity and preeclampsia share similar patho-mechanisms and can both affect placental pathology. We aimed to investigate pregnancy outcomes in correlation with placental pathology among pregnancies complicated by preeclampsia in three different maternal body mass index (BMI, kg/m2) groups. METHODS In this retrospective cohort study, medical and pathological records of patients with preeclampsia and a singleton pregnancy delivered between 2008 and 2021 at a single tertiary medical center were reviewed. Study population was divided into three BMI groups: BMI < 22.6 kg/m2 (low BMI group), 22.7 ≤ BMI ≤ 28.0 kg/m2 (middle-range BMI group), and BMI > 28.0 kg/m2 (high BMI group). Data regarding maternal characteristics, neonatal outcomes, and placental histopathological lesions were compared. RESULTS The study groups included a total of 295 patients diagnosed with preeclampsia-98, 99, and 98 in the low, middle-range, and high BMI groups respectively. Neonatal birth weight was significantly decreased in the low maternal BMI group compared to both middle and high BMI groups (p = 0.04) with a similar trend seen in placental weight (p = 0.03). Villous changes related to maternal malperfusion were more prevalent in the low and high BMI groups compared to middle-range BMI group (p < 0.01) and composite maternal vascular malperfusion lesions were also more prevalent in the groups of BMI extremities compared to the middle-range BMI group (p < 0.01). CONCLUSION Maternal BMI might influence neonatal outcomes and placental pathology in pregnancies complicated by preeclampsia. Both extremes of BMI were associated with higher rates of placental maternal vascular malperfusion. Balanced BMI in women at risk for preeclampsia may reduce the incidence of placental lesions.
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Affiliation(s)
- Elad Barber
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Ram
- Clalit Health Organization, Jerusalem, Israel
| | - Liat Mor
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel.
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yael Ganor Paz
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Shmueli
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sandy Bornstein
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giulia Barda
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Levy
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P. O. Box 5, 58100, Holon, Israel
- Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Morey R, Bui T, Cheung VC, Dong C, Zemke JE, Requena D, Arora H, Jackson MG, Pizzo D, Theunissen TW, Horii M. iPSC-based modeling of preeclampsia identifies epigenetic defects in extravillous trophoblast differentiation. iScience 2024; 27:109569. [PMID: 38623329 PMCID: PMC11016801 DOI: 10.1016/j.isci.2024.109569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/20/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
Preeclampsia (PE) is a hypertensive pregnancy disorder with increased risk of maternal and fetal morbidity and mortality. Abnormal extravillous trophoblast (EVT) development and function is considered to be the underlying cause of PE, but has not been previously modeled in vitro. We previously derived induced pluripotent stem cells (iPSCs) from placentas of PE patients and characterized abnormalities in formation of syncytiotrophoblast and responses to changes in oxygen tension. In this study, we converted these primed iPSC to naïve iPSC, and then derived trophoblast stem cells (TSCs) and EVT to evaluate molecular mechanisms underlying PE. We found that primed (but not naïve) iPSC-derived PE-EVT have reduced surface HLA-G, blunted invasive capacity, and altered EVT-specific gene expression. These abnormalities correlated with promoter hypermethylation of genes associated with the epithelial-mesenchymal transition pathway, specifically in primed-iPSC derived PE-EVT. Our findings indicate that abnormal epigenetic regulation might play a role in PE pathogenesis.
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Affiliation(s)
- Robert Morey
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
- Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA 92093, USA
- Center for Perinatal Discovery, University of California San Diego, La Jolla, CA 92093, USA
| | - Tony Bui
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
- Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA 92093, USA
- Center for Perinatal Discovery, University of California San Diego, La Jolla, CA 92093, USA
| | - Virginia Chu Cheung
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
- Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA 92093, USA
- Center for Perinatal Discovery, University of California San Diego, La Jolla, CA 92093, USA
| | - Chen Dong
- Department of Developmental Biology and Center of Regenerative Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Joseph E. Zemke
- Department of Developmental Biology and Center of Regenerative Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Daniela Requena
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
- Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA 92093, USA
- Center for Perinatal Discovery, University of California San Diego, La Jolla, CA 92093, USA
| | - Harneet Arora
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
- Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA 92093, USA
- Center for Perinatal Discovery, University of California San Diego, La Jolla, CA 92093, USA
| | - Madeline G. Jackson
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
- Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA 92093, USA
- Center for Perinatal Discovery, University of California San Diego, La Jolla, CA 92093, USA
| | - Donald Pizzo
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
| | - Thorold W. Theunissen
- Department of Developmental Biology and Center of Regenerative Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mariko Horii
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
- Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA 92093, USA
- Center for Perinatal Discovery, University of California San Diego, La Jolla, CA 92093, USA
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de Vos ES, van der Meeren LE, Koning AHJ, Nikkels PGJ, Steegers EAP, Steegers-Theunissen RPM, Mulders AGMGJ. First-trimester 3D power Doppler imaging markers of utero-placental vascular development are associated with placental weight and diameter at birth: The Rotterdam Periconception Cohort. Placenta 2024; 148:44-52. [PMID: 38367314 DOI: 10.1016/j.placenta.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/14/2024] [Accepted: 01/30/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Early utero-placental vascular development impacts placental development and function throughout pregnancy. We investigated whether impaired first-trimester utero-placental vascular development is associated with pathologic features of the postpartum placenta. METHODS In this prospective observational study of 65 ongoing pregnancies, we obtained three-dimensional power Doppler ultrasounds of the placenta at 7, 9 and 11 weeks of gestation. We applied VOCAL software to measure placental volume (PV), virtual reality based segmentation to measure utero-placental vascular volume (uPVV) and applied a skeletonization algorithm to generate the utero-placental vascular skeleton (uPVS). Vascular morphology was quantified by assigning a morphologic characteristic to each voxel in the uPVS (i.e. end-, bifurcation-, crossing- or vessel point). Following delivery, placentas were measured and histologically examined according to the Amsterdam criteria to assess maternal vascular malperfusion (MVM). We used linear mixed models to estimate trajectories of PV, uPVV and uPVS development. Multivariable linear regression analysis with adjustments for confounders was used to evaluate associations between PV, uPVV and uPVS development and features of the postpartum placenta. RESULTS We observed no associations between first-trimester PV development and measurements of the postpartum placenta. Increased first-trimester utero-placental vascular development, reflected by uPVV (β = 0.25 [0.01; 0.48]), uPVS end points (β = 0.25 [0.01; 0.48]), bifurcation points (β = 0.22 [0.05; 0.37]), crossing points (β = 0.29 [0.07; 0.52]) and vessel points (β = 0.09 [0.02; 0.17]) was positively associated with the postpartum placental diameter. uPVV was positively associated with postpartum placental weight. No associations were found with MVM. DISCUSSION Development of the first-trimester utero-placental vasculature is associated with postpartum placental size, whereas placental tissue development contributes to a lesser extent.
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Affiliation(s)
- Eline S de Vos
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Lotte E van der Meeren
- Department of Pathology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands; Department of Pathology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Anton H J Koning
- Department of Pathology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Peter G J Nikkels
- Department of Pathology, University Medical Center Utrecht, H04.312, PO Box 85500, 3505 GA, Utrecht, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Régine P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Annemarie G M G J Mulders
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Davis DL, Lechner AC, Chapel DB, Slack JC, Carreon CK, Quade BJ, Parra-Herran C. Outcome-Based Risk Stratification Model for the Diagnosis of Placental Maternal Vascular Malperfusion. Mod Pathol 2024; 37:100370. [PMID: 38015042 DOI: 10.1016/j.modpat.2023.100370] [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: 07/29/2023] [Revised: 09/15/2023] [Accepted: 10/08/2023] [Indexed: 11/29/2023]
Abstract
The Amsterdam Consensus Statement introduced the term maternal vascular malperfusion (MVM) to group a constellation of findings associated with impaired maternal-placental circulation. In isolation, these findings are relatively common in placentas from normal gestations, and there is uncertainty on how many, and which, are required. We aimed to determine the criteria essential for MVM diagnosis in correlation with obstetrical outcomes. A total of 200 placentas (100 with a reported diagnosis of MVM and 100 controls matched by maternal age and gravida-para-abortus status) were reviewed to document MVM features. Obstetrical outcomes in the current pregnancy were recorded including hypertension, pre-eclampsia with or without severe features, gestational diabetes, prematurity, fetal growth restriction, and intrauterine fetal demise. On univariate logistic regression analysis, adverse outcome was associated with low placental weight (LPW, <10% percentile for gestational age), accelerated villous maturation (AVM), decidual arteriopathy (DA), infarcts (presence and volume), distal villous hypoplasia, and excess multinucleated trophoblast in basal plate ≥2 mm (all P < .01) but not with retroplacental hemorrhage. In a multivariable model DA, infarcts and AVM were significantly associated with adverse outcomes, whereas LPW showed a trend toward significance. A receiver-operating characteristic curve including these 4 parameters showed good predictive ability (area under the curve [AUC], 0.8256). Based on the probability of an adverse outcome, we recommend consistent reporting of DA, AVM, infarcts, and LPW, summarizing them as "diagnostic of MVM" (DA or AVM plus any other feature, yielding a probability of 65%-97% for adverse obstetrical outcomes) or "suggestive of MVM" (if only 1 feature is present, or only 2 features are infarcts plus LPW, yielding a probability of up to 52%). Other features such as distal villous hypoplasia, excess (≥2 mm) multinucleated trophoblast, and retroplacental hemorrhage can also be reported, and their role in MVM diagnosis should be further studied.
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Affiliation(s)
- Dale L Davis
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Adam C Lechner
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts; University of Missouri School of Medicine, Columbia, Missouri
| | - David B Chapel
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jonathan C Slack
- Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Bradley J Quade
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carlos Parra-Herran
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
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Patnaik P, Khodaee A, Vasam G, Mukherjee A, Salsabili S, Ukwatta E, Grynspan D, Chan ADC, Bainbridge S. Automated detection of microscopic placental features indicative of maternal vascular malperfusion using machine learning. Placenta 2024; 145:19-26. [PMID: 38011757 DOI: 10.1016/j.placenta.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Hypertensive disorders of pregnancy (HDP) and fetal growth restriction (FGR) are common obstetrical complications, often with pathological features of maternal vascular malperfusion (MVM) in the placenta. Currently, clinical placental pathology methods involve a manual visual examination of histology sections, a practice that can be resource-intensive and demonstrates moderate-to-poor inter-pathologist agreement on diagnostic outcomes, dependant on the degree of pathologist sub-specialty training. METHODS This study aims to apply machine learning (ML) feature extraction methods to classify digital images of placental histopathology specimens, collected from cases of HDP [pregnancy induced hypertension (PIH), preeclampsia (PE), PE + FGR], normotensive FGR, and healthy pregnancies, according to the presence or absence of MVM lesions. 159 digital images were captured from histological placental specimens, manually scored for MVM lesions (MVM- or MVM+) and used to develop a support vector machine (SVM) classifier model, using features extracted from pre-trained ResNet18. The model was trained with data augmentation and shuffling, with the performance assessed for patch-level and image-level classification through measurements of accuracy, precision, and recall using confusion matrices. RESULTS The SVM model demonstrated accuracies of 70 % and 79 % for patch-level and image-level MVM classification, respectively, with poorest performance observed on images with borderline MVM presence, as determined through post hoc observation. DISCUSSION The results are promising for the integration of ML methods into the placental histopathological examination process. Using this study as a proof-of-concept will lead our group and others to carry ML models further in placental histopathology.
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Affiliation(s)
- Purvasha Patnaik
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Afsoon Khodaee
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - Goutham Vasam
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Anika Mukherjee
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sina Salsabili
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - Eranga Ukwatta
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada; School of Engineering, University of Guelph, Guelph, ON, Canada
| | - David Grynspan
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Department of Pathology and Laboratory Medicine, Faculty of Medicine, The University of British Columbia, Vernon Jubilee Hospital, Vancouver, BC, Canada
| | - Adrian D C Chan
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - Shannon Bainbridge
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
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Feenstra ME, Bourgonje MF, Bourgonje AR, Schoots MH, Hillebrands JL, Muller Kobold AC, Prins JR, van Goor H, Ganzevoort W, Gordijn SJ. Systemic Oxidative Stress in Severe Early-Onset Fetal Growth Restriction Associates with Concomitant Pre-Eclampsia, Not with Severity of Fetal Growth Restriction. Antioxidants (Basel) 2023; 13:46. [PMID: 38247471 PMCID: PMC10812523 DOI: 10.3390/antiox13010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Placental insufficiency is an important mechanism underlying early-onset fetal growth restriction (eoFGR). Reduced placental function causes impaired metabolic and gaseous exchange. This unfavorable placental environment is among other processes characterized by increased oxidative stress. Systemic free thiols (FT) are known for their reactive oxygen species scavenging capacity, and higher plasma levels of FT are associated with a better outcome in a multitude of ischemic and inflammatory diseases. We aimed to investigate the relationships between systemic FT levels and maternal and perinatal clinical characteristics and outcomes. STUDY DESIGN In a post hoc analysis of the Dutch Strider study, a cohort of women with eoFGR, we investigated the association between the maternal redox status (FT) levels at study inclusion, placental biomarkers, and maternal and neonatal outcomes in 108 patients. RESULTS FT were significantly lower in pregnancies complicated with eoFGR with concurrent maternal hypertensive disorders (pregnancy-induced hypertension; ρ = -0.281 p = 0.004, pre-eclampsia; ρ = -0.505 p = 0.000). In addition, lower FT levels were significantly associated with higher systolic (ρ = -0.348 p = 0.001) and diastolic blood pressure (ρ = -0.266 p = 0.014), but not with the severity of eoFGR. FT levels were inversely associated with sFlt (ρ = -0.366, p < 0.001). A strong relation between systemic FT levels and PlGF levels was observed in women with pre-eclampsia at delivery (ρ = 0.452, p = 0.002), which was not found in women without hypertensive disorders (ρ = 0.008, p = 0.958). CONCLUSIONS In women with pregnancies complicated with eoFGR, FT levels reflect the severity of maternal disease related to the underlying placental insufficiency rather than the severity of the placental dysfunction as reflected in eoFGR or perinatal outcomes.
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Affiliation(s)
- Marjon E. Feenstra
- Department of Gynecology and Obstetrics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.E.F.); (J.R.P.)
| | - Martin F. Bourgonje
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.F.B.); (A.R.B.); (M.H.S.); (J.-L.H.); (H.v.G.)
| | - Arno R. Bourgonje
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.F.B.); (A.R.B.); (M.H.S.); (J.-L.H.); (H.v.G.)
| | - Mirthe H. Schoots
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.F.B.); (A.R.B.); (M.H.S.); (J.-L.H.); (H.v.G.)
| | - Jan-Luuk Hillebrands
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.F.B.); (A.R.B.); (M.H.S.); (J.-L.H.); (H.v.G.)
| | - Anneke C. Muller Kobold
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Jelmer R. Prins
- Department of Gynecology and Obstetrics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.E.F.); (J.R.P.)
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.F.B.); (A.R.B.); (M.H.S.); (J.-L.H.); (H.v.G.)
| | - Wessel Ganzevoort
- Department of Gynecology and Obstetrics, Amsterdam University Medical Centers, Amsterdam Reproduction and Development Research Institute, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Sanne J. Gordijn
- Department of Gynecology and Obstetrics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.E.F.); (J.R.P.)
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Turdybekova YG, Kopobayeva IL, Kamyshanskiy YK, Turmukhambetova AA. Comparative clinical and placental pathologic characteristics in pregnancies with and without SARS-CoV-2 infection. J Perinat Med 2023; 51:1179-1188. [PMID: 37475693 DOI: 10.1515/jpm-2022-0371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 06/11/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES To compare the clinical and morphological characteristics of the "mother-placenta-fetus" system in high risk pregnant women of three groups: no SARS-CoV-2 infection, mild SARS-CoV-2 infection, and severe SARS-CoV-2 infection. METHODS A case-control study was performed for all deliveries, at 28 weeks' gestation or greater, who had standard indications for placental pathologic examination. Three groups were formed: (1) control group (no SARS-CoV-2 infection), (2) mild SARS-CoV-2 infection, (3) severe SARS-CoV-2 infection. High-risk pregnancies were registered in all cases in the study groups. The examination of the placenta and the selection of fragments of placental tissue were carried out in accordance with the consensus recommendations of the Amsterdam Placental Workshop Group. The sections were subjected to standard processing and stained with hematoxylin and eosin according to the standard protocol. All cases were reviewed by two pathologists, which did not know any information on pregnancy outcome and clinical data. Statistical analysis was performed using SPSS, p<0.05 was considered statistically significant. RESULTS Women with severe SARS-CoV-2 infection had an increased rate of multimorbidity including diabetes, chronic hypertension and obesity (p<0.01) compared with the other groups. Placentas at severe COVID-19 course were damaged by both chronic and acute injuries, in comparison to the mild and control groups (p<0.001). Also an important finding in severe COVID-19 was diffuse necrosis of the villous trophoblast - homogenization, diffuse circular eosinophilic masses surrounding the chorionic villi. CONCLUSIONS Women with multimorbidity are an "at-risk" subgroup for severe SARS-CoV-2 infection and greater likelihood of both placental damage and perinatal hypoxic-ischemic events. These results suggest that patient education, SARS-CoV-2 disease monitoring and preventive measures would be of benefit to this group.
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Hong X, Rosenberg AZ, Heymann J, Yoshida T, Waikar SS, Ilori TO, Wang G, Rebuck H, Pearson C, Wang M, Winkler CA, Kopp JB, Wang X. Joint Associations of Pregnancy Complications and Postpartum Maternal Renal Biomarkers With Severe Cardiovascular Morbidities: A US Racially and Ethnically Diverse Prospective Birth Cohort Study. J Am Heart Assoc 2023; 12:e029311. [PMID: 37947096 PMCID: PMC10727285 DOI: 10.1161/jaha.122.029311] [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: 12/24/2022] [Accepted: 07/25/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Pregnancy complications are risk factors for cardiovascular disease (CVD). Little is known about the role of renal biomarkers measured shortly after delivery, individually or in combination with pregnancy complications, in predicting subsequent severe maternal CVD. METHODS AND RESULTS This study included 566 mothers of diverse races and ethnicities from the Boston Birth cohort, enrolled at delivery and followed prospectively. Plasma creatinine and CysC (cystatin C) were measured 1 to 3 days after delivery. CVD during follow-up was defined by physician diagnoses in electronic medical records. Associations of renal biomarkers and pregnancy complications with time-to-CVD events were assessed using Cox proportional hazards models. During an average of 10.3±3.2 years of follow-up, 30 mothers developed 1 or more CVDs. Only a modest association was observed between creatinine and risk of CVD. In comparison, we found that per 0.1 mg/L increase of CysC was associated with a hazard ratio (HR) of 1.2 (95% CI, 1.1-1.4) for CVD after adjusting for covariates. Compared with those without preeclampsia and with normal CysC level (≤75th percentile), mothers with preeclampsia and elevated CysC (>75th percentile) had the highest risk of CVD (HR, 4.6 [95% CI, 1.7-17.7]), whereas mothers with preeclampsia only or with elevated CysC only did not have significantly increased CVD risk. Similar synergistic effects for CVD were observed between CysC and preterm delivery. CONCLUSIONS In this sample of US, traditionally underrepresented multiracial and multiethnic high-risk mothers, elevated maternal plasma CysC, independently and jointly with pregnancy complications, increased risk of CVD later in life. These findings warrant further investigation. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03228875.
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Affiliation(s)
- Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of DiseaseJohns Hopkins University Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Jurgen Heymann
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of HealthMDBethesdaUSA
| | - Teruhiko Yoshida
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of HealthMDBethesdaUSA
| | - Sushrut S. Waikar
- Section of Nephrology, Department of MedicineBoston University Chobanian & Avedisian School of Medicine and Boston Medical CenterBostonMAUSA
| | - Titilayo O. Ilori
- Section of Nephrology, Department of MedicineBoston University Chobanian & Avedisian School of Medicine and Boston Medical CenterBostonMAUSA
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of DiseaseJohns Hopkins University Bloomberg School of Public HealthBaltimoreMDUSA
| | - Heather Rebuck
- Clinical Chemistry Research LabUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Colleen Pearson
- Department of PediatricsBoston University Chobanian & Avedisian School of Medicine and Boston Medical CenterBostonMAUSA
| | - Mei‐Cheng Wang
- Department of BiostatisticsJohns Hopkins University Bloomberg School of Public HealthBaltimoreMDUSA
| | - Cheryl A. Winkler
- Cancer Innovation Laboratory, Center for Cancer ResearchNational Cancer Institute and Basic Research Program, Frederick National LaboratoryFrederickMDUSA
| | - Jeffrey B. Kopp
- Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of HealthMDBethesdaUSA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of DiseaseJohns Hopkins University Bloomberg School of Public HealthBaltimoreMDUSA
- Division of General Pediatrics & Adolescent Medicine, Department of PediatricsJohns Hopkins University School of MedicineBaltimoreMDUSA
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11
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Yogeshkumar S, Dhananjay S, Gowdar S, Gowdar G, Kulkarni V, Byranahalli S, Goudar SS, Dhaded SM, Somannavar MS, Tikamani SS, Saleem S, Ahmed I, Ghanchi NK, Uddin Z, Yasmin H, Jackson K, McClure EM, Goldenberg RL. Morphological study of the placenta in deliveries with pre-eclampsia: Results from a prospective, observational study in India and Pakistan (PURPOSe). BJOG 2023; 130 Suppl 3:36-42. [PMID: 37530629 DOI: 10.1111/1471-0528.17617] [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: 04/15/2023] [Accepted: 07/06/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To compare placental findings in women with and without pre-eclampsia. DESIGN The PURPOSe study included women with stillbirths, women with preterm births and women at term as controls. The placenta of each case was evaluated using the Amsterdam criteria. SETTING Two sites and five tertiary care hospitals of south Asia (Three in India and two in Pakistan). POPULATION Pregnancies in India and Pakistan with placental histology including women with documented hypertension and documented proteinuria and women with neither hypertension nor proteinuria. METHODS We compared the placental findings of the two groups using the Amsterdam criteria and further evaluated the placental findings in women with and without pre-eclampsia who had a stillbirth, preterm live birth, or term live birth (control). MAIN OUTCOME MEASURES The main outcome measures were the frequency of maternal and fetal vascular malperfusion and the frequency of placental inflammation and its components, chorioamnionitis, funisitis, villitis and intervillitis in women with and without pre-eclampsia. RESULTS A total of 733 women had pre-eclampsia and 2334 women had neither hypertension nor proteinuria. In the placentas of women with pre-eclampsia, 57.3% had maternal vascular malperfusion compared with 37.1% in women without pre-eclampsia (p < 0.0001). There was not a significant difference in the prevalence of fetal vascular hypertension between mothers with (17.1%) and without (14.8%, p = 0.6118) pre-eclampsia. When placentas were classified as 'histologically normal' or not, 61.3% of those from pre-eclamptic pregnancies were classified as abnormal, whereas if there was no pre-eclampsia, only 45.0% were classified as histologically abnormal (p < 0.0001). We also considered rates of placental maternal vascular malperfusion in women with and without pre-eclampsia with stillbirth, preterm neonatal death, and term live birth. In women at term with no pre-eclampsia, 16.7% of the placentas had features of maternal vascular malperfusion. This occurred in 79.9% of women with stillbirths with pre-eclampsia compared with 51.8% of those without pre-eclampsia. Maternal vascular malperfusion was present in 49.7% of preterm live births with pre-eclampsia compared with 33.8% without pre-eclampsia. We also evaluated the inflammatory lesions by whether the mother had or did not have pre-eclampsia. When all inflammatory lesions were considered, women with pre-eclampsia had significantly fewer inflammatory lesions than those women without pre-eclampsia (17.1% versus 23.6% p = 0.001). Each of the specific inflammatory lesions was less common in placentas of women with pre-eclampsia than those with chorioamnionitis (16.1% versus 21.9%, p = 0.004) and funisitis (1.5% versus. 5.1%, p = 0.0004). CONCLUSIONS Of placental lesions in women with pre-eclampsia, maternal vascular malperfusion was the most common. Inflammatory lesions were less common in women with pre-eclampsia.
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Affiliation(s)
- S Yogeshkumar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Shobha Dhananjay
- Bapuji Education Association's JJM Medical College, Davangere, Karnataka, India
| | - Sarvamangala Gowdar
- Bapuji Education Association's JJM Medical College, Davangere, Karnataka, India
| | - Guruprasad Gowdar
- Bapuji Education Association's JJM Medical College, Davangere, Karnataka, India
| | - Vardendra Kulkarni
- Bapuji Education Association's JJM Medical College, Davangere, Karnataka, India
| | - Sunil Byranahalli
- Bapuji Education Association's JJM Medical College, Davangere, Karnataka, India
| | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Sangappa M Dhaded
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | | | | | | | | | | | | | - Kay Jackson
- RTI International, Durham, North Carolina, USA
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Makker K, Zhang M, Wang G, Hong X, Aziz K, Brady TM, Wang X. Longitudinal Trajectory and Early Life Determinant of Childhood Adipokines: Findings From a Racially Diverse Birth Cohort. J Clin Endocrinol Metab 2023; 108:1747-1757. [PMID: 36617246 PMCID: PMC10271223 DOI: 10.1210/clinem/dgad005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
CONTEXT Leptin and adiponectin play important roles in systemic metabolic homeostasis, beginning in utero. Limited data exist on the levels and trajectories of these 2 hormones at birth and in childhood and their biological and social determinants. OBJECTIVE We examined the longitudinal trajectories of leptin and adiponectin from birth to early childhood, along with influential prenatal and infancy factors, and whether the trajectories and risk factors differ by preterm birth status. METHODS We included mother-infant pairs in the Boston Birth Cohort, a predominantly Black, indigenous, and people of color (BIPOC) study population. We measured infant plasma leptin and adiponectin levels at birth and in early childhood. We examined longitudinal trajectories and the associated prenatal maternal and infancy factors. We analyzed 716 infants (158 preterm) who had leptin and adiponectin measured at birth and in early childhood (mean corrected age 2.18 years [interquartile range, 0.4-10.4]). RESULTS Cord leptin was higher in term infants (40 230 vs 20 481 in preterm, P < 0.0001) but childhood leptin did not differ by prematurity (4123 in term vs 4181 in preterm, P = 0.92). Adiponectin was higher in term infants at birth (18 416 vs 11 223, P < 0.0001) and in childhood (12 108 vs 10532, P = 0.04). In stepwise regression, Black race was associated with higher childhood leptin and lower childhood adiponectin. Female sex was associated with higher childhood leptin levels and lower childhood adiponectin levels in multivariable regression models. CONCLUSION Our results highlight preterm status, race, and biological sex as predictors of adipokine trajectory throughout childhood. These findings raise the possibility that early life programming of adipokines may contribute to higher metabolic risk in life, especially among Black children born preterm.
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Affiliation(s)
- Kartikeya Makker
- Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Mingyu Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02115, USA
| | - Guoying Wang
- Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA
| | - Xiumei Hong
- Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA
| | - Khyzer Aziz
- Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Tammy M Brady
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Xiaobin Wang
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA
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Ferraz T, Benton SJ, Zareef I, Aribaloye O, Bloise E, Connor KL. Impact of Co-Occurrence of Obesity and SARS-CoV-2 Infection during Pregnancy on Placental Pathologies and Adverse Birth Outcomes: A Systematic Review and Narrative Synthesis. Pathogens 2023; 12:pathogens12040524. [PMID: 37111410 PMCID: PMC10140965 DOI: 10.3390/pathogens12040524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Obesity is a risk factor for severe COVID-19 disease during pregnancy. We hypothesized that the co-occurrence of high maternal body mass index (BMI) and gestational SARS-CoV-2 infection are detrimental to fetoplacental development. We conducted a systematic review following PRISMA/SWiM guidelines and 13 studies were eligible. In the case series studies (n = 7), the most frequent placental lesions reported in SARS-CoV-2(+) pregnancies with high maternal BMI were chronic inflammation (71.4%, 5/7 studies), fetal vascular malperfusion (FVM) (71.4%, 5/7 studies), maternal vascular malperfusion (MVM) (85.7%, 6/7 studies) and fibrinoids (100%, 7/7 studies). In the cohort studies (n = 4), three studies reported higher rates of chronic inflammation, MVM, FVM and fibrinoids in SARS-CoV-2(+) pregnancies with high maternal BMI (72%, n = 107/149; mean BMI of 30 kg/m2) compared to SARS-CoV-2(−) pregnancies with high BMI (7.4%, n = 10/135). In the fourth cohort study, common lesions observed in placentae from SARS-CoV-2(+) pregnancies with high BMI (n = 187 pregnancies; mean BMI of 30 kg/m2) were chronic inflammation (99%, 186/187), MVM (40%, n = 74/187) and FVM (26%, n = 48/187). BMI and SARS-CoV-2 infection had no effect on birth anthropometry. SARS-CoV-2 infection during pregnancy associates with increased prevalence of placental pathologies, and high BMI in these pregnancies could further affect fetoplacental trajectories.
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Affiliation(s)
- Thaina Ferraz
- Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada
| | | | - Israa Zareef
- Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada
| | | | - Enrrico Bloise
- Department of Morphology, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Kristin L. Connor
- Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada
- Correspondence: ; Tel.: +1-613-520-2600 (ext. 4202)
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Hong X, Rosenberg AZ, Heymann J, Yoshida T, Waikar SS, Ilori TO, Wang G, Rebuck H, Pearson C, Wang MC, Winkler CA, Kopp JB, Wang X. Joint associations of pregnancy complications and postpartum maternal renal biomarkers with severe cardiovascular morbidities: A US racially diverse prospective birth cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.14.23287276. [PMID: 36993418 PMCID: PMC10055449 DOI: 10.1101/2023.03.14.23287276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Rationale & Objective Pregnancy complications are risk factors for cardiovascular diseases (CVD). Little is known about the role of renal biomarkers measured shortly after delivery, individually or in combination with pregnancy complications, in predicting subsequent severe maternal CVD. Methods This study included 576 mothers of diverse ethnicities from the Boston Birth cohort, enrolled at delivery and followed prospectively. Plasma creatinine and cystatin C were measured 1-3 days after delivery. CVD during follow-up was defined by physician diagnoses in electronic medical records. Associations of renal biomarkers and pregnancy complications with time-to-CVD events were assessed using Cox proportional hazards models. Results During an average of 10.3±3.2 years of follow-up, 34 mothers developed one or more CVD events. Although no significant associations were found between creatinine and risk of CVD, per unit increase of cystatin C (CysC) was associated with a hazard ratio (HR) of 5.21 (95%CI = 1.49-18.2) for CVD. A borderline significant interactive effect was observed between elevated CysC (≥75th percentile) and preeclampsia. Compared to those without preeclampsia and with normal CysC level (<75 th percentile), mothers with preeclampsia and elevated CysC had the highest risk of CVD (HR=3.8, 95%CI = 1.4-10.2), while mothers with preeclampsia only or with elevated CysC only did not have significantly increased CVD risk. Similar synergistic effects for CVD were observed between CysC and preterm delivery. Conclusions In this sample of US, traditionally under-represented multi-ethnic high-risk mothers, elevated maternal plasma cystatin C and pregnancy complications synergistically increased risk of CVD later in life. These findings warrant further investigation. Clinical Perspectives What is new?Maternal postpartum elevated levels of cystatin C are independently associated with higher risk of cardiovascular diseases (CVD) later in life.Maternal pregnancy complications coupled with postpartum elevated levels of cystatin C synergistically increased future risk of CVD.What are the clinical implications?These findings, if further confirmed, suggest that women with pregnancy complications and elevated postpartum cystatin C may be at particular high risk for CVD later in life compared to women without these risk factors.
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15
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Makker K, Zhang M, Wang G, Hong X, Zhang C, Wang X. Early-life determinants of childhood plasma insulin levels: implications for primordial prevention of diabetes. Pediatr Res 2023; 93:189-197. [PMID: 35449397 PMCID: PMC10184189 DOI: 10.1038/s41390-022-02070-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/31/2022] [Accepted: 02/27/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND We earlier reported prematurity as an independent risk factor for elevated insulin levels. Investigation is still lacking on the influence of prenatal and perinatal factors on childhood insulin levels. METHODS In this secondary analysis of a prospective birth cohort, plasma insulin levels were measured at birth and early childhood. Regression models identified early-life factors associated with the primary outcome: log-transformed childhood plasma insulin levels. RESULTS One thousand one hundred and nine children had insulin levels at birth and 825 at both time points. Compared to term, preterm infants had higher plasma insulin levels (geometric mean) at birth (612, 95% CI 552-679 vs. 372, 95% CI 345-402 pmol/ml) and in early childhood (547, 95% CI 494-605 vs. 445, 95% CI 417-475 pmol/ml). Factors associated with higher early childhood insulin levels included higher insulin level at birth, black race, female sex, maternal smoking during pregnancy, maternal perceived stress, in utero drug exposure, maternal pregestational diabetes mellitus, and maternal preconception overweight and obesity. CONCLUSIONS In this high-risk US birth cohort, we identified multiple prenatal and perinatal risk factors for higher early childhood insulin levels, in addition to prematurity. These findings lend support to primordial preventive strategies for diabetes mellitus. IMPACT In this secondary analysis of a large prospective study from a high-risk racially diverse cohort, we identify biological and social factors that contribute to elevated levels of plasma insulin in early childhood. Our study also investigates factors affecting plasma insulin in preterm infants along with comorbidities commonly seen during the neonatal intensive care stay. Our work reaffirms the importance of Developmental Origins of Health and Disease with regards to in utero programming of insulin levels. Our work supports the possibility that primordial preventive strategies for diabetes mellitus in high-risk populations may need to begin as early as the prenatal period.
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Affiliation(s)
- Kartikeya Makker
- Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Mingyu Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Guoying Wang
- Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiumei Hong
- Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cuilin Zhang
- Division of Intramural Population Health Research, NICHD, National Institutes of Health, Johns Hopkins School of Medicine, Baltimore, USA
| | - Xiaobin Wang
- Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Characteristics of Placental Histopathology in Women with Uncomplicated Pregnancies Affected by SARS-CoV-2 Infection at the Time of Delivery: A Single-Center Experience. Biomedicines 2022; 10:biomedicines10123003. [PMID: 36551759 PMCID: PMC9775152 DOI: 10.3390/biomedicines10123003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was, firstly, to analyze the histopathological characteristics of placentas in women with uneventful pregnancies and affected by COVID-19 at the time of delivery; and secondly, to correlate histological findings to maternal and neonatal characteristics. In our single-center prospective observational study, 46 placentas from term uncomplicated singleton pregnancies of patients with a documented SARS-CoV-2 infection at the time of delivery underwent histological examination. Despite a normal feto-maternal outcome, most of the placentas (82.6%) presented signs of maternal vascular malperfusion, while features of fetal vascular malperfusion were found in 54% of cases. No correlation was detected between maternal and neonatal characteristics and the severity of blood circulation disease, and abnormal findings were also described in asymptomatic patients. Moreover, we did not find any maternal symptoms or clinical details allowing for the prediction of abnormal placental findings in pregnancy complicated by COVID-19 infection. Our results suggest that SARS-CoV-2 infection during pregnancy could lead to acute placental dysfunction.
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Podzolkova NM, Skvortsova MY, Denisova YV, Denisova TV. Is high normotension a norm or a risk factor for perinatal complications: prospective cohort study. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.7.201785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim. Comparative assessment of the effect of high normotension and hypertension 12nd stage on the risk of gestational and perinatal complications.
Materials and methods. A prospective cohort study (n=110) assessing the effect of high normotension on the risk of gestational complications and pregnancy outcomes was conducted. The main group (n=70) included 30 patients with high normotension subgroup A, and 40 patients with hypertension 12nd stage subgroup B. The comparison group included 40 patients with "white coat hypertension".
Results. The most frequent complications in the 2nd and 3rd trimesters of pregnancy were toxaemia, threatened miscarriage, edema (detected in more than half of patients with high normotension and hypertension 12nd stage) and well as threatened preterm labor (p0.05). The frequency of pre-eclampsia development in subgroups A and B did not differ significantly, however, in patients with high normotension in the 3rd trimester during a test of endothelium-dependent vasodilation were detected signs of endothelial dysfunction, which may be one of the mechanisms for the subsequent formation of hypertension in these patients. Placental insufficiency of varying severity was detected only in subgroups A and B. Placental insufficiency, along with intrauterine fetal hypoxia of different etiologies, were the most frequent causes of emergency caesarean section, occurring only in the main group 3 (75.0%) in subgroup A and 6 (66.67%) in subgroup B and associated with blood pressure above 130/85 mm Hg.
Conclusion. The importance of preventing blood pressure increase to high normal rate is explained by the development of endothelial dysfunction at late gestation, which can serve as the mechanisms of hypertension formation in this category of pregnant women.
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Chilukuri N, Bustamante-Helfrich B, Ji Y, Wang G, Hong X, Cheng TL, Wang X. Maternal folate status and placental vascular malperfusion: Findings from a high-risk US minority birth cohort. Placenta 2022; 129:87-93. [PMID: 36274480 DOI: 10.1016/j.placenta.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Maternal folate deficiency was associated with preeclampsia (PE) and PE was associated with placental maternal vascular malperfusion (MVM). However, no study has examined the association of maternal folate status with placental MVM. METHODS We examined the association of maternal folate status and placental MVM in the Boston Birth Cohort. Primary exposure variables were maternal self-reported multivitamin supplement (<2, 3-5, >5 times/week) per trimester; and plasma folate levels (nmol/L) after birth. Primary outcome was presence/absence of placental MVM defined by the Amsterdam Placental Workshop Group standard classification. Covariates included demographics, chronic hypertension, clinically diagnosed PE, eclampsia and HELLP syndrome, gestational and pre-gestational diabetes, overweight/obesity, maternal cigarette smoking and alcohol use. Associations between folate and placental MVM were evaluated using multivariate logistic regressions. RESULTS Of 3001 mothers in this study, 18.8% of mothers had PE, 37.5% had MVM. Mothers with the lowest self-reported frequency of folate intake had the highest risk of MVM (OR 1.45, 95% CI 1.03-2.05), after adjusting for the covariates. Consistently, among a subset of 939 mothers with plasma folate levels, folate insufficiency was associated with increased risk of MVM (OR 1.65, 95% CI 1.03-2.63), after adjusting for the covariables. As expected, mothers with low folate and placental MVM had highest rates of PE compared to those of high folate and no MVM (p < 0.001). DISCUSSION In this high-risk birth cohort, low maternal folate status was associated with increased risk of placental MVM. Further investigation should explore the association between folate status, placental findings and the great obstetrical syndrome.
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Affiliation(s)
- Nymisha Chilukuri
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe Street, Suite 2088, Baltimore, MD, 21287, United States.
| | - Blandine Bustamante-Helfrich
- University of the Incarnate Word School of Osteopathic Medicine, 7615 Kennedy Hill, San Antonio, TX, 78235, United States.
| | - Yuelong Ji
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, United States.
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, United States.
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, United States.
| | - Tina L Cheng
- University of Cincinnati, Cincinnati Children's Research Foundation, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 3016, Cincinnati, OH, 45229-3026, United States.
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, United States.
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Makker K, Zhang M, Wang G, Hong X, Aziz KB, Wang X. Maternal and fetal factors affecting cord plasma leptin and adiponectin levels and their ratio in preterm and term newborns: New insight on fetal origins of metabolic dysfunction. PRECISION NUTRITION 2022; 1:e00013. [PMID: 36968193 PMCID: PMC10035290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Background Understanding of maternal and fetal factors affecting leptin, adiponectin and adiponectin: leptin ratio at birth, may provide valuable insights into potential future risk of metabolic alterations and inform primordial prevention and precision nutrition strategies. Objective To identify maternal and fetal risk factors that affect leptin and adiponectin levels (markers of adiposity) and adiponectin/leptin ratio (a marker of dysfunctional adipose tissue) at birth. Methods We studied mother-infant pairs in the Boston Birth Cohort. Cord blood was collected at birth. We used student t-tests to compare log normalized cord leptin and adiponectin levels. Regression analysis were performed to examine the association of maternal and fetal factors with leptin and adiponectin levels and adiponectin: leptin ratio at birth in both term and preterm infants. Results We analyzed 1012 infants (245 preterm). Both cord leptin and adiponectin were higher in term infants than preterm infants (10.2 ± 0.9 vs. 9.2 ± 1.3, p < 0.0001 and 9.5 ± 0.7 vs. 8.9 ± 0.8, p < 0.0001 respectively). Cord leptin was higher for Black infants (10.1 ± 1.1 vs. 9.9 ± 1.2; p < 0.001) although Black (ref: non Black) infants had lower cord adiponectin levels (9.3 ± 0.8 vs. 9.5 ± 0.7; p = 0.01). Ratio of adiponectin to leptin (log normalized) was higher in preterm infants (-0.24) vs. term infants (-0.69). On regression analysis cord leptin was positively associated with longer gestational age, birth weight z score, Black race, maternal overweight and obesity, gestational diabetes and pregestational diabetes mellitus and negatively associated with male sex. Cord adiponectin was positively associated with gestational age, birth weight z score and negatively with Black race and male sex. Adiponectin: leptin ratio was positively with male sex and negatively with GA, birth wt. z score, Black race, gestational DM, pregestational DM and maternal overweight and obesity. Conclusion We identified several factors that affect leptin and adiponectin levels along with adiponectin-leptin ratio at birth beyond GA and birth weight which could also play an important role in influencing the trajectory of these hormones and future cardio metabolic outcomes. This knowledge can help tailor precision nutrition interventions.
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Affiliation(s)
- Kartikeya Makker
- Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mingyu Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Guoying Wang
- Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Xiumei Hong
- Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Khyzer B. Aziz
- Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Xiaobin Wang
- Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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Arts N, Schiffer V, Severens-Rijvers C, Bons J, Spaanderman M, Al-Nasiry S. Cumulative effect of maternal vascular malperfusion types in the placenta on adverse pregnancy outcomes. Placenta 2022; 129:43-50. [PMID: 36215782 DOI: 10.1016/j.placenta.2022.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Placental vascular disease, characterized by Maternal Vascular Malperfusion (MVM) lesions, is considered to be the underlying cause of pregnancy complications. Aim is to evaluate the relationship between the cumulative number of MVM lesion types, and adverse pregnancy- and neonatal outcomes. METHODS This retrospective cohort study included 272 women with singleton gestations who gave birth at a Dutch tertiary hospital between 2017 and 2018 with available placental histopathology reports. Analyzed according to the Amsterdam Placental Workshop Group Consensus Statement, placentas were divided into groups based on the cumulative number of MVM lesions: no lesions (n = 124), 1-2 types (n = 124) and 3-5 types of lesions (n = 24). RESULTS The proportion of placenta syndrome (PS) was highest (95.8%) in the 3-5 MVM lesions group (p < 0.001). The presence of MVM lesions was highly associated with PS during pregnancy (aOR 6.81, 95% CI 3.76-12.33). Furthermore, every additional type of MVM lesion corresponded with a threefold increased odds for the occurrence of PS (aOR 3.00, 95% CI 2.10-4.29). The group with 3-5 types of MVM lesions showed the highest incidence of adverse neonatal outcomes, lower mean birth weight, prolonged hospitalization, NICU admissions and neonatal deaths (aOR 6.47, 95% CI 0.33-127.68), corresponding with a fourfold increased odds for the occurrence of neonatal death for every additional MVM lesion (aOR 4.19, 95% CI 1.39-12.68). DISCUSSION A higher number of MVM lesion types is strongly associated with an increased incidence of adverse pregnancy- and neonatal outcomes, indicating that guidelines should focus also on the amount of MVM lesion types for the monitoring/management of subsequent pregnancies.
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Affiliation(s)
- Nadi Arts
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Netherlands.
| | - Veronique Schiffer
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Netherlands
| | | | - Judith Bons
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Netherlands
| | - Marc Spaanderman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Netherlands
| | - Salwan Al-Nasiry
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Netherlands
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Bobei TI, Sima RM, Gorecki GP, Poenaru MO, Olaru OG, Bobirca A, Cirstoveanu C, Chicea R, Topirceanu-Andreoiu OM, Ples L. Placenta, the Key Witness of COVID-19 Infection in Premature Births. Diagnostics (Basel) 2022; 12:diagnostics12102323. [PMID: 36292012 PMCID: PMC9600231 DOI: 10.3390/diagnostics12102323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022] Open
Abstract
Adverse perinatal outcomes, such as increased risks of pre-eclampsia, miscarriage, premature birth, and stillbirth have been reported in SARS-CoV-2 infection. For a better understanding of COVID-19 complications in pregnancy, histopathological changes in the placenta, which is the interface between mother and foetus, could be the place to look at. The aim of this study was to determine placental histopathological changes and their role in preterm birth in pregnant women with SARS-CoV-2 infection. We performed a prospective, observational study in a COVID-only hospital, which included 39 pregnant women with SARS-CoV-2 infection and preterm birth compared with a control group of 39 women COVID-19 negative with preterm birth and a placental pathology exam available. The microscopic examination of all placentas revealed placental infarction (64.1% vs. 30.8%), decidual arteriopathy (66.7% vs. 23.1%), intervillous thrombi (53.8% vs. 38.5%), perivillous fibrin deposits (59% vs. 46.2%), inflammatory infiltrate (69.2% vs. 46.2%), chorangiosis (17.9% vs. 10.3%), and accelerated maturation of the villi (23.1% vs. 28.2%).
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Affiliation(s)
- Tina-Ioana Bobei
- Department PhD, IOSUD, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Romina-Marina Sima
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
- Correspondence:
| | - Gabriel-Petre Gorecki
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
| | - Mircea-Octavian Poenaru
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Octavian-Gabriel Olaru
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
| | - Anca Bobirca
- Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Catalin Cirstoveanu
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Pediatrics Department, “Maria Sklodowska Curie” Emergency Children Clinical Hospital, 041451 Bucharest, Romania
| | - Radu Chicea
- Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania
| | | | - Liana Ples
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Bucur” Maternity, Saint John Hospital, 012361 Bucharest, Romania
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22
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Makker K, Zhang M, Wang G, Hong X, Aziz KB, Wang X. Maternal and fetal factors affecting cord plasma leptin and adiponectin levels and their ratio in preterm and term newborns: New insight on fetal origins of metabolic dysfunction. PRECISION NUTRITION 2022; 1:e00013. [PMID: 37745945 PMCID: PMC10035290 DOI: 10.1097/pn9.0000000000000013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/15/2022] [Accepted: 06/27/2022] [Indexed: 09/26/2023]
Abstract
Background Understanding of maternal and fetal factors affecting leptin, adiponectin, and adiponectin:leptin ratio at birth may provide valuable insights into potential future risk of metabolic alterations and inform primordial prevention and precision nutrition strategies. The objective of this study is to identify maternal and fetal risk factors that affect leptin and adiponectin levels (markers of adiposity) and adiponectin/leptin ratio (a marker of dysfunctional adipose tissue) at birth. Methods We studied mother-infant pairs in the Boston Birth Cohort. Cord blood was collected at birth. We used student t- tests to compare log normalized cord leptin and adiponectin levels. Regression analysis was performed to examine the association of maternal and fetal factors with leptin and adiponectin levels and adiponectin:leptin ratio at birth in both term and preterm infants. Results We analyzed 1012 infants (245 preterm). Both cord leptin and adiponectin were higher in term infants than preterm infants (10.2 ± 0.9 vs. 9.2 ± 1.3, P < 0.0001 and 9.5 ± 0.7 vs. 8.9 ± 0.8, P < 0.0001, respectively). Cord leptin was higher for Black infants (10.1 ± 1.1 vs. 9.9 ± 1.2; P < 0.001) although Black (ref: non-Black) infants had lower cord adiponectin levels (9.3 ± 0.8 vs. 9.5 ± 0.7; P = 0.01). Ratio of adiponectin to leptin (log normalized) was higher in preterm infants (-0.24) vs. term infants (-0.69). On regression analysis, cord leptin was positively associated with longer gestational age (GA), birth weight z score, Black race, maternal overweight and obesity, gestational diabetes and pregestational diabetes mellitus and negatively associated with male sex. Cord adiponectin was positively associated with GA, birth weight z score and negatively with Black race and male sex. Adiponectin:leptin ratio was positively with male sex and negatively with GA, birth weight z score, Black race, gestational DM, pregestational DM and maternal overweight and obesity. Conclusions We identified several factors that affect leptin and adiponectin levels along with adiponectin-leptin ratio at birth beyond GA and birth weight which could also play an important role in influencing the trajectory of these hormones and future cardiometabolic outcomes. This knowledge can help tailor precision nutrition interventions.
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Affiliation(s)
- Kartikeya Makker
- Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mingyu Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Guoying Wang
- Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Xiumei Hong
- Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Khyzer B. Aziz
- Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Xiaobin Wang
- Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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23
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The placental pathology in Coronavirus disease 2019 infected mothers and its impact on pregnancy outcome. Placenta 2022; 127:1-7. [PMID: 35917629 PMCID: PMC9293376 DOI: 10.1016/j.placenta.2022.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/19/2022] [Accepted: 07/14/2022] [Indexed: 12/28/2022]
Abstract
Introduction This study aims at observing placental pathologies in COVID-19 infected women, and analyzing its impact on pregnancy outcome. Method This is a descriptive-analytical study done at a tertiary centre of Northern India. All COVID-19 positive pregnant women with gestational age ≥20 weeks, with placental histopathological reporting, were included in this study. A total of 173 COVID-19 pregnant women were included in the study. Results Placental abnormalities were noticed in 49·16% of total 179 placentae examined. Maternal vascular malperfusion (27·93%) was the most observed placental pathology followed by villous fibrin deposits (22·90%), fetal vasculopathy (16·75%), and acute inflammation (6·70%). Stillbirths were 22 and NICU admissions were seen in 50 neonates. Abnormal placental abnormalities led to higher stillbirths (p value 0·011) and lower Apgar scores at 1 and 5 min (p-value 0·028; p-value 0·002, respectively). Intervillous fibrin deposits had higher risk associated with lower Apgar score at 1 and 5 min [RR 2·05 (95% CI 1·21–3·48, p-value 0·010) and RR 5·52 (95% CI 2·58–11·81, p-value <0·001), respectively]. RP clot/hemorrhage was also associated with lower Apgar score at 1 and 5 min [RR 2·61 (95% CI 1·52–4·49, p-value 0·002) and RR 3.54 (95% CI 1·66–7·55, p-value 0·001), respectively]. Discussion Placental abnormalities in COVID-19 infection were associated with significant higher incidence of unexplained stillbirths, and lower Apgar scores. Although, this is the largest descriptive-analytical study done so far, comparative studies are required to draw a clear conclusion regarding the impact of COVID-19 infection on human placenta and its effect on pregnancy outcomes.
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McArthur KL, Zhang M, Hong X, Wang G, Buckley JP, Wang X, Mueller NT. Trimethylamine N-Oxide and Its Precursors Are Associated with Gestational Diabetes Mellitus and Pre-Eclampsia in the Boston Birth Cohort. Curr Dev Nutr 2022; 6:nzac108. [PMID: 35949367 PMCID: PMC9356535 DOI: 10.1093/cdn/nzac108] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/14/2022] [Accepted: 06/08/2022] [Indexed: 12/01/2022] Open
Abstract
Background Trimethylamine N-oxide (TMAO) and its precursors choline, betaine, and carnitine have been associated with cardiometabolic disease in nonpregnant adults. However, studies examining TMAO and its precursors in relation to cardiometabolic conditions during pregnancy are lacking. Objectives The primary objective was to estimate the association of TMAO and its precursors in maternal and cord plasma with gestational diabetes mellitus (GDM) and pre-eclampsia (PE) among women in the Boston Birth Cohort. A secondary objective was to determine whether associations vary by race/ethnicity. Methods ORs for each outcome according to tertiles and to an SD increment of TMAO, choline, betaine, and carnitine were estimated using logistic regression. Final models were adjusted for covariates. Results Among 1496 women, 115 women had GDM and 159 had PE during the index pregnancy. Intermetabolite correlations of TMAO and its precursors were stronger within cord plasma (r = 0.38-0.87) than within maternal plasma (r = 0.08-0.62). Maternal TMAO was associated with higher odds of GDM (third compared with first tertile OR: 1.75; 95% CI: 1.04, 2.94), whereas maternal choline, betaine, and carnitine were not associated with GDM. Maternal TMAO and choline were not associated with PE, whereas carnitine was associated with higher (OR: 1.86; 95% CI: 1.18, 2.94) and betaine with lower odds of PE (OR: 0.37; 95% CI: 0.23, 0.59). In cord plasma, TMAO was not associated with GDM or PE, but choline, betaine, and carnitine were associated with higher odds of PE (OR: 3.11; 95% CI: 1.62, 5.96; OR: 2.65; 95% CI: 1.42, 4.93; OR: 2.56; 95% CI: 1.39, 4.69, respectively). Cord choline was associated with lower odds of GDM (OR: 0.52; 95% CI: 0.27, 0.99), whereas other cord metabolites were not significantly associated with GDM. Associations did not vary by race/ethnicity. Conclusions TMAO and its precursors were associated with GDM and PE, but the associations differed based on the metabolite medium (maternal compared with cord plasma).This trial was registered at clinicaltrials.gov as NCT03228875.
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Affiliation(s)
- Kristen L McArthur
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mingyu Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessie P Buckley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Noel T Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
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Abstract
The Amsterdam Placental Workshop Group Consensus Statement on Sampling and Definitions of Placental Lesions has become widely accepted and is increasingly used as the universal language to describe the most common pathologic lesions found in the placenta. This review summarizes the most salient aspects of this seminal publication and the subsequent emerging literature based on Amsterdam definitions and criteria, with emphasis on publications relating to diagnosis, grading, and staging of placental pathologic conditions. We also provide an overview of the recent expert recommendations on the pathologic grading of placenta accreta spectrum, with insights on their clinical context. Finally, we discuss the emerging entity of SARS-CoV2 placentitis.
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Benton SJ, Mery EE, Grynspan D, Gaudet LM, Smith GN, Bainbridge SA. Placental Pathology as a Tool to Identify Women for Postpartum Cardiovascular Risk Screening following Preeclampsia: A Preliminary Investigation. J Clin Med 2022; 11:jcm11061576. [PMID: 35329905 PMCID: PMC8954716 DOI: 10.3390/jcm11061576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 12/11/2022] Open
Abstract
Preeclampsia (PE) is associated with an increased risk of cardiovascular disease (CVD) in later life. Postpartum cardiovascular risk screening could identify patients who would benefit most from early intervention and lifestyle modification. However, there are no readily available methods to identify these high-risk women. We propose that placental lesions may be useful in this regard. Here, we determine the association between placental lesions and lifetime CVD risk assessed 6 months following PE. Placentas from 85 PE women were evaluated for histopathological lesions. At 6 months postpartum, a lifetime cardiovascular risk score was calculated. Placental lesions were compared between CVD risk groups and the association was assessed using odds ratios. Multivariable logistic regression was used to develop prediction models for CVD risk with placental pathology. Placentas from high-risk women had more severe lesions of maternal vascular malperfusion (MVM) and resulted in a 3-fold increased risk of screening as high-risk for CVD (OR 3.10 (1.20–7.92)) compared to women without these lesions. MVM lesion severity was moderately predictive of high-risk screening (AUC 0.63 (0.51, 0.75); sensitivity 71.8% (54.6, 84.4); specificity 54.7% (41.5, 67.3)). When clinical parameters were added, the model’s predictive performance improved (AUC 0.73 (0.62, 0.84); sensitivity 78.4% (65.4, 87.5); specificity 51.6% (34.8, 68.0)). The results suggest that placenta pathology may provide a unique modality to identify women for cardiovascular screening.
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Affiliation(s)
- Samantha J. Benton
- Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada;
| | - Erika E. Mery
- School of Interdisciplinary Health Sciences, University of Ottawa, Ottawa, ON K1H 8L1, Canada;
| | - David Grynspan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada;
| | - Laura M. Gaudet
- Department of Obstetrics and Gynaecology, Queen’s University, Kingston, ON K7L 2V7, Canada; (L.M.G.); (G.N.S.)
| | - Graeme N. Smith
- Department of Obstetrics and Gynaecology, Queen’s University, Kingston, ON K7L 2V7, Canada; (L.M.G.); (G.N.S.)
| | - Shannon A. Bainbridge
- School of Interdisciplinary Health Sciences, University of Ottawa, Ottawa, ON K1H 8L1, Canada;
- Correspondence:
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McBride CA, Bernstein IM, Sybenga AB, McLean KC, Orfeo T, Bravo MC. Placental Maternal Vascular Malperfusion is Associated with Prepregnancy and Early Pregnancy Maternal Cardiovascular and Thrombotic Profiles. REPRODUCTIVE MEDICINE 2022; 3:50-61. [PMID: 36923963 PMCID: PMC10012330 DOI: 10.3390/reprodmed3010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Characteristics of maternal vascular malperfusion (MVM) are frequently observed in placentas from pregnancies impacted by preeclampsia, intrauterine growth restriction, preterm labor, and intrauterine fetal demise. We sought to evaluate the associations of features of MVM with subclinical measures of cardiovascular health and coagulation potential in healthy young women. Sixty-three healthy young women were recruited and assessed prior to pregnancy on cycle day 9 ± 4, at gestational age 90 ± 6 of early pregnancy, and gestational age 216 ± 5 of late pregnancy. Women were assessed for plasma volume, blood pressure, response to volume loading, cardiac output, and uterine hemodynamics. Platelet-poor plasma was collected to assess thrombin generation on a subset of 33 women at all time points. Following delivery, placentas were collected and analyzed for evidence of MVM. Thrombin generation (TG) was evaluated in the presence of tissue factor (TF) with and without recombinant soluble thrombomodulin (TM). For each, we compared TG lagtime, peak level, and endogenous thrombin potential (ETP). Comparisons were made between dichotomized presence and absence of each individual feature of MVM and cardiovascular and coagulation features. Mean ± standard deviation are presented. Women were 31 ± 4 years of age, body mass index of 24 ± 5 kg/m2, 86% white race, and 80% nulliparous. MVM occurred in 70% of placentas, with infarcts and agglutination (44%), decidual arteriopathy (40%), accelerated villous maturation (32%), placental hypoplasia (29%), and distal villous hypoplasia (17%) documented. Decidual arteriopathy and distal villous hypoplasia were associated with prepregnancy maternal physiology, including decreased plasma volume and subclinical cardiovascular variations. All assessed MVM characteristics had identifiable early pregnancy physiologic characteristics consistent with altered cardiovascular function and decreased uterine response to pregnancy when compared with women who did and did not develop MVM. Accelerated villous maturation was the only MVM feature to differ by thrombin generation parameters in early pregnancy. Thrombin generation potential and blood pressure were elevated in late pregnancy in women who developed decidual arteriopathy. Prepregnancy health status and adaptation to pregnancy play important roles in pregnancy outcomes. Both cardiovascular health and thrombin generation potential may influence early placentation. Longitudinal assessment of subclinical maternal factors may allow for better understanding of the etiologies of MVM lesions, as well as allow for identification of a timeline of the origins of placental pathologies.
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Affiliation(s)
- Carole A McBride
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Ira M Bernstein
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Amelia B Sybenga
- Department of Pathology, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Kelley C McLean
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Thomas Orfeo
- Department of Biochemistry, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Maria Cristina Bravo
- Department of Biochemistry, University of Vermont Larner College of Medicine, Burlington, VT, United States
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Ramey-Collier K, Craig AM, Hall A, Weaver KE, Wheeler SM, Gilner JB, Swamy GK, Hughes BL, Dotters-Katz SK. Symptomatic versus asymptomatic COVID-19: does it impact placental vasculopathy? J Matern Fetal Neonatal Med 2022; 35:9460-9462. [PMID: 35172668 DOI: 10.1080/14767058.2022.2041597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study sought to assess the impact of COVID-19 on placental vasculature in the context of maternal symptomatology - comparing asymptomatic to symptomatic pregnant patients - and disease severity - comparing pregnant patients with mild, moderate, severe, and critical COVID-19 infection. PCR-confirmed COVID-19 positive pregnant patients in a single health system who delivered between 3/2020-5/2021 included. All patients had positive COVID test and delivered during the study period. Primary outcome was incidence of any vascular malperfusion on placental pathology. Secondary outcomes were FVM and MVM on placental pathology. Placental pathology compared between symptomatic (sCOVID) and asymptomatic (aCOVID) patients. Secondary analysis of symptomatic patients, comparing placental pathology between mild disease(mCOVID) and worse disease(moderate, severe, or critical-defined by 2020 NIH guidelines) (dCOVID), also performed. Of 112 patients, 53 (47%) had symptoms. Twenty-seven (24.1%) patients had evidence of vascular malperfusion; 26 (23.2%) had MVM. When comparing aCOVID and sCOVID patients, no difference in rate of vascular malperfusion identified, nor any differences in rates of FVM or MVM. Among sCOVID patients (n = 53), 39 (74%) had mCOVID and 14 (26%) had dCOVID (moderate n = 4, severe n = 9, critical n = 1). Patients with dCOVID had earlier median delivery GA (37.4wks vs 39.2wks, p = .03). No difference in latency from diagnosis to delivery seen between mCOVID and dCOVID groups (4.4 vs 3.0wks, p = .96). Twelve (30.8%) patients had vascular malperfusion on pathology, all had mCOVID (p = .02). Eleven (28.2%) mCOVID patients had MVM; no dCOVID patients had evidence of vascular malperfusion (p = .03). No difference in FVM was found between cohorts. Symptomatic COVID-19 infection did not impact placental vasculature differently than asymptomatic infection, even when stratifying by trimester of infection. Among pregnant patients with symptomatic COVID-19, mild disease was associated with placental vascular changes on the maternal side while severe disease was not. Further studies are needed to understand the implications of these findings.
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Affiliation(s)
| | - Amanda M Craig
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Allison Hall
- Formerly of Department of Pathology, Duke University, Durham, NC, USA
| | - Kristin E Weaver
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Sarahn M Wheeler
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Jennifer B Gilner
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Brenna L Hughes
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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Radan AP, Baud D, Favre G, Papadia A, Surbek D, Baumann M, Raio L. Low placental weight and altered metabolic scaling after severe acute respiratory syndrome coronavirus type 2 infection during pregnancy: a prospective multicentric study. Clin Microbiol Infect 2022; 28:718-722. [PMID: 35150886 PMCID: PMC8828389 DOI: 10.1016/j.cmi.2022.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 12/17/2022]
Abstract
Objectives A higher risk of adverse pregnancy outcomes is associated with SARS-CoV-2 infection; this could be partially explained by an altered placental function. Because histopathology is often unspecific, we aimed to assess placental weight, birthweight/placental weight (b/p) ratio, and the metabolic scaling exponent ß, an indicator of normal fetal-placental growth, to analyze placental function. Methods We included 153 singleton pregnancies with SARS-CoV-2–positive PCR result who delivered at three referring hospitals in Switzerland. Placental weight and b/p ratio were compared to published reference charts. Logistic regression analysis investigated the role of time of infection and other confounding factors on placental weight. The scaling exponent β was compared to the reference value of 0.75. Results Placental weight was inferior or equal to the tenth centile in 42.5% (65 of 153) and to the third centile in 19% (29 of 153) of the cases. The risk of low placental weight was not influenced by the trimester in which infection occurred. The b/p ratio was >50th centile in 80.4% (123 of 153) of the cases. The incidence of foetal growth restriction, preeclampsia, and gestational diabetes was 11.8% (18 of 153), 3.3% (5 of 153), and 19.6% (30 of 153). Linear regression modelling revealed a pathologic metabolic scaling exponent β of 0.871 ± 0.064 (R2 = 0.56). Discussion SARS-CoV-2 infection during pregnancy was associated with a higher incidence of low placental weight, an increased b/p ratio, and an abnormal scaling exponent β in our cohort. This could be particularly relevant for the still controversial issue of an increased stillbirth rate in SARS-CoV-2 infection during pregnancy. In this regard, intensified foetal surveillance should be mandatory in these pregnancies.
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Affiliation(s)
- Anda-Petronela Radan
- Department of Obstetrics and feto-maternal Medicine, University Hospital of Bern, University of Bern, Switzerland.
| | - David Baud
- Women - Mother - Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Guillaume Favre
- Women - Mother - Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and feto-maternal Medicine, University Hospital of Bern, University of Bern, Switzerland
| | - Marc Baumann
- Department of Obstetrics and feto-maternal Medicine, University Hospital of Bern, University of Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and feto-maternal Medicine, University Hospital of Bern, University of Bern, Switzerland
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Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy. Am J Obstet Gynecol 2022; 226:S1211-S1221. [PMID: 35177218 PMCID: PMC8857508 DOI: 10.1016/j.ajog.2020.10.027] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 02/03/2023]
Abstract
High blood pressure in the postpartum period is most commonly seen in women with antenatal hypertensive disorders, but it can develop de novo in the postpartum time frame. Whether postpartum preeclampsia or eclampsia represents a separate entity from preeclampsia or eclampsia with antepartum onset is unclear. Although definitions vary, the diagnosis of postpartum preeclampsia should be considered in women with new-onset hypertension 48 hours to 6 weeks after delivery. New-onset postpartum preeclampsia is an understudied disease entity with few evidence-based guidelines to guide diagnosis and management. We propose that new-onset hypertension with the presence of any severe features (including severely elevated blood pressure in women with no history of hypertension) be referred to as postpartum preeclampsia after exclusion of other etiologies to facilitate recognition and timely management. Older maternal age, black race, maternal obesity, and cesarean delivery are all associated with a higher risk of postpartum preeclampsia. Most women with delayed-onset postpartum preeclampsia present within the first 7 to 10 days after delivery, most frequently with neurologic symptoms, typically headache. The cornerstones of treatment include the use of antihypertensive agents, magnesium, and diuresis. Postpartum preeclampsia may be associated with a higher risk of maternal morbidity than preeclampsia with antepartum onset, yet it remains an understudied disease process. Future research should focus on the pathophysiology and specific risk factors. A better understanding is imperative for patient care and counseling and anticipatory guidance before hospital discharge and is important for the reduction of maternal morbidity and mortality in the postpartum period.
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Rodríguez-Soto AE, Pham D, Tran T, Meads M, Stanley V, Melber D, Lamale-Smith L, Zhang-Rutledge K, Rakow-Penner R, Alshawabkeh L, Parast MM, Contijoch F. Evidence of maternal vascular malperfusion in placentas of women with congenital heart disease. Placenta 2022; 117:209-212. [PMID: 34953287 DOI: 10.1016/j.placenta.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022]
Affiliation(s)
| | - Donna Pham
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Tracy Tran
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Morgan Meads
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Valentina Stanley
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Dora Melber
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Leah Lamale-Smith
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Kathy Zhang-Rutledge
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | | | - Laith Alshawabkeh
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Mana M Parast
- Department of Pathology, University of California San Diego, La Jolla, CA, USA; Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA, USA
| | - Francisco Contijoch
- Department of Radiology, University of California San Diego, La Jolla, CA, USA; Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
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Mavedatnia D, Tran J, Oltean I, Bijelić V, Moretti F, Lawrence S, El Demellawy D. Impact of Co-Existing Placental Pathologies in Pregnancies Complicated by Placental Abruption and Acute Neonatal Outcomes. J Clin Med 2021; 10:5693. [PMID: 34884395 PMCID: PMC8658381 DOI: 10.3390/jcm10235693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
Placental abruption (PA) is a concern for maternal and neonatal morbidity. Adverse neonatal outcomes in the setting of PA include higher risk of prematurity. Placental pathologies include maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute chorioamnionitis, and villitis of unknown etiology (VUE). We aimed to investigate how placental pathology contributes to acute neonatal outcome in PA. A retrospective cohort study of all placentas with PA were identified. Exposures were MVM, FVM, acute chorioamnionitis and VUE. The primary outcome was NICU admission and the secondary outcomes included adverse base deficit and Apgar scores, need for resuscitation, and small-for-gestational age. A total of 287 placentas were identified. There were 160 (59.9%) of placentas with PA alone vs 107 (40.1%) with PA and additional placental pathologies. Odds of NICU admission were more than two times higher in pregnancies with placental pathologies (OR = 2.37, 95% CI 1.28-4.52). These estimates were in large part mediated by prematurity and birthweight, indirect effect acting through prematurity was OR 1.79 (95% CI 1.12-2.75) and through birthweight OR 2.12 (95% CI 1.40-3.18). Odds of Apgar score ≤ 5 was more than four times higher among pregnancies with placental pathologies (OR = 4.56, 95% CI 1.28-21.26). Coexisting placental pathology may impact Apgar scores in pregnancies complicated by PA. This knowledge could be used by neonatal teams to mobilize resources in anticipation of the need for neonatal resuscitation.
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Affiliation(s)
- Dorsa Mavedatnia
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
| | - Jason Tran
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
| | - Irina Oltean
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (I.O.); (V.B.)
- Department of Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Vid Bijelić
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; (I.O.); (V.B.)
| | - Felipe Moretti
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
| | - Sarah Lawrence
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
| | - Dina El Demellawy
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; (D.M.); (J.T.); (F.M.)
- Department of Pathology, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
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Zhang P. Phenotypic Switch of Endovascular Trophoblasts in Decidual Vasculopathy with Implication for Preeclampsia and Other Pregnancy Complications. Fetal Pediatr Pathol 2021; 40:543-562. [PMID: 32068473 DOI: 10.1080/15513815.2020.1722507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BackgroundThis study aims to investigate decidual vasculopathy in preeclampsia at term and its relationship to spiral artery remodeling at implantation sites. Study design: Implantations sites with endovascular trophoblasts were reviewed from abortions with immunostaining for CD56. Placentas from patients with preeclampsia were also reviewed in association with other pathological features using placentas with decidual vasculopathy but not preeclampsia as controls. Results: Endovascular trophoblasts were phenotypically switched to express CD56 upon entering the spiral artery at implantation. CD56 expression is identified in classic decidual vasculopathy at term with or without preeclampsia. CD56 expression in addition to cytokeratin in decidual vasculopathy demonstrated the fetal trophoblastic origin, establishing the presence of endovascular trophoblasts at implantation and the decidual vasculopathy at term. Conclusion: Decidual vasculopathy at term contains the same CD56 positive extravillous endovascular trophoblasts seen with spiral artery remodeling in early pregnancy. CD56 may serve as a possible marker for decidual vasculopathy in the later stages of pregnancy.
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Affiliation(s)
- Peilin Zhang
- Pathology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, USA
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Genest DS, Dal Soglio D, Girard S, Rey E. Association between proteinuria and placental pathology in preeclampsia: A retrospective study. SAGE Open Med 2021; 9:20503121211058053. [PMID: 34925835 PMCID: PMC8673865 DOI: 10.1177/20503121211058053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Preeclampsia develops due to placental insufficiency and systemic proinflammatory and antiangiogenic mediator release, with ensuing systemic endothelial dysfunction. Nephrotic-range proteinuria appears to be associated with worse pregnancy outcomes. The relationship between differing degrees of proteinuria and the severity of placental alterations has not been studied. Methods: This is a single-centre retrospective comparison of 150 singleton pregnancies complicated by preeclampsia and varying degrees of proteinuria. Maternal demographic, obstetrical and fetal outcome data were obtained from chart review. The placental histologic evaluations were performed by a placental pathologist blinded to all other clinical information. Results: Preeclamptic women with massive proteinuria had evidence of more severe maternal vascular malperfusion lesions. The severity of the lesions was progressive through mild, moderate and massive proteinuria. Women with massive proteinuria had a higher incidence of renal dysfunction and severe hypertension, and had earlier preterm deliveries compared to preeclamptic women with mild and moderate proteinuria (p < 0.05). Conclusion: Preeclampsia with more severe proteinuria is associated with a higher prevalence of placental maternal vascular malperfusion.
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Affiliation(s)
| | - Dorothée Dal Soglio
- Department of Pathology and Clinical Laboratory Medicine, CHU Sainte-Justine, Montreal, QC, Canada
| | - Sylvie Girard
- Department of Obstetrics and Gynecology, Université de Montréal, Centre de Recherche, CHU Sainte-Justine, Montreal, QC, Canada
| | - Evelyne Rey
- Department of Obstetrics and Gynecology, Université de Montréal, Centre de Recherche, CHU Sainte-Justine, Montreal, QC, Canada
- Division of Obstetric Medicine, Department of Medicine, University of Montreal, CHU Sainte-Justine, Montreal, QC, Canada
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Bar J, Weiner E, Levy M, Gilboa Y. The thrifty phenotype hypothesis: The association between ultrasound and Doppler studies in fetal growth restriction and the development of adult disease. Am J Obstet Gynecol MFM 2021; 3:100473. [PMID: 34481995 DOI: 10.1016/j.ajogmf.2021.100473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022]
Abstract
Barker pioneered the idea that the epidemic of coronary heart disease in Western countries in the 20th century, which paradoxically coincided with improved standards of living and nutrition, has its origin in fetal life. Indeed, there is substantial evidence associating low birthweight because of fetal growth restriction with an increased risk of vascular disease in later adult life. These conclusions led to the second part of the Barker hypothesis, the thrifty phenotype, in which adaptation to undernutrition in fetal life leads to permanent metabolic and endocrine changes. Such changes are beneficial if the undernutrition persists after birth but may predispose the individual to obesity and impaired glucose tolerance if conditions improve. The hypothesis assumes that a poor nutrient supply during a critical period of in utero life may "program" a permanent structural or functional change in the fetus, thereby altering the distribution of cell types, gene expression, or both. The fetus, in response to placental undernutrition and to maintain sufficient vascular supply to the brain, decreases resistance to blood flow in the middle cerebral artery. Simultaneously, because of the limited blood supply to the fetus, the arterial redistribution process is accompanied by increased resistance to flow to other fetal vital organs, such as the heart, kidneys, liver, and pancreas. It may explain why individuals exposed to ischemic changes in utero develop dyslipidemia, lower nephron number, and impaired glucose tolerance, all factors contributing to metabolic syndrome later in life. Nevertheless, support for the hypotheses comes mainly from studies in rodents and retrospective epidemiologic studies. This review focused on ultrasound and Doppler studies of human fetal growth restriction in several fetal organs: the placenta, fetal circulation, brain, heart, kidneys, adrenal glands, liver, and pancreas. Support for the hypothesis was provided by animal studies involving conditions that create fetuses with growth restriction with effects on various fetal organs and by human studies that correlate impaired fetal circulation with the in utero development and function of fetal organs.
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Affiliation(s)
- Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Dr. Bar, Dr Weiner, and Dr. Levy); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr. Bar, Dr. Weiner, Dr. Levy, and Dr. Gilboa)
| | - Eran Weiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Dr. Bar, Dr Weiner, and Dr. Levy); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr. Bar, Dr. Weiner, Dr. Levy, and Dr. Gilboa).
| | - Michal Levy
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel (Dr. Bar, Dr Weiner, and Dr. Levy)
| | - Yinon Gilboa
- Ultrasound Unit, Helen Schneider Comprehensive Women's Health Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel (Dr. Gilboa); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr. Bar, Dr. Weiner, Dr. Levy, and Dr. Gilboa)
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Long J, Zhang M, Wang G, Hong X, Ji Y, Bustamante-Helfrich B, Wang X, Mueller NT. Association of Placental Pathology With Childhood Blood Pressure Among Children Born Preterm. Am J Hypertens 2021; 34:1154-1162. [PMID: 34424290 PMCID: PMC9526806 DOI: 10.1093/ajh/hpab097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/08/2021] [Accepted: 08/12/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The in utero pathologies underlying the link between preterm birth and offspring high blood pressure (BP) are still unknown. We investigated the prospective associations of placental histopathological findings with childhood BP among children born preterm. METHODS Our study sample included 546 mother-child pairs with preterm birth (before 37 weeks gestation) enrolled from 1999 to 2013 at the Boston Medical Center. Early preterm birth was defined as gestational age between 23 and 34 weeks. We histologically classified maternal placental pathology using the latest recommended categories: no placental complications, histologic chorioamnionitis, maternal vascular malperfusion, and other placental complications. We calculated age-, sex-, and height-specific systolic BP (SBP) percentiles for children using the 2017 American Academy of Pediatrics Clinical Practice Guideline. We used linear regression models with generalized estimating equations to examine the associations. RESULTS The mean (standard deviation (SD)) postnatal follow-up of the study children was 9.29 (4.1) years. After adjusting for potential confounders, histologic chorioamnionitis was associated with a 5.42 percentile higher childhood SBP (95% confidence interval: 0.32, 10.52) compared with no placental pathologic findings. This association was stronger among early preterm children. Maternal vascular malperfusion was associated with a 8.44 percentile higher childhood SBP among early preterm children (95% confidence interval: 1.54, 15.34) but the association was attenuated (6.25, 95% confidence interval: -0.76, 13.26) after additional adjustment for child standardized birthweight, a potential mediator of the association. CONCLUSIONS These findings suggest that among children born preterm, especially those born early preterm, both placental histologic chorioamnionitis and vascular malperfusion may help to differentiate a child's risk of high BP.
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Affiliation(s)
- Jingmiao Long
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mingyu Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Guoying Wang
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Xiumei Hong
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yuelong Ji
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Blandine Bustamante-Helfrich
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Clinical and Applied Science Education (Pathology), University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas, USA
| | - Xiaobin Wang
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Noel T Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Correspondence: Noel T. Mueller ()
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Asúnsolo Á, Chaowen C, Ortega MA, Coca S, Borrell LN, De León-Luis J, García-Honduvilla N, Álvarez-Mon M, Buján J. Association Between Lower Extremity Venous Insufficiency and Intrapartum Fetal Compromise: A Nationwide Cross-Sectional Study. Front Med (Lausanne) 2021; 8:577096. [PMID: 34307390 PMCID: PMC8300430 DOI: 10.3389/fmed.2021.577096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/20/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction: Chronic venous disorder (CVeD) has a high prevalence, being commonly diagnosed by the presence of varicose veins. In fact, the development of varicose veins in lower extremities and/or pelvic venous insufficiency (LEPVI) is frequent. However, its potential impact on fetal health has not been investigated. This study aimed to examine whether the presence of varicose veins in women's LEPVI is related to an intrapartum fetal compromise event. Materials: A cross-sectional, national study was conducted using medical administrative records (CMBD) of all vaginal births (n = 256,531) recorded in 2015 in Spain. The independent variable was defined as the presence of varicose veins in the legs, vulva, and perineum or hemorrhoids. A logistic regression model was used to assess the association of interest. Results: Among women with vaginal deliveries, those with varicose veins in their LEPVI have a significantly greater odds of intrapartum fetal compromise (OR = 1.30, 99.55%CI = 1.08–1.54) than their counterparts without varicose veins. After adjustment, this association remained significant (OR = 1.25, 99.5%CI = 1.05–1.50). Conclusions: Our findings of an association between varicose veins in women's lower extremities and/or pelvis and intrapartum fetal compromise suggest that varicose veins may be a novel and important clinical risk factor for fetal well-being and health.
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Affiliation(s)
- Ángel Asúnsolo
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcala, Alcalá de Henares, Spain.,Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, United States
| | - Chen Chaowen
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcala, Alcalá de Henares, Spain
| | - Miguel A Ortega
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.,Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Santiago Coca
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.,Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Luisa N Borrell
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcala, Alcalá de Henares, Spain.,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, United States
| | - Juan De León-Luis
- Service of Gynecology and Obstetrics, Section of Fetal Maternal Medicine, University Hospital Gregorio Marañón, Madrid, Spain
| | - Natalio García-Honduvilla
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.,Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Melchor Álvarez-Mon
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.,Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain.,Immune System Diseases-Rheumatology and Oncology Service (CIBEREHD), University Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | - Julia Buján
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain.,Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
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38
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Bebell LM, Parks K, Le MH, Ngonzi J, Adong J, Boatin AA, Bassett IV, Siedner MJ, Gernand AD, Roberts DJ. Placental decidual arteriopathy and vascular endothelial growth factor A (VEGF-A) expression among women with and without HIV. J Infect Dis 2021; 224:S694-S700. [PMID: 33880547 DOI: 10.1093/infdis/jiab201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women with HIV (WHIV) are at higher risk of adverse birth outcomes. Proposed mechanisms for the increased risk include placental arteriopathy (vasculopathy) and maternal vascular malperfusion (MVM) due to antiretroviral therapy (ART) and medical comorbidities. However, these features and their underlying pathophysiologic mechanisms have not been well characterized in WHIV. METHODS We performed gross and histologic examination and immunohistochemistry staining for vascular endothelial growth factor A (VEGF-A), a key angiogenic factor, on placentas from women with one or more MVM risk factors including: weight <5 th percentile, histologic infarct or distal villous hypoplasia, nevirapine-based ART, hypertension, and pre-eclampsia/eclampsia during pregnancy. We compared pathologic characteristics by maternal HIV serostatus. RESULTS A total of 27/41 (66%) placentas assessed for VEGF-A were from WHIV. Mean maternal age was 27 years. Among WHIV, median CD4 T-cell count was 440 cells/mm 3 and HIV viral load was undetectable in 74%. Of VEGF-A stained placentas, both decidua and villous endothelium tissue layers were present in 36 (88%). VEGF-A was detected in 31/36 (86%) with decidua present, and 39/40 (98%) with villous endothelium present. There were no differences in VEGF-A presence in any tissue type by maternal HIV serostatus (P=0.28-1.0). MVM was more common in placentas selected for VEGF-A staining (51 versus 8%, P<0.001). CONCLUSIONS VEGF-A immunostaining was highly prevalent, and staining pattern did not differ by maternal HIV serostatus among those with MVM risk factors, indicating the role of VEGF-A in placental vasculopathy may not differ by maternal HIV serostatus.
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Affiliation(s)
- Lisa M Bebell
- Massachusetts General Hospital Division of Infectious Diseases, Boston, MA, USA.,MassGeneral Global Health, Massachusetts General Hospital, Boston, MA, USA.,Medical Practice Evaluation Center of Massachusetts General Hospital, Boston, MA, USA
| | - Kalynn Parks
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Mylinh H Le
- Medical Practice Evaluation Center of Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Ngonzi
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Julian Adong
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adeline A Boatin
- MassGeneral Global Health, Massachusetts General Hospital, Boston, MA, USA.,Massachusetts General Hospital Department of Obstetrics and Gynecology, Boston, MA, USA
| | - Ingrid V Bassett
- Massachusetts General Hospital Division of Infectious Diseases, Boston, MA, USA.,Medical Practice Evaluation Center of Massachusetts General Hospital, Boston, MA, USA
| | - Mark J Siedner
- Massachusetts General Hospital Division of Infectious Diseases, Boston, MA, USA.,MassGeneral Global Health, Massachusetts General Hospital, Boston, MA, USA.,Medical Practice Evaluation Center of Massachusetts General Hospital, Boston, MA, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
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39
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Placental Lesions and Pregnancy Outcome in Anterior as Compared to Posterior Placenta Previa. Reprod Sci 2021; 28:3241-3247. [PMID: 33825166 DOI: 10.1007/s43032-021-00558-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
The uterine location of placenta previa (PP), anterior vs. posterior has an impact on pregnancy outcome. We aimed to study maternal and neonatal outcome and placental histopathology lesions in anterior vs. posterior PP. The medical records and histopathology reports of all singleton cesarean deliveries (CD) performed due to PP, from 24 to 41 weeks, between 12.2008 and 10.2018, were reviewed. Placental lesions were classified into maternal and fetal vascular malperfusion lesions (MVM, FVM), maternal and fetal inflammatory responses (MIR, FIR). Gestational age (GA) at delivery was similar between the anterior PP (n = 67) and posterior PP (n = 105) groups. As compared to the posterior PP group, the anterior PP group had higher rate of previous CD (p < 0.001), placental accreta spectrum (p = 0.04), lower neonatal Hb at birth (p = 0.03), higher rate of neonatal blood transfusion (p = 0.007) and prolonged maternal hospitalization (p = 0.02). Placentas from the anterior PP group had lower weights (p = 0.035), with increased rate of MVM lesions (p = 0.017). The anterior PP location is associated with increased adverse maternal and neonatal outcome, lower placental weights and increased rate of malperfusion lesions. Abnormal placentation in the scarred uterine wall probably has an impact on placental function.
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40
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IKUMI NM, MALABA TR, PILLAY K, COHEN MC, MADLALA HP, MATJILA M, ANUMBA D, MYER L, NEWELL ML, GRAY CM, PIMS Study Group. Differential impact of antiretroviral therapy initiated before or during pregnancy on placenta pathology in HIV-positive women. AIDS 2021; 35:717-726. [PMID: 33724257 PMCID: PMC8630811 DOI: 10.1097/qad.0000000000002824] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the association between timing of antiretroviral treatment (ART) initiation in HIV-infected women and placental histopathology. DESIGN A nested substudy in a larger cohort of HIV-infected women which examined the association between ART status and birth outcomes. METHODS Placentas (n = 130) were examined for histopathology from two ART groups: stable (n = 53), who initiated ART before conception and initiating (n = 77), who started ART during pregnancy [median (interquartile range) 15 weeks gestation (11-18)]. Using binomial regression we quantified associations between ART initiation timing with placental histopathology and pregnancy outcomes. RESULTS One-third of all placentas were less than 10th percentile weight-for-gestation and there was no significant difference between ART groups. Placental diameter, thickness, cord insertion position and foetal-placental weight ratio were also similar by group. However, placentas from the stable group showed increased maternal vascular malperfusion (MVM) (39.6 vs. 19.4%), and decreased weight (392 vs. 422 g, P = 0.09). MVM risk was twice as high [risk ratios 2.03 (95% confidence interval: 1.16-3.57); P = 0.01] in the stable group; the increased risk remaining significant when adjusting for maternal age [risk ratios 2.04 (95% confidence interval: 1.12-3.72); P = 0.02]. Furthermore, MVM was significantly associated with preterm delivery and low birth weight (P = 0.002 and <0.0001, respectively). CONCLUSION Preconception initiation of ART was associated with an increased MVM risk, and may contribute to placental dysfunction. The association between MVM with preterm delivery and low birth weight suggests that a placenta-mediated mechanism likely links the putative association between long-term use of ART and adverse birth outcomes.
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Affiliation(s)
- Nadia M IKUMI
- Division of Immunology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Thokozile R MALABA
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Komala PILLAY
- Division of Anatomical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
| | - Marta C COHEN
- Department of Histopathology, Sheffield Children’s NHS Foundation Trust , Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK, Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town South Africa
| | - Hlengiwe P MADLALA
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mushi MATJILA
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town South Africa
| | - Dilly ANUMBA
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Landon MYER
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Marie-Louise NEWELL
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Clive M GRAY
- Division of Immunology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
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41
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Countouris ME, Villanueva FS, Berlacher KL, Cavalcante JL, Parks WT, Catov JM. Association of Hypertensive Disorders of Pregnancy With Left Ventricular Remodeling Later in Life. J Am Coll Cardiol 2021; 77:1057-1068. [PMID: 33632480 PMCID: PMC10544734 DOI: 10.1016/j.jacc.2020.12.051] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with short-term cardiac structure and function abnormalities, but later life changes are not well studied. OBJECTIVES This study aimed to determine if HDP history is associated with echocardiographic differences 8 to 10 years after delivery, and if subgroups with placental maternal vascular malperfusion (MVM) lesions or current hypertension may be particularly affected. METHODS Women with pregnancies delivered from 2008 to 2009 were selected from a clinical cohort with abstracted pregnancy and placental pathology data to undergo transthoracic echocardiography (2017 to 2020). Medical history, blood pressure, and weight were measured at the study visit. RESULTS The authors enrolled 132 women (10 ± 1 years post-delivery, age 38 ± 6 years): 102 with normotensive pregnancies and 30 with HDP: pre-eclampsia (n = 21) or gestational hypertension (n = 9). Compared with women with normotensive pregnancies, those with HDP history were more likely to have current hypertension (63% vs. 26%; p < 0.001). After adjusting for age, race, MVM lesions, body mass index, current hypertension, and hemoglobin A1c, women with HDP history had higher interventricular septal thickness (β = 0.08; p = 0.04) and relative wall thickness (β = 0.04; p = 0.04). In subgroup analyses, those with both HDP history and current hypertension had a higher proportion of left ventricular remodeling (79.0%) compared with all other groups (only HDP [36.4%; p = 0.01], only current hypertension [46.2%; p = 0.02], and neither HDP nor hypertension [38.2%; p < 0.001]), and lower mitral inflow E/A and annular e'. Accounting for placental MVM lesions did not impact results. CONCLUSIONS Women with both HDP history and current hypertension have pronounced differences in left ventricular structure and function a decade after pregnancy, warranting continued surveillance and targeted therapies for cardiovascular disease prevention.
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Affiliation(s)
- Malamo E Countouris
- University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA.
| | - Flordeliza S Villanueva
- University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Kathryn L Berlacher
- University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - W Tony Parks
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Janet M Catov
- Department of Obstetrics, Gynecology, and Reproductive Sciences and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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42
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Davis MB. Long-Term Left Ventricular Remodeling After Hypertensive Disorders of Pregnancy: Beyond the Hype. J Am Coll Cardiol 2021; 77:1069-1072. [PMID: 33632481 DOI: 10.1016/j.jacc.2021.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Melinda B Davis
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
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Ho A, Hutter J, Slator P, Jackson L, Seed PT, Mccabe L, Al-Adnani M, Marnerides A, George S, Story L, Hajnal JV, Rutherford M, Chappell LC. Placental magnetic resonance imaging in chronic hypertension: A case-control study. Placenta 2021; 104:138-145. [PMID: 33341490 PMCID: PMC7921773 DOI: 10.1016/j.placenta.2020.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION We aimed to explore the use of magnetic resonance imaging (MRI) in vivo as a tool to elucidate the placental phenotype in women with chronic hypertension. METHODS In case-control study, women with chronic hypertension and those with uncomplicated pregnancies were imaged using either a 3T Achieva or 1.5T Ingenia scanner. T2-weighted images, diffusion weighted and T1/T2* relaxometry data was acquired. Placental T2*, T1 and apparent diffusion coefficient (ADC) maps were calculated. RESULTS 129 women (43 with chronic hypertension and 86 uncomplicated pregnancies) were imaged at a median of 27.7 weeks' gestation (interquartile range (IQR) 23.9-32.1) and 28.9 (IQR 26.1-32.9) respectively. Visual analysis of T2-weighted imaging demonstrated placentae to be either appropriate for gestation or to have advanced lobulation in women with chronic hypertension, resulting in a greater range of placental mean T2* values for a given gestation, compared to gestation-matched controls. Both skew and kurtosis (derived from histograms of T2* values across the whole placenta) increased with advancing gestational age at imaging in healthy pregnancies; women with chronic hypertension had values overlapping those in the control group range. Upon visual assessment, the mean ADC declined in the third trimester, with a corresponding decline in placental mean T2* values and showed an overlap of values between women with chronic hypertension and the control group. DISCUSSION A combined placental MR examination including T2 weighted imaging, T2*, T1 mapping and diffusion imaging demonstrates varying placental phenotypes in a cohort of women with chronic hypertension, showing overlap with the control group.
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Affiliation(s)
- Alison Ho
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom.
| | - Jana Hutter
- Centre for the Developing Brain, King's College London, London, United Kingdom; Biomedical Engineering Department, King's College London, London, United Kingdom
| | - Paddy Slator
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, United Kingdom
| | - Laurence Jackson
- Centre for the Developing Brain, King's College London, London, United Kingdom; Biomedical Engineering Department, King's College London, London, United Kingdom
| | - Paul T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Laura Mccabe
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Mudher Al-Adnani
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Andreas Marnerides
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Simi George
- Department of Cellular Pathology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Lisa Story
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, King's College London, London, United Kingdom; Biomedical Engineering Department, King's College London, London, United Kingdom
| | - Mary Rutherford
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
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Makker K, Ji Y, Hong X, Wang X. Antenatal and neonatal factors contributing to extra uterine growth failure (EUGR) among preterm infants in Boston Birth Cohort (BBC). J Perinatol 2021; 41:1025-1032. [PMID: 33589730 PMCID: PMC7883994 DOI: 10.1038/s41372-021-00948-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/16/2020] [Accepted: 01/20/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Identify antenatal and neonatal factors associated with primary outcome of EUGR. METHODS 1063 preterm infants from a subset of the BBC were included in this prospective cohort study. Regression analysis was carried out to evaluate associations of EUGR with antenatal factors and neonatal factors. RESULTS 6.1% of the infants had in-utero growth restriction (IUGR) at birth and 21.7% of infants had EUGR. The adjusted odds ratio for EUGR status were significant for birth weight (OR 0.99, p = 0.00, CI 0.99-0.99), for GA at birth (OR 4.58, p = 0.00, CI 3.25-6.44), for PDA (OR 2.9, p = 0.02, CI 1.17-7.1), for NEC (OR 5.14, p = 0.012, CI 1.44-18.3) and for day of life of reaching full feeds (OR 1.04, p = 0.001, CI 1.01-1.06). CONCLUSION This study highlights important factors associated with EUGR. Additional studies are needed to gain further insight.
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Affiliation(s)
- Kartikeya Makker
- Division of Neonatology Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Yuelong Ji
- grid.21107.350000 0001 2171 9311Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Xiumei Hong
- grid.21107.350000 0001 2171 9311Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Xiaobin Wang
- grid.21107.350000 0001 2171 9311Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD USA
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45
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Hong X, Rosenberg AZ, Zhang B, Binns-Roemer E, David V, Lv Y, Hjorten RC, Reidy KJ, Chen TK, Wang G, Ji Y, Simpson CL, Davis RL, Kopp JB, Wang X, Winkler CA. Joint Associations of Maternal-Fetal APOL1 Genotypes and Maternal Country of Origin With Preeclampsia Risk. Am J Kidney Dis 2020; 77:879-888.e1. [PMID: 33359152 DOI: 10.1053/j.ajkd.2020.10.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/24/2020] [Indexed: 12/25/2022]
Abstract
RATIONALE & OBJECTIVES Preeclampsia, which disproportionately affects Black women, is a leading cause of preterm delivery and risk for future hypertension and chronic kidney disease (CKD). Apolipoprotein L1 (APOL1) kidney risk alleles, common among Black individuals, contribute substantially to CKD disparities. Given the strong link between preeclampsia and CKD, we investigated whether maternal and fetal APOL1 risk alleles can jointly influence preeclampsia risk, and explored potential modifiers of the association between APOL1 and preeclampsia. STUDY DESIGN Nested case-control study. SETTING & PARTICIPANTS 426 Black mother-infant pairs (275 African Americans and 151 Haitians) from the Boston Birth Cohort. EXPOSURE Maternal and fetal APOL1 risk alleles. OUTCOMES Preeclampsia. ANALYTICAL APPROACH Logistic regression models with adjustment for demographic characteristics were applied to analyze associations between fetal and maternal APOL1 risk alleles and risk of preeclampsia and to investigate the effects of modification by maternal country of origin. RESULTS Fetal APOL1 risk alleles tended to be associated with an increased risk of preeclampsia, which was not statistically significant in the total genotyped population. However, this association was modified by maternal country of origin (P<0.05 for interaction tests): fetal APOL1 risk alleles were significantly associated with an increased risk of preeclampsia among African Americans under recessive (odds ratio [OR], 3.6 [95% CI, 1.3-9.7]; P=0.01) and additive (OR, 1.7 [95% CI, 1.1-2.6]; P=0.01) genetic models but not in Haitian Americans. Also, maternal-fetal genotype discordance at the APOL1 locus was associated with a 2.6-fold higher risk of preeclampsia (P<0.001) in African Americans. LIMITATIONS Limited sample size in stratified analyses; self-reported maternal country of origin; pre-pregnancy estimated glomerular filtration rate (eGFR) and proteinuria data in mothers were not collected; unmeasured confounding social and/or environmental factors; no replication study. CONCLUSIONS This study supports the hypothesis that fetal APOL1 kidney risk alleles are associated with increased risk for preeclampsia in a recessive mode of inheritance in African Americans and suggests that maternal-fetal genotype discordance is also associated with this risk. These conclusions underscore the need to better understand maternal-fetal interaction and their genetic and environmental factors as contributors to ethnic disparities in preeclampsia.
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Affiliation(s)
- Xiumei Hong
- Department of Population, Family and Reproductive Health, Center for the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Avi Z Rosenberg
- Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Boyang Zhang
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth Binns-Roemer
- Molecular Genetic Epidemiology Section, Frederick National Laboratory for Cancer Research in the Basic Research Laboratory, National Cancer Institute, Frederick, MD
| | - Victor David
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD
| | - Yiming Lv
- Department of Population, Family and Reproductive Health, Center for the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Rebecca C Hjorten
- Department of Medicine, Division of Nephrology, University of Washington, Seattle, WA
| | - Kimberly J Reidy
- Department of Pediatrics, Division of Pediatric Nephrology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Teresa K Chen
- Department of Medicine, Division of Nephrology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Center for the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Yuelong Ji
- Department of Population, Family and Reproductive Health, Center for the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Claire L Simpson
- Department of Genetics, Genomics, and Informatics, University of Tennessee Health Science Center, Memphis, TN
| | - Robert L Davis
- Center for Biomedical Informatics, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Jeffrey B Kopp
- Kidney Diseases Section, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Center for the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Cheryl A Winkler
- Molecular Genetic Epidemiology Section, Frederick National Laboratory for Cancer Research in the Basic Research Laboratory, National Cancer Institute, Frederick, MD.
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Ganer Herman H, Mizrachi Y, Farhadian Y, Shevach Alon A, Gluck O, Bar J, Kovo M, Raziel A. Placental disorders of pregnancy in subsequent IVF pregnancies - a sibling cohort. Reprod Biomed Online 2020; 42:620-626. [PMID: 33468400 DOI: 10.1016/j.rbmo.2020.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022]
Abstract
RESEARCH QUESTION To assess whether the incidence of placental disorders of pregnancy decreases with increasing parity in repeat IVF pregnancies, in the same way as natural pregnancies. DESIGN This was a retrospective cohort of deliveries between November 2008 and January 2020, in a single university-affiliated medical centre. The study included women with only IVF-attained singleton pregnancies (no natural conception) with at least two deliveries, and compared the obstetric and perinatal outcomes between first, second and third deliveries. Each woman served as her own control. The primary outcome was the incidence of placental-related disorders of pregnancy, defined as small for gestational age (SGA) neonates and/or pre-eclampsia. RESULTS A total of 307 first deliveries, 307 second deliveries and 49 third deliveries by the same women were compared. A trend for a decreased rate of pre-eclampsia was noted with increased parity (P = 0.06) and a significant decrease in the rate of SGA: 11.7% for first delivery, 7.8% for second delivery and 2.0% for third (P = 0.04). This difference in SGA incidence was maintained in a matched sub-analysis of the 49 women with three deliveries (P = 0.04), and after adjustment for fresh/frozen embryo transfer (P = 0.03). Although SGA and pre-eclampsia were generally more common in IVF than natural pregnancies, their decrease with increasing parity mimicked that in natural pregnancies. CONCLUSION IVF pregnancies are associated with an increased risk of placental disorders of pregnancy. However, they exhibit a decrease in incidence with increasing parity.
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Affiliation(s)
- Hadas Ganer Herman
- In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yossi Mizrachi
- In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasmin Farhadian
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayala Shevach Alon
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Gluck
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arieh Raziel
- In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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The association between first trimester placental biomarkers and placental lesions of maternal vascular malperfusion. Placenta 2020; 103:206-213. [PMID: 33161363 DOI: 10.1016/j.placenta.2020.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Abnormal levels of first trimester placental biomarkers are associated with the development of placental syndrome (PS). However, prediction performance is moderate, possibly explained by the clinical heterogeneity of PS. Aim of this study is to investigate the association between first trimester biomarkers and the presence of maternal vascular malperfusion (MVM), as a marker for placental insufficiency. METHODS This retrospective study included 195 women with available first trimester blood sample and placenta histological sections for examination at the Maastricht University Medical Centre. Women were divided into 4 groups, based on the presence of having MVM lesions and/or PS. Levels of PAPP-A, PlGF and sFlt-1 were measured and MVM lesions were classified according to the Amsterdam Placental Workshop Group Consensus Statement. RESULTS MVM occurrence was observed in 32% of the uncomplicated pregnancies. Women with MVM (regardless of the PS) had lower levels of PAPP-A (p = 0.038) and sFLt-1 (p = 0.006), and a non-significant trend for lower PlGF and sFlt-1/PlGF ratio compared to women without MVM. Low PAPP-A levels individually and in combination with the presence of PS was significantly associated with MVM lesions (aOR = 3.0 and 6.1, respectively), as did the combination of low PlGF levels and PS (aOR = 4.6). In women with PS, having MVM increased the incidence of fetal growth restriction, small for gestational age neonates, lower birthweight and adverse neonatal outcome. DISCUSSION Our findings suggest that MVM lesions were found to be associated with increased obstetric risks due to early placental dysfunction that can potentially be predicted by the use of first trimester biomarkers.
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Smithgall MC, Liu-Jarin X, Hamele-Bena D, Cimic A, Mourad M, Debelenko L, Chen X. Third-trimester placentas of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive women: histomorphology, including viral immunohistochemistry and in-situ hybridization. Histopathology 2020; 77:994-999. [PMID: 32692408 PMCID: PMC7405484 DOI: 10.1111/his.14215] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023]
Abstract
Aims The wide variety of affected organ systems associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection highlights the need for tissue‐specific evaluation. We compared placentas from SARS‐CoV‐2‐positive and SARS‐CoV‐2‐negative women in our hospital in New York City, which became the epicenter of the coronavirus disease 2019 pandemic in March 2020. To date, some limited studies have been published on placentas from SARS‐CoV‐2‐positive women. The aim of our study, in addition to describing histomorphology, was to utilize in‐situ hybridization (ISH) for the S‐gene encoding the spike protein and immunohistochemistry (IHC) with the monoclonal SARS‐CoV‐2 spike antibody 1A9 for placental evaluation. Methods and results In this study, 51 singleton, third‐trimester placentas from SARS‐CoV‐2‐positive women and 25 singleton, third‐trimester placentas from SARS‐CoV‐2‐negative women were examined histomorphologically according to the Amsterdam Criteria and with ISH and/or IHC. The corresponding clinical findings and neonatal outcomes also were recorded. Although no specific histomorphologic changes related to SARS‐CoV‐2 were noted in the placentas, evidence of maternal–fetal vascular malperfusion was identified, with placentas from SARS‐CoV‐2‐positive women being significantly more likely to show villous agglutination (P = 0.003) and subchorionic thrombi (P = 0.026) than placentas from SARS‐CoV‐2‐negative women. No evidence of direct viral involvement was identified with ISH and IHC. Conclusions In this study, third‐trimester placentas from SARS‐CoV‐2‐positive women were more likely to show evidence of maternal–fetal vascular malperfusion; however, ISH and IHC provided no evidence of direct viral involvement or vertical transmission.
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Affiliation(s)
- Marie C Smithgall
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Xiaolin Liu-Jarin
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Diane Hamele-Bena
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Adela Cimic
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Mirella Mourad
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Larisa Debelenko
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Xiaowei Chen
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
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Menter T, Mertz KD, Jiang S, Chen H, Monod C, Tzankov A, Waldvogel S, Schulzke SM, Hösli I, Bruder E. Placental Pathology Findings during and after SARS-CoV-2 Infection: Features of Villitis and Malperfusion. Pathobiology 2020; 88:69-77. [PMID: 32950981 PMCID: PMC7573905 DOI: 10.1159/000511324] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/31/2020] [Indexed: 11/19/2022] Open
Abstract
Since the outbreak of coronavirus disease 2019 (COVID-19), there has been a debate whether pregnant women are at a specific risk for COVID-19 and whether it might be vertically transmittable through the placenta. We present a series of five placentas of SARS coronavirus 2 (SARS-CoV-2)-positive women who had been diagnosed with mild symptoms of COVID-19 or had been asymptomatic before birth. We provide a detailed histopathologic description of morphological changes accompanied by an analysis of presence of SARS-CoV-2 in the placental tissue. All placentas were term deliveries (40th and 41st gestational weeks). One SARS-CoV-2-positive patient presented with cough and dyspnoea. This placenta showed prominent lymphohistiocytic villitis and intervillositis and signs of maternal and foetal malperfusion. Viral RNA was present in both placenta tissue and the umbilical cord and could be visualized by in situ hybridization in the decidua. SARS-CoV-2 tests were negative at the time of delivery of 3/5 women, and their placentas did not show increased inflammatory infiltrates. Signs of maternal and/or foetal malperfusion were present in 100% and 40% of cases, respectively. There was no transplacental transmission to the infants. In our cohort, we can document different time points regarding SARS-CoV-2 infection. In acute COVID-19, prominent lymphohistiocytic villitis may occur and might potentially be attributable to SARS-CoV-2 infection of the placenta. Furthermore, there are histopathological signs of maternal and foetal malperfusion, which might have a relationship to an altered coagulative or microangiopathic state induced by SARS-CoV-2, yet this cannot be proven considering a plethora of confounding factors.
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Affiliation(s)
- Thomas Menter
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Sizun Jiang
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Han Chen
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Cécile Monod
- Department of Obstetrics and Antenatal Care, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Salome Waldvogel
- Department of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Sven M. Schulzke
- Department of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Irene Hösli
- Department of Obstetrics and Antenatal Care, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Elisabeth Bruder
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
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50
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Avagliano L, Monari F, Po’ G, Salerno C, Mascherpa M, Maiorana A, Facchinetti F, Bulfamante GP. The Burden of Placental Histopathology in Stillbirths Associated With Maternal Obesity. Am J Clin Pathol 2020; 154:225-235. [PMID: 32338725 DOI: 10.1093/ajcp/aqaa035] [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: 11/12/2022] Open
Abstract
OBJECTIVES Obesity is an increasing health problem that has become a common medical disorder among women of childbearing age, representing worldwide a risk factor for stillbirth. The aim of the study is to evaluate the association between placental histopathologic findings and obesity in stillbirth. METHODS Placentas were analyzed according to the Amsterdam consensus statement. Histologic findings in stillbirth from obese and lean mothers were analyzed and compared with those observed in liveborn controls. RESULTS Stillbirth in obese mothers displayed placental pathology in all gestational ages, mostly at term of pregnancy. The most observed placental lesions were those consistent with maternal vascular malperfusion of the placental bed. Decidual arteriopathy and placental infarcts appeared specifically associated with maternal obesity. Moreover, obese women with stillbirth showed the highest cumulative number of placental lesions. CONCLUSIONS Considering the significant association between stillbirth, maternal obesity, and placental histopathologic findings, health care providers should be aware about the importance of placental examination in obese women, especially in stillborn cases. The high prevalence of lesions consistent with vascular malperfusion of the placental bed suggests that stillbirth prevention strategies in obese women should rely on the development of tools to study and improve decidual artery functioning early in pregnancy.
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Affiliation(s)
- Laura Avagliano
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - Francesca Monari
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, Modena, Italy
| | - Gaia Po’
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, Modena, Italy
| | - Cristina Salerno
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, Modena, Italy
| | - Margaret Mascherpa
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - Antonino Maiorana
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, Modena, Italy
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