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Jones HN, Olbrych SK, Smith KL, Cnota JF, Habli M, Ramos-Gonzales O, Owens KJ, Hinton AC, Polzin WJ, Muglia LJ, Hinton RB. Hypoplastic left heart syndrome is associated with structural and vascular placental abnormalities and leptin dysregulation. Placenta 2015; 36:1078-86. [PMID: 26278057 PMCID: PMC4609616 DOI: 10.1016/j.placenta.2015.08.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 07/29/2015] [Accepted: 08/04/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hypoplastic left heart syndrome (HLHS) is a severe cardiovascular malformation (CVM) associated with fetal growth abnormalities. Genetic and environmental factors have been identified that contribute to pathogenesis, but the role of the placenta is unknown. The purpose of this study was to systematically examine the placenta in HLHS with and without growth abnormalities. METHODS HLHS term singleton births were identified from a larger cohort when placenta tissue was available. Clinical data were collected from maternal and neonatal medical records, including anthropometrics and placental pathology reports. Placental tissues from cases and controls were analyzed to assess parenchymal morphology, vascular architecture and leptin signaling. RESULTS HLHS cases (n = 16) and gestational age-matched controls (n = 18) were analyzed. Among cases, the average birth weight was 2993 g, including 31% that were small for gestational age. When compared with controls, gross pathology of HLHS cases demonstrated significantly reduced placental weight and increased fibrin deposition, while micropathology showed increased syncytial nuclear aggregates, decreased terminal villi, reduced vasculature and increased leptin expression in syncytiotrophoblast and endothelial cells. DISCUSSION Placentas from pregnancies complicated by fetal HLHS are characterized by abnormal parenchymal morphology, suggesting immature structure may be due to vascular abnormalities. Increased leptin expression may indicate an attempt to compensate for these vascular abnormalities. Further investigation into the regulation of angiogenesis in the fetus and placenta may elucidate the causes of HLHS and associated growth abnormalities in some cases.
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Affiliation(s)
- Helen N Jones
- Divisions of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stephanie K Olbrych
- Divisions of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathleen L Smith
- The Division of Maternal Fetal Medicine, Good Samaritan Hospital, Cincinnati, OH, USA
| | - James F Cnota
- Divisions of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mounira Habli
- Divisions of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; The Division of Maternal Fetal Medicine, Good Samaritan Hospital, Cincinnati, OH, USA; The Fetal Care Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Osniel Ramos-Gonzales
- Divisions of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathryn J Owens
- Divisions of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrea C Hinton
- The Division of Maternal Fetal Medicine, Good Samaritan Hospital, Cincinnati, OH, USA
| | - William J Polzin
- The Division of Maternal Fetal Medicine, Good Samaritan Hospital, Cincinnati, OH, USA; The Fetal Care Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Louis J Muglia
- Divisions of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert B Hinton
- Divisions of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Scott-Finley M, Woo JG, Habli M, Ramos-Gonzales O, Cnota JF, Wang Y, Kamath-Rayne BD, Hinton AC, Polzin WJ, Crombleholme TM, Hinton RB. Standardization of amniotic fluid leptin levels and utility in maternal overweight and fetal undergrowth. J Perinatol 2015; 35:547-52. [PMID: 25927274 DOI: 10.1038/jp.2015.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Leptin is an adipokine that regulates energy homeostasis. The objective of this study was to establish a gestational age-specific standard for amniotic fluid leptin (AFL) levels and examine the relationship between AFL, maternal overweight and fetal growth restriction. STUDY DESIGN Amniotic fluid was obtained at mid-gestation from singleton gravidas, and leptin was quantified using enzyme-linked immunosorbent assay. Amniotic fluid samples from 321 term pregnancies were analyzed. Clinical data, including fetal ultrasound measurements and maternal and infant characteristics, were available for a subset of patients (n=45). RESULTS The median interquartile range AFL level was significantly higher at 14 weeks' gestation (2133 pg ml(-1) (1703 to 4347)) than after 33 weeks' gestation (519 pg ml(-1) (380 to 761), P trend<0.0001), an average difference of 102 pg ml(-1) per week. AFL levels were positively correlated with maternal pre-pregnancy body mass index (BMI) (r=0.36, P=0.03) adjusting for gestational age at measurement, but were not associated with fetal growth. CONCLUSIONS AFL levels are higher at mid-gestation than at late gestation, and are associated with maternal pre-pregnancy BMI.
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Affiliation(s)
- M Scott-Finley
- Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH, USA
| | - J G Woo
- 1] Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA [2] Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - M Habli
- 1] Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH, USA [2] Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - O Ramos-Gonzales
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J F Cnota
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Y Wang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - B D Kamath-Rayne
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - A C Hinton
- Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH, USA
| | - W J Polzin
- 1] Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH, USA [2] Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - T M Crombleholme
- Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - R B Hinton
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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