Kajantie Eero, Thornburg Kent L, Eriksson Johan G, Osmond Clive, Barker David J P
National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki, Finland.
Int J Dev Biol. 2010;54(2-3):469-73. doi: 10.1387/ijdb.082833ek.
A small placental surface area at birth is associated with an increased risk of hypertension in the offspring in later life. Preeclampsia is associated with impaired implantation and with increased blood pressure in the offspring. We hypothesized that preeclampsia would be associated with a small placental surface area. We studied placental size in 6410 deliveries at the Helsinki University Central Hospital during 1934-44. 284 of the pregnancies were complicated by preeclampsia. 1855 were complicated by hypertension without proteinuria. The area of the placental surface was estimated from two diameters that were routinely recorded, a maximal diameter and a lesser one at right angles to it. Compared to normotensive pregnancies, the placentas from pregnancies complicated by preeclampsia had a reduced surface area and the surface was more oval. The thickness, however, was increased. When the two diameters were analyzed together, preeclampsia was not associated with the length of the maximal diameter, but was strongly associated with a short lesser diameter (p<0.0001). This was a graded relation: the shorter the lesser diameter, the greater the risk for, and severity of, preeclampsia. Placentas from pregnancies complicated by hypertension without proteinuria had a reduced surface area, with short lesser and maximal diameters. Processes that underlie preeclampsia may be closely related to the amount of placental tissue on the minor axis of the placenta. We postulated that placental growth is polarized from the time of implantation, so that growth along the major and minor axes is qualitatively different.
出生时胎盘表面积小与后代成年后患高血压风险增加有关。子痫前期与着床受损及后代血压升高有关。我们假设子痫前期与胎盘表面积小有关。我们研究了1934年至1944年期间赫尔辛基大学中心医院6410例分娩的胎盘大小。其中284例妊娠合并子痫前期,1855例合并无蛋白尿的高血压。胎盘表面积通过常规记录的两个直径估算,即最大直径和与之垂直的较小直径。与血压正常的妊娠相比,合并子痫前期的妊娠胎盘表面积减小,且表面更呈椭圆形。然而,胎盘厚度增加。当对两个直径进行综合分析时,子痫前期与最大直径长度无关,但与较小直径短密切相关(p<0.0001)。这是一种分级关系:较小直径越短,子痫前期的风险和严重程度越高。合并无蛋白尿高血压的妊娠胎盘表面积减小,较小直径和最大直径均短。子痫前期潜在的过程可能与胎盘短轴上的胎盘组织量密切相关。我们推测胎盘从着床时起生长就是极化的,因此沿长轴和短轴的生长在性质上是不同的。