Kadyrov M, Moser G, Rath W, Kweider N, Wruck C J, Pufe T, Huppertz B
Institut für Anatomie und Zellbiologie, Universitätsklinikum RWTH Aachen, Deutschland.
Z Geburtshilfe Neonatol. 2013 Jun;217(3):88-94. doi: 10.1055/s-0033-1347179. Epub 2013 Jun 28.
Pregnancy-related complications not only represent a risk for maternal and fetal morbidity and mortality, but are also a risk for several diseases later in life. Many epidemiological studies have shown clear associations between an adverse intrauterine environment and an increased risk of diabetes, hypertension, cardiovascular disease, depression, obesity, and other chronic diseases in the adult. Some of these syndromes could be prevented by avoiding adverse stimuli or insults including psychological stress during pregnancy, intake of drugs, insufficient diet and substandard working conditions. Hence, all of these stimuli have the potential to alter health later in life. The placenta plays a key role in regulating the nutrient supply to the fetus and producing hormones that control the fetal as well as the maternal metabolism. Thus, any factor or stimulus that alters the function of the hormone producing placental trophoblast will provoke critical alterations of placental function and hence could induce programming of the fetus. The factors that change placental development may interfere with nutrient and oxygen supply to the fetus. This may be achieved by a direct disturbance of the placental barrier or more indirectly by, e. g., disturbing trophoblast invasion. For both path-ways, the respective pathologies are known: while preeclampsia is caused by alterations of the villous trophoblast, intra-uterine growth restriction is caused by insufficient invasion of the extravillous trophoblast. In both cases the effect can be undernutrition and/or fetal hypoxia, both of which adversely affect organ development, especially of brain and heart. However, the mechanisms responsible for disturbances of trophoblast differentiation and function remain elusive.
与妊娠相关的并发症不仅对孕产妇和胎儿的发病及死亡构成风险，还会增加日后患多种疾病的风险。许多流行病学研究表明，不良的子宫内环境与成年人患糖尿病、高血压、心血管疾病、抑郁症、肥胖症及其他慢性病的风险增加之间存在明显关联。其中一些综合征可以通过避免不良刺激或伤害来预防，包括孕期的心理压力、药物摄入、饮食不足和工作条件不达标准。因此，所有这些刺激都有可能改变日后的健康状况。胎盘在调节向胎儿的营养供应以及产生控制胎儿和母体新陈代谢的激素方面起着关键作用。因此，任何改变产生激素的胎盘滋养层功能的因素或刺激都会引发胎盘功能的严重改变，进而可能导致胎儿编程。改变胎盘发育的因素可能会干扰向胎儿的营养和氧气供应。这可以通过直接干扰胎盘屏障或更间接地通过例如干扰滋养层侵入来实现。对于这两种途径，各自的病理情况是已知的：子痫前期是由绒毛滋养层的改变引起的，而子宫内生长受限是由绒毛外滋养层侵入不足引起的。在这两种情况下，结果可能是营养不足和/或胎儿缺氧，这两者都会对器官发育产生不利影响，尤其是对脑和心脏。然而，负责滋养层分化和功能紊乱的机制仍然不清楚。
