Odibo A O, Patel K R, Spitalnik A, Odibo L, Huettner P
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ultrasound and Genetic and Fetal Care Center, Washington University School of Medicine, St Louis, MO, USA.
Department of Pathology and Immunology, Washington University School Of Medicine, St Louis, MO, USA.
J Perinatol. 2014 Mar;34(3):186-91. doi: 10.1038/jp.2013.176. Epub 2014 Jan 16.
We investigated the relationship between placental pathological findings in pregnancies with adverse pregnancy outcomes and first-trimester serum analytes and uterine artery Doppler results.
This is a secondary analysis of a prospective study of first-trimester screening for adverse pregnancy outcomes, including preterm birth (PTB (delivery<37 weeks)), pre-eclampsia (PE), gestational hypertension, and small for gestational age (SGA) infants (birth weight <10th percentile). We compared the mean levels of serum analytes (pregnancy-associated plasma protein A (PAPP-A), placental protein 13 (PP13), a-disintegrin and metalloproteinase 12 (ADAM12), placental growth factor (PLGF)) and uterine artery Doppler pulsatility index (UADPI) obtained between 11 and 14 weeks gestation in cases with adverse outcomes and abnormal placental histology to a control group without adverse outcome or abnormal placental pathology. Placental findings were classified as: lesions of maternal under perfusion, lesions causing reduced placental reserve, infections/inflammatory lesions, and fetal vascular lesions.
Among 193 cases, lesions of maternal under perfusion were seen in 50 cases (25.9%), lesions causing reduced placental reserve in 63 cases (32.8%), infection/inflammation in 65 cases (34.2%) and fetal vascular lesions in 23 cases (11.9%). There were 123 pregnancies with no adverse pregnancy outcome or placental lesion used as controls. Pregnancies with PE had a significant association with lesions of maternal under perfusion (P=0.005) and placental infection/inflammation (P=0.003). Significant differences were seen in mean levels of PAPP-A, ADAM12 and PLGF in cases with PE, PTB and SGA with specific placental histological findings when compared with controls. UADPI was not significantly different between the cases with adverse pregnancy outcomes and abnormal histology.
Our findings provide evidence linking placental pathology with suboptimal secretion of analytes in the first trimester in pregnancies with adverse outcomes, especially PE.
我们研究了妊娠结局不良的孕妇胎盘病理检查结果与孕早期血清分析物及子宫动脉多普勒结果之间的关系。
这是一项对孕早期不良妊娠结局筛查的前瞻性研究的二次分析，不良妊娠结局包括早产（PTB（分娩孕周<37周））、子痫前期（PE）、妊娠期高血压以及小于胎龄儿（SGA）（出生体重<第10百分位数）。我们比较了不良结局且胎盘组织学异常的病例与无不良结局或胎盘病理正常的对照组在妊娠11至14周时血清分析物（妊娠相关血浆蛋白A（PAPP-A）、胎盘蛋白13（PP13）、解整合素金属蛋白酶12（ADAM12）、胎盘生长因子（PLGF））的平均水平以及子宫动脉多普勒搏动指数（UADPI）。胎盘检查结果分为：母体灌注不足性病变、导致胎盘储备减少的病变、感染/炎症性病变以及胎儿血管病变。
在193例病例中，母体灌注不足性病变50例（25.9%），导致胎盘储备减少的病变63例（32.8%），感染/炎症65例（34.2%），胎儿血管病变23例（11.9%）。有123例无不良妊娠结局或胎盘病变的妊娠用作对照。患有PE的妊娠与母体灌注不足性病变（P = 0.005）和胎盘感染/炎症（P = 0.003）显著相关。与对照组相比，患有PE、PTB和SGA且有特定胎盘组织学检查结果的病例中，PAPP-A、ADAM12和PLGF的平均水平存在显著差异。不良妊娠结局且组织学异常的病例与对照组之间UADPI无显著差异。
我们的研究结果提供了证据，表明在妊娠结局不良尤其是PE的孕妇中，胎盘病理与孕早期分析物分泌不佳有关。
