Laboratorio de Función y Reactividad Vascular, Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile Santiago, Chile ; International Center for Andean Studies, Universidad de Chile Santiago, Chile.
División de Obstetricia y Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile Santiago, Chile.
Front Pharmacol. 2014 Jun 24;5:149. doi: 10.3389/fphar.2014.00149. eCollection 2014.
The placenta is the exchange organ that regulates metabolic processes between the mother and her developing fetus. The adequate function of this organ is clearly vital for a physiologic gestational process and a healthy baby as final outcome. The umbilico-placental vasculature has the capacity to respond to variations in the materno-fetal milieu. Depending on the intensity and the extensity of the insult, these responses may be immediate-, mediate-, and long-lasting, deriving in potential morphostructural and functional changes later in life. These adjustments usually compensate the initial insults, but occasionally may switch to long-lasting remodeling and dysfunctional processes, arising maladaptation. One of the most challenging conditions in modern perinatology is hypoxia and oxidative stress during development, both disorders occurring in high-altitude and in low-altitude placental insufficiency. Hypoxia and oxidative stress may induce endothelial dysfunction and thus, reduction in the perfusion of the placenta and restriction in the fetal growth and development. This Review will focus on placental responses to hypoxic conditions, usually related with high-altitude and placental insufficiency, deriving in oxidative stress and vascular disorders, altering fetal and maternal health. Although day-to-day clinical practice, basic and clinical research are clearly providing evidence of the severe impact of oxygen deficiency and oxidative stress establishment during pregnancy, further research on umbilical and placental vascular function under these conditions is badly needed to clarify the myriad of questions still unsettled.
胎盘是调节母亲和发育中胎儿代谢过程的交换器官。这个器官的充分功能显然对生理妊娠过程和健康婴儿的最终结果至关重要。脐胎盘血管系统有能力对母体-胎儿环境的变化做出反应。根据损伤的强度和范围，这些反应可能是即时的、中介的和持久的，导致以后生活中潜在的形态结构和功能变化。这些调整通常可以补偿最初的损伤，但偶尔也可能转变为持久的重塑和功能障碍过程，导致适应不良。在现代围产医学中，最具挑战性的情况之一是发育过程中的缺氧和氧化应激，这两种疾病都发生在高海拔和低海拔胎盘功能不全中。缺氧和氧化应激可诱导内皮功能障碍，从而减少胎盘灌注，限制胎儿生长和发育。这篇综述将重点介绍胎盘对缺氧条件的反应，这些条件通常与高海拔和胎盘功能不全有关，导致氧化应激和血管疾病，改变胎儿和母亲的健康。尽管日常临床实践、基础和临床研究清楚地提供了证据，证明怀孕期间缺氧和氧化应激的建立对健康有严重影响，但在这些条件下对脐胎盘血管功能进行进一步研究，以澄清仍未解决的众多问题是非常必要的。
