Sundheimer Lauren W, Pisarska Margareta D
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.
Division of Reproductive Endocrinology and Infertility, UCLA David Geffen School of Medicine, Los Angeles, California.
Semin Reprod Med. 2017 May;35(3):205-216. doi: 10.1055/s-0037-1603570. Epub 2017 Jun 28.
Infertility and the fertility treatments utilized are associated with abnormal placentation leading to adverse pregnancy outcomes related to placentation, including preterm birth, low birth weight, placenta accrete and placenta previa. This may be due to the underlying genetics predisposing to infertility or the epigenetic changes associated with the fertility treatments utilized, as specific disease states leading to infertility are at increased risk of adverse outcomes, including placental abruption, fetal loss, GDM, and outcomes related to placentation, as well as the treatments utilized including in vitro fertilization (IVF) and NIFT (non-IVF fertility treatment). Placentation defects, leading to adverse maternal and fetal outcomes, which are more pronounced in the infertile population, occur due to changes in trophoblast invasion, vascular defects, changes in the environmental milieu, chronic inflammation and oxidative stress. These similar processes are recognized as major contributors to lifelong risk of cardiovascular and metabolic disease for both the mother and her offspring. Thus, abnormal placentation, found to be more prevalent in the infertile population, may be the key to better understand how infertility affects overall and long term health.
不孕症及所采用的生育治疗与胎盘形成异常相关,会导致与胎盘形成有关的不良妊娠结局,包括早产、低出生体重、胎盘植入异常和前置胎盘。这可能是由于导致不孕的潜在遗传因素,或与所采用的生育治疗相关的表观遗传变化,因为导致不孕的特定疾病状态出现不良结局的风险增加,包括胎盘早剥、流产、妊娠期糖尿病以及与胎盘形成有关的结局,还有所采用的治疗方法,包括体外受精(IVF)和非体外受精生育治疗(NIFT)。胎盘形成缺陷会导致不良的母婴结局,在不孕人群中更为明显,其发生是由于滋养层细胞侵袭的变化、血管缺陷、环境微环境的变化、慢性炎症和氧化应激。这些相似的过程被认为是母亲及其后代患心血管和代谢疾病终身风险的主要因素。因此,在不孕人群中发现的异常胎盘形成可能是更好地理解不孕症如何影响整体和长期健康的关键。