Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, United States of America.
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, United States of America.
PLoS One. 2022 Mar 1;17(3):e0264733. doi: 10.1371/journal.pone.0264733. eCollection 2022.
Trophoblast inclusions-cross sections of abnormal trophoblast bilayer infoldings-have previously been associated with aneuploidy, placenta accreta, and prematurity. This study was conducted to establish the relationship between trophoblast inclusions and a range of placental, pregnancy, and birth outcomes in a patient population with high smoking and alcohol exposure. Specifically, we sought to evaluate the association between the presence of trophoblast inclusions and 1) three primary birth outcomes: full-term birth, preterm birth, and stillbirth; 2) gestational age at delivery; and 3) specific placental pathologies.
Two slides containing chorionic villi were evaluated from 589 placentas that were collected from Stellenbosch University in Cape Town, South Africa as part of the prospective, multicenter cohort Safe Passage Study of the Prenatal Alcohol and SIDS and Stillbirth Network. The subsample included 307 full-term live births, 212 preterm live births, and 70 stillbirths.
We found that the odds of identifying at least one trophoblast inclusion across two slides of chorionic villi was significantly higher for placentas from preterm compared to term liveborn deliveries (OR = 1.74; 95% CI: 1.22, 2.49, p = 0.002), with an even greater odds ratio for placentas from stillborn compared to term liveborn deliveries (OR = 4.95; 95% CI: 2.78, 8.80, p < 0.001). Gestational age at delivery was inversely associated with trophoblast inclusion frequency. Trophoblast inclusions were significantly associated with small for gestational age birthweight, induction of labor, villous edema, placental infarction, and inflammation of the chorionic plate.
The novel associations that we report warrant further investigation in order to understand the complex network of biological mechanisms through which the factors that lead to trophoblast inclusions may influence or reflect the trajectory and health of a pregnancy. Ultimately, this line of research may provide critical insights that could inform both clinical and research applications.
滋养层包涵体——异常滋养层双层内折的横截面——先前与非整倍体、胎盘植入和早产有关。本研究旨在确定在吸烟和饮酒暴露水平较高的患者人群中，滋养层包涵体与一系列胎盘、妊娠和分娩结局之间的关系。具体而言，我们试图评估滋养层包涵体的存在与以下三个主要分娩结局之间的关系：足月分娩、早产和死产；2）分娩时的胎龄；3）特定的胎盘病理。
从南非开普敦斯坦陵布什大学收集的 589 个胎盘中评估了两张包含绒毛膜绒毛的切片，这些胎盘是作为产前酒精和 SIDS 及死产网络的 Safe Passage 研究的前瞻性多中心队列的一部分收集的。该子样本包括 307 例足月活产、212 例早产活产和 70 例死产。
我们发现，与足月活产相比，在两张绒毛膜绒毛切片中至少发现一个滋养层包涵体的可能性，在早产儿中明显更高（OR=1.74；95%CI：1.22，2.49，p=0.002），而在死产中与足月活产相比，其比值比甚至更高（OR=4.95；95%CI：2.78，8.80，p<0.001）。分娩时的胎龄与滋养层包涵体的频率呈反比。滋养层包涵体与小于胎龄出生体重、引产、绒毛水肿、胎盘梗死和绒毛膜板炎显著相关。
我们报告的新关联需要进一步研究，以了解导致滋养层包涵体的因素影响或反映妊娠轨迹和健康的复杂生物学机制网络。最终，这一系列研究可能会提供关键的见解，为临床和研究应用提供信息。
