Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
Placenta. 2023 Sep 7;140:90-99. doi: 10.1016/j.placenta.2023.07.297. Epub 2023 Jul 31.
To characterize early-gestation changes in placental structure, perfusion, and oxygenation in the context of ischemic placental disease (IPD) as a composite outcome and in individual sub-groups.
In a single-center prospective cohort study, 199 women were recruited from antenatal clinics between February 2017 and February 2019. Maternal magnetic resonance imaging (MRI) studies of the placenta were temporally conducted at two timepoints: 14-16 weeks gestational age (GA) and 19-24 weeks GA. The pregnancy was monitored via four additional study visits, including at delivery. Placental volume, perfusion, and oxygenation were assessed at both MRI timepoints. The primary outcome was defined as pregnancy complicated by IPD, with group assignment confirmed after delivery.
In early gestation, mothers with IPD who subsequently developed fetal growth restriction (FGR) and/or delivered small-for gestational age (SGA) infants showed significantly decreased MRI indices of placental volume, perfusion, and oxygenation compared to controls. The prediction of FGR or SGA by multiple logistic regression using placental volume, perfusion, and oxygenation revealed receiver operator characteristic curves with areas under the curve of 0.81 (Positive predictive value (PPV) = 0.84, negative predictive value (NPV) = 0.75) at 14-16 weeks GA and 0.66 (PPV = 0.78, NPV = 0.60) at 19-24 weeks GA.
MRI indices showing decreased placental volume, perfusion and oxygenation in early pregnancy were associated with subsequent onset of IPD, with the greatest deviation evident in subjects with FGR and/or SGA. These early-gestation MRI changes may be predictive of the subsequent development of FGR and/or SGA.
本研究旨在探讨胎盘结构、灌注和氧合在缺血性胎盘疾病（IPD）中的变化特征，并将其作为复合结局，以及在个体亚组中进行分析。
在一项单中心前瞻性队列研究中，于 2017 年 2 月至 2019 年 2 月期间，在产前门诊招募了 199 名孕妇。对孕妇的胎盘进行两次时间点的磁共振成像（MRI）检查：14-16 孕周（GA）和 19-24 孕周。通过四次额外的研究访视监测妊娠情况，包括分娩时。在两次 MRI 时间点评估胎盘体积、灌注和氧合。主要结局定义为妊娠合并 IPD，分娩后进行组分配确认。
在早期妊娠中，随后发生胎儿生长受限（FGR）和/或分娩出小于胎龄儿（SGA）的 IPD 母亲，其胎盘体积、灌注和氧合的 MRI 指标明显低于对照组。使用胎盘体积、灌注和氧合的多变量逻辑回归预测 FGR 或 SGA 的结果显示，14-16 孕周时的曲线下面积为 0.81（阳性预测值（PPV）= 0.84，阴性预测值（NPV）= 0.75），19-24 孕周时为 0.66（PPV = 0.78，NPV = 0.60）。
早期妊娠中显示胎盘体积、灌注和氧合减少的 MRI 指标与随后发生的 IPD 相关，在 FGR 和/或 SGA 患者中差异最大。这些早期妊娠 MRI 变化可能可预测随后发生的 FGR 和/或 SGA。
