Chapter 78 - The placental role in fetal programming

Abstract

This chapter aims to outline the role of the placenta in fetal programming. In order to understand this, placental function and regulation will be outlined and the evidence for placental involvement in programming, together with the maternal and environmental factors which may influence placental function is discussed. Finally, the implications for the identification of individuals at future risk of disease due to poor placental function and the potential opportunities for interventions will be discussed. This section will outline the roles and functions of the placenta and how it facilitates the transport of substances required by the fetus while preventing the transport of those which are not. Fetal programming summarizes the evidence for programming in humans and animals, and discusses the evidence for the role of the placenta in fetal programming. The placenta is subject to a wide range of influences from both the mother and the fetus. Hormonal, nutrient and epigenetic influences on placental function have been discussed, and in this section, broader maternal and environmental influences will be discussed. The association between impaired growth in utero and chronic disease in later life means that in assessing an individual's risk of later ill-health it may be important to know how they developed before birth. The mechanisms by which this occurs are likely to involve epigenetic changes, as well as changes in developmentally determined parameters such as nephron number. These interactions between the environment, mother, placenta and fetus are outlined here.