Confined placental mosaicism and intrauterine fetal development

Abstract

Chromosomal mosaicism is the presence of two or more cell lines with different chromosomal complements in an individual derived from a single zygote (which is distinguishable from chimaerism in which an individual is derived from more than one zygote). Mosaicism may involve a number of different karyotypic abnormalities including those for whole sets of chromosomes (polyploidy, including triploidy and tetraploidy), trisomies, sex chromosomal anomalies and chromosomal rearrangements. Mosaicism itself may be present in all the tissues of the body and placenta, or it may only be seen in certain tissues or may be restricted to only the placenta and extraembryonic membranes. The type of mosaicism seen depends upon the stage of development at which it originated, the tissue types to which the abnormal cell lines were distributed and the cell cycle times of both the normal and abnormal cells. The phenotypic effects or consequences of chromosomal mosaicism may be dramatic. During the pregnancy, high levels of mosaicism are seen in early abnormal preimplantation embryos, spontaneous abortions, intrauterine growth restriction and intrauterine fetal death. However, not all cases of mosaicism are serious and the presence of a normal cell line may dilute the effects of an abnormal cell line to such an extent that in many cases mosaicism will remain undetected because the consequences are not severe. Investigations of chromosomal mosaicism were, until recently, restricted to those cells which could be induced to divide and be karyotyped from metaphase analysis. Advances in molecular genetics and cytogenetics have made possible the identification of chromosomal abnormalities, specifically mosaicism in interphase cells. The identification of abnormalities such as confined placental mosaicism and its association with uniparental disomy has led to the recognition that chromosomal mosaicism plays a major role in abnormal human development and dysmorphology (Hall, 1990). An understanding of mosaicism and the role of the placenta during development, including the phenomenon of trisomic zygote rescue, is helping to cast light on problems in prenatal diagnosis, many of which involve confined placental mosaicism.