Abstract
Bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) may either be concordant or discordant between multiple gestation births. Abnormal placental development, particularly maternal vascular malperfusion, may account for discordance in BPD-PH through fetal programming mechanisms. Maternal vascular malperfusion is a placental histologic lesion associated with intrauterine growth restriction and BPD-PH. We conducted a retrospective longitudinal cohort study of infants born <29 weeks gestation with available placental histology at Prentice Women's Hospital in Chicago from 2005–2012. The primary outcome was discordant BPD-PH associated with placental maternal vascular malperfusion. We secondarily assessed whether the risk of BPD-PH and placental lesions was different among infants of multiple (compared to singleton) gestations. The cohort consisted of 135 multiple gestation infants and 355 singletons. In a separate cohort of 39 singletons and 35 multiples, associations between 12 cytokines and angiogenic growth factors in cord blood plasma for biomarker discordance, maternal vascular malperfusion, and bronchopulmonary dysplasia were explored. Among multiples, discordant maternal vascular malperfusion was not associated with BPD-PH (OR = 1.9 (0.52, 6.9); p = 0.33) in infants exposed to placental maternal vascular malperfusion. However, singleton infants were more likely to develop BPD-PH (compared to multiples) after adjusting for mode of delivery, chorioamnionitis, chronic hypertension, placental abruption, small-for-gestational age birth weight, and gestational age (aOR = 2.7 (1.2, 5.8); p = 0.038). Singletons were more likely to be small-for-gestational age (11% vs 4%, p = 0.025) and have placental lesions compared to their multiple-gestation counterparts (96% vs 81%, p < 0.001), principally severe maternal vascular malperfusion (17% vs 4%, p < 0.001) and chronic inflammation (32% vs 11%, p < 0.001). Increased risk of BPD-PH in singleton pregnancies <29 weeks gestation compared to multiples may be related to increased frequency of these histologic lesions. Placental pathology in singleton and multiple gestation pregnancies may serve as an early biomarker to predict BPD-PH.
Highlights
Placental histopathology may provide insight as increasing evidence suggests that the process leading to Bronchopulmonary dysplasia (BPD) begins before birth with the placenta playing a key role in regulating fetal and neonatal angiogenesis
maternal vascular malperfusion (MVM) is commonly present in pregnancies complicated by maternal preeclampsia, intrauterine growth restriction, and stillbirth
Bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-pulmonary hypertension (PH)) was defined by echocardiography, according to previously published criteria5,7; all premature infants born at
Summary
Placental histopathology may provide insight as increasing evidence suggests that the process leading to BPD begins before birth with the placenta playing a key role in regulating fetal and neonatal angiogenesis.. Fetal programming in the context of an abnormally functioning placenta may predispose an infant to develop BPD-PH postnatally, when maternal vascular malperfusion (MVM) is present.. MVM is commonly present in pregnancies complicated by maternal preeclampsia, intrauterine growth restriction, and stillbirth.. Malperfusion of the placental bed, due to a constellation of villous and vascular pathologies, may have direct or indirect impact on the developing pulmonary vasculature MVM is commonly present in pregnancies complicated by maternal preeclampsia, intrauterine growth restriction, and stillbirth. Malperfusion of the placental bed, due to a constellation of villous and vascular pathologies, may have direct or indirect impact on the developing pulmonary vasculature
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