Placental Surface Area Research Articles

Birth weight, umbilical and placental traits in relation to neonatal loss in cloned pigs

Cloned piglets generated through somatic cell nuclear transfer (SCNT) have a high rate of neonatal death. Postnatal loss is associated with low birth weight, umbilical status and placental parameters in fertilisation-derived piglets. To investigate whether or not this relationship also exists in cloned piglets, birth weight, umbilical status, placental parameters, placental morphology and gene expression pattern were compared among four piglet groups, namely, SCNT-derived male piglets that died within 4 days (SCNT-DW4), SCNT-derived male piglets that survived over 4 days (SCNT-SO4), artificial insemination (AI)-generated male piglets that died within 4 days (AI-DW4) and AI-generated male piglets that survived over 4 days (AI-SO4). Results showed that the occurring frequency of abnormal umbilical cord in SCNT-DW4 piglets was significantly higher than that in AI-SO4 piglets but was similar to that in SCNT-SO4 and AI-DW4 piglets. The birth weight, placental surface area and placental weight of AI-SO4, AI-DW4 and SCNT-SO4 groups were similar but were significantly higher than those in SCNT-DW4 group. SCNT-SO4 placentas exhibited mild but SCNT-DW4 placentas showed severe morphological abnormalities compared with AI-SO4 placentas. The expression profiles of imprinting, angiopoiesis, nutrient transport, apoptosis and oxidative stress-related genes in SCNT-DW4 placentas were erroneous compared with those in SCNT-SO4 and AI-SO4 placentas, which both had similar gene expression patterns. These results indicate that birth weight, umbilical status, placental parameters, placental morphology and gene expression were associated with neonatal death of cloned piglets. The high loss of cloned piglets during neonatal age may be caused by severe deficiency of extra-embryonic development during prenatal stage.

Rapid conceptus elongation in the pig: An interleukin 1 beta 2 and estrogen-regulated phenomenon.

Establishment and maintenance of pregnancy in the pig involves activating many physiological, cellular, and molecular signaling pathways between the developing conceptus and hormonally regulated maternal endometrium. Rapid elongation of the pig trophoblast allows for the establishment of sufficient placental surface area for the transport of nutrients to the fetus throughout pregnancy. Estrogens secreted by the conceptus during elongation act on uterine epithelia to induce secretion of uterine factors required for conceptus development and for preventing endocrine secretion of prostaglandin F2α, which would cause luteolysis. Thus, trophoblast expansion within the uterine lumen during early gestation is an essential process for implantation and maintenance of pregnancy in species with an epitheliochorial form of placentation. In the pig, rapid conceptus elongation involves the unique expression of interleukin-1 beta 2 (IL1B2), which establishes pro-inflammatory effects that may be tempered by the spatiotemporal secretion of estrogen from the conceptuses. The present review provides current information on pig conceptus remodeling and signaling via estrogen and IL1B2 pathways, as well as endometrial responses to those conceptus factors leading to establishment of pregnancy.

Relationship between placental surface area and fetal growth rate in artiodactyls and perissodactyls

Abstract Gestation periods in mammals are generally in line with scaling laws. There are several exceptions in which species of relatively similar size and degree of neonatal maturation show a significant difference in gestation length. For example the giraffids have a very long gestation period, compared to bovids of similar size. By using published data about the placental surface area at term, we show that in ungulates this surface area is more tightly correlated to the average fetal growth rate than to fetal and placenta weight. These data suggest that, within one type of placenta, gestation length and placental surface area are associated parameters.

Histomorphometric parameters of normal full term placenta of Sudanese women.

The aim of the study was to provide values for morphometric parameters of histological components of normally delivered full term placentas of Sudanese women and compare them with reported parameters for other ethnic groups. A total of 200 histological sections, stained with hematoxylin and eosin and trichrome stains were used to give a final sample of 1000 fields saved as PowerPoint images for histomorphometry. A systematic random sampling procedure was adopted to ensure the optimum sample size that keeps the percentage error below 5% for the volume estimates. Standard stereological methods of point-counting and intersection-counting were applied to the microscopic fields to determine the volumes of placental components and surface area of fetal-maternal interface. The morphometric parameters showed no variations either between the placentas or between central and peripheral regions. The placental villi and the intervillus space occupied 65% and 35% of placental volume respectively with mean absolute values of 318 cm3 and 169 cm3. The mean absolute volume of the intervillus space was less than that of other ethnic groups by 8.67% but was significantly larger than that of the fetal capillaries which measured 41.2 cm3. The ratio of the absolute volume of the intervillus space to the volume of the fetal blood capillaries was 4:1 in both Sudanese and other ethnic groups. In the placental villi the fetal connective tissue together with the contained blood vessels larger than capillaries occupied 88% of the villus volume. The mean surface area of the fetal-maternal interface of the placental villi (syncytiotrophoblast) was 12.59 M2.

Morphometrical analysis of placental functional efficiency in normotensive versus preeclamptic South African black women

ABSTRACTObjective: To assess the umbilical cord centrality, placental morphometrics, and functional efficiency in preeclampsia. Methods: Placental morphometry of normotensive (n = 69) and preeclamptic (n = 69) patients was evaluated. Results: There was a significant reduction in mean placental surface area (p = 0.0001), length (p = 0.0001), thickness (p = 0.016), and volume (p = 0.0001) in the preeclamptic than in the normotensive groups. Umbilical cord insertion was predominantly eccentric with marginal in early (29%) and late-onset preeclampsia (16%). Placental and birth weight was lower (p = 0.0001) in preeclampsia than in the normotensive group. Placental efficiency was reduced in early-onset preeclampsia. Conclusion: This study demonstrates reduced placental morphometrics with impaired placental efficiency in preeclampsia.

The relationship between human placental morphometry and ultrasonic measurements of utero-placental blood flow and fetal growth

IntroductionUltrasonic fetal biometry and arterial Doppler flow velocimetry are widely used to assess the risk of pregnancy complications. There is an extensive literature on the relationship between pregnancy outcomes and the size and shape of the placenta. However, ultrasonic fetal biometry and arterial Doppler flow velocimetry have not previously been studied in relation to postnatal placental morphometry in detail. MethodsWe conducted a prospective cohort study of nulliparous women in The Rosie Hospital, Cambridge (UK). We studied a group of 2120 women who had complete data on uterine and umbilical Doppler velocimetry and fetal biometry at 20, 28 and 36 weeks' gestational age, digital images of the placenta available, and delivered a liveborn infant at term. Associations were expressed as the difference in the standard deviation (SD) score of the gestational age adjusted ultrasound measurement (z-score) comparing the lowest and highest decile of the given placental morphometric measurement. ResultsThe lowest decile of placental surface area was associated with 0.87 SD higher uterine artery Doppler mean pulsatility index (PI) at 20 weeks (95% CI: 0.68 to 1.07, P < 0.001). The lowest decile of placental weight was associated with 0.73 SD higher umbilical artery Doppler PI at 36 weeks (95% CI: 0.54 to 0.93, P < 0.001). The lowest decile of both placental weight and placental area were associated with reduced growth velocity of the fetal abdominal circumference between 20 and 36 weeks (both P < 0.001). ConclusionPlacental area and weight are associated with uterine and umbilical blood flow, respectively, and both are associated with fetal growth rate.

Placental Changes in Gestational Diabetes Controlled with Insulin versus Diet without Insulin Compared with Normal Uncomplicated Pregnancy: Clinical and Histopathological Study

The fetus, placenta and mother constitute a triad of contributors to pregnancy outcome. Whenpregnancy is complicated by a medical problem like, diabetes mellitus which affects maternal health,architecture and functions of the placenta may even jeopardize the fetal normalcy. The placenta being thebridge between maternal and fetal activities, considered as a window through which maternal dysfunctionsand their impacts on fetal well being can be understood.The aim of this research isstudying the pathological changes of placentae of women with gestational diabetes mellitus and tocompare the results with normal pregnancies. Methods: It was an observational study conducted in Zagazig University hospitals, 20 placentaefrom pregnant women clinically diagnosed with gestational diabetes mellitus (GDM) controlled only with diet and life style modificationsand another 20 placentaefrom pregnant women clinically diagnosed with gestational diabetes mellitus (GDM) controlled with insulin and 20 placentae fromuncomplicated normal pregnant womenwere collected from labour room and operation theatre of departmentof obstetrics and gynaecology. Confirmedgestational diabetic caseswere selected purposively from gestational diabetes clinic of endocrinology unit while controls were taken sequentially. Pathologic features of each placentawere recorded in histopathology department. Results:The results showed that placental weight, diameter, surface area and central thickness from diabetic mothers controlled with insulin were significantly more than diabetic mothers controlled only by diet or mothers of normal uncomplicatedpregnancies, while no significant differences were observed in shape and site of umbilical cord insertion.The terminal villi in placentae of GDM controlled by insulin showed a significant varying degreeof changes like, the increased number of syncytial knots, villous edema and fibrinoid necrosis however, these changes were very minimal in cases of GDM treated only with diet and controlled without need of insulin. Conclusion:The placentae ofwomenwith gestational diabetesmellitus treated with insulin even controlled showsignificant variation in gross morphology and light microscopy thatcan be associated with impaired function ofplacenta, leading to possible adverse perinataloutcome. In the other hand, the placentae ofwomenwith gestational diabetesmellitus controlled with diet alone showed minimal changes with no significant differences from normal uncomplicated pregnancy. Control of GDM or better prevention by education, diet, optimum weight control and life style modifications should be strictly encouraged and insulin use should be the last resort.

The placenta is the center of the chronic disease universe

Over the past quarter century it has become clear that adult onset chronic diseases like heart disease and type 2 diabetes have their roots in early development. The report by David Barker and colleagues showing an inverse relationship between birthweight and mortality from ischemic heart disease was the first clear-cut demonstration of fetal programming. Because fetal growth depends upon the placental capacity to transport nutrients from maternal blood, it has been a suspected causative agent since the original Barker reports. Epidemiological studies have shown that placental size and shape have powerful associations with offspring disease. More recent studies have shown that maternal phenotypic characteristics, such as body mass index and height, interact with placental size and shape to predict disease with much more precision than does birthweight alone. For example, among people in the Helsinki Birth Cohort, who were born during 1924–1944, the risk for acquiring colorectal cancer increased as the placental surface became longer and more oval. Among people in whom the difference between the length and breadth of the surface exceeded 6 cm, the hazard ratio for the cancer was 2.3 (95% CI 1.2–4.7, p=0.003) compared with those in whom there was no difference. Among Finnish men, the hazard ratio for coronary heart disease was 1.07 (1.02–1.13, P =0.01) per 1% increase in the placental weight/birthweight ratio. Thus, it appears that the ratio of birthweight to placental weight, known as placental efficiency, predicts cardiovascular risk as well. Babies born with placentas at the extremes of efficiency are more vulnerable for adult onset chronic diseases. Recent evidence suggests that placental growth patterns are sex specific. Boys’ placentas are, in general, more efficient than those made by girls. Another recent discovery is that the size, shape and efficiencies of the placenta can change over years of time with very narrow confidence limits. This suggests that the growth of the placenta within a population of women is strongly affected by their nutritional environment. Even though it is known that an individual placenta can expand to improve its nutrient acquisition capacity in the first 2/3rd of gestation, the mechanisms by which placentas grow in response to a specific nutritional environment are not known. Discovering those mechanisms is the task of the current generation of scientists. While it may seem obvious that good nutrition is highly important for women who are pregnant because it supports optimal placentation and fetal development, more research is needed to determine the mechanisms by which maternal nutrition, placenta growth and fetal health are related.

HISTOMORPHOLOGICAL AND MORPHOMETRICAL CHANGES OF PLACENTAL TERMINAL VILLI OF NORMOTENSIVE AND HYPERTENSIVE MOTHERS

Background &amp; Objectives: Placental examination has clinical value in preeclampsia (PE) and IUGR. The luminal diameter of the uterine spiral arterioles in women with PE is narrowed leading to placental ischemia thus causing fetal hypoxia and pathological changes in placenta. The main objective of the present study is to compare morphological and histomorphometrical changes in placentas of preeclamptic and normotensive mothers. Methods: 50 placentas from both vaginal and LSCS delivery were collected at Dept. of OBG in a tertiary care center, half of them from normotensive pregnancies and the rest from preeclamptic mothers. An inclusion criterion for control was normal blood pressure and no proteinuria. Exclusion criteria for both control and study group was DM, obesity, severe anemia or any systemic disorders. Placental thickness, weight, diameter and surface area were recorded. Histopathological sections stained with H&amp;E were observed for surface area and diameter of TV. Results: The mean placental weight in PE was 430 g. The placental diameter was decreased in PE (16 cm) compared to controls (19 cm). Neonatal weight followed the same trend. Histologically, the changes in the TV and blood vessels was significant; there was decrease in the diameter of villi in PE cases(0.01 μm) when compared to controls (0.05 μm). There was significant decrease in the diameter of blood vessels in PE (0.0049 μm) than in controls (0.01 mm). Conclusion: This study has revealed that there are significant changes in the placenta in cases of PE both morphologically and histologically. There is also a need for further studies to prove the molecular and genetic factors involved in preeclampsia.

Placental weight and Surface area in IUGR cases

The placentas of 100 mothers with Intrauterine Growth Retardation(IUGR) were compared to Placentas collected from 100 mothers who had uncomplicated pregnancies.This study demonstrated that,Placentas with Low weight and surface area is associated with IUGR babies . The findings of this study support the hypothesis that,in IUGR some alterations in  blood flow and possibly umbilical blood flows causes   changes in placental structure and function and reduction in placental weight and surface area.

Morphological and morphometrical study of placenta in normal and hypertensive pregnancies.

Abstract Background and Aim: Placenta is the main channel in utero, through which the fetus receives its nutrition from the mother. Hypertensive disorders of pregnancy are fairly common and affect the growth and development of the placenta and fetus in many ways. Knowledge of these changes in placenta due to hypertension in pregnancy is essential as many of these changes can be diagnosed prenatally by available techniques to improve the fetal outcome and reduce perinatal morbidity and mortality. Materials and Methods: The present study was conducted to note the morphometrical and morphological parameters in the placenta of normal and hypertensive pregnancies and to correlate them with fetal outcome. The study was done on 30 placentae as control group, obtained after delivery of normotensive women and 30 placentae as study group, which were obtained after delivery of hypertensive mothers which included chronic hypertension, pre eclampsia and eclampsia. The placental specimens were collected from the department of obstetrics and gynecology, KIMS, Bangalore and new bom parameters were taken from their records. Results: The placental morphometrical parameters were significantly less in hypertensive group as compared to the control group. The mean placental weight was 458.33±70.47 gms; mean placental surface area was 215.82±27.83 sqcms, the mean placental volume was 583.67+66.21 cc and mean decidual thickness was 2.50 ±0.24 cms in hypertensive group while in the control group the values were 561.67±77.33 gms, 241.91±37.23 sqcms, 674.00±88.50 cc and 2.83±0.34 cms respectively. The mean birth weight (kg) of newborn was 2.92 ± 0.45 in control group and it was and 2.47 ±0.40 in hypertensive group. Conclusion: Thus hypertensive disorders of pregnancy affects the placenta in a major way by decreasing its weight, surface area, thickness and volume and by increasing pathological changes like placental infarcts and calcified areas which adversely affect fetal parameters like weight and APGAR score.

Intrauterine growth restriction is associated with strong alterations in placental structure and function in horses

In equids, placentation is diffuse and the nutrient supply to the fetus is determined by uterine size, which is correlated to maternal size and parity. That the size of the mare affects fetal development has previously been shown by embryo transfer (ET) between Ponies and Thoroughbreds [Allen WR, et al; Reproduction 2002;123:445-53.]. We enhanced or restricted fetal growth through ET using Pony (P), Saddlebred (S) and Draft (D) horses and investigated placental morphology, histology and function at term. Control pregnancies of P-P (n1⁄421), S-S (n1⁄428) and D-D (n1⁄48) were obtained by artificial insemination. Enhanced and restricted pregnancies were obtained by transferring P (P-D, n1⁄46) and S embryos (S-D, n1⁄48) into D mares or S embryos into P mares (S-P, n1⁄46), respectively. Placental weight and gross surface area were recorded at delivery. Samples were collected for stereology (quantitative histology) and RT-qPCR analysis of expression of genes involved in placental growth, vascularization and nutrient transport. Statistical analysis of data was performed by Kruskal-Wallis with Dunn’s posthoc test. Data are expressed as means SEM. Mean placental weight and gross surface area were higher in S-S and in D-D compared to P-P (p<0.05) whereas S-S and D-D were not different (4.6 0.17kg and 8046 176.1cm2 in S-S versus 4.9 0.41kg and 9229 596.2cm2 in D-D versus 2.5 0.14kg and 2940 111.7cm2 in P-P for placental weight and surface, respectively). No histological changes were observed among controls, but most genes had their expression decreased in P-P compared to S-S and D-D. P-D foals had a

2D-ultrasound and endocrinologic evaluation of placentation in early pregnancy and its relationship to fetal birthweight in normal pregnancies and pre-eclampsia

ObjectivesTo study the relationships between 2D ultrasound measurements of placentation and maternal serum (MS) levels of PAPP-A, inhibin A and fβhCG in early pregnancy and subsequent fetal growth in pregnancies with a normal and abnormal outcome. Study designProspective population-based cohort study of 301 pregnancies with a normal outcome, 18 with a pregnancy complicated by pre-term delivery (PTD) and 14 with subsequent pre-eclampsia (PE). Main outcome measuresBasal placental surface area, placental thickness, ellipsivity and volume; MS PAPP-A and fβhCG at 11–13 + 6 weeks, MS inhibin A at 15–22 weeks and birthweight centile at delivery. ResultsIn the normal group, the basal surface area showed a significantly (P < 0.001) positive correlation with placental thickness and placental ellipsivity. With the exception of placental ellipsivity, all other placental ultrasound parameters were significantly related with birthweight centile. Inhibin A showed a significant (P < 0.005) correlation with birthweight centiles. The basal plate surface area and MS PAPP-A were significantly (P < 0.01 and P < 0.001, respectively) lower and MS inhibin A significantly (P < 0.01) higher in PE than in controls. No changes were found in pregnancies complicated by PTD. ConclusionThe basal plate surface area at 11–14 weeks reflects indirectly normal and abnormal placentation and development of the definitive placenta. Combined with MS PAPP-A and/or inhibin A levels this parameter could be useful in identifying from the end of the first trimester, pregnancies subsequently complicated with PE.

Maternal cotyledons at birth predict blood pressure in childhood

IntroductionA small placental surface at birth has been shown to be associated with the development of hypertension in later life. In this study we extend this observation by looking at the relationship between the number of placental cotyledons and blood pressure in childhood. Because the number of cotyledons is correlated with the surface area, we hypothesized that fewer cotyledons would be associated with higher blood pressure. MethodsThe Alspac study is a longitudinal study of 13,971 children born in Bristol. Their placentas were stored in formalin. We photographed the placentas of a sample of the children and related the number of maternal cotyledons to their blood pressure levels at age 9 years. ResultsContrary to our hypothesis, a greater number of maternal cotyledons was associated with higher blood pressure. Among boys, a greater number of cotyledons was associated with higher systolic and diastolic pressure but not with higher pulse pressure. Diastolic pressure rose by 2.2 mmHg (95% CI 0.6 to 3.7, p = 0.007) for every 10 additional cotyledons. Among girls, a greater number of cotyledons was associated with higher systolic pressure and pulse pressure but not with higher diastolic pressure. Pulse pressure rose by 2.7 mmHg (1.1–4.3, p < 0.001) for every 10 additional cotyledons. These associations were little changed by adjustment for placental surface area. ConclusionOur study has shown that a large number of maternal cotyledons is associated with raised blood pressure in childhood. The associations differ in the two sexes.

Placental Morphometry Determines the Birth Weight

Placental morphometry determines the foetal development and adulthood disease pattern. Hence, in the present study the influence of placental weight, volume, surface area, and thickness were studied in different groups of birth weight by sex of the newborn. Present study was conducted on 164 consecutive singleton deliveries from a teaching hospital of Northern Karnataka, India. Multivariate linear regression models were constructed by maximum likelihood method after checking the linearity. The sensitivity, specificity and predictive values of regression models were computed to exhibit their utility for physicians. Gestational age exhibited positive relationship with birth weight. Placental parameters showed a positive and significant relationship (p<0.001) with birth weight and higher values in males. The birth weight was estimated by regression models using sex of the newborn and placental morphometry; weight (R(2)=0.474), surface area (R(2)=0.420), and volume (R(2)=0.477) at 95% confidence interval. Low birth weight babies in the study were correctly identified by placental weight, surface area, volume and sex of the newborn. Their sensitivity, specificity and predictive values have been specified. Placental morphometry: weight, surface area, volume and sex of the baby determined the birth weight efficiently to initiate the corrective measures for planning better maternal care and to pacify mothers and their relatives.

Histomorphological and morphometrical changes of placental terminal villi of normotensive and preeclamptic mothers

Placental morphology and cellular arrangement are altered in maternal diseases such as preeclampsia (PE) in which oxygen delivery from the mother to the fetus is greatly disturbed, ultimately resulting in cellular oxidative stress. The present study was conducted at the Department of Anatomy and included 112 placentas (56 each from mothers with and without PE [controls]) collected at the Department of Obstetrics and Gynecology. A histological study was performed using hematoxylin and eosin staining. The morphology of stem and terminal villi (TV) was studied, and the surface area and diameter of TV and capillaries were measured. The gross placental morphometrical study revealed that the mean placental weight, thickness, diameter, and surface area were significantly lower in placentas with PE than in controls. The histomorphometrical findings of the villous surface area and diameter were lower in placentas with PE, whereas the TV density was higher in placentas with PE than in controls, and the differences were significant (P<0.0001). In these TV, the diameter and density of fetal blood vessels of placentas with PE were significantly lower than those of controls (P<0.05). In conclusion, the both morphological and histological changes in PE placentas are indicative of the pathogenesis of maternal and fetal morbidity and mortality in women with PE. The observed and comparative histomorphometrical changes indicate a decline in all aspects of the PE placenta, except the number of TV.

Maternal neonatal outcome in relation to placental location, dimensions in early pregnancy

Background: Placenta, which is the vital link between mother and fetus, is critical for maternal neonatal well-being. Its study in early pregnancy may provide information about maternal neonatal disorders. Aim: The study aimed to evaluate the relationship of placental location and dimensions in early pregnancy with maternal neonatal outcomes. Subjects and Methods: Primigravida (801) with singleton pregnancy at 10-weeks gestation and no past/present medical and obstetric disorder had ultrasonography for placental location and dimensions and were followed by ultrasonographic (USG) examination (at 20th week and 30th week), clinically for maternal-neonatal outcome. Statistical analysis was done by Epi 6 software (version 6.0, developed by Centres for Disease Control and Prevention, Atlanta, Georgia, USA) using Chi-square test and Fischer exact test for determining the statistical significance of the observations. P values of 55 cm2 6.8% (13/190), had hypertensive disorders. area 55 cm2 3.7% (7/190) had placental abruption. With thick placenta, 39.2% (58/148), thin, 9.4% (9/96), and normal placenta, 5.2% (29/562) had hypertensive disorders. With thick, 11.5% (17/148), thin 16.7% (16/96), and normal placenta 2.7% (15/562) had placental abruption. With anterior 0.5% (1/200), posterior 14.6% (18/123), fundal placenta 10.55% had preterm births. With anterior 7.5% (15/200), posterior 23.6% (29/123), fundal placenta 18% (58/322) had CS.With placental surface area 55 cm2 14% (28/200) had CS. With thin 27% (25/91), with thick 36.1% (53/148), with normal placenta none had CS for fetal distress. Conclusions: Study of placental location and dimensions in early pregnancy is useful in identifying risks. Keywords: Dimensions, early pregnancy, location, maternal-neonatal outcome, placenta

Placental size is associated with mental health in children and adolescents.

BackgroundThe role of the placenta in fetal programming has been recognized as a highly significant, yet often neglected area of study. We investigated placental size in relation to psychopathology, in particular attention deficit hyperactivity disorder (ADHD) symptoms, in children at 8 years of age, and later as adolescents at 16 years.Methodology/Principal FindingsProspective data were obtained from The Northern Finland Birth Cohort (NFBC) 1986. Placental weight, surface area and birth weight were measured according to standard procedures, within 30 minutes after birth. ADHD symptoms, probable psychiatric disturbance, antisocial disorder and neurotic disorder were assessed at 8 years (n = 8101), and ADHD symptoms were assessed again at 16 years (n = 6607), by teachers and parents respectively. We used logistic regression analyses to investigate the association between placental size and mental health outcomes, and controlled for gestational age, birth weight, socio-demographic factors and medical factors, during gestation. There were significant positive associations between placental size (weight, surface area and placental-to-birth-weight ratio) and mental health problems in boys at 8 and 16 years of age. Increased placental weight was linked with overall probable psychiatric disturbance (at 8y, OR = 1.14 [95% CI = 1.04–1.25]), antisocial behavior (at 8 y, OR = 1.14 [95% CI = 1.03–1.27]) and ADHD symptoms (inattention-hyperactivity at 16y, OR = 1.19 [95% CI = 1.02–1.38]). No significant associations were detected among girls.Conclusions/SignificanceCompensatory placental growth may occur in response to prenatal insults. Such overgrowth may affect fetal development, including brain development, and ultimately contribute to psychopathology.

Long-term effects of placental growth on overweight and body composition.

Obesity is programmed in utero and small babies generally have small placentas. In some circumstances, an undernourished fetus can expand its placental surface to extract more nutrients. We hypothesize that this results in an imbalanced nutrient supply to the fetus leading to obesity. To determine whether placental size determines overweight and body composition, we studied 2003 subjects in adult life. Associations between placental surface area and indices of overweight were restricted to people who carried the Pro12Pro genotype of the PPARγ2 gene. For every 1 SD increase in placental surface area, the odds ratio for overweight was 1.37 (95% CI 1.10 to 1.71; P = 0.005). Expansion of the placental surface in compensation for fetal undernutrition increases the risk of overweight and a higher body fat percentage in people carrying the Pro12Pro genotype. We suggest that similar underlying multifactorial mechanisms affect the development of obesity in general.

The sex-specific effects of famine on the association between placental size and later hypertension

BackgroundPeople who had low birth weight are at increased risk of hypertension. This may reflect fetal programming by undernutrition. Placental size is also associated with hypertension. Maternal undernutrition during the Dutch famine reduced placental surface area. We examined whether maternal undernutrition altered the relationship between placental size and later hypertension. MethodsRetrospective cohort study among 860 subjects born in Amsterdam during 1943–47. 216 subjects were taking anti-hypertensive medication. Birth records included placental length and breadth from which we calculated its area. ResultsAmong men who were not in utero during the famine hypertension was associated with a small placental surface area due to a small placental breadth, and with an oval-shaped surface. The OR for hypertension was 0.83 (95% CI 0.70 to 1.00) for a 40 cm2 increase in surface area. Among men who were in utero during the famine hypertension was associated with a large placental surface area due to a large placental breadth, and with a round-shaped surface. The OR for hypertension was 1.34 (95% CI 0.99 to 1.80) for a 40 cm2 increase in surface area. The associations between placental size and hypertension in men who were and were not in utero during the famine were significantly different (p values for interaction = 0.008 for placental surface area, 0.001 for the breadth and 0.01 for the difference in the two diameters). Among women hypertension was not associated with placental size. ConclusionsOur study provides the first direct evidence that changes in maternal diet during pregnancy alter the relationship between placental size and later hypertension among men but not women. We suggest that among men who were not in utero during the famine, hypertension was related to impaired implantation, whereas among men who were in utero during the famine it was related to compensatory expansion of the placental surface.