Failure of physiologic transformation of the spiral arteries in patients with preterm labor and intact membranes

Kim, Yeon Mee; Bujold, Emmanuel; Chaiworapongsa, Tinnakorn; Gomez, Ricardo; Yoon, Bo Hyun; Thaler, Howard T.; Rotmensch, Siegfried; Romero, Roberto

doi:10.1067/s0002-9378(03)00838-x

Cited by 358 publications

(253 citation statements)

References 19 publications

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“…6 More recently, Kim et al reported that failure of physiologic transformation of the myometrial portion of the spiral arteries, fetal thrombotic vasculopathy and decidual vessel thrombosis were more frequent in placental bed biopsies and placentas from patients with preterm labor and intact membranes who delivered preterm than those from normal patients. 8 Since patients with an episode of "false preterm labor" had a higher frequency of maternal and/or fetal vascular lesions in the placenta (without histologic inflammation) than patients who delivered preterm, it is possible that vascular insults may have contributed to the occurrence of both the episode of preterm labor and the delivery of an SGA neonate.…”

Section: What Is the Mechanism Of Disease Whereby An Episode Of Incrementioning

confidence: 99%

An episode of preterm labor is a risk factor for the birth of a small-for-gestational-age neonate

Espinoza

Kusanovic

Kim

et al. 2007

American Journal of Obstetrics and Gynecology

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Objective-Patients presenting with an episode of preterm labor that subsides in response to tocolysis and who subsequently deliver at term are considered to have false preterm labor. However, the episode of "preterm labor" may represent the uterine response (i.e., uterine contractions) to an insult that was not severe enough to trigger preterm parturition but which may put the fetus at risk for additional pregnancy complications including growth restriction. The objective of this study was to compare the frequency of small for gestational age (SGA) neonates among patients with an episode of increased uterine contractility who delivered at term and those who delivered preterm.Study design-This retrospective cohort study included 849 patients. Inclusion criteria were: 1) regular uterine contractions that required hospitalization; 2) intact membranes; 3) gestational age between 20 and 36 weeks. SGA was defined as a birth weight <10 th percentile for gestational age. Placental pathology was reviewed and the results were used to classify patients into an inflammatory cluster, vascular cluster or both. Contingency tables, Mann-Whitney U test, and multivariate logistic regression were used for statistical analyses. A p-value of <0.05 was considered significant. Results-1)The prevalence of SGA neonates in the study population was 16.1% (124/772); 2) patients who delivered at term had a significantly higher frequency of SGA neonates than those who delivered preterm [21.5% (64/298) vs. 12.7% (60/474); p=0.001]; 2) the results of placental pathology were available in 63.7% (492/772) of patients. Patients who delivered at term had a higher frequency of fetal or maternal vascular lesions without histologic evidence of inflammation than those who delivered preterm [29.1 % (43/148) vs. 18.9% (65/344); p=0.01]; and 3) term delivery after an episode of regular preterm uterine contractions was associated with an odds ratio of 2.22 (95% CI: 1.28-3.85) to deliver an SGA neonate after controlling for confounding variables. A subanalysis limited to patients who received tocolysis showed similar results. warfiela@mail.nih.gov Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-1) patients with an episode of increased uterine contractility that subsided and delivered at term are at risk for delivering an SGA neonate; 2) this suggests that an episode of false preterm labor is not a benign condition; and 3) we propose that insults to the feto-placental unit may be resolved by either irreversible preterm parturition or restricting fetal growth. NIH Public Access

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Section: What Is the Mechanism Of Disease Whereby An Episode Of Incrementioning

confidence: 99%

An episode of preterm labor is a risk factor for the birth of a small-for-gestational-age neonate

Espinoza

Kusanovic

Kim

et al. 2007

American Journal of Obstetrics and Gynecology

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“…Cell contact, and the signalling events that follow downstream, play a profound role in the control of proliferation, death, migration and invasion in the uterine environment. A 275 better understanding of trophoblast migration and the regulation of the molecular switches that make it possible will be critical in addressing pathologies of pregnancy including preeclampsia [72][73][74], preterm labour [75], late miscarriage [76], hypertension, [77] and IUGR [74,78], in which trophoblast migration and maternal vascular remodelling are impaired. 280 …”

Section: Junctional Proteinsmentioning

confidence: 99%

Adhesion Molecules in Human Trophoblast – A Review. II. Extravillous Trophoblast

2009

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“…Placental insufficiency may in turn result in PTD, IUGR and preeclampsia. [34][35][36] Placental lipoprotein lipase (LPL) mRNA expression was shown by Tabano 15 to be significantly higher when IUGR complicated the pregnancy.…”

Section: Maternal Nutrition Fetal Growth and Ptdmentioning

confidence: 99%

Maternal and fetal variation in genes of cholesterol metabolism is associated with preterm delivery

et al. 2007

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Objective: To examine the contribution of variants in fetal and maternal cholesterol metabolism genes in preterm delivery (PTD).Study Design: A total of 40 single-nucleotide polymorphisms (SNPs) in 16 genes related to cholesterol metabolism were examined for 414 preterm infants (gestational ages 22 to 36 weeks; comprising 305 singletons and 109 twins) and at least 1 parent. Fetal effects were assessed using the transmission disequilibrium test (TDT) for each SNP, followed by a log linear model-based approach to utilize families with missing parental genotypes for those SNPs showing significance under TDT. Genetic variant effects were examined for a role in PTD, gestational age and birth weight. Maternal effects were estimated using a log linear model-based approach.Result: Among singleton gestations, suggestive association (P<0.01 without adjusting for multiple comparisons) was found between birth weight and fetal DHCR7 gene/SNP combinations (rs1630498, P ¼ 0.002 and rs2002064, P ¼ 0.003). Among all gestations, suggestive associations were found between PTD and fetal HMGCR (rs2303152, P ¼ 0.002) and APOA1 (rs 5070, P ¼ 0.004). The result for HMGCR was further supported by the log linear model-based test in the single births (P ¼ 0.007) and in all births (P ¼ 0.006). New associations (APOE and ABCA1) were observed when birth weight was normalized for gestational age suggesting independent effects of variants on birth weight separate from effects on PTD. Testing for maternally mediated genetic effects has identified suggestive association between ABCA1 (rs4149313, P ¼ 0.004) and decreased gestational age.Conclusion: Variants in maternal and fetal genes for cholesterol metabolism were associated with PTD and decreased birth weight or gestational age in this study. Genetic markers may serve as one mechanism to identify high-risk mothers and fetuses for targeted nutritional treatment and/or prevention of low birth weight or PTD.

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Failure of physiologic transformation of the spiral arteries in patients with preterm labor and intact membranes

Cited by 358 publications

References 19 publications

An episode of preterm labor is a risk factor for the birth of a small-for-gestational-age neonate

An episode of preterm labor is a risk factor for the birth of a small-for-gestational-age neonate

Adhesion Molecules in Human Trophoblast – A Review. II. Extravillous Trophoblast

Maternal and fetal variation in genes of cholesterol metabolism is associated with preterm delivery

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