Placental pathology in maternal autoimmune diseases-new insights and clinical implications

Abstract

Background: Pregnancy in women with autoimmune diseases is frequently associated with placental insufficiency leading to adverse perinatal outcome. Aim of the study was to investigate the presence and possible clinical significance of placental lesions in mothers with different autoimmune disorders.Methods: In this retrospective study, 11 placentas from 10 mothers with diverse autoimmune diseases including systemic lupus Erythematosus (SLE), antiphospholipid antibodies (APLA), idiopathic thrombocytopenic purpura (ITP) and antinuclear antibodies (ANA) were studied.Results: Placental correlates were reduced placental weight, maternal vascular under perfusion, abruption, villitis of unknown etiology, multifocal chorangiomatosis, distal villous immaturity, massive perivillous fibrin deposition/maternal floor infarction and foetal thrombotic vasculopathy. Of the 11 pregnancies 3 were untreated (1 SLE, 2 APLA) and resulted in intrauterine foetal demise. The lesions were more severe in these cases. All the treated pregnancies resulted in live born babies (8), of which 3 were growth restricted, 2 were complicated with oligohydramnios and 3 were delivered preterm.Conclusions: In this group of diverse autoimmune disorders, placental lesions were not specific for each of them. Apart from maternal vascular under perfusion, lesions like villitis of unknown etiology, distal villous immaturity and massive perivillous fibrin deposition were identified and may recur in subsequent pregnancies and treatment should be directed towards modifying it. The placental examination should be mandatory in all cases of maternal autoimmunity and pregnancies with poor foetal outcome.