Associations of Serum Inflammatory Biomarkers During Pregnancy With Placental Pathology and Placental Gene Expression at Delivery.

Problem: We sought to investigate whether maternal inflammatory cytokines during pregnancy are associated with histologic inflammatory or vascular lesions in the placenta and/or correlated with gene expression patterns in the placenta.

Method Of Study: We leveraged data from a large randomized controlled trial (RCT) at a single site. Maternal serum was collected in the second and third trimesters, and a composite inflammatory score was created using five measured biomarkers (CRP, IL-6, IL-1ra, IL-10, and TNF-α).

A multidimensional tool for quantifying structural racism: Application to adverse pregnancy outcomes in Chicago, Illinois.

Understanding the relationship between structural racism and health is essential for identifying practice- and policy-based interventions to reduce health inequities. We developed neighborhood-based measures of structural racism and tested their associations with adverse pregnancy outcomes, health outcomes characterized by some of the most pronounced racial inequities. We leveraged electronic health records from 89,410 pregnant patients at six Chicago-area hospitals.

Addition of Lay Language Comments in Placental Pathology Reports Increases Provider Understanding and Comfort.

Context.—: Placental pathology reports may contain terminology that obstetric providers do not feel comfortable discussing with their patients.

Objective.

Placental Pathology and Blood Pressure at Age 7: A Longitudinal Discordant Twin Analysis.

Background: Evidence suggests that the intrauterine environment shapes offspring cardiovascular disease risk. Although placental dysfunction may be an important pathophysiologic pathway, numerous parental and pregnancy characteristics that influence offspring blood pressure are strong confounders of the mechanistic role of the placenta in observational analyses of singletons. Therefore, we leverage twin- and sibling-based comparison designs to determine whether placental pathology is associated with offspring blood pressure at age 7 while mitigating major sources of confounding.

Vascular Placental Pathology and Cardiac Structure in Stillborn Fetuses.

Objective:  Adverse pregnancy outcomes, including preterm birth and preeclampsia, are associated with worse cardiovascular outcomes for offspring. Examination of the placenta is important for understanding how the prenatal period shapes long-term cardiovascular health. We sought to investigate the association between placental vascular malperfusion and fetal cardiac structure.

Histopathologic Findings in Large for Gestational Age Placentas and Correlation With CD15 Immunohistochemistry.

Background: The histopathology and CD15 expression in large for gestational age (LGA) placentas is not well-documented.

Methods: To analyze this, we utilized 2 separate cohorts of placentas from singleton term deliveries. LGA and appropriate for gestational age (AGA) placentas were compared for major histopathologies including acute and chronic inflammation, maternal and fetal vascular malperfusion, delayed villous maturation (DVM), and villous hypervascularity/chorangiosis.

Measures of Fetal Growth and Cardiac Structure in Stillbirths With Placental Maternal Vascular Malperfusion: Evidence for Heart Weight Sparing and Structural Cardiac Alterations in Humans.

Background: Placental maternal vascular malperfusion (MVM) is associated with fetal growth restriction (FGR). While FGR increases the risk of cardiovascular disease, the impact of MVM on fetal cardiac structure is understudied.

Methods: We utilized a cohort of autopsied stillbirths; 29 with MVM as the cause of death and 21 with a cause of death unrelated to MVM.

A comprehensive analysis of the association between placental pathology and recurrent preterm birth.

Background: Histologic examination of the placenta is often performed after preterm birth. Although placental examination cannot change the index pregnancy outcome, it may inform the risk of adverse outcomes in a subsequent pregnancy. Previous research has examined the association between individual histologic lesions and pregnancy outcomes without consistent results.

Complaints about excessive use of police force in women's neighborhoods and subsequent perinatal and cardiovascular health.

There are substantial, unexplained racial disparities in women’s health. Some of the most pronounced involve elevated rates of preterm delivery (PTD) and cardiovascular disease (CVD) among Black women. We hypothesized that stress associated with excessive use of force by police may contribute to these disparities.

Living in a block group with a higher eviction rate is associated with increased odds of preterm delivery.

Background: Housing instability is associated with adverse pregnancy outcomes. Recent studies indicate that eviction, which may affect a larger segment of the population than other forms of housing instability, is also associated with adverse pregnancy outcomes. However, these studies evaluate eviction across large areas, such as counties, so it remains unclear whether these patterns extend to individual-level pregnancy outcomes.

Chronic villitis: Refining the risk ratio of recurrence using a large placental pathology sample.

Introduction: Chronic villitis is an inflammatory lesion that affects 5-15% of placentas and is associated with adverse pregnancy outcomes. Chronic villitis may also recur; however, studies estimating recurrence are based on small samples and estimates of recurrence range from 10 to 56%.

Methods: We utilized data from placentas submitted to pathology at a Chicago hospital between January 2009 and March 2018.

Adverse Pregnancy Outcomes Following the Assassination of John F. Kennedy in 1963.

Introduction: Women exposed to stressful events during pregnancy are thought to be at increased risk of adverse birth outcomes. However, studies investigating stressful events are often unable to control for important confounders, such as behavioral and genetic characteristics, or to isolate the impact of the stressor from other secondary effects. We used a discordant-sibling design, which provides stronger inferences about causality, to examine whether a widespread stressor with limited impact on day-to-day life (John F.

Time-dependent changes in placental mRNA expression after delivery due to delayed specimen collection.

Problem: Current scientific guidelines recommend collecting placental specimens within two hours of delivery for gene expression analysis. However, collecting samples in a narrow time window is a challenge in the dynamic and unpredictable clinical setting, so delays in placental specimen collection are possible. The purpose of our analysis was to investigate temporal changes in placental gene expression by longitudinally sampling placentas over a 24 h period.

Formulating a Meaningful and Comprehensive Placental Phenotypic Classification.

Introduction: While many placental lesions have been identified and defined, the significance of multiple overlapping lesions has not been addressed. The purpose of our analysis was to evaluate overlapping patterns of placental pathology and determine meaningful phenotypes associated with adverse birth outcomes.

Methods: Placental pathology reports were obtained from a single hospital between 2009 and 2018.

Seasonal Variation of Chronic Villitis of Unknown Etiology.

Introduction: Chronic villitis of unknown etiology (VUE) is a chronic inflammatory lesion of the placenta. VUE is hypothesized to result from an alloimmune response or as response to an unidentified infection. Lack of a seasonal trend is thought to support VUE as an alloimmune response, though data on seasonal VUE trends are limited.

The association of stillbirth with placental abnormalities in growth-restricted and normally grown fetuses.

Background: Stillbirth, defined as foetal death ≥20 weeks' gestation, is associated with poor foetal growth and is often attributed to placental abnormalities, which are also associated with poor foetal growth. Evaluating inter-relationships between placental abnormalities, poor foetal growth, and stillbirth may improve our understanding of the underlying mechanisms for some causes of stillbirth.

Objective: Our primary objective was to determine whether poor foetal growth, operationalised as small for gestational age (SGA), mediates the relationship between placental abnormalities and stillbirth.

Interpregnancy interval and risk of stillbirth: a population-based case control study.

Purpose: We examined the association between interpregnancy intervals (IPIs) and stillbirth (defined as fetal death ≥20 weeks), as both short and long IPIs have been associated with adverse perinatal outcomes. Prior pregnancy loss is also a known risk factor for stillbirth, and women who suffer a prior loss often have shorter IPIs. For these reasons, we also sought to quantify the proportion of the association between prior pregnancy loss and subsequent stillbirth risk that may be attributed to a short IPI.

Findings in Stillbirths Associated with Placental Disease.

Objective: Placental disease is a leading cause of stillbirth. Our purpose was to characterize stillbirths associated with placental disease.

Study Design: The Stillbirth Collaborative Research Network conducted a prospective, case-control study of stillbirths and live births from 2006 to 2008.

Associations Between Features of Placental Morphology and Birth Weight in Dichorionic Twins.

Low birth weight is associated with perinatal and long-term morbidity and mortality, and may be a result of abnormal placental development and function. In studies of singletons, associations have been reported between features of placental morphology and birth weight. Evaluating similar associations within twin pairs offers a unique opportunity to control for key confounders shared within a twin pair, including gestational age, parental characteristics, and intrauterine environment.

Comparison of diameter-based and image-based measures of surface area from gross placental pathology for use in epidemiologic studies.

Placental surface area is often estimated using diameter measurements. However, as many placentas are not elliptical, we were interested in the validity of these estimates. We compared placental surface area from images for 491 singletons from the Stillbirth Collaborative Research Network (SCRN) Study (416 live births, 75 stillbirths) to estimates obtained using diameter measurements.