Placental pathology, first-trimester biomarkers and adverse pregnancy outcomes

OBJECTIVE: We investigated the relationship between placental pathological findings in pregnancies with adverse pregnancy outcomes and first-trimester serum analytes and uterine artery Doppler results. STUDY DESIGN: This is a secondary analysis of a prospective study of first-trimester screening for adverse pregnancy outcomes, including preterm birth (PTB (delivery <37 weeks)), pre-eclampsia (PE), gestational hypertension, and small for gestational age (SGA) infants (birth weight <10th percentile). We compared the mean levels of serum analytes (pregnancy-associated plasma protein A (PAPP-A), placental protein 13 (PP13), a-disintegrin and metalloproteinase 12 (ADAM12), placental growth factor (PLGF)) and uterine artery Doppler pulsatility index (UADPI) obtained between 11 and 14 weeks gestation in cases with adverse outcomes and abnormal placental histology to a control group without adverse outcome or abnormal placental pathology. Placental findings were classified as: lesions of maternal under perfusion, lesions causing reduced placental reserve, infections/inflammatory lesions, and fetal vascular lesions. RESULT: Among 193 cases, lesions of maternal under perfusion were seen in 50 cases (25.9%), lesions causing reduced placental reserve in 63 cases (32.8%), infection/inflammation in 65 cases (34.2%) and fetal vascular lesions in 23 cases (11.9%). There were 123 pregnancies with no adverse pregnancy outcome or placental lesion used as controls. Pregnancies with PE had a significant association with lesions of maternal under perfusion (P = 0.005) and placental infection/inflammation (P = 0.003). Significant differences were seen in mean levels of PAPP-A, ADAM12 and PLGF in cases with PE, PTB and SGA with specific placental histological findings when compared with controls. UADPI was not significantly different between the cases with adverse pregnancy outcomes and abnormal histology. CONCLUSION: Our findings provide evidence linking placental pathology with suboptimal secretion of analytes in the first trimester in pregnancies with adverse outcomes, especially PE.