Placental origins of neonatal diseases: toward a precision medicine approach

Pediatr Res. 2021 Jan;89(2):377-383. doi: 10.1038/s41390-020-01293-6. Epub 2020 Dec 7.

Abstract

The placenta is the single most reliable source for precise information on intrauterine environment, as well as maternal and fetal health. It mediates the physiology of two distinct yet highly interconnected individuals. The pathology that develops in the placenta, and the adaptations the placenta undergoes to mitigate this pathology, may influence the later life health of the mother and baby. Pathological placental examination provides a unique opportunity to explore and understand the intrauterine environment, as well as providing a record of events that may be associated with adverse pregnancy outcomes. A number of placental lesions have been described in association with various neonatal morbidities. The purpose of this review is to summarize the evidence for the association of placental pathologic lesions with neurodevelopmental outcomes infants with specific neonatal morbidities, including (1) neonatal encephalopathy, (2) bronchopulmonary dysplasia, (3) congenital heart diseases, and (4) autism spectrum disorders. For each of these disease processes, we will also propose specific research priorities in future studies. We conclude with a hospital-specific protocol for triaging which placentas should receive histological evaluation as a fundamental first step for the field of neuroplacentology to guide precision-based therapeutic approaches in the affected newborns. IMPACT: The purpose of this review is to summarize the evidence for placental origins of neonatal diseases. We propose specific research priorities in the field of neuroplacentology in future studies. We also present a targeted hospital-based approach for triaging which placentas should receive histological evaluation.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Age Factors
  • Autism Spectrum Disorder / etiology*
  • Autism Spectrum Disorder / pathology
  • Autism Spectrum Disorder / physiopathology
  • Autism Spectrum Disorder / therapy
  • Bronchopulmonary Dysplasia / etiology*
  • Bronchopulmonary Dysplasia / pathology
  • Bronchopulmonary Dysplasia / physiopathology
  • Bronchopulmonary Dysplasia / therapy
  • Child Development*
  • Female
  • Heart Defects, Congenital / genetics
  • Heart Defects, Congenital / pathology
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / therapy
  • Humans
  • Hypoxia-Ischemia, Brain / etiology*
  • Hypoxia-Ischemia, Brain / pathology
  • Hypoxia-Ischemia, Brain / physiopathology
  • Hypoxia-Ischemia, Brain / therapy
  • Infant, Newborn
  • Nervous System / growth & development*
  • Placenta / pathology*
  • Precision Medicine*
  • Pregnancy
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Triage