Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-22T22:31:49.172Z Has data issue: false hasContentIssue false
  • English
  • Français

Eccentric placentae have reduced surface area and are associated with lower birth weight in babies small for gestational age

Part of: Liggins Institute, New Zealand and the Japanese DOHaD Society

Published online by Cambridge University Press:  14 January 2018

G. Ravikumar ,
J. Crasta ,
J. S. Prabhu ,
T. Thomas ,
P. Dwarkanath ,
A. Thomas ,
T. S. Sridhar  and
A. V. Kurpad
G. Ravikumar*
Affiliation:
Department of Pathology, St. John’s Medical College, Bangalore, KA, India
J. Crasta
Affiliation:
Department of Pathology, St. John’s Medical College, Bangalore, KA, India
J. S. Prabhu
Affiliation:
Division of Molecular Medicine, St. John’s Research Institute, Bangalore, KA, India
T. Thomas
Affiliation:
Department of Biostatistics, St. John’s Medical College, Bangalore, KA, India
P. Dwarkanath
Affiliation:
Division of Nutrition, St. John’s Research Institute, Bangalore, KA, India
A. Thomas
Affiliation:
Department of Obstretics and Gynecology, St. John’s Medical College Hospital, Bangalore, KA, India
T. S. Sridhar
Affiliation:
Division of Molecular Medicine, St. John’s Research Institute, Bangalore, KA, India
A. V. Kurpad
Affiliation:
Department of Physiology, Division of Nutrition, St. John’s Medical College, Bangalore, KA, India
*
Author for correspondence: Dr G. Ravikumar, Department of Pathology, St. John's Medical College, Sarjapur Road, Koramangala, Bangalore, KA, India. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Placental structure and function determine birth outcomes. Placental mass does not always correlate with fetal birth weight (BW) in uncomplicated pregnancies which raises the possibility of other variables such as placental shape and cord insertion being the determinants of placental efficiency. In total, 160 women with singleton pregnancy, recruited into a pregnancy cohort were studied. Placental weight (PW) was measured and other data were obtained from clinical records. Birth outcomes were classified as small for gestational age (SGA) and appropriate for gestational age (AGA) based on fetal gender, gestational age (GA) and BW. High-resolution images of the chorionic plate were recorded. The shape of the placenta and the insertion of the cord were measured using eccentricity index (EI) and cord centrality index (CCI). Only placentae with eccentrically inserted cords (n=136) were included. The mean BW and PW were 2942 (±435) g and 414 (±82) g with average GA of 38.6 weeks. The mean CCI and EI was 0.483 (±0.17) and 0.482 (±0.16). Neither of these correlated with placental efficiency. However, EI showed negative correlation with placental surface area and breadth. Upon sub-grouping the cohort into SGA (n=32) and AGA (n=104), the SGA babies with the highest EI (third tertile) had significantly lower BW than those with the least eccentric placentae (first tertile). Although eccentric-shaped placentae were present in both SGA and AGA groups, the effect on BW was observed only in the SGA group.

Keywords

cord centrality indexeccentricity indexplacental efficiencyplacental shapeSGA
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 9 , Issue 3: Themed Issue: NZ-Japan , June 2018 , pp. 281 - 286
Check for updates
Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Figueras, F, Gratacós, E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014; 36, 86–98.Google Scholar
2. Barker, DJ. The fetal and infant origins of adult disease. BMJ: British Medical Journal. 1990; 301, 1111.Google Scholar
3. Sankaran, S, Kyle, P. Aetiology and pathogenesis of IUGR. Best Prac Res Clin Obstet Gynaecol. 2009; 23, 765–777.CrossRefGoogle ScholarPubMed
4. Pathak, S, Hook, E, Hackett, G, et al. Cord coiling, umbilical cord insertion and placental shape in an unselected cohort delivering at term: relationship with common obstetric outcomes. Placenta. 2010; 31, 963–968.Google Scholar
5. Tamblyn, JA, Morris, RK. Small for gestational age and intrauterine growth restriction. In Obstetrics & Gynaecology: An Evidence-Based Text for MRCOG, 3rd edn (eds. Luesley DM, Kilby MD), 2016; pp. 281–2914. CRC Press: Boca Raton, Florida.Google Scholar
6. RCOG. Small-for-Gestational-Age foetus, Investigation and management. Green–top guideline No. 31. London: RCOG, 2013:1–34. https://www.rcog.or.uk.Google Scholar
7. De Boo, HA, Harding, JE. The developmental origins of adult disease (Barker) hypothesis. Aust N Z J Obstet Gynaecol. 2006; 46, 4–14.Google Scholar
8. Dwarkanath, P, Barzilay, JR, Thomas, T, et al. High folate and low vitamin B-12 intakes during pregnancy are associated with small-for-gestational age infants in South Indian women: a prospective observational cohort study. Am J Clin Nutr. 2013; 98, 1450–1458.Google Scholar
9. Baergen, RN. Macroscopic evaluation of the second and third trimester placenta. In Manual of Pathology of the Human Placenta (eds. Baergen RN), 2011; pp. 32–33. Springer: Berlin.Google Scholar
10. Kaplan, C, Lowell, DM, Salafia, C. College of American Pathologists Conference XIX on the examination of the placenta: report of the working group on the definition of structural changes associated with abnormal function in the maternal/fetal/placental unit in the second and third trimesters. Arch Pathol Lab Med. 1991; 115, 709–716.Google Scholar
11. Khong, TY, Mooney, EE, Ariel, I, et al. Sampling and definitions of placental lesions: Amsterdam placental workshop group consensus statement. Arch Pathol Lab Med. 2016; 140, 698–713.Google Scholar
12. Cleave Books. Ellipses calculator. 2004, www.cleavebooks.co.uk/scol/callipse.htm.Google Scholar
13. Salafia, CM, Misra, DP, Yampolsky, M, et al. Allometric metabolic scaling and fetal and placental weight. Placenta. 2009; 30, 355–360.Google Scholar
14. Salafia, CM, Yampolsky, M. Metabolic scaling law for foetus and placenta. Placenta. 2009; 30, 468–471.Google Scholar
15. World Health Organization. WHO Expert Committee on Physical Status: The use and interpretation of anthropometry physical status. WHO Technical Report Series 854. WHO: Geneva, 1995.Google Scholar
16. Salafia, CM, Zhang, J, Charles, AK, et al. Placental characteristics and birthweight. Paediatr Perinat Epidemiol. 2008; 22, 229–239.Google Scholar
17. Yampolsky, M, Salafia, C, Shlakhter, O, et al. Modelling the variability of shapes of a human placenta. Placenta. 2008; 29, 790–797.CrossRefGoogle ScholarPubMed
18. Salafia, CM, Yampolsky, M, Misra, DP, et al. Placental surface shape, function, and effects of maternal and fetal vascular pathology. Placenta. 2010; 31, 958–962.CrossRefGoogle ScholarPubMed
19. Alwasel, SH, Abotalib, Z, Aljarallah, JS, et al. The breadth of the placental surface but not the length is associated with body size at birth. Placenta. 2012; 33, 619–622.CrossRefGoogle Scholar
20. Reddy, VM, Geetha, SP, Nim, VK. Variations in Placental attachment of umbilical cord. J Anat Soc India. 2012; 61, 1–4.Google Scholar
21. Di Salvo, DN, Benson, CB, Laing, FC, et al. Sonographic evaluation of the placental cord insertion site. Am J Roentgenol. 1998; 170, 1295–1298.CrossRefGoogle ScholarPubMed
22. Sepulveda, W, Rojas, I, Robert, JA, et al. Placental detection of velamentous insertion of the umbilical cord: a prospective colour Doppler ultrasound study. Ultrasound Obstet Gynecol. 2003; 21, 564–569.Google Scholar
23. Sepulveda, W, Wong, AE, Gomez, L, et al. Improving sonographic evaluation of the umbilical cord at the second trimester anatomy scan. J Ultrasound Med. 2009; 28, 831–835.CrossRefGoogle ScholarPubMed
24. Collins, J H, Collins, C L, Collins, CC. Umblical cord accidents, 2010. http://www.preginst.com/UCA_2010.pdf.Google Scholar
25. Yampolsky, M, Salafia, CM, Shlakhter, O, et al. Centrality of the umbilical cord insertion in a human placenta influences the placental efficiency. Placenta. 2009; 30, 1058–1064.Google Scholar
26. Quant, HS, Sammel, MD, Parry, S, et al. Second‐trimester 3‐dimensional placental sonography as a predictor of small‐for‐gestational‐age birth weight. J Ultrasound Med. 2016; 35, 1693–1702.Google Scholar
Supplementary material: Image

Ravikumar et al. supplementary material

Ravikumar et al. supplementary material 1

Download Ravikumar et al. supplementary material(Image)
Image 2 MB
Supplementary material: Image

Ravikumar et al. supplementary material

Ravikumar et al. supplementary material 2

Download Ravikumar et al. supplementary material(Image)
Image 620.4 KB
Supplementary material: File

Ravikumar et al. supplementary material

Ravikumar et al. supplementary material 3

Download Ravikumar et al. supplementary material(File)
File 4.9 MB
Supplementary material: File

Ravikumar et al. supplementary material

Ravikumar et al. supplementary material 4

Download Ravikumar et al. supplementary material(File)
File 1.6 MB