The frequency of acute atherosis in normal pregnancy and preterm labor, preeclampsia, small-for-gestational age, fetal death and midtrimester spontaneous abortion*

Abstract

Objective Acute atherosis is characterized by subendothelial lipid-filled foam cells, fibrinoid necrosis and perivascular lymphocytic infiltration. This lesion is generally confined to non-transformed spiral arteries and is frequently observed in patients with preeclampsia. However, the frequency of acute atherosis in the great obstetrical syndromes is unknown. The purpose of this study was to determine the frequency and topographic distribution of acute atherosis in placentas and placental bed biopsy samples obtained from women with normal pregnancy and those affected by the “great obstetrical syndromes”. We also examined the relationship between acute atherosis and pregnancy outcome in patients with preeclampsia. Material and methods A retrospective cohort study of pregnant women who delivered between July 1998 and July 2014 at Hutzel Women’s Hospital/Detroit Medical Center was conducted to examine 16,345 placentas. Patients were classified into the following groups: 1) uncomplicated pregnancy; 2) spontaneous preterm labor and preterm prelabor rupture of membranes (PPROM); 3) preeclampsia; 4) gestational hypertension; 5) small for gestational age; 6) chronic hypertension; 5) fetal death; 6) spontaneous abortion; and 7) others. A subset of patients had placental bed biopsy. The incidence of acute atherosis was compared among the different groups. Results 1) The prevalence of acute atherosis in uncomplicated pregnancies was 0.4% (29/6,961) based upon examination of nearly 7,000 placentas; 2) the frequency of acute atherosis was 10.2% (181/1,779) in preeclampsia, 9% (26/292) in fetal death, 2.5% (3/120) in midtrimester spontaneous abortion, 1.7% (22/1,298) in small for gestational age neonates, and 1.2% (23/1,841) in spontaneous preterm labor and PPROM; 3) among patients with preeclampsia, those with acute atherosis had significantly more severe disease, earlier onset, and a greater frequency of small-for-gestational age neonates than in those without the lesion (p < 0.05 all); 4) the lesion was more frequently observed in the decidua (parietalis or basalis) than in the decidual segment of the spiral arteries in patients with placental bed biopsies. Conclusions Acute atherosis is rare in normal pregnancy, and occurs more frequently in patients with pregnancy complications, including preeclampsia, spontaneous preterm labor, preterm PROM, midtrimester spontaneous abortion, fetal death, and SGA.

Porphyromonas gingivalis strain-dependent inhibition of uterine spiral artery remodeling in the pregnant rat†

“…Decidual vasculopathy is most commonly defined as the presence of foam filled macrophages and fibrinoid necrosis within the vessel wall, but perivascular inflammatory cell infiltration with thrombosis and medial hypertrophy have also been reported [2,64]. In preeclamptic women, fetal morbidity and mortality is correlated with the degree of decidual vasculopathy, particularly if it includes thrombosis [64].…”

“…DDP is a common disorder of various pregnancy complications with detection rates ranging between 48 and 83% of first and second trimester spontaneous abortions, 35% of preterm premature rupture of membranes, 34% of spontaneous preterm births, 58% of abruption placentae, 48% of intrauterine growth restriction (IUGR), and 73% of preeclampsia cases [2]. Uterine arteries that have failed to be remodeled during pregnancy may also exhibit uterine atherosis, a late pregnancy lesion that is characterized by peri-vascular infiltrates of foam filled macrophages and lymphocytes with fibrinoid necrosis and thrombosis of the vessel [1].…”

Maternal plasma angiogenic index-1 (placental growth factor/soluble vascular endothelial growth factor receptor-1) is a biomarker for the burden of placental lesions consistent with uteroplacental underperfusion: a longitudinal case-cohort study

“…Disruption of maternal vascular development is thought to result in reduced blood supply to the placenta. Histologic placental features consistent with maternal vascular underperfusion (MVU) are associated with preeclampsia [27–55], intrauterine growth restriction [35, 50, 56–67], fetal death [50, 68–81], and delivery of small-for-gestational-age (SGA) newborns [81–83]. These conditions contribute to a substantial fraction of perinatal morbidity and mortality, often mediated by indicated preterm delivery [84–87].…”

“…These conditions contribute to a substantial fraction of perinatal morbidity and mortality, often mediated by indicated preterm delivery [84–87]. Uteroplacental vasculopathy is also associated with spontaneous preterm labor (PTL) with intact membranes and preterm prelabor rupture of the membranes (PPROM) [50, 88–92]; thus, maternal vascular obstructive lesions, bleeding/vessel integrity, and lack of physiologic conversion of maternal spiral arteries might constitute or interact in pathways to spontaneous as well as indicated preterm delivery [93], possibly contributing to an even larger fraction of adverse pregnancy outcomes [94]. Indeed, we propose that processes resulting in maternal vascular lesions contribute to many of the “great obstetrical syndromes” [22, 95, 96].…”

A pilot study investigating the LOX index as a potential biomarker of endothelial function in pregnancy

“…4,19) Since systemic inflammation increases as gestation advances even in normal pregnancy, pregnancy is thought to be a "stress test for endothelial function". Indeed, acute atherosis, which is characterized by subendothelial lipid-filled foam cells and fibrinoid necrosis, is observed not only in preeclamptic pregnancies but also in uncomplicated pregnancies, 20) indicating that latent impairment of endothelial function can occur due to subclinical atherogenic dyslipidaemia in normal pregnancies. Soluble LOX-1 is released from the cell surface by proteolysis of LOX-1, which is the target site of atherogenic lipoproteins in the vascular endothelium.…”