The Role of the Placenta in Intrauterine Growth Restriction (IUGR)

Abstract

Intrauterine growth restriction (IUGR) represents a reduction from the physiological growth rate. Fetal growth depends from the maternal supply of nutrients through the placenta into the umbilical circulation. Consequently, fetal growth restriction is associated with a reduced nutritional placental supply and this can result from a decrease in utero-placental blood flows as well as a reduced placental transport capacity. In IUGR, the placental supply of amino acids is significantly reduced independently from the severity of growth restriction and from the presence of hypoxia. Moreover, maternal-fetal gradients of glucose are increased in severe IUGR fetuses, i. e. those with alterations of umbilical blood flows, and reduced conversion ratios of long chain-polyunsaturated fatty acids (LC-PUFA) from their parent fatty acids have been demonstrated. Mouse and human models suggest that epigenetic regulation of fetal growth may also play a significant role, through placental imprinted genes. This review summarizes the current knowledge about placental role in intrauterine growth restricion.

Zusammenfassung

Die intrauterine Wachstumsrestriktion ist definiert als eine Einschränkung der physiologischen Wachstumsrate. Das Wachstum des Feten hängt von der mütterlichen Versorgung mit Nahrungsstoffen über die Plazenta in den Nabelschnurkreislauf ab. Die Wachstumsbeeinträchtigung des Feten ist mit einer Retsriktion der plazentaren Zufuhr von Nahrungsstoffen assoziiert und dies kann Folge einer Abnahme des utero-plazentaren Blutflusses wie auch einer Verminderung der plazentaren Transportkapazität sein. Bei der IUGR ist die Versorgung mit Aminosäuren deutlich vermindert unabhängig von der Schwere der IUGR und davon, ob eine Hypoxie besteht. Darüber hinaus ist der materno-fetale Gradient für Glukose bei schwerer IUGR erhöht, d. h. bei solchen mit gestörtem Blutfluss im umbilikalen Kreislauf, und eine verminderte Konversion von langkettigen, ungesättigten Fettsäuren (LC-PUFA) von den entsprechenden Vorstufen wurde gezeigt. In Modellen der Maus sowie auch beim Menschen bestehen Hinweise darauf, dass auch eine epigenetische Regulation des Wachstums des Feten durch sog. imprinted Gene der Plazenta von Bedeutung ist. In dieser Übersicht sind die wichtigsten Erkenntnisse über die Rolle der Planzenta bei der IUGR zusammengefasst.

Key words

intrauterine growth restriction - IUGR - placenta - placental genes

Schlüsselwörter

intrauterine Wachstumsrestriktion - IUGR - Plazenta - Gene der Plazenta

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Correspondence