Formulating a Meaningful and Comprehensive Placental Phenotypic Classification

Alexa A. Freedman, Lauren S. Keenan-Devlin, Ann Borders, Gregory E. Miller, Linda M. Ernst*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

Introduction: While many placental lesions have been identified and defined, the significance of multiple overlapping lesions has not been addressed. The purpose of our analysis was to evaluate overlapping patterns of placental pathology and determine meaningful phenotypes associated with adverse birth outcomes. Methods: Placental pathology reports were obtained from a single hospital between 2009 and 2018. Placental lesions were grouped into four major categories: acute inflammation (AI), chronic inflammation (CI), maternal vascular malperfusion (MVM), and fetal vascular malperfusion (FVM). Within each category, lesions were classified as not present, low grade or high grade. Combinations of pathologies were evaluated in relation to preterm birth (<37 weeks) and small for gestational age (SGA) infant (birthweight <10th percentile). Results: During the study period, 19,027 placentas were reviewed by pathologists. Results from interaction models indicate that MVM and MVM in combination with CI and/or FVM are associated with the greatest odds of SGA infant and PTB. When incorporating grade, we identified 21 phenotype groups, each with characteristic associations with the SGA infant and patterns of PTB. Discussion: We have developed a comprehensive and meaningful placental phenotype that incorporates severity and multiplicity of placental lesions. We have also developed a web application to facilitate phenotype determination (https://placentaexpression.shinyapps.io/phenotype).

Original languageEnglish (US)
Pages (from-to)337-350
Number of pages14
JournalPediatric and Developmental Pathology
Volume24
Issue number4
DOIs
StatePublished - Aug 2021

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported, in part, by the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (award number F32HD100076 to AAF), National Institute on Minority Health and Health Disparities (award number R01MD011749), and National Center for Advancing Translational Sciences (award number UL1TR001422). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

  • birth weight
  • infant
  • inflammation
  • pathologist
  • placenta
  • premature birth
  • small for gestational age birth

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pathology and Forensic Medicine

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