Placental Nutrient Transport and Intrauterine Growth Restriction - PubMed (original) (raw)

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Placental Nutrient Transport and Intrauterine Growth Restriction

Francesca Gaccioli et al. Front Physiol. 2016.

Abstract

Intrauterine growth restriction refers to the inability of the fetus to reach its genetically determined potential size. Fetal growth restriction affects approximately 5-15% of all pregnancies in the United States and Europe. In developing countries the occurrence varies widely between 10 and 55%, impacting about 30 million newborns per year. Besides having high perinatal mortality rates these infants are at greater risk for severe adverse outcomes, such as hypoxic ischemic encephalopathy and cerebral palsy. Moreover, reduced fetal growth has lifelong health consequences, including higher risks of developing metabolic and cardiovascular diseases in adulthood. Numerous reports indicate placental insufficiency as one of the underlying causes leading to altered fetal growth and impaired placental capacity of delivering nutrients to the fetus has been shown to contribute to the etiology of intrauterine growth restriction. Indeed, reduced expression and/or activity of placental nutrient transporters have been demonstrated in several conditions associated with an increased risk of delivering a small or growth restricted infant. This review focuses on human pregnancies and summarizes the changes in placental amino acid, fatty acid, and glucose transport reported in conditions associated with intrauterine growth restriction, such as maternal undernutrition, pre-eclampsia, young maternal age, high altitude and infection.

Keywords: amino acids; fetal growth; glucose; lipids; nutrient allocation; placental insufficiency.

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Figures

Figure 1

Figure 1

The human placenta at term. Right: a schematic cross-section of the human term placenta with the fetal circulation in umbilical cord and chorionic villi, while maternal blood pools in the intervillous space. Left: representation of the placental barrier, which includes the syncytiotrophoblast layer and the fetal capillary endothelial cells. The two polarized syncytiotrophoblast plasma membranes, the microvillous plasma membrane (MVM) and the basal plasma membrane (BM) are indicated. Modified illustration from Nordisk Nutrition (Lager, 2013), re-printed with permission.

Figure 2

Figure 2

Maternal and environmental conditions associated with IUGR. Several maternal/environmental conditions are associated with placental insufficiency and decreased delivery of nutrients to the developing fetus. Net placental transport is determined by multiple factors, such as uteroplacental and umbilical blood flows, placental exchange area and metabolism, as well as the activity and expression of placental nutrient transporters.

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