Placenta underlies reduced fetal movement

Jul 23 2012

By Piriya Mahendra

Poor perinatal outcome after the maternal perception of reduced fetal movement (RFM) is linked to factors associated with placental dysfunction, say experts.

Alexander Heazell (University of Manchester, UK) and co-authors found that 22.1% of 305 pregnant women who presented with RFM after 28 weeks of gestation had poor perinatal outcomes.

Of these, seven (4.1%) were preterm (<37 weeks' gestation), two (0.7%) term infants were admitted to a neonatal intensive care unit, 51 (16.8%) were small for gestational age at term (birthweight <10th centile), and seven (2.3%) were small for gestational age and preterm.

The concentrations of human chorionic gonadotropin (hCG), human placental lactogen (hPL), and progesterone were significantly lower in women who had poor perinatal outcomes following RFM than those with normal outcomes.

Indeed, compared with women who had normal perinatal outcomes, those with poor perinatal outcomes had a serum hCG concentration of 12,500 mIU/mL versus 17,500 mIU/mL, a hPL concentration of 320 mg/mL versus 390 mg/mL, and a progesterone concentration of 370 ng/mL versus 390 ng/mL.

Further analysis of a group of 55 women from the cohort who gave birth within 1 week of their serum samples being collected showed a significant positive correlation between placental weight and hPL and progesterone. However, there was no significant association between placental weight and hCG.

Multivariate analysis showed that diastolic blood pressure (60 mmHg), estimated fetal weight centile (53rd), and log [hPL] (2.54) were significant predictors for poor perinatal outcome, at adjusted odds ratios of 1.04, 0.95, and 0.13, respectively.

In addition, an hPL value of less than one standard deviation below the mean for any given gestation was associated with poor pregnancy outcome, at an odds ratio of 4.91.

Pregnancies with RFM have altered placental structure and function, including increased infarction, reduced vascularity, and reduced neutral amino acid transport, say the authors in PLoS One. "The relationship between diastolic blood pressure, estimated fetal weight centile, log [hPL], and poor perinatal outcome after RFM is likely to relate to their association with placental dysfunction," they add.

Heazell and team note that a pilot study to determine the feasibility of ultrasound fetal assessment in combination with evaluation of placental function to direct the management of RFM is underway.

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