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The Placenta as a Window to Maternal Vascular Health

W. Tony Parks, MDa, Janet M. Catov, PhD, MSb,c,d,*

KEY POINTS

 

 The placenta is evaluated to understand fetal health, and emerging evidence indicates that maternal vascular malperfusion (MVM) features may provide clues to women’s later life cardiovascular risk.

 Pathologic changes that directly involve the maternal vascular supply to the placenta, collectively termed decidual vasculopathy, develop early in gestation, and their effects on maternal blood flow to the placenta may be etiologic for the other MVM findings.

 A second group of MVM lesions includes those entities that likely arise subsequently in the pregnancy as a result of hypoxic/ischemic injury and oxidative damage to the placenta (small placental size, villous infarction, retroplacental hemorrhage, accelerated villous maturation, and distal villous hypoplasia).

 MVM lesions are detected in each of the great obstetric syndromes, and emerging evidence suggests that decidual vasculopathy may be linked to future pregnancy complications, maternal dyslipidemia, higher blood pressure, and increased vascular resistance years after delivery.

 Identification of the mechanisms leading to decidual vasculopathy may improve pregnancy health and contribute new sex-specific insights regarding the etiology of cardiovascular disease in women.

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