title: An immunologic basis for placental insufficiency in fetal growth restriction.
abstract: OBJECTIVE
  We sought to determine whether chronic villitis, an immunologic disease of the placenta, was related to fetal growth restriction.
  
  
  METHODS
  Beginning in October 1999, a protocol was instituted that required placentas of high-risk births be submitted for standardized histological examination. Chronic villitis was diagnosed when a lymphohistiocytic infiltrate involving placental villi was present and was graded according to the extent and location of the infiltrate. Fetal growth restriction was defined as weight less than 3rd, 5th, and 10th percentiles. Placental hypoplasia was defined as weight less than 10th percentile.
  
  
  RESULTS
  In the 10,204 placental examinations that were performed, low-grade and high-grade chronic villitis was associated with hypoplastic placentas and fetal growth restriction. Infants with placentas with low-grade and high-grade chronic villitis were more likely to require cesarean delivery for nonreassuring fetal heart rate compared with controls (27% and 25% versus 21%; p < 0.05). Fetal acidemia (umbilical artery pH < 7.0) was associated with high-grade chronic villitis compared with controls (4% versus 2%; p < 0.05).
  
  
  CONCLUSIONS
  Chronic villitis was associated with anatomic and functional placental insufficiency manifested as placental hypoplasia, growth restriction, increased risk of cesarean for nonreassuring fetal heart rate, and fetal acidemia. These findings support an immunologic basis for fetal growth restriction.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: Laura G
authors.initials: LG
authors.lastname: Greer
authors.forename: Mandolin S
authors.initials: MS
authors.lastname: Ziadie
authors.forename: Brian M
authors.initials: BM
authors.lastname: Casey
authors.forename: Beverly B
authors.initials: BB
authors.lastname: Rogers
authors.forename: Donald D
authors.initials: DD
authors.lastname: McIntire
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Leveno
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data; D002824:Chorionic Villi / Q000276:immunology* / Q000473:pathology; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology / Q000276:immunology*; D005865:Gestational Age; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D010298:Parity; D010922:Placenta Diseases / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology; D010927:Placental Insufficiency / Q000453:epidemiology / Q000276:immunology*; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors