title: Maternal perception of reduced fetal movements is associated with altered placental structure and function.
abstract: BACKGROUND
  Maternal perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). DFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency. To date there have been no studies of placental structure in cases of DFM.
  
  
  OBJECTIVE
  To determine whether maternal perception of reduced fetal movements (RFM) is associated with abnormalities in placental structure and function.
  
  
  METHODS
  Placentas were collected from women with RFM after 28 weeks gestation if delivery occurred within 1 week. Women with normal movements served as a control group. Placentas were weighed and photographs taken. Microscopic structure was evaluated by immunohistochemical staining and image analysis. System A amino acid transporter activity was measured as a marker of placental function. Placentas from all pregnancies with RFM (irrespective of outcome) had greater area with signs of infarction (3.5% vs. 0.6%; p<0.01), a higher density of syncytial knots (p<0.001) and greater proliferation index (p<0.01). Villous vascularity (p<0.001), trophoblast area (p<0.01) and system A activity (p<0.01) were decreased in placentas from RFM compared to controls irrespective of outcome of pregnancy.
  
  
  CONCLUSIONS
  This study provides evidence of abnormal placental morphology and function in women with RFM and supports the proposition of a causal association between placental insufficiency and RFM. This suggests that women presenting with RFM require further investigation to identify those with placental insufficiency.
authors.affiliation: School of Biomedicine, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Lynne K
authors.initials: LK
authors.lastname: Warrander
authors.forename: Gauri
authors.initials: G
authors.lastname: Batra
authors.forename: Giovanna
authors.initials: G
authors.lastname: Bernatavicius
authors.forename: Susan L
authors.initials: SL
authors.lastname: Greenwood
authors.forename: Philip
authors.initials: P
authors.lastname: Dutton
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Jones
authors.forename: Colin P
authors.initials: CP
authors.lastname: Sibley
authors.forename: Alexander E P
authors.initials: AE
authors.lastname: Heazell
mesh_terms: D000293:Adolescent; D000328:Adult; D026924:Amino Acid Transport System A / Q000378:metabolism; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology*; D005324:Fetal Movement; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D010465:Perception; D010920:Placenta / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology*; D011247:Pregnancy
chemical_list: D026924:Amino Acid Transport System A