title: The perinatal origins of major reproductive disorders in the adolescent: Research avenues.
abstract: The fetal endometrium becomes responsive to steroid hormones around the fourth month of pregnancy starting with an oestrogenic phase, which is followed late in pregnancy by a secretory phase. Based on post-mortem studies, the endometrium at birth is secretory in only one-third of neonates and proliferative in the remaining cases. Decidual or menstrual changes are rare in fetal endometrium despite high circulating steroid hormone levels, which drop rapidly after birth. Hence, acquisition of progesterone responsiveness appears to be dependent on endometrial maturation and relative immaturity may persist in a majority of girls until the menarche and early adolescence. Two major reproductive disorders have been linked with either advanced or delayed endometrial maturation. First, early-onset endometriosis may be caused by menstruation-like bleeding in the neonate, leading to tubal reflux and ectopic implantation of endometrial stem/progenitor cells. Second, persistence of partial progesterone resistance in adolescent girls may compromise deep placentation and account for the increased risk of major obstetrical syndromes, including preeclampsia, fetal growth retardation and preterm birth. The concept of neonatal origins of common reproductive disorders poses important research challenges but also subsumes potential new preventative strategies.
authors: Leuven Institute for Fertility and Embryology, Tiensevest 168, B-3000 Leuven, Belgium. Electronic address: ivo.brosens@med.kuleuven.be.
authors: I
authors: I
authors: Brosens
authors: Department of Gynecology and Obstetrics, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
authors: A
authors: A
authors: Ćurčić
authors: Department of Gynecology and Obstetrics, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
authors: T
authors: T
authors: Vejnović
authors: The Ritchie Centre, MIMR-PHI Institute of Medical Research, Clayton 3168, Australia; Department of Obstetrics and Gynecology, Monash University, Clayton 3168, Australia.
authors: C E
authors: CE
authors: Gargett
authors: The Division of Reproductive Health, Warwick Medical School, Coventry CV2 2DX, United Kingdom.
authors: J J
authors: JJ
authors: Brosens
authors: Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy.
authors: G
authors: G
authors: Benagiano
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine / Q000639:trends; D000818:Animals; D035843:Biomedical Research / Q000639:trends; D004715:Endometriosis / Q000151:congenital* / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D004717:Endometrium / Q000276:immunology / Q000378:metabolism*; D005260:Female; D047109:Fetal Development; D005831:Genital Diseases, Female / Q000151:congenital / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D008954:Models, Biological; D010500:Perinatology / Q000639:trends; D010929:Placentation; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology* / Q000276:immunology / Q000378:metabolism / Q000517:prevention & control; D011374:Progesterone / Q000378:metabolism*; D018456:Reproductive Medicine / Q000639:trends
chemical_list: D011374:Progesterone
keywords: Endometriosis; Endometrium; Neonatal uterine bleeding; Obstetrical disorders; Progesterone resistance