title: Maternal obesity and sex-specific differences in placental pathology.
abstract: OBJECTIVE
  Adverse effects of obesity have been linked to inflammation in various tissues, but studies on placental inflammation and obesity have demonstrated conflicting findings. We sought to investigate the influence of pregravid obesity and fetal sex on placental histopathology while controlling for diabetes and hypertension.
  
  
  METHODS
  Placental histopathology focusing on inflammatory markers of a cohort of normal weight (BMI = 20-24.9) and obese (BMI ≥ 30) patients was characterized. Demographic, obstetric and neonatal variables were assessed.
  
  
  RESULTS
  192 normal and 231 obese women were included. Placental characteristics associated with obesity and fetal sex independent of diabetes and hypertension were placental disc weight >90(th) percentile, decreased placental efficiency, chronic villitis (CV), fetal thrombosis, and normoblastemia. Additionally, female fetuses of obese mothers had higher rates of CV and fetal thrombosis. Increasing BMI increased the risk of normoblastemia and CV. The final grade and extent of CV was significantly associated with obesity and BMI, but not fetal gender. Finally, CV was less common in large-for-gestation placentas.
  
  
  CONCLUSIONS
  Maternal obesity results in placental overgrowth and fetal hypoxia as manifested by normoblastemia; it is also associated with an increased incidence of CV and fetal thrombosis, both more prevalent in female placentas. We have shown for the first time that the effect of maternal obesity on placental inflammation is independent of diabetes and hypertension, but significantly affected by fetal sex. Our data also point to the intriguing possibility that CV serves to normalize placental size, and potentially fetal growth, in the setting of maternal obesity.
authors.affiliation: Department of Reproductive Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Leon-Garcia
authors.affiliation: Department of Reproductive Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Roeder
authors.affiliation: Department of Pathology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
authors.forename: Katharine K
authors.initials: KK
authors.lastname: Nelson
authors.affiliation: Department of Pathology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Liao
authors.affiliation: Department of Pathology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Pizzo
authors.affiliation: Department of Reproductive Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
authors.forename: Louise C
authors.initials: LC
authors.lastname: Laurent
authors.affiliation: Department of Pathology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
authors.forename: Mana M
authors.initials: MM
authors.lastname: Parast
authors.affiliation: Department of Reproductive Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA. Electronic address: dlacoursiere@ucsd.edu.
authors.forename: D Yvette
authors.initials: DY
authors.lastname: LaCoursiere
mesh_terms: D000328:Adult; D001724:Birth Weight / Q000502:physiology; D015992:Body Mass Index; D005260:Female; D047109:Fetal Development / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation / Q000150:complications / Q000473:pathology; D008297:Male; D009765:Obesity / Q000473:pathology*; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology*; D012727:Sex Characteristics
keywords: Chronic villitis; Fetal vascular thrombosis; Maternal obesity; Placental pathology