Various factors, such as infections and inflammation, may induce adverse pregnancy outcomes, including preterm birth. Researchers supported by NICHD through the Human Placenta Project are working to develop novel noninvasive imaging technologies to assess placental immune response during pregnancy to better predict and help prevent preterm births.
Monitoring Placental Immune and Inflammatory Responses
Pregnancy losses and preterm birth are the most common adverse pregnancy outcomes. Subclinical (nondetectable) infections during pregnancy trigger intrauterine inflammation that may be linked to preterm birth, stillbirth, and miscarriage. However, the precise mechanisms associated with these adverse pregnancy outcomes are not clearly understood.
In one study, the research team at the Washington University School of Medicine, St. Louis analyzed placental tissue derived from pregnancy losses (miscarriages and stillbirth) and from spontaneous preterm births. They also conducted separate bioinformatic analyses to identify pathogenic molecules and pathways involved in these pregnancies. The researchers found an association between immune inflammatory pathways and the adverse pregnancy outcomes analyzed.
Credit: Placental immune imaging (PII) was used to generate representative, color-coded images of placental immune cellularity at 12, 20, 32, and 36 weeks of gestation over the entire placenta from a normal patient; the images were then superimposed on T2-weighted anatomical images. The team has conducted 206 longitudinal image sequences on 82 patients to establish the typical placental immune responses in healthy full-term pregnancies. This knowledge will aid in identifying and characterizing abnormal placental immune responses associated with maternal conditions such as stillbirth, preterm birth, and preeclampsia.
Credit: Yong Wang, Ph.D.
Using Placental Immune Imaging to Monitor Placental Immune Responses
The same research team is also working to develop a noninvasive technology to assess placental immune response throughout pregnancy. Placental immune imaging (PII) uses nonconventional magnetic resonance imaging (MRI) techniques called diffusion basis spectrum imaging (DBSI) to help obtain measures of systemic inflammation within the placenta. DBSI has already been validated for imaging inflammation in the brain. The research team is further refining this technique for use in monitoring placental inflammation by combining it with assessments of placental tissues and other measures of systemic inflammation.
Initial Research Implications
The researchers hope to identify and differentiate placental immune responses characteristic of healthy term pregnancies, versus immune responses characteristic of high-risk pregnancies. The team also hopes to identify immune markers during pregnancy associated with the hormone progesterone and its role in preterm birth. The long-term goal is to improve the prediction of preterm births and identify effective clinical interventions for preventing this adverse outcome.
Learn more about the team
Principal Investigators:
Learn more about the HPP-funded project:
Applying Diffusion Basis Spectrum Imaging to Characterize Human Placenta Immuno-response during normal term and preterm pregnancies
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