Obstet Gynecol Sci.  2014 Sep;57(5):358-366. 10.5468/ogs.2014.57.5.358.

The significance of placental ratios in pregnancies complicated by small for gestational age, preeclampsia, and gestational diabetes mellitus

• Kim HS
• Cho SH
• Kwon HS
• Sohn IS
• Hwang HS

• KMID: 2051716
• DOI: http://doi.org/10.5468/ogs.2014.57.5.358

Abstract

OBJECTIVE
This study aimed to evaluate the placental weight, volume, and density, and investigate the significance of placental ratios in pregnancies complicated by small for gestational age (SGA), preeclampsia (PE), and gestational diabetes mellitus (GDM).
METHODS
Two hundred and fifty-four pregnant women were enrolled from August 2005 through July 2013. Participants were divided into four groups: control (n=82), SGA (n=37), PE (n=102), and GDM (n=33). The PE group was classified as PE without intrauterine growth restriction (n=65) and PE with intrauterine growth restriction (n=37). Birth weight, placental weight, placental volume, placental density, and placental ratios including birth weight/placental weight ratio (BPW) and birth weight/placental volume ratio (BPV) were compared between groups.
RESULTS
Birth weight, placental weight, and placental volume were lower in the SGA group than in the control group. However, the BPW and BPV did not differ between the two groups. Birth weight, placental weight, placental volume, BPW, and BPV were all significantly lower in the PE group than in the control group. Compared with the control group, birth weight, BPW, and BPV were higher in the GDM group, whereas placental weight and volume did not differ in the two groups. Placental density was not significantly different among the four groups.
CONCLUSION
Placental ratios based on placental weight, placental volume, placental density, and birth weight are helpful in understanding the pathophysiology of complicated pregnancies. Moreover, they can be used as predictors of pregnancy complications.

Keyword

Birth weight/placental weight ratio; Complicated pregnancies; Placental volume

MeSH Terms

Birth Weight
Diabetes, Gestational*
Female
Gestational Age*
Humans
Parturition
Pre-Eclampsia*
Pregnancy Complications
Pregnancy*
Pregnant Women

Figure

• 

  Fig. 1 Measurement of placental volume. The placental long radius (A), short radius (B), and height (H) were used to calculate the dome-shaped placental volume.

• 

  Fig. 2 Correlation between birth weight and placental weight. The control, small for gestational age (SGA), preeclampsia (PE), and gestational diabetes mellitus (GDM) groups show a positive correlation between birth weight and placental weight. a)The correlation coefficients were r=0.473 in the control group (A), r=0.523 in the SGA group (B), r=0.736 in the PE group (C), and r=0.615 in the GDM group (D) (Pearson's rank correlation test, P<0.01).

• 

  Fig. 3 Correlation between birth weight and placental weight. a)The correlation coefficients were r=0.715 in the preeclampsia (PE) without intrauterine growth restriction (IUGR) group (A) and r=0.736 in the PE with IUGR group (B) (Pearson's rank correlation test, P<0.01).

Reference

1. Vedmedovska N, Rezeberga D, Teibe U, Melderis I, Donders GG. Placental pathology in fetal growth restriction. Eur J Obstet Gynecol Reprod Biol. 2011; 155:36–40.

2. Roberts JM, Lain KY. Recent Insights into the pathogenesis of pre-eclampsia. Placenta. 2002; 23:359–372.

3. Hunt KJ, Schuller KL. The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin North Am. 2007; 34:173–199.

4. Godfrey KM. The role of the placenta in fetal programming: a review. Placenta. 2002; 23:Suppl A. S20–S27.

5. Thame M, Osmond C, Bennett F, Wilks R, Forrester T. Fetal growth is directly related to maternal anthropometry and placental volume. Eur J Clin Nutr. 2004; 58:894–900.

6. Thame M, Osmond C, Wilks R, Bennett FI, Forrester TE. Second-trimester placental volume and infant size at birth. Obstet Gynecol. 2001; 98:279–283.

7. Pietryga M, Biczysko W, Wender-Ozegowska E, Brazert J, Bieganska E, Biczysko R. Ultrastructural examination of the placenta in pregnancy complicated by diabetes mellitus. Ginekol Pol. 2004; 75:111–118.

8. Hwang HS, Cho NH, Maeng YS, Kang MH, Park YW, Kim YH. Differential expression of nestin in normal and pre-eclamptic human placentas. Acta Obstet Gynecol Scand. 2007; 86:909–914.

9. Hwang HS, Kwon HS, Sohn IS, Park YW, Kim YH. Increased CXCL12 expression in the placentae of women with pre-eclampsia. Eur J Obstet Gynecol Reprod Biol. 2012; 160:137–141.

10. Janthanaphan M, Kor-Anantakul O, Geater A. Placental weight and its ratio to birth weight in normal pregnancy at Songkhlanagarind Hospital. J Med Assoc Thai. 2006; 89:130–137.

11. Strom-Roum EM, Haavaldsen C, Tanbo TG, Eskild A. Placental weight relative to birthweight in pregnancies with maternal diabetes mellitus. Acta Obstet Gynecol Scand. 2013; 92:783–789.

12. Bortolus R, Chatenoud L, Di Cintio E, Rossi P, Benzi G, Surace M, et al. Placental ratio in pregnancies at different risk for intrauterine growth. Eur J Obstet Gynecol Reprod Biol. 1998; 80:157–158.

13. Mayhew TM, Manwani R, Ohadike C, Wijesekara J, Baker PN. The placenta in pre-eclampsia and intrauterine growth restriction: studies on exchange surface areas, diffusion distances and villous membrane diffusive conductances. Placenta. 2007; 28:233–238.

14. Di Cianni G, Volpe L, Lencioni C, Miccoli R, Cuccuru I, Ghio A, et al. Prevalence and risk factors for gestational diabetes assessed by universal screening. Diabetes Res Clin Pract. 2003; 62:131–137.

15. Azpurua H, Funai EF, Coraluzzi LM, Doherty LF, Sasson IE, Kliman M, et al. Determination of placental weight using two-dimensional sonography and volumetric mathematic modeling. Am J Perinatol. 2010; 27:151–155.

16. Shehata F, Levin I, Shrim A, Ata B, Weisz B, Gamzu R, et al. Placenta/birthweight ratio and perinatal outcome: a retrospective cohort analysis. BJOG. 2011; 118:741–747.

17. Higgins M, Felle P, Mooney EE, Bannigan J, McAuliffe FM. Stereology of the placenta in type 1 and type 2 diabetes. Placenta. 2011; 32:564–569.

18. Effendi M, Demers S, Giguere Y, Forest JC, Brassard N, Girard M, et al. Association between first-trimester placental volume and birth weight. Placenta. 2014; 35:99–102.

19. Barker DJ, Bull AR, Osmond C, Simmonds SJ. Fetal and placental size and risk of hypertension in adult life. BMJ. 1990; 301:259–262.

20. Williams LA, Evans SF, Newnham JP. Prospective cohort study of factors influencing the relative weights of the placenta and the newborn infant. BMJ. 1997; 314:1864–1868.

21. Lao TT, Wong WM. Placental ratio: its relationship with mild maternal anaemia. Placenta. 1997; 18:593–596.

22. Van der Velde WJ, Treffers PE. Smoking in pregnancy: the influence on percentile birth weight, mean birth weight, placental weight, menstrual age, perinatal mortality and maternal diastolic blood pressure. Gynecol Obstet Invest. 1985; 19:57–63.

23. Lao TT, Tam KF. Placental ratio and anemia in third-trimester pregnancy. J Reprod Med. 2000; 45:923–928.

24. Kovo M, Schreiber L, Ben-Haroush A, Wand S, Golan A, Bar J. Placental vascular lesion differences in pregnancy-induced hypertension and normotensive fetal growth restriction. Am J Obstet Gynecol. 2010; 202:561.e1–561.e5.