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      Current research and evidence gaps on placental development in iron deficiency anemia

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          Abstract

          Studying the effects of maternal iron deficiency anemia (IDA) is complex owing to its diverse causes, each independently impacting the placenta and fetus. Simple treatment with iron supplements does not always resolve the anemia. Therefore, delving into how IDA alters placental development at a molecular level is crucial to further optimize treatment. This review addresses the effects of IDA on placental structures and functions, including changes in oxygen levels, blood vessels, and the immune system. Profound understanding of physiological characteristics and regulatory mechanisms of placental development is key to explain the mechanisms of abnormal placental development in pregnancy-associated disorders. In turn, future strategies for the prevention and treatment of pregnancy complications involving the placenta can be devised. These studies are significant for improving human reproductive health, enhancing sociodemographic qualities, and even lifelong wellbeing, a focal point in future placental research.

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          Mechanisms of early placental development in mouse and humans

          Myriam Hemberger, Courtney Hanna, Wendy Dean (2019)
          The importance of the placenta in supporting mammalian development has long been recognized, but our knowledge of the molecular, genetic and epigenetic requirements that underpin normal placentation has remained remarkably under-appreciated. Both the in vivo mouse model and in vitro-derived murine trophoblast stem cells have been invaluable research tools for gaining insights into these aspects of placental development and function, with recent studies starting to reshape our view of how a unique epigenetic environment contributes to trophoblast differentiation and placenta formation. These advances, together with recent successes in deriving human trophoblast stem cells, open up new and exciting prospects in basic and clinical settings that will help deepen our understanding of placental development and associated disorders of pregnancy.
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            The Impact of Hypoxia in Early Pregnancy on Placental Cells

            Hui. Zhao, Ronald J. Wong, David K. Stevenson (2021)
            Oxygen levels in the placental microenvironment throughout gestation are not constant, with severe hypoxic conditions present during the first trimester. This hypoxic phase overlaps with the most critical stages of placental development, i.e., blastocyst implantation, cytotrophoblast invasion, and spiral artery remodeling initiation. Dysregulation of any of these steps in early gestation can result in pregnancy loss and/or adverse pregnancy outcomes. Hypoxia has been shown to regulate not only the self-renewal, proliferation, and differentiation of trophoblast stem cells and progenitor cells, but also the recruitment, phenotype, and function of maternal immune cells. In this review, we will summarize how oxygen levels in early placental development determine the survival, fate, and function of several important cell types, e.g., trophoblast stem cells, extravillous trophoblasts, syncytiotrophoblasts, uterine natural killer cells, Hofbauer cells, and decidual macrophages. We will also discuss the cellular mechanisms used to cope with low oxygen tensions, such as the induction of hypoxia-inducible factor (HIF) or mammalian target of rapamycin (mTOR) signals, regulation of the metabolic pathway, and adaptation to autophagy. Understanding the beneficial roles of hypoxia in early placental development will provide insights into the root cause(s) of some pregnancy disorders, such as spontaneous abortion, preeclampsia, and intrauterine growth restriction.
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              Prevalence of anemia and sociodemographic characteristics among pregnant and non-pregnant women in southwest China: a longitudinal observational study

              Yu Wu, Hanfeng Ye, Jihong Liu … (2020)
              Background Globally, the prevalence of anemia among women of reproductive age is about 29.4%, and anemia impacts about 40% of pregnant women and more than 20% of non-pregnant women. We conducted a longitudinal observational study of anemia in pregnant and non-pregnant women, and analyzed the association between the prevalence of anemia and sociodemographic characteristics of women in southwest China. Methods This study was a longitudinal observational study which involved 640,672 women aged 18–49 years from 129 counties in southwest China. Data were from databases of National Free Preconception Health Examination Project (NFPHEP) and electronic medical records of local hospitals. We adjusted the diagnostic thresholds of anemia for altitude. The prevalence of anemia was expressed in percentages and 95% confidence intervals (95% CI). The association between the prevalence of anemia and sociodemographic characteristics of pregnant and non-pregnant women were analyzed using univariate and multivariate logistic regression method, expressed in crude odds ratio (cOR), adjusted odds ratio (aOR) and 95%CI. Results Of the 640,672 participants, 121,254 women suffered from anemia, with the prevalence of 18.9% (95%CI: 18.8–19.0%). From 2014 to 2018, the prevalence of anemia declines from 23.0–16.4%.The prevalence was 21.6% in the first trimester, higher than women in non-pregnancy (17.4%) and women in the third trimester (10.5%). Results from the multivariable logistic regression showed that women aged 18–20 (aOR = 1.28) or over 35 years old (aOR = 1.07), being farmers (aOR = 1.42), being ethnic minorities (aOR: 1.19 ~ 1.73), during the first trimester (aOR = 1.32) were more likely to be anemic. Conclusions Although the anemia prevalence of women of reproductive age has been decreasing in recent years, the prevalence of anemia is still high in pregnant and non-pregnant women in southwest China, especially during the first trimester. Women who were older or younger, being farmers, being ethnic minorities were at high risk of anemia. Anemia in women of reproductive age cannot be neglected.
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                Author and article information

                Contributors
                Xueqin Zhang
                Journal
                Journal ID (nlm-ta): Open Life Sci
                Journal ID (iso-abbrev): Open Life Sci
                Journal ID (publisher-id): biol
                Title: Open Life Sciences
                Publisher: De Gruyter
                ISSN (Electronic): 2391-5412
                Publication date (Electronic): 21 February 2024
                Publication date Collection: 2024
                Volume: 19
                Issue: 1
                Electronic Location Identifier: 20220827
                Affiliations
                Department of Obstetrics, School of Medicine, Women and Children’s Hospital, Xiamen University , Xiamen, China
                Article
                Publisher ID: biol-2022-0827
                DOI: 10.1515/biol-2022-0827
                PMC ID: 10921475
                PubMed ID: 38465334
                SO-VID: 4a92cdbf-1198-424f-92fd-229fa40d3902
                Copyright © © 2024 the author(s), published by De Gruyter
                License:

                This work is licensed under the Creative Commons Attribution 4.0 International License.

                History
                Date received : 10 October 2023
                Date revision received : 19 December 2023
                Date accepted : 22 December 2023
                Page count
                Pages: 8
                Categories
                Subject: Review Article

                Keywords: iron deficiency,maternal anemia,placental development,placental-associated disorders
                Data availability:
                Keywords: iron deficiency, maternal anemia, placental development, placental-associated disorders

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