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Stereological evaluation of vascular adaptations in human placental villi to differing forms of hypoxic stress
Abstract
The aim was to determine whether the fetal vasculature of the human placenta adapts in a uniform manner to different forms of hypoxic stress. Stereological analyses were performed on the intermediate and terminal villi of placentae obtained from each of the following conditions; high altitude (up to 2800 m), maternal iron-deficiency anaemia and pre-eclampsia. These conditions were taken to represent hypoxic, anaemic and ischaemic hypoxia, respectively. In each situation, there was a trend for the volume fraction of the fetal capillaries to be higher than in the controls, although the differences were statistically significant only for the cases of hypoxic and anaemia hypoxia. This was due, in part, to capillaries being of larger diameter. Evidence for capillary proliferation was inconsistent. At high altitude there was a trend for the capillary length density to be raised, but there was no change in the ratio of capillary:villous length. In both maternal anaemia and pre-eclampsia the capillary length density remained constant, but the ratio of capillary:villous length was significantly raised in the former. These results suggest that dilatation of the capillary sinusoids, with accompanying thinning of the villous membrane, is the principal adaptation to hypoxia under the conditions studied.
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“In all high-altitude populations studied to date, there is increased villous vascularisation as a result of increased vasculogenesis and angiogenesis (7, 78, 176, 509, 532).”
From Placental Origins of Chronic Disease (2016) · cites this paper as [78]
In the citing paper
“This is achieved through selective dilation of the capillary sinusoids at the vasculosyncytial membranes (78), a mechanism that increases placental diffusing capacity but has minimal effects on extracorporeal blood volume and the load on the fetal heart.”
From Placental Origins of Chronic Disease (2016) · cites this paper as [78]
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“Decreased oxygen tension at high altitude stimulates placental blood vessel development (Burton et al., 1996; Mayhew, 2003; Zhang et al., 2002; Tissot van Patot et al., 2003, 2004; Zamudio, 2003), including an increase in fetal capillary density and the number of uteroplacental arteries (Tissot van…”
BackgroundAnatomy and Genesis of the Placenta
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Placental vascular morphogenesis
Jones, D. S., & Burton, G. J. (2000) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1053/beog.2000.0137 · Cited by 96
Self-citationAlterations of Placental Vascular Function in Asthmatic Pregnancies
Clifton, V. L., Giles, W. B., Smith, R., Bisits, A., HEMPENSTALL, P. A. J., Kessell, C. G., & Gibson, P. G. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.164.4.2009119 · Cited by 92
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The gonadotropins: Tissue-specific angiogenic factors?
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“Others have shown that preeclampsia is associated with smaller capillary lengths, but with larger diameters than in control placentas (Burton et al., 1996).”
BackgroundEffect of early maternal iron stores on placental weight and structure
Hindmarsh, P. C., Geary, M. P., Rodeck, C. H., Jackson, M., & Kingdom, J. C. (2000) · The Lancet · doi:10.1016/s0140-6736(00)02630-1 · Cited by 81
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Angiogenesis and placental growth in normal and compromised pregnancies
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“Capillary loops are hypothesised to dilate and remodel laterally under transmural hydrostatic pressure between the fetal and maternal placental circulations (Burton et al. 1996).”
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“Capillary volume represents around 20% of the terminal villi (Burton et al. , 1996; Plitman Mayo et al. , 2016), allowing closer proximity of fetal blood to the maternal blood, and greatly facilitating exchanges.”
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Espinoza, J., Sebire, N. J., McAuliffe, F., Krampl, E., & Nicolaides, K. H. (2001) · Placenta · doi:10.1053/plac.2001.0696 · Cited by 67
Remodelling of Uteroplacental Arteries is Decreased in High Altitude Placentae
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“Placental villi that develop in hypoxic condition show increase share of fetal capillaries, with no specific signs of proliferation and changes are the result of capillary dilatation (18).”
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Image-Based Modeling of Blood Flow and Oxygen Transfer in Feto-Placental Capillaries
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“density and the number of capillaries increased [21].”
BackgroundArchitecture of Normal Villous Trees
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“The conclusion that the diameter of blood vessels increased at high altitude is in agreement with previous studies (Burton et al. 1996; Espinoza et al. 2001).”
BackgroundResultChorangiosis of Chorionic Villi: What Does It Really Mean?
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“Unlike previous reports of improved placental vascularization at high altitude [5,11,22,23,25], our data indicate less capillary volume, and unchanged capillary length density, total length and diameter at 3100 m compared to sea-level.”
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“Many studies have supported the role of maternal hypoxia [1,9]; pregnancy at high altitude was reported to be associated with maternal”
BackgroundAnalysis of the Fetal Placental Vascular Tree by X-ray Micro-computed Tomography
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Hypoxia and Placental Remodelling
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“been reported to be impaired by reduced surface area, reduced capillary length density and/or greater trophoblast thickness ( 9 , 47).”
BackgroundMaternal iron homeostasis: effect on placental development and function
Roberts, H., Bourque, S. L., & Renaud, S. J. (2020) · Reproduction · doi:10.1530/rep-20-0271 · Cited by 36
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“They are maintained in maternal anaemia and preeclampsia (Reshetnikova et al. 1995; Burton et al. 1996) and increased at high altitude (Mayhew et al. 1990; Reshetnikova et al. 1994) and during maternal diabetes (Mayhew et al. 1993b).”
BackgroundLi, Y., Zhao, Y., Zou, Q., Zhang, K. X., Wu, Y., Zhou, C., Wang, K., & Zheng, J. J. (2014) · Journal of Histochemistry & Cytochemistry · doi:10.1369/0022155414558063 · Cited by 29
“In particular, Burton et al. (1996) demonstrated that the placental capillary volume fraction, capillary surface density, and capillary length density were all similar between PE pregnancies and GA-matched (38– 40 weeks) controls, even though 20% of the PE placentas were collected from mild PE…”
BackgroundResultInfluentialDistinct roles of HIF1A in endothelial adaptations to physiological and ambient oxygen
Jiang, Y., Li, Y., Wang, K., Dai, C., Huang, S., Chen, D., & Zheng, J. J. (2014) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2014.04.008 · Cited by 30
Ansari, T. (2003) · Placenta · doi:10.1016/s0143-4004(03)00044-4 · Cited by 29
Early influences on embryonic and placental growth
Robinson, J. S., Hartwich, K. M., Walker, S., Erwich, J., & Owens, J. A. (1997) · Acta Paediatrica · doi:10.1111/j.1651-2227.1997.tb18401.x · Cited by 29
Mild anemia during pregnancy upregulates placental vascularity development
Stangret, A., Skoda, M., Wnuk, A., Pyźlak, M., & Szukiewicz, D. (2017) · Medical Hypotheses · doi:10.1016/j.mehy.2017.03.007 · Cited by 29
“The increased density and the number of capillaries as well as compensatory placental hypertrophy have been reported in anemic women [71,72].”
BackgroundEscudero, C., Puebla, C., Westermeier, F., & Sobrevía, L. (2009) · Current Vascular Pharmacology · doi:10.2174/157016109789043865 · Cited by 28
“A reduction in the total surface and length of the placental capillary [85] or no changes [75, 86] had been detected in pre-eclamptic placenta.”
BackgroundJiang, Y., Wang, K., Li, Y., Dai, C., Wang, P., Kendziorski, C. M., Chen, D., & Zheng, J. J. (2013) · Biology of Reproduction · doi:10.1095/biolreprod.113.108225 · Cited by 27
“For example, at high altitudes, where O2 tension is lower than at sea level, placental villous vascularization is greatly increased in European pregnant women compared with those at sea level [6, 7].”
BackgroundEffects of Developmental Hypoxia on the Vertebrate Cardiovascular System
Galli, G. L. J., Lock, M. C., Smith, K. L. M., Giussani, D. A., & Crossley, D. A. (2022) · Physiology · doi:10.1152/physiol.00022.2022 · Cited by 26
Feto-placental Unit: From Development to Function
Covarrubias, A. E., Aguilera-Olguín, M., Carrasco‐Wong, I., Pardo, F., Díaz-Astudillo, P., & Martín, S. S. (2023) · Advances in experimental medicine and biology · doi:10.1007/978-3-031-32554-0_1 · Cited by 22
Robertson, C. E., & Wilsterman, K. (2020) · Journal of Experimental Biology · doi:10.1242/jeb.215350 · Cited by 21
Fetal growth, high altitude, and evolutionary adaptation: a new perspective
Wilsterman, K., & Cheviron, Z. A. (2021) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00067.2021 · Cited by 19
Villarroel, F., Ponce, N., Gómez, F. A., Muñoz, C., Ramírez, E., Nualart, F., & Salinas, P. (2024) · Reproductive Toxicology · doi:10.1016/j.reprotox.2024.108610 · Cited by 19
Jiang, Y., Wang, K., Li, Y., Dai, C., Wang, P., Kendziorski, C. M., Chen, D., & Zheng, J. J. (2013) · Biology of Reproduction · doi:10.1095/biolreprod.113.110551 · Cited by 16
“In contrast, many diseases associated with endothelial dysfunction such as preeclampsia and atherosclerosis-induced chronic ischemia are often accompanied by an even lower pO2 [10–13].”
Metadata
- Authors
- Burton, G. J., Reshetnikova, O. S., Milovanov, A. P., & Teleshova, O. V.
- Affiliations
- University of Cambridge (GB)
- Luhansk State Medical University (UA)
- Corresponding author
- Burton, G.J.
- Venue
- Placenta
- Publisher
- Elsevier BV
- Published
- 1996-01
- Volume
- 17
- Issue
- 1
- Pages
- 49-55
- ISSN
- 0143-4004 (ISSN-L)
- OpenAlex
- W1967702415
- Cited by
- 149
- References
- 24
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 5 · 2023: 4 · 2022: 2 · 2021: 6 · 2020: 6 · 2019: 3 · 2018: 5 · 2017: 3 · 2016: 6 · 2015: 2 · 2014: 5 · 2013: 5 · 2012: 7
- FWCI
- 8.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Placenta (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Physiology (medical) › High Altitude and Hypoxia
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Keywords
- placental villi, fetal vasculature, hypoxic stress, high altitude, preeclampsia, capillary density, capillary dilation, stereology
- MeSH terms
- Altitude, Hypoxia, Capillaries, Female, Fetus, Humans, Male, Placenta, Pre-Eclampsia, Pregnancy, Pregnancy Complications, Anemia, Iron-Deficiency
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