Maternal Nutrition in Early Pregnancy Effects Placental Development

Background: Recent experimental and clinical studies have identified maternal malnutrition at conception or during early period of gestation as an important factor determining the fetal growth as early as the first trimester of pregnancy. Placenta is a transient embryonic organ of communication between mother and fetus during pregnancy and is the only source of nutrient transfer to the fetus. Hence its proper development is essential for fetal growth and development right from embryonic stages of development. Objectives: To assess and compare the placental morphology by measuring the villous structure, vascular endothelial growth factor (VEG F) and placental growth factor (PLGF) expression from placental tissue at 7-10 weeks of gestation of low socioeconomic status (LSES) and high socioeconomic status (HSES) groups, in relation to their nutritional status. Materials: Placental tissue samples obtained at 7-10 weeks of gestation from healthy women undergoing medical termination of pregnancy constituted the study material. Methodology: A total of 99 placental tissue samples, 59 from LSES and 40 from HSES groups were examined to assess the morphology of placental villi and also stained for VEG F and PLGF expression. Nutritional status of the subjects was measured by recording weight, height and hemoglobin, serum retinol, serum zinc and folic acid using standard methods. Results: Women belonging to both the income groups were of comparable to age. Body Mass Index (BMI) was significantly lower (P < 0.001) in the LSES group. Hemoglobin concentrations were significantly (P < 0.05) more in HSES groups when compared to LSES group. Hematoxylin-eosin stained placental tissue sections showed that number of floating villi (P < 0.001), villous vascular density (P < 0.001), central disposition of blood vessels (P < 0.05) and syncytial sprouts (SS) (P < 0.05) were significantly higher in the LSES group. While the intensity of staining for VEGF was higher, the decidual vascular density was significantly (P < 0.05) lower in the LSES group. Serum retinol, folic acid and zinc of both groups were within normal range and comparable. Conclusion: The significant disparity in placental morphology observed in this study between LSES and HSES groups at a comparable gestational period is interesting and suggestive of predominant hypoxemic placental development under the stress of under nutrition.