Keywords
placenta
IUGR
CMV
Abstract
The placenta is considered the first interface between mother and fetus, and a normal placenta is essential for pregnancy without complications. IUGR is considered the most common condition recognized in complicated pregnancy and accounts for 26% or more of stillbirth. The current study aims to explore the presence of IUGR and placental angiogenesis by investigating the expression of VEGF and eNOS in both placenta of IUGR of CMV-infected mother and placenta of normal mother in relation to awareness of CMV in Iraqi women.
The expressions of VEGF and e NOS was studied using the avidin-biotin-peroxidase technique, while awareness was studied using 10-minute surveys in Al-Karkh directorate (Baghdad) to investigate their knowledge of CMV infection in relation to the level of education and economic status.
The expression of angiogenic factors (VEGF, eNOS) was significant in syncitiotrophoblasts, smooth muscle cells and corionic villous stromal cells, and was significant in unaware, low-educated women with low income. Increased expression of angiogenic factors of IUGR babies may be a result of unawareness of CMV infection, which leads to dysregulation of angiogenic factors, and, subsequently, to inadequate placental vascularization.
References
1. Njue A, Coyne C, Margulis AV, Wang D, Marks MA, Russell K, et al. The role of congenital cytomegalovirus infection in adverse birth outcomes: A review of the potential mechanisms. Viruses. 2021;13:20.
2. Patro ARK. Subversion of immune response by human cytomegalovirus. Front Immunol. 2019;10:1155.
3. Zuhair M, Smit GSA, Wallis G, Jabbar F, Smith C, et al. Estimation of the worldwide seroprevalence of cytomegalovirus: A systematic review and meta-analysis. Rev Med Virol. 2019;29:e2034.
4. Saldan A, Forner G, Mengoli C, Gussetti N, Palu G, Abate D. Testing for cytomegalovirus in pregnancy. J Clin Microbiol. 2017;55:693-702.
5. Fisher S, Genbacev O, Maidji E, Pereira L. Human cytomegalovirus infection of placental cytotrophoblasts in vitro and in utero: Implications for transmission and pathogenesis. J Virol. 2000;74: 6808-20.
6. Maltepe E, Fisher SJ. Placenta: the forgotten organ. Ann Rev Cell Dev Biol. 2015;31:523-52.
7. Resnik R, Lockwood CJ, Moore T, Greene MF, Copel JA, Silver RM. Creasy and Resnik’s maternal-fetal medicine: principles and practice. 8th ed. Philadelphia: Elsevier; 2019.
8. Hustin J, Schaaps JP. Echographic [corrected] and anatomic studies of the maternotrophoblastic border during the first trimester of pregnancy. Am J Obstet Gynecol. 1987;157:162-8.
9. Jauniaux E, Watson AL, Hempstock J, Bao YP, Skepper JN, Burton GJ. Onset of maternal arterial blood flow and placental oxidative stress. A possible factor in human early pregnancy failure. Am J Pathol. 2000;157:2111-22.
10. Castellucci M, Scheper M, Scheffen I, Celona A, Kaufmann P. The development of the human placental villous tree. Anat Embryol (Berl). 1990;181:117-28.
11. Kaufmann P, Mayhew TM, Charnock-Jones DS. Aspects of human fetoplacental vasculogenesis and angiogenesis. II. Changes during normal pregnancy. Placenta. 2004;25:114-26.
12. Ahmed A, Perkins J. Angiogenesis and intrauterine growth restriction. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14: 981-98.
13. Frater JL, Kay NE, Goolsby CL, Crawford SE, Dewald GW, Peterson LC. Dysregulated angiogenesis in B-chronic lymphocytic leukemia: Morphologic, immunohistochemical, and flow cytometric evidence. Diagn Pathol. 2008;3:16.
14. Cannon MJ. Congenital cytomegalovirus (CMV) epidemiology and awareness. J Clin Virol. 2009;46:6-10.
15. Tastad KJ, Schleiss MR, Lammert SM, Basta NE. Awareness of congenital cytomegalovirus and acceptance of maternal and newborn screening. PLoS ONE. 2019;14(8):e0221725.
16. Thackeray R, Magnusson BM. Women’s attitudes toward practicing cytomegalovirus prevention behaviors. Prev Med Rep. 2016;4:517-24.
17. Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121-6.
18. Jeon J, Victor M, Adler SP, Arwady A, Demmler G, Fowler K, et al. Knowledge and awareness of congenital cytomegalovirus among women. Infect Dis Obstet Gynecol. 2006;2006:80383.
19. Galan HL, Pandipati S, Filly RA. Ultrasound evaluation of fetal biometry and normal and abnormal fetal growth . In: Ultrasonography in obstetrics and gynecology. 5th edition. Edited by Callen PW. USA: Saunders Elsevier; 2008: 225-65.
20. Al-kaabi M, Noel KI, Al-rubai A. Evaluation of immunohistochemical expression of stem cell markers (NANOG and CD133) in normal, hyperplastic, and malignant endometrium. J Med Life. 2022;15(1):117-23.
21. Hameed AF, Ibraheem MM, Ahmed BS. C-MYC and BCL2 expression in normal tissue around proliferative breast conditions in relation to ER, PR in a sample of Iraqi women. UKJPB. 2018;6(3):1-6.
22. Pereira L, Maidji E. Cytomegalovirus infection in the human placenta: Maternal immunity and developmentally regulated receptors on trophoblasts converge. Curr Top Microbiol Immunol. 2008;325:383-95.
23. Weisblum Y, Panet A, Haimov-Kochman R, Wolf DG. Models of vertical cytomegalovirus (CMV) transmission and pathogenesis. Semin Immunopathol. 2014;36:615-25.
24. Barut F, Barut A, Gun BD, Kandemir NO, Harma MI, Harma M, et al. Intrauterine growth restriction and placental angiogenesis. Diagnostic Pathology. 2010;5:24.
25. Weckman AM, Ngai M, Wright J, McDonald CR, Kain KC. The Impact of infection in pregnancy on placental vascular development and adverse birth outcomes. Front Microbiol. 2019;10:1924.
26. Wang Y, Zhao S. Vascular biology of the placenta. San Rafael: Morgan & Claypool Life Sciences; 2010.
27. Demir R, Seval Y, Huppertz B. Vasculogenesis and angiogenesis in the early human placenta. Acta Histochem. 2007;109:257-65.
28. Kinzler WL, Vintzileos AM. Fetal growth restriction. Curr Opin Obstet Gynecol. 2008;2:125-31.
29. Mayhew TM, Charnock-Jones DS, Kaufmann P. Aspects of human fetoplacental vasculogenesis and angiogenesis. III. Changes in complicated pregnancies. Placenta. 2004;25:127-39.
30. Ferrara N. Vascular endothelial growth factor: Basic science and clinical progress. Endocrine Rev. 2004;25(4):581-611.
31. Searles CD. Transcriptional and posttranscriptional regulation of endothelial nitric oxide synthase expression. Am J Physiol Cell Physiol. 2006;291:C803-C16.
32. Lyall F, Young A, Boswell F, Kingdom JCP, Greer IA. Placental expression of vascular endothelial growth factor in placentae from pregnancies complicated by pre-eclampsia and intrauterine growth restriction does not support placental hypoxia at delivery. Placenta. 1997;18:269-76.
33. Noris M, Todeschini M, Cassis P, Pasta F, Cappellini A, Bonazzola S. L-arginine depletion in preeclampsia orients nitric oxide synthase toward oxidant species. Hypertension. 2004;43:614-22.
34. Jeon J, Victor M, Adler S, Arwady A, Demmler G, Fowler K, et al. Knowledge and awareness of congenital cytomegalovirus among women. Infect Dis Obstet Gynecol. 2006;2006:80383.
35. Doutre SM, Barrett TS, Greenlee J, White KR. Losing ground: Awareness of congenital cytomegalovirus in the United States. JHEDI. 2016;1(2):39-48
36. Aljumaili ZKM, Alsamarai AM, Najem WS. Cytomegalovirus seroprevalence in women with bad obstetric history in Kirkuk, Iraq. J Infect Public Health. 2014;7(4):277-88.
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