| ObjectiveTo describe the incidence of the small for gestational age in Ma’anshan,and to explore the impact of placental morphological indicators on the risk of the small for gestational age.MethodsWe adapted nested case-control studies,from May 2013 to September 2014,3 474pregnant women between 8-14 weeks of pregnancy and signed informed consent were included in the Ma’anshan-Anhui Birth Cohort(MABC),collected sociodemographic information and pregnancy complications through questionnaires and clinical examination records during pregnancy follow-up,then collected the neonatal physical examination data and placental gross morphological index data through measurement records and clinical excerpts during childbirth.After the end of data collection,166 pairs of cases with small for gestational age were obtained by propensity score matching,and used random sampling SPSS yielded 58 pairs of placental tissue samples.The pathological morphology of the placenta was obtained by HE staining and immunohistochemical analysis of the placenta during the later experiments.Data analysis mainly includes using independent sample t test and chi-square test to described the distribution characteristics of various research factors,logistic regression model to analyzed the relationship between the placental morphological index and the risk of small for gestational age and their gender differences.The independent sample t test and Mann-Whitney U test were used to investigate whether there were statistical differences in the expression of various types of proteins in the placenta between different births.ResultsAmong the 2 309 subjects,the mean of placenta morphological indicators were18.76 cm for length,16.48 cm for width,2.32 cm for thickness,244.08 cm~2 for surface area,and 378.17 cm~3 for volume and all the indicators increased with the increment of newborn birth weight.The results of logistic regression analysis with adjusted confounding factors showed that smaller placenta length(OR=6.85,95%CI:3.58-13.13)and greater placenta length(OR=2.38,95%CI:1.25-4.54)、smaller placenta width(OR=4.59,95%CI:2.62-8.05)and greater placenta width(OR=2.10,95%CI:1.21-3.66)、smaller placenta thickness(OR=3.00,95%CI:1.62-5.57)and greater placenta thickness(OR=1.90,95%CI:1.18-3.04)、smaller chorionic area(OR=4.68,95%CI:2.76-7.95)、smaller placenta volume(OR=6.13,95%CI:3.45-11.23)and greater placenta volume(OR=2.55,95%CI:1.40-4.67)were protective factors for small for gestational age.And after stratified analysis according to the sex of the newborn,the results showed that there was a gender difference in the impact of the general morphological parameters of the placenta on the risk of small for gestational age.The HE staining image showed that the placental tissue in the small for gestational age group was more disorderly arranged,the number of blood sinuses was significantly smaller,and the average blood sinus area was also significantly smaller.Furthermore,the results of immunohistochemical analysis showed that the positive expression rate and average optical density of FKBP52 in the placenta of the small for gestational age group were significantly lower than those of the normal control group,however the positive expression rate and average optical density of HIF1-αin the placenta of the small for gestational age group were significantly higher than that of the normal control group,and the differences in the expression of ALKBH5,FGF21 and VEGF-C proteins in the placental tissues of the two groups were not statistically significant.ConclusionThe gross morphological index of placenta is closely related to the occurrence of the small for gestational age,and there is a gender difference in the influence of the indexes on the occurrence risk of the small for gestational age.In addition,there were significant changes in the pathological morphology of the placenta tissues of the small for gestational age,and there were also significant differences in the expression of some placental proteins. |
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