A recent opinion piece published on September 18 in Trends in Molecular Medicine, a journal from Cell Press, underscores the need for greater clinical utilization of placental pathology, which is often overlooked after childbirth. The authors, a team of physician-scientists, advocate for routine placental evaluations as an integral component of obstetric and neonatal care, emphasizing the necessity for further research in this area.
“Placentas should not be regarded as mere waste tissue,” asserts senior author Mana Parast, MD, PhD, a professor of pathology at the University of California, San Diego School of Medicine.
The placenta plays a vital role in nutrient and waste exchange between the developing fetus and the pregnant individual. When the placenta is compromised by disease, it can adversely affect both the parent and the child during pregnancy and beyond. Severe placental conditions can lead to stillbirths, which is often the scenario in which placentas are clinically examined. However, various placental pathologies are also linked to low birth weight, neurological complications in infants, and maternal health issues such as hypertension (preeclampsia) and other cardiovascular disorders.
“Understanding placental pathology can reveal not only the causes of adverse outcomes for the infant but also provide insights into maternal health implications,” explains Parast, who serves as the director of the perinatal pathology service at UC San Diego Health. “For instance, certain lesions in the placenta, like decidual arteriopathy, may indicate future cardiovascular risks for women, while other lesions could signal the likelihood of recurring issues such as preeclampsia or stillbirth in future pregnancies.”
Furthermore, analyzing the placentas of preterm infants can significantly enhance their immediate care by facilitating the early detection of fungal infections, which typically take days to identify through conventional blood tests.
“Preterm infants in neonatal intensive care units often receive antimicrobial antibiotics to fend off potential bacterial infections, but they are not routinely given antifungal treatments,” Parast notes. “By rapidly examining the placentas for signs of fungal infections, we can promptly inform the NICU team to include antifungal medication in their treatment protocol.”
Despite their potential to provide valuable clinical insights, placentas are frequently underutilized in medical practice. The researchers propose that healthcare providers begin incorporating placental pathology into the management of complicated pregnancies.
“There are hospitals in the U.S. where pathologists examine all placentas, even those from uncomplicated pregnancies. This can lead to additional investigations but requires considerable resources,” Parast explains.
While some associations between placental pathology and health outcomes are understood, many remain ambiguous, and the causes of these placental issues are largely unexplored. As a result, the authors argue that placental research warrants increased funding and should be integrated into prospective clinical trials.
“Including placental evaluations in ongoing clinical trials will yield crucial insights into how different placental lesions relate to both current and future health, as well as the underlying mechanisms of these conditions,” Parast states. “Neglecting placental pathology in these trials would be akin to conducting a cancer study without pathology—essentially proceeding without vital information.”
