Physician-scientists emphasize that since many placentas are thrown away post-birth, the study of placental diseases is often overlooked in medical practice. They believe it should become a standard part of care for expectant and newborn patients while also calling for more research in this area.
In an opinion piece published on September 18 in the Cell Press journal Trends in Molecular Medicine, physician-scientists stress that since most placentas are disposed of after childbirth, the clinical examination of placental pathology is often neglected. They advocate for it to be a routine aspect of obstetrics and neonatology, and urge for increased research in this field.
“Placentas should not be seen as waste material,” states Mana Parast, MD, PhD, a professor of pathology at the University of California San Diego School of Medicine and the senior author of the article. “They can provide valuable insights about the problems encountered during a pregnancy and help us understand implications for future pregnancies, benefiting the health of both the mother and child.”
The placenta plays a vital role in managing the transfer of nutrients and waste between the developing fetus and the mother. When the placenta is affected by disease, it can lead to complications for both the mother and child during pregnancy and beyond. Serious placental issues can sometimes result in stillbirth, which is when placentas are most commonly examined. However, various placental conditions can also be linked to low birth weight and developmental issues in infants, as well as high blood pressure (preeclampsia) and cardiovascular problems in mothers.
“Studying placental pathology can help not only explain adverse outcomes for babies but also provide insights into maternal health and future risks,” explains Parast, a perinatal pathologist and director of the perinatal pathology service at UC San Diego Health. “For instance, we are discovering that a specific placental condition known as decidual arteriopathy may signal a risk for cardiovascular diseases in women. Other placental issues can indicate whether problems like preeclampsia or stillbirth might occur again in future pregnancies.”
Investigating the placentas of premature infants can contribute to their care by swiftly identifying fungal infections that usually require days to diagnose.
“Preterm infants in the neonatal intensive care unit routinely receive antibiotics to prevent bacterial infections due to their weak immune systems, but they often do not receive antifungal treatment,” observes Parast. “While culturing blood for fungal infections can be time-consuming, examining the placentas of preterm babies quickly can help us notify the NICU team to start antifungal treatment right away.”
Despite their potential to provide significant information, placentas are not frequently utilized in clinical settings. The researchers recommend that clinicians integrate placental pathology assessments into the management of complex pregnancies.
“There are hospitals in the United States where every placenta is assessed by pathologists—even those from uncomplicated pregnancies. Such evaluations can sometimes lead to further testing, but this approach requires substantial resources,” notes Parast.
While some placental disease patterns are understood, many others remain shrouded in mystery, and the reasons behind these conditions are largely unknown. The researchers contend that placental research warrants increased funding and must be included in upcoming clinical trials.
“By incorporating placental assessments into ongoing clinical studies, we can gain greater insights into how different placental conditions affect maternal and child health as well as the underlying mechanisms involved,” adds Parast. “Failing to include placental pathology in these trials would be like conducting a cancer study without examining the pathology—it would be utterly blind.”
