Journal of Pediatric Neurology 2017; 15(01): 070-072
DOI: 10.1055/s-0036-1597911
Book Review
Georg Thieme Verlag KG Stuttgart · New York

The Placenta and Neurodisability

Alfredo Pinto-Rojas
1   Department of Pathology and Laboratory Medicine (Paediatric Pathology [APR] and Neuropathology [HBS]), University of Calgary Cumming School of Medicine and Alberta Children's Hospital, Calgary, Alberta, Canada
,
Harvey B. Sarnat
1   Department of Pathology and Laboratory Medicine (Paediatric Pathology [APR] and Neuropathology [HBS]), University of Calgary Cumming School of Medicine and Alberta Children's Hospital, Calgary, Alberta, Canada
2   Department of Paediatrics, University of Calgary Cumming School of Medicine and Alberta Children's Hospital, Calgary, Alberta, Canada
3   Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine and Alberta Children's Hospital, Calgary, Alberta, Canada
› Author Affiliations
Further Information

Publication History

21 November 2016

22 November 2016

Publication Date:
04 January 2017 (online)

Crocker I, Bax M, eds. The Placenta and Neurodisability. 2nd ed. London, UK: Mac Keith Press; 2016 (172 pp). ISBN: 978-1898683445

This is a well-written book by internationally recognized authorities in the field. It displays state-of-the-art knowledge in placental pathology relevant to brain injury, clarifies misconceptions, and also emphasizes how much remains unknown about this topic and the need for further research to validate interpretations and evolve new concepts.

Chapter 1 is a comprehensive review of the pathophysiology of lesions and histologic criteria to identify these pathologic lesions in the placenta. Different pathologic lesions corresponding to gestational age are related to increased risk of injury to the central nervous system (CNS). Most studies have shown that CNS injury is associated with multiple placental lesions (mixed pathology). Chapters 2 and 3 are devoted to the development of placental function during pregnancy. The pathophysiology of the complex system of nutrients that cross the placenta is reviewed, and the need is discussed for developing biomarkers to test placental structure and function in utero to improve diagnosis of complications in pregnancy. Magnetic resonance imaging (MRI) is a promising tool to evaluate placental dysfunction. The regulation and signaling of hormones from maternal and placental sources in the development of the fetal brain at different stages of gestational age are discussed. Because the mechanisms for association of placental dysfunction with impaired fetal growth and neurologic disabilities are still unclear, further studies are needed to clarify the consequences of disrupted hormonal production in pregnancy and its subsequent impact on brain development.

Chapter 4 reviews current knowledge about molecular mechanisms and complex physiologic concepts of the hemodynamics of vascular interactions between uteroplacental and fetoplacental blood flow at various gestational ages. Current methodology (U/S) to assess placental blood flow can be misleading; hence new methods are needed to clarify the impact of alterations in uteroplacental and fetoplacental blood flow during development. Chapter 5 discusses what is known about the complexities of the maternal immune system and secreted factors in creating placental tolerance and pregnancy maintenance. Chapter 6 reviews the fetal immune system during pregnancy and in response to pathogenetic stimuli directly and indirectly as a result of maternal inflammatory response. The consequences of inflammation in fetal life for both the immediate neonatal period and the long-term well-being of a child are also reviewed.

Chapter 7 addresses fetal brain injury, particularly to white matter, as a consequence of ischemia in relation to defective placental circulation, including electrophysiologic (electroencephalogram [EEG]) and ultrasound imaging perspectives. Fetal MRI is not discussed and neuropathological studies are mentioned only briefly. Chapter 8 discusses imaging of the placenta in utero, mainly using ultrasound. Chapter 9 relates fetal growth and intrauterine growth restriction of the fetus to placental abnormalities and includes a discussion of clinical markers, such as lactate peaks by MR spectroscopy, for more precise prenatal diagnosis. Chapter 10 is a bit speculative in attempting to relate placental events to programming of brain development and later schizophrenia, but it presents some provocative evidence. Chapter 11 addresses a variety of therapeutic measures to minimize adverse influences on the fetus, including medications such as steroids and antibiotics, as well as temperature control and other physical factors. The final Chapter 12 is a summary statement and an attempt to identify promising areas of future research to solve the many pending problems and unanswered questions about placental impact on fetal growth and development.

In general, the book is well organized, has an excellent list of both classic and current references accompanying each chapter, and is well illustrated. It is a valuable asset to pediatric pathologists, perinatologists, fetal neurologists, fetal radiologists, and others with an interest in fetal development, particularly from neurologic and pathologic perspectives.