Researchers of the National Institutes of Health’s Perinatology Research Branch at the Wayne State University School of Medicine have proposed the need for a new taxonomy of obstetric diseases that considers the results of biomarkers found through placental examinations rather than simply the symptoms physicians now rely upon.
Published in The American Journal of Obstetrics and Gynecology, “Toward a new taxonomy of obstetrical disease: Improved performance of maternal blood biomarkers for the great obstetrical syndromes when classified according to placental pathology” demonstrates that the performance of biomarkers improves if the results of placental pathology are taken into account.
“We have found that the classification of obstetrical syndromes according to the presence or absence of placental lesions of maternal vascular malperfusion allowed biomarkers to be informative earlier in gestation, and enhanced the strength of association between biomarkers and clinical outcomes,” said Roberto Romero, M.D., DMedSci, chief of the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Perinatology Research Branch and professor of Molecular Obstetrics and Genetics at the School of Medicine. “We have proposed that this new taxonomy of obstetrical disorders will facilitate the discovery and implementation of biomarkers and the prediction and prevention of such disorders.”
Maternal vascular malperfusion, or MVM, develops when normal healthy blood flow to the placenta is interrupted or impeded, which can form placental lesions. The lesions are indicative of a host of health issues, from preeclampsia to fetal death.
The lesions, the researchers found, result in blood and placental biomarkers that can be employed to distinguish and differentiate the particular conditions, and do so much earlier in gestation.
When obstetrical syndromes are defined according to the combination of clinical signs and the presence or absence of placental lesions caused by MVM, specific maternal blood biomarkers become informative earlier in gestation, indicate a stronger magnitude of association with the development of individual syndromes, and demonstrate significant association with the development of preterm labor and preterm premature rupture of the membranes, conditions that researchers did not previously believe were predictive of such biomarkers.
“The current taxonomy of obstetrical disorders is largely based on symptoms and signs, which are inadequate descriptors of disease because they are nonspecific and, importantly, represent the late manifestations of pathologic processes,” said Dr. Romero, lead author of the new study. Terms like preterm labor, preterm premature rupture of the membranes, preeclampsia, small for gestational age or fetal death provide scant information about the underlying causes of these conditions. “A more rational approach to the prediction and prevention of obstetrical disorders should be based on the understanding of the causes and the mechanisms responsible for complications of pregnancy.”
Evidence in the study supports the generation of a new taxonomy of obstetrical syndromes that would define specific conditions through the combination of clinical symptoms and the biomarkers caused by placental lesions. The new identification and naming system would improve the characterization of obstetrical disorders by including information about the mechanisms of disease reflected in placental pathology, the researchers said.
This new homogenous approach could facilitate the discovery and implementation of biomarkers, and provide a framework to test therapeutic interventions and prevention strategies.