Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor Marc E. A. Spaanderman, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Second opponent: Professor Emeritus Christina Vogt, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU)
- Third member and chair of the evaluation committee: Professor Ingebjørg Seljeflot, Faculty of Medicine, University of Oslo
Chair of the Defence
Associate Professor G. Cecilie Alfsen, Faculty of Medicine, University of Oslo
Principal Supervisor
Professor Annetine Staff, Faculty of Medicine, University of Oslo
Summary
Preeclampsia, a hypertensive disease of pregnancy, impacts on both mother and child health during pregnancy, and adds to the mother’s risk of developing atherosclerotic cardiovascular disease later in life. Underlying mechanisms are unclear.
Acute atherosis is a lesion of the uteroplacental spiral arteries supplying the placenta in pregnancy, and prevalent in preeclampsia. Acute atherosis shares morphological similarities with early stage atherosclerosis.
The aims of this study were to provide simplified and reproducible criteria for the defining characteristics of acute atherosis, evaluating associated features, and a better understanding of the lesion’s distribution throughout the uterine lining in pregnancy (decidua).
Decidual samples were obtained from women recruited to the Oslo Pregnancy Biobank (Oslo University Hospital), using standardized collection methods following caesarean section delivery. Immunohistochemical staining aided evaluation of decidual spiral artery features by light microscopy of serial sectioned sample slides.
Acute atherosis was defined as the presence of a minimum of two intramural vacuolated cells with corresponding positive CD68 staining, demonstrating high reproducibility (inter- and intraobserver agreement). Acute atherosis was more readily detected in placental bed decidua (basalis) collected by vacuum suction, compared to conventional decidual tissue sampling.
Acute atherosis was detected in 37% of preeclamptic, and in 11% of normotensive pregnancies. Decidual acute atherosis was associated with higher concentrations of CD3+CD8- cells (assumed to represent CD4 T-lymphocytes) surrounding the spiral arteries. In preeclamptic women, acute atherosis associated with a lower gestational age and lower birth weight percentile at delivery, but not with conventional cardiovascular disease risk factors: age, BMI, or diabetes.
In future studies, this standardized definition of acute atherosis could be tested as a stratification tool for early life cardiovascular risk of parous women.
Additional information
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