Preterm placental calcification: maternal calcium, magnesium, 25(OH)D levels and adverse obstetric outcomes in low-risk pregnant women

Year 2022, Volume: 5 Issue: 2, 579 - 585, 15.03.2022

Simten Genç Yağmur Özkan Sadık Kükrer Hicran Şirinoğlu Veli Mihmanlı

https://doi.org/10.32322/jhsm.1065286

Abstract

Aim: The aim of our study is to examine early and late preterm placental calcification (PPC) and compare their relationship with maternal calcium, magnesium and 25(OH) D levels and adverse obstetric outcomes.
Material and Method: This prospective cohort study was conducted by examining the pregnant women at their 24th to 36th gestational weeks who applied to the Gynecology Department of Okmeydani Training and Research Hospital. In this study, 207 patients were selected as the study group.
Results: When the early and late PPC groups were compared, rates of low birth weight (LBW) was statistically higher in the early PPC group. (p=0.022) Oligohydramnios was more common in the early and late PPC patients compared to non-PPC pregnant women. However, oligohydramnios and LBW were not found statistically significant difference in logistic regression analysis. There was also no statistically significant difference in maternal calcium, magnesium and vitamin D levels between the groups.
Conclusion: Preterm placental calcifications might be associated with fetal and maternal complications. But the diagnosis of PPC alone is not effective in determining fetal prognosis.

Keywords

Calcium, Low birth weight, Magnesium, Preterm Placental calcification, Vitamin D

References

• Poggi SH, Bostrom KI, Demer LL, Skinner HC, Koos BJ. Placental calcification: a metastatic process? Placenta 2001; 22: 591-6.
• Grannum PA, Berkowitz RL, Hobbins JC. The ultrasonic changes in the maturing placenta and their relation to fetal pulmonic maturity. Am J Obstet Gynecol 1979; 133: 915-22.
• Mastrolia SA, Weintraub AY, Sciaky-Tamir Y, Tirosh D, Loverro G, Hershkovitz R. Placental calcifications: a clue for the identification of high-risk fetuses in the low-risk pregnant population? J Matern Fetal Neonatal Med 2016; 29: 921-7.
• Miller JM Jr, Brown HL, Kissling GA, Gabert HA. The relationship of placental grade to fetal size and growth at term. Am J Perinatol 1988; 5: 19-21.
• Chen KH, Chen LR, Lee YH. Exploring the relationship between preterm placental calcification and adverse maternal and fetal outcome. Ultrasound Obstet Gynecol 2011; 37: 328-34.
• Jamal A, Moshfeghi M, Moshfeghi S, Mohammadi N, Zarean E, Jahangiri N. Is preterm placental calcification related to adverse maternal and foetal outcome? J Obstet Gynaecol 2017; 37: 605-9.
• Lemancewicz A, Laudańska H, Laudański T, Karpiuk A, Batra S. Permeability of fetal membranes to calcium and magnesium: possible role in preterm labour. Hum Reprod 2000; 15: 2018-22.
• Czajkowski K, Wójcicka-Bentyn J, Grymowicz M, Smolarczyk R, Malinowska-Polubiec A, Romejko E. Calcium-phosphorus-magnesium homeostasis in pregnant women after renal transplantation. Int J Gynaecol Obstet 2003; 80: 111-6.
• Bedir Findik R, Ersoy AO, Fidanci V, Tasci Y, Helvacioglu Y, Karakaya J. Vitamin D deficiency and placental calcification in low-risk obstetric population: are they related? J Matern Fetal Neonatal Med 2016; 29: 3189-92.
• Ergür AT, Berberoğlu M, Atasay B, et al. Vitamin D deficiency in Turkish mothers and their neonates and in women of reproductive age. J Clin Res Pediatr Endocrinol 2009; 1: 266-9.
• Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: Statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy 2001; 20: ix-xiv.
• Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol 2018; 131: e49-e64.
• McKenna D, Tharmaratnam S, Mahsud S, Dornan J. Ultrasonic evidence of placental calcification at 36 weeks' gestation: maternal and fetal outcomes. Acta Obstet Gynecol Scand 2005; 84: 7-10.
• Wallingford MC, Benson C, Chavkin NW, Chin MT, Frasch MG. Placental vascular calcification and cardiovascular health: ıt ıs time to determine how much of maternal and offspring health ıs written in stone. Front Physiol 2018; 9: 1044.
• Guo Y, Zhang D, Lu H, Luo S, Shen X. Association between calcifying nanoparticles and placental calcification. Int J Nanomedicine 2012; 7: 1679-86.
• Goswami P, Memon S and Pardeep K. Morphological, histological and radiological study of calcified placenta and its relation with foetal outcome. IOSR J Dental Med Sci 2013; 7: 82-8.
• Ericksen K, Fogel J, Verma RP. Placental histopathology in late preterm infants: clinical implications. Clin Exp Pediatr 2020; 63: 48-51.
• Yin TT, Loughna P, Ong SS, Padfield J, Mayhew TM. No correlation between ultrasound placental grading at 31-34 weeks of gestation and a surrogate estimate of organ function at term obtained by stereological analysis. Placenta 2009; 30: 726-30.
• Kaushal M, Magon N. Vitamin D in pregnancy: a metabolic outlook. Indian J Endocrinol Metab 2013; 17: 76-82.
• Mitchell DM, Jüppner H. Regulation of calcium homeostasis and bone metabolism in the fetus and neonate. Curr Opin Endocrinol Diabetes Obes 2010; 17: 25-30.
• Ohata Y, Yamazaki M, Kawai M, et al. Elevated fibroblast growth factor 23 exerts its effects on placenta and regulates vitamin D metabolism in pregnancy of Hyp mice. J Bone Miner Res 2014; 29: 1627-38.
• Vosmar MB, Jongsma HW, van Dongen PW. The value of ultrasonic placental grading: no correlation with intrauterine growth retardation or with maternal smoking. J Perinat Med 1989; 17: 137-43.
• Liu NQ, Ouyang Y, Bulut Y, et al. Dietary vitamin D restriction in pregnant female mice is associated with maternal hypertension and altered placental and fetal development. Endocrinology 2013; 154: 2270-80.
• Shin JS, Choi MY, Longtine MS, Nelson DM. Vitamin D effects on pregnancy and the placenta. Placenta 2010; 31: 1027-34.
• Sofi NY, Jain M, Kapil U, et al. Status of Serum Vitamin D and Calcium Levels in Women of Reproductive Age in National Capital Territory of India. Indian J Endocrinol Metab 2017; 21: 731-3.
• Barati M, Masihi S, Barahimi E, Khorrami MA. Relationship between placental calcification and estimated fetal weight percentile at 30-34 weeks of pregnancy. Int J Women's Health Reproduct Sci 2019; 7: 478-82.
• Spinillo A, Gardella B, Bariselli S, Alfei A, Silini E, Dal Bello B. Placental histopathological correlates of umbilical artery Doppler velocimetry in pregnancies complicated by fetal growth restriction. Prenat Diagn 2012; 32: 1263-72.
• Moran M, Higgins M, Zombori G, Ryan J, McAuliffe FM. Computerized assessment of placental calcification post-ultrasound: a novel software tool. Ultrasound Obstet Gynecol 2013; 41: 545-9.
• Rossi C, Gerosa C, Pampaloni P, et al. Placental Calcification Score: a new semiquantitative method to assess pattern and grading of placental calcifications. J Pediatr Neonat Individual Med [Internet] 2019; 8: e080206.
• White WM, Mielke MM, Araoz PA, et al. A history of preeclampsia is associated with a risk for coronary artery calcification 3 decades later. Am J Obstet Gynecol 2016; 214: 519.e1-519.e8.
• Chitlange SM, Hazari KT, Joshi JV, Shah RK, Mehta AC. Ultrasonographically observed preterm grade III placenta and perinatal outcome. Int J Gynaecol Obstet 1990; 31: 325-8.
• Nigam J, Misra V, Singh P, Singh P, Chauhan S, Thakur B. Histopathological study of placentae in low birth weight babies in India. Ann Med Health Sci Res 2014; 4: S79-83.
• Zhang LY, Yu YH, Hu ML. Association between ultrasonographic signs of placental premature aging and pregnancy outcome. Di Yi Jun Yi Da Xue Xue Bao 2005; 25: 318-20.
• Agababov RM, Abashina TN, Suzina NE, Vainshtein MB, Schwartsburd PM. Link between the early calcium deposition in placenta and nanobacterial-like infection. J Biosci 2007; 32: 1163-8.
• Zeng J, Marcus A, Buhtoiarova T, Mittal K. Distribution and potential significance of intravillous and intrafibrinous particulate microcalcification. Placenta. 2017; 50: 94-8.
• Chen KH, Seow KM, Chen LR. The role of preterm placental calcification on assessing risks of stillbirth. Placenta 2015; 36: 1039-44.
• Mirza FG, Ghulmiyyah LM, Tamim H, Makki M, Jeha D, Nassar A. To ignore or not to ignore placental calcifications on prenatal ultrasound: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2018; 31: 797-804.