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Vol. 27, Art. 27 (pp. 629-652)    |    2026       

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Morphological characteristics of villous chorion in maternal obesity with emphasis on vascular parameters

Gabaraev S.E., Drobintseva A.O., Nasyrov R.A.
Saint Petersburg State Pediatric Medical University of the Ministry of Health of the Russian Federation, SaintPetersburg, Russia

Brief summary

Obesity in pregnant women is associated with placental dysfunction, increased incidence of pregnancy complications and adverse perinatal outcomes. Aim of the study. To identify the relationship between maternal body mass index (BMI) and morphological changes in the villous chorion, with a focus on vascular parameters. Materials and methods. We studied 60 cases of singleton pregnancy with live birth at 37-40 weeks’ gestation. Based on maternal BMI, the following groups were formed: control group (BMI 20-25 kg/m², n=15) and obesity groups I (BMI 30-35 kg/m², n=15), II (BMI 35-40 kg/m², n=15), III (BMI > 40 kg/m², n=15). Placental microslides were examined using hematoxylin and eosin staining and immunohistochemistry with antibodies against CD31. We assessed the number of vessels, syncytiocapillary membranes (SCM), vessel area, stromal area, vascularization index and vessel density per 1 mm² of stroma in terminal villi, wall thickness and lumen area of large vessels in stem villi, and accelerated and delayed villous maturation. Results. The study revealed no significant differences in placental-fetal weight ratio (PFWR), placental weight, birth weight, or Apgar scores. No significant differences were found in the number of vessels and SCM per terminal villus, stromal area, or vessel lumen area in terminal villi. The vascularization index of terminal villi in the obesity groups remained at the control level. In group I, a significant increase in vessel density in terminal villi was noted. In stem villi, thickening of the walls of large vessels was detected, reaching statistical significance in groups II and III. In group III, a significant reduction in vessel lumen area was found, accompanied by disorganization of the muscular layer. The obesity groups did not differ significantly from the control group in the presence of accelerated or delayed villous maturation. Conclusion. In terminal villi, maternal obesity showed no significant changes in vessel number, mean vessel area, stromal area, vascularization index, or the number of SCM. The isolated increase in vessel density in group I may be incidental and is not supported by changes in more informative parameters. In stem villi, a staged macroangiopathy was found: from isolated wall hypertrophy to obstructive remodeling in morbid obesity. Thus, the concept of compensatory angiogenesis as a universal response to hypoxia in obesity is not supported. The described changes were observed against a background of normal birth weight and Apgar scores of the newborns, which reflects a relatively favorable course of pregnancy and raises the question of the placental phenotype in maternal obesity combined with anthropometric deviations in the newborns.


Key words

obesity, placenta, morphometry, villous chorion

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