Search Results (479)

Background/Objectives: It is unclear whether the type of intrauterine inflammatory exposure influences global oxidant/antioxidant status or neutrophil gelatinase-associated lipocalin (NGAL) in preterm infants. Methods: Ninety-four infants born before 32 weeks of gestation were enrolled prospectively at three centers and grouped as clinical chorioamnionitis (n = 31), preterm premature rupture of membranes (PPROM; n = 33), or controls (n = 30) delivered preterm chiefly for preeclampsia, growth restriction, or placental insufficiency. Groups were not matched, but gestational age and birth weight were comparable. Serum total oxidant status (TOS), total antioxidant status (TAS), and NGAL were measured at the 1st postnatal hour. Results: TAS, TOS, and the oxidative stress index did not differ among groups (p = 0.966, 0.525, and 0.729). NGAL differed (p = 0.031) and was lowest in the clinical chorioamnionitis group, confined to the clinical chorioamnionitis-versus-PPROM contrast (adjusted p = 0.029) and persisting after multivariable adjustment. After correction for multiple testing, no biomarker correlated with C-reactive protein, blood counts, or procalcitonin at the 1st or 24th postnatal hour, or with the first-hour Töllner sepsis score; the strongest single association was NGAL with the first-hour neutrophil count (ρ = 0.29). Necrotizing enterocolitis was more frequent in controls (p = 0.003); mortality (20.2%) did not differ among groups. Conclusions: A single early measurement of these biomarkers did not reliably classify the type of intrauterine inflammatory exposure; discrimination was modest (area under the curve, 0.689), so serum NGAL has no current clinical applicability. These hypothesis-generating findings require confirmation in adequately powered studies with serial sampling. Full article

Background: Several scenarios of abnormal fetal growth develop during pregnancy in women with pregestational diabetes. A trend towards a higher incidence of large-for-gestational-age (LGA) births among women with type 1 diabetes (T1D) is observed worldwide despite novel approaches to maternal glycaemic control. Fetal growth restriction (FGR) is commonly recognised as a severe condition. However, the risk of adverse outcomes in LGA fetuses generally remains underestimated. Methods: We conducted a comparative analysis of pregnancy outcomes across different birthweight categories in pregnancies with T1D based on published data (2001–2026). Results: Interactions between disorders of early placentation, impaired nutrient transfer, fetal overnutrition, and genetic background result in alterations in birthweight and disproportionate fetal adipose tissue deposition. Both FGR and macrosomia are associated with increased risks of adverse perinatal outcomes. Although stillbirth occurs at both extremes of fetal growth, term LGA fetuses may remain particularly vulnerable because routine surveillance methods, including arterial Doppler assessment, fail to identify compromised fetuses with excessive growth. Accelerated fetal growth in T1D pregnancies, when placentation is initially impaired, may cause growth-restricted fetuses to appear appropriate for gestational age (AGA). Routine assessment may classify these vulnerable fetuses as being at low risk of perinatal complications. Disproportionate growth, even among infants classified as AGA, is associated with shoulder dystocia, birth trauma, and operative delivery. Neonatal hypoglycaemia and respiratory disorders remain frequent complications across the spectrum of abnormal fetal growth. Conclusions: Increased glucose variability may explain differences in placental and fetal growth trajectories and the high rate of pregnancy complications in patients with target glycated haemoglobin levels and routine capillary glucose monitoring results. Fetal overgrowth reflects impaired intrauterine development and should be considered a high-risk condition requiring careful consideration of the timing and mode of delivery. Full article

Placental inflammation and dysfunction play critical roles in adverse pregnancy outcomes, including preeclampsia and intrauterine growth restriction. Exposure to environmental factors, such as dietary toxins, infectious agents, and pollution, is thought to increase the risk of these outcomes. Despite the widespread use of HTR-8/SVneo and BeWo cells as trophoblast models, their comparative sensitivity to maternal exposome-related stimuli has not been systematically evaluated within the same experimental framework. we examined the responses of HTR-8/SVneo and BeWo trophoblast cell lines to mycotoxin deoxynivalenol (DON), an inflammatory cytokine cocktail (CC; TNF-α, IL-1β, IFN-γ), and particulate matter (PM2.5). Cells were seeded with either 0.2% or 1% penicillin/streptomycin (P/S) and exposed for 24 h. Cytokine secretion (IL-6 and IL-8), human chorionic gonadotropin (hCG) production, and mRNA and protein expression of junctional markers (ZO-1, OCLD, CLDN-3, CLDN-4, E-CAD) were analysed. DON significantly increased IL-6 secretion in both cell lines and elevated IL-8 levels in HTR-8/SVneo cells only. DON suppressed hCG production in both cell lines. CC exposure markedly elevated IL-6 and IL-8 levels, particularly in HTR-8/SVneo cells, without affecting hCG level. PM exposure did not significantly alter IL-6, IL-8, or hCG levels in either cell line. DON and CC altered the mRNA and protein expression of junctional markers in BeWo cells(ZO-1, OCLD, CLDN-3,CLDN-4), whereas HTR-8/SVneo cells showed more limited changes. Most cellular responses were consistent across both P/S concentrations. HTR-8/SVneo and BeWo cells exhibit differential sensitivity to DON, CC, and PM2.5, underscoring the importance of cell model selection in in vitro placental toxicology research. These results provide a comparative framework for interpreting trophoblast responses to maternal exposome-related stimuli and highlight the need for functional validation in future studies. Full article

Background: Congenital infections included in the TORCH complex remain an important cause of fetal and neonatal morbidity and mortality, being associated with miscarriage, intrauterine growth restriction, congenital malformations, neurological impairment, and long-term developmental sequelae. Prenatal serological screening may contribute to the early identification of maternal infections and facilitate preventive and therapeutic interventions. However, data regarding the utilization of TORCH screening and associated socio-demographic determinants in Romania remain limited. Objective: This study aimed to evaluate the self-reported uptake of prenatal serological testing for one or more infections included in the TORCH complex, particularly Toxoplasma gondii, rubella virus, cytomegalovirus (CMV), herpes simplex virus (HSV), and syphilis, and to identify socio-demographic, obstetrical, and prenatal care-related factors associated with TORCH testing among pregnant women in Romania. Materials and Methods: A cross-sectional observational study was conducted using an online self-administered questionnaire completed by 1301 pregnant women from Romania. Data collection was performed between August 2022 and March 2023 through digital platforms, including social media and pregnancy-related forums. The primary outcome was self-reported performance of serological testing for at least one TORCH-related infection during pregnancy. Associations between explanatory variables and TORCH testing were evaluated using chi-square tests and multivariable binary logistic regression models. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Results: Overall, 75.6% of participants reported undergoing serological testing for at least one infection included in the TORCH complex during pregnancy, while 49.3% reported a complete TORCH panel. The most frequently reported investigations were for Toxoplasma gondii (92.8%) and rubella virus (89.9%), whereas HSV testing was less commonly reported (42.5%). Lower educational level was the strongest independent factor associated with reduced likelihood of TORCH testing (adjusted OR = 0.08; 95% CI: 0.03–0.19; p < 0.001) (adjusted OR—aOR). Unemployment status (aOR = 0.70; 95% CI: 0.50–0.99; p = 0.045) and multiparity (aOR = 0.62; 95% CI: 0.49–0.77; p < 0.001) were also associated with lower testing uptake. In contrast, participation in prenatal education programs was associated with increased likelihood of TORCH testing (aOR = 1.37; 95% CI: 1.04–1.80; p = 0.024). The number of prenatal consultations was not independently associated with testing uptake. Conclusions: The uptake of prenatal serological screening for congenital infections (assessed using an expanded Romanian panel that includes hepatitis B and HIV in addition to the classical TORCH agents) in Romania appears to be influenced predominantly by socio-educational and behavioral factors rather than by the quantitative utilization of prenatal care services alone. Given the online recruitment strategy and the predominantly urban and highly educated sample, the reported uptake rates may overestimate population-level coverage. Significant inequalities in access to preventive prenatal investigations were observed, particularly among women with lower educational and socio-economic status. Strengthening prenatal education programs and improving equitable access to standardized prenatal screening may contribute to optimizing congenital infection prevention and maternal–fetal health outcomes. Full article

Maternal nutritional status before and during pregnancy is an important modifiable factor that may influence foetal development and long-term offspring health. Both undernutrition and excessive maternal body weight have been associated with adverse metabolic, cardiovascular, neurodevelopmental and immune-related outcomes in offspring. This narrative review summarises selected experimental, clinical and epidemiological evidence on maternal nutritional status, intrauterine programming and offspring health. Relevant literature was identified by searching the PubMed, Scopus and Web of Science databases covering publications from 2000 to 2026, with the majority of included papers published after 2015. The search terms included maternal nutrition, undernutrition, obesity, intrauterine programming, DOHaD, epigenetics, DNA methylation, microRNA and offspring health. The available evidence suggests that maternal undernutrition is associated with intrauterine growth restriction (IUGR) and an increased risk of cognitive and metabolic disorders. In contrast, maternal overweight or obesity is associated with macrosomia, as well as an increased risk of obesity, cardiovascular disease and metabolic dysfunction in later life. Both extremes of maternal nutritional status may also negatively affect the psychological health of the offspring. These associations suggest a potential role for epigenetic mechanisms; however, causal conclusions from observational studies in humans remain limited. Overall, the findings highlight the importance of optimising maternal nutritional and metabolic status before and during pregnancy as a key strategy for promoting favourable intrauterine programming and improving long-term offspring health. A better understanding of the underlying epigenetic mechanisms could facilitate the development of targeted nutritional and preventive interventions. As a narrative review, this analysis is limited by the associative nature of human observational studies and the inherent challenges in separating intrauterine effects from postnatal environmental confounders. Full article

Background/Objectives: Evidence suggests that assessment of neonatal body fat mass (FM) may provide additional insight into the relationship between disrupted fetal growth and neonatal health outcomes. Our objective was to determine whether neonatal body composition parameters are associated with hypoglycemia, hypothermia, and respiratory distress syndrome. Methods: We conducted a prospective study of preterm neonates born at ≤37 weeks of gestational age. Body composition was measured in the first week of life with bioelectrical impedance analysis (BIA). Results: We studied 101 neonates of mean gestational age 32.2 ± 3.2 weeks and mean birth weight 1792 ± 706 g. Neonates with intrauterine growth restriction (IUGR) had a significantly lower FM percentage (6.8 ± 3.6 compared with 8.3 ± 3.6%, p = 0.038), and higher free-FM percentage (93.1 ± 3.6 compared with 91.6 ± 3.4%, p = 0.041), compared with non-IUGR neonates. Compared with neonates with normal FM, neonates with decreased FM presented higher rates of hypothermia (35% compared with 9%, p = 0.005), hypoglycemia (46% compared with 9%, p < 0.001), and respiratory distress syndrome (58% compared with 27%, p = 0.008). Decreased FM percentage was significantly associated with hypoglycemia (OR 8.06, 95%CI 2.49–26.08, p < 0.001), hypothermia (OR 8.11, 95%CI 2.24–29.32, p = 0.001), and respiratory distress syndrome (OR 13.90, 95%CI 4.07–27.42, p < 0.001) after adjusting for gestational age, sex, and antenatal steroid administration. Conclusions: Lower FM percentage showed stronger associations with common neonatal morbidities, compared with standard anthropometric measurements alone. When a low FM percentage is detected, even when birth weight is normal, neonates at risk of undernutrition-related morbidity may benefit from closer nutritional and metabolic monitoring. Full article

Maternal exposure to polycyclic aromatic hydrocarbons (PAHs) during pregnancy has been associated with adverse obstetric and perinatal outcomes, including miscarriage, low birth weight, intrauterine growth restriction, and spontaneous abortion. Exposure occurs through multiple pathways, including dietary intake and inhalation, which ultimately determine the final body burden. PAHs may reach relevant levels in the blood, representing the initial step in their internal distribution to the placenta, umbilical cord, and breast milk, thereby compromising maternal–fetal health. In this exploratory study, maternal blood samples were collected from pregnant women residing in different regions of Antioquia, Colombia. Serum was isolated from whole blood, subsequently extracted using freezing-assisted liquid–liquid extraction, purified by solid-phase extraction, and analyzed by GC–MS. Method performance showed PAH recoveries between 60 and 120%, limits of detection (LOD) ranging from 0.5 to 3.3 ng·mL⁻¹, and limits of quantification (LOQ) ranging from 1.4 to 9.9 ng·mL⁻¹. Airborne PAH concentrations were measured using a photoelectric aerosol sensor, and higher levels were observed in municipalities intersected by major highways, indicating a strong vehicular contribution, with an average concentration of 72.6 ± 39.2 ng·m⁻³. Low and medium-molecular weight PAHs were detected in serum samples at an average concentration of 43.8 ± 8.8 ng·g⁻¹ of lipid (mean of ∑ individual congeners). In contrast, a high-molecular-weight PAH, benzo[a]pyrene (BaP), was detected in one participant. Pyrene (PYR) and fluoranthene (FLU) were the predominant congeners, suggesting combustion-related sources, primarily vehicular emissions. Serum PAH levels showed a correlation with the frequency of consumption of canned fish and meat, but not with short-term airborne PAH measurements. These exploratory findings suggest that dietary intake is a primary pathway of bioaccumulation during acute exposure and plays a key role in determining the parental PAHs burden during pregnancy in polluted environments. However, additional data on parent PAHs and their metabolites are needed to provide a more comprehensive assessment of cumulative exposure arising from dietary sources and chronic inhalation of airborne PAHs. Full article

Maternal psychoactive substance use during pregnancy represents a major threat to placental integrity and fetal development. As the central interface for maternal–fetal exchange, the placenta is highly susceptible to psychoactive substances, including alcohol, tobacco, cannabis, cocaine, opioids, and synthetic drugs, which can cross the placental barrier and induce structural and functional alterations. This review synthesizes current evidence on the biological mechanisms, diagnostic approaches, and forensic relevance of psychoactive substances-induced placental pathology. We summarize how different substances disrupt placental vascularization, oxidative balance, epigenetic regulation, and cellular viability, leading to impaired nutrient and oxygen transfer and increasing the risk of adverse outcomes such as intrauterine growth restriction, preterm birth, congenital anomalies, and long-term neurodevelopmental impairment. We further discuss the role of placental tissue in identifying prenatal drug exposure and reconstructing exposure timelines. Beyond its clinical relevance, placental examination provides objective evidence with potential forensic value in cases of suspected maternal substance use, while also informing non-punitive, evidence-based interventions. Overall, integrating placental pathology into reproductive health research and prenatal care offers a multidisciplinary framework to improve maternal–fetal outcomes and guide public health strategies addressing substance use during pregnancy. Full article

L-citrulline is a non-protein amino acid with critical roles in perinatal and neonatal physiology through the intestinal–renal arginine–citrulline axis and nitric oxide (NO) production. During pregnancy, L-citrulline supports placental angiogenesis, vascular adaptation, and fetal growth through augmentation of arginine availability and endothelial NO production. In neonates, particularly preterm infants, developmental immaturity of citrulline and arginine synthesis contributes to hypoargininemia and may increase susceptibility to necrotizing enterocolitis, bronchopulmonary dysplasia with pulmonary hypertension, sepsis, and impaired intestinal function. Although L-citrulline has emerged as a promising modulator of NO bioavailability, prior reviews have largely focused on either adult cardiovascular disease or isolated neonatal applications, with limited integration of its mechanistic and translational relevance across the perinatal and neonatal continuum. Collectively, current evidence supports L-citrulline as a promising translational target in maternal–fetal and neonatal medicine because of its central role in vascular, inflammatory, and metabolic regulation. However, adequately powered clinical trials are needed to define optimal dosing, timing, patient selection, and long-term outcomes before routine clinical implementation can be recommended. This review provides a comprehensive evaluation of L-citrulline metabolism and its therapeutic potential from pregnancy through neonatal life, with emphasis on the intestinal–renal arginine–citrulline axis, endothelial function, and NO-mediated vascular regulation. We specifically examine the role of citrulline in key pathophysiologic mechanisms underlying maternal and neonatal disease, including endothelial dysfunction, impaired NO bioavailability, inflammation, oxidative stress, and abnormal placental vascular remodeling. Full article

Background: Micro- and nano-plastics (MNPs) are pervasive environmental contaminants that accumulate in various tissues, including the placenta. Experimental and clinical studies suggest potential cytotoxic, oxidative, and inflammatory effects that may lead to placental dysfunction and adverse obstetric outcomes. However, high-quality evidence on the clinical relevance of MNPs exposure during pregnancy remains scarce, underscoring the need for systematic evaluation of their impact on maternal and fetal health. Methods: The databases PubMed, ScienceDirect, CENTRAL, Embase, MDPI and Google Scholar were searched for studies published up to September 2025 investigating the relationship between MNPs and obstetric outcomes. Results: Twelve studies were included in this review, with half employing an observational design in human subjects and the other half using experimental studies in murine models. Although the available evidence is limited, there are studies reporting the association between MNPs exposure and premature birth, low birth weight, intrauterine growth restriction, and miscarriage. The most prevalent polymer detected was polyethylene, and the most commonly used MNPs detection techniques were Raman microspectroscopy, digital microscopy, Fourier Transform Infrared, and Pyrolysis gas chromatography-mass spectrometry. Conclusions: This systematic review summarizes current limited insights on the potential effects of MNPs on obstetric outcomes, highlighting possible associations with low gestational age, low birth weight, intrauterine growth restriction, and miscarriage. Findings do not allow causal inference due to heterogeneity in study design, exposure assessment, contamination control, and analytical methodologies. Full article

This prospective study evaluated first-trimester markers in pregnancies with isolated and combined forms of fetal growth disorders and gestational diabetes mellitus (GDM). Among 1869 screened women, the analysis included 83 controls, 55 GDM, 22 isolated intrauterine growth restriction (iIUGR), and 33 isolated large-for-gestational-age (iLGA) cases, with GDM subgroups stratified by fetal growth (GDM with normal fetal weight, GDM + IUGR, and GDM + LGA). First-trimester clinical and routine biochemical parameters were recorded, and serum concentrations of 80 proteins were measured using targeted LC-MRM-MS proteomics. Different trajectories emerged: IUGR phenotypes showed low PAPP-A/PlGF and high TSH (p < 0.01), indicating early placental insufficiency, while macrosomia showed opposite trends. GDM + IUGR represented the most severe “double hit” phenotype (lowest PlGF, earliest delivery), whereas GDM + LGA showed increased umbilical artery resistance despite excessive growth, suggesting endothelial dysfunction. Targeted proteomics revealed characteristic signatures: iIUGR featured low complement (C4A|C4B) and IGF proteins (IGFALS, IGFBP3) versus GDM and iLGA (p < 0.001); GDM + IUGR showed elevated PZP and CD5L versus iIUGR (p < 0.05); GDM + LGA was marked by high C4BPA and low RBP4, SERPINA7 versus iLGA (p < 0.05). Complement and IGF pathways were consistently implicated. Machine learning achieved 77% sensitivity for IUGR prediction using clinical parameters and 88% sensitivity for LGA prediction using proteomic data. These findings demonstrate that fetal growth disorders represent pathophysiologically unique entities detectable in the first trimester, enabling early risk stratification and personalized management. Full article

The Barker hypothesis links intrauterine conditions, mainly low birth weight, subject to poor nutrition with paradoxically improved standards of living and nutrition after World War II in Western countries, to adult disease, mainly coronary heart disease. The limitations of his hypothesis include the fact that it is based only on human epidemiological data and animal studies, and also that it is difficult to isolate the effect of the intrauterine environment from postnatal conditions, familial and genetic background. In the last 20 years, the introduction of ultrasound and Doppler techniques in the assessment of fetal and maternal vascularity added a major contribution to the evaluation of the intrauterine environment. Studies based on ultrasound and Doppler assist in differentiating between prematurity and fetal growth restriction (FGR), mainly in those with placental insufficiency, and postnatal morbidity and even mortality. In addition, the Pedersen hypothesis regarding fetuses with overgrowth, mainly with diabetic mothers, states that they are also prone to postnatal morbidity. However, most of the studies on the issue do not emphasize the effects of the intrauterine environment on fetal organs, such as the brain, heart, liver, kidneys and pancreas in FGR and fetal overgrowth, that may impose a different prognosis in later life. This narrative review aims to summarize current evidence from animal and human studies regarding the impact of intrauterine undernutrition and overnutrition on fetal organ development, and to evaluate how ultrasound and Doppler findings may contribute to understanding the link between the intrauterine environment and postnatal morbidity. Full article

Endothelial dysfunction (ED) arises in multiple pathologies, and its severity correlates with disease progression. Common ED biomarkers could provide prognostic value for associated complications. This study aims to identify shared ED biomarkers and assess their prognostic significance. Endothelial cells in culture (human microvascular endothelial cells, HMEC-1) were exposed to sera from patients in five disease groups (n = 20 patients/group)—liver cirrhosis with portal hypertension, idiopathic pulmonary arterial hypertension, placental disorders such as intrauterine growth restriction, coronary artery disease with acute myocardial infarction, and chronic kidney disease—or matched controls, in the absence/presence of anti-inflammatory (apixaban) and antioxidant (EUK134) compounds. We explored changes in: VCAM-1, ICAM-1, eNOS, VWF, extracellular matrix thrombogenicity, and reactive oxygen species (ROS). In serum samples, proteomics and metabolomics analyses (including lipids, amino acids, and polar metabolites) were performed through an extraction protocol to identify common ED biomarkers. Expression of VCAM-1, ICAM-1, VWF, platelet adhesion, and ROS increased in most groups versus controls (p < 0.05). Both drugs decreased all biomarker levels except eNOS (n = 6 for in vitro experiments). For serum ED biomarkers, 18 metabolites and 24 proteins showed AUC-ROC and hit rates >77.5%, and six metabolites were associated with event-free survival. These diseases share ED driven by systemic inflammatory, oxidative, and metabolic stress, are partially reversible in vitro, and are linked to biomarkers associated with clinical outcomes. Overall, ED emerges as a modifiable pathological axis with potential prognostic value. Full article

Background: Preterm birth, the leading cause of neonatal mortality, is associated with reduced nephron endowment and an increased risk of kidney disease in later life. In preterm infants, the interruption of nephrogenesis leads to a lower nephron number and structural abnormalities. Prenatal factors such as intrauterine growth restriction, and postnatal factors including nephrotoxic medications, patent ductus arteriosus, perinatal asphyxia, and infections contribute to this deficit. Ultrasound is a key tool for assessing renal volume at birth and can, when indexed to body weight, be used to estimate nephron endowment, which is known to vary widely among individuals. Methods: This study analyzed 52 preterm infants with birth weight < 1000 g, assessing combined renal volume (sum of right and left kidney volumes) indexed to body weight. Results: The mean combined kidney volume-to-body weight ratio was 12.12 (SD = 2.03). Values below the 10th percentile (9.46) or more than one standard deviation below the mean (10.11) may indicate nephron deficiency at birth. Conclusions: Standardized ultrasound-based parameters enable the early identification of neonates at risk for nephron deficit, supporting targeted preventive strategies. Long-term follow-up is essential to detect early renal functional impairment and reduce the risk of chronic kidney disease. Full article

Background and Objectives: Placental vascular lesions are significant histopathological findings that indicate disruptions in uteroplacental and fetoplacental circulations and are associated with adverse pregnancy outcomes such as preeclampsia, intrauterine growth restriction (IUGR), and perinatal morbidity. This study aimed to re-examine the frequency and distribution of placental vascular lesions in placentas submitted for histopathological analysis at our center, based on criteria established by the Amsterdam Placental Workshop Group Consensus Statement. Materials and Methods: In this retrospective study, placental samples examined in the Department of Pathology at Akdeniz University Faculty of Medicine from 2016 to 2019 were analyzed. A total of 571 cases with at least one placental vascular lesion identified on histopathology were included. Hematoxylin–eosin-stained sections from all cases were re-evaluated, and maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), and other placental vascular pathologies were assessed according to the Amsterdam consensus criteria. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 25 (IBM Corp., Armonk, NY, USA). Categorical variables were compared using the chi-square or Fisher’s exact test, while continuous variables were analyzed with the Mann–Whitney U test. Results: MVM and FVM were considered the primary outcomes of the study. MVM was identified in 95.1% of cases, whereas FVM was present in 1.9%. Among individual lesions, chorangiosis (97.2%) and villous/perivillous fibrinoid deposition (88.3%) were the most frequent findings, followed by mucinous cystic degeneration of the umbilical cord (61.5%) and dystrophic calcification (58.1%). Retroplacental hematoma was observed in 38.4% of cases. Although no significant association was found between MVM and placental weight or size, umbilical cord length was significantly shorter in MVM-positive cases (p = 0.032). In contrast, FVM showed significant associations with chorangiosis (p = 0.035) and placentomegaly (p = 0.003). The high frequency of chorangiosis may reflect a compensatory angiogenic response to chronic intrauterine hypoxia, potentially mediated by vascular growth factors, with variable effectiveness depending on the severity of the underlying condition. Conclusions: These findings suggest that placental vascular lesions are not only markers of obstetric complications but also serve as morphological indicators of fetoplacental adaptive responses. Full article