Current understanding of the pathogenesis of placenta accreta spectrum disorder with focus on mitochondrial function

Hiroshi Kobayashi; Sho Matsubara; Chiharu Yoshimoto; Hiroshi Shigetomi; Shogo Imanaka

doi:10.1111/jog.15936

Current understanding of the pathogenesis of placenta accreta spectrum disorder with focus on mitochondrial function

J Obstet Gynaecol Res. 2024 Mar 27. doi: 10.1111/jog.15936. Online ahead of print.

Authors

Hiroshi Kobayashi^{1

2}, Sho Matsubara^{2

3}, Chiharu Yoshimoto^{2

4}, Hiroshi Shigetomi^{2

5}, Shogo Imanaka^{1

2}

Affiliations

¹ Department of Gynecology and Reproductive Medicine, Kashihara, Japan.
² Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan.
³ Department of Medicine, Kei Oushin Clinic, Nishinomiya, Japan.
⁴ Department of Obstetrics and Gynecology, Nara Prefecture General Medical Center, Nara, Japan.
⁵ Department of Gynecology and Reproductive Medicine, Aska Ladies Clinic, Nara, Japan.

PMID: 38544343
DOI: 10.1111/jog.15936

Abstract

Aim: The refinement of assisted reproductive technology, including the development of cryopreservation techniques (vitrification) and ovarian stimulation protocols, makes frozen embryo transfer (FET) an alternative to fresh ET and has contributed to the success of assisted reproductive technology. Compared with fresh ET cycles, FET cycles were associated with better in vitro fertilization outcomes; however, the occurrence of pregnancy-induced hypertension, preeclampsia, and placenta accreta spectrum (PAS) was higher in FET cycles. PAS has been increasing steadily in incidence as a life-threatening condition along with cesarean rates worldwide. In this review, we summarize the current understanding of the pathogenesis of PAS and discuss future research directions.

Methods: A literature search was performed in the PubMed and Google Scholar databases.

Results: Risk factors associated with PAS incidence include a primary defect of the decidua basalis or scar dehiscence, aberrant vascular remodeling, and abnormally invasive trophoblasts, or a combination thereof. Freezing, thawing, and hormone replacement manipulations have been shown to affect multiple cellular pathways, including cell proliferation, invasion, epithelial-to-mesenchymal transition (EMT), and mitochondrial function. Molecules involved in abnormal migration and EMT of extravillous trophoblast cells are beginning to be identified in PAS placentas. Many of these molecules were also found to be involved in mitochondrial biogenesis and dynamics.

Conclusion: The etiology of PAS may be a multifactorial genesis with intrinsic predisposition (e.g., placental abnormalities) and certain environmental factors (e.g., defective decidua) as triggers for its development. A distinctive feature of this review is its focus on the potential factors linking mitochondrial function to PAS development.

Keywords: defective decidua; mitochondria function; mitochondrial dynamics; placenta accreta spectrum; trophoblast.

Publication types

Review