What do stillbirths, child stunting and impaired cognitive development have in common? It could be that all these problems start in the womb, with a placenta that doesn’t function as it should.

Researchers at the University of Pretoria’s Research (UP) Centre for Maternal, Fetal, Newborn and Child Health Care Strategies have been studying these problems for years. They have also been looking into why South Africa has about 19 000 stillbirths a year, most of these among apparently healthy pregnant women.

“A major cause of stillbirths is placental insufficiency, a condition where the placenta does not function properly, the foetus is then deprived of the nutrients and oxygen it needs to survive and grow,” says Professor Ute Feucht, Director of the centre. Placental insufficiency can be tested using the UmbiflowTM Doppler screening device, a portable, continuous-wave Doppler ultrasound device that was developed in South Africa and costs about one- tenth of conventional ultrasound equipment. This makes routine Doppler screening at public healthcare clinics feasible.

Studies by the centre showed that otherwise healthy South African pregnant women have about 10 times more placental insufficiency than those in high-income countries. Referring pregnant women with an abnormal UmbiflowTM result to a higher level of care resulted in 45% fewer stillbirths – a substantial reduction with enormous potential for a positive impact on the health system.

The next question

But what about the newborns who survived into infancy? Did placental insufficiency affect their growth and brain development in the longer term, or did they recover and go on to thrive?

“To answer these questions, we conceived the UmbiBaby study, which followed a group of infants over the first two years of their lives, looking at their growth, body composition and neurodevelopment,” Dr Helen Mulol says.

The results were intriguing. Children with abnormal Doppler results had a lower birth weight, and remained lighter up to 24 months of age; they also grew at a slower rate and were more likely to be short for their age if the mother was also living with HIV. Additionally, they were also likely to have a lower fat-free mass trajectory (even if corrected for their shorter length), though fat mass was not affected. This suggests that placental insufficiency has an impact on the development of lean tissue, which includes muscles and organs, while fat tissue continues to grow normally. This could predispose these children to developing obesity.

Furthermore, they had poorer cognitive development scores at 18 months, even more so if the mother was living with HIV. Children who were short for their age additionally also had poorer motor development.

“Taken together, this paints a concerning picture,” Dr Sanja Nel says. “Placental insufficiency is rife among even

relatively healthy pregnant women, and it seems to be impacting affecting children’s growth and cognitive development.”

Where to now?

“Pinpointing placental insufficiency as a common contributory factor to all these problems, is an important step, but it is still far from a solution,” Prof Feucht says. “The reason for the high prevalence of placental insufficiency is unknown. We initially suspected that HIV might be to blame, but the data from our Umbiflow studies don’t support this. Thus, our next planned study (funded by ELMA Philanthropies) will go look elsewhere – at factors

that affect the development of the small placental blood vessels.”

This will involve blood tests on pregnant women with a range of placental function, from normal Doppler results to severe placental dysfunction. At the same time, researchers will look at the women’s nutritional status and diet.

“Finding the culprits will be the first step to developing a cure – or better yet, a way to prevent the condition entirely,” Prof Feucht says.

Why this research matters

South Africa has an alarmingly high rate of stillbirths occurring in otherwise healthy women. Around half of stillbirths in these women could be prevented. The search to find the cause of the placental insufficiency that is so common among South African women, and a way to improve or prevent it, has enormous implications.

Foetuses would get enough nutrients while in the womb, allowing their bodies and brains to develop optimally. This could go a long way to reducing childhood stunting in South Africa.

This article was originally featured in the Re.Search Magazine. Check out issue 10 of the magazine here.

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