“Foetal–Maternal Conflicts” and Adverse Outcomes in Human Pregnancies

Abstract

Lay Summary In most pregnancies, there is a delicate balance between foetal demands and the maternal supply of nutrients; however, in some instances, abnormal foetal–maternal interactions can lead to pregnancy complications. These abnormal interactions can occur at the uteroplacental interface, in the pla- cental vascular system and at the level of foetal–maternal signalling. Some of the consequences of abnormal foetal–maternal interactions include pregnancy complications such as foetal growth restriction, pre-eclampsia, gestational diabetes, preterm parturition and in extreme cases foetal death. We propose that an absolute reduction in the blood flow to the uteroplacental unit may participate in the mechanisms of disease in foetal growth restriction, early-onset pre-eclampsia and maternal thrombophilias, whereas a relative reduction in the supply line due to an excessive foetal demands for nutrients may be more relevant in the mechanism of injury in late-onset pre-eclampsia and gestational diabetes. It is possible that some of these pregnancy com- plications may have evolved as survival strategies for the foetus or the mother. In this context, interventions aimed at modulating the maternal blood pressure during pregnancy or delaying preterm parturition should be tailored to maximize both maternal and perinatal outcomes. J.