ABSTRACT
The journey from conception to birth is fraught with danger. It has been estimated that 50-70% of all conceptions fail. Complications that occur during pregnancy remain a serious clinical problem and the triggers and mediators of placental and fetal damage are poorly understood. Recurrent pregnancy loss affects 1-3% of couples.1,2 Despite aggressive efforts to understand the basic biology underlying neonatal death and morbidity, their incidence has remained unchanged over the past 20-30 years. Furthermore, the well-established genetic, anatomic, endocrine, and infectious causes of fetal damage are not demonstrable in 50-60% of pregnancy complications, and more work is necessary to elucidate their pathogenesis.2 In addition, preterm birth occurs in up to 10% of pregnancies, accounting for 70% of neonatal deaths and related neonatal morbidity, including neurological, respiratory, and metabolic complications in the newborn.3,4
Intrauterine growth restriction (IUGR) occurs in up to 10% of infants born in the United States5
and growth-restricted fetuses have higher mortality and morbidity rates than fetuses with weights > 10th percentile. While the insult to the fetus occurs in utero, the deleterious influence of IUGR contributes to long-term developmental delay, and a suboptimal intrauterine environment has been linked to metabolic disorders
during adult life, including coronary artery disease, hypertension, hyperlipidemia, and insulin resistance.6
