Book review

Article Outline

• Copyright

Advances in fetal medicine and neonatal care within the last years have decreased perinatal mortality rates considerably. The survival of very preterm infants and low birth weight are accompanied by higher prevalence of neurological and developmental disabilities. Consequently, the focus of attention in perinatal medicine shifts to developmental outcome of these babies in later childhood since perinatal brain injury is a major cause of long-term neurodisability. Despite advances in recent years, knowledge of the pathobiology underlying developmental neurodisabilities is sparse. The book focuses on the placenta and its importance for the pathogenesis of prenatal brain damage and disturbed brain development. Impaired placenta function may lead to poor neurological outcome by restriction of nutrient supply, by releasing factors or by impaired barrier function leading to a suboptimal environment of brain development. It is not only the first book but also the first throughout review of such relationship. Thirteen experts in the placenta and developmental neurology deal with the state of knowledge of this relationship from clinical and experimental viewpoints. Six of the 11 chapters provide detailed accounts of lesions that affect structure and function of the placenta exceeding the traditionally view of a disturbed oxygen supply rather focussing on underlying mechanisms as vascular and inflammatory placental lesions. In spite of incomplete evidence placental thrombotic vascular pathology and chorioamnionitis seem to be keystones in the development of neurodisabilities. It is shown how the impaired placental function contributes to reduced fetal growth and altered brain development and how it leads to brain injury and neurological disability in later childhood. These discussions show that the mechanisms underlying the association between intrauterine growth restriction, altered brain development and brain injury are by far not clear yet. Three chapters deal with specific placental transporter systems that protect the fetus from drugs and xenobiotics in the maternal circulation, animal models used to elucidate mechanisms leading to fetal brain damage and the interaction between fetal genes and intrauterine environment that predispose to the development of schizophrenia in later life. One chapter describes the possibilities of structural imaging of the placenta and imaging of placenta function with MRI. A conclusion chapter gives a comprehensive summary of the entire book. The review of experimental physiological data in combination with the limited number of clinical studies most of them being case reports is the special value of this book. The book focuses on placental pathology rather than on the mechanisms in the brain leading to cerebral maldevelopment, dysfunction or injury. With this restriction, the book represents the current knowledge in the field showing at the same time that much of the relationship between placental dysfunction and neurodisability is still hypothetic. This book certainly presents a wealth of information useful for anyone in placenta research and clinicians in obstetrics, perinatology or pediatric neurology who is interested in the origins or deals with the consequences of perinatal brain damage.