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Review
. 2020 Jun 8;21(11):4092.
doi: 10.3390/ijms21114092.

Endometrial Decidualization: The Primary Driver of Pregnancy Health

Shu-Wing Ng  1   2 , Gabriella A Norwitz  3 , Mihaela Pavlicev  4 , Tamara Tilburgs  5   6 , Carlos Simón  7   8   9 , Errol R Norwitz  1   2
Affiliations
Review

Endometrial Decidualization: The Primary Driver of Pregnancy Health

Shu-Wing Ng et al. Int J Mol Sci. .

Abstract

Interventions to prevent pregnancy complications have been largely unsuccessful. We suggest this is because the foundation for a healthy pregnancy is laid prior to the establishment of the pregnancy at the time of endometrial decidualization. Humans are one of only a few mammalian viviparous species in which decidualization begins during the latter half of each menstrual cycle and is therefore independent of the conceptus. Failure to adequately prepare (decidualize) the endometrium hormonally, biochemically, and immunologically in anticipation of the approaching blastocyst-including the downregulation of genes involved in the pro- inflammatory response and resisting tissue invasion along with the increased expression of genes that promote angiogenesis, foster immune tolerance, and facilitate tissue invasion-leads to abnormal implantation/placentation and ultimately to adverse pregnancy outcome. We hypothesize, therefore, that the primary driver of pregnancy health is the quality of the soil, not the seed.

Keywords: adverse pregnancy outcome; decidualization; endometrium; preconception.

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Conflict of interest statement

Carlos Simón is Founder and Head of the Scientific Advisory Board of Igenomix.

Figures

Figure 1
Figure 1
Anatomic arrangement of the decidua. Three anatomically and functionally discrete regions of the decidua are defined based on their relationship to the fetoplacental unit. The decidua basalis (or decidua placentalis) lies directly below the placenta. The decidua capsularis covers (encapsulates) the developing embryo as it grows and expands into the uterine cavity. The decidua parietalis (or decidua vera) lines the uterus remote from the placenta. A virtual space exists between the decidua capsularis and decidua parietalis until about 15–16 weeks of gestation, at which point these two tissues come together and fuse.
Figure 2
Figure 2
Molecular pathways involved in decidualization.
Figure 3
Figure 3
Signal transduction pathways involved in the genetic reprogramming and terminal differentiation of endometrial stromal fibroblast cells (ESCs) to decidual stromal fibroblast cells (DSCs).
See this image and copyright information in PMC

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References

    1. Cross J.C., Werb Z., Fisher S.J. Implantation and the placenta: Key pieces of the development puzzle. Science. 1994;266:1508–1518. doi: 10.1126/science.7985020. - DOI - PubMed
    1. Norwitz E.R., Schust D.J., Fisher S.J. Implantation and the survival of early pregnancy. N. Engl. J. Med. 2001;345:1400–1408. doi: 10.1056/NEJMra000763. - DOI - PubMed
    1. Norwitz E.R. Defective implantation and placentation: Laying the blueprint for pregnancy complications. Reprod. Biomed. Online. 2006;13:591–599. doi: 10.1016/S1472-6483(10)60649-9. - DOI - PubMed
    1. Brosens I., Pijnenborg R., Vercruysse L., Romero R. The “Great Obstetrical Syndromes” are associated with disorders of deep placentation. Am. J. Obstet. Gynecol. 2011;204:193–201. doi: 10.1016/j.ajog.2010.08.009. - DOI - PMC - PubMed
    1. Redman C.W., Sargent I.L. Immunology of pre-eclampsia. Am. J. Reprod. Immunol. 2010;63:534–543. doi: 10.1111/j.1600-0897.2010.00831.x. - DOI - PubMed

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