Altered Decidualization and Pregnancy Complications

A new hot research topic: decidualization

Key Points

Highlights:

• Endometrial decidualization has an important role in various conditions, ranging from implantation failure and recurrent pregnancy loss to several complications of advanced gestation.
• Women with endometriosis have an altered decidualization response which could be operative on their reproductive problems besides infertility.

Importance:

• Scientific evidence supports the notion that an improper decidualization response could well be the determinant of pregnancy complications, both in early and advanced gestation.

What’s done here:

• This is a comprehensive review of the biological significance and changes characterizing the decidualization process with a discussion on the clinical implications of defective or disordered decidualization.
• The authors aimed to highlight how endometrial diseases, including endometriosis, contribute to decidualization failure, with specific emphasis on early pregnancy complications.

Key results:  

• Disordered decidualization response could result in:
  • accelerated endometrial stromal cell senescence
  • impaired differentiation to decidual cells,
  • local immune dysregulation,
  • defective vascular remodeling,
  • disturbed signaling pathways, altered gene expression along with differently expressed miRNA, and
  • progesterone resistance.
• These altered decidual responses could result in infertility, recurrent implantation failure, recurrent abortuses, and advanced pregnancy complications such as fetal growth restriction, preeclampsia, abruptio placenta, placenta accreta, preterm labor.

Lay Summary

Dr. Carlo Ticconi and colleagues from Italy published their comprehensive review manuscript “Clinical consequences of defective decidualization” in the June 2021 issue of “Tissue and Cell”.

Currently, there has been growing research interest in the study of decidualization, and knowledge of this important biological process has been evolving. Growing evidence supports the concept that an improper decidualization could well be a determinant of several pregnancy complications, both in early and in advanced gestation.

This comprehensive review has targeted reviewing the biological significance and the major changes characterizing decidualization, discussing the clinical implications of a defective or disordered decidualization, and highlighting how endometrial diseases, such as endometriosis, contribute to decidualization failure resulting in early pregnancy complications. Being a combination of genetic, metabolic, morphological, biochemical, vascular, and immune reactions of the inner layer of the uterus, decidualization prepares a bed for the embryo. When the decidualization is improper or altered in women with the diseases of the endometrium, such as chronic endometritis and endometriosis, recurrent implantation failure, and recurrent pregnancy loss, advanced pregnancy complications occur easily.

Altered decidualization of endometrium could have results such as accelerated endometrial stromal cell senescence and impaired differentiation to decidual cells, local immune dysregulation, defective vascular remodeling, disturbed signaling pathways, altered gene expression along with differently expressed miRNA and progesterone resistance.

These pathologic responses could have clinical consequences such as infertility, recurrent implantation failure, recurrent abortuses, and advanced pregnancy complications such as growth restriction of the baby, preeclampsia,  early detachment of the placenta, placenta attachment anomalies, and preterm labor.

The authors conclude that research projects are in need to fully understand the biomolecular mechanisms and events underlying abnormal decidualization. This could well be operative in the development of both diagnostic and therapeutic pathways improving clinical efforts for successful pregnancies.

Research Source: https://pubmed.ncbi.nlm.nih.gov/34217128/