Does paternity contribute to pe?

[caryn]

LOL! This is where PE gets messy.

The placenta is formed from the blastocyst, specifically from the outer cells of the blastocyst, which are a specific kind of cell called a trophoblast. Scientists had trouble establishing trophoblastic cell lines for study in the lab, because those cells have evolved to thrive in a very particular environment, inside the mother and particularly inside her decidua, the lining of the uterus that's shed each month in your period. (Total nerds like me will say "aha!" when I say that one of our "pseudotrophoblastic" cell lines turned out to just be HeLa.)

Once the blastocyst has landed - that's a quote from the caption of this Lennart Nilsson photo - the trophoblastic cells embed into the uterus and establish the placenta. They're really just paternal cells, not fetal cells, because they've been epigenetically imprinted to shut down the expression of the maternal genes. And this is where the term "maternal-fetal conflict" comes from. They have Plans about how much blood flow the fetus will ultimately get. The mother's immune system has a different set of Plans, because she also wants the fetus to *fit out* once delivery rolls around.

The first order of business for the trophoblastic cells isn't to remodel the spiral arteries or start building the placenta, though it will do those shortly. The first thing is to coax the maternal immune system into ignoring the foreign proteins it's expressing. We do not entirely understand how this works, and scientific investigation into the question is obviously very difficult. But we do know that it communicates with the maternal decidual natural killer cells and talks them into *helping it* build the placenta.

There's some very interesting work coming out of Cambridge on this. The maternal KIR are polymorphic - that means that a bunch of different versions show up in humans. The paternal HLA is also polymorphic. KIR AA phenotype coupled to HLA-C is much more likely to lead to PE pregnancies, probably because the receptors simply cannot accept the molecule that serves the function of modulating some of the immune response, because the shape of the receptor cannot accomodate the shape of the antigen.

This means while it isn't *entirely* the dad's fault all the time, if he's making HLA-C and you're carrying KIR-AA, it can be partly his fault. ("Honey! It's your fault!")

(Funky philosophical concepts here include altruism, speciation, and functions. Your mileage may vary!)

[blythe]

Translation please?

[caryn]

Here's an interesting recent one: http://www.ncbi.nlm.nih.gov/pubmed/21529966

I'd quote the interesting bits, but the whole abstract is relevant, as you can see from the first three sentences: Preeclampsia is often considered as simply a maternal disease with variable degrees of fetal involvement. More and more the unique immunogenetic maternal-paternal relationship is appreciated, and also the specific 'genetic conflict' that is characteristic of haemochorial placentation. From that perspective, pre-eclampsia can be seen as a disease of an individual couple with primarily maternal and fetal manifestations.

So yes - because the placenta is really involved in preeclampsia, and because the father's genes are really involved in the placenta, this seems very reasonable to me. It's not the only problem, because maternal susceptibility to inflammation in response to the foreign proteins is also really relevant. But it's certainly still in play.

(I think this has really significant implications for a couple of philosophical problems in biology. A number of existing quandaries in definitions and mechanisms can be usefully modified with reference to some of this newer data and the Van Valen idea of the Red Queen.)

[tracym]

Thanks Heather

It wasn't any of those and I can't find my consent forms...I don't think it was a PE specific trial...something to do with IUGR, PPROM, PE and preterm delivery. It was current during 2005 and it was my PE history that made me eligible. Lucky for me, as no one expected me to get PE again, let alone worse and earlier. It definitely meant my symptoms were caught earlier than they would have been with a regular appointment schedule. I had fortnightly visits with blood draws, 12 hour urines and ultrasounds (pelvic and transvaginal). Also a 3hr GD test at 28ish weeks (on top of the regular 1hr test at 27 weeks, irrespective of those results). They also took blood from dh and took my placenta at delivery. They did tell me that I would not be able to find out any of my personal results but I would love to find out what the outcome of the trial was, just out of interest. It's pretty cool knowing that my weird pregnancy may help with research outcomes

[blythe]

Hi Tracy, that's very cool that you were in one of the studies!

I'm fairly certain other researchers' paternity studies have refuted (to at least some extent) this doctor - if anyone is interested you can check pubmed or the links Caryn has gathered in "recent studies and articles" viewtopic.php?f=28&t=26469&p=331108#p331108 under "paternity and preeclampsia".

As to your specific question, I'm not sure how to find your exact study results. Here's a few things I would try:

http://www.ncbi.nlm.nih.gov/pubmed?term ... a%20dekker - does it look like any of those studies were the one you were part of?

When I was in graduate school and helped conduct research (just helping professors on a few studies, I'm no researcher!) we were required to give written informed consent forms that included information on how to contact us for the overall study results when the study was completed. I assume you could just contact the institution where the research was conducted and ask. I believe Jasmin (reihlism) is a professor - Jasmin, what would you suggest?

I'll also ping Catherine, I'm pretty sure her research grant is from the NIH, so she should have some ideas, too.

I guess we can be a little thankful to the spam for bumping this for you!

[tracym]

I know this was only bumped from the never ending spam we keep getting...but Prof. Dekker was my dr with my second pregnancy, and I participated in a research trial at the time...does anyone (Caryn, Heather) know if it's possible to find out what any results were (just out of interest)? It was some sort of joint thing with the NIH from memory.

[Dawn D]

wanted to add that I was told by a nurse that I was "allergic to my husbands sperm" and (as many have been told) it is "only common in first pregnancies" and that if I were to have a child with another man (so nice of her to say in front of my dh) it could happen again because it would be like a first pregnancy. I carried these comments in my mind for a long time - believing them....I am grateful to know PF is establishedand is committed to keeping the information as accurate as possible.

Dawn (33)
Mya (3) born @30 weeks/3 lbs/ emerg c-sec/severe preE worsened following delivery

[jillmushet]

I learned this theory in the hospital post-partum. Maybe it was a NICU nurse that told me. I believed it for awhile. I even told my husband. I think he was hurt by it. He had to react to everything as his family lay in the hospital in serious condition. It didn't help for his wife to lay blame on him in the name of science.

Jill
Claire, 34wks, 3lbs 3ozs
3/3/00, PE & HELLP

[kdreher]

I don't care for it either and my peri threw that notion out the window when I met with him.

Kris (35) & Tom (35)
Connecticut State Coordinator

My Angel - Tyler 3/9/95 to 3/23/95 (15 oz, 26 wks severe pe/HELLP)
Tubal Ligation 2/2000
Tubal Reversal 10/2004
Miscarriage 1/05



tkstevens@sbcglobal.net

[laura]

Susan, that's why I *personally* really hate "the" theory. Any of them. Because there will always someone who thinks there should be blame and there shouldn't be blame, ever. We are all blameless for what happened to us and our babies and there shouldn't ever be guilt involved (although, speaking from experience, there always is.) I don't think these well-meaning researchers realize that they squeeze our hearts when they find "the" answer, only for a new "answer" to emerge the next month.

Laura
Webmaster/Forum Administrator
AK Area Coordinator

Alicia (severe PE) 5/98 ~ Camille (htn, oligo) 4/03
http://www.babiesonline.com/babies/c/camilleandallie/