Prof Ivo Brosens (collaborator of Caroline Gargett)
This opinion piece provides emerging evidence to support an hypothesis that biological immaturity of the adolescent uterus, in particular the inability of the endometrium to respond to the pregnancy hormone progesterone (progesterone resistance) . How quickly the teenage endometrium transitions to an adult endometrium likely determines pregnancy outcomes. Several cell types have important roles in the earliest stages of placental development - uterine NK cells and endometrial mesenchymal stem cells that both influence the invasion of placental trophoblasts into the spiral arterioles to establish the formation of the placenta.
The Ritchie Centre
Endometrial stem cell biology group
Journal and article title
Social factors and inadequate antenatal care are often blamed for the poor pregnancy outcomes of teenage girls. However we are finding that the biological immaturity of the teenage uterus appears to have a key role. One of these cell types involved in the vessel remodelling that is essential for placental development are the perivascular endometrial mesenchymal stem cells. These cells normally disappear during this process, but in teenage pregnancies they remain in poorly remodelled vessels that lead to pregnancy disorders such as preeclampsia, fetal growth restriction and preterm birth.
A better understanding of how the uterus matures in teenagers assists our understanding of how quiescent endometrial stem cells gradually become activated during the first menstrual cycles. This then enables the endometrium to become a highly plastic remodelling organ capable of monthly tissue regeneration, placental development and pregnancy unlike any other tissue in the body. Improved nutritional, lifestyle and reproductive health education for teenage girls is important to prevent obstetrical disorders in this group as most interventions do not address uterine immaturity.
Obstetrical syndromes in adolescents - pre-eclampsia, fetal growth restriction, preterm birth