Collagen of the umbilical cord and its alteration in EPH-gestosis (preeclampsia)

Edema, proteinuria, hypertension (EPH)-gestosis, known in the literature also as preeclampsia, is the most common, pregnancy-associated pathological process. It is accompanied by significant alterations in the extracellular matrix of the umbilical cord. In particular, a distinct (two-fold) increase in collagen content and alterations between the proportional amounts of type I: type III collagens have been found in the umbilical cord arteries (UCAs). An accumulation of collagen in the UCAs of newborns delivered by mothers with EPH-gestosis is accompanied by a significant reduction in the amount of elastin in the arterial walls. Metabolic studies have demonstrated that changes in collagen and elastin biosynthesis and degradation rates are responsible for these phenomena. These alterations co-exist with early replacement of hyaluronic acid by sulphated glycosaminoglycans, both in the arterial walls and in the surrounding Wharton’s jelly. Such phenomena correspond to “premature ageing” of the extracellular matrix of the umbilical cord tissues in fetuses of mothers with EPH-gestosis. It may be the case that similar changes occur in other fetal arteries also. This may result in an increase in peripheral resistance as well as in blood pressure in the fetal vascular system. The raised blood pressure may persist after birth. One suspects that EPH-gestosis is a factor which evokes the initiation of hypertensionin utero and sustains its amplification throughout childhood and adult life.