Placenta-fetal lung communication: from mechanisms to personalized perinatal medicine

Abstract

The placenta is a dynamic and essential organ that orchestrates fetal development, influencing postnatal health. Its communication with the fetal lung, crucial for autonomous respiration, occurs through hormonal signals, growth factors, extracellular vesicles, and mechanical stimuli. Alterations in this complex interaction, caused by placental insufficiency, inflammation, hypertensive disorders, or gestational diabetes, lead to neonatal pathologies such as growth restriction, bronchopulmonary dysplasia, and persistent pulmonary hypertension. These conditions predisposed to future chronic diseases. Current research aims to unravel the direct molecular placenta-lung communication and develop integrated organoid models for more precise study. The goal is to identify biomarkers for early diagnosis and design prenatal therapies that modulate placental function. This proactive approach promises to transform perinatal medicine, preventing pulmonary alterations before birth and laying the groundwork for optimal child health. The objective of this review was to analyze the molecular, physiological, and clinical mechanisms that underpin the functional communication between the placenta and the fetal lung, to understand its impact on the programming of neonatal cardiopulmonary health and to explore diagnostic and therapeutic strategies aimed at personalized perinatal medicine.