Key Takeaways

  • Immune activation in a pregnant woman can occur in response to metabolic diseases like obesity, infections in pregnancy, exposure to pollution and environmental toxins, or even stress and can have negative effects on fetal brain immune cells (microglia).
  • It’s not possible to monitor microglia within the fetal brain, but new research from Massachusetts General Hospital indicates that macrophages in the placenta can act as an indicator of these cells’ health.
  • Assessing placental immune cells can reveal when immune activation may harm the health of fetal brain immune cells, potentially putting newborns at risk of developing neurodevelopmental disorders.

BOSTON—Immune activation in a pregnant woman can have negative effects on the development of fetal brain microglia—or macrophage immune cells in the brain—and even lead to neurodevelopmental disorders in newborns.

It’s not possible to monitor how microglia are developing within the fetal brain, but new research indicates that the health of fetal macrophages in the placenta can act as an indicator of the health of fetal brain microglia.

The research was led by investigators from Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system, and is published in Cell Reports.

“If we can use fetal placental macrophages as a surrogate cell type or biomarker for fetal brain microglial programming, we have the opportunity to identify those children at greatest risk from in utero immune-activating exposures. Identifying these children early creates the potential to intervene during key developmental windows to ameliorate the impact of those pregnancy exposures,” said senior author Andrea Edlow, MD MSc, an associate professor of Obstetrics, Gynecology, and Reproductive Biology, and a Maternal-Fetal Medicine specialist at Massachusetts General Hospital. Dr. Edlow is also an MGH Research Scholar.

Examples of immune-activating exposures during pregnancy include bacterial and viral infections, metabolic inflammation from obesity and diabetes, environmental toxins and maternal stress.  Edlow and her colleagues assessed placental macrophages in a mouse model of maternal diet-induced obesity.

Single-cell RNA sequencing of mouse fetal placental macrophages (or Hofbauer cells) revealed similar gene expression signatures as fetal brain microglia during normal conditions and also in response to maternal diet-induced obesity.

Interestingly, the sex of the fetus impacted how maternal obesity affects the placenta and the fetal brain. Specifically, male placental macrophages and fetal brain microglia had a greater number of genes dysregulated by maternal obesity and more neuroinflammatory signaling than female cells.

When the investigators compared their mouse data with published human datasets, they found conserved gene expression patterns in placental macrophages in mice and humans, suggesting that their findings in mice may have clinical implications in humans.

“This work is a promising start for using fetal placental macrophages as a biomarker for fetal brain microglial programming in a variety of maternal exposures, and it could form the basis for creating personalized fetal models of neurodevelopment using cells from the placenta that are easily accessible at birth,” said Edlow.


Authorship: Rebecca Batorsky, Alexis M Ceasrine, Lydia L Shook, Sezen Kislal, Evan A. Bordt, Benjamin A. Devlin, Roy H. Perlis, Donna K. Slonim, Staci D. Bilbo, and Andrea G. Edlow.

Disclosures: Disclosure forms provided by the authors are available with the full text of this article at

This research was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development, the Robert and Donna Landreth Family Foundation, and the Charles Lafitte Foundation.

Paper cited: Batorsky R et al. “Hofbauer cells and fetal brain microglia share transcriptional profiles and responses to maternal diet-induced obesity.” Cell Reports

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About Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. MGH is a founding member of the Mass General Brigham healthcare system.