The Hidden Influence of Placental Health on Child Development

We are Dima and Phuong, MSc students in the Developmental Psychology and Psychopathology programme at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. As part of our accredited placement, we had the exciting opportunity to review findings from two studies led by researchers at King’s College London, in collaboration with the Safe Passage Study group in South Africa. These studies focus on understanding early developmental risk and resilience – key areas that have not only deepened our interest in developmental psychology but have helped shape the direction of our upcoming dissertation projects. Through this article, we can share some key insights we have gained and reflect on how this placement experience is influencing our research journey.

Not all connections are built to last, and when they break, the effects can be profound. Whether it’s a personal relationship or a biological one, disruptions can leave lasting marks. During pregnancy, the mother and baby are connected through the placenta, a temporary yet vital organ that acts as the bridge, facilitating the exchange of oxygen, nutrients, and waste, ensuring the baby’s development. The placenta contains two distinct areas (i.e., vascular compartments) where blood flows: maternal and foetal. However, complications during pregnancy can arise when placenta functioning is impaired by altered maternal blood flow.

We will unpack placental malperfusion (PM)—a condition where blood flow through the placenta is reduced or uneven, affecting either the mother’s or the baby’s blood vessels—and recent research investigating links between PM and offspring development.

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Understanding Placental Malperfusion

Affecting around 5–15% of normal pregnancies, PM may consequently put both mother and baby at risk of health problems. There are two main types of PM, categorised by where the interruption of blood flow occurs:

• Maternal Vascular Malperfusion (MVM): Maternal blood doesn’t flow properly to the placenta. This is often linked to preeclampsia (a condition marked by high blood pressure and signs of damage to another organ system, most often the liver and kidneys) and poor foetal growth.

  
  

• Foetal Vascular Malperfusion (FVM): Foetal blood flow within the placenta is compromised, commonly seen in preterm births and associated with intrauterine growth restriction (IUGR), a condition where the baby grows more slowly than expected in the womb.

While PM is a recognised term, inconsistencies in naming and classification have complicated cross-study comparisons. Causes of PM are likely multifactorial, involving a mix of maternal, placental, and foetal factors, with lifestyle risks (smoking, diabetes, obesity) and maternal mental health implicated.

Placental Malperfusion and Child Development: What the Research Says

Study 1: Reviewing the Evidence

In recent years, scientists have become increasingly interested in how reduced blood flow to the placenta may affect a child’s brain development, at birth and into adulthood. While some individual studies have touched on this connection, there hadn’t been a thorough review of all the existing evidence—until Ibrahim and colleagues (2025) conducted a systematic review study on this topic. This type of study design systematically identifies, selects and evaluates all relevant research on a specific topic.

The authors reviewed studies where PM was identified by closely examining placental tissue under a microscope to check for signs of infection, inflammation, or problems with the blood vessels. Child development outcomes included movement, cognitive, language, and mental health assessments up to age 8.

What did the Research Team Report?

In total, nine studies examined links between PM and child neurodevelopment. Of these, four studies found that MVM was linked to poorer neurodevelopmental outcomes, such as the development of autism, delays in motor skills, poor language development, or delayed cognition, in children between 10 months and 18 years of age. Interestingly, among preterm babies (born before or at 34 weeks of pregnancy), assessed before the age of 2 years, there was no clear evidence of links between MVM in women and their children’s development.

Among six studies examining FVM, findings were also mixed. Two studies reported FVM associated with poor development in children aged 2 to 8 years, especially among preterm babies with growth restriction. In contrast, there was no evidence of links between FVM and children’s physical outcomes or the functions of their nervous system after birth. For some studies, better cognitive skills and lower risk for autism spectrum disorder were even found, which may have been due to differences in the group of participants studied or positive environmental factors that helped make up for early challenges.

What do the findings imply?

The link between PM and child development depends on things such as how early the baby was born, how severe the placental issues were, and when the child’s development was measured. However, many studies had small sample sizes or used different ways to define and diagnose PM. To really understand the risks, future research needs to get on the same page—using consistent definitions, considering other pregnancy complications like preeclampsia, and making sure developmental assessments happen at similar times.

Photo by Curated Lifestyle for Unsplash+

Study 2: Utilising existing data to answer a new research question

Next, using existing data from the Safe PASSage Study of the Prenatal Alcohol in Sudden Infant Death Syndrome and Stillbirth Network, the research team analysed data from 1,297 pregnant women from a low-income community in South Africa and their full-term babies, investigating how maternal blood flow resistance during pregnancy affects cognitive development at one year.

Weissgold et al. (2025) focused on maternal placental health by examining the uterine artery pulsatility index (PI)—a measure of blood flow resistance in the uterine arteries.

During the second and third trimesters, uterine artery PI was measured using Doppler ultrasound (an imaging technique to assess blood flow). Higher PI indicated greater resistance to blood flow and potential maternal-side placental malperfusion—essentially, the placenta is not getting as much maternal blood as it needs.

After birth, placentas were examined under a microscope for signs of dysfunction, particularly MVM and accelerated villous maturation – two well-known markers of placental pathology.

Cognitive and motor skills at two months were also assessed.

So, what did this study report?

Greater resistance to blood flow (i.e. higher uterine artery PI) was associated with lower cognitive scores at one year, even after accounting for alcohol consumption and mothers’ experiences of depression during the second trimester of pregnancy (weeks 13 to 27). Surprisingly, placental pathology findings after birth did not affect this relationship, suggesting that blood flow resistance during pregnancy independently affects neurodevelopment.

The clinical effects observed, however, were quite small, and key information was gathered through self-reported surveys, which can sometimes be unreliable. Plus, the study only included a limited number of pregnant women, recruited on specific days, which raises questions about how well the sample represents the broader population.

Future research should aim to include larger and more diverse groups of participants, extend recruitment over longer periods, and rely on more objective tools to measure alcohol use and mental health. It would also be valuable to explore other environmental factors that may influence a child’s development.

Clinical Implications

While Ibrahim and colleagues’ (2025) systematic review focused on the link between PM and children's development by examining the placenta after birth, Weissgold and colleagues' evidence suggests that in-utero blood flow resistance (detectable during pregnancy) may signal risk to offspring development before birth.

This is especially important for low-resource settings, where early intervention can make a profound difference in a child’s life trajectory.

By integrating insights from both studies, this research team is helping to map the invisible early influences that shape a child’s future. In the words of the researchers, ‘the womb is not just a place of growth, it's where the story of brain development begins’. Monitoring placental blood flow through ultrasound and examining placentas after delivery could improve our ability to identify at-risk children early.

Early identification of placental abnormalities could help paediatricians initiate developmental screening and intervention sooner. Obstetricians, pathologists, and paediatricians should collaborate more closely, standardise reporting, and include placental pathology findings in neonatal records.

Clinicians should individualise discussions about placental findings, balancing medical significance with parental needs. Open, supportive conversations can empower families with critical knowledge about their child's developmental journey.