{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T18:38:59Z","timestamp":1791657539746,"version":"4.3.4"},"reference-count":146,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T00:00:00Z","timestamp":1591574400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Interventions to prevent pregnancy complications have been largely unsuccessful. We suggest this is because the foundation for a healthy pregnancy is laid prior to the establishment of the pregnancy at the time of endometrial decidualization. Humans are one of only a few mammalian viviparous species in which decidualization begins during the latter half of each menstrual cycle and is therefore independent of the conceptus. Failure to adequately prepare (decidualize) the endometrium hormonally, biochemically, and immunologically in anticipation of the approaching blastocyst\u2014including the downregulation of genes involved in the pro- inflammatory response and resisting tissue invasion along with the increased expression of genes that promote angiogenesis, foster immune tolerance, and facilitate tissue invasion\u2014leads to abnormal implantation\/placentation and ultimately to adverse pregnancy outcome. We hypothesize, therefore, that the primary driver of pregnancy health is the quality of the soil, not the seed.<\/jats:p>","DOI":"10.3390\/ijms21114092","type":"journal-article","created":{"date-parts":[[2020,6,9]],"date-time":"2020-06-09T05:16:14Z","timestamp":1591679774000},"page":"4092","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":312,"title":["Endometrial Decidualization: The Primary Driver of Pregnancy Health"],"prefix":"10.3390","volume":"21","author":[{"given":"Shu-Wing","family":"Ng","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Tufts University School of Medicine, Boston, MA 02111, USA"},{"name":"Mother Infant Research Institute, Tufts Medical Center, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella A.","family":"Norwitz","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8439-9351","authenticated-orcid":false,"given":"Mihaela","family":"Pavlicev","sequence":"additional","affiliation":[{"name":"Department of Theoretical Biology, University of Vienna, 1010 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Tilburgs","sequence":"additional","affiliation":[{"name":"Division of Immunobiology and Center for Inflammation and Tolerance, Cincinnati Children\u2019s Hospital, Cincinnati, OH 45229, USA"},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Sim\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Valencia University and INCLIVA, 46010 Valencia, Spain"},{"name":"Department of Obstetrics &amp; Gynecology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA"},{"name":"Igenomix Foundation and INCLIVA, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Errol R.","family":"Norwitz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Tufts University School of Medicine, Boston, MA 02111, USA"},{"name":"Mother Infant Research Institute, Tufts Medical Center, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1126\/science.7985020","article-title":"Implantation and the placenta: Key pieces of the development puzzle","volume":"266","author":"Cross","year":"1994","journal-title":"Science"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1056\/NEJMra000763","article-title":"Implantation and the survival of early pregnancy","volume":"345","author":"Norwitz","year":"2001","journal-title":"N. 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