The Association between Placenta Accreta Spectrum Severity and Incidence of Small for Gestational Age Neonates

被引:6
作者
Detlefs, Sarah E. [1 ,2 ]
Carusi, Daniela A. [3 ]
Modest, Anna M. [4 ]
Einerson, Brett D. [5 ]
Lyell, Deirdre [6 ]
Grace, Matthew R. [7 ]
Shrivastava, Vineet K. [8 ]
Khandelwal, Meena [9 ]
Salmanian, Bahram [1 ,2 ]
Shainker, Scott A. [4 ]
Fox, Karin A. [1 ,2 ]
Subramaniam, Akila [10 ]
Crosland, Adam [8 ]
Duryea, Elaine L. [11 ]
Shamshirsaz, Amir A. [1 ,2 ]
Shrestha, Kevin [10 ]
Belfort, Michael A. [1 ,2 ]
Silver, Robert M. [5 ]
Clark, Steven L. [1 ,2 ]
Shamshirsaz, Alireza A. [1 ,2 ]
机构
[1] Baylor Coll Med, Div Maternal Fetal Med, Dept Obstet & Gynecol, Houston, TX USA
[2] Texas Childrens Hosp, Houston, TX 77030 USA
[3] Brigham & Womens Hosp, Dept Obstet & Gynecol, 75 Francis St, Boston, MA 02115 USA
[4] Beth Israel Deaconess Med Ctr, Dept Obstet & Gynecol, Boston, MA 02215 USA
[5] Univ Utah Hlth, Div Maternal Fetal Med, Dept Obstet & Gynecol, Salt Lake City, UT USA
[6] Stanford Univ, Div Maternal Fetal Med, Dept Obstet & Gynecol, Palo Alto, CA 94304 USA
[7] Vanderbilt Univ, Med Ctr, Div Maternal Fetal Med, Dept Obstet & Gynecol, 221 Kirkland Hall, Nashville, TN 37235 USA
[8] Miller Childrens & Womens Hosp, Div Maternal Fetal Med, Dept Obstet & Gynecol, Long Beach, CA USA
[9] Cooper Univ Hosp, Div Maternal Fetal Med, Dept Obstet & Gynecol, Princeton, NJ USA
[10] Univ Alabama Birmingham, Dept Obstet & Gynecol, Birmingham, AL USA
[11] Univ Texas Southwestern Med Ctr, Div Maternal Fetal Med, Dept Obstet & Gynecol, Dallas, TX USA
关键词
placenta accreta spectrum; birthweight; small for gestational age;
D O I
10.1055/s-0042-1757261
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective The aim of the study is to evaluate whether pathologic severity of placenta accreta spectrum (PAS) is correlated with the incidence of small for gestational age (SGA) and neonatal birthweight. Study Design This was a multicenter cohort study of viable, non-anomalous, singleton gestations delivered with histology-proven PAS. Data including maternal history, neonatal birthweight, and placental pathology were collected and deidentified. Pathology was defined as accreta, increta, or percreta. The primary outcome was rate of SGA defined by birth weight less than the 10th percentile. The secondary outcomes included incidence of large for gestational age (LGA) babies as defined by birth weight greater than the 90th percentile as well as incidence of SGA and LGA in preterm and term gestations. Statistical analysis was performed using Chi-square, Kruskal-Wallis, and log-binomial regression. Increta and percreta patients were each compared with accreta patients. Results Among the cohort of 1,008 women from seven United States centers, 865 subjects were included in the analysis. The relative risk (RR) of SGA for increta and percreta did not differ from accreta after adjusting for confounders (adjusted RR = 0.63, 95% confidence interval [CI]: 0.36-1.10 for increta and aRR = 0.72, 95% CI: 0.45-1.16 for percreta). The results were stratified by placenta previa status, which did not affect results. There was no difference in incidence of LGA ( p = 1.0) by PAS pathologic severity. The incidence of SGA for all PAS patients was 9.2% for those delivered preterm and 18.7% for those delivered at term ( p = 0.004). The incidence of LGA for all PAS patients was 12.6% for those delivered preterm and 13.2% for those delivered at term ( p = 0.8203). Conclusion There was no difference in incidence of SGA or LGA when comparing accreta to increta or percreta patients regardless of previa status. Although we cannot suggest causation, our results suggest that PAS, regardless of pathologic severity, is not associated with pathologic fetal growth in the preterm period.
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页码:9 / 14
页数:6
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