Impacts of Indicated Preterm Birth and Placental Pathology on Neonatal Outcomes in Early Preterm Births

Document Type

Conference Proceeding

Publication Date

3-19-2024

Publication Title

Reprod Sci

Abstract

Introduction: Preterm birth (PTB) can be classifed into those who delivered due to maternal or fetal indications (indicated PTB) and those who delivered spontaneously. Types of preterm delivery and mechanisms of disease as informed by placenta histopathology (i.e. infection infammation vs. maternal vascular malperfusion lesions) could identify neonates at risk for specifc adverse neonatal outcomes. Methods: A retrospective cohort study was conducted to include singleton, pregnant women who delivered at 22- 32 weeks of gestation between 2017 and 2022. Pregnancies were categorized by type of PTB (spontaneous or indicated). Data was directly abstracted from the medical records. Placental pathology was reviewed by an experienced pathologist and reported according to the Amsterdam criteria. Adverse neonatal outcomes included neonatal death (ND), bronchopulmonary dysplasia (BPD), and necrotizing enterocolitis (NEC). Results: 341 PTBs were included, of which 46.3% were indicated. After adjusting for GA at delivery, birthweight percentile, and multiple comparisons by false discovery rate (q< 0.1), the following associations persisted: 1) for early PTB ≥ 24 weeks, the presence of maternal vascular malperfusion (MVM)-vascular lesions was associated with a three-fold increased risk for BPD grade 2 or 3 and/or ND (competing outcome); 2) NEC and/or ND was associated with indicated PTB [OR 3.97 (95% CI, 2.04 -8.06); p = 0.001], MVM-villous lesions [OR 2.32 (95% CI, 1.11-4.86), p = 0.02], and MVM-infarcts [OR 2.32 (95% CI, 1.12-4.82); p=0.02]. However, the association between NEC and/or ND and indicated PTB disappeared after consideration of the placenta lesions; and 3) a protective efect against ND was observed with exposure to antenatal steroids [OR 0.22 (95% CI, 0.08-0.59); p=0.002] and magnesium sulfate [OR 0.32 (95% CI, 0.14-0.75); p= 0.008) for early PTB. Conclusion: Indicated PTB (versus spontaneous) is associated with an increased risk of NEC and/or ND because of the high frequency of MVM lesions observed in this subtype of PTB. Since MVM lesions were associated with both BPD or NEC and/or ND, an anti-angiogenic state (mechanism of disease leading to MVM lesion) in the mothers may be a link to these adverse neonatal outcomes.

Volume

31

Issue

Suppl 1

First Page

210A

Last Page

211A

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