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Association between maternal characteristics, abnormal serum aneuploidy analytes, and placental abruption

https://doi.org/10.1016/j.ajog.2014.03.027Get rights and content

Objective

The objective of the study was to examine the association between placental abruption, maternal characteristics, and routine first- and second-trimester aneuploidy screening analytes.

Study Design

The study consisted of an analysis of 1017 women with and 136,898 women without placental abruption who had first- and second-trimester prenatal screening results, linked birth certificate, and hospital discharge records for a live-born singleton. Maternal characteristics and first- and second-trimester aneuploidy screening analytes were analyzed using logistic binomial regression.

Results

Placental abruption was more frequent among women of Asian race, age older than 34 years, women with chronic and pregnancy-associated hypertension, preeclampsia, preexisting diabetes, previous preterm birth, and interpregnancy interval less than 6 months. First-trimester pregnancy-associated plasma protein–A of the fifth percentile or less, second-trimester alpha fetoprotein of the 95th percentile or greater, unconjugated estriol of the fifth percentile or less, and dimeric inhibin-A of the 95th percentile or greater were associated with placental abruption as well. When logistic models were stratified by the presence or absence of hypertensive disease, only maternal age older than 34 years (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.0–2.0), pregnancy-associated plasma protein–A of the 95th percentile or less (OR, 1.9; 95% CI, 1.2–3.1), and alpha fetoprotein of the 95th percentile or greater (OR, 2.3; 95% CI, 1.4–3.8) remained statistically significantly associated for abruption.

Conclusion

In this large, population-based cohort study, abnormal maternal aneuploidy serum analyte levels were associated with placental abruption, regardless of the presence of hypertensive disease.

Section snippets

Materials and Methods

The study sample was drawn from a cohort of 236,714 singleton pregnancies undergoing first- and second-trimester prenatal serum screening through the California Prenatal Screening Program administered by the Genetic Disease Screening Program (GDSP), with expected dates of delivery in 2009 and 2010. The sample was restricted to pregnancies that had a linked live birth and hospital discharge record in the birth cohort database maintained by the Office of Statewide Health Planning and Development

Results

When analyzing the demographics of the cohort, Asian race (OR, 1.4; 95% CI, 1.1–1.7) and maternal age older than 34 years (OR, 1.4; 95% CI, 1.2–1.6) were more common among women with placental abruption. Women with placental abruption were also more likely to have 1 or more hypertensive disorders. Specifically, they were more than twice as likely to have pregestational hypertension (OR, 2.5; 95% CI, 1.6–3.8) and more than 3 times as likely to have preeclampsia or eclampsia (OR, 3.8; 95% CI,

Comment

In this large population-based study, we show that abnormal aneuploidy screening analytes are independent markers of placental abruption, including among patients with hypertensive disease. Although the greatest risk for placental abruption was observed in the pregnancies with hypertensive disorders (nearly 3- to more than 5-fold increased risk), first-trimester PAPP-A of the fifth percentile or less and second-trimester AFP of the 95th percentile or greater were associated with an increased

References (32)

Cited by (34)

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This study was supported in part by grants from the March of Dimes Prematurity Center, Stanford University School of Medicine, Stanford, CA.

The authors report no conflict of interest.

Cite this article as: Blumenfeld YJ, Baer RJ, Druzin ML, et al. Association between maternal characteristics, abnormal serum aneuploidy analytes, and placental abruption. Am J Obstet Gynecol 2014;211:144.e1-9.

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