Placental abruption and cardiovascular disease (CVD) have common etiologic underpinnings and there is accumulating evidence that abruption may be associated with future CVD. We estimate associations between abruption and coronary heart disease (CHD) and stroke. The meta-analysis was based on the random-effects risk ratio (RR) and 95% confidence interval (CI) as the effect measure. We conducted a bias analysis to account for abruption misclassification, selection bias and unmeasured confounding. We included 11 cohort studies comprised of 6,325,152 pregnancies, 69,759 abruptions and 49,265 CHD and stroke cases (1967 to 2016). Risks of the combined CVD morbidity-mortality among abruption and non-abruption groups were 16.7 and 9.3 per 1000 births, respectively (RR 1.76, 95% CI: 1.24, 2.50; I2=94%; τ2=0.22). Women who suffered abruption were at 2.65-fold (95% CI: 1.55, 4.54; I2=85%; τ2=0.36) higher risk for deaths related to CHD/stroke than non-fatal CHD/stroke complications (RR 1.32, 95% CI: 0.91, 1.92; I2=93%; τ2=0.15). Abruption was associated with higher mortality from CHD (RR 2.64, 95% CI: 1.57, 4.44; I2=76%; τ2=0.31) than stroke (RR 1.70, 95% CI: 1.19, 2.42; I2=40%; τ2=0.05). Corrections for the aforementioned biases increased these estimates. Women with pregnancies complicated by placental abruption may benefit from postpartum screening or therapeutic interventions to help mitigate CVD risks.
Objective We hypothesized that the origins of abruption may extend to the stages of placental implantation; however, there are no reliable markers to predict its development. Based on this hypothesis, we sought to evaluate whether first-trimester and second-trimester serum analytes predict placental abruption. Methods We performed a secondary analysis of data of 35,307 women (250 abruptions) enrolled in the First and Second Trimester Evaluation of Risk (FASTER) cohort (1999–2003) – a multicenter, prospective cohort study. Percentiles (based on multiples of the median, MoM) of first-trimester (pregnancy-associated plasma protein A [PAPP-A], and total, and free-β human chorionic gonadotropin [β-hCG]), and second-trimester (maternal serum alpha fetoprotein [AFP], unconjugated estriol [uE3], and Inhibin-A) serum analytes were examined in relation to abruption. Associations are based on risk ratio (RR) and 95% confidence interval (CI). Results Women with an abnormally low PAPP-A (≤5 percentile) were at increased risk of abruption compared to those without an abruption (9.6% versus 5.3%; RR 1.9, 95% CI, 1.2–2.8). Maternal serum AFP ≥95 percentile was more common among abruption (9.6%) than non-abruption (5.1%) pregnancies (RR 1.9, 95% CI, 1.3–3.0). Inhibin-A ≤5 percentile (8.0% versus 5.1%; RR 1.8, 95% CI, 1.1–2.9), and ≥95 percentile (9.6% versus 5.0%; RR 2.0, 95% CI, 1.3–3.1) were associated with abruption. Women with all three abnormal PAPP-A, maternal serum AFP, and Inhibin-A analytes were at 8.8-fold (95% CI, 2.3–34.3) risk of abruption. No associations were seen with other analytes. Conclusions These data provide support to our hypothesis that the origins of placental abruption may extend to the early stages in pregnancy.
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