Ischemic placental disease: A unifying concept for preeclampsia, intrauterine growth restriction, and placental abruption

Ananth, Cande V.

doi:10.1053/j.semperi.2014.03.001

Cited by 101 publications

(112 citation statements)

References 14 publications

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“…In line with our positive findings for placental disorders, we found a positive association between TTP and IPD, a syndrome that includes preeclampsia, intrauterine growth restriction, and placental abruption (21, 22). These three obstetrical conditions have been hypothesized to represent distinct clinical manifestations of the same underlying disease process at varying gestational ages (21).…”

Section: Discussionsupporting

confidence: 90%

“…There was only a weak association between fertility treatment and PTB risk (RR=1.05, 95% CI: 0.72, 1.54), which explains why control for fertility treatment had little effect on the association between TTP and PTB. When we further controlled for ischemic placental disease (IPD), which accounts for up to 50% of medically-indicated PTB (21), the RR for TTP (≥12 versus <3 cycles) and medicallyindicated PTB was 1.05 (95% CI: 0.48, 2.31). The overall association between TTP (≥12 versus <3 cycles) and PTB became stronger when we used a more stringent definition of PTB (<36 weeks’ gestation: IRR=2.25, 95% CI: 1.09, 4.65; <35 weeks’ gestation: IRR=4.20, 95% CI: 1.48, 11.9).…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…These three obstetrical conditions have been hypothesized to represent distinct clinical manifestations of the same underlying disease process at varying gestational ages (21). Ananth postulated that IPD results from inadequate placental attachment or premature placental detachment (21). Risk factors for IPD include abnormal extracellular matrix remodeling, thrombosis and coagulation defects, inflammation, infection, and angiogenesis (21).…”

Section: Discussionmentioning

confidence: 99%

“…Postpartum hemorrhage was defined as blood loss of ≥500 mL. Ischemic placental disease (IPD) included intrauterine growth restriction, placental abruption, and preeclampsia (21, 22). A list of ICD-10 codes used to identify selected birth outcomes is shown in Table 1.…”

Section: Methodsmentioning

confidence: 99%

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Prospective study of time to pregnancy and adverse birth outcomes

Wise

Mikkelsen

Sørensen

et al. 2015

Fertility and Sterility

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Objective To investigate the association between time-to-pregnancy (TTP) and adverse birth outcomes. Design Prospective cohort study. Setting Internet-based observational study of Danish pregnancy planners (2007-2012). Patient(s) 3,521 singletons born to women aged 18-40 years at cohort entry. Intervention(s) None. Main outcome measure(s) selected birth outcomes—including preterm birth (PTB, <37 weeks’ gestation), low birth weight (LBW, <2500 g), small-for-gestational age (SGA), large-for-gestational age (LGA), and placental disorders— ascertained from the Danish Medical Birth Registry and Danish National Registry of Patients. Risk ratios (RR) and 95% confidence intervals (CI) were estimated using log-binomial regression, with adjustment for potential confounders and fertility treatment. Results Multivariable RRs for PTB in relation to TTP of 3-5, 6-11, and ≥12 versus <3 cycles were: 1.59 (CI: 0.94, 2.69), 0.85 (CI: 0.48, 1.50), and 1.57 (CI: 0.93, 2.65). The association was slightly stronger for spontaneous PTB (TTP ≥12 versus <3 cycles: RR=1.69, CI: 0.84, 3.42) than medically-indicated PTB (RR=1.39, 95%: 0.62, 3.12). Longer TTPs (≥12 cycles) were associated with increased risks of LBW (RR=1.80, CI: 0.97, 3.35), caesarean delivery (RR=1.64, CI: 1.27, 2.12), placental disorders (RR=2.21, CI: 1.07, 4.56), ischemic placental disease (RR=1.56, CI: 0.99, 2.44), preeclampsia (RR=1.45, CI: 0.79, 2.65), and postpartum hemorrhage (RR=1.58, CI: 1.14, 2.19), and decreased risks of macrosomia (≥4,500g; RR=0.63, CI: 0.35, 1.13) and LGA (RR=0.76, CI: 0.58, 1.00). Longer TTP showed little association with SGA. Conclusion In a prospective cohort study of Danish pregnancy planners, delayed conception was a marker for adverse birth outcomes, after accounting for fertility treatment.

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Section: Discussionsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Prospective study of time to pregnancy and adverse birth outcomes

Wise

Mikkelsen

Sørensen

et al. 2015

Fertility and Sterility

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Risk of Stroke Hospitalization After Infertility Treatment

Sachdev,

Yamada,

Lee

et al. 2023

JAMA Netw Open

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ImportanceStroke accounts for 7% of pregnancy-related deaths in the US. As the use of infertility treatment is increasing, many studies have sought to characterize the association of infertility treatment with the risk of stroke with mixed results.ObjectiveTo evaluate the risk of hospitalization from hemorrhagic and ischemic strokes in patients who underwent infertility treatment.Design, Setting, and ParticipantsThis population-based, retrospective cohort study used data abstracted from the Nationwide Readmissions Database, which stores data from all-payer hospital inpatient stays from 28 states across the US, from 2010 and 2018. Eligible participants included individuals aged 15 to 54 who had a hospital delivery from January to November in a given calendar year, and any subsequent hospitalizations from January to December in the same calendar year of delivery during the study period. Statistical analysis was performed between November 2022 and April 2023.ExposureHospital delivery after infertility treatment (ie, intrauterine insemination, assisted reproductive technology, fertility preservation procedures, or use of a gestational carrier) or after spontaneous conception.Main Outcomes and MeasuresThe primary outcome was hospitalization for nonfatal stroke (either ischemic or hemorrhagic stroke) within the first calendar year after delivery. Secondary outcomes included risk of stroke hospitalization at less than 30 days, less than 60 days, less than 90 days, and less than 180 days post partum. Cox proportional hazards regression models were used to estimate associations, which were expressed as hazard ratios (HRs), adjusted for confounders. Effect size estimates were corrected for biases due to exposure misclassification, selection, and unmeasured confounding through a probabilistic bias analysis.ResultsOf 31 339 991 patients, 287 813 (0.9%; median [IQR] age, 32.1 [28.5-35.8] years) underwent infertility treatment and 31 052 178 (99.1%; median [IQR] age, 27.7 [23.1-32.0] years) delivered after spontaneous conception. The rate of stroke hospitalization within 12 months of delivery was 37 hospitalizations per 100 000 people (105 patients) among those who received infertility treatment and 29 hospitalizations per 100 000 people (9027 patients) among those who delivered after spontaneous conception (rate difference, 8 hospitalizations per 100 000 people; 95% CI, −6 to 21 hospitalizations per 100 000 people; HR, 1.66; 95% CI, 1.17 to 2.35). The risk of hospitalization for hemorrhagic stroke (adjusted HR, 2.02; 95% CI, 1.13 to 3.61) was greater than that for ischemic stroke (adjusted HR, 1.55; 95% CI, 1.01 to 2.39). The risk of stroke hospitalization increased as the time between delivery and hospitalization for stroke increased, particularly for hemorrhagic strokes. In general, these associations became larger for hemorrhagic stroke and smaller for ischemic stroke following correction for biases.Conclusions and RelevanceIn this cohort study, infertility treatment was associated with an increased risk of stroke-related hospitalization within 12 months of delivery; this risk was evident as early as 30 days after delivery. Timely follow-up in the immediate days post partum and continued long-term follow-up should be considered to mitigate stroke risk.

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Association of Temporal Changes in Gestational Age With Perinatal Mortality in the United States, 2007-2015

et al. 2018

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IMPORTANCE Whether the changing gestational age distribution in the United States since 2005 has affected perinatal mortality remains unknown. OBJECTIVE To examine changes in gestational age distribution and gestational age-specific perinatal mortality. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined trends in US perinatal mortality by linking live birth and infant death data among more than 35 million singleton births from January 1, 2007, through December 31, 2015. EXPOSURES Year of birth and changes in gestational age distribution. MAIN OUTCOMES AND MEASURES Changes in the proportion of births at gestational ages 20 to 27, 28 to 31, 32 to 33, 34 to 36, 37 to 38, 39 to 40, 41, and 42 to 44 weeks; changes in perinatal mortality (stillbirth at Ն20 weeks, and neonatal deaths at <28 days) rates; and contribution of gestational age changes to perinatal mortality. Trends were estimated from log-linear regression models adjusted for confounders. RESULTS Among the 34 236 577 singleton live births during the study period, the proportion of births at all gestational ages declined, except at 39 to 40 weeks, which increased (54.5% in 2007 to 60.2% in 2015). Overall perinatal mortality declined from 9.0 to 8.6 per 1000 births (P < .001). Stillbirths declined from 5.7 to 5.6 per 1000 births (P < .001), and neonatal mortality declined from 3.3 to 3.0 per 1000 births (P < .001). Although the proportion of births at gestational ages 34 to 36, 37 to 38, and 42 to 44 weeks declined, perinatal mortality rates at these gestational ages showed annual adjusted relative increases of 1.0% (95% CI, 0.6%-1.4%), 2.3% (95% CI, 1.9%-2.8%), and 4.2% (95% CI, 1.5%-7.0%), respectively. Neonatal mortality rates at gestational ages 34 to 36 and 37 to 38 weeks showed a relative adjusted annual increase of 0.9% (95% CI, 0.2%-1.6%) and 3.1% (95% CI, 2.1%-4.1%), respectively. Although the proportion of births at gestational age 39 to 40 weeks increased, perinatal mortality showed an annual relative adjusted decline of −1.3% (95% CI, −1.8% to −0.9%). The decline in neonatal mortality rate was largely attributable to changes in the gestational age distribution than to gestational age-specific mortality. CONCLUSIONS AND RELEVANCE Although the proportion of births at gestational age 39 to 40 weeks increased, perinatal mortality at this gestational age declined. This finding may be owing to pregnancies delivered at 39 to 40 weeks that previously would have been unnecessarily delivered earlier, leaving fetuses at higher risk for mortality at other gestational ages.

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Ischemic placental disease: A unifying concept for preeclampsia, intrauterine growth restriction, and placental abruption

Cited by 101 publications

References 14 publications

Prospective study of time to pregnancy and adverse birth outcomes

Prospective study of time to pregnancy and adverse birth outcomes

Risk of Stroke Hospitalization After Infertility Treatment

Association of Temporal Changes in Gestational Age With Perinatal Mortality in the United States, 2007-2015

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