Maternal Cardiovascular and Cerebrovascular Health After Placental Abruption: A Systematic Review and Meta-Analysis (CHAP-SR)

Abstract

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.

Vascular malperfusion and abruption are prevalent in placentas from pregnancies with congenital heart disease and not associated with cardiovascular risk

“…Placental abruption, or a premature separation of a previously normally implanted placenta, occurs through unknown mechanisms outside of the coup-countercoup phenomena in trauma and with hypertensive diseases of pregnancy. However, it is well documented that an obstetrical history of placental abruption history has been correlated to future coronary heart disease risk, including both hemorrhagic and ischemic stroke 12 , 13 . These findings raise the consideration for a common abnormal vascular etiology related to both the biology underlying the abruption and the subsequent vascular event.…”

Incidence, risk factors, and clinical outcomes of placental abruption in a tertiary hospital in Hong Kong: a retrospective case-control study

“…Other risk factors for placental abruption include pre-eclampsia (5-fold increased risk 14 ), fetal growth restriction, non-vertex presentations, polyhydramnios, advanced maternal age, multiparity, low body mass index, pregnancy following assisted reproductive techniques, intrauterine infection, preterm prelabour rupture of membranes, abdominal trauma, smoking and drug misuse (cocaine and amphetamines) during pregnancy 15 . In our cohort, other risk factors for placental abruption were pre-eclampsia, preterm prelabour rupture of membranes, antepartum haemorrhage, and the use of antenatal aspirin, but these became not significant after adjusting for confounders, except for a history of antepartum haemorrhage.…”

Vascular malperfusion and abruption are prevalent in placentas from pregnancies with congenital heart disease and not associated with cardiovascular risk

“…Placental abruption, or a premature separation of a previously normally implanted placenta, occurs through unknown mechanisms outside of the coup-countercoup phenomena in trauma and with hypertensive diseases of pregnancy. However, it is well documented that an obstetrical history of placental abruption history has been correlated to future coronary heart disease risk, including both hemorrhagic and ischemic stroke 12,13 . These ndings raise the consideration for a common abnormal vascular etiology related to both the biology underlying the abruption and the subsequent vascular event.…”