Alisse Hauspurg1, Emily K Redman2, Vanessa Assibey-Mensah3, W Tony Parks4, Arun Jeyabalan3, James M Roberts3, Janet M Catov5. 1. Departments of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA, USA; Magee-Womens Research Institute, University of Pittsburgh, 204 Craft Avenue, Pittsburgh, PA, USA. Electronic address: janickia@upmc.edu. 2. Departments of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA, USA. 3. Departments of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA, USA; Magee-Womens Research Institute, University of Pittsburgh, 204 Craft Avenue, Pittsburgh, PA, USA. 4. Department of Pathology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, USA. 5. Departments of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA, USA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA, USA.
Abstract
INTRODUCTION: Women with adverse pregnancy outcomes (APOs) have excess risk of later life cardiovascular disease (CVD) perhaps related to an underlying high-risk vascular phenotype. We sought to determine if placental evidence of maternal malperfusion in uncomplicated pregnancies is associated with an increased risk of APOs in subsequent pregnancies. METHODS: 536 women with more than one delivery and an initial uncomplicated pregnancy with placental pathology examination between 2008 and 2012 were included. APOs (small for gestational age, preterm delivery, or preeclampsia) were identified for each delivery. Multivariable log-binomial regression was used to estimate the risk of an APO in a subsequent pregnancy associated with MVM lesions in index pregnancy with adjustment for covariates. RESULTS: Placental pathology from the initial pregnancy was compared between women with no APO in any pregnancy (-APO/-APO; n = 403) and women with an initial uncomplicated pregnancy and a subsequent adverse outcome (-APO/+APO; n = 133). Women with MVM lesions had an increased risk of an APO in a subsequent pregnancy relative to women with no MVM lesions after adjusting for covariates (aOR = 1.61; 95%CI = 1.06-2.46). Decidual vasculopathy was found in 13/133 (9.8%) of -APO/+APO women compared with 16/403 (4.0%) of -APO/-APO women, with an adjusted odds ratio of 2.51 (95% CI = 1.31-4.80). DISCUSSION: MVM lesions found in placentas in uncomplicated pregnancies are associated with an increased risk of an adverse outcome in a subsequent pregnancy. Placental evidence of vascular malperfusion could offer a novel approach to risk stratification for subsequent pregnancy complications and perhaps future CVD.
INTRODUCTION:Women with adverse pregnancy outcomes (APOs) have excess risk of later life cardiovascular disease (CVD) perhaps related to an underlying high-risk vascular phenotype. We sought to determine if placental evidence of maternal malperfusion in uncomplicated pregnancies is associated with an increased risk of APOs in subsequent pregnancies. METHODS: 536 women with more than one delivery and an initial uncomplicated pregnancy with placental pathology examination between 2008 and 2012 were included. APOs (small for gestational age, preterm delivery, or preeclampsia) were identified for each delivery. Multivariable log-binomial regression was used to estimate the risk of an APO in a subsequent pregnancy associated with MVM lesions in index pregnancy with adjustment for covariates. RESULTS: Placental pathology from the initial pregnancy was compared between women with no APO in any pregnancy (-APO/-APO; n = 403) and women with an initial uncomplicated pregnancy and a subsequent adverse outcome (-APO/+APO; n = 133). Women with MVM lesions had an increased risk of an APO in a subsequent pregnancy relative to women with no MVM lesions after adjusting for covariates (aOR = 1.61; 95%CI = 1.06-2.46). Decidual vasculopathy was found in 13/133 (9.8%) of -APO/+APOwomen compared with 16/403 (4.0%) of -APO/-APOwomen, with an adjusted odds ratio of 2.51 (95% CI = 1.31-4.80). DISCUSSION: MVM lesions found in placentas in uncomplicated pregnancies are associated with an increased risk of an adverse outcome in a subsequent pregnancy. Placental evidence of vascular malperfusion could offer a novel approach to risk stratification for subsequent pregnancy complications and perhaps future CVD.
Authors: Janet M Catov; Matthew F Muldoon; Robin E Gandley; Judith Brands; Alisse Hauspurg; Carl A Hubel; Marie Tuft; Mandy Schmella; Gong Tang; W Tony Parks Journal: Hypertension Date: 2021-12-09 Impact factor: 9.897
Authors: Marie-Pierre St-Onge; Brooke Aggarwal; Matthew A Allison; Jeffrey S Berger; Sheila F Castañeda; Janet Catov; Judith S Hochman; Carl A Hubel; Sanja Jelic; David A Kass; Nour Makarem; Erin D Michos; Lori Mosca; Pamela Ouyang; Chorong Park; Wendy S Post; Robert W Powers; Harmony R Reynolds; Dorothy D Sears; Sanjiv J Shah; Kavita Sharma; Tanya Spruill; Gregory A Talavera; Dhananjay Vaidya Journal: J Am Heart Assoc Date: 2021-02-23 Impact factor: 5.501