Fetal Growth Restriction in Hypertensive vs. Heavy Smoking Women-Placental Pathology, Ultrasound Findings, and Pregnancy Outcomes.
Adult
Birth Weight
Cesarean Section
Female
Fetal Growth Retardation
/ diagnostic imaging
Fetus
/ diagnostic imaging
Gestational Age
Humans
Hypertension
/ complications
Hypertension, Pregnancy-Induced
/ diagnosis
Infant, Low Birth Weight
Infant, Premature
Live Birth
Placenta
/ pathology
Predictive Value of Tests
Pregnancy
Pregnancy Outcome
Prenatal Exposure Delayed Effects
Risk Assessment
Risk Factors
Smokers
Smoking
/ adverse effects
Ultrasonography, Doppler
Ultrasonography, Prenatal
Cigarette smoking
Fetal growth restriction
Hypertensive disorder
Neonatal outcomes
Placental malperfusion
Sonographic findings
Journal
Reproductive sciences (Thousand Oaks, Calif.)
ISSN: 1933-7205
Titre abrégé: Reprod Sci
Pays: United States
ID NLM: 101291249
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
07
06
2020
accepted:
21
10
2020
pubmed:
4
11
2020
medline:
24
11
2021
entrez:
3
11
2020
Statut:
ppublish
Résumé
We compared placental pathology, ultrasonographic findings, and obstetric outcomes, in gestations complicated by fetal growth restriction (FGR) with either a background of hypertensive disorder or heavy tobacco cigarette smoking. The medical records and placental pathology reports of pregnancies complicated with FGR (birthweight < 10th percentile) between December 2008 and May 2018 from a single tertiary center were reviewed. Placental pathology, ultrasound findings, and pregnancy outcomes were compared between hypertensive patients (HTN) and heavy smokers (SMO). We included 213 pregnancies: 129 (60.6%) in the SMO group and 84 (39.4%) in the HTN group. The HTN group was characterized by a higher BMI (p = 0.01), higher rates of Cesarean deliveries (p = 0.006), and a lower gestational age at delivery (35.6 ± 3.8 vs. 37.5 ± 2.9 weeks, p < 0.001). The HTN group had higher rates of placental weights < 10th percentile (p = 0.04) and maternal vascular malperfusion lesions (p < 0.001), while the SMO group had higher rates of inflammatory lesions (p = 0.04). On ultrasound, the HTN group had a higher head/abdomen circumference ratio (p < 0.001) and more abnormal Doppler studies (< 0.001). Neonates in the HTN group had lower birthweights (p < 0.001) and higher rates of NICU admissions (p = 0.002) and adverse neonatal outcome (p = 0.006). On multivariable analysis, gestational age at delivery (aOR = 0.65, 95%CI 0.55-0.87), hypertensive disorders (aOR = 1.8, 95%CI = 1.21-4.81), placental MVM lesions (aOR = 1.23, 95%CI = 1.08-5.02), and the combination of HTN+MVM (aOR = 2.63, 95%CI 1.78-7.30) were independently associated with adverse neonatal outcome. Hypertension and smoking may lead to FGR in different pathways as the two groups significantly differed in maternal characteristics, placental pathology, ultrasound findings, and neonatal outcomes. A hypertensive disorder probably represents a more hostile maternal environment than smoking and these pregnancies would probably benefit from closes monitoring.
Identifiants
pubmed: 33140325
doi: 10.1007/s43032-020-00373-6
pii: 10.1007/s43032-020-00373-6
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
819-827Références
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