(365) Burden of Placental Pathology is associated with Severity of Clinical Outcomes

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Stephanie Schreiber, DO (she/her/hers)

Endeavor Health
Evanston, Illinois, United States

Coauthor(s)

Sunitha Suresh, MD (she/her/hers)

Attending Physician
Endeavor Health
Evanston, Illinois, United States
Ann EB Borders, MD, MPH, MSc (she/her/hers)

Ian Bernard Horowitz Chair of Obstetrics, Clinical Professor
Endeavor Health, Evanston Hospital
Evanston, IL, United States
Alexa A. Freedman, PhD (she/her/hers)

Northwestern University
Chicago, Illinois, United States
LE

Linda M. Ernst, MD

Endeavor Health
Evanston, Illinois, United States
GM

Greg E. Miller, PhD

Professor
Northwestern University
Chicago, Illinois, United States

Objective: Hypertensive disorders of pregnancy (HDP) and Small for Gestational Age (SGA) neonates have both been previously associated with placental pathology. Here we evaluate the association of placental disease burden with severity of clinical disease - either HDP or SGA alone compared to the combination of both HDP and SGA.

Study Design: Placentas were prospectively collected and examined by a perinatal pathologist in the Stress, Pregnancy, and Health study. We compared placentas from patients with neither HDP nor SGA, HDP or SGA, and both HDP+SGA by four categories of placental pathology: acute inflammation (AI), chronic inflammation (CI), maternal vascular malperfusion (MVM), and fetal vascular malperfusion (FVM). Univariate analysis was performed using chi2 tests, ANOVA, and Kruskal-Wallis as appropriate. Multivariate analysis was conducted with logistic regression adjusted for BMI, mode of conception, diabetes, and socioeconomic status. We additionally examined the number of MVM related lesions.

Results: Of 571 placentas, 421 (74%) served as the control with neither HDP nor SGA, 138 (24%) had either HDP or SGA, and 12 (2%) had both HDP+SGA. Prevalence of MVM was higher with increasing clinical disease (22.1% control, 45.7% HDP or SGA, 75% HDP+SGA, p< .001). After adjustment, odds of MVM increased more than 3-fold from just HDP or SGA (aOR 3.34 [95%CI 2.08,5.34]) to both HDP+SGA (aOR12.3 [95%CI 3.17,47.5]) compared to the control group. There was no significant difference in prevalence of AI (p=0.09), FVM (p=0.78), and CI (p=0.6) between the three groups. In examining placental disease burden, increasing MVM was seen with increasing amount of clinical disease (median [IQR] MVM score 0[0,1] for control, 1[0,3]for HDP or SGA, 3.5[1.5,5] for HDP+SGA, p=.0001).

Conclusion: A combination of both HDP and SGA, compared to either alone, is associated with greater prevalence of placental MVM lesions as well as higher MVM score. Future research should focus on further understanding this relationship and potential opportunities for intervention for patients with HDP and suspected SGA.