Chronic hypertension and risk of placental abruption: is the association modified by ischemic placental disease?
Abstract
Objective The purpose of this study was to evaluate whether the increased risk of placental abruption among women with chronic hypertension is modified by ischemic placental disease, specifically pregnancy-induced hypertension (PIH) and fetal growth restriction (FGR).Study design We used the US linked natality and fetal death data files (1995-2002) and restricted the analysis to women who had a singleton birth at > or = 22 weeks of gestation and to fetuses who weighed > or = 500 g (n = 30,189,949). Fetal growth was defined both on a continuum (<1, 1-2, 3-4, 5-9, 10-19, ..., > or = 90) and as birthweight of < 10th percentile for gestational age (FGR) or birthweight of > 90th percentile (large for gestational age [LGA]). All analyses were adjusted for potential confounding factors through multivariable logistic regression.Results Rates of abruption among women with and without chronic hypertension were 15.6 and 5.8 per 1000 pregnancies, respectively (relative risk [RR], 2.4; 95% CI, 2.3, 2.5). In comparison with normotensive women with appropriately grown babies (ie, 10th-90th percentile), the association between chronic hypertension and abruption was modified in the presence of FGR (RR, 3.8; 95% CI, 3.6, 4.1) and PIH (RR, 7.7; 95% CI, 6.6, 8.9). However, the highest risk was seen among women with chronic hypertension, PIH, and LGA (RR, 9.0; 95% CI, 7.2, 11.3). A dose-response relationship was observed between the risk of abruption and fetal growth (assessed on a continuum), with the risk being lowest among LGA babies.Conclusion The association between chronic hypertension and abruption is strong; ischemic placental disease (PIH and FGR) modified this relationship. These findings suggest an etiologic relationship between abruption and chronic placental disease. Chronic hypertension, if associated with LGA, is not associated with abruption; however, chronic hypertension with superimposed PIH accompanied by LGA is associated with significantly increased risk.
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The risk of abruption is 3 to 4-fold higher among pregnant people with chronic hypertension.
“The risk of abruption is 3 to 4-fold higher among pregnant people with chronic hypertension, and 4 to 6-fold higher among those with preeclampsia, particularly preeclampsia with severe features and superimposed preeclampsia (28–31).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [31]
The risk of abruption is 4 to 6-fold higher among those with preeclampsia, particularly preeclampsia with severe features and superimposed preeclampsia.
“The risk of abruption is 3 to 4-fold higher among pregnant people with chronic hypertension, and 4 to 6-fold higher among those with preeclampsia, particularly preeclampsia with severe features and superimposed preeclampsia (28–31).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [31]
Chorioamnionitis is a clinical risk factor for abruption.
“Other clinical risk factors for abruption include pregestational and gestational diabetes, preterm prelabor rupture of membranes (PROM), chorioamnionitis, and oligohydramnios (31–33).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [31]
Oligohydramnios is a clinical risk factor for abruption.
“Other clinical risk factors for abruption include pregestational and gestational diabetes, preterm prelabor rupture of membranes (PROM), chorioamnionitis, and oligohydramnios (31–33).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [31]
Pregestational and gestational diabetes are clinical risk factors for abruption.
“Other clinical risk factors for abruption include pregestational and gestational diabetes, preterm prelabor rupture of membranes (PROM), chorioamnionitis, and oligohydramnios (31–33).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [31]
Preterm prelabor rupture of membranes is a clinical risk factor for abruption.
“Other clinical risk factors for abruption include pregestational and gestational diabetes, preterm prelabor rupture of membranes (PROM), chorioamnionitis, and oligohydramnios (31–33).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [31]
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- Authors
- Ananth, C. V., Peltier, M. R., Kinzler, W. L., Smulian, J. C., & Vintzileos, A. M.
- Corresponding author
- Ananth, Cande V.
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2007-09
- Volume
- 197
- Issue
- 3
- Pages
- 273.e1-273.e7
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W2024643876
- Cited by
- 108
- References
- 34
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 10 · 2023: 2 · 2022: 7 · 2021: 2 · 2020: 6 · 2019: 3 · 2018: 11 · 2017: 7 · 2016: 10 · 2015: 7 · 2014: 10 · 2013: 4 · 2012: 6
- FWCI
- 4.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD038902, R01HD038902)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Psychiatry and Mental health › Neurological Complications and Syndromes
- Keywords
- chronic hypertension in pregnancy, placental abruption, ischemic placental disease, gestational hypertension, fetal growth restriction, large for gestational age, dose-response relationship, birth weight percentiles, singleton pregnancy
- MeSH terms
- Abruptio Placentae, Adult, Chronic Disease, Female, Fetal Growth Retardation, Gestational Age, Humans, Hypertension, Ischemia, Placenta, Pregnancy, Risk Factors, Hypertension, Pregnancy-Induced
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