Etiologic determinants of abruptio placentae
Abstract
OBJECTIVE: To quantify the roles of suspected sociodemographic, anthropometric, behavioral, and pathologic determinants in the etiology of abruptio placentae. METHODS: We performed a hospital-based cohort study of 36,875 nonreferred births between January 1978 and March 1989. Gestational age was based on menstrual dates confirmed (within 7 days) by early ultrasound. RESULTS: Parity, maternal education, pre-pregnancy weight, and the rate of net gestational weight gain did not have significant independent associations with abruption. Significant determinants included the following: severe small for gestational-age (SGA) birth (odds ratio [OR] 3.99; 95% confidence interval [CI] 2.75, 5.77), chorioamnionitis (OR 2.50; 95% CI 1.58, 3.98), prolonged rupture of membranes (OR 2.38; 95% CI 1.55, 3.65), preeclampsia (OR 2.05; 95% CI 1.39, 3.04), pregnancy-induced hypertension without albuminuria (OR 1.57; 95% CI 1.00, 2.46), pre-pregnancy hypertension (OR 1.77; 95% CI 1.05, 2.99), maternal age at least 35 years (OR 1.50; 95% CI 1.14, 2.01), unmarried status (OR 1.50; 95% CI 1.13, 1.98), cigarette smoking (OR 1.40; 95% CI 1.00, 1.97 for ten to 19 cigarettes per day and OR 1.13; 95% CI 0.81, 1.59 for at least 20 cigarettes per day), and male fetal gender (OR 1.38; 95% CI 1.12, 1.70). Removal of SGA from the regression model resulted in little change in the magnitude of the other associations. CONCLUSIONS: Severe fetal growth restriction, prolonged rupture of membranes, chorioamnionitis, hypertension (before pregnancy and pregnancy-induced), cigarette smoking, advanced maternal age, unmarried status, and male fetal gender are significant etiologic determinants of placental abruption. Non-SGA determinants appear to operate largely independently of their effects on fetal growth.
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Tobacco smoking is associated with a 1.7 to 2-fold increased risk of abruption, with a strong dose-response association between the number of cigarettes smoked per day.
“Tobacco smoking is associated with a 1.7 to 2-fold increased risk of abruption, with a strong dose-response association between the number of cigarettes smoked per day (39–41).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [39]
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- Authors
- KRAMER, M., USHER, R., POLLACK, R., BOYD, M., & USHER, S.
- Affiliations
- McGill University (CA)
- Venue
- Obstetrics & Gynecology
- Published
- 1997-02
- Volume
- 89
- Issue
- 2
- Pages
- 221-226
- ISSN
- 0029-7844 (ISSN-L)
- OpenAlex
- W2037837420
- Cited by
- 212
- References
- 36
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 5 · 2022: 6 · 2021: 9 · 2020: 6 · 2019: 6 · 2018: 9 · 2017: 7 · 2016: 7 · 2015: 8 · 2014: 6 · 2013: 5 · 2012: 12
- FWCI
- 5.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- placental abruption, small for gestational age, fetal growth restriction, chorioamnionitis, prolonged rupture of membranes, preeclampsia, gestational hypertension, chronic hypertension in pregnancy, maternal age, marital status, cigarette smoking, fetal sex, gestational weight gain, parity, maternal education, gestational age at delivery
- MeSH terms
- Abruptio Placentae, Adult, Anthropometry, Female, Humans, Infant, Newborn, Infant, Small for Gestational Age, Male, Pregnancy, Risk-Taking, Socioeconomic Factors, Cohort Studies, Confidence Intervals, Logistic Models, Odds Ratio
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