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Cited by 30Infant Development and Preterm CareNeonatal and fetal brain pathologyPregnancy and preeclampsia studies

Neurodevelopmental outcomes in children in relation to placental abruption

Ananth, CV, Friedman, AM, Lavery, JA, VanderWeele, TJ, Keim, S, Williams, MA·2017·BJOG: An International Journal of Obstetrics & Gynaecology
DOI 10.1111/1471-0528.14049
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Abstract

OBJECTIVE: Placental abruption has a profound impact on perinatal mortality, but implications for neurodevelopment during childhood remain unknown. We examined the association between abruption and neurodevelopment at 8 months and 4 and 7 years and evaluated the extent to which these associations were mediated through preterm delivery. DESIGN: Secondary analysis of a multicenter prospective cohort study. SETTING: Multicenter US National Collaborative Perinatal Project (1959-76). POPULATION: Women that delivered singleton live births. METHODS: Analyses of IQ scores were based on marginal structural models (MSM) to account for losses to follow-up. We also carried out a causal mediation analysis to evaluate if the association between abruption and cognitive deficits was mediated through preterm delivery, and performed a sensitivity analysis for unobserved confounding. MAIN OUTCOME MEASURES: We evaluated cognitive development based on the Bayley scale at 8 months (Mental and Motor Scores), and intelligent quotient (IQ) based on the Stanford-Binet scale at 4 years and the Wechsler Intelligence Scale for Children at 7 years. RESULTS: The confounder and selection-bias adjusted risk ratio (RR) of abnormal 8-month Motor and Mental assessments were 2.35 (95%CI 1.39, 3.98) and 2.03 (95%CI 1.13, 3.64), respectively, in relation to abruption. The associations at 4 years were attenuated and resolved at 7 years. The proportion of children with abruption-associated neurological deficits mediated through preterm delivery ranged from 27 to 75%. Following adjustment for unobserved confounding the proportion mediated through preterm delivery was attenuated. CONCLUSION: The effect of abruption on neurodevelopmental outcomes appears restricted to an effect that is largely mediated through preterm delivery. TWEETABLE ABSTRACT: Increased risk of cognitive deficits in relation to abruption appears to be mediated through preterm delivery.

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Crossref · 10.1111/1471-0528.14049

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  • The associations between abruption and abnormal motor and mental assessments at 4 years were attenuated and resolved fully at 7 years.

    “The associations at 4 years were attenuated and resolved fully at 7 years (22).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [22]

  • Preterm birth mediated up to three-fourths of the association between abruption and neurodevelopmental outcomes at 8 months, with progressively decreasing proportions at 4 and 7 years.

    “Importantly, this study showed that preterm birth mediated up to three-fourths of this association at 8-months, with progressively decreasing proportions at 4 and 7 years of the abruption-neurodevelopmental associations (22).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [22]

  • Among singleton deliveries at term gestations in the United States Collaborative Perinatal Project (1959-66), the rate of clinical abruption was 1.4% (589 of 42,821).

    “Among singleton deliveries at term gestations in the United States (US) Collaborative Perinatal Project (CPP, 1959–66), the rate of clinical abruption was 1.4% (589 of 42,821) (22).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [22]

  • Data from the US CPP (1959-66 with follow-up to 1974) showed that the risk ratio of abnormal motor assessments at 8 months of life was 2.35 (95% CI 1.39-3.98) in relation to abruption.

    “Data from the US CPP (1959–66 with follow-up to 1974) showed that the risk ratio of abnormal motor and mental assessments at 8-months of life were 2.35 (95% CI 1.39–3.98) and 2.03 (95% CI 1.13–3.64), respectively, in relation to abruption.”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [22]

  • Data from the US CPP (1959-66 with follow-up to 1974) showed that the risk ratio of abnormal mental assessments at 8 months of life was 2.03 (95% CI 1.13-3.64) in relation to abruption.

    “Data from the US CPP (1959–66 with follow-up to 1974) showed that the risk ratio of abnormal motor and mental assessments at 8-months of life were 2.35 (95% CI 1.39–3.98) and 2.03 (95% CI 1.13–3.64), respectively, in relation to abruption.”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [22]

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Authors
Ananth, C., Friedman, A., Lavery, J., VanderWeele, T., Keim, S., & Williams, M.
Affiliations
  • Columbia University Irving Medical Center (US)
  • Department of Obstetrics and Gynecology College of Physicians and Surgeons Columbia University New York NY USA
  • Harvard University (US)
  • Nationwide Children's Hospital (US)
Corresponding author
Ananth, CV
ORCID
Venue
BJOG: An International Journal of Obstetrics & Gynaecology
Publisher
Wiley
Published
2016-04-22
Volume
124
Issue
3
Pages
463-472
ISSN
  • 0306-5456 (ISSN-L)
  • 1470-0328
  • 1471-0528
DOI
10.1111/1471-0528.14049
OpenAlex
W2340553143
Cited by
30
References
44
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2023: 5 · 2022: 8 · 2020: 4 · 2019: 4 · 2018: 3 · 2017: 3
FWCI
3.88
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
Keywords
placental abruption, brain development, preterm birth, cognitive development, IQ, motor development, mediation analysis, perinatal outcomes, National Collaborative Perinatal Project, singleton live births
MeSH terms
Abruptio Placentae, Child, Child Development, Child, Preschool, Cognition, Female, Humans, Infant, Infant, Newborn, Obstetric Labor, Premature, Pregnancy, Prospective Studies, Risk Factors, United States, Cohort Studies, Premature Birth, Neurodevelopmental Disorders

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