An international contrast of rates of placental abruption: an age-period-cohort analysis
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BACKGROUND: Although rare, placental abruption is implicated in disproportionately high rates of perinatal morbidity and mortality. Understanding geographic and temporal variations may provide insights into possible amenable factors of abruption. We examined abruption frequencies by maternal age, delivery year, and maternal birth cohorts over three decades across seven countries. METHODS: Women that delivered in the US (n = 863,879; 1979-10), Canada (4 provinces, n = 5,407,463; 1982-11), Sweden (n = 3,266,742; 1978-10), Denmark (n = 1,773,895; 1978-08), Norway (n = 1,780,271, 1978-09), Finland (n = 1,411,867; 1987-10), and Spain (n = 6,151,508; 1999-12) were analyzed. Abruption diagnosis was based on ICD coding. Rates were modeled using Poisson regression within the framework of an age-period-cohort analysis, and multi-level models to examine the contribution of smoking in four countries. RESULTS: Abruption rates varied across the seven countries (3-10 per 1000), Maternal age showed a consistent J-shaped pattern with increased rates at the extremes of the age distribution. In comparison to births in 2000, births after 2000 in European countries had lower abruption rates; in the US there was an increase in rate up to 2000 and a plateau thereafter. No birth cohort effects were evident. Changes in smoking prevalence partially explained the period effect in the US (P = 0.01) and Sweden (P<0.01). CONCLUSIONS: There is a strong maternal age effect on abruption. While the abruption rate has plateaued since 2000 in the US, all other countries show declining rates. These findings suggest considerable variation in abruption frequencies across countries; differences in the distribution of risk factors, especially smoking, may help guide policy to reduce abruption rates.
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The prevalence of abruption has been increasing in the United States and Canada, but declining in Finland, Denmark, Norway, Sweden, and Spain.
“The prevalence of abruption has been increasing in the US and Canada, but declining in other European countries, including Finland, Denmark, Norway, Sweden, and Spain (27).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [27]
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- Authors
- Ananth, C. V., Keyes, K. M., Hamilton, A., Gissler, M., Wu, C., Liu, S., Luque-Fernandez, M. A., Skjærven, R., Williams, M. A., Tikkanen, M., & Cnattingius, S.
- Affiliations
- Columbia University (US)
- Finnish Institute for Health and Welfare (FI)
- Aarhus University (DK)
- Public Health Agency of Canada (CA)
- Norwegian Institute of Public Health (NO)
- Harvard University (US)
- Helsinki University Hospital (FI)
- Karolinska Institutet (SE)
- Corresponding author
- Ananth, Cande V.
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-05-27
- Volume
- 10
- Issue
- 5
- Pages
- e0125246
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4446321
- OpenAlex
- W2151012434
- Cited by
- 131
- References
- 60
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 9 · 2023: 11 · 2022: 18 · 2021: 10 · 2020: 22 · 2019: 15 · 2018: 14 · 2017: 9 · 2016: 4 · 2015: 2
- FWCI
- 9.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- BIBSYS Brage (BIBSYS (Norway)) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Figshare (submittedVersion, cc-by)
- Työväentutkimus Vuosikirja (submittedVersion)
- Columbia Academic Commons (Columbia University)
- Funders
- Public Health Agency of Canada
- Public Health Agency
- National Institutes of Health
- National Institute on Alcohol Abuse and Alcoholism (K01AA021511)
- 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, maternal age, birth cohort effects, temporal trends, smoking, cross-national comparison, perinatal morbidity, perinatal mortality, risk factors
- MeSH terms
- Abruptio Placentae, Canada, Denmark, Female, Finland, Humans, Maternal Age, Norway, Pregnancy, Risk Factors, Smoking, Spain, Sweden, United States, Cohort Studies, Prevalence, Age Distribution
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