Ischemic placental disease: epidemiology and risk factors

Preeclampsia, small for gestational age (SGA) and placental abruption - conditions that constitute the syndrome of "ischemic placental disease" (IPD) - may portend different clinical manifestations of a common underlying pathophysiology. We examined if (i) preeclampsia, SGA and abruption share similar risk profiles; and (ii) if there are any differences in these profiles between patients with IPD that delivered at term and preterm gestations.

We utilized data from the US Collaborative Perinatal Project, a multicenter, prospective cohort study (1959-1966), restricted to women that delivered singleton births at ≥ 20 weeks (n=47,495.) We compared risk factors between women with and without IPD as well as preeclampsia, SGA and abruption.

A strong overlap in risk factors for all 3 conditions was evident. Socio-economic class, income, age, parity, education, race, BMI, marital status, and history of preterm birth were different between preterm and term gestations in women with IPD. Although rates of preeclampsia only, SGA only and preeclampsia with SGA were similar between term and preterm birth, rates of other conditions were higher at preterm gestations, with abruption being the driving condition behind these associations.

The similar risk profiles for preeclampsia, SGA, and abruption provide compelling evidence to suggest that these conditions may share common pathophysiological mechanisms-ischemic placental disease. Greater homogeneity in risk profiles within preterm than term births suggests that IPD may be a syndrome that has strong underpinnings at preterm gestations.