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Neurodevelopmental outcomes in children in relation to placental abruption

C V Ananth1,2, A M Friedman1, J A Lavery1

  • 1Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.

BJOG : an International Journal of Obstetrics and Gynaecology
|April 23, 2016
PubMed

Insights

Placental abruption is linked to early neurodevelopmental deficits, but this association largely resolves by age seven. Preterm delivery significantly mediates these effects, accounting for a substantial proportion of the observed deficits.

Area of Science:

  • Perinatal Medicine
  • Neurodevelopmental Pediatrics
  • Epidemiology

Background:

  • Placental abruption significantly impacts perinatal mortality.
  • The long-term neurodevelopmental consequences of placental abruption in children are not well understood.
  • Preterm delivery is a known risk factor for adverse neurodevelopmental outcomes.

Purpose of the Study:

  • To investigate the association between placental abruption and neurodevelopment at 8 months, 4 years, and 7 years of age.
  • To determine the extent to which preterm delivery mediates the relationship between placental abruption and neurodevelopmental outcomes.
  • To assess the impact of confounding factors and unobserved confounding on these associations.

Main Methods:

  • Secondary analysis of a multicenter prospective cohort study (US National Collaborative Perinatal Project).
  • Evaluation of cognitive development using Bayley Scales (8 months), Stanford-Binet (4 years), and Wechsler Intelligence Scale for Children (7 years).
  • Application of marginal structural models (MSM) and causal mediation analysis, with sensitivity analysis for unobserved confounding.

Main Results:

  • Placental abruption was associated with an increased risk of abnormal neurodevelopmental assessments at 8 months (Motor: RR 2.35, 95% CI 1.39-3.98; Mental: RR 2.03, 95% CI 1.13-3.64).
  • These associations were attenuated by age 4 and resolved by age 7.
  • Preterm delivery mediated 27-75% of the abruption-associated neurological deficits, with this proportion attenuated after adjusting for unobserved confounding.

Conclusions:

  • The impact of placental abruption on neurodevelopmental outcomes appears to be primarily mediated through preterm delivery.
  • The neurodevelopmental effects of placental abruption are largely transient, diminishing by later childhood.
  • Effective management of preterm delivery may mitigate the neurodevelopmental risks associated with placental abruption.
Abstract

Keywords:
Causal modelsconfoundingmarginal structural modelmediation analysisneurodevelopmental outcomesplacental abruptionselection bias

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