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Risk factors for placenta accreta spectrum: findings from the Japan environment and Children's study
Hyo Kyozuka1,2, Akiko Yamaguchi3, Daisuke Suzuki4
1Fukushima Regional Center for the Japan Environmental and Children's Study, 1, Hikarigaoka, Fukushima, 960-1295, Japan. kyozuka@fmu.ac.jp.
Insights
Placenta accreta spectrum (PAS) is a serious obstetric complication. Key risk factors identified in Japan include placenta previa, assisted reproductive technology, smoking, multiple prior cesarean sections, and uterine anomalies.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Medicine
- Public Health
Background:
- Placenta accreta spectrum (PAS) poses a significant risk to maternal health.
- Unexpected PAS cases are associated with higher mortality and morbidity.
- Understanding PAS prevalence and risk factors is crucial for improved obstetric care.
Purpose of the Study:
- To determine the prevalence of PAS in a large Japanese birth cohort.
- To identify and analyze the risk factors associated with PAS.
Main Methods:
- Analysis of a nationwide prospective birth cohort study in Japan (2011-2014).
- Inclusion of 90,554 participants from 15 regional centers.
- Utilized multiple regression models on data from questionnaires and medical records.
Main Results:
- Identified 202 PAS cases among 90,554 participants.
- Significant risk factors for PAS included placenta previa (aOR: 12.86), ART pregnancies (aOR: 6.78), smoking (aOR: 1.95), >2 prior C-sections (aOR: 2.51), and uterine anomalies (aOR: 3.97).
- All identified risk factors showed statistical significance (P < 0.05).
Conclusions:
- Placenta previa, ART pregnancies, smoking, multiple cesarean sections, and uterine anomalies are significant risk factors for PAS in the Japanese population.
- These findings can inform risk assessment and management strategies for PAS.
Background:
Placenta accreta spectrum (PAS) is a life-threating complication in the field of obstetrics. Sometimes we face with unexpected PAS cases which is potentially higher maternal mortality and morbidity compared with expected cases. The present study was conducted to examine the prevalence of PAS and to elucidate its risk factors using a large Japanese birth cohort study.
Methods:
We reviewed the results of a nationwide prospective birth cohort study in Japan, and identified 90,554 participants treated from 2011 to 2014 in 15 regional centers. Multiple regression models were created to identify the risk factors for PAS. These data were obtained from self-reported questionnaires or patient medical records.
Results:
This analysis consisted of 202 cases of PAS (18 with placenta previa and 184 without placenta previa) and 90,352 cases without PAS. The multiple logistic regression analysis showed that placenta previa (adjusted odds ratio [aOR]: 12.86, 95% confidence interval [CI] 7.70-21.45, P < 0.001), assisted reproductive technology-related pregnancies (aOR: 6.78, 95% CI 4.54-10.14, P < 0.001), smoking during pregnancy (aOR: 1.95, 95% CI 1.15-3.31, P = 0.013), more than two previous cesarean sections (aOR: 2.51, 95% CI 1.35-4.67, P = 0.004), and uterine anomalies (aOR: 3.97, 95% CI 1.24-12.68, P = 0.020) increased the risk of PAS.
Conclusion:
In general population, placenta previa, assisted reproductive technology-related pregnancy, smoking during pregnancy, repeated cesarean sections, and uterine anomalies were risk factors for PAS in the Japanese population.