Can Placental Histopathology Lesions Predict Recurrence of Small for Gestational Age Neonates?

OBJECTIVE

To study the role of placental pathology in predicting the recurrence of delivery of small for gestational age (SGA) neonates.

METHODS

The medical records and placental pathological reports of normotensive women who gave birth at 24 to 42 weeks to neonates with birth weight (BW) <10th percentile were reviewed. Patients were divided according to their subsequent pregnancy into those who developed or did not develop recurrent SGA (BW < 10th percentile). The clinical and pathological characteristics of the index pregnancies were compared between the groups. A prediction model was generated for SGA recurrence.

RESULTS

The recurrent SGA group (n = 67) was characterized by a higher rate of placental weight <10th percentile ( P = .01), and higher neonatal to placental weight ratio ( P = .003), as compared to the nonrecurrent SGA group (n = 99). On multivariate logistic regression analysis, placental maternal and fetal vascular malperfusion lesions and higher neonatal to placental weight ratio were all independently associated with recurrent SGA. Birth weight <3rd percentile was the only clinical variable associated with recurrent SGA. A prediction model for recurrent SGA included the following independent risk factors: BW <3rd percentile, villous lesions of maternal vascular malperfusion, and neonatal to placental weight ratio.

CONCLUSION

The presence of placental vascular malperfusion lesions and increased neonatal to placental weight ratio at index pregnancy are associated with recurrent SGA in subsequent pregnancy.