Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Room E4132, Baltimore, MD, United States.
Department of Clinical and Applied Science Education (Pathology), University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, United States.
Placenta. 2019 Aug;83:17-25. doi: 10.1016/j.placenta.2019.06.374. Epub 2019 Jun 14.
Preterm birth (PTB) and in-utero inflammation are recognized risk factors of neurodevelopmental disabilities (NDDs); however, their combined role in NDDs is unknown. We examined the independent and joint association of PTB and placental histological findings with the childhood risk of NDDs (overall and by subgroups including autism spectrum disorder (ASD) and ADHD).
We analyzed data from the Boston Birth Cohort, where mother-infant pairs were enrolled at birth and followed from birth onwards. Birth outcomes, placental pathology and NDDs were obtained from electronic medical records. Placental pathology was categorized using a standardized classification system proposed by the Amsterdam Placental Workshop Group.
PTB (all, including spontaneous, medically indicated) was an independent risk factor for NDDs. Placental histological chorioamnionitis (CA) and PTB additively increased the odds of NDDs (aOR: 2.16, 95% CI: 1.37, 3.39), as well as ADHD (aOR: 2.75, 95% CI: 1.55, 4.90), other developmental disabilities (aOR: 1.96, 95% CI: 1.18, 3.25) and possibly ASD (aOR: 2.31, 95% CI: 0.99, 5.39). The above associations were more pronounced in spontaneous than medically indicated PTB. PTB alone in the absence of CA only had a moderate association with ASD and ADHD. Placental maternal vascular malperfusion alone or in combination with PTB was not associated with the risk of NDDs.
Our study provided new insights on PTB and NDDs by further considering preterm subtypes and placental histology. We revealed that children of spontaneous PTB along with histological CA were at the highest risk for a spectrum of NDDs.
早产（PTB）和宫内炎症是公认的神经发育障碍（NDD）的危险因素；然而，它们在 NDD 中的共同作用尚不清楚。我们研究了 PTB 和胎盘组织学发现与儿童患 NDD（总体和亚组，包括自闭症谱系障碍（ASD）和注意缺陷多动障碍（ADHD））风险的独立和联合关联。
我们分析了波士顿出生队列的数据，该队列在出生时招募母婴对，并从出生开始进行随访。从电子病历中获取出生结局、胎盘病理学和 NDDs。胎盘病理学使用由阿姆斯特丹胎盘工作组提出的标准化分类系统进行分类。
所有类型的 PTB（包括自发性、医学指征性）都是 NDDs 的独立危险因素。胎盘组织学绒毛膜羊膜炎（CA）和 PTB 会增加 NDDs（优势比：2.16，95%置信区间：1.37，3.39）、ADHD（优势比：2.75，95%置信区间：1.55，4.90）、其他发育障碍（优势比：1.96，95%置信区间：1.18，3.25）和可能的 ASD（优势比：2.31，95%置信区间：0.99，5.39）的发生风险。与医学指征性 PTB 相比，自发性 PTB 具有更强的相关性。单纯 PTB 而没有 CA 与 ASD 和 ADHD 只有中度相关性。单纯胎盘母体血管灌注不良或与 PTB 联合存在与 NDDs 的风险无关。
通过进一步考虑早产亚型和胎盘组织学，我们的研究为 PTB 和 NDDs 提供了新的见解。我们发现，自发性 PTB 合并组织学 CA 的儿童患一系列 NDD 的风险最高。
