Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 E. Chicago Ave., Chicago, IL, 60611, United States.
Division of Neonatology, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323, Harry Hines Blvd., Dallas, TX, United States.
Placenta. 2019 Aug;83:37-42. doi: 10.1016/j.placenta.2019.06.385. Epub 2019 Jun 26.
African American women are at higher risk for preterm birth compared to white women, but no placental pathology has characterized this disparity. The objective of this study was to examine the association of race with placental pathology among very preterm births.
We conducted an eight-year retrospective cohort study of very preterm infants born at ≤32 weeks at Northwestern Prentice Women's Hospital in Chicago, Illinois. Archived placental slides underwent standardized masked histopathologic review. Logistic regression was performed for placental pathology, adjusting for available relevant covariates and stratified by infant sex and gestational age.
Placentas were available for 296 white and 224 African American mother-infant pairs among births at ≤32 weeks gestation. Compared to placentas from white births, the adjusted OR (aOR) for acute inflammation in placentas from African American births was 1.95 (95% CI 0.87-4.37), the aOR for chronic inflammation was 3.35 (1.49-7.54), the aOR for fetal vascular pathology was 0.82 (0.29-2.32), and the aOR for maternal vascular pathology was 1.01 (0.51-1.99). Stratified analysis showed associations between all placental pathologies and race among male births. Across gestational age groups (<28 and ≥ 28 weeks), the association between race and placental pathology was present for chronic inflammation and fetal vascular pathology.
Race is associated with placental pathology, and in particular, with chronic inflammation among very preterm births. The effect is modified by infant sex and gestational age. Placental histopathology may be useful markers for understanding the biological processes that shape disparities in pregnancy outcomes.
与白人女性相比，非裔美国女性发生早产的风险更高，但尚未有胎盘病理学特征能够解释这种差异。本研究的目的是探讨种族与极早产（妊娠时间小于等于 32 周）产妇胎盘病理的相关性。
我们进行了一项为期八年的回顾性队列研究，研究对象为伊利诺伊州芝加哥西北 Prentice 妇女医院出生的妊娠时间小于等于 32 周的极早产儿。对存档的胎盘切片进行了标准化的、有针对性的病理盲法复查。采用逻辑回归分析胎盘病理，调整了可用的相关协变量，并按婴儿性别和胎龄进行了分层。
在妊娠时间小于等于 32 周的分娩中，有 296 例白人产妇和 224 例非裔美国产妇的胎盘可供研究。与白人产妇的胎盘相比，非裔美国产妇胎盘的急性炎症调整后的比值比（aOR）为 1.95（95%可信区间 0.87-4.37），慢性炎症为 3.35（1.49-7.54），胎儿血管病变为 0.82（0.29-2.32），而母体血管病变为 1.01（0.51-1.99）。分层分析显示，所有胎盘病变与男性出生的种族之间均存在相关性。在所有胎龄组（<28 周和≥28 周）中，种族与胎盘病理的相关性均存在于慢性炎症和胎儿血管病变中。
种族与胎盘病理相关，尤其是与极早产的慢性炎症相关。这种关联受到婴儿性别和胎龄的影响。胎盘组织病理学可能是理解导致妊娠结局差异的生物学过程的有用标志物。
