University of Montreal Hospital Research Centre, 900 Saint Denis St., Montreal, QC, H2X 0A9, Canada.
Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada.
Arch Gynecol Obstet. 2021 Oct;304(4):943-950. doi: 10.1007/s00404-021-06044-4. Epub 2021 Apr 4.
The association between placental detachment disorders and risk of chronic disease is unclear. We determined the association of placenta accreta and retained placenta with risk of future maternal cardiovascular disease and cancer.
We tracked a longitudinal cohort of 541,051 pregnant women over a period of 13 years (2006-2019) in Quebec, Canada. The main exposure measures were placenta accreta and retained placenta in any pregnancy. Outcomes included future hospitalizations for cardiovascular disease and cancer. Using Cox regression models adjusted for maternal characteristics, we estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of accreta and retained placenta with cardiovascular disease and cancer at 13 years.
The incidence of cardiovascular hospitalization was 21.2 per 10,000 person-years for accreta and 23.4 per 10,000 for retained placenta with postpartum hemorrhage, compared with 20.3 per 10,000 for neither placental disorder. Cancer incidence followed a similar pattern, with rates highest for retained placenta with hemorrhage. Retained placenta with hemorrhage was associated with 1.19 times the risk of cardiovascular disease (95% CI 1.03-1.38) and 1.27 times the risk of cancer (95% CI 1.06-1.53). Retained placenta with hemorrhage was associated with heart failure (HR 1.84, 95% CI 1.04-3.27), cardiomyopathy (HR 1.88, 95% CI 1.03-3.43), and cervical cancer (HR 2.03, 95% CI 1.17-3.52). Accreta and retained placenta without hemorrhage were not associated with these outcomes.
Retained placenta with hemorrhage may be a risk marker for cardiovascular disease and certain cancers later in life.
胎盘脱离疾病与慢性病风险之间的关系尚不清楚。我们旨在确定胎盘植入和胎盘滞留与未来产妇心血管疾病和癌症风险之间的关系。
我们对加拿大魁北克省的一个 541051 名孕妇的纵向队列进行了为期 13 年（2006-2019 年）的跟踪研究。主要暴露措施是任何一次妊娠中出现胎盘植入和胎盘滞留。结果包括未来因心血管疾病和癌症住院的情况。我们使用 Cox 回归模型，根据产妇特征进行调整，估计胎盘植入和胎盘滞留与 13 年后心血管疾病和癌症的关联的风险比（HR）和 95%置信区间（CI）。
伴有产后出血的胎盘植入的心血管住院发生率为每 10000 人年 21.2 例，而伴有产后出血的胎盘滞留为每 10000 人年 23.4 例，而两者均无胎盘疾病的发生率为每 10000 人年 20.3 例。癌症的发病率也呈现出类似的模式，出血性胎盘滞留的发生率最高。伴有出血的胎盘滞留与心血管疾病的风险增加 1.19 倍（95%CI 1.03-1.38），与癌症的风险增加 1.27 倍（95%CI 1.06-1.53）。伴有出血的胎盘滞留与心力衰竭（HR 1.84，95%CI 1.04-3.27）、心肌病（HR 1.88，95%CI 1.03-3.43）和宫颈癌（HR 2.03，95%CI 1.17-3.52）相关。无出血的胎盘植入和胎盘滞留与这些结果无关。
伴有出血的胎盘滞留可能是未来发生心血管疾病和某些癌症的风险标志物。
