Institute for Policy Research, Northwestern University, Evanston, IL, USA; Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA.
Institute for Policy Research, Northwestern University, Evanston, IL, USA; Department of Psychology, Northwestern University, Evanston, IL, USA.
Placenta. 2021 Sep 1;112:135-140. doi: 10.1016/j.placenta.2021.07.298. Epub 2021 Jul 30.
Chronic villitis is an inflammatory lesion that affects 5-15% of placentas and is associated with adverse pregnancy outcomes. Chronic villitis may also recur; however, studies estimating recurrence are based on small samples and estimates of recurrence range from 10 to 56%.
We utilized data from placentas submitted to pathology at a Chicago hospital between January 2009 and March 2018. During the study period, 883 patients had two placentas submitted to pathology. We estimated the risk of recurrent chronic villitis, adjusted for maternal and pregnancy characteristics. We also evaluated whether prevalence of small for gestational age infant differed for those with recurrent chronic villitis and we investigated whether placental pathology worsened in the second study pregnancy among those with recurrent chronic villitis.
The overall prevalence of recurrent chronic villitis in the study sample was 11.5%. Among those with chronic villitis in the first pregnancy, 54% developed chronic villitis in the second pregnancy, corresponding to an adjusted risk ratio of 2.36 (95% confidence interval: 1.92, 2.91). Recurrent chronic villitis was not associated with increased prevalence of small for gestational infant as compared with non-recurrent villitis. Among those with recurrent chronic villitis, high-grade chronic inflammation and fetal vascular malperfusion were more common in the second pregnancy as compared with the first.
Our results suggest that those with chronic villitis in the first pregnancy are over twice as likely to develop chronic villitis in the second pregnancy and that chronic inflammation and fetal vascular malperfusion may worsen among those with recurrent chronic villitis.
慢性绒毛膜炎是一种炎症病变，影响 5-15%的胎盘，并与不良妊娠结局相关。慢性绒毛膜炎也可能复发；然而，估计复发的研究基于小样本，估计复发率从 10%到 56%不等。
我们利用了 2009 年 1 月至 2018 年 3 月期间在芝加哥一家医院提交给病理科的胎盘数据。在研究期间，有 883 名患者的两份胎盘提交给了病理科。我们估计了复发慢性绒毛膜炎的风险，调整了母体和妊娠特征。我们还评估了复发慢性绒毛膜炎患者的胎儿生长受限发生率是否不同，并研究了复发慢性绒毛膜炎患者的第二份妊娠胎盘病理是否恶化。
研究样本中复发慢性绒毛膜炎的总体患病率为 11.5%。在首次妊娠中患有慢性绒毛膜炎的患者中，54%在第二次妊娠中发展为慢性绒毛膜炎，对应的调整风险比为 2.36（95%置信区间：1.92，2.91）。与非复发性绒毛膜炎相比，复发慢性绒毛膜炎与胎儿生长受限的发生率增加无关。在复发慢性绒毛膜炎患者中，与首次妊娠相比，第二次妊娠中高级别慢性炎症和胎儿血管功能不良更为常见。
我们的研究结果表明，首次妊娠中患有慢性绒毛膜炎的患者再次发生慢性绒毛膜炎的可能性是首次妊娠的两倍以上，并且再次发生慢性绒毛膜炎的患者慢性炎症和胎儿血管功能不良可能会恶化。
