Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts.
Am J Perinatol. 2023 Jan;40(1):9-14. doi: 10.1055/s-0042-1757261. Epub 2022 Sep 12.
The aim of the study is to evaluate whether pathologic severity of placenta accreta spectrum (PAS) is correlated with the incidence of small for gestational age (SGA) and neonatal birthweight.
This was a multicenter cohort study of viable, non-anomalous, singleton gestations delivered with histology-proven PAS. Data including maternal history, neonatal birthweight, and placental pathology were collected and deidentified. Pathology was defined as accreta, increta, or percreta. The primary outcome was rate of SGA defined by birth weight less than the 10th percentile. The secondary outcomes included incidence of large for gestational age (LGA) babies as defined by birth weight greater than the 90th percentile as well as incidence of SGA and LGA in preterm and term gestations. Statistical analysis was performed using Chi-square, Kruskal-Wallis, and log-binomial regression. Increta and percreta patients were each compared with accreta patients.
Among the cohort of 1,008 women from seven United States centers, 865 subjects were included in the analysis. The relative risk (RR) of SGA for increta and percreta did not differ from accreta after adjusting for confounders (adjusted RR = 0.63, 95% confidence interval [CI]: 0.36-1.10 for increta and aRR = 0.72, 95% CI: 0.45-1.16 for percreta). The results were stratified by placenta previa status, which did not affect results. There was no difference in incidence of LGA ( = 1.0) by PAS pathologic severity. The incidence of SGA for all PAS patients was 9.2% for those delivered preterm and 18.7% for those delivered at term ( = 0.004). The incidence of LGA for all PAS patients was 12.6% for those delivered preterm and 13.2% for those delivered at term ( = 0.8203).
There was no difference in incidence of SGA or LGA when comparing accreta to increta or percreta patients regardless of previa status. Although we cannot suggest causation, our results suggest that PAS, regardless of pathologic severity, is not associated with pathologic fetal growth in the preterm period.
· PAS severity is not associated with SGA in the preterm period.. · PAS severity is not associated with LGA.. · Placenta previa does not affect the incidence of SGA in women with PAS..
本研究旨在评估胎盘植入谱系（PAS）的病理严重程度是否与小于胎龄儿（SGA）和新生儿出生体重相关。
这是一项多中心队列研究，纳入了经组织学证实的 PAS 分娩的有活力、非畸形的单胎妊娠。收集并匿名化了包括母体病史、新生儿出生体重和胎盘病理在内的数据。病理学定义为粘连、植入或穿透。主要结局为出生体重低于第 10 百分位数的 SGA 发生率。次要结局包括定义为出生体重大于第 90 百分位数的巨大儿（LGA）发生率以及早产和足月妊娠的 SGA 和 LGA 发生率。使用卡方检验、克鲁斯卡尔-沃利斯检验和对数二项式回归进行统计分析。将植入和穿透患者分别与粘连患者进行比较。
在来自美国 7 个中心的 1008 名女性队列中，865 名受试者纳入分析。在调整混杂因素后，植入和穿透患者的 SGA 相对风险（RR）与粘连患者无差异（调整 RR = 0.63，95%置信区间 [CI]：0.36-1.10 为植入，aRR = 0.72，95%CI：0.45-1.16 为穿透）。按胎盘前置状态分层，结果无差异。根据 PAS 病理严重程度，LGA 的发生率没有差异（=1.0）。所有 PAS 患者中，早产者的 SGA 发生率为 9.2%，足月者为 18.7%（=0.004）。所有 PAS 患者中，早产者的 LGA 发生率为 12.6%，足月者为 13.2%（=0.8203）。
无论有无前置胎盘，粘连与植入或穿透患者相比，SGA 或 LGA 的发生率均无差异。尽管我们不能认为这是因果关系，但我们的结果表明，PAS 无论严重程度如何，与早产期间的病理性胎儿生长无关。
· PAS 严重程度与早产期间的 SGA 无关。· PAS 严重程度与 LGA 无关。· 胎盘前置不影响 PAS 妇女的 SGA 发生率。
