Oltean Irina, Rajaram Ajay, Tang Ken, MacPherson James, Hondonga Tadiwanashe, Rishi Aanchal, Toltesi Regan, Gowans Rachel, Jahangirnia Ashkan, Nasr Youssef, Lawrence Sarah L, El Demellawy Dina
Department of Surgery & Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada.
Department of Pathology, McGill University, Montreal, QC H4A 3J1, Canada.
J Clin Med. 2022 Dec 27;12(1):205. doi: 10.3390/jcm12010205.
Placental histopathology provides insights, or "snapshots", into relevant antenatal factors that could elevate the risk of perinatal brain injury. We present a systematic review and meta-analysis comparing frequencies of adverse neurological outcomes in infants born to women with placental abruption versus without abruption. Records were sourced from MEDLINE, Embase, and the CENTRAL Trials Registry from 1946 to December 2019. Studies followed the PRISMA guidelines and compared frequencies of neurodevelopmental morbidities in infants born to pregnant women with placental abruption (exposure) versus women without placental abruption (comparator). The primary endpoint was cerebral palsy. Periventricular and intraventricular (both severe and any grades of IVH) and any histopathological neuronal damage were the secondary endpoints. Study methodologic quality was assessed by the Ottawa-Newcastle scale. Estimated odds ratios (OR) and hazards ratio (HR) were derived according to study design. Data were meta-analyzed using a random effects model expressed as pooled effect sizes and 95% confidence intervals. We included eight observational studies in the review, including 1245 infants born to women with placental abruption. Results of the random effects meta-analysis show that the odds of infants born to pregnant women with placental abruption who experience cerebral palsy is higher than in infants born to pregnant women without placental abruption (OR 5.71 95% CI (1.17, 27.91); = 84.0%). There is no statistical difference in the odds of infants born to pregnant women with placental abruption who experience severe IVH (grade 3+) (OR 1.20 95% CI (0.46, 3.11); = 35.8%) and any grade of IVH (OR 1.20 95% CI (0.62, 2.32); = 32.3%) vs. women without placental abruption. There is no statistically significant difference in the odds of infants born to pregnant women with placental abruption who experience PVL vs. pregnant women without placental abruption (OR 6.51 95% CI (0.94, 45.16); = 0.0%). Despite our meta-analysis suggesting increased odds of cerebral palsy in infants born to pregnant women with placental abruption versus without abruption, this finding should be interpreted cautiously, given high heterogeneity and overall poor quality of the included studies.
胎盘组织病理学能够提供有关可能增加围产期脑损伤风险的相关产前因素的见解或“快照”。我们进行了一项系统综述和荟萃分析，比较胎盘早剥孕妇与无胎盘早剥孕妇所生婴儿不良神经学结局的发生率。记录来源于1946年至2019年12月的MEDLINE、Embase和CENTRAL试验注册库。研究遵循PRISMA指南，比较胎盘早剥孕妇（暴露组）与无胎盘早剥孕妇（对照组）所生婴儿神经发育疾病的发生率。主要终点是脑瘫。脑室周围和脑室内（重度和任何级别的IVH）以及任何组织病理学神经元损伤为次要终点。研究方法学质量通过渥太华-纽卡斯尔量表进行评估。根据研究设计得出估计比值比（OR）和风险比（HR）。使用随机效应模型对数据进行荟萃分析，以合并效应量和95%置信区间表示。我们在综述中纳入了八项观察性研究，包括1245名胎盘早剥孕妇所生婴儿。随机效应荟萃分析结果显示，胎盘早剥孕妇所生婴儿患脑瘫的几率高于无胎盘早剥孕妇所生婴儿（OR 5.71，95% CI（1.17，27.91）；P = 84.0%）。胎盘早剥孕妇所生婴儿发生重度IVH（3级及以上）（OR 1.20，95% CI（0.46，3.11）；P = 35.8%）和任何级别的IVH（OR 1.20，95% CI（0.62，2.32）；P = 32.3%）的几率与无胎盘早剥孕妇所生婴儿相比无统计学差异。胎盘早剥孕妇所生婴儿发生脑室周围白质软化（PVL）的几率与无胎盘早剥孕妇所生婴儿相比无统计学显著差异（OR 6.51，95% CI（0.94，45.16）；P = 0.0%）。尽管我们的荟萃分析表明胎盘早剥孕妇所生婴儿患脑瘫的几率高于无胎盘早剥孕妇所生婴儿，但鉴于纳入研究的高度异质性和总体质量较差，这一发现应谨慎解读。
