Oral Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Recurrence of “placental spectrum disorders” (#33)

Jodi Ryan 1 , Vivien Lee 2 , Mark A Brown 3 4 , Gregory Davis 1 2 , Franziska Pettit 3 4 , Amanda Henry 1 2
  1. Women's and Children's Health, St George Hospital, Kogarah, Sydney, NSW, Australia
  2. School of Women's and Children's Health, UNSW Medicine, Sydney, NSW, Australia
  3. St George Clinical School, UNSW Medicine, Sydney, NSW, Australia
  4. Department of Renal Medicine, St George Hospital, Kogarah, Sydney, NSW, Australia

Background and aims: Hypertensive disorders of pregnancy (HDP) and small for gestational age (SGA) are associated with placental pathology, often recur, and may occur jointly. We sought to quantify frequency and risk factors for recurrence of these “placental spectrum disorders” (PSD) in subsequent pregnancies.

Methods: Case-control study of women having more than one pregnancy at St George Hospital, Sydney with their index pregnacy affected by HDP and/or SGA infants (birthweight<10th population centile for gestation and gender).This PSD cohort (N=614) were matched with control women with unaffected index pregnancies (N=1228). Index (IP) and subsequent pregnancy (SP) characteristics were analysed.

Results: 332 cases had SGA without HDP (54%), 237 HDP (39%), and 45 both HDP and SGA (7%) during their IP, the majority of which were nulliparous (61%) and delivered at term (mean gestation 39 weeks). PSD recurrence (Table) was significantly higher for both IP HDP only (54%) and mixed HDP/SGA (49%) than for IP SGA only (32%), p=0.001. HDP recurred predominantly as HDP only (115/129 recurrences, 89%), as did pure SGA (90% of recurrences). In the small mixed HDP/SGA subgroup, 68% of recurrences (15/22) were HDP only. In IP SGA, approximately 1/3 of infants were <3rd centile (SGA<3). Recurrence of SGA<3 (42%) was greater than SGA 3rd-10th centile recurrence (27%), p=0.004. Risk factors for HDP recurrence included PSD history, high BMI and pre-existing chronic hypertension and renal disease. SGA recurrence correlated with low BMI.

Conclusions: Recurrence of “PSD” was common, and true-to-type in that index HDP recurred primarily as HDP only, and index SGA as SGA only in 90% of recurrences. SGA was less likely to recur than HDP or HDP+SGA, but tended to recur with greater severity (SGA<3 subtype). In our study population of predominantly late-gestation disease-onset, HDP and SGA appear distinct subtypes of placental disease, with little risk of crossover in subsequent pregnancies. This may assist in counselling women regarding recurrence risks.

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