Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 170, Issue 2, Pages 148-158Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwp131
Keywords
blood vessels; placenta; premature birth
Categories
Funding
- National Institute of Child Health and Human Development
- National Institute of Nursing Research [R01 HD34543]
- March of Dimes Foundation
- Thrasher Research Foundation [20-FY04-37, 02816-7]
- Centers for Disease Control and Prevention [U01 DP000143-01]
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The authors examined the associations between placental vascular findings and preterm delivery in 1,053 subcohort women (239 preterm, 814 term) from a Michigan pregnancy cohort study (1998-2004). Twenty-nine placental vascular variables from microscopic examinations were grouped into 5 constructs: 3 maternal constructs-obstructive lesions (MV-O), bleeding/vessel integrity (MV-I), and lack of physiologic conversion of maternal spiral arteries (MV-D)-and 2 fetal constructs-obstructive lesions (FV-O) and bleeding/vessel integrity (FV-I). Construct-specific scores were created by adding the number of positive findings and deriving a dichotomous variable to approximate the top quintile (high) and bottom 4 quintiles (not high) within each construct. In multivariate polytomous logistic regression models, medically indicated preterm delivery at < 35 weeks was significantly associated with high scores for each of the vascular constructs; adjusted odds ratios ranged from 2.4 to 5.4. Spontaneous preterm delivery at 35-36 weeks was significantly associated with a high score on any 1 of 3 constructs: MV-I, MV-D, and FV-I. Spontaneous preterm delivery at < 35 weeks was significantly associated with a high score on 2 or more of 3 constructs: MV-I, MV-D, and FV-I; adjusted odds ratios ranged from 4.1 to 7.4. These results support a role for various placental vascular lesions in medically indicated and spontaneous preterm delivery.
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