Risk factors for uteroplacental vascular compromise and inflammation.
OBJECTIVE
The purpose of this study was to identify potentially modifiable risk factors of placental injury that reflect maternal uteroplacental vascular compromise (UPVC) and acute and chronic placental inflammation.


METHODS
A prospective epidemiologic study was conducted. A total of 1270 placentas were characterized by gross and microscopic examination. Placental pathologic condition was coded for features of amniotic fluid infection syndrome (AFIS), chronic villitis, UPVC, and fetal vascular obstructive lesions. Odds ratios between UPVC, the acute and the chronic inflammatory lesions, and risk factors of interest were calculated.


RESULTS
After adjustment for confounders, we found that women with a history of preterm birth had 1.60 times the odds of chronic inflammation (95% CI, 1.10, 2.55). Women with a previous elective termination had 3.28 times the odds of acute inflammation (95% CI, 1.89, 5.70). The odds of chronic villitis increased with parity; the odds of AFIS decreased with parity.


CONCLUSIONS
We have identified several predictors of UPVC, AFIS, and chronic villitis. Further studies are needed to examine whether interventions to alter UPVC, AFIS, and chronic villitis will lead to improved pregnancy outcomes.
Baker
Arthur M
AM
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7516, USA. abaker2@med.unc.edu
Braun
Joe M
JM
Salafia
Carolyn M
CM
Herring
Amy H
AH
Daniels
Julie
J
Rankins
Nicole
N
Thorp
John M
JM
D000328:Adult; D000653:Amniotic Fluid; D002824:Chorionic Villi / Q000473:pathology; D003656:Decidua / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation; D016017:Odds Ratio; D010920:Placenta / Q000473:pathology; D010922:Placenta Diseases / Q000453:epidemiology* / Q000473:pathology; D021041:Placental Circulation / Q000502:physiology*; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors
Am J Obstet Gynecol. 2006 Sep;195(3):803-8
16949415
Am J Reprod Immunol. 2004 Jan;51(1):49-55
14725566
Obstet Gynecol. 1989 Mar;73(3 Pt 1):383-9
2915862
Obstet Gynecol Surv. 2003 Jan;58(1):67-79
12544786
Am J Perinatol. 1995 Mar;12(2):106-10
7779189
N Engl J Med. 2003 Jun 12;348(24):2379-85
12802023
Am J Public Health. 1992 Mar;82(3):378-82
1536353
N Engl J Med. 2007 Aug 16;357(7):648-53
17699814
Am J Obstet Gynecol. 1995 Oct;173(4):1065-70
7485294
N Engl J Med. 1995 Dec 28;333(26):1732-6
7491136
BJOG. 2005 Apr;112(4):430-7
15777440
Paediatr Perinat Epidemiol. 1999 Jan;13(1):114-25
9987790
Biometrics. 1986 Mar;42(1):121-30
3719049
Am J Perinatol. 1992 May;9(3):190-3
1575840
Hum Pathol. 1997 Mar;28(3):353-8
9042801
Clin Perinatol. 1993 Mar;20(1):107-25
8458160
Acta Obstet Gynecol Scand. 2005 Jun;84(6):547-50
15901265
Pediatrics. 2007 Apr;119(4):e866-74
17339387
Semin Perinatol. 2007 Jun;31(3):142-58
17531896
Acta Obstet Gynecol Scand. 2000 Aug;79(8):644-8
10949228
BJOG. 2001 Oct;108(10):1036-42
11702834
Epidemiol Rev. 1993;15(2):414-43
8174665
J Matern Fetal Neonatal Med. 2007 May;20(5):391-5
17674243
Am J Obstet Gynecol. 2006 Sep;195(3):792-6
16846583
Int J Gynaecol Obstet. 2007 Jan;96(1):12-5
17196205
Obstet Gynecol. 1992 Jan;79(1):137-42
1727572
Paediatr Perinat Epidemiol. 1998 Jan;12(1):72-83
9483618