Placental pathology in pregnancies with maternally perceived decreased fetal movement--a population-based nested case-cohort study.
BACKGROUND
Decreased fetal movements (DFM) are associated with fetal growth restriction and stillbirth, presumably linked through an underlying placental dysfunction. Yet, the role of placental pathology has received limited attention in DFM studies. Our main objective was to explore whether maternal perceptions of DFM were associated with placental pathology in pregnancies recruited from a low-risk total population.


RESULTS
Placentas from 129 DFM and 191 non-DFM pregnancies were examined according to standardized macro- and microscopic protocols. DFM was defined as any maternal complaint of DFM leading to a hospital examination. Morphological findings were timed and graded according to their estimated onset and clinical importance, and classified in line with a newly constructed Norwegian classification system for reporting placental pathology. With our population-based approach we were unable to link DFM to an overall measure of all forms of placental pathology (OR 1.3, 95% CI 0.8-2.2, p = 0.249). However, placental pathology leading to imminent delivery could be a competing risk for DFM, making separate subgroup analyses more appropriate. Our study suggests a link between DFM and macroscopic placental pathology related to maternal, uteroplacental vessels, i.e. infarctions, placental lesions (intraplacental hematomas) and abruptions. Although not statistically significant separately, a compound measure showed a significant association with DFM (OR 2.4, 95%CI 1.1-5.0, p = 0.023). This association was strengthened when we accounted for relevant temporal aspects. More subtle microscopic materno-placental ischemic changes outside the areas of localized pathology showed no association with DFM (OR 0.5, 95%CI 0.2-1.4, p = 0.203). There was a strong association between placental pathology and neonatal complications (OR 2.9, 95% CI 1.6-5.1, p<0.001).


CONCLUSIONS
In our population-based study we were generally unable to link maternally perceived DFM to placental pathology. Some associations were seen for subgroups.
Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. brita.winje@fhi.no
Brita Askeland
BA
Winje
Borghild
B
Roald
Nina Petrov
NP
Kristensen
J Frederik
JF
Frøen
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005317:Fetal Growth Retardation; D005324:Fetal Movement; D006801:Humans; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology; D011256:Pregnancy Outcome