Neurodevelopmental outcomes in children in relation to placental abruption.
Placental abruption has a profound impact on perinatal mortality, but implications for neurodevelopment during childhood remain unknown. We examined the association between abruption and neurodevelopment at 8 months and 4 and 7 years and evaluated the extent to which these associations were mediated through preterm delivery.



Secondary analysis of a multicenter prospective cohort study.



Multicenter US National Collaborative Perinatal Project (1959-76).



Women that delivered singleton live births.



Analyses of IQ scores were based on marginal structural models (MSM) to account for losses to follow-up. We also carried out a causal mediation analysis to evaluate if the association between abruption and cognitive deficits was mediated through preterm delivery, and performed a sensitivity analysis for unobserved confounding.



We evaluated cognitive development based on the Bayley scale at 8 months (Mental and Motor Scores), and intelligent quotient (IQ) based on the Stanford-Binet scale at 4 years and the Wechsler Intelligence Scale for Children at 7 years.



The confounder and selection-bias adjusted risk ratio (RR) of abnormal 8-month Motor and Mental assessments were 2.35 (95%CI 1.39, 3.98) and 2.03 (95%CI 1.13, 3.64), respectively, in relation to abruption. The associations at 4 years were attenuated and resolved at 7 years. The proportion of children with abruption-associated neurological deficits mediated through preterm delivery ranged from 27 to 75%. Following adjustment for unobserved confounding the proportion mediated through preterm delivery was attenuated.



The effect of abruption on neurodevelopmental outcomes appears restricted to an effect that is largely mediated through preterm delivery.



Increased risk of cognitive deficits in relation to abruption appears to be mediated through preterm delivery.
Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.|Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA.
C V
CV
Ananth
Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
A M
AM
Friedman
Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
J A
JA
Lavery
Department of Epidemiology, TH Chan School of Public Health, Harvard University, Boston, MA, USA.
T J
TJ
VanderWeele
Research Institute at Nationwide Children's Hospital, Center for Behavioral Health, Department of Pediatrics and Epidemiology, Ohio State University, Columbus, OH, USA.
S
S
Keim
Department of Epidemiology, TH Chan School of Public Health, Harvard University, Boston, MA, USA.
M A
MA
Williams
D000037:Abruptio Placentae / Q000453:epidemiology*; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003071:Cognition; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D065886:Neurodevelopmental Disorders / Q000453:epidemiology* / Q000209:etiology; D007752:Obstetric Labor, Premature / Q000453:epidemiology*; D011247:Pregnancy; D047928:Premature Birth; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
Causal models; confounding; marginal structural model; mediation analysis; neurodevelopmental outcomes; placental abruption; selection bias