Placental abruption and long‐term neurological hospitalisations in the offspring

• Published in: Paediatric and perinatal epidemiology 2019-05, Vol.33 (3), p.215-222
• Main Authors: Pariente, Gali, Wainstock, Tamar, Walfisch, Asnat, Landau, Daniella, Sheiner, Eyal
• Format: Article
• Language: English
• Subjects: Abruptio Placentae - epidemiology; Adult; Asphyxia; Cerebral palsy; Child; Child, Preschool; Children; Congenital anomalies; Congenital defects; Developmental disabilities; developmental disorders; Diabetes mellitus; Disorders; Female; Hazards; Health risk assessment; Hospitalization; Hospitalization - statistics & numerical data; Humans; Incidence; Infant; Israel - epidemiology; long‐term follow‐up; Maternal Age; Medical prognosis; Mental disorders; Middle Aged; Minority & ethnic groups; Morbidity; Mortality; Nervous System Diseases - epidemiology; neurological morbidity; Neurology; Offspring; Paralysis; Placenta; placental abruption; Pregnancy; Premature birth; Prenatal Exposure Delayed Effects - epidemiology; Retrospective Studies; Risk analysis; Risk factors; Statistical models; Time Factors; Young Adult
• ISSN: 0269-5022; 1365-3016
• DOI: 10.1111/ppe.12553

Background Placental abruption is a major determinant of maternal and perinatal morbidity and mortality, often related to asphyxia and preterm birth. However, the impact of abruption on the long‐term morbidity of the offspring is less investigated. Methods We designed a hospital‐based cohort study, in which the incidence of long‐term neurology‐related hospitalisations of offspring to women with and without placental abruption was assessed. All singleton deliveries between 1991 and 2014 were included in the study. Congenital anomalies, perinatal mortality, and multifetal pregnancies were excluded from the analyses. We compared cumulative morbidity incidence using Kaplan‐Meier survival curves and estimated the risk for long‐term neurological hospitalisations from Cox proportional hazards models after adjustment for putative including maternal age, parity, hypertensive disorders, pre‐gestational and gestational diabetes, gender, ethnicity, and year of birth. Results Over the 22‐year period, 2 202 269 person‐years of follow‐up, there were 217 910 deliveries of which 0.5% (n = 1003) were complicated with placental abruption. The median (interquartile range) follow‐up of children in the abruption and non‐abruption groups was 10.3 (4.6, 15.9) and 12.0 (6.3, 16.5) years, respectively. The cumulative incidence of total neurological hospitalisations was comparable between abruption (3.32 per 1000 person‐years) and non‐abruption (3.16 per 1000 person‐years). Abruption was associated with increased rates of cerebral palsy (hazard ratio [HR] 6.71, 95% CI 3.32, 13.58) and developmental disorders (HR 3.36, 95% CI 1.38, 8.13), but not for total neurology‐related hospitalisations (HR 1.08, 95% CI 0.78, 1.49). Conclusion Placental abruption is associated with increased rate of cerebral palsy and developmental disorders in the offspring later in life. This study may define risk factors for childhood neuropsychiatric disorders, enabling early diagnosis and intervention in children with such disorders, and perhaps improving their prognosis.