INTRODUCTION: Abnormal placental cord insertion has been associated with an increase in preterm delivery, low birth weight, neonatal intensive care admissions and cesarean delivery. Assisted reproductive technology (ART) has been associated with some similar placenta-medicated pregnancy complications. We hypothesize an increase in abnormal placental cord insertion in pregnancies conceived using ART, thereby contributing to the increased association of adverse pregnancy outcomes. METHODS: We performed an IRB approved, retrospective chart review of 3728 singleton and twin placentas sent to pathology at the University of Massachusetts between January 2011-January 2016. Placental pathology reports were reviewed and evidence of abnormal placental cord insertion, either velamentous or marginal, were recorded. Chi-square test was used for categorical variables and student T-test for continuous. Logistic regression was used to control for potential confounders. P less than 0.05 was used for statistical significance. RESULTS: Of the 3728 pregnancies, 3615 were conceived via spontaneous conception, whereas 113 were conceived through ART. Women who conceived with ART were more likely to be married, of white race, older and have multiple gestations than those with spontaneous conception. ART pregnancies were over 2-fold more likely to have abnormal placental cord insertions (OR 2.1 [1.1–3.9], P=.03). After adjusting for confounding factors, statistical significance was no longer noted. CONCLUSION: Pregnancies conceived with ART were more likely to have abnormal placental cord insertion in our study. A larger sample size of women conceived using ART would be needed to fully understand the effect of ART on abnormal placental cord insertion beyond the confounding effect of multiple gestations.

INTRODUCTION: To identify factors associated with hypertension 2-5 years following delivery complicated by a hypertensive disease of pregnancy. METHODS: We performed a single-center, retrospective cohort study of women with a hypertensive disease of pregnancy who delivered between 7/2009-1/2014. Women with hypertension predating the incident pregnancy and those discharged on anti-hypertensive medications were excluded. Hypertension was defined as SBP greater than 140 mmHg, and/or DBP greater than 90 mmHg, and/or office visit for management of anti-hypertensive medications. A secondary analysis using SBP greater than 130 mmHg and/or DBP greater than 80 mmHg was also performed. Data was collected through review of electronic medical record. Institutional IRB approval was obtained. RESULTS: 284 women were eligible for analysis. Of these women, 123 (43%) were considered hypertensive at 2-5 years following delivery. They were more likely to be older (P=.001), have a higher pre-pregnancy BMI (p<.001), be of higher parity (p<.001), undergo cesarean section (P=.002), and to have higher blood pressure immediately postpartum (P=.002, P=.027). When the definition of hypertension outlined by 2017 AHA recommendations (greater than 130/80) was used, 65% of the women were found to have hypertension and the same associations existed. CONCLUSION: A large proportion of women with a hypertensive disease of pregnancy had evidence of hypertension at 2-5 years postpartum. This proportion was even greater when the 2017 AHA definition was applied. Some factors associated with developing hypertension were identified in this study and could be considered while addressing importance of long term follow up for women given the magnitude of effect.

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