The Association between Placenta Accreta Spectrum Severity and Incidence of Small for Gestational Age Neonates

Abstract

Objective The aim of the study is to evaluate whether pathologic severity of placenta accreta spectrum (PAS) is correlated with the incidence of small for gestational age (SGA) and neonatal birthweight. Study Design This was a multicenter cohort study of viable, non-anomalous, singleton gestations delivered with histology-proven PAS. Data including maternal history, neonatal birthweight, and placental pathology were collected and deidentified. Pathology was defined as accreta, increta, or percreta. The primary outcome was rate of SGA defined by birth weight less than the 10th percentile. The secondary outcomes included incidence of large for gestational age (LGA) babies as defined by birth weight greater than the 90th percentile as well as incidence of SGA and LGA in preterm and term gestations. Statistical analysis was performed using Chi-square, Kruskal–Wallis, and log-binomial regression. Increta and percreta patients were each compared with accreta patients. Results Among the cohort of 1,008 women from seven United States centers, 865 subjects were included in the analysis. The relative risk (RR) of SGA for increta and percreta did not differ from accreta after adjusting for confounders (adjusted RR = 0.63, 95% confidence interval [CI]: 0.36–1.10 for increta and aRR = 0.72, 95% CI: 0.45–1.16 for percreta). The results were stratified by placenta previa status, which did not affect results. There was no difference in incidence of LGA (p = 1.0) by PAS pathologic severity. The incidence of SGA for all PAS patients was 9.2% for those delivered preterm and 18.7% for those delivered at term (p = 0.004). The incidence of LGA for all PAS patients was 12.6% for those delivered preterm and 13.2% for those delivered at term (p = 0.8203). Conclusion There was no difference in incidence of SGA or LGA when comparing accreta to increta or percreta patients regardless of previa status. Although we cannot suggest causation, our results suggest that PAS, regardless of pathologic severity, is not associated with pathologic fetal growth in the preterm period. Key Points

Impact of planned versus emergency cesarean delivery on neonatal outcomes in pregnancies complicated by abnormal placentation: A systematic review and meta-analysis

“…[18,19,22] The potential linkage of SGA may lie in the placental pathology per se, as previous studies suggested that both PP and PAS can contribute to SGA or intra-uterine growth restriction due to impaired uteroplacental circulation. [40][41][42] Yet, it is noteworthy that not all adverse neonatal outcomes in the ECD groups are solely attributed to the lower gestational age at delivery. A recent multinational, multicenter cohort study based on the International Society for Placenta Accreta Spectrum (IS-PAS) registry compared neonatal outcomes between different modes of cesarean delivery within the same gestational range (24 0/7 -34 0/7 weeks, 34 1/7 -36 0/7 weeks, and 36 1/7 weeks).…”

“…[18,19,22] The potential linkage of SGA may lie in the placental pathology per se, as previous studies suggested that both PP and PAS can contribute to SGA or intra-uterine growth restriction due to impaired uteroplacental circulation. [40–42]…”