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- Title
Neurodevelopmental outcomes in children in relation to placental abruption.
- Authors
Ananth, CV; Friedman, AM; Lavery, JA; VanderWeele, TJ; Keim, S; Williams, MA; Ananth, C V; Friedman, A M; Lavery, J A; VanderWeele, T J; Williams, M A
- Abstract
<bold>Objective: </bold>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.<bold>Design: </bold>Secondary analysis of a multicenter prospective cohort study.<bold>Setting: </bold>Multicenter US National Collaborative Perinatal Project (1959-76).<bold>Population: </bold>Women that delivered singleton live births.<bold>Methods: </bold>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.<bold>Main Outcome Measures: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>The effect of abruption on neurodevelopmental outcomes appears restricted to an effect that is largely mediated through preterm delivery.<bold>Tweetable Abstract: </bold>Increased risk of cognitive deficits in relation to abruption appears to be mediated through preterm delivery.
- Subjects
UNITED States; PLACENTA abnormalities; PERINATAL death; NEURODEVELOPMENTAL treatment for infants; PREMATURE labor; MEDIATION (Statistics); CHILD development; COGNITION; COMPARATIVE studies; PREMATURE infants; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; RESEARCH; EVALUATION research; ABRUPTIO placentae
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2017, Vol 124, Issue 3, p463
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.14049