Placental maternal vascular malperfusion pathology is associated with decreased school performance at age 12.

INTRODUCTION

The placenta is essential for fetal growth and development. Placental pathological processes are often involved in pregnancy complications and adverse outcomes. However, its role in long-term neurocognitive outcomes remains largely unexplored. This study examines the association between placental lesions and neurocognitive developmental outcomes, using school performance at 12 years of age as a proxy.

METHODS

This study was a cross-sectional data linkage study, making use of three Dutch national registries; Palga (the Dutch nationwide pathology databank), Perined (perinatal data) and Statistics Netherlands (educational data). 2% of children with educational data were linked to Perined and Palga, reflecting a selected cohort since placentas are examined based on clinical indications. The primary outcome was school performance, analyzed using regression models with lesion types entered as binary variables and adjusted for confounders. Inverse probability weighting was applied to account for selection bias into the pathology sample.

RESULTS

In this selected cohort of 36,197 children, placental lesions were identified in 57% of placentas. Placental lesions were associated with lower school performance scores (-0.06SD, 95% CI -0.10 to -0.02; adjusted for confounding factors) and fewer children received theoretical secondary school level advice (49.9% vs 52.4%; adjusted odds ratio 0.92, 95% CI 0.87 to 0.96). Among the different lesions, only maternal vascular malperfusion (MVM) was independently associated with decreased school performance.

DISCUSSION: MVM was associated with lower school performance at the age of 12. These findings underscore the importance of placental pathology as a contributor to - and predictor of both neonatal and long-term neurocognitive developmental outcomes.