Neurodevelopmental outcomes in children in relation to placental abruption.

OBJECTIVE

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.

DESIGN

Secondary analysis of a multicenter prospective cohort study.

SETTING

Multicenter US National Collaborative Perinatal Project (1959-76).

POPULATION: Women that delivered singleton live births.

METHODS

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.

MAIN OUTCOME MEASURES: 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.

RESULTS

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.

CONCLUSION

The effect of abruption on neurodevelopmental outcomes appears restricted to an effect that is largely mediated through preterm delivery.

TWEETABLE ABSTRACT: Increased risk of cognitive deficits in relation to abruption appears to be mediated through preterm delivery.