Placental pathology in pregnancies complicated by hypertensive disorders of pregnancy and small for gestational age neonates: prevalence and severity of maternal vascular malperfusion in a prospectively collected cohort

OBJECTIVE: We evaluate how the presence and severity of placental pathology correlates with adverse pregnancy outcomes including hypertensive disorders of pregnancy (HDP) and small for gestational age (SGA) neonates. STUDY DESIGN: This is a secondary, descriptive analysis of the prospectively collected Stress, Pregnancy, and Health study. We compared placentas from patients with neither HDP nor SGA neonate, HDP alone, SGA neonate alone, and both HDP+SGA neonate by four categories of placental pathology: acute inflammation (AI), chronic inflammation (CI), maternal vascular malperfusion (MVM), and fetal vascular malperfusion (FVM) as well as the number of MVM-related lesions. Univariable analysis was performed using chi-square tests, ANOVA, and Kruskal-Wallis as appropriate. Multivariable analysis with logistic regression adjusted for BMI, mode of conception, diabetes, and socioeconomic status. Sensitivity analysis excluding chronic hypertension in HDP diagnosis also performed. RESULTS: =.0001). CONCLUSION: A combination of both HDP and SGA neonates, compared to either condition alone, is associated with greater prevalence of placental MVM lesions as well as higher MVM score. Future research should focus on further understanding the physiology of this relationship and identifying potential opportunities for intervention for patients with HDP and suspected SGA.