Preterm placental abruption and long term neurological morbidity of the offspring

Objective
Preterm placental abruption is a severe complication associated with significant perinatal morbidity and mortality. We aimed to evaluate the association between preterm placental abruption and long-term neurological morbidity of the offspring.

Study Design
In this population-based cohort study, the incidence of long-term neurological morbidity of offspring to patients with and without preterm placental abruption was evaluated. Deliveries occurred between the years 1991 and 2014 in a tertiary medical center. We excluded multifetal pregnancies, congenital anomalies, and perinatal mortality cases. Kaplan-Meier survival curve was used to compare cumulative morbidity incidence. Cox proportional hazards model was performed to control for confounders

Results
During the study period 13,945 preterm deliveries were included, of which 3.1% (n=430) were in women with placental abruption. Children born to mothers with preterm placental abruption did not have a significantly higher incidence of total long-term neurological hospitalizations, as compared with children born preterm to mothers without placental abruption (Table). Likewise, the cumulative incidence of total neurological hospitalizations was comparable between the groups (Kaplan-Meier survival analysis, Log rank test p= 0.87; Figure). In the Cox regression analysis, adjusted for confounders such as maternal age and gestational age, preterm placental abruption did not exhibit an independent association with total long-term neurological hospitalizations of the offspring (adjusted HR=0.8, 95% CI 0.5-1.2, p=0.30).However, preterm offspring born to mothers with placental abruption had higher risk for cerebral palsy (0.9% vs 0.2%, OR= 4.2 95% CI 1.4-12.0; p=0.003) and developmental disorders (0.7% vs 0.2%, OR=4.1 95% CI 1.2-13.7; p=0.01) compared to preterm offspring born to mothers without placental abruption (Table).

Conclusion
Preterm placental abruption does not increase the crude risk for long-term neurological hospitalizations of the offspring. However, in our population, preterm placental abruption is associated with an increased risk for CP and long-term developmental delay.