259905 Placenta accreta and feto-infant morbidity outcomes

Monday, October 29, 2012

Alfred Mbah, PhD , Department of Epidemiology and Biostatistics, University of South Florida, College of Public Health, Tampa, FL
Cara de la Cruz, PhD, MPH , Chiles Center for Healthy Mothers and Babies, University of South Florida, College of Public Health, Tampa, FL
Euna M. August, PhD, MPH , Department of Community and Family Health, University of South Florida, College of Public Health, Tampa, FL
Abraham Salinas, MD, MPH , Department of Community and Family Health, University of South Florida, College of Public Health, Tampa, FL
Valerie Whiteman, MD , Department of Obstetrics and Gynecology, University of South Florida, College of Medicine, Tampa, FL
Hamisu Salihu, MD, PhD , Department of Epidemiology and Biostatistics, University of South Florida, College of Public Health, Tampa, FL
Background: Numerous studies have identified placenta accreta as a major cause of maternal morbidity. Furthermore, a major risk factor for placenta accreta is cesarean delivery, which increases the likelihood of adverse birth outcomes. However, the relationship between placenta accreta and feto-infant morbidity remains poorly understood. Methods: Using a retrospective cohort design, we analyzed linked hospital discharge and vital statistics data for the state of Florida (1998-2007) to assess the association between placenta accreta and feto-infant morbidity outcomes (i.e., low birth weight [LBW], very low birth weight [VLBW], preterm birth [PTB], very preterm birth [VPTB], and small for gestational age [SGA]) among mothers with singleton births during the study period (N=1,696,827). Propensity score matching was conducted to match cases (mothers with placenta accreta) to controls (mothers without placenta accreta). Conditional logistic regression was employed to generate odds ratios (OR) for the matched observations. Results: Mothers with placenta accreta were more likely to be white, married women of advanced age (>35 years old) who smoked (p<0.01). However, these differences dissolved after propensity score matching. When the mother experienced placenta accreta, infants had elevated risks for all of the considered fetal morbidity outcomes (LBW: OR=2.02, 95% CI=1.80-2.28; VLBW: OR=3.49, 95% CI=2.70-4.50; PTB: OR=1.75, 95% CI=1.57-1.95; VPTB: OR=3.39, 95% CI=2.66-4.32; SGA: OR=1.42; 95% CI=1.27-1.59). Conclusions: These findings indicate that placenta accreta is strongly associated with a heightened risk for feto-infant morbidities. Further research is warranted to expand knowledge and understanding of the impact of placenta accreta on birth outcomes.

Learning Areas:
Epidemiology
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
1. Explain the impact of placenta accreta on feto-infant morbidity outcomes. 2. Demonstrate the utility of propensity scores to minimize bias in observational studies.

Keywords: Maternal Morbidity, Birth Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been involved in all aspects of this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3088.0: Women and Children's Health Poster Session