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Neurodevelopmental outcomes in children in relation to placental abruption
Author(s) -
Ananth CV,
Friedman AM,
Lavery JA,
VanderWeele TJ,
Keim S,
Williams MA
Publication year - 2017
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14049
Subject(s) - medicine , placental abruption , confounding , wechsler adult intelligence scale , pediatrics , population , prospective cohort study , cohort study , obstetrics , pregnancy , psychiatry , cognition , fetus , environmental health , genetics , biology
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.