064 - High grade Maternal Vascular Malperfusion and Developmental Concerns before Four Years of Age

Publication Number: 64.5392

Janedelie Romero, Endeavor Health, Deerfield, IL, United States; Lauren Keenan-Devlin, Endeavor Health, Evanston, IL, United States; Linda Ernst, Northshore/Endeavor Health, Evanston, IL, United States; Adriana Weisleder, Northwestern University, Evanston, IL, United States; Matthew Pellerite, University of Chicago Pritzker School of Medicine, Evanston, IL, United States; Greg Miller, Northwestern University The Feinberg School of Medicine, Evanston, IL, United States; Ann Borders, Endeavor Health, Evanston Hospital, University of Chicago, Evanston, IL, United States; Alexa Freedman, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States

Background: Abnormal placental pathology, such as placental vascular malperfusion and chronic inflammation, has been associated with lifelong adverse neurodevelopmental disabilities such as cerebral palsy and autism spectrum disorder. However, the association between abnormal placental pathology and risk for more subtle forms of developmental concern in early childhood is not well understood.

Objective: This analysis evaluated the associations between placental pathology with child developmental outcomes in children at 3 years.

Design/Methods: Developmental outcomes were assessed through retrospective medical chart review for 605 children enrolled in a previous Chicagoland study who were born between 2018-2023. Children were included if they were 48 months (about 4 years) or older and they had documented visits in their electronic medical records. Developmental concern was indicated through 1.) physician referrals to early intervention or specialized services such as speech, physical, or occupational, 2.) positive screens in clinically administered Ages and Stages Questionnaires, or 3.) diagnosed developmental delays via ICD-10 codes in the medical chart at any point before the age of four. Placentas were collected within 6 hours of delivery and evaluated by an experienced placental pathologist using the Amsterdam criteria and included 4 major domains of placental pathology (acute inflammation, chronic inflammation, fetal vascular malperfusion, and maternal vascular malperfusion). Lesions were further classified as none, low, and high grade. Logistic regressions were used to determine the association between placental pathologies and developmental concerns, adjusted for gestational age at delivery, infant sex, maternal education, and NICU admission.

Results: Of 605 children who were >=4 at the time of outcome assessment, 131 had pediatric visits and were included in analysis. In both unadjusted and adjusted models, high grade maternal vascular malperfusion was associated with increased odds of developmental concern (aOR= 5.39, 95%CI 1.02, 28.40). Other placental pathologies were not associated with developmental concern.

Conclusion(s): Children whose placentas exhibited high grade maternal vascular malperfusion were more likely to have a clinically identified developmental concern before the age of 4. Future research is needed to evaluate whether placental pathology may improve identification of infants at increased risk of developmental concerns or delay.

Table 1. Demographic characteristics of Cohort (N=131)
Numbers represent (SD) or number (%). IPR (Income to Poverty Ratio) is a comparison of a person or family's income to their poverty threshold that indicates whether they are in poverty. A ratio less than 1 means that the income is less than the poverty level. When the ratio equals 1, the income and poverty level are the same, and when the ratio is greater than 1, the income is higher than the poverty level. *p < 0.05

Table 2. Developmental Concerns by Placental Histology
*p < 0.05