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 Of 571 participants included, 421 (74%) had neither HDP nor a SGA neonate, 121 (21%) had HDP alone, 17 (3%) had SGA neonate alone, and 12 (2%) had both HDP+SGA neonate. Prevalence of MVM was higher with increasing burden of HDP and/or SGA neonate (22.1% control, 45.5% HDP, 47.1% SGA neonate, 75% HDP+SGA neonate, p