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Am J Perinatol 2023; 40(01): 009-014
DOI: 10.1055/s-0042-1757261
SMFM Fellowship Series Article

The Association between Placenta Accreta Spectrum Severity and Incidence of Small for Gestational Age Neonates

Sarah E. Detlefs
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
,
Daniela A. Carusi
2   Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
,
Anna M. Modest
3   Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Brett D. Einerson
4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
,
Deirdre Lyell
5   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
,
Matthew R. Grace
6   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
,
Vineet K. Shrivastava
7   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Miller Children's and Women's Hospital, Long Beach, California
,
Meena Khandelwal
8   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cooper University Hospital, Princeton, New Jersey
,
Bahram Salmanian
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
,
Scott A. Shainker 
3   Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Karin A. Fox
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
,
Akila Subramaniam
9   Department of Obstetrics and Gynecology, University of Alabama, Birmingham, Alabama
,
Adam Crosland
7   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Miller Children's and Women's Hospital, Long Beach, California
,
Elaine L. Duryea 
10   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Amir A. Shamshirsaz
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
,
Kevin Shrestha
9   Department of Obstetrics and Gynecology, University of Alabama, Birmingham, Alabama
,
Michael A. Belfort
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
,
Robert M. Silver
4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
,
Steven L. Clark
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
,
Alireza A. Shamshirsaz
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Abstract

Objective The aim of the study is to evaluate whether pathologic severity of placenta accreta spectrum (PAS) is correlated with the incidence of small for gestational age (SGA) and neonatal birthweight.

Study Design This was a multicenter cohort study of viable, non-anomalous, singleton gestations delivered with histology-proven PAS. Data including maternal history, neonatal birthweight, and placental pathology were collected and deidentified. Pathology was defined as accreta, increta, or percreta. The primary outcome was rate of SGA defined by birth weight less than the 10th percentile. The secondary outcomes included incidence of large for gestational age (LGA) babies as defined by birth weight greater than the 90th percentile as well as incidence of SGA and LGA in preterm and term gestations. Statistical analysis was performed using Chi-square, Kruskal–Wallis, and log-binomial regression. Increta and percreta patients were each compared with accreta patients.

Results Among the cohort of 1,008 women from seven United States centers, 865 subjects were included in the analysis. The relative risk (RR) of SGA for increta and percreta did not differ from accreta after adjusting for confounders (adjusted RR = 0.63, 95% confidence interval [CI]: 0.36–1.10 for increta and aRR = 0.72, 95% CI: 0.45–1.16 for percreta). The results were stratified by placenta previa status, which did not affect results. There was no difference in incidence of LGA (p = 1.0) by PAS pathologic severity. The incidence of SGA for all PAS patients was 9.2% for those delivered preterm and 18.7% for those delivered at term (p = 0.004). The incidence of LGA for all PAS patients was 12.6% for those delivered preterm and 13.2% for those delivered at term (p = 0.8203).

Conclusion There was no difference in incidence of SGA or LGA when comparing accreta to increta or percreta patients regardless of previa status. Although we cannot suggest causation, our results suggest that PAS, regardless of pathologic severity, is not associated with pathologic fetal growth in the preterm period.

Key Points

  • PAS severity is not associated with SGA in the preterm period.

  • PAS severity is not associated with LGA.

  • Placenta previa does not affect the incidence of SGA in women with PAS.

Keywords

placenta accreta spectrum - birth weight - small for gestational age

Supplementary Material



Publication History

Received: 15 September 2021

Accepted: 17 June 2022

Article published online:
12 September 2022

© 2022. Thieme. All rights reserved.

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