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A new customised placental weight standard redefines the relationship between maternal obesity and extremes of placental size and is more closely associated with pregnancy complications than an existing population standard

Published online by Cambridge University Press:  07 October 2019

Jacqueline M. Wallace Open the ORCID record for Jacqueline M. Wallace [Opens in a new window] ,
Joeleita P. Agard  and
Graham W. Horgan
Jacqueline M. Wallace*
Affiliation:
Rowett Institute, University of Aberdeen, Aberdeen, AB25 2ZD, UK
Joeleita P. Agard
Affiliation:
Rowett Institute, University of Aberdeen, Aberdeen, AB25 2ZD, UK
Graham W. Horgan
Affiliation:
Biomathematics & Statistics Scotland, Aberdeen, AB25 2ZD, UK
*
Address for correspondence: Jacqueline M. Wallace, Rowett Institute, University of Aberdeen, Aberdeen, AB25 2ZD, UK. Email: Jacqueline.Wallace@abdn.ac.uk
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Abstract

Placental weight is a valuable indicator of its function, predicting both pregnancy outcome and lifelong health. Population-based centile charts of weight-for-gestational-age and parity are useful for identifying extremes of placental weight but fail to consider maternal size. To address this deficit, a multiple regression model was fitted to derive coefficients for predicting normal placental weight using records from healthy pregnancies of nulliparous/multiparous women of differing height and weight (n = 107,170 deliveries, 37–43 weeks gestation). The difference between actual and predicted placental weight generated a z-score/individual centile for the entire cohort including women with pregnancy complications (n = 121,591). The association between maternal BMI and placental weight extremes defined by the new customised versus population-based standard was investigated by logistic regression, as was the association between low placental weight and pregnancy complications. Underweight women had a greater risk of low placental weight [<10thcentile, OR 1.84 (95% CI 1.66, 2.05)] and obese women had a greater risk of high placental weight [>90th centile, OR 1.98 (95% CI 1.88, 2.10)] using a population standard. After customisation, the risk of high placental weight in obese/morbidly obese women was attenuated [OR 1.17 (95% CI 1.09, 1.25)]/no longer significant, while their risk of low placental weight was 59%–129% higher (P < 0.001). The customised placental weight standard was more closely associated with stillbirth, hypertensive disease, placental abruption and neonatal death than the population standard. Our customised placental weight standard reveals higher risk of relative placental growth restriction leading to lower than expected birthweights in obese women, and a stronger association between low placental weight and pregnancy complications generally. Further, it provides an alternative tool for defining placental weight extremes with implications for the placental programming of chronic disease.

Keywords

Placental weightbody mass indexcustomised weight standardspregnancy complications
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 11 , Issue 4 , August 2020 , pp. 350 - 359
Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2019

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