Placental Growth Measures in Relation to Birth Weight in a Latin American Population

Abstract

Introduction The placenta, translates how the fetus experiences the maternal environment and is a principal influence on birth weight (BW).

Objective To explore the relationship between placental growth measures (PGMs) and BW in a public maternity hospital.

Methods Observational retrospective study of 870 singleton live born infants at Hospital Maternidad Sardá, Universidad de Buenos Aires, Argentina, between January 2011 and August 2012 with complete data of PGMs. Details of history, clinical and obstetrical maternal data, labor and delivery and neonatal outcome data, including placental measures derived from the records, were evaluated. The following manual measurements of the placenta according to standard methods were performed: placental weight (PW, g), larger and smaller diameters (cm), eccentricity, width (cm), shape, area (cm²), BW/PW ratio (BPR) and PW/BW ratio (PBR), and efficiency. Associations between BW and PGMs were examined using multiple linear regression.

Results Birth weight was correlated with placental weight (R² = 0.49, p < 0.001), whereas gestational age was moderately correlated with placental weight (R² = 0.64, p < 0.001). By gestational age, there was a positive trend for PW and BPR, but an inverse relationship with PBR (p < 0.001). Placental weight alone accounted for 49% of birth weight variability (p < 0,001), whereas all PGMs accounted for 52% (p < 0,001). Combined, PGMs, maternal characteristics (parity, pre-eclampsia, tobacco use), gestational age and gender explained 77.8% of BW variations (p < 0,001). Among preterm births, 59% of BW variances were accounted for by PGMs, compared with 44% at term. All placental measures except BPR were consistently higher in females than in males, which was also not significant. Indices of placental efficiency showed weakly clinical relevance.

Conclusions Reliable measures of placental growth estimate 53.6% of BW variances and project this outcome to a greater degree in preterm births than at term. These findings would contribute to the understanding of the maternal–placental programming of chronic diseases.

Resumo

Introdução A placenta traduz como o feto experimenta o ambiente materno, além de ser a principal influência sobre o peso ao nascer (PN).

Objetivo Explorar a relação entre medidas de crescimento da placenta (MCPs) e PN em uma maternidade pública.

Métodos Estudo retrospectivo observacional de 870 recém-nascidos vivos únicos na Maternidade Sardá, Universidade de Buenos Aires, Argentina, entre janeiro de 2011 e agosto de 2012 com os dados completos das MCPs. Foram avaliados dados da história clínica e obstétrica materna, trabalho de parto e resultados neonatais, incluindo medidas da placenta derivadas dos registros médicos. Foram realizadas as seguintes medições manuais da placenta: peso da placenta (PP, g), diâmetros maior e menor (cm), excentricidade, espessura (cm), forma, área (cm²), razões PN/PP e PP/PN e eficiência. Associações entre PN e MCPs foram examinadas por meio de regressão linear múltipla.

Resultados Peso ao nascer foi correlacionado com peso placentário (R² = 0,49, p < 0,001), enquanto idade gestacional foi moderadamente correlacionada com peso placentário (R² = 0,64, p < 0,001). Por idade gestacional, houve uma tendência positiva para a relação PP e PN/PP, mas uma relação inversa com a razão PP/PN (p < 0,001). Somente peso da placenta respondeu por 49% da variabilidade do peso ao nascer (p < 0,001), ao passo que todas as MCPs foram responsáveis por 52% (p < 0,001). Combinados, MCPs, características maternas (paridade, pré-eclâmpsia, fumo), idade gestacional e sexo explicaram 77,8% da variação do peso ao nascer (p < 0,001). Entre nascimentos pré-termo, 59% da variância do PN foi contabilizada pelas MCPs, em comparação com 44% a termo. Todas as medidas placentárias, exceto a razão PN/PP, foram consistentemente maiores em mulheres do que em homens, mas não significativas. Índices de eficiência placentária mostraram fraca relevância clínica.

Conclusões medidas confiáveis de crescimento placentário estimam 53,6% da variância do peso ao nascer, e projetam esse resultado a um maior grau em nascimentos pré-termo do que a termo. Estes resultados contribuiriam para a compreensão da programação materno-placentária de doenças crónicas.

Keywords

Placenta - placental weight - placental characteristics - birth weight - gestational age

Palavras-chave

Placenta - peso da placenta - características da placenta - peso ao nascer - idade gestacional

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