Choosing placental hypoxic-ischemic measures that have clinical implications in child development and diseases

Abstract

Purpose

Placental hypoxic-ischemic pathology is one of the common causes for adverse outcomes. But there is no commonly accepted evaluation system on specific morphological and histopathological measures of the placenta.

Objective

This study aims to systematically select several core placental hypoxic-ischemic measures that have a high prognostic relevance to child health.

Methods

We used data from the Collaborative Perinatal Project, a multicenter prospective cohort study that recruited over 55,000 pregnant women and followed their offspring to 7 years old. Women who had information on placental pathology and child outcomes were included. 57 placental measures considered to be relevant to hypoxia-ischemia were selected. Apgar score, intelligence quotient, preeclampsia, birth weight and subclinical neurology injuries were chosen as outcomes. The least absolute shrinkage and selection operator (LASSO) procedure as well as training and testing methods were used to select a more efficient and simpler placental hypoxic-ischemic measures that may have clinical implications.

Results

Of the 57 measures, 7 were selected as candidates by LASSO. Based on the training and testing methods, we retained placental measures with a higher odds ratio of child morbidity. We further narrowed down to four measures that had the highest prognostic relevance. They were: short cord length (ΣOR = 8.51), calcification of cut surface (ΣOR = 8.31), opaque membranes (ΣOR = 5.26), Hofbauer cells in terminal villi (ΣOR = 4.69).

Conclusions

Our four-measure system is relatively simple and closely related to the child health. It may be used as a novel placental hypoxic-ischemic evaluation criterion, and function as the first line tool for future research.

Keywords:

• Placental pathology
• LASSO
• choosing measures
• child development
• ischemia
• hypoxia

Ethical approval

The CPP data are available through the U.S. National Archives (www.archives.gov), using of publicly de-identified data is exempt from our Institutional Review Board review.

Acknowledgments

The authors are grateful to the U.S. National Archives and Records Administration for providing data of the Collaborative Perinatal Project. We also wish to acknowledge the contributions of professor Caixia Li.

Disclosure statement

No author has any potential conflict of interest.

Author contributions

JZ designed the analysis; YJZ conducted the data analysis and drafted the paper; HJZ was responsible for all aspects of placental pathology and revised the draft; YC, TW contributed to the selection and interpretation of child outcomes. All authors have agreed to the submission and publication of the manuscript.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [grant No. 81703235], Shanghai Children's Hospital Excellent Youth Physician Training Project [2017YYQ02] and Shanghai "New star of Yiyuan" Young Medical Talents Training Project [No. [2019] 72].