Can Placental Histopathology Lesions Predict Recurrence of Small for Gestational Age Neonates?

OBJECTIVE: To study the role of placental pathology in predicting the recurrence of delivery of small for gestational age (SGA) neonates.

METHODS: The medical records and placental pathological reports of normotensive women who gave birth at 24 to 42 weeks to neonates with birth weight (BW) <10th percentile were reviewed. Patients were divided according to their subsequent pregnancy into those who developed or did not develop recurrent SGA (BW < 10th percentile). The clinical and pathological characteristics of the index pregnancies were compared between the groups. A prediction model was generated for SGA recurrence.

RESULTS: The recurrent SGA group (n = 67) was characterized by a higher rate of placental weight <10th percentile ( P = .01), and higher neonatal to placental weight ratio ( P = .003), as compared to the nonrecurrent SGA group (n = 99). On multivariate logistic regression analysis, placental maternal and fetal vascular malperfusion lesions and higher neonatal to placental weight ratio were all independently associated with recurrent SGA. Birth weight <3rd percentile was the only clinical variable associated with recurrent SGA. A prediction model for recurrent SGA included the following independent risk factors: BW <3rd percentile, villous lesions of maternal vascular malperfusion, and neonatal to placental weight ratio.

CONCLUSION: The presence of placental vascular malperfusion lesions and increased neonatal to placental weight ratio at index pregnancy are associated with recurrent SGA in subsequent pregnancy.