Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-05T08:32:35.712Z Has data issue: false hasContentIssue false
  • English
  • Français

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: [email protected]
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Burton, GJ, Fowden, AL, Thornburg, KL. Placental origins of chronic disease. Physiol Rev. 2016; 96, 1509–1565.CrossRefGoogle ScholarPubMed
Barker, DJ, Thornburg, KL. Placental programming of chronic diseases, cancer and lifespan: a review. Placenta. 2013; 34, 841–845.CrossRefGoogle ScholarPubMed
Wallace, JM, Horgan, GW, Bhattacharya, S. Placental weight and efficiency in relation to maternal body mass index and the risk of pregnancy complications in women delivering singleton babies. Placenta. 2012; 33, 611–618.CrossRefGoogle ScholarPubMed
Soliman, AT, Eldabbagh, M, Saleem, W, et al.Placental weight: relation to maternal weight and growth parameters of full-term babies at birth and during childhood. J Trop Pediatr. 2013; 59, 358–364.CrossRefGoogle ScholarPubMed
Eskild, A, Haavaldsen, C, Vatten, LJ. Placental weight and placental weight to birthweight ratio in relation to Apgar score at birth: a population study of 522 360 singleton pregnancies. Acta Obstet Gynecol Scand. 2014; 93, 1302–1308.CrossRefGoogle ScholarPubMed
Thornburg, KL, Marshall, N. The placenta is the center of the chronic disease universe. Am J Obstet Gynecol. 2015; 213(4), S14–S20.CrossRefGoogle ScholarPubMed
Bhattacharya, S, Campbell, DM, Liston, WA, Bhattacharya, S. Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies. BMC Public Health. 2007; 7, 168.CrossRefGoogle ScholarPubMed
McDonald, SD, Han, Z, Mulla, S, Beyene, J. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ (Clin Res Ed). 2010; 341, c3428.CrossRefGoogle ScholarPubMed
Han, Z, Mulla, S, Beyene, J, Liao, G, McDonald, SD. Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol. 2011; 40, 65–101.CrossRefGoogle ScholarPubMed
Cnattingius, S, Villamor, E, Lagerros, YT, Wikström, AK, Granath, F. High birth weight and obesity – a vicious circle across generations. Int J Obes (Lond). 2012; 36, 1320–1324.CrossRefGoogle Scholar
Yu, Z, Han, S, Zhu, J, Sun, X, Ji, C,Guo, X. Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analyses. PLoS ONE. 2016; 8, e61627.CrossRefGoogle Scholar
Shin, D, Song, WO. Prepregnancy body mass index is an independent risk factor for gestational hypertension, gestational diabetes, preterm labor, and small- and large-for-gestational-age infants. J Mat Fetal Neonat Med. 2015; 28, 1679–1686.CrossRefGoogle ScholarPubMed
Wallace, JM, Bhattacharya, S, Horgan, GW. Gestational age, gender and parity specific centile charts for placental weight for singleton deliveries in Aberdeen, UK. Placenta. 2013; 34, 269–274.CrossRefGoogle ScholarPubMed
Wallace, JM, Bhattacharya, S, Campbell, DM, Horgan, GW. Inter-pregnancy weight change impacts placental weight and is associated with the risk of adverse pregnancy outcomes in the second pregnancy. BMC Pregnancy Childbirth. 2014; 14, 40.CrossRefGoogle ScholarPubMed
Gardosi, J, Francis, A. Adverse pregnancy outcome and association with small for gestational age birthweight by customized and population-based percentiles. Am J Obstet Gynecol. 2009; 201, e1–8.CrossRefGoogle ScholarPubMed
Gardosi, J, Clausson, B, Francis, A. The value of customised centiles in assessing perinatal mortality risk associated with parity and maternal size. BJOG. 2009; 116, 1356–1363.CrossRefGoogle ScholarPubMed
Gardosi, J, Francis, A, Turner, S, Williams, M. Customized growth charts: rationale, validation and clinical benefits. Am J Obstet Gynecol. 2018; 218, S609–S618.CrossRefGoogle ScholarPubMed
Chiossi, G, Pedroza, C, Costantine, MM, et al.Customized vs population-based growth charts to identify neonates at risk of adverse outcome: systematic review and Bayesian meta-analysis of observational studies. Ultrasound Obstet Gynecol. 2017; 50, 156–166.CrossRefGoogle ScholarPubMed
Bonellie, S, Chalmers, J, Gray, R, et al.Centile charts for birthweight for gestational age for Scottish singleton births. BMC Pregnancy Childbirth. 2008; 8, 5.CrossRefGoogle ScholarPubMed
Gardosi, J, Mongelli, M, Wilcox, M, Chang, A. An adjustable fetal weight standard. Ultrasound Obstet Gyncol. 1995; 6, 168–174.CrossRefGoogle ScholarPubMed
Roland, MCP, Friis, CM, Godang, K, et al.Maternal factors associated with fetal growth and birthweight are independent determinants of placental weight and exhibit differential effects by fetal sex. PLoS ONE. 2014; 9, e87303.CrossRefGoogle ScholarPubMed
Strøm-Roum, EM, Tanbo, TG, Eskild, A. The associations of maternal body mass index with birth-weight and placental weight. Does maternal diabetes matter? A population study of 106 191 pregnancies. Acta Obstet Gynecol Scand. 2016; 95, 1162–1170.CrossRefGoogle Scholar
Higgins, L, Greenwood, SL, Wareing, M, Sibley, CP, Mills, TA. Obesity and the placenta: A consideration of nutrient exchange mechanisms in relation to aberrant fetal growth. Placenta. 2011; 32, 1–7.CrossRefGoogle ScholarPubMed
Gallo, LA, Barrett, HL, Dekker Nitert, M. Review: Placental transport and metabolism of energy substrates in maternal obesity and diabetes. Placenta. 2017; 54, 59–67.CrossRefGoogle ScholarPubMed
Huang, L, Liu, J, Feng, L, et al.Maternal prepregnancy obesity is associated with higher risk of pathological lesions. Placenta. 2014; 35, 563–569.CrossRefGoogle ScholarPubMed
He, M,Curran, P, Raker, C, et al.Placental findings associated with maternal obesity at early pregnancy. Pathol Res Pract. 2016; 212, 282–287.CrossRefGoogle ScholarPubMed
Roberts, KA, Riley, SC, Reynolds, RM, et al.Placental structure and inflammation in pregnancies associated with obesity. Placenta. 2011; 32, 247–254.CrossRefGoogle ScholarPubMed
McIntyre, HD, Gibbons, KS, Flenady, VJ, Callaway, LK. Overweight and obesity in Australian mothers: epidemic or endemic? Med J Aust. 2012; 196, 184–188.CrossRefGoogle ScholarPubMed
Anderson, NH, Sadler, LC, Stewart, AW, Fyfe, EM, McCowan, LME. Independent risk factors for infants who are small for gestational age by customised birthweight centiles in a multi-ethnic New Zealand population. Aust N Z J Obstet Gynaecol. 2013; 53, 136–142.CrossRefGoogle Scholar
Wang, Z, Wang, P, Liu, H, et al.Maternal adiposity as an independent risk factor for pre-eclampsia: a meta-analysis of prospective cohort studies. Obes Rev. 2013 ; 14, 508–521.CrossRefGoogle ScholarPubMed
Aune, D, Saugstad, OD, Henriksen, T, Tonstad, S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA. 2014; 311, 1536–1546.CrossRefGoogle ScholarPubMed
Thompson, JMD, Irgens, LM, Skjaerven, R, Rasmussen, S. Placenta weight percentile curves for singleton deliveries. BJOG. 2007; 114, 715–720.CrossRefGoogle ScholarPubMed
Ogawa, M, Matsuda, Y, Nakai, A, et al.Standard curve of placental weight and fetal/placental weight ratio in Japanese population: difference according to the delivery mode, fetal sex, or maternal parity. Eur J Obstet Gynecol Reprod Biol. 2016; 206, 225–231.CrossRefGoogle ScholarPubMed
Dombrowski, MP, Berry, SM, Johnson, MP, Saleh, AA, Sokol, RJ. Birthweight-length ratios, ponderal indexes, placental weights, and birthweight-placental ratios in a large population. Arch Pediatr Adolesc Med. 1994; 148, 508–512.CrossRefGoogle Scholar
Almog, B, Shehata, F, Aljabri, S, Levin, I, Shalom-Paz, E, Shrim, A. Placenta weight percentile curves for singleton and twin deliveries. Placenta. 2011; 32, 58–62.CrossRefGoogle Scholar
L’Abée, C, Vrieze, I, Kluck, T, et al.Parental factors affecting the weights of the placenta and the offspring. J Perinatal Med. 2011; 39, 27–34.Google ScholarPubMed
Leary, SD, Godfrey, KM, Greenaway, LJ, Davill, VA, Fall, CH. Contribution of the umbilical cord and membranes to untrimmed placental weight. Placenta. 2003; 25, 276–278.CrossRefGoogle Scholar
Williams, M, Southam, M, Gardosi, J. Antenatal detection of fetal growth restriction and stillbirth risk in mothers with high and low body mass index. Arch Dis Child Fetal Neonatal Ed. 2010; 95, Fa92.CrossRefGoogle Scholar
Schartz, N, Sammel, MD, Leite, R, Parry, S. First-trimester placental ultrasound and maternal serum markers as predictors of small-for-gestational-age infants. Am J Obstet Gynecol. 2014; 211, e1–8.Google Scholar
Plasencia, W, Akolekar, R, Dagklis, T, Veduta, A, Nicolaides, KH. Placental volume at 11-13 weeks’ gestation in the prediction of birth weight percentile. Fetal Diagn Ther. 2011; 30, 23–28.CrossRefGoogle ScholarPubMed
Effendi, M, Demers, S, Giguère, Y, et al.Association between first-trimester placental volume and birth weight. Placenta. 2014; 35, 99–102.CrossRefGoogle ScholarPubMed
Kermack, AJ, Van Rijn, BB, Houghton, FD, Calder, PC, Cameron, IT, Macklon, NS. The ‘Developmental Origins’ Hypothesis: relevance to the obstetrician and gynaecologist. J Dev Orig Health Dis. 2015; 6, 415–424.CrossRefGoogle Scholar