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Category: Obstetric Quality and Safety
Poster Session IV
Placenta accreta spectrum (PAS) is associated with high morbidity and mortality. Maternal obesity is independently associated with adverse perinatal outcomes and may augment poor obstetrical outcomes. We sought to determine if increasing maternal body mass index (BMI) is associated with worse perinatal outcomes in patients with PAS.
Study Design:
We conducted a retrospective cohort study of viable gestations (>230/7 wks) with histology-proven PAS delivering at participating PAS referral centers (2010-2021). Patients were grouped by BMI class at delivery. The primary outcome was a maternal morbidity composite including transfusion (RBCs, platelets, FFP, Cryoprecipitate), estimated blood loss (EBL) > 1500mL and readmission; secondary outcomes included individual maternal outcomes, antenatal diagnosis of PAS and neonatal outcomes (Table 2). We compared outcomes using Chi-Square and Kruskal Wallis tests as appropriate (alpha < 0.05); multivariable regression models (covariates in Table Footnotes) calculated aOR (95% CI) using a BMI of < 25 as the referent group.
Results:
In the 897 included patients, composite maternal morbidity was frequent but similar across groups (range 69.7-80.2%, p=0.1). After multivariable analysis, composite maternal morbidity was only significantly decreased in the BMI 25-29.9 (vs < 25) group (aOR 0.5 [0.3 - 0.8], p=0.004). EBL and EBL> 1500mL were inconsistently, significantly different across groups (Table 1). The neonatal composite significantly increased with BMI (p=0.008), specifically among those with BMI >40 (aOR 2.2 [1.2-3.9]), even after adjusting for gestational age. Other maternal and neonatal outcomes were similar across groups (Tables 1 & 2). Antenatal diagnosis of PAS was frequent (76%) and similar across BMI groups (p=0.26).
Conclusion:
In patients delivering at PAS referral centers, adverse maternal outcomes did not linearly increase with increasing BMI. BMI 25-29.9 showed a protective effect. As expected, higher BMI was associated with worse composite neonatal morbidity.
Kevin S. Shrestha, MD, MPH
Resident
University of Alabama at Birmingham
Birmingham, Alabama, United States
Bahram Salmanian, MD
Maternal-Fetal Medicine Fellow
University of Colorado
Denver, Colorado, United States
Brett D. Einerson, MD, MPH (he/him/his)
Assistant Professor, Director of The Utah Placenta Accreta Program
University of Utah Health
Salt Lake City, Utah, United States
Daniela A. Carusi, MD, MSCR (she/her/hers)
Associate Professor
Brigham and Women's Hospital and Harvard Medical School
Boston, Massachusetts, United States
Scott A. Shainker, MS,DO (he/him/his)
Director, New England Center for Placental Disorders / Assistant Professor of Obstetrics, Gynecology, and Reproductive Biology
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States
Albaro J. Nieto-Calvache, MD (he/him/his)
Abnormally Invasive Placenta Clinic
Fundación Valle del Lili
Cali, Valle del Cauca, Colombia
Vineet Shrivastava, MD
Long Beach Memorial Medical Center Women's Hospital and UC Irvine
Long Beach, California, United States
Matthew R. Grace, MD
Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Deirdre J. Lyell, MD
Professor
Stanford University
Palo Alto, California, United States
Meena Khandelwal, MD
Attending Physician
Cooper University Hospital
Camden, New Jersey, United States
Garrett Fitzgerald, MD
Assistant Professor
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
Adam Crosland, MD,MPH
Maternal Fetal Medicine Physician
Oregon Health and Science University Hospital
Long Beach, California, United States
Kamran Hessami, MD (he/him/his)
Postdoctoral research fellow
Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
Boston, Massachusetts, United States
Rebecca H. Jessel, MD
Assitant Professor
University of Maryland
Baltimore, Maryland, United States
Karin A. Fox, MD
Assistant Professor
Baylor College of Medicine and Texas Children's Hospital
Houston, Texas, United States
Robert M. Silver, MD
University of Utah Health
Salt Lake City, Utah, United States
Alireza Shamshirsaz, MD
Department of Obstetrics & Gynecology, Division of Fetal Intervention, Baylor College of Medicine and Texas Children’s Hospital
Houston, Texas, United States
Akila Subramaniam, MD,MPH
Associate Professor
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States