9: Diffuse decidual leukocytoclastic necrosis (DDLN) of the decidua basalis is associated with diminished IQ at age 6 years

Article Outline

• Objective
• Study design
• Results
• Conclusion
• Copyright

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Objective 

DDLN at the choriodecidual interface is a possible marker of placental hypoxia and vascular compromise. We assessed the association of DDLN and chronic placental inflammation (CPI) with cerebral palsy (CP) and IQ at age 6 years.

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Study design 

A cohort of 261 infants delivered between 23 and 32 weeks gestation were evaluated for CP and IQ at age 6.8±0.7 years (using the Weschler Intelligence Scale for Children-III). Placental histology was performed by a single pathologist.

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Results 

DDLN was present in 75 (30%) placentas and was associated with preeclamsia (Pre-E; 57.3% vs. 23.1%, p<.0001), indicated preterm birth (IPTB; 65.3% vs. 24.9%, p<.0001) and CPI (20% vs. 11%, p=.058). CPI was associated with IPTB (52.8% vs. 35.3%, p=.045) but less so with Pre-E (47.2% vs. 31.7%, p=.067). No difference was observed among cases with and without DDLN or CPI regarding race, income, smoking, marital status, or infant gender (all p≥0.1). Those with CPI were less likely to have <12 years of maternal education (27.8% vs. 45.4%, p=.048) and zero parity (33.3% vs. 52.1%, p=.037). DDLN was associated with an increased risk of an SGA baby (21.3% vs. 1.7%, p<.0001). The frequency of CPI decreased with increasing delivery GA (21.7% at 23-26 wks’ to 7.6% at 31-32 wks’, M-H p=.051). DDLN was unrelated to delivery GA (31.0% at 23-26 wks’ to 32.7% at 31-32 wks’, M-H p=.943). An IQ<70 occurred in 41 (15.8%) children and was more common in cases with CPI (30.6% vs. 13.9%, p=.012) and DDLN (21.3% vs. 14.0%) but not significantly so (p=.153). However, in a regression model controlling for delivery GA and other factors associated with childhood IQ (including maternal IQ), DDLN (p=.043), but not CPI (p=.437), was significantly associated with childhood IQ accounting for a 4-point reduction in IQ score. DDLN was not significantly associated with CP (n=11;RR 1.91,95%CI .6-6.1).

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Conclusion 

DDLN, a possible marker of placental hypoxia and vascular compromise, is not associated with delivery GA between 23 and 32 wks’ but is associated with Pre-E, IPTB, SGA and significantly lower IQ at age 6 years.