583: Placental malperfusion in term and near-term births and referral for developmental delay at age three

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Placental malperfusion is associated with adverse neurologic outcomes and lifelong neurologic disability, however, the association between malperfusion and subtler differences in neurodevelopment is not well understood. This analysis evaluated associations between placental malperfusion and placental gene expression with child developmental outcomes at age 3. Developmental outcomes were assessed for 48 children delivered between 2014-2015 via medical chart review at a single suburban hospital. Children were included if they were part of the Stress, Pregnancy and Health Study, had delivery gestational age ≥35’0 weeks’, and placenta collection at delivery. Suspected delay was indicated by physician referral to early intervention (EI) therapy by age 3. Placentas were grossed and assessed for vascular malperfusion, including fetal (FVM) and/or maternal vascular malperfusion (MVM), by a single perinatal pathologist. Associations between delay and malperfusion were assessed using a chi-square test. Differentially expressed genes (DEGs) from fresh chorionic villous biopsies were identified based on a fold-change of ≥1.25. In this sample 9/48 (18.6%) children were referred to EI by 3 years, and 7/9 (77.8%) were referred with concern for language development. There was not a significant difference in gestational age between those with delay and those without. The presence of placental malperfusion was significantly associated with delay (p=0.03). Children with delay had increased proportions of high grade FVM and MVM, though this was not statistically significant (Table 1). There was no difference in frequency of low grade villitis between groups, and only one case of high-grade villitis. Villous biopsies of those with delay had decreased expression of genes associated with vascular remodeling, including EGFL6, CTHRC1, and VCAM1. These results suggest that placental vascular malperfusion may be related to placental gene expression and developmental delay. Future work should investigate these associations in a larger sample.