Abstract
BackgroundPlacenta accreta spectrum (PAS) is a life-threating complication in the field of obstetrics. Sometimes we face with unexpected PAS cases which is potentially higher maternal mortality and morbidity compared with expected cases. The present study was conducted to examine the prevalence of PAS and to elucidate its risk factors using a large Japanese birth cohort study.MethodsWe reviewed the results of a nationwide prospective birth cohort study in Japan, and identified 90,554 participants treated from 2011 to 2014 in 15 regional centers. Multiple regression models were created to identify the risk factors for PAS. These data were obtained from self-reported questionnaires or patient medical records.ResultsThis analysis consisted of 202 cases of PAS (18 with placenta previa and 184 without placenta previa) and 90,352 cases without PAS. The multiple logistic regression analysis showed that placenta previa (adjusted odds ratio [aOR]: 12.86, 95% confidence interval [CI] 7.70–21.45, P < 0.001), assisted reproductive technology-related pregnancies (aOR: 6.78, 95% CI 4.54–10.14, P < 0.001), smoking during pregnancy (aOR: 1.95, 95% CI 1.15–3.31, P = 0.013), more than two previous cesarean sections (aOR: 2.51, 95% CI 1.35–4.67, P = 0.004), and uterine anomalies (aOR: 3.97, 95% CI 1.24–12.68, P = 0.020) increased the risk of PAS.ConclusionIn general population, placenta previa, assisted reproductive technology-related pregnancy, smoking during pregnancy, repeated cesarean sections, and uterine anomalies were risk factors for PAS in the Japanese population.
Highlights
Placenta accreta spectrum (PAS) is a life-threating complication in the field of obstetrics
In this study, we investigated the results of the Japan Environment and Children’s Study (JECS), which is a nationwide, government-funded, birth cohort study [10] that was started in January 2011 to investigate the effects of environmental factors on children’s health
We used two types of data: (1) T1: comprising data obtained from self-reported questionnaires collected around the participants’ first trimesters, and including questions related to the maternal medical background; (2) M0: obstetrics outcome collected from medical records provided by each participant’s institution
Summary
Placenta accreta spectrum (PAS) is a life-threating complication in the field of obstetrics. Wu et al reported that the incidence of placenta accreta was 1 of 533 births in 1982–2002 [3], which is considerably higher than the incidence reported in previous studies, ranging from 1 of 4027 births to 1 of 2510 births in the 1970s to 1980s [2, 4]. This condition could increase maternal morbidities, such as hemorrhage (adjusted odds ratio [aOR]: 16.6, 95% confidence interval [CI]: 13.4– 20.5), transfusion (aOR: 41.8, 95% CI: 33.4–52.2), and hysterectomy (aOR: 950, 95% CI: 632.9–1427.9) [5].
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