Vasculopathic risks for intra‐uterine fetal demise in the Bronx, New York

Abstract

Background: Placental malperfusion (PM) and hypertension (HTN) are vasculopathic risks that lead to intra-uterine fetal demise (IUFD). Mothers in low socioeconomic areas suffer disproportionately. To date, no study has evaluated these factors in the medically underserved Bronx region. Objective: To compare the rates and associations of these risks in the Bronx over the last 12 years. Design: 170 IUFD cases from 1995–2006, at Montefiore Medical Center (MMC) in the Bronx, were grouped by date and compared. Histologic criteria used to identify PM cases: vasculitis, syncytial knotting, & Tenney-Parker sign. Results: Group 1 (1995–2000, n=70): Hispanic (40.9%), Black (28.8%). Group 2 (2001–2006, n=100): Hispanic (53.1%), Black (38.5%). The following risks significantly increased in incidence between groups: PM (17.5% to 41.2%, Fisher’s exact, p=0.001); umbilical cord insertion anomaly (7.1% to 18.0%, p<0.05); & hypoxic/ischemic fetal brain injury (19.4% to 44.0%, p=0.001). The odds (OR) became significant across groups that PM cases were associated with diabetes, from OR=2.5 (95% CI=0.21–30.29) to OR=3.77 (CI=1.07–13.29), & with HTN, from OR=3.53 (CI=0.70–17.74) to OR=6.21 (CI=1.58–24.35). The odds remained significant that PM cases involved placental infarction, from OR=7.35 (CI=1.80–30.07) to OR=8.5 (CI=2.98–24.26), & small placenta, from OR=6.11 (CI=1.42–26.36) to OR=5.19 (CI=1.87–14.41). Conclusion: Vasculopathic risks like PM and their associations have risen in incidence at MMC. These results can prompt prenatal programs in underserved areas to reduce IUFD risk by screening moms for PM & HTN.