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Cardiovascular disease and cancer in women with accreta and retained placenta: a longitudinal cohort study

Abstract

Purpose

The association between placental detachment disorders and risk of chronic disease is unclear. We determined the association of placenta accreta and retained placenta with risk of future maternal cardiovascular disease and cancer.

Methods

We tracked a longitudinal cohort of 541,051 pregnant women over a period of 13 years (2006–2019) in Quebec, Canada. The main exposure measures were placenta accreta and retained placenta in any pregnancy. Outcomes included future hospitalizations for cardiovascular disease and cancer. Using Cox regression models adjusted for maternal characteristics, we estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of accreta and retained placenta with cardiovascular disease and cancer at 13 years.

Results

The incidence of cardiovascular hospitalization was 21.2 per 10,000 person-years for accreta and 23.4 per 10,000 for retained placenta with postpartum hemorrhage, compared with 20.3 per 10,000 for neither placental disorder. Cancer incidence followed a similar pattern, with rates highest for retained placenta with hemorrhage. Retained placenta with hemorrhage was associated with 1.19 times the risk of cardiovascular disease (95% CI 1.03–1.38) and 1.27 times the risk of cancer (95% CI 1.06–1.53). Retained placenta with hemorrhage was associated with heart failure (HR 1.84, 95% CI 1.04–3.27), cardiomyopathy (HR 1.88, 95% CI 1.03–3.43), and cervical cancer (HR 2.03, 95% CI 1.17–3.52). Accreta and retained placenta without hemorrhage were not associated with these outcomes.

Conclusion

Retained placenta with hemorrhage may be a risk marker for cardiovascular disease and certain cancers later in life.

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Fig. 1

Data availability

The data used to produce study findings can be accessed by submitting a request to the Quebec Statistics Institute (https://statistique.quebec.ca/research/#/accueil).

Code availability

The SAS code used to analyze the data can be made available by the corresponding author (NA) upon reasonable request.

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Acknowledgements

The authors thank Siyi He for assistance with statistical analysis.

Funding

This study was supported by the Heart & Stroke Foundation of Canada (G-18–0021776) and Fonds de recherche du Québec-Santé (34695). The sponsors were not involved in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

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Authors

Contributions

Auger: Project development, data management, data analysis, manuscript writing/editing. Marcoux: Manuscript writing/editing. Paradis: Manuscript writing/editing. Healy-Profitós: Data analysis, manuscript writing/editing. Wei: Manuscript writing/editing. Potter: Manuscript writing/editing.

Corresponding author

Correspondence to Nathalie Auger.

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Conflict of interest

The authors report no conflict of interests.

Ethical approval

We received an ethics waiver from the institutional review board of the University of Montreal Hospital Centre, because the data were anonymized and informed consent was not needed for use of the registry.

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Auger, N., Marcoux, S., Paradis, G. et al. Cardiovascular disease and cancer in women with accreta and retained placenta: a longitudinal cohort study. Arch Gynecol Obstet 304, 943–950 (2021). https://doi.org/10.1007/s00404-021-06044-4

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Keywords

  • Cancer
  • Cardiovascular diseases
  • Postpartum hemorrhage
  • Placenta accrete
  • Placenta
  • Retained