Babies born to mothers who experienced a placental abruption during labor could be more at risk of developing or dying of heart disease later in life, according to research published in the Journal of the American Heart Association.

Placental abruption is a serious pregnancy complication in which the placenta detaches from the uterine wall, usually in the third trimester. The complication is rare — studies show it occurs in about 1% of pregnancies in the US — and experts are still working to understand the effects on the long-term health of infants.

“What we now see is that the impact is not just on the mother but also on their future offspring, and the earlier we catch that, the better we can intervene,” said Rachel Bond, MD, system director of women’s heart health at Dignity Health in Phoenix, who was not involved with the study.

The new study included nearly 3 million pregnancies recorded in the Placental Abruption and Cardiovascular Event Risk cohort, originally a retrospective population-based study that linked birth records with hospitalizations to examine the long-term cardiovascular risks for mothers and their offspring following placental abruption. All children were born in New Jersey between 1993 and 2020. About 1% of these pregnancies included a placental abruption. The average follow-up was about 14 years, although some were followed for up to 28 years.

Children born after placenta abruption were four times more likely to die of heart disease in the first 28 years of life than those born from pregnancies not complicated by the condition (4 vs 1 per 100,000 person-years).

The children were also three times more likely to develop nonfatal cardiovascular disease, such as cardiac arrhythmias or congenital heart disease. These heart issues usually became apparent within the first year of life, highlighting the importance of early screening.

“The incidence of cardiovascular events in these babies is not high, but even one is too many,” said Cande Ananth, PhD, MPH, professor of obstetrics, gynecology, and reproductive sciences at the Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, who led the study. “Not only should moms have intense follow-up during the first year after delivery, but the baby as well.”

This should include screening infants for conditions such as high blood pressure.

In a secondary piece of the research, Ananth and his team ran a sibling pair analysis to adjust for unaccounted risk factors in the general cohort, such as genetics and the environment in which a child grew up. One sibling was born following placental abruption, and the other was not. The findings showed the same increased risk for cardiovascular disease as the original analysis.

“These children are full siblings, so genes cannot explain these risks. They were brought up in the same household, so they had the same environment while growing up,” Ananth said.

An Unrecognized Risk

The reason these infants were at a higher risk for cardiovascular disease was not likely related to the placenta detachment itself but rather the placenta being impaired, Bond said.

“It’s less about the event but more about the environment that that fetus is developing in that exposes them to that future cardiovascular risk,” Bond said. “The baby will have decreased oxygen and blood flow, and that will affect how their vascular system forms.”

Ananth said abruption also causes hypoxia in the fetus.

“Whenever there is an abruption, there is also increased oxidative stress,” he said.

Ananth said hypoxia could explain the increased risk for stroke, particularly in babies younger than 1 year.

“Perhaps we should be more aggressive about how we are screening for more traditional cardiovascular risk factors like high blood pressure in kids born from placental abruption pregnancies,” Bond said. “Physicians should be taking detailed pregnancy information, not just what happened to the baby during that pregnancy but to the mother.”

Bond and Ananth reported no relevant financial disclosures. 

Kaitlin Sullivan is a journalist living in Colorado.