News article: Placenta size linked to stillbirth

(This is post #100 so far this year! -- not bad...!)

A slightly belated news item that I wanted to share:

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Placenta size linked to stillbirth

Dave McGinn
From Thursday's Globe and Mail

Last updated on Friday, Aug. 28, 2009 03:39AM EDT

The size of a pregnant woman's placenta can determine whether a fetus is at a high risk of stillbirth, according to a new study conducted by a clinician-researcher at Mount Sinai Hospital in Toronto.

"A lot of problems are being solved in pregnancy relating to healthy babies, but the huge area that's unsolved and getting worse is placental problems," says John Kingdom, principal researcher of the study, published yesterday online in the journal Ultrasound in Obstetrics and Gynecology.

This research is "a big piece of the puzzle in the right direction," he adds.

The study looked at 90 women with both low levels of pregnancy-associated plasma protein-A, or PAPP-A (which is routinely tested to screen for Down syndrome) and elevated levels of alpha-fetoprotein, or AFP (which is tested to screen for Down Syndrome and spina bifida).

Researchers found that those with both conditions as well as a small placenta were at an increased risk of stillbirth and extreme pre-term delivery.

The results suggest that placenta screening, which determines size and shape through an ultrasound, should be done alongside tests for Down syndrome and spina bifida to guard against the possibility of stillbirth."Any one single test alone doesn't have enough positive predictive value," says Dr. Kingdom, a maternal fetal-medicine specialist.

Placenta screening is not as prominent as other prenatal tests despite the important role played by the placenta during pregnancy.

"Up until now, we've diagnosed placental insufficiency after the baby is born," Dr. Kingdom says. "We can diagnose placental insufficiency at week 18 to 20 when the baby is still healthy, then we can test interventions to keep the baby healthy."

Stillbirths are on the rise in Canada. In 2005, the number of stillbirths reached 2,209, an increase of 6.9 per cent from 2004, according to Statistics Canada. Such numbers show the importance of placenta screening, Dr. Kingdom says.

"The baby's growth and well-being are entirely dependant upon the placenta working normally," Dr. Kingdom says. "It's the placenta that actually transfer the nutrients and oxygen to the baby."

The study found that among women with low PAPP-A, elevated AFP and a small placenta, at least 25 per cent can expect to see their pregnancy end in stillbirth.

In greatest danger are women with additional risk factors, including those with a previous history of stillbirth, those more than 40 years of age, or those with chronic hypertension or Type 1 diabetes. Their pregnancies are practically guaranteed to end in stillbirth.

There are options available for pregnant women with small placentas, however, from dietary measures to ultrasound monitoring.

"There's a broad range of ways to help people," Dr. Kingdom says. "For example, a program of careful ultrasound surveillance will save the lives of babies that would otherwise die unnecessarily." Performing emergency cesarean sections in cases where fetuses have not reached full term, however, is an extreme treatment option, he adds.The Placenta Clinic at Mount Sinai now routinely screens all pregnant women with a low PAPP-A level and a high AFP level using a placental ultrasound as a result of Dr. Kingdom's research.

More hospitals need to follow suit, he says, but encouraging pregnant women to undergo placenta screening may require a change in the way prenatal test options are offered.

Women often decline to undergo tests for Down syndrome and spina bifida for fear of receiving false-positive results, he explains. "In Ontario, four women out of 10 decline these tests. My guess is, if you asked those four women, 'However, would you like to have the test done for a good reason, like to promote better placental health?' I bet you three out of four would say yes."

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Dr. K. was the doctor on call that my dh spoke with when I had a horrific migraine on our 13th (!) wedding anniversary during my pregnancy, and also the doctor who came by my hospital room the morning after I delivered Katie while making his rounds as the dr on call. He seemed very interested when I mentioned Katie's IUGR & my placenta, and said he'd like to examine it. Not sure whether he ever did, or what he could have done for me 11 years ago. I always intended to ask for a consultation with him during my next pregnancy (which, of course, never happened).

It's too late for me now -- but I'm so glad that progress is being made that may help other women & save them from the heartbreak that we & so many other families have been through.