Association of Placental Morphological Abnormalities with Adverse Pregnancy Outcomes in Hypertensive Disorders of Pregnancy: A Propensity Score-Matched Cohort Study
- 1Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- 2Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen, People’s Republic of China
- 3Department of Prenatal Diagnosis Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
Abstract
Objective: To investigate the association between placental morphological abnormalities and adverse pregnancy outcomes in patients with hypertensive disorders of pregnancy (HDP).
Methods: This retrospective cohort study included patients with HDP who delivered at Wuhan Union Hospital, Wuhan, China, between May 2020 and June 2025. Based on prenatal ultrasound, patients were classified as having abnormal placental morphology (thickened or small placenta) or normal morphology. A two-stage propensity score matching procedure was used to balance baseline characteristics at a 1:2 ratio. Conditional logistic regression stratified by matched pairs evaluated maternal and neonatal outcomes. Model 1 included placental morphology alone, whereas Model 2 additionally adjusted for abnormal umbilical artery or middle cerebral artery Doppler findings and ultrasound-estimated fetal growth lag.
Results: Among 1928 patients, 111 (5.8%) had abnormal placental morphology. After matching, abnormal morphology was associated with higher odds of preterm birth, early preterm birth, low birth weight, very low birth weight, 1-minute Apgar score <7, and NICU admission in Model 1. After additional adjustment in Model 2, these associations were attenuated and no longer statistically significant. In subtype analyses, small-placenta subgroups showed more frequent abnormal Doppler findings and suspected fetal growth restriction and generally less favorable neonatal outcomes than the isolated thickening group. Landmark analyses showed that associations detected at 28 weeks included early preterm birth and very low birth weight, with the latter remaining significant after additional adjustment, whereas associations observed at 34 weeks were attenuated after adjustment.
Conclusion: Placental morphological abnormalities were associated with adverse pregnancy outcomes in HDP, but these associations were attenuated after accounting for concurrent Doppler and fetal growth abnormalities. Placental morphology may provide complementary structural information as part of integrated assessment of placental and perinatal risk in HDP.
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BibTeX
@article{tao2026association,
title = {{Association of Placental Morphological Abnormalities with Adverse Pregnancy Outcomes in Hypertensive Disorders of Pregnancy: A Propensity Score-Matched Cohort Study}},
author = {Hui Tao and Lei Sun and Ruilin Ma and Wencong He and Zejun Yang and Shaoqi Chen and Yanan Li and Ziyang Liu and Zetong Wang and Guixiang Xu and Yin Zhao},
journal = {International Journal of Women's Health},
year = {2026},
month = oct,
doi = {10.2147/ijwh.s638807},
url = {https://doi.org/10.2147/ijwh.s638807},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Association of Placental Morphological Abnormalities with Adverse Pregnancy Outcomes in Hypertensive Disorders of Pregnancy: A Propensity Score-Matched Cohort Study
AU - Hui Tao
AU - Lei Sun
AU - Ruilin Ma
AU - Wencong He
AU - Zejun Yang
AU - Shaoqi Chen
AU - Yanan Li
AU - Ziyang Liu
AU - Zetong Wang
AU - Guixiang Xu
AU - Yin Zhao
PY - 2026
DA - 2026/10/27
JO - International Journal of Women's Health
DO - 10.2147/ijwh.s638807
UR - https://doi.org/10.2147/ijwh.s638807
AB - Objective: To investigate the association between placental morphological abnormalities and adverse pregnancy outcomes in patients with hypertensive disorders of pregnancy (HDP). Methods: This retrospective cohort study included patients with HDP who delivered at Wuhan Union Hospital, Wuhan, China, between May 2020 and June 2025. Based on prenatal ultrasound, patients were classified as having abnormal placental morphology (thickened or small placenta) or normal morphology. A two-stage propensity score matching procedure was used to balance baseline characteristics at a 1:2 ratio. Conditional logistic regression stratified by matched pairs evaluated maternal and neonatal outcomes. Model 1 included placental morphology alone, whereas Model 2 additionally adjusted for abnormal umbilical artery or middle cerebral artery Doppler findings and ultrasound-estimated fetal growth lag. Results: Among 1928 patients, 111 (5.8%) had abnormal placental morphology. After matching, abnormal morphology was associated with higher odds of preterm birth, early preterm birth, low birth weight, very low birth weight, 1-minute Apgar score <7, and NICU admission in Model 1. After additional adjustment in Model 2, these associations were attenuated and no longer statistically significant. In subtype analyses, small-placenta subgroups showed more frequent abnormal Doppler findings and suspected fetal growth restriction and generally less favorable neonatal outcomes than the isolated thickening group. Landmark analyses showed that associations detected at 28 weeks included early preterm birth and very low birth weight, with the latter remaining significant after additional adjustment, whereas associations observed at 34 weeks were attenuated after adjustment. Conclusion: Placental morphological abnormalities were associated with adverse pregnancy outcomes in HDP, but these associations were attenuated after accounting for concurrent Doppler and fetal growth abnormalities. Placental morphology may provide complementary structural information as part of integrated assessment of placental and perinatal risk in HDP.
SN - 1179-1411
ER -