You are on page 1of 7

Original Research

Placenta Previa and the Risk of Delivering


a Small-for-Gestational-Age Newborn
Sari Risnen, PhD, Vijaya Kancherla, PhD, Michael R. Kramer, PhD, MMSc, Mika Gissler, DrPhil, MSocSc,
and Seppo Heinonen, MD, PhD

OBJECTIVE: To evaluate whether there is an association prior SGA newborn, prior preeclampsia, smoking,
between placenta previa and delivery of a small-for- in vitro fertilization, socioeconomic status, and pre-
gestational-age (SGA) newborn and to quantify the eclampsia (adjusted OR 2.08, 95% CI 1.502.89). Further-
contribution of individual risk factors for SGA that are more, only one-fourth of the association between SGA
associated with placenta previa stratified by maternal and placenta previa could be explained by controlling for
parity. risk factors clustering with placenta previa among mul-
METHODS: A cross-sectional study using the Finnish tiparous women.
Medical Birth Register during 20002010. All singleton CONCLUSION: Placenta previa is associated with
births (N5596,562) were included; major congenital impaired fetal growth in multiparous but not nulliparous
anomalies were excluded. An association between SGA women.
(less than 2 standard deviations below the mean) and (Obstet Gynecol 2014;124:28591)
placenta previa was modeled by parity-specific unad- DOI: 10.1097/AOG.0000000000000368
justed and adjusted statistical models. LEVEL OF EVIDENCE: II
RESULTS: Placenta previa complicated 625 of 249,476
singleton births among nulliparous women (2.50/1,000)
and 915 of 347,086 singleton births among multiparous
women (2.64/1,000). Among nulliparous women, the
P lacenta previa occurs in approximately 5 in 1,000
pregnancies.1 Advanced maternal age,24 smoking
during pregnancy,2,46 in vitro fertilization (IVF),2
most common risk factor for placenta previa was prior cesarean delivery,24,7 and multiparity2,5,6 are
in vitro fertilization; placenta previa was not associated found to increase the risk of placenta previa. A large
with an increased prevalence of SGA controlling for population-based study reported that multiparity
maternal age, smoking, in vitro fertilization, socioeco- increased the risk of placenta previa and that cumula-
nomic status, and preeclampsia (adjusted odds ratio [OR]
tive effects of previous pregnancies may further con-
0.81, 95% confidence interval [CI] 0.571.17). Among
tribute to the risk.8
multiparous women, placenta previa was associated with
Neonates born to mothers with placenta previa
a twofold increased risk of SGA controlling for maternal
are more likely to be delivered preterm (less than 37
age, parity, prior preterm birth, prior caesarean delivery,
weeks of gestation),2,4,911 stillborn,2,6 or die early in
the neonatal period.2,5,6,12 The association between
From the Department of Epidemiology, Emory University Rollins School of placenta previa and small-for-gestational age (SGA)
Public Health, Atlanta, Georgia; the Department of Obstetrics and Gynaecology, newborn has been inconsistent, ranging from mod-
Kuopio University Hospital, and the School of Medicine, University of Eastern
Finland, Kuopio, and the National Institute for Health and Welfare, Helsinki,
erate4,9 to no risk.2,13,14 The relation between pla-
Finland; and the Nordic School of Public Health, Gothenburg, Sweden. centa previa and SGA may be explained by
Dr. Risnen was supported by the Emil Aaltonen Foundation and the Saasta- suboptimal placental implantation and decreased
moinen Foundation. perfusion to the fetus. Previous studies on this asso-
Corresponding author: Sari Risnen, PhD, Department of Epidemiology, ciation had varied findings as a result of differences
Emory University Rollins School of Public Health 1518 Clifton Road NE, in their study designs and sample sizes, selection and
Atlanta, GA 30322; e-mail: shraisan@student.uef.fi.
clinical criteria that define SGA, and availability and
Financial Disclosure
The authors did not report any potential conflicts of interest.
adjustment of varied confounding factors.2,4,9,10,13,14
The aim of the present study was to evaluate the
2014 by The American College of Obstetricians and Gynecologists. Published
by Lippincott Williams & Wilkins. association between placenta previa and delivery of
ISSN: 0029-7844/14 a SGA newborn and to quantify the contribution of

VOL. 124, NO. 2, PART 1, AUGUST 2014 OBSTETRICS & GYNECOLOGY 285
individual risk factors for SGA that are associated with previa underwent repeat ultrasound examinations
placenta previa stratified by maternal parity. during the third trimester. Information on severity
of placenta previa (complete or incomplete) was not
MATERIALS AND METHODS available. Small-for-gestational-age was recorded if
The data included the entire population of singleton the newborns sex- and parity-specific birth weight
births (N5596,562) during 20002010 in Finland; was less than 2 standard deviations below the mean
major congenital anomalies (n523,934 [4.0%]) and (based on the Finnish population-based birth curves
multiple births (n518,217 [3.1%]) were excluded. for 19962008).15 Women were grouped based on
Births with missing information on gestational age number of prior childbirths as nulliparous (those
(n52,141 [0.4%]), birth weight (n5630 [0.1%]), having no prior childbirths) and multiparous
newborns with unknown sex (n521 [0.0%]), and (those with at least one prior childbirth). We classi-
parity (n5667 [0.1%]) were excluded from the anal- fied parity into three groups based on prior child-
ysis. In total, 2,135 (0.4%) singleton births were births among multiparous women (one, two to four,
excluded from the bivariable analyses and 2,803 and five or more prior childbirths). Maternal age
births (0.5%) from the multivariable. was classified as younger than 20, 2029, 3039,
Data for our analyses were acquired from two or 40 years or older (advanced age). The gestational
sources. The first was the Finnish Medical Birth age was estimated based on first- or second-
Register, established in 1987 and currently main- trimester ultrasonography measurements or from
tained by the National Institute for Health and the date of the last menstrual period. Birth weight
Welfare. The Medical Birth Register contains socio- (grams) was used as a continuous variable. Women
demographic characteristics, maternal reproductive were classified based on self-reported smoking hab-
history, pregnancy and delivery characteristics of its during pregnancy (reviewed during antenatal vis-
the index pregnancy, and maternal and newborn its) as nonsmoking, smoking (quitted smoking
diagnoses on all live births and stillbirths (delivered during the first trimester or continued smoking after
after the 22nd gestational week or weighing 500 g or the first trimester), or missing information on smok-
more) through the first postnatal week. Further- ing (n515,910 [2.7%]). Marital status was classified
more, Medical Birth Register data were supple- as either single or in a relationship (married or liv-
mented by information on selected maternal ing with a partner). Women were classified also by
conditions from a second data source, the Hospital socioeconomic status (defined based on maternal
Discharge Register. The Hospital Discharge Regis- occupation at birth) based on Finlands National
ter, established in 1967, contains information on Social Classification, which follows international
diagnoses, medical interventions, and surgical pro- recommendations (http://www.stat.fi/meta/luoki-
cedures of outpatient and inpatient care in special- tukset/ammatti/001-2001/kuvaus_en.html, in Finn-
ized health care in Finland. Thus, records from the ish). Socioeconomic status was categorized as upper
Medical Birth Register and Hospital Discharge white collar workers such as physicians and lawyers;
Register were deterministically linked using the lower white collar workers such as nurses and sec-
parturients encrypted personal identification num- retaries; blue collar workers such as cooks and
bers. Hospital Discharge Register data were used to cleaners; others; and missing information, as cate-
assess maternal preeclampsia (O14 and O15), ges- gorized and published elsewhere.16 Others com-
tational diabetes (O24.4), and maternal diabetes prised percent (n5152,894 [25.6%]) of all cases and
mellitus (O24.0 and O24.1), all defined and gath- included all births with unclassifiable occupations
ered based on the International Classification of such as entrepreneurs, students, retired, unem-
Diseases, 10th Revision codes in the Hospital Dis- ployed, and housewives. The group with missing
charge Register. information on socioeconomic status comprised
Placenta previa was defined based on Interna- 16.9% (n5101,182) of all births. In vitro fertilization
tional Classification of Diseases, 10th Revision included intracytoplasmic sperm injection and fro-
codes from the Medical Birth Register (O44). The zen embryo transfers.
validity of placenta previa diagnosis was quite high Differences between women with and without
in the Medical Birth Register because almost 100% placenta previa, and with and without SGA new-
of the pregnant women underwent ultrasound borns, were evaluated by x2 test for dichotomous and
examination during their first and second trimester categorical variables and Mann-Whitney test for con-
(http://www.finlex.fi/fi/laki/alkup/2011/20110339, tinuous variables. Non-SGA newborns were defined as
in Finnish), and specifically, those with placenta appropriate- or large-for-gestational-age. Unadjusted

286 Raisanen et al Placenta Previa and Small-for-Gestational-Age Newborn OBSTETRICS & GYNECOLOGY
and several partially adjusted odds ratios (ORs) and restricted to pregnancies with placenta previa and
95% confidence intervals (CIs) were estimated to mea- cesarean delivery, which were more likely to be
sure all associations using unconditional logistic regres- severe cases. Associations were deemed to be sig-
sion analysis. Possible confounders were selected based nificant if the P value was ,.05. All analyses were
on the literature and the results of bivariable analyses performed using SPSS for Windows 19.0.
(P#.1) and explored separately for nulliparous women Permission to use the confidential register data in
(maternal age, smoking during pregnancy, IVF, socio- this study was approved on February 16, 2012, by the
economic status, and preeclampsia) and multiparous National Institute for Health and Welfare in Finland
women (maternal age, prior childbirths, prior preterm (reference number 1749/5.05.00/2011).
births, prior cesarean births, prior SGA newborn, prior
preeclampsia, smoking during pregnancy, IVF, socio- RESULTS
economic status, and preeclampsia). A preliminary The prevalence of placenta previa, among all
model (model 1) was used to estimate the unadjusted singleton births not complicated by major congen-
association between placenta previa and a SGA new- ital anomalies between the years 2000 and 2010,
born. Selected confounders were added one by one was estimated as 2.50 (95% CI 2.322.71) per 1,000
to partially adjusted models 29 (see Table 1). Model births among nulliparous women and 2.64 (95% CI
10 was the final model and included all the con- 2.472.81) per 1,000 births among multiparous
founders. The contribution of each confounder in women (P5.33). As shown in Table 2, an increased
models 410 was measured by the percentage prevalence of placenta previa in nulliparous women
reduction in the OR of placenta previa associated was associated with advanced maternal age (40
with a SGA newborn compared with model 2 or 3 years or older), nonsmoking status, socioeconomic
by using the formula: (OR model 2 or 32OR status, IVF achieved pregnancy, gestational diabe-
model x)/(OR model 2 or 321). Sensitivity analy- tes, and maternal diabetes mellitus (P,.05). Simi-
ses were performed to study whether severity of larly, placenta previa in multiparous women was
placenta previa affected the results; analysis was positively associated with advanced maternal age

Table 1. Small-for-Gestational-Age (Less Than 2 Standard Deviations) Newborns Associated With Placenta
Previa After Adjustment for Sociodemographics and Pregnancy Characteristics in Nulliparous and
Multiparous Women Among Singleton Births* During 20002010 in Finland

Differences With Multiparous Differences With


SGA Nulliparous Women Model x (%) Women Model x (%)

Model 1 unadjusted 0.85 (0.591.23) 2.47 (1.803.39)


Model 2 adjusted by maternal age 0.81 (0.561.16) 1 () 2.35 (1.713.23) 1 (8.2)
Model 3 adjusted by age and parity NA 2 () 2.43 (1.763.34) 2 ()
Model 4 adjusted by model 3+prior NA 2 () 2.31 (1.683.18) 3 (8.4)
preterm birth
Model 5 adjusted by model 3+prior NA 2 () 2.33 (1.693.21) 3 (7.0)
caesarean delivery
Model 6 adjusted by model 3+prior NA 2 () 2.22 (1.603.07) 3 (14.7)
SGA newborn
Model 7 adjusted by model 3+in vitro 0.82 (0.571.18) 2 () 2.43 (1.773.34) 3 (0)
fertilization
Model 8 adjusted by model 2 or 3 0.81 (0.561.16) 2 (0) 2.36 (1.713.25) 3 (4.9)
+smoking
Model 9 adjusted by model 2 or 3 0.81 (0.571.17) 2 (0) 2.36 (1.713.25) 3 (4.9)
+preeclampsia
Model 10 adjusted by model 2 or 3 0.81 (0.571.17) 2 (0) 2.08 (1.502.89) 3 (24.5)
+all confounders
SGA, small for gestational age; NA, not applicable.
Data are odds ratio (95% confidence) interval unless otherwise specified.
* Cases with major congenital anomalies were excluded.

The contribution of each factor was measured by the percentage reduction in the odds ratio of placenta previa compared with model 2 by
using formula (OR model 2 or 32OR model x)/(OR model 2 or 321).

In nulliparous women, OR of SGA adjusted for maternal age, smoking, IVF, socioeconomic status, and preeclampsia. In multiparous
women, OR of SGA adjusted for maternal age, parity, prior preterm birth, prior cesarean delivery, prior SGA newborn, prior
preeclampsia, smoking, IVF, socioeconomic status, and preeclampsia.

VOL. 124, NO. 2, PART 1, AUGUST 2014 Raisanen et al Placenta Previa and Small-for-Gestational-Age Newborn 287
Table 2. Delivery Characteristics Among Women With Singleton Births With and Without Placenta Previa
During 20002010 in Finland

Nulliparous Women (n5249,476) Multiparous Women (n5347,086)


Placenta Previa No Placenta Previa Placenta Previa No Placenta Previa
Characteristic (n5625 [0.3%]) (n5248,851 [99.7%]) P* (n5915 [0.3%]) (n5346,171 [99.7%]) P*

Maternal age (y) 30.665.4 27.365.3 #.001 32.665.1 31.065.1 #.001


Younger than 20 1.9 6.0 0.1 0.4
2029 38.6 61.2 27.8 39.1
3039 54.4 31.1 63.2 55.6
40 or older 5.1 1.6 9.0 4.9
Gestational age (wk) 37.762.9 39.861.9 #.001 37.163.0 39.861.7 #.001
Smoking status .002 .22
Nonsmoking 85.8 80.5 83.6 84.1
Smoking 12.0 17.5 14.2 13.0
Missing 2.2 2.1 2.2 3.0
information
Married or in 94.2 90.7 .003 95.4 95.1 .72
a relationship
Socioeconomic status #.001 .08
Upper white collar 8.0 8.0 8.5 8.6
worker
Lower white collar 39.0 31.8 34.4 36.6
worker
Blue collar worker 11.4 13.7 15.4 15.0
Others 20.8 27.1 23.3 24.5
Missing 20.8 19.3 18.5 15.2
No. of prior deliveries NA NA .007
1 56.4 57.3
24 36.9 38.2
5 or more 6.7 4.5
Prior cesarean NA NA 28.9 17.9 #.001
delivery
Prior preterm birth NA NA 13.1 7.3 #.001
Prior SGA newborn NA NA 7.8 5.1 #.001
Prior preeclampsia NA NA 0.5 0.4 .43
In vitro fertilization 12.8 2.2 #.001 4.3 0.8 #.001
Preeclampsia 0.8 0.9 .83 2.7 1.5 .001
Gestational diabetes 9.9 7.6 .03 14.3 13.0 .24
Preexisting diabetes 7.2 5.5 .07 11.7 9.7 .04
mellitus
Male sex 54.1 51.1 .14 53.6 51.1 .14
Birth weight (g) 3,063.46661 3,438.26539 #.001 3,038.86759 3,615.56532 #.001
Mode of delivery #.001 #.001
Vaginal 16.0 66.2 20.4 84.0
spontaneous
Breech 0.2 0.7 0.3 0.5
Vacuum assistance 3.2 13.7 1.0 2.9
Forceps 2.7 0.1 0.7 0.0
Cesarean 77.9 19.4 77.6 12.7
NA, not applicable; SGA, small for gestational age.
Data are mean6standard deviation or % unless otherwise specified.
* x2 or Mann-Whitney U test, P value significant at ,.05.

Others comprise entrepreneurs, students, retired women, unemployed women, housewives, and all unclassifiable cases.

(40 years or older), higher number of prior births, placenta previa during pregnancy were more likely
prior cesarean delivery, prior preterm birth, prior to be delivered by cesarean at a lower gestational
SGA newborn, IVF achieved pregnancy, pre- age and with a lower mean birth weight compared
eclampsia, gestational diabetes, and maternal dia- wit newborns not affected by placenta previa
betes mellitus (P,.05). Newborns affected by (Table 2).

288 Raisanen et al Placenta Previa and Small-for-Gestational-Age Newborn OBSTETRICS & GYNECOLOGY
Table 3 shows sociodemographics and delivery gestational-age was positively associated with higher
characteristics among women with and without SGA number of prior births, prior cesarean delivery, prior
newborns stratified by parity. An increased prevalence preterm birth, prior SGA newborn, prior preeclamp-
of SGA newborns was associated with advanced sia, and placenta previa in multiparous women.
maternal age (40 years or older), smoking, single mar- Table 1 shows unadjusted and partially adjusted
ital status, low socioeconomic status, and preeclampsia models examining the association between placenta
among both parity groups. An increased prevalence of previa and SGA stratified by parity. In nulliparous
SGA was associated with male fetal sex in nulliparous women, placenta previa was not a risk factor for SGA
women but not in multiparous women. Small-for- after adjusting for maternal age, smoking, IVF,

Table 3. Delivery Characteristic Factors Among Women With Singleton Small-for-Gestational-Age (Less
Than 2 Standard Deviations) and NonSmall-for-Gestational-Age Newborns During 20002010 in
Finland

Nulliparous Women (n5248,725) Multiparous Women (n5345,702)


SGA (n514,378 Non-SGA (n5234,347 SGA (n56,370 Non-SGA (n5339,332
Characteristic [5.8%]) [94.2%]) P* [1.8%]) [98.2%]) P*

Maternal age (y) 30.665.4 27.365.3 #.001 32.665.1 31.065.1 #.001


Younger than 20 6.5 6.0 0.6 0.4
2029 56.6 61.4 34.4 39.1
3039 34.7 31.0 56.9 55.6
40 or older 2.6 1.6 8.0 4.8
Gestational age (wk) 37.762.9 39.861.9 #.001 37.163.0 39.861.7 #.001
Smoking status #.001 #.001
Nonsmoking 72.8 81.0 69.1 84.5
Smoking 24.9 17.0 28.1 12.7
Missing 2.3 2.0 2.8 2.9
information
Married or in 88.9 90.8 #.001 92.7 95.2 #.001
a relationship
Socioeconomic status #.001 #.001
Upper white collar 7.3 8.1 5.9 8.6
worker
Lower white collar 31.7 31.9 34.7 36.7
worker
Blue collar worker 15.0 13.7 18.3 15.0
Others 26.4 27.1 25.1 24.5
Missing 19.6 19.3 16.0 15.2
No. of prior deliveries NA NA #.001
1 38.7 57.6
24 55.7 37.9
5 or more 5.6 4.5
Prior cesarean NA NA 24.5 17.8 #.001
delivery
Prior preterm birth NA NA 15.1 7.2 #.001
Prior SGA newborn NA NA 26.3 4.7 #.001
Prior preeclampsia NA NA 0.9 0.4 #.001
In vitro fertilization 2.0 2.2 .08 0.7 0.8 .17
Preeclampsia 3.9 0.7 #.001 6.3 1.4 #.001
Gestational diabetes 5.6 7.7 #.001 9.7 13.1 #.001
Preexisting diabetes 4.0 5.6 #.001 7.2 9.8 #.001
mellitus
Placenta previa 0.2 0.3 .39 0.6 0.3 #.001
Male sex 51.9 51.1 .05 50.3 51.2 .20
Birth weight (g) 3,063.46661 3,438.26539 #.001 3,038.86759 3,615.56532 #.001
NA, not applicable; SGA, small for gestational age.
Data are mean6standard deviation or % unless otherwise specified.
* x2 or Mann-Whitney U test, P value significant at ,.05.

Others comprise entrepreneurs, students, retired women, unemployed women, housewives, and all unclassifiable cases.

VOL. 124, NO. 2, PART 1, AUGUST 2014 Raisanen et al Placenta Previa and Small-for-Gestational-Age Newborn 289
socioeconomic status, and preeclampsia (model 10; reports and confirmed an association among IVF, prior
adjusted OR 0.81, 95% CI 0.571.17). Among mul- cesarean delivery, and placenta previa.2,7 However,
tiparous women, the prevalence of SGA was two- current findings did not confirm maternal smoking as
fold greater for those affected with placenta previa a predisposing factor for placenta previa as reported by
compared with those without (model 10; adjusted previous studies.2,46 This could be because nulliparous
OR 2.08, 95% CI 1.502.89). Furthermore, in multipa- women with placenta previa were less likely to be
rous women, 24.5% of the association between placenta smokers in our study, and no significant association
previa and SGA could be explained by adjustment for was noted in multiparous women. Many nulliparous
prior preterm birth, prior cesarean delivery, prior SGA women conceived by IVF and were of high socioeco-
newborn, prior preeclampsia, smoking, socioeconomic nomic status, older, and less likely to smoke.17
status, IVF and preeclampsia during index pregnancy The most important strengths of our research are
(model 10). Contribution of individual factors, includ- size of the study population and subsequently its
ing prior preterm birth, prior cesarean delivery, and generalizability. Our study included all singleton births
prior SGA newborn to the prevalence of SGA associ- in Finland using data from two national population
ated with placenta previa, was 8.4%, 7.0%, and 14.7%, registers, spanning most recent years, thus minimizing
respectively (models 46). selection bias. Data quality and coverage of the national
Sensitivity analyses were performed to study health registers have shown to be good or excellent.18,19
whether severity of placenta previa might affect the Furthermore, we had information on several important
association between placenta previa and SGA (anal- confounders. Because ultrasound examinations during
yses were restricted to women with placenta previa the first and second trimester are conducted in all preg-
who gave birth by cesarean delivery), but our results nant women in Finland as stated by law, and patients
were almost the same as noted in the previous with placenta previa underwent repeat ultrasound
analysis (data not shown). examinations, the validity of placenta previa diagnosis
in our study is quite high. One limitation in our analysis
DISCUSSION is that we did not have information on the type of
For births between 2000 and 2010 in Finland, the placenta previa (complete or incomplete).
prevalence of placenta previa among singleton preg- In conclusion, the current cross-sectional study
nancies not affected by major congenital anomalies was with a total population of singleton births from
2.52.6 per 1,000 births. These prevalence estimates Finland showed that both predisposing factors for
were comparable with a previous review by Cresswell placenta previa and the association between placental
et al.1 The novelty of the present study was that the previa and a SGA newborn were substantially mod-
association between placenta previa and prevalence of ified by parity. Pregnancies of multiparous women
a SGA newborn was substantially modified by mater- with placenta previa are more likely to result in the
nal parity. Additionally, predisposing factors that led to delivery of a SGA newborn. Future studies should
placenta previa varied by parity; in nulliparous examine the association between placenta previa and
women, placenta previa was more frequently associ- SGA in other population-based samples and consider
ated with IVF and in multiparous women with a prior parity and other factors that may potentially contrib-
cesarean delivery. Placenta previa was not a risk factor ute to this association.
for SGA in nulliparous women but was associated with
a twofold increased prevalence of SGA in multiparous REFERENCES
women. Of the increased prevalence of SGA associated 1. Cresswell JA, Ronsmans C, Calvert C, Filippi V. Prevalence of
with placenta previa in multiparous women, only 24.5% placenta praevia by world region: a systematic review and
meta-analysis. Trop Med Int Health 2013;18:71224.
of the placenta previaSGA association is attributable to
prior preterm birth, prior cesarean delivery, prior SGA 2. Nrgaard LN, Pinborg A, Lidegaard , Bergholt T. A Danish
national cohort study on neonatal outcome in singleton pregnancies
newborn, prior preeclampsia, smoking during preg- with placenta previa. Acta Obstet Gynecol Scand 2012;91:54651.
nancy, IVF, socioeconomic status, and preeclampsia, 3. Yang Q, Wen SW, Phillips K, Oppenheimer L, Black D,
which typically cluster both with a history of cesarean Walker MC. Comparison of maternal risk factors between placen-
delivery as well as with the occurrence of placenta pre- tal abruption and placenta previa. Am J Perinatol 2009;26:27986.
via. Consequently, placenta previa is associated with 4. Rosenberg T, Pariente G, Sergienko R, Wiznitzer A, Sheiner E.
Critical analysis of risk factors and outcome of placenta previa.
a doubling of SGA prevalence among multiparous
Arch Gynecol Obstet 2011;284:4751.
women even after accounting for known risk factors.
5. Salihu HM, Li Q, Rouse DJ, Alexander GR. Placenta previa:
Our findings concerning predisposing factors of neonatal death after live births in the United States. Am J Ob-
placenta previa were in accordance with previous stet Gynecol 2003;188:13059.

290 Raisanen et al Placenta Previa and Small-for-Gestational-Age Newborn OBSTETRICS & GYNECOLOGY
6. Hung TH, Hsieh CC, Hsu JJ, Chiu TH, Lo LM, Hsieh TT. Risk 13. Yeniel AO, Ergenoglu AM, Itil IM, Askar N, Meseri R. Effect
factors for placenta previa in an Asian population. Int J Gynae- of placenta previa on fetal growth restriction and stillbirth. Arch
col Obstet 2007;97:2630. Gynecol Obstet 2012;286:2958.
7. Getahun D, Oyelese Y, Salihu HM, Ananth CV. Previous 14. Harper LM, Odibo AO, Macones GA, Crane JP, Cahill AG.
cesarean delivery and risks of placenta previa and placental Effect of placenta previa on fetal growth. Am J Obstet Gynecol
abruption. Obstet Gynecol 2006;107:7718. 2010;203:330.e15.
8. Ananth CV, Wilcox AJ, Savitz DA, Bowes WA Jr, Luther ER. 15. Sankilampi U, Hannila ML, Saari A, Gissler M, Dunkel L. New
Effect of maternal age and parity on the risk of uteroplacental population-based references for birth weight, length, and head
bleeding disorders in pregnancy. Obstet Gynecol 1996;88: circumference in singletons and twins from 23 to 43 gestation
5116. weeks. Ann Med 2013;45:44654.
9. Ananth CV, Demissie K, Smulian JC, Vintzileos AM. Relationship 16. Gissler M, Rahkonen O, Arntzen A, Cnattingius S, Andersen AM,
among placenta previa, fetal growth restriction, and preterm deliv- Hemminki E. Trends in socioeconomic differences in Finnish
ery: a population-based study. Obstet Gynecol 2001;98:299306. perinatal health 1991-2006. J Epidemiol Community Health
2009;63:4205.
10. Crane JM, van den Hof MC, Dodds L, Armson BA, Liston R.
Neonatal outcomes with placenta previa. Obstet Gynecol 1999; 17. Risnen S, Randell K, Nielsen HS, Gissler M, Kramer MR,
93:5414. Klemetti R, et al. Socioeconomic status affects the prevalence,
11. Zlatnik MG, Cheng YW, Norton ME, Thiet MP, Caughey AB. but not the perinatal outcomes, of in vitro fertilization pregnan-
cies. Hum Reprod 2013;28:311825.
Placenta previa and the risk of preterm delivery. J Matern Fetal
Neonatal Med 2007;20:71923. 18. Gissler M, Shelley J. Quality of data on subsequent events in
12. Ananth CV, Smulian JC, Vintzileos AM. The effect of placenta a routine medical birth register. Med Inform Internet Med
previa on neonatal mortality: a population-based study in the 2002;27:338.
United States, 1989 through 1997. Am J Obstet Gynecol 2003; 19. Sund R. Quality of the Finnish Hospital Discharge Register:
188:1299304. a systematic review. Scand J Public Health 2012;40:50515.

Submit Your Manuscript to Obstetrics & Gynecology


To submit your manuscript, visit Editorial ManagerTM at http://ong.editorialmanager.com
First-time users: Click the Register button on the menu bar and enter the requested
information. Upon successful registration, you will be sent an e-mail with instructions to
verify your registration.
Authors: Click the Login button on the menu bar and log in to the system as Author.
Then submityour manuscriptand track its progress through the system.
Instructions for authors, a submission checklist, and an author agreement form are available online at
http://ong.editorialmanager.com. rev 7/2013

VOL. 124, NO. 2, PART 1, AUGUST 2014 Raisanen et al Placenta Previa and Small-for-Gestational-Age Newborn 291