Leading causes of preterm delivery as risk factors for intraventricular hemorrhage in very preterm infants: results of the EPIPAGE 2 cohort study

Am J Obstet Gynecol. 2017 May;216(5):518.e1-518.e12. doi: 10.1016/j.ajog.2017.01.002. Epub 2017 Jan 16.


Background: Intraventricular hemorrhage is a major risk factor for neurodevelopmental disabilities in preterm infants. However, few studies have investigated how pregnancy complications responsible for preterm delivery are related to intraventricular hemorrhage.

Objective: We sought to investigate the association between the main causes of preterm delivery and intraventricular hemorrhage in very preterm infants born in France during 2011 between 22-31 weeks of gestation.

Study design: The study included 3495 preterm infants from the national EPIPAGE 2 cohort study who were admitted to neonatal intensive care units and had at least 1 cranial ultrasound assessment. The primary outcome was grade I-IV intraventricular hemorrhage according to the Papile classification. Multinomial logistic regression models were used to study the relationship between risk of intraventricular hemorrhage and the leading causes of preterm delivery: vascular placental diseases, isolated intrauterine growth retardation, placental abruption, preterm labor, and premature rupture of membranes, with or without associated maternal inflammatory syndrome.

Results: The overall frequency of grade IV, III, II, and I intraventricular hemorrhage was 3.8% (95% confidence interval, 3.2-4.5), 3.3% (95% confidence interval, 2.7-3.9), 12.1% (95% confidence interval, 11.0-13.3), and 17.0% (95% confidence interval, 15.7-18.4), respectively. After adjustment for gestational age, antenatal magnesium sulfate therapy, level of care in the maternity unit, antenatal corticosteroids, and chest compressions, infants born after placental abruption had a higher risk of grade IV and III intraventricular hemorrhage compared to those born under placental vascular disease conditions, with adjusted odds ratios of 4.3 (95% confidence interval, 1.1-17.0) and 4.4 (95% confidence interval, 1.1-17.6), respectively. Similarly, preterm labor with concurrent inflammatory syndrome was associated with an increased risk of grade IV intraventricular hemorrhage (adjusted odds ratio, 3.4; 95% confidence interval, 1.1-10.2]). Premature rupture of membranes did not significantly increase the risk.

Conclusion: Relationships between the causes of preterm birth and intraventricular hemorrhage were limited to specific and rare cases involving acute hypoxia-ischemia and/or inflammation. While the emergent nature of placental abruption would challenge any attempts to optimize management, the prenatal care offered during preterm labor could be improved.

Keywords: cohort study; intraventricular hemorrhage; maternal event; risk factor; very preterm infant.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abruptio Placentae / epidemiology
  • Cerebral Hemorrhage / classification
  • Cerebral Hemorrhage / epidemiology*
  • Cohort Studies
  • Female
  • France / epidemiology
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Infant, Premature, Diseases / classification
  • Infant, Premature, Diseases / epidemiology*
  • Obstetric Labor, Premature / epidemiology
  • Pregnancy
  • Pregnancy Complications / epidemiology
  • Premature Birth / epidemiology*
  • Risk Factors
  • Systemic Inflammatory Response Syndrome / epidemiology