Maternal Factors and Placental Pathologies Associated with a Diagnosis of Chronic Villitis

Abstract

Objective To evaluate maternal risk factors associated with chronic villitis of unknown etiology (VUE) and to describe cooccurring placental pathologies.

Study Design A retrospective case–control study was conducted using placental pathology records from deliveries ≥ 20 weeks between 2010 and 2018. Cases were placentas with documented chronic villitis without infectious cause, hereafter called VUE. Controls were placentas without this diagnosis, matched to the cases 2:1. Maternal and neonatal demographic and clinical data were collected. Descriptive statistics are reported with Fisher's exact test or a chi-squared test, as appropriate, and multivariable conditional logistic regression was conducted.

Results Our study included 352 cases with VUE and 657 controls. A diagnosis of gestational diabetes (p = 0.03) and gestational hypertension (p = 0.06) was 1.5 times more likely to occur in those with a VUE diagnosis. A trend was also seen for chronic hypertension (odds ratio [OR] = 1.7, p = 0.07) and preeclampsia (OR = 1.5, p = 0.09) compared with controls. Placentas with VUE, specifically high-grade VUE, were more likely to be small for gestational age (p = 0.01), and to be diagnosed with other placental findings including lymphoplasmacytic or chronic deciduitis (p < 0.01), maternal (p < 0.01) and fetal vascular malperfusion (p = 0.02), and chorionitis (acute or chronic; p < 0.01).

Conclusion Gestational diabetes and hypertension were associated with a diagnosis of VUE, and overall, VUE placentas have more abnormal placental findings compared with control. Understanding VUE risk factors may facilitate prenatal care strategies and counseling to achieve the best outcomes for pregnant patients and their neonates.

Key Points

• VUE is a common inflammatory lesion of the placenta.

• Gestational diabetes and hypertension are associated with a VUE diagnosis.

• Findings of other placental pathologies increase in VUE.

Keywords

villitis of unknown etiology - gestational diabetes - gestational hypertension - placenta - pathology

Note

Some of the data included in this manuscript was presented virtually at the Society of Maternal Fetal Medicine (SMFM) Annual Meeting January 31 to February 5, 2022.

Publication History

Received: 11 April 2023

Accepted: 04 December 2023

Accepted Manuscript online:
06 December 2023

Article published online:
31 December 2023

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