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Hypertension in pregnancy and adverse outcomes among low-risk nulliparous people expectantly managed at or after 39 weeks: a secondary analysis of a randomized controlled trial. BJOG : an international journal of obstetrics and gynaecology Fishel Bartal, M., Premkumar, A., Rice, M. M., Reddy, U. M., Tita, A. T., Silver, R. M., El-Sayed, Y. Y., Wapner, R. J., Rouse, D. J., Saade, G. R., Thorp, J. M., Costantine, M. M., Chien, E. K., Casey, B. M., Srinivas, S. K., Swamy, G. K., Simhan, H. N., Eunice Kennedy Shriver National Institute of Child Health, H. D. 1800

Abstract

OBJECTIVE: To evaluate whether hypertensive disorders of pregnancy (HDP) among low-risk nulliparous people expectantly managed (EM) at or after 39 weeks of gestation are associated with adverse outcomes.DESIGN: Secondary analysis of a randomized trial.SETTING: Multicenter United States.POPULATION: Individuals in the EM group who delivered on or after 39 weeks.METHODS: Multivariable analysis to estimate adjusted relative risks (aRR) for binomial outcomes, adjusted odds ratios (aOR) for multinomial outcomes, and 95% confidence intervals (CI).MAIN OUTCOME MEASURES: Composite adverse maternal outcome including placental abruption, pulmonary edema, postpartum hemorrhage, postpartum infection, venous thromboembolism, or intensive care unit admission. Secondary outcomes included a composite of perinatal death or severe neonatal complications, mode of delivery, small and large for gestational age, and neonatal intermediate or intensive unit length of stay.RESULTS: Of the 3,044 randomized to EM in the original trial, 2,718 (89.3%) were eligible for this analysis, of whom 373 (13.7%) developed HDP. Compared with participants who remained normotensive, those who developed HDP were more likely to experience the maternal composite (12% vs. 6%, aRR 1.84, 95% CI 1.33-2.54) and cesarean delivery (29% vs. 23%, aOR 1.32, 95% CI 1.01-1.71). Differences between the two groups were not significantly different for the adverse perinatal composite (7% vs. 5%, aRR 1.38, 95% CI 0.92-2.07), or other secondary outcomes.CONCLUSION: Almost 14% of low-risk nulliparous individuals expectantly managed at 39 weeks developed HDP, and were more likely to experience adverse maternal outcomes compared with those who did not develop HDP.

View details for DOI 10.1111/1471-0528.17059

View details for PubMedID 34927787