Hypertension in pregnancy and adverse outcomes among low-risk nulliparous women expectantly managed at or after 39 weeks: a secondary analysis of a randomised controlled trial

Michal Fishel Bartal, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas, USA.
Ashish Premkumar, Northwestern University, Chicago, Illinois, USA.
Madeline Murguia Rice, George Washington University Biostatistics Center, Washington, District of Columbia, USA.
Uma M. Reddy, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA.
Alan T. Tita, Departments of Obstetrics and Gynecology of University of Alabama at Birmingham, Birmingham, Alabama, USA.
Robert M. Silver, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
Yasser Y. El-Sayed, Stanford University, Stanford, California, USA.
Ronald J. Wapner, Columbia University, New York, New York, USA.
Dwight J. Rouse, Brown University, Providence, Rhode Island, USA.
George R. Saade, University of Texas Medical Branch, Galveston, Texas, USA.
John M. Thorp, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Maged M. Costantine, The Ohio State University, Columbus, Ohio, USA.
Edward K. Chien, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio, USA.
Brian M. Casey, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Sindhu K. Srinivas, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Geeta K. Swamy, Duke University, Durham, North Carolina, USA.
Hyagriv N. Simhan, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Document Type

Journal Article

Publication Date

7-1-2022

Journal

BJOG : an international journal of obstetrics and gynaecology

Volume

129

Issue

8

DOI

10.1111/1471-0528.17059

Keywords

adverse maternal outcome; adverse neonatal outcome; caesarean delivery; expectant management; hypertensive disorders of pregnancy; induction of labour; pre-eclampsia

Abstract

OBJECTIVE: To evaluate whether hypertensive disorders of pregnancy (HDP) among low-risk nulliparous women expectantly managed at or after 39 weeks of gestation are associated with adverse outcomes. DESIGN: Secondary analysis of a randomised trial. SETTING: Multicentre, USA. POPULATION: Individuals in the expectantly managed 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% CI. MAIN OUTCOME MEASURES: Composite adverse maternal outcome including placental abruption, pulmonary oedema, postpartum haemorrhage, 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 3044 women randomised to expectant management in the original trial, 2718 (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% versus 6%, aRR 1.84, 95% CI 1.33-2.54) and caesarean delivery (29% versus 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% versus 5%, aRR 1.38, 95% CI 0.92-2.07) or for 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. TWEETABLE ABSTRACT: Almost 14% of low-risk nulliparous individuals expectantly managed at 39 weeks developed hypertensive disorders of pregnancy, and were more likely to experience adverse maternal outcomes compared with those who did not develop hypertensive disorders.

Department

Epidemiology

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