Adverse Neonatal Outcomes Among Women With Hypertensive Disorders of Pregnancy [28C

Abstract

INTRODUCTION: The American College of Obstetricians and Gynecologists (the College) provided new guidance for diagnosis and management of hypertensive disorders of pregnancy. The impact of these changes is unclear; so we sought to compare adverse neonatal outcomes among women with hypertensive disorders of pregnancy. METHODS: Retrospective cohort study of singleton deliveries occurring greater than or equal to 23 weeks gestational age from September 2015 to March 2016 in a single institution. Subjects were screened for hypertension in pregnancy utilizing hospital discharge codes, and diagnoses confirmed by individual chart review. Subjects were placed into 4 groups by College criteria: chronic hypertension (CHTN), gestational hypertension (GHTN), preeclampsia (PE) without severe features (SF), and PE with SF. RESULTS: In our cohort of 1,399 consecutive deliveries, 193 women (13.8%) with hypertensive disease met inclusion criteria; CHTN (3.1%), GHTN (3.2%), PE without SF (3.6%) and PE with SF (4.1%). Women with CHTN had higher BMI and were less often nulliparous compared to those with GHTN or PE (BMI p < 0.001; nulliparous p=0.001). Subjects with CHTN delivered earlier than those with GHTN or PE without SF (p=0.003). Rates of adverse neonatal outcomes were increased with CHTN compared to GHTN (preterm birth p=0.040; NICU admission p=0.021; RDS p=0.026), but adverse outcomes were similar between CHTN and PE without SF. CONCLUSION: We find that women with CHTN have rates of adverse neonatal outcomes similar to women with PE without SF, but higher than GHTN. Our findings reinforce the College’s recommendation to maintain vigilance in pregnancies complicated by CHTN.