Abstract
The present study seeks to assess the impact of gestational hypertensive disorders on premature newborns below 34 weeks and to establish the main morbidities and mortality in the neonatal period and at 18 months. A retrospective observational study was carried out with 695 premature newborns of gestational age (GA) between 24 and 33 weeks and 6 days, born alive in the Neonatal ICU of Brasília's Mother and Child Hospital (HMIB), in the period from January 1, 2014, to July 31, 2019. In total, 308 infants were born to hypertensive mothers (G1) and 387 to normotensive mothers (G2). Twin pregnancies and diabetic patients with severe malformations were excluded. Outcomes during hospitalization and outcomes of interest were evaluated: respiratory distress syndrome (RDS), brain ultrasonography, diagnosis of bronchopulmonary dysplasia (BPD), diagnosis of necrotizing enterocolitis, retinopathy of prematurity, breastfeeding rate at discharge, survival at discharge and at 18 months of chronological age and relationship between weight and gestational age. Newborns with hypertensive mothers had significantly lower measurements of birth weight and head circumference. The G1 group had a higher risk small for gestational age (OR 2.4; CI 95% 1.6-3.6; p <0.00), as well as a greater risk of being born with a weight less than 850 g (OR 2.4; 95% CI 1.2-3.5; p <0.00). Newborns of mothers with hypertension presented more necrotizing enterocolitis (OR 2.0; CI 95% 1.1-3.7); however, resuscitation in the delivery room and the need to use surfactant did not differ between groups, nor did the length of stay on mechanical ventilation, or dependence on oxygen at 36 weeks of gestational age. Survival was better in newborns of normotensive mothers, and this was a protective factor against death (OR 0.7; 95% CI 0.5-0.9; p <0.01). In the follow-up clinic, survival at 18 months of chronological age was similar between groups, with rates of 95.3% and 92.1% among hypertensive and normotensive mothers, respectively. Exclusive breastfeeding at discharge was 73.4% in the group of hypertensive women and 77.3% in the group of normotensive mothers. There were no significant differences between groups. Among the analyzed outcomes, arterial hypertension during pregnancy can increase the risk of low weight, small babies for gestational age (SGA), deaths in the neonatal period and enterocolitis, with no differences in weight and survival at 18 months of chronological age. Arterial hypertension presents a high risk of prematurity in the neonatal period, with no difference at 18 months of age.
Highlights
Hypertensive Disorders of Pregnancy (HDP) present a serious complication that affects approximately 2.5 to 3.0 percent of women, increasing the risk of maternal and neonatal complications [1, 2]
Newborns of mothers with hypertension presented more necrotizing enterocolitis; resuscitation in the delivery room and the need to use surfactant did not differ between groups, nor did the length of stay on mechanical ventilation, or dependence on oxygen at 36 weeks of gestational age
Arterial hypertension during pregnancy can increase the risk of low weight, small babies for gestational age (SGA), deaths in the neonatal period and enterocolitis, with no differences in weight and survival at 18 months of chronological age
Summary
Hypertensive Disorders of Pregnancy (HDP) present a serious complication that affects approximately 2.5 to 3.0 percent of women, increasing the risk of maternal and neonatal complications [1, 2]. Hypertensive Disorders of Pregnancy cannot be prevented; the identification of maternal risk factors becomes an important obstetric mission [1]. The risk factors associated with the development of gestational hypertension, previous history of pre-eclampsia, primiparity, obesity, family history of pre-eclampsia, number of previous pregnancies (if any) and chronic medical conditions, such as hypertension and diabetes, maternal age greater than or equal to 40 years, obesity, diabetes mellitus, chronic kidney disease, systemic lupus erythematosus, presence of antiphospholipid, multiple pregnancies and high altitude. It is important to highlight the action of transplant of live kidneys, which can increase the risk of developing preeclampsia in the recipients by up to six-fold more than in non-transplanted women [1,2,3,4,5,6]
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