Intensification of fetal and maternal surveillance in pregnant women with hypertensive disorders

Abstract

Objective: To examine the need to intensify fetal and maternal surveillance in pregnant women with mild pregnancy hypertension. Methods: The multi-center cohort study in 2413 healthy nulliparae analyzed differences in hypertension-related adverse events (small-for-gestational age, perinatal mortality, eclampsia, abruptio placentae and HELLP syndrome) according to maximum diastolic blood pressure and proteinuria. Results: Compared to the reference group (diastolic blood pressure 70–85 mmHg) ( n=1882) the relative risks of adverse fetal and maternal outcome in 34 proteinuric hypertensive women were 8.9 (95% CI 3.3–24.1) and 41.5 (95% CI 9.7–178.4), respectively. In 203 non-proteinuric women with a maximum diastolic blood pressure of ≥95 mmHg only the relative risk of adverse maternal outcome was increased (11.6, 95% CI 3.1–42.8), but it was not increased in 230 non-proteinuric women with a maximum diastolic of 90 mmHg. Conclusions: Intensified surveillance in women with mild pregnancy hypertension is not indicated and should be reserved for groups with increased fetal and maternal risk.