BACKGROUND AND PURPOSE:

• HYPITAT-II trial (Hypertension and Preeclampsia Intervention Trial at near Term) studied whether immediate delivery or expectant management was preferable in women with mild late preterm hypertensive disorders of pregnancy (see ‘Related ObG Topics’ below)
  • There was no statistical risk reduction in adverse maternal outcomes in women who were delivered immediately (1.1%) compared to expectant management (3.1%)
  • There was a statistically significant increase in neonatal RDS in the immediate delivery group (5.7%) compared to the expectant management group (1.7%)
• Zwertbroek et al. (AJOG, 2019) studied the effects of immediate delivery vs expectant management on the neurodevelopmental and behavioral outcomes at 2 years of those offspring whose mothers were enrolled in HYPITAT-II

METHODS:

• Follow-up study of the HYPITAT-II trial, a randomized controlled trial (RCT)
  • HYPITAT-II trial: Women with hypertension between 34 and 37 weeks’ gestation were randomized to (1) immediate delivery vs (2) expectant monitoring
• Participants in current study
  • Children born to women enrolled in HYPITAT-II
• Data collection
  • Women were asked to complete the following when their toddlers were 2 years old
    • The Ages and Stages Questionnaire for developmental outcome (screening questionnaire for developmental delay)
    • The Child Behavior Checklist for behavioral problems (assesses behavioral and emotional issues)
  • Filled out between 23 and 26 months of age, corrected for prematurity

RESULTS:

• 330 women returned the questionnaires | 61% of those approached
• More children had an abnormal Ages and Stages Questionnaire score in the immediate delivery group
  • Immediate delivery group: 28% (45/162)
  • Expectant monitoring group: 18% (27/148)
  • Risk difference 9.6% (95% CI, 0.3 to 18.0%; P = .045)
  • Risk difference after correcting for maternal education: OR 0.48 (95% CI, 0.24 to 0.96; P = .03)
  • Most pronounces area of delay was that of fine motor skills
• There was no statistical difference in the Abnormal Ages and Stage Questionnaire scores when comparing children born before or after 36 weeks
  • <36 weeks: 27%
  • >36 weeks: 22%
  • Odds ratio (OR) 0.77 (95% CI, 0.44 to 1.34)
• There was no statistical difference found in the Abnormal Child Behavior Checklist
  • Immediate delivery group: 18% (31/175)
  • Expectant monitoring group: 15% (24/166)
  • Risk difference 3.2% (95% CI, –4.6% to 11.0%)

CONCLUSION:

• Management strategy directly influenced gestational age at delivery, which together affect development
• There may be an increased risk of developmental delay following early delivery, compared to expectant monitoring for women with late preterm hypertensive disorders of pregnancy
• The authors state that

This follow-up study underlines the conclusion of the original HYPITAT-II study that, until the clinical situation deteriorates, expectant monitoring remains the most appropriate management strategy in the light of short- and long-term neonatal outcomes in women with preterm hypertensive disorders 

Learn More – Primary Sources:

Neonatal developmental and behavioral outcomes of immediate delivery versus expectant monitoring in mild hypertensive disorders of pregnancy: 2-year outcomes of the HYPITAT-II trial

Related ObG Topics:

HYPITAT-II: Immediate Delivery or Expectant Management for Non-Severe Hypertension at 34 – 37 weeks?

Diagnosing Preeclampsia – Key Definitions and ACOG Guidelines

ACOG Preeclampsia Guidelines: Antenatal Management and Timing of Delivery