BACKGROUND AND PURPOSE:

• Mulder et al. (BJOG, 2020) examined the associations between deferred delivery in early-onset preeclampsia, fetal consequences, and maternal cardiovascular outcomes

METHODS:

• Observational study (1996 to 2018)
• Participants
  • Nulliparous women diagnosed with preeclampsia <34 weeks within 2 years of delivery | <24 weeks excluded
  • Women were participants in a routine postpartum cardiovascular risk assessment program
  • Excluded: Women with hypertension, diabetes mellitus or renal disease prior to pregnancy
• Study design
  • The association between pregnancy prolongation and outcome measures were analyzed using regression analysis to account for confounding
• Primary outcomes
  • Offspring outcomes
  • Prevalence of decreased maternal cardiovascular, renal, and metabolic function

RESULTS:

• 564 women
  • Median (IQR) pregnancy prolongation: 10 (6 to 12) days
  • HELLP syndrome: 72%
• Gestational age
  • GA at diagnosis was 30 weeks | GA at delivery was 32 weeks
  • GA at diagnosis was lower in the group of women with the longest pregnancy prolongation (p<0.001 for trend)
• Pregnancy prolongation after diagnosis resulted in
  • A decrease in infant mortality | Adjusted odd ratio (aOR) 0.907 (95% CI, 0.852 to 0.965) per day prolongation
  • An increase in absolute birthweight when comparing ≤6 days (1278 g) vs ≥14 days (1620 g); p<0.001 for trend
• Pregnancy prolongation was associated with an elevated risk of moderately increased maternal albuminuria (adjusted for gestational age at delivery, maternal age, year of postpartum assessment, and metabolic syndrome constituents)
  • aOR 1.025 (95% CI, 1.006 to 1.045) per day prolongation
• There was no association between pregnancy prolongation and
  • Other renal parameters (e.g., Cr clearance)
  • Cardiac geometry (relative wall thickness, LV mass index)
  • Cardiac systolic or diastolic dysfunction (e.g., ejection fraction)
  • Persistent hypertension
  • Metabolic syndrome

CONCLUSION:

• For women with early-onset preeclampsia, prolonging pregnancy decreased infant mortality and increased birthweight
• Pregnancy prolongation did not have a negative effect on short-term adverse maternal outcomes, except for an increased risk for albuminuria
• Limitations of this study include
  • Effect of specific treatment could not be ascertained
  • Detail regarding maternal condition that resulted in delivery was not available
• The authors note that after preterm preeclampsia, women show persistent cardiovascular remodeling; however, this study did not demonstrate that prolonging pregnancy has much of an impact and they further suggest that

A possible explanation could be that the known association with unfavourable structural alteration in preeclampsia may have already occurred by the time the diagnosis was made 

Learn More – Primary Sources:

Effect of pregnancy prolongation in early‐onset pre‐eclampsia on postpartum maternal cardiovascular, renal and metabolic function in primiparous women: an observational study

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