Pregnancy Prolongation in Women with Early-Onset Preeclampsia: What is the Impact on Postpartum Fetal and Maternal Outcomes?
BACKGROUND AND PURPOSE:
Mulder et al. (BJOG, 2020) examined the associations between deferred delivery in early-onset preeclampsia, fetal consequences, and maternal cardiovascular outcomes
Observational study (1996 to 2018)
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
The association between pregnancy prolongation and outcome measures were analyzed using regression analysis to account for confounding
Prevalence of decreased maternal cardiovascular, renal, and metabolic function
Median (IQR) pregnancy prolongation: 10 (6 to 12) days
HELLP syndrome: 72%
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)
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
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