Late-preterm hypertensive disorders: expectant management yields better child outcomes

  • Am J Obstet Gynecol

  • von Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Expectant management of late-preterm mild preeclampsia and gestational hypertension is associated with better neonatal and 2-year child outcomes.

Why this matters

  • Data support current recommendations of the American College of Obstetricians and Gynecologists (ACOG).
  • Unless the clinical situation deteriorates, expectant management up to 37 weeks 0 days may be most appropriate for preterm hypertensive disorders in late-preterm pregnancies.

Study design

  • Cohort taken from HYPITAT-II, a randomized cohort trial of women with hypertensive disorder of pregnancy between 34 weeks 0 days and 36 weeks 6 days.
  • Outcomes of immediate delivery compared with expectant management up to 37 weeks 0 days.
  • Neonatal sequelae of iatrogenic preterm birth including neonatal respiratory distress syndrome, hypoglycemia, and hyperbilirubinemia analyzed.
  • Infants were followed until age 2 years to assess developmental and behavioral problems using Ages and Stages Questionnaire (ASQ) and the Child Behavior Checklist (n=342).
  • Funding: ZonMw.

Key results

  • Neonates born in the immediate group were less likely to be small for gestational age (11% vs 18%; P=.05) and more likely to have transient tachypnoea of the newborn (7.4% vs 2.4%; P=.03).  
  • Children from the immediate group were more likely to have abnormal ASQ scores (28% vs 18%; P=.045).

Limitations

  • Small numbers in study.