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Observational Study
. 2023 Apr;130(5):524-530.
doi: 10.1111/1471-0528.17370. Epub 2023 Jan 23.

Preterm and term pre-eclampsia: Relative burdens of maternal and perinatal complications

Peter von Dadelszen  1 , Argyro Syngelaki  1   2 , Ranjit Akolekar  3   4 , Laura A Magee  1 , Kypros H Nicolaides  2
Affiliations
Observational Study

Preterm and term pre-eclampsia: Relative burdens of maternal and perinatal complications

Peter von Dadelszen et al. BJOG. 2023 Apr.

Abstract

Objective: To determine the relative burdens of maternal and perinatal complications for preterm and term pre-eclampsia.

Design: Prospective observational cohort study.

Setting: Two English maternity units.

Population: Unselected women with singleton pregnancies who developed pre-eclampsia (International Society for the Study of Hypertension in Pregnancy definition).

Methods: Outcomes were ascertained by health record review and compared between pregnancies with preterm (versus term) pre-eclampsia.

Main outcome measures: Severe maternal hypertension, maternal mortality or major maternal morbidity, perinatal mortality or major neonatal morbidity, neonatal unit (NNU) admission ≥48 hours, and birthweight <3rd percentile.

Results: Among 40 241 singleton pregnancies, 298 (0.7%, 95% confidence interval [CI] 0.66-0.83) and 1194 (3.0%, 95% CI 2.8-3.1) developed preterm and term pre-eclampsia, respectively. Women with preterm (versus term) pre-eclampsia more commonly experienced adverse maternal or perinatal events: severe hypertension 18.5% (95% CI 14.5-23.3) versus 13.6% (95% CI 11.7-15.6); maternal mortality/major morbidity 7.4% (95% CI 4.9-10.9) versus 2.2% (95% CI 1.5-3.2); perinatal mortality/major neonatal morbidity 29.5% (95% CI 24.6-34.9) versus 2.2% (95% CI 1.5-3.2); and birthweight <3rd percentile 54.4% (95% CI 48.7-59.9) versus 14.2% (95% CI 12.4-16.3). However, in absolute terms, most maternal complications occurred in women with term pre-eclampsia, as did a large proportion of perinatal complications: severe hypertension 74.7% (95% CI 68.5-80.0); maternal mortality/major morbidity 54.2% (95% CI 40.3-67.4); perinatal mortality/major neonatal morbidity 22.8% (95% CI 16.1-31.3); NNU admission ≥48 hours 38.1% (95% CI 32.4-44.1); and birthweight <3rd percentile 51.2% (95% CI 45.8-56.5).

Conclusions: Although adverse event risks are greater with preterm (versus term) pre-eclampsia, term disease is associated with at least equivalent total numbers of maternal, and a significant proportion of perinatal, adverse events. Increased efforts should be made to decrease the incidence of term pre-eclampsia.

Keywords: adverse maternal outcomes; adverse perinatal outcomes; pre-eclampsia; preterm; term.

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References

REFERENCES

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