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

E. G. Mulder*, C. Ghossein-Doha, J. R. W. Crutsen, S. M. J. Van Kuijk, B. Thilaganathan, M. E. A. Spaanderman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Web of Science)

Abstract

Objective To evaluate the association between deferred delivery in early-onset pre-eclampsia and offspring outcome and maternal cardiovascular, renal and metabolic function in the postpartum period. Design Observational study. Setting Tertiary referral hospital. Population Nulliparous women diagnosed with pre-eclampsia before 34 weeks' gestation who participated in a routine postpartum cardiovascular risk assessment programme. Women with hypertension, diabetes mellitus or renal disease prior to pregnancy were excluded. Methods Regression analyses were performed to assess the association between pregnancy prolongation and outcome measures. Main outcome measures Offspring outcome and prevalence of deviant maternal cardiovascular, renal and metabolic function. Results The study population included 564 women with a median pregnancy prolongation of 10 days (interquartile range [IQR] 4-18) who were assessed at on average 8 months (IQR 6-12) postpartum. Pregnancy prolongation after diagnosis resulted in a decrease in infant mortality (adjusted odd ratio [aOR] 0.907, 95% CI 0.852-0.965 per day prolongation). This improvement in offspring outcome was associated with an elevated risk of moderately increased albuminuria (aOR 1.025, 95% CI 1.006-1.045 per day prolongation), but not with aberrant cardiac geometry, cardiac systolic or diastolic dysfunction, persistent hypertension or metabolic syndrome. Conclusion Pregnancy prolongation in early-onset pre-eclampsia is associated with improved offspring outcome and survival. These effects do not appear to be deleterious to short-term maternal cardiovascular and metabolic function but are associated with a modest increase in risk of residual albuminuria. Tweetable abstract Pregnancy prolongation in pre-eclampsia has only a limited effect on postpartum maternal cardiovascular function.

Original languageEnglish
Pages (from-to)121-129
Number of pages9
JournalBjog-an International Journal of Obstetrics and Gynaecology
Volume128
Issue number1
Early online date13 Aug 2020
DOIs
Publication statusPublished - Jan 2021

Keywords

  • Albuminuria
  • DIABETES-MELLITUS
  • DISEASE
  • DISORDERS
  • EXPECTANT MANAGEMENT
  • HYPERTENSION
  • OUTCOMES
  • PREDICTORS
  • PROTEINURIA
  • RISK-FACTORS
  • WEEKS GESTATION
  • cardiovascular health
  • deferred delivery
  • early-onset pre-eclampsia
  • hypertension
  • metabolic syndrome
  • HYPERTENSIVE DISORDERS
  • PRETERM

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