Abstract
Background: Preeclampsia (PE) is a hypertensive disorder specific to pregnancy, which sometimes causes severe maternal-neonatal complications. The International Society for the Study of Hypertension in Pregnancy revised their criteria for PE in 2018; a PE diagnosis can be established in the absence of proteinuria when other specific symptoms exist, such as other organ dysfunction or uteroplacental dysfunction. Therefore, the initial findings of PE (IFsPE) at the first diagnosis can vary considerably across patients. However, there are no reports on patients with PE based on different IFsPE and their impact on patients’ clinical outcomes. Thus, we aimed to investigate the predictors of maternal and neonatal outcomes based on IFsPE according to the new criteria.Methods: This was a retrospective study involving 3729 women who delivered at our hospital between 2015 and 2019. All women were reclassified based on the new criteria. They were divided into three groups based on the IFsPE: Classification 1 (C-1), proteinuria (classical criteria); Classification 2 (C-2), damage to other maternal organs; and Classification 3 (C-3), uteroplacental dysfunction. Maternal and fetal conditions and perinatal outcomes were assessed in the three groups.Results: In total, 104 women with PE were included. Of those, 42 (40.4%), 28 (26.9%), and 34 (32.7%) were assigned to C-1, C-2, and C-3 groups, respectively. All women in C-3 showed fetal growth restriction (FGR). The number of gestational weeks at PE diagnosis and delivery was significantly lower in the C-3 group (C-1, 35.5±3.0 weeks; C-2, 35.2±3.6 weeks; C-3, 31.6±4.6 weeks, P < 0.01; and C-1, 36.8±2.8 weeks; C-2, 36.3±3.2 weeks; C-3, 33.4±4.4 weeks, P < 0.01, respectively). The rates of preterm delivery at < 34 weeks (odds ratio [OR]=4.58 [1.74-12.10] and OR=2.83 [1.01-7.97]), cesarean delivery (OR=4.35 [1.41-13.45] and OR=5.03 [1.51-16.78]), Apgar scores < 7 at 1 min (OR=6.58 [2.08-20.80] and OR=4.09 [1.26-13.29]), neonatal intensive care unit admission (OR=12.19 [3.62-41.08], OR=7.50 [2.09-26.96]), and composite neonatal complications (OR=6.58 [2.08-20.80] and OR=5.33 [1.52-18.70]) were significantly higher in the C-3 group than in the C-1 and C-2 groups.Conclusions: PE patients with FGR had the most unfavorable prognosis for both maternal and neonatal outcomes.
Impact of maternal obesity on neonatal outcomes of pregnancies complicated by fetal growth restriction
