Optimal Timing of Delivery for Pregnant Individuals With Mild Chronic Hypertension.

To investigate the optimal gestational age to deliver pregnant people with chronic hypertension to improve perinatal outcomes. We conducted a planned secondary analysis of a randomized controlled trial of chronic hypertension treatment to different blood pressure goals. Participants with term, singleton gestations were included. Those with fetal anomalies and those with a diagnosis of preeclampsia before 37 weeks of gestation were excluded. The primary maternal composite outcome included death, serious morbidity (heart failure, stroke, encephalopathy, myocardial infarction, pulmonary edema, intensive care unit admission, intubation, renal failure), preeclampsia with severe features, hemorrhage requiring blood transfusion, or abruption. The primary neonatal outcome included fetal or neonatal death, respiratory support beyond oxygen mask, Apgar score less than 3 at 5 minutes, neonatal seizures, or suspected sepsis. Secondary outcomes included intrapartum cesarean birth, length of stay, neonatal intensive care unit admission, respiratory distress syndrome (RDS), transient tachypnea of the newborn, and hypoglycemia. Those with a planned delivery were compared with those expectantly managed at each gestational week. Adjusted odds ratios (aORs) with 95% CIs are reported. We included 1,417 participants with mild chronic hypertension; 305 (21.5%) with a new diagnosis in pregnancy and 1,112 (78.5%) with known preexisting hypertension. Groups differed by body mass index (BMI) and preexisting diabetes. In adjusted models, there was no association between planned delivery and the primary maternal or neonatal composite outcome in any gestational age week compared with expectant management. Planned delivery at 37 weeks of gestation was associated with RDS (7.9% vs 3.0%, aOR 2.70, 95% CI, 1.40-5.22), and planned delivery at 37 and 38 weeks was associated with neonatal hypoglycemia (19.4% vs 10.7%, aOR 1.97, 95% CI, 1.27-3.08 in week 37; 14.4% vs 7.7%, aOR 1.82, 95% CI, 1.06-3.10 in week 38). Planned delivery in the early-term period compared with expectant management was not associated with a reduction in adverse maternal outcomes. However, it was associated with increased odds of some neonatal complications. Delivery timing for individuals with mild chronic hypertension should weigh maternal and neonatal outcomes in each gestational week but may be optimized by delivery at 39 weeks.

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Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

Financial Disclosure: Torri D. Metz reports personal fees from Pfizer for her role as a medical consultant for a SARS-CoV-2 vaccination in pregnancy study, grants from Pfizer for role as a site PI for SARS-CoV-2 vaccination in pregnancy study, and grants from Pfizer for role as a site PI for RSV vaccination in pregnancy study outside the submitted work. Sherri Longo reports that UAB received NIH funding for the CHAP trial and Ochsner was one of the sites participating in the trial. Ochsner received a subaward from UAB for participation in the trial. Ochsner is a subsite to UAB, who is in the MFMU network; therefore, they have participated in trials. They have participated in other studies with UAB, including the CSOAP trial. They have collaborated on studies with Tulane and have subawards. Kelly Gibson reports money was paid to her institution from NHLBI, NICHD, and Materna Medical. Lauren Plante reports receiving payment from Cambridge University Press and Taylor & Francis for textbook royalties. She also received an honorarium speaking fee from Monmouth Medical Center. Sean Esplin received payment from Laborie and Nemo Health. Heather Frey and Wendy Kinzler received payment from UpToDate. Todd Rosen's institution received payment from Materna, Inc. and Myriad, Inc. Mary Norton received payment from Luna Genetics. Daniel Skupski received payment from Organon and Cooper Surgical. Leonardo Pereira's institution received payment for a Johnson & Johnson clinical trial. He received payment from Prehevbrio for serving on the data safety monitoring board for hepatitis vaccine in pregnancy. Namasivayam Ambalavanan received payment from Oak Hill Bio and for serving on the advisory board and holding intellectual property with AlveolusBio and Resbiotic. Alan T. N. Tita's institution received payment from Pfizer. Everett Magann received payment from UpToDate for co-authorship of the Ultrasound Assessment of Amniotic Fluid Volume chapter. Lorraine Dugoff reports that money was paid to her institution from Myriad and Natera. Brenna L. Hughes reports receiving funding from UpToDate and Moderna. Eugene Chang reports money was paid to his institution from Roche Diagnostics and Roche. The other authors did not report any potential conflicts of interest.