Fellow, PGY-5 Marshall University Joan C. Edwards School of Medicine Hurricane, West Virginia, United States
Background: Optimal time of delivery for mothers with gestational hypertension (GH) is controversial. Objective: We aimed to compare neonatal and maternal outcomes for mothers with GH that delivered at 37 weeks versus 38-40 weeks. Design/Methods: We conducted a retrospective chart review of all deliveries at 37-40 weeks between 10/1/2020 and 9/30/2022. Singleton deliveries with the diagnosis of GH were included. Exclusion criteria were chronic hypertension, elevated blood pressure before 20 weeks gestation, incomplete prenatal records, and neonatal genetic disorders. The study population was divided into two groups: Group 1 delivered at 37 weeks (n=160) and Group 2 delivered at 38-40 weeks (n=110). Primary maternal outcomes were preeclampsia, need for antihypertensive medication, post-partum readmission and development of a severe hypertension-related complication. Primary neonatal outcome was admission to the NICU. Secondary outcomes were neonatal need for respiratory support, phototherapy, exclusive breastfeeding at discharge and length of stay (LOS). Categorical variables were compared by Chi-squared or Fisher exact tests. Continuous variables were analyzed using univariable linear and quantile regression. A p-value < 0.05 was considered significant. Results: A total of 2274 pregnancies delivered between 37-40 weeks during our study period; GH was diagnosed in 402 (17.6%) of them. After exclusions, 270 mother/infant dyads qualified: 160 delivered at 37 weeks and 110 at 38-40 weeks. Between the groups there were no statistical differences in maternal demographics, LOS, or primary maternal outcomes. However, infants were admitted to the NICU at significantly higher rates when delivered at 37 weeks (14% vs 5%, p = 0.021). Neonates delivered at 37 weeks also required more respiratory support (9% vs 1%, p = 0.005), more phototherapy (14% vs 1%, p < 0.001) and had a longer LOS (6 days vs 3 days, p< 0.001). Exclusive breastfeeding at discharge was lower in those delivered at 37 weeks but not statistically significant (64% vs 70%, p = 0.530). There were no instances of maternal or neonatal death or stillbirth.
Conclusion(s): We did not find any maternal advantage to delivering at 37 weeks versus 38-40 weeks for mothers with GH. However, neonates delivered at 37 weeks had higher rates of NICU admission, need for respiratory support, phototherapy and longer LOS. Our results suggest that expectant management of mothers with GH until 38-40 weeks gestation may be a safe option.
