Severe preeclampsia strongly tied to foetal growth reduction

  • Mateus J & al.
  • Am J Obstet Gynecol
  • 18 Jun 2019

  • International Clinical Digest
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Takeaway

  • Severe preeclampsia shows a “significant and consistent” effect on foetal growth, associated with reductions compared with foetal growth with normotensive pregnancy or mild preeclampsia.

Why this matters

  • Prospective longitudinal studies of foetal growth in association with hypertensive disorders of pregnancy are lacking. 

Key results

  • Foetal weights were reduced at 22-38 weeks with severe preeclampsia vs normotensive pregnancies (P values all <.008>
  • Foetal abdominal circumference was smaller from 23-31 and 33-37 weeks of gestation (weekly pairwise P values <.04 e.g. mm smaller at weeks>
  • Growth trajectories tracked lower with severe preeclampsia.
  • Differences were not seen with other hypertensive disorders of pregnancy.
  • Preeclampsia also linked to earlier delivery, at mean gestational age of 35.9±3.2 weeks (P<.0001>
  • It was also linked to lower birthweights vs normotensive pregnancies: mean −949.5 g (95% CI, −1117.7 to −781.2 g; P<.0001>

Study design

  • Prospective, longitudinal study, 2462 women (93.3% normotensive, 1.3% severe preeclampsia) at 12 US sites, 2009-2013.
  • Gestational age confirmed by ultrasounds.
  • Severe preeclampsia included eclampsia and HELLP syndrome.
  • Funding: NIH. 

Limitations

  • Predated implementation of 2013 criteria for preeclampsia diagnosis, but authors do not think using the newer system would significantly change their findings.
  • Small sample sizes for hypertensive disorders of pregnancy groups.