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Oral Concurrent Session 4 - Hypertension

Oral Concurrent Sessions

(45) Optimal Gestational Age for Delivery of Pregnant Individuals with Mild Chronic Hypertension

Wednesday, February 14, 2024
11:00 AM – 11:15 AM  
Location: Potomac Ballroom AB, Ballroom Level

    Primary & Presenting Author(s)

  • Torri D. Metz, MD, MSCI (she/her/hers)

    Associate Professor
    University of Utah Health
    Salt Lake City, UT, United States

    Disclosure(s): I have no relevant financial relationships to report.

Objective:

ACOG recommends delivery as early as 37w0d gestation to as late as 39w6d for chronic hypertension (CHTN). Our aim was to investigate the optimal gestational age to deliver pregnant people with CHTN to improve perinatal outcomes.

Study Design:

Secondary analysis of a randomized controlled trial of CHTN treatment to different blood pressure goals. Participants with a term, singleton gestation were included. Pregnancies with fetal anomalies and those with a diagnosis of preeclampsia (preE) or gestational HTN < 37 weeks were excluded. The primary maternal composite outcome included death, serious morbidity (heart failure, stroke, encephalopathy, MI, pulmonary edema, ICU, intubation, renal failure), preE with severe features, hemorrhage requiring blood transfusion, or abruption. The primary neonatal outcome included fetal or neonatal death, respiratory support beyond oxygen mask, Apgar < 3 at 5 minutes, neonatal seizures, proven sepsis. Secondary outcomes included cesarean birth, length of stay, NICU admission, suspected sepsis, RDS, TTN, hypoglycemia. Those with a planned delivery were compared with those expectantly managed at each gestational week. Adjusted odds ratios with 95% CIs are reported.

Results:

1,417 participants with mild CHTN were included; 305 (21.5%) with a new diagnosis in pregnancy and 1112 (78.5%) with known pre-existing HTN. Groups differed by BMI and pre-existing diabetes. In adjusted models, there was not an association between planned delivery and the maternal composite outcome in any gestational age week compared with expectant management (Table). Planned delivery in week 37 was associated with cesarean birth. Planned delivery in week 37 and 38 was associated with adverse neonatal outcomes (Table).

Conclusion:

Planned delivery in the early term period compared with expectant management was not associated with a reduction in adverse maternal outcomes and increased the odds of cesarean delivery. Early term delivery was also associated with an increase in neonatal complications. Delivery timing should weigh maternal and neonatal outcomes in each gestational week.