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Ultrasound/Imaging

Poster Session 2

(548) Fetal growth trajectories in women with chronic hypertension and superimposed pregnancy-associated hypertensive disorders

Tuesday, February 13, 2024

3:30 PM – 5:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Charlotte Orzolek, MD

Strong Memorial Hospital University of Rochester
Rochester, NY, United States

Coauthor(s)

VL

Victoria Ly, MD

Strong Memorial Hospital University of Rochester
Rochester, NY, United States
Tieg E. Beazer, DO

Fellow
Strong Memorial Hospital University of Rochester
Rochester, New York, United States
DL

Dongmei Li, PhD

Strong Memorial Hospital University of Rochester
Rochester, NY, United States
JG

J. Christopher Glantz, MD,MPH

Strong Memorial Hospital University of Rochester
Rochester, NY, United States

Objective: To compare longitudinal fetal growth trajectories between those who develop superimposed pregnancy-associated hypertensive disorders (PAH) versus pregnant patients with only chronic hypertension (cHTN).

Study Design: Retrospective cohort study from 2015-2021 comparing fetal growth patterns in cHTN vs cHTN with superimposed PAH (including preeclampsia and HELLP syndrome). Included patients were age ≥18 with singletons, had cHTN or superimposed PAH by 2020 ACOG guidelines and ≥3 ultrasounds with growth assessment. Pre-gestational diabetics and neonates with genetic disorders were excluded. Significant covariates were selected for linear mixed effects model with restricted maximum likelihood estimates for each group. EFW, BPD, HC, AC, and FL of absolute values and percentiles versus gestational age were plotted using locally estimated scatterplot smoothing (LOESS) curves. Mean and SD of biometric parameters were generated weekly from 17-39 weeks gestation with paired differences calculated. Maternal and neonatal outcomes were also compared.

Results: 341 patients were analyzed: 219 (64%) had cHTN and 122 (36%) classified with cHTN with superimposed PAH. 1593 ultrasounds were used to generate growth trajectories. LOESS curves of biometry percentiles and measurements were not significantly different. There was no significant difference when comparing mean measurements in grams and millimeters of EFW, BPD, HC, AC, or FL, with week-to-week paired comparisons ranging from -178 -77 g for EFW and -10 to 6 mm for AC (p >.05). No difference in FGR or SGA infants (p=0.451). Superimposed PAH group were more likely to experience acute kidney injury, postpartum hemorrhage, have a longer hospital stay, and be on more antihypertensive at delivery and discharge, but there was no difference in delivery modality.

Conclusion: No significant patterns of fetal growth were observed in patients with cHTN versus those with cHTN and superimposed PAH in this cohort. This may be due to the heterogeneity in severity and diagnostic factors in types of hypertensive disorders that contribute to variability in fetal growth trajectory.