Neonatal outcome in hypertensive disorders of pregnancy
Introduction
Hypertensive disorders in pregnancy account for increased perinatal morbidity and mortality when compared with uneventful gestations. Hypertension may be pre-existent, may develop during pregnancy or both conditions may concur. The outcome of pregnancy depends on the type of disorder concerned [1], [2], [3], [4], [5], [6]. The relationship between proteinuria, maternal hypertension and perinatal complications was already emphasized three decades ago [5]. An increased rate of still-birth and low birth-weight (LBW) infants was demonstrated to occur when the two symptoms are associated. We reported similar findings in a study concerning 444 pregnancies showing that the occurrence of proteinuria in hypertensive disorders was a negative factor for neonatal outcome and it could be considered as a clinical late marker of the vascular damage [6].
The presence of proteinuria was considered the essential marker for poor pregnancy outcome and gestational and chronic hypertension were not included in most randomized trials designed to investigate preventive strategies for preeclampsia [7]. As a consequence, the frequency of adverse perinatal outcome in hypertensive disorders of pregnancy not complicated by proteinuria was less investigated in the past [8], [9].
Recently, however, it was reported that gestational hypertension occurring early in pregnancy is associated with a higher rate of low birth-weight infants and lower gestational age at delivery when compared with both late gestational hypertension and preeclampsia [10], raising the question whether other factors than proteinuria could be looked at as marker of adverse pregnancy outcome following maternal hypertension.
Moreover, looking at series from different countries reported in the literature [6], [11], [12], [13], [14], [15], [16], strong dissimilarities were observed either in the prevalence of hypertension in pregnancy or in the associated perinatal outcome according to birth weight and rate of small-for-gestational age babies, suggesting a genetic polymorphism of the disorder.
In the present study concerning a much larger series than our previous one, we selected only Italian pregnant women in order to compare the perinatal outcome after different kinds of hypertension with a control group of uncomplicated pregnancies in our institution, and also to make a comparison with series reported in the literature.
Section snippets
Methods
A series of 965 Italian women with hypertension in pregnancy admitted to the Department of Obstetrics and Gynecology of the Catholic University of Rome between 1986 and 1995 and registered on an electronic database were examined for the present study. This year interval was appropriately taken in order to have a homogeneous Italian white population sample before the beginning of the massive immigration of recent years.
The sample was divided into four groups of hypertensive women according to
Results
Table 1 shows the distribution of hypertension in the studied sample and the pregnancy outcome.
Mean GA at birth, mean BW and birth percentile as well as the rate of preterm and very preterm deliveries, were significantly lower in each group of neonates born to hypertensive mothers compared to controls, being the difference more evident in the PE and CHPE groups.
Perinatal outcome is shown in Table 2: according to prevalence of preterm delivery in the different groups, perinatal asphyxia was
Discussion
According to previous studies, pregnancies complicated by hypertension, are characterized by an increased rate of preterm delivery, LBW and VLBW infants, compared with normal pregnancies [13], [18], [19], [20]. This is true in all groups of hypertensive women independent on the presence or absence of proteinuria.
Prematurity alone does not justify the whole amount of LBW and VLBW. Maternal hypertension accounts for a reduced utero-placental perfusion and, consequently, impaired fetal growth [21]
Ethical statement
I declare that I participated in the design, execution, and analysis of the paper byand colleagues entitled:that I have seen and approved the final version and that it has neither been published nor submitted elsewhere. I also declare that I have no conflict of interest, other than any noted in the covering letter to the editor.
All authors should have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and
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