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Analytical Approaches To Evaluating Hypertensive Disorders of Pregnancy

  • Rubymel J. Knupp
    Correspondence
    Corresponding Author: Dr. Rubymel Jijón Knupp, University of Alabama at Birmingham, Department of OB/GYN, 1700 6th Avenue South, Birmingham, AL, Phone: 205-934-2565; Fax: 205-975-9858.
    Affiliations
    Center for Women's Reproductive Health, University of Alabama at Birmingham; Birmingham, Alabama

    Department of Obstetrics and Gynecology, University of Alabama at Birmingham; Birmingham, Alabama
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  • Akila Subramaniam
    Affiliations
    Center for Women's Reproductive Health, University of Alabama at Birmingham; Birmingham, Alabama

    Department of Obstetrics and Gynecology, University of Alabama at Birmingham; Birmingham, Alabama
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  • Alan N.T. Tita
    Affiliations
    Center for Women's Reproductive Health, University of Alabama at Birmingham; Birmingham, Alabama

    Department of Obstetrics and Gynecology, University of Alabama at Birmingham; Birmingham, Alabama
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  • Rachel Sinkey
    Affiliations
    Center for Women's Reproductive Health, University of Alabama at Birmingham; Birmingham, Alabama

    Department of Obstetrics and Gynecology, University of Alabama at Birmingham; Birmingham, Alabama
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  • Ashley N. Battarbee
    Affiliations
    Center for Women's Reproductive Health, University of Alabama at Birmingham; Birmingham, Alabama

    Department of Obstetrics and Gynecology, University of Alabama at Birmingham; Birmingham, Alabama
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Published:November 14, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100816

      ABSTRACT

      Background

      Data from the ARRIVE trial suggested that low-risk pregnant patients randomized to expectant management at term had a higher risk of developing hypertensive disorders of pregnancy compared to pregnant patients randomized to elective induction at 39 weeks. Additionally, hypertensive disorders of pregnancy was reported to decrease with advancing gestational age when comparing outcomes by gestational age at delivery.

      Objective

      Thus, the aim of this study was to verify these contrasting findings by evaluating the relationship between hypertensive disorders of pregnancy at term and gestational age at delivery.

      Study Design

      This was a secondary analysis of a multicenter, prospective cohort study of nulliparous pregnant patients with singleton gestations (nuMoM2b). Pregnant patients who delivered ≥370 weeks gestation were included. Patients were excluded if they did not consent for data release in subsequent studies or were missing outcome data. The primary outcome was hypertensive disorders of pregnancy, defined as gestational hypertension or preeclampsia with or without severe features according to ACOG guidelines. Descriptive statistics were used to evaluate hypertensive disorders of pregnancy in two ways: Analysis 1) incidence of hypertensive disorders of pregnancy by gestational age week among all ongoing pregnancies and Analysis 2) the incidence of hypertensive disorders of pregnancy by gestational age week among deliveries at that gestational age week. It was assumed that hypertensive disorders of pregnancy were not expectantly managed at term.

      Results

      Of the 8,011 pregnant patients included in this analysis, 1,003 (12.5%) had hypertensive disorders of pregnancy: 162 (24.5%) delivered at 370-6/7, 232 (18%) delivered at 380-6/7, 310 (12.1%) delivered at 390-6/7, 207 (8.7%) delivered at 400-6/7, and 92 (8.1%) delivered at ≥410. In Analysis 1, the incidence of hypertensive disorders of pregnancy increased with advancing gestational age among all pregnancy ongoing pregnancies with a hypertensive disorder of pregnancy (2.0% at 37 and 8.1% at 41wk). In Analysis 2, the incidence of hypertensive disorders of pregnancy decreased with advancing gestational age among deliveries at that gestational age week alone (24.5% at 37 and 8.1% at 41wk).

      Conclusion

      Our results confirm the findings from ARRIVE that the risk of hypertensive disorders of pregnancy increases with advancing gestational age, but hypertensive disorders of pregnancy is more common among deliveries at earlier gestational ages. These key differences illustrate how important study design and analytic approach are in order to accurately interpret results and apply findings clinically.

      KEYWORDS

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