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Am J Perinatol 2024; 41(S 01): e2010-e2016
DOI: 10.1055/a-2096-3403
Original Article

Comparison of Adverse Maternal Outcomes between Early- and Late-Onset Superimposed Preeclampsia

Authors

  • Kazuma Onishi 

    1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia

  • Elizabeth Seagraves

    2   Department of Maternal Fetal Medicine, Beaumont Maternal-Fetal Medicine, Beverly Hills, Michigan

  • Dana Baraki

    3   Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio

  • Thomas Donaldson

    4   Department of Obstetrics and Gynecology, Temple University, Philadelphia, Pennsylvania

  • Carole Barake

    5   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas

  • Alfred Abuhamad

    1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia

  • Jim C. Huang

    6   Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan

  • Tetsuya Kawakita

    1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
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Abstract

Objective Superimposed preeclampsia (SIPE), defined as preeclampsia in individuals with chronic hypertension, is one of the most common complications, accounting for 13 to 40% of pregnancies with chronic hypertension. However, there are limited data regarding maternal outcomes of early- and late-onset SIPE in individuals with chronic hypertension. We hypothesized that early-onset SIPE was associated with increased odds of adverse maternal outcomes compared with late-onset SIPE. Therefore, we aimed to compare adverse maternal outcomes between individuals with early-onset SIPE and those with late-onset SIPE.

Study Design This was a retrospective cohort study of pregnant individuals with SIPE who delivered at 22 weeks' gestation or greater at an academic institution. Early-onset SIPE was defined as the onset of SIPE before 34 weeks' gestation. Late-onset SIPE was defined as the onset of SIPE at or after 34 weeks' gestation. Our primary outcome was a composite of eclampsia, hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome, maternal death, placental abruption, pulmonary edema, SIPE with severe features, and thromboembolic disease. Maternal outcomes were compared between early- and late-onset SIPE. We used simple and multivariate logistic regression models to calculate crude and adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).

Results Of 311 individuals, 157 (50.5%) had early-onset SIPE, 154 (49.5%) had late-onset SIPE. There were significant differences in the proportions of obstetric complications, including the primary outcome, HELLP syndrome, SIPE with severe features, fetal growth restriction (FGR), and cesarean delivery between early- and late-onset SIPE. Compared with individuals with late-onset SIPE, those with early-onset SIPE had increased odds of the primary outcome (aOR: 3.28; 95% CI: 1.42–7.59), SIPE with severe features (aOR: 2.72; 95% CI: 1.25–5.90), FGR (aOR: 6.07; 95% CI: 3.25–11.36), and cesarean delivery (aOR 3.42; 95% CI: 2.03–5.75).

Conclusion Individuals with early-onset SIPE had higher odds of adverse maternal outcomes compared with those with late-onset SIPE.

Key Points

  • We revealed the incidence of maternal outcomes in early- and late-onset SIPE.

  • Severe features were common in individuals with SIPE.

  • Early-onset SIPE was associated with increased adverse maternal outcomes compared with late-onset SIPE.

Keywords

chronic hypertension - eclampsia - fetus growth restriction - HELLP - placental abruption - pulmonary edema - preeclampsia with severe features - thromboembolism

Note

This study was presented as a poster presentation at the Society for Maternal-Fetal Medicine 43rd Annual Pregnancy Meeting (February 6–11, 2023).




Publikationsverlauf

Eingereicht: 24. Februar 2023

Angenommen: 18. Mai 2023

Accepted Manuscript online:
19. Mai 2023

Artikel online veröffentlicht:
19. Juni 2023

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