Effect of pregnancy prolongation in early-onset pre-eclampsia on postpartum maternal cardiovascular, renal and metabolic function in primiparous women: an observational study.

Autor: Mulder EG; Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands., Ghossein-Doha C; Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands., Crutsen J; Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands., Van Kuijk S; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands., Thilaganathan B; St George's University of London, Molecular and Clinical Sciences Research Institute, St George's University Hospitals NHS Foundation Trust, London, UK., Spaanderman M; Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands.
Jazyk: angličtina
Zdroj: BJOG : an international journal of obstetrics and gynaecology [BJOG] 2021 Jan; Vol. 128 (1), pp. 121-129. Date of Electronic Publication: 2020 Aug 13.
DOI: 10.1111/1471-0528.16435
Abstrakt: Objective: To evaluate the association between deferred delivery in early-onset pre-eclampsia and offspring outcome and maternal cardiovascular, renal and metabolic function in the postpartum period.
Design: Observational study.
Setting: Tertiary referral hospital.
Population: Nulliparous women diagnosed with pre-eclampsia before 34 weeks' gestation who participated in a routine postpartum cardiovascular risk assessment programme. Women with hypertension, diabetes mellitus or renal disease prior to pregnancy were excluded.
Methods: Regression analyses were performed to assess the association between pregnancy prolongation and outcome measures.
Main Outcome Measures: Offspring outcome and prevalence of deviant maternal cardiovascular, renal and metabolic function.
Results: The study population included 564 women with a median pregnancy prolongation of 10 days (interquartile range [IQR] 4-18) who were assessed at on average 8 months (IQR 6-12) postpartum. Pregnancy prolongation after diagnosis resulted in a decrease in infant mortality (adjusted odd ratio [aOR] 0.907, 95% CI 0.852-0.965 per day prolongation). This improvement in offspring outcome was associated with an elevated risk of moderately increased albuminuria (aOR 1.025, 95% CI 1.006-1.045 per day prolongation), but not with aberrant cardiac geometry, cardiac systolic or diastolic dysfunction, persistent hypertension or metabolic syndrome.
Conclusion: Pregnancy prolongation in early-onset pre-eclampsia is associated with improved offspring outcome and survival. These effects do not appear to be deleterious to short-term maternal cardiovascular and metabolic function but are associated with a modest increase in risk of residual albuminuria.
Tweetable Abstract: Pregnancy prolongation in pre-eclampsia has only a limited effect on postpartum maternal cardiovascular function.
(© 2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.)
Databáze: MEDLINE
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