Eva F Zwertbroek1, Maureen T M Franssen2, Kim Broekhuijsen3, Josje Langenveld4, Henk Bremer5, Wessel Ganzevoort6, Aren J van Loon7, Maria G van Pampus8, Robbert J P Rijnders9, Marko J Sikkema10, Sicco A Scherjon2, Mallory D Woiski11, Ben W J Mol12, Anneloes L van Baar13, Henk Groen14. 1. Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands. Electronic address: e.f.zwertbroek@umcg.nl. 2. Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands. 3. Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands. 4. Obstetrics and Gynaecology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands. 5. Obstetrics and Gynecology, Reinier de Graaf Gasthuis, Delft, The Netherlands. 6. Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, The Netherlands. 7. Obstetrics and Gynecology, Martini Hospital, Groningen, The Netherlands. 8. Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands. 9. Obstetrics and Gynecology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. 10. Obstetrics and Gynecology, ZGT Almelo, Almelo, The Netherlands. 11. Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands. 12. Obstetrics and Gynaecology, Monash University, Melbourne, Australia. 13. Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands. 14. Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands.
Abstract
BACKGROUND: Management of preterm hypertensive disorders remains a clinical dilemma. The maternal benefits of delivery need to be weighed against the adverse neonatal consequences of preterm birth. Long-term consequences of obstetric management in offspring of women with hypertensive disorders in preterm pregnancy are largely unknown. We report child neurodevelopmental and behavioral outcomes at 2 years after the Hypertension and Preeclampsia Intervention Trial at near Term (HYPITAT-II) trial, which compared immediate delivery versus expectant monitoring in mild late preterm hypertensive disorders of pregnancy. OBJECTIVE: To compare effects of immediate delivery vs expectant monitoring on neurodevelopmental and behavioral outcomes at 2 years of age in offspring of women with mild late preterm hypertensive disorders. MATERIALS AND METHODS: We studied children born in the HYPITAT-II trial, a study in which women (n = 704) with hypertensive disorders of pregnancy who were between 34 and 37 weeks' gestation were randomized to immediate delivery or expectant monitoring. Participating women were asked to complete the Ages and Stages Questionnaire for developmental outcome and the Child Behavior Checklist for behavioral problems when their toddlers were 2 years old. RESULTS: We approached 545 of 704 randomized women (77%); 330 of 545 (61%) returned the questionnaires. In the immediate delivery group, 45 of 162 infants (28%) had an abnormal Ages and Stages Questionnaire score compared to 27 of 148 (18%) in the expectant monitoring group (risk difference, 9.6%; 95% CI, 0.3-18.0%); P = .045. In the pregnancies (n = 94) that delivered before reaching 36 weeks, 27% (n = 25) had an abnormal Ages and Stages Questionnaire score compared to 22% (n = 47) when delivered after 36 weeks (odds ratio, 0.77; confidence interval, 0.44-1.34). An abnormal Child Behavior Checklist outcome was found in 31 of 175 (18%) in the delivery group vs 24 of 166 (15%) in the expectant monitoring group (risk difference, 3.2%; 95% CI, -4.6% to 11.0%). After correction for maternal education, management strategy remained an independent predictor of abnormal Ages and Stages Questionnaire score (odds ratio, 0.48; confidence interval, 0.24 to -0.96, P = .03). In multivariable analyses, low birth weight, low maternal education, and immediate delivery policy were all significantly associated with an abnormal Ages and Stages Questionnaire score. CONCLUSION: In this study, we found that early delivery in women with late preterm hypertensive disorders is associated with poorer neurodevelopmental outcomes in their children at 2 years of age. These findings indicate an increased risk of developmental delay after early delivery compared to expectant monitoring. This follow-up study underlines the conclusion of the original HYPITAT-II study that, until the clinical situation deteriorates, expectant monitoring remains the most appropriate management strategy in the light of short- and long-term neonatal outcomes in women with preterm hypertensive disorders.
RCT Entities:
BACKGROUND: Management of preterm hypertensive disorders remains a clinical dilemma. The maternal benefits of delivery need to be weighed against the adverse neonatal consequences of preterm birth. Long-term consequences of obstetric management in offspring of women with hypertensive disorders in preterm pregnancy are largely unknown. We report child neurodevelopmental and behavioral outcomes at 2 years after the Hypertension and Preeclampsia Intervention Trial at near Term (HYPITAT-II) trial, which compared immediate delivery versus expectant monitoring in mild late preterm hypertensive disorders of pregnancy. OBJECTIVE: To compare effects of immediate delivery vs expectant monitoring on neurodevelopmental and behavioral outcomes at 2 years of age in offspring of women with mild late preterm hypertensive disorders. MATERIALS AND METHODS: We studied children born in the HYPITAT-II trial, a study in which women (n = 704) with hypertensive disorders of pregnancy who were between 34 and 37 weeks' gestation were randomized to immediate delivery or expectant monitoring. Participating women were asked to complete the Ages and Stages Questionnaire for developmental outcome and the Child Behavior Checklist for behavioral problems when their toddlers were 2 years old. RESULTS: We approached 545 of 704 randomized women (77%); 330 of 545 (61%) returned the questionnaires. In the immediate delivery group, 45 of 162 infants (28%) had an abnormal Ages and Stages Questionnaire score compared to 27 of 148 (18%) in the expectant monitoring group (risk difference, 9.6%; 95% CI, 0.3-18.0%); P = .045. In the pregnancies (n = 94) that delivered before reaching 36 weeks, 27% (n = 25) had an abnormal Ages and Stages Questionnaire score compared to 22% (n = 47) when delivered after 36 weeks (odds ratio, 0.77; confidence interval, 0.44-1.34). An abnormal Child Behavior Checklist outcome was found in 31 of 175 (18%) in the delivery group vs 24 of 166 (15%) in the expectant monitoring group (risk difference, 3.2%; 95% CI, -4.6% to 11.0%). After correction for maternal education, management strategy remained an independent predictor of abnormal Ages and Stages Questionnaire score (odds ratio, 0.48; confidence interval, 0.24 to -0.96, P = .03). In multivariable analyses, low birth weight, low maternal education, and immediate delivery policy were all significantly associated with an abnormal Ages and Stages Questionnaire score. CONCLUSION: In this study, we found that early delivery in women with late preterm hypertensive disorders is associated with poorer neurodevelopmental outcomes in their children at 2 years of age. These findings indicate an increased risk of developmental delay after early delivery compared to expectant monitoring. This follow-up study underlines the conclusion of the original HYPITAT-II study that, until the clinical situation deteriorates, expectant monitoring remains the most appropriate management strategy in the light of short- and long-term neonatal outcomes in women with preterm hypertensive disorders.
Authors: Rachael Hunter; Alice Beardmore-Gray; Melanie Greenland; Louise Linsell; Edmund Juszczak; Pollyanna Hardy; Anna Placzek; Andrew Shennan; Neil Marlow; Lucy C Chappell Journal: Pharmacoecon Open Date: 2022-07-21
Authors: Alice Beardmore-Gray; Melanie Greenland; Louise Linsell; Edmund Juszczak; Pollyanna Hardy; Anna Placzek; Rachael Hunter; Jenie Sparkes; Marcus Green; Andrew Shennan; Neil Marlow; Lucy C Chappell Journal: BJOG Date: 2022-05-12 Impact factor: 7.331
Authors: Lucy C Chappell; Peter Brocklehurst; Marcus E Green; Rachael Hunter; Pollyanna Hardy; Edmund Juszczak; Louise Linsell; Virginia Chiocchia; Melanie Greenland; Anna Placzek; John Townend; Neil Marlow; Jane Sandall; Andrew Shennan Journal: Lancet Date: 2019-08-28 Impact factor: 79.321