Eva F Zwertbroek1, Julia Zwertbroek2, Kim Broekhuijsen3, Maureen T M Franssen2, Wessel Ganzevoort4, Josje Langenveld5, Ben W J Mol6, Marielle van Pampus7, Sicco Scherjon2, Anneloes L van Baar8, Henk Groen9. 1. Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands. Electronic address: e.f.zwertbroek@umcg.nl. 2. Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands. 3. Obstetrics and Gynaecology, Haaglanden Medical Center, The Hague, The Netherlands. 4. Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, The Netherlands. 5. Obstetrics and Gynaecology, Zuyderland Medical Center Heerlen, Heerlen, The Netherlands. 6. Obstetrics and Gynaecology, Monash University, Melbourne, Australia. 7. Obstetrics and Gynaecology, OLVG, Amsterdam, The Netherlands. 8. Child and Adolescent Studies, Utrecht University Utrecht, The Netherlands. 9. Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands.
Abstract
OBJECTIVE: To compare effects of immediate delivery vs expectant monitoring on neurodevelopmental and behavioral outcomes at 5 years of age in offspring of women with mild late preterm hypertensive disorders. STUDY DESIGN: We studied children born during the HYPITAT-II trial, in which 704 women with a hypertensive disorder between 34 and 37 weeks of gestation were randomized to immediate delivery or expectant monitoring. Participating women were asked to complete the Ages and Stages Questionnaire (ASQ) for developmental outcome and the Child Behavior Checklist (CBCL) for behavioral problems when their child was 5 years old. Outcomes were dichotomized and analyzed by logistic regression analysis. We also assessed factors influencing development and behavior at both 2 and 5 years after a hypertensive pregnancy. RESULTS: Five years after the original study 322(46%) women were contacted for follow-up, of whom 148 (46%) responded. In the delivery group 22%(n = 14/65) of the children had an abnormal ASQ score compared to 21% (n = 13/62) in the expectant monitoring group (p = 0.9). Abnormal CBCL-scores were found in 19% (n = 14/72) of the children in the delivery group versus in 27% (n = 20/75) in the expectant monitoring group (p = 0.3). The main predictor of development and behavior at 2 and 5 years was fetal growth restriction (for abnormal development OR 2.1, CI 1.0-4.4; for behavior problems OR 2.2, CI 1.1-5.5). Higher maternal education decreased abnormal behavior outcomes (OR 0.5, CI 0.2-0.9) and a similar tendency was observed for developmental problems (OR 0.6, CI 0.3 - 1.1). CONCLUSION: We did not find different developmental and behavior outcomes at 5 years of age between a management policy of immediate delivery and expectant management in preterm hypertensive disorders. The increased risk of developmental delay at 2 years of age after immediate delivery, we found in the 2 year follow up study, did not persist at 5 years of age.
RCT Entities:
OBJECTIVE: To compare effects of immediate delivery vs expectant monitoring on neurodevelopmental and behavioral outcomes at 5 years of age in offspring of women with mild late preterm hypertensive disorders. STUDY DESIGN: We studied children born during the HYPITAT-II trial, in which 704 women with a hypertensive disorder between 34 and 37 weeks of gestation were randomized to immediate delivery or expectant monitoring. Participating women were asked to complete the Ages and Stages Questionnaire (ASQ) for developmental outcome and the Child Behavior Checklist (CBCL) for behavioral problems when their child was 5 years old. Outcomes were dichotomized and analyzed by logistic regression analysis. We also assessed factors influencing development and behavior at both 2 and 5 years after a hypertensive pregnancy. RESULTS: Five years after the original study 322(46%) women were contacted for follow-up, of whom 148 (46%) responded. In the delivery group 22%(n = 14/65) of the children had an abnormal ASQ score compared to 21% (n = 13/62) in the expectant monitoring group (p = 0.9). Abnormal CBCL-scores were found in 19% (n = 14/72) of the children in the delivery group versus in 27% (n = 20/75) in the expectant monitoring group (p = 0.3). The main predictor of development and behavior at 2 and 5 years was fetal growth restriction (for abnormal development OR 2.1, CI 1.0-4.4; for behavior problems OR 2.2, CI 1.1-5.5). Higher maternal education decreased abnormal behavior outcomes (OR 0.5, CI 0.2-0.9) and a similar tendency was observed for developmental problems (OR 0.6, CI 0.3 - 1.1). CONCLUSION: We did not find different developmental and behavior outcomes at 5 years of age between a management policy of immediate delivery and expectant management in preterm hypertensive disorders. The increased risk of developmental delay at 2 years of age after immediate delivery, we found in the 2 year follow up study, did not persist at 5 years of age.
Authors: Liona C Poon; Laura A Magee; Stefan Verlohren; Andrew Shennan; Peter von Dadelszen; Eyal Sheiner; Eran Hadar; Gerard Visser; Fabricio Da Silva Costa; Anil Kapur; Fionnuala McAuliffe; Amala Nazareth; Muna Tahlak; Anne B Kihara; Hema Divakar; H David McIntyre; Vincenzo Berghella; Huixia Yang; Roberto Romero; Kypros H Nicolaides; Nir Melamed; Moshe Hod Journal: Int J Gynaecol Obstet Date: 2021-07 Impact factor: 4.447
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