David A Savitz1,2,3, Valery A Danilack2, Jerson Cochancela4, Brenna L Hughes5, Dwight J Rouse2, Roee Gutmann1,2,3,4,5. 1. From the Department of Epidemiology, Brown University, Providence, RI. 2. Department of Obstetrics and Gynecology, Brown University, Providence, RI. 3. Department of Pediatrics, Brown University, Providence, RI. 4. Department of Biostatistics, Brown University School of Public Health, Providence, RI. 5. Department of Obstetrics and Gynecology, Duke University School of Medicine.
Abstract
BACKGROUND: Clinicians caring for the nearly 10% of patients in the United States with nonsevere hypertensive disorders in late pregnancy need better evidence to balance risks and benefits of clinician-initiated delivery. METHODS: We conducted a record-based cohort study of maternal and infant health outcomes among deliveries from 2002-2013 at Women & Infants Hospital of Rhode Island. Participants had gestational hypertension or nonsevere preeclampsia before 39 weeks' gestation (N=4,295). For each gestational week from 34 to 38, we compared outcomes between clinician-initiated deliveries (induction of labor or prelabor cesarean) and those not initiated in that week, using propensity score models to control confounding by indication. RESULTS: The analysis predicted an increment in risk of adverse maternal and infant outcomes sustained through week 37 if all patients underwent clinician-initiated delivery, with risk differences on the order of 0.2 for maternal outcomes and 0.3 for infant outcomes weeks 34 and 35. For women undergoing clinician-initiated delivery, the analysis identified increased risk of progression to severe disease in weeks 35 and 36, increases in all adverse infant outcomes only in week 34, increases in Neonatal Intensive Care Unit admission and infant hospital stay in weeks 35 and 36, and no meaningful increase in any of the adverse outcomes in weeks 37 or 38. CONCLUSIONS: We estimate that hypertensive pregnancies chosen for intervention were minimally harmed by early delivery after 34 weeks' gestation but predict benefit from extension to 37 weeks. Our study also showed adverse infant health consequences associated with routine delivery prior to 37 weeks.
BACKGROUND: Clinicians caring for the nearly 10% of patients in the United States with nonsevere hypertensive disorders in late pregnancy need better evidence to balance risks and benefits of clinician-initiated delivery. METHODS: We conducted a record-based cohort study of maternal and infant health outcomes among deliveries from 2002-2013 at Women & Infants Hospital of Rhode Island. Participants had gestational hypertension or nonsevere preeclampsia before 39 weeks' gestation (N=4,295). For each gestational week from 34 to 38, we compared outcomes between clinician-initiated deliveries (induction of labor or prelabor cesarean) and those not initiated in that week, using propensity score models to control confounding by indication. RESULTS: The analysis predicted an increment in risk of adverse maternal and infant outcomes sustained through week 37 if all patients underwent clinician-initiated delivery, with risk differences on the order of 0.2 for maternal outcomes and 0.3 for infant outcomes weeks 34 and 35. For women undergoing clinician-initiated delivery, the analysis identified increased risk of progression to severe disease in weeks 35 and 36, increases in all adverse infant outcomes only in week 34, increases in Neonatal Intensive Care Unit admission and infant hospital stay in weeks 35 and 36, and no meaningful increase in any of the adverse outcomes in weeks 37 or 38. CONCLUSIONS: We estimate that hypertensive pregnancies chosen for intervention were minimally harmed by early delivery after 34 weeks' gestation but predict benefit from extension to 37 weeks. Our study also showed adverse infant health consequences associated with routine delivery prior to 37 weeks.
Authors: Kim Broekhuijsen; Gert-Jan van Baaren; Maria G van Pampus; Wessel Ganzevoort; J Marko Sikkema; Mallory D Woiski; Martijn A Oudijk; Kitty W M Bloemenkamp; Hubertina C J Scheepers; Henk A Bremer; Robbert J P Rijnders; Aren J van Loon; Denise A M Perquin; Jan M J Sporken; Dimitri N M Papatsonis; Marloes E van Huizen; Corla B Vredevoogd; Jozien T J Brons; Mesrure Kaplan; Anton H van Kaam; Henk Groen; Martina M Porath; Paul P van den Berg; Ben W J Mol; Maureen T M Franssen; Josje Langenveld Journal: Lancet Date: 2015-03-25 Impact factor: 79.321
Authors: Paul A Harris; Robert Taylor; Brenda L Minor; Veida Elliott; Michelle Fernandez; Lindsay O'Neal; Laura McLeod; Giovanni Delacqua; Francesco Delacqua; Jacqueline Kirby; Stephany N Duda Journal: J Biomed Inform Date: 2019-05-09 Impact factor: 6.317
Authors: Eva F Zwertbroek; Julia Zwertbroek; Kim Broekhuijsen; Maureen T M Franssen; Wessel Ganzevoort; Josje Langenveld; Ben W J Mol; Marielle van Pampus; Sicco Scherjon; Anneloes L van Baar; Henk Groen Journal: Eur J Obstet Gynecol Reprod Biol Date: 2019-11-06 Impact factor: 2.435
Authors: Corine M Koopmans; Denise Bijlenga; Henk Groen; Sylvia Mc Vijgen; Jan G Aarnoudse; Dick J Bekedam; Paul P van den Berg; Karin de Boer; Jan M Burggraaff; Kitty Wm Bloemenkamp; Addy P Drogtrop; Arie Franx; Christianne Jm de Groot; Anjoke Jm Huisjes; Anneke Kwee; Aren J van Loon; Annemiek Lub; Dimitri Nm Papatsonis; Joris Am van der Post; Frans Jme Roumen; Hubertina Cj Scheepers; Christine Willekes; Ben Wj Mol; Maria G van Pampus Journal: Lancet Date: 2009-08-03 Impact factor: 79.321
Authors: Alan T N Tita; Mark B Landon; Catherine Y Spong; Yinglei Lai; Kenneth J Leveno; Michael W Varner; Atef H Moawad; Steve N Caritis; Paul J Meis; Ronald J Wapner; Yoram Sorokin; Menachem Miodovnik; Marshall Carpenter; Alan M Peaceman; Mary J O'Sullivan; Baha M Sibai; Oded Langer; John M Thorp; Susan M Ramin; Brian M Mercer Journal: N Engl J Med Date: 2009-01-08 Impact factor: 91.245