Chronic hypertension without superimposed pre-eclampsia was associated with an increased risk of small for gestational age babies compared to the general population (10.9% vs 4.1%; OR 2.9, 95% CI 1.6-5.0).
Cohort (n=155)
No
Does chronic hypertension in pregnancy increase perinatal morbidity compared to the general obstetric population?
Chronic hypertension in pregnancy, even without superimposed pre-eclampsia, is associated with a significantly increased risk of delivering a small for gestational age baby.
Odds Ratio: 2.9 (95% CI 1.6–5)
Absolute Event Rate: 10.9% vs 4.1%
OBJECTIVE: To investigate if chronic hypertension in the absence of superimposed pre-eclampsia is associated with increased perinatal morbidity (especially small for gestational age babies and preterm deliveries) when compared to the general obstetric population. DESIGN: A retrospective cohort study. SETTING: A tertiary referral obstetric hospital. PARTICIPANTS: One hundred and fifty-five pregnant women with chronic hypertension who had a diastolic blood pressure of greater than 90 mmHg before 20 weeks or had pre-existing essential hypertension were studied. The study period was January 1 1991 to June 30 1993. MAIN OUTCOME MEASURES: Perinatal related loss rate, birthweight less than the fifth centile (small for gestational age) preterm delivery, placental abruption and development of superimposed pre-eclampsia. RESULTS: Women with chronic hypertension without superimposed pre-eclampsia had an increased rate of small for gestational age babies (10.9%) compared with the general population (4.1%) (odds ratio 2.9 -confidence interval 1.6 to 5.0). Women with chronic hypertension without superimposed pre-eclampsia did not have a significant increase in preterm delivery or perinatal loss. Severe hypertension (diastolic blood pressure > or =110) at less than 20 weeks was associated with a trend to an increased risk of small for gestational age babies (odds ratio 3.8 -confidence interval 1.0 to 13.7-), increased rate of delivery at less than 32 weeks (odds ratio 7.4 -confidence interval 1.9 to 29.5-) and increased rate of superimposed pre-eclampsia (odds ratio 5.2 -confidence interval 1.5 to 17.2-). Women with superimposed pre-eclampsia had the greatest perinatal morbidity. CONCLUSIONS: Women with chronic hypertension without pre-eclampsia have an increased risk of delivering a small for gestational age baby. Perinatal morbidity and pre-eclampsia is greatest in women with severe hypertension at less than 20 weeks. Preterm delivery is more common in women with superimposed pre-eclampsia.
McCowan et al. (Thu,) conducted a cohort in Chronic hypertension in pregnancy (n=155). Chronic hypertension without superimposed pre-eclampsia vs. General obstetric population was evaluated on Small for gestational age babies (birthweight less than the fifth centile) (OR 2.9, 95% CI 1.6 to 5.0). Chronic hypertension without superimposed pre-eclampsia was associated with an increased risk of small for gestational age babies compared to the general population (10.9% vs 4.1%; OR 2.9, 95% CI 1.6-5.0).
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