Timing matters: Unveiling the distinct effects of early vs late onset pre-eclampsia on mothers and newborns in a tertiary hospital in Bangladesh

Background: Pre-eclampsia (PE) is a significant cause of maternal and perinatal morbidity and mortality worldwide. The clinical course and severity of PE can vary depending on the gestational age at onset. However, limited data from developing countries including Bangladesh stratify outcomes by onset timing, hindering context-specific management. This study aimed to differentiate maternal and perinatal outcomes associated with early-onset PE (EO-PE, <34 weeks) versus late-onset PE (LO-PE, ≥34 weeks) in a tertiary care setting in Bangladesh. Methods: A cross-sectional study was conducted at Faridpur Medical College Hospital, Faridpur, Bangladesh, from March to August 2023. Data were collected from hospital records and through pre-structured telephone questionnaires for 255 mothers diagnosed with PE (EO-PE: n=121; LO-PE: n=134). Maternal, fetal and neonatal outcomes were compared between the EO-PE and LO-PE groups. Results: The prevalence of PE among admitted pregnant women was 11.28%. EO-PE was associated with more adverse perinatal outcomes compared to LO-PE, including lower fetal survival (72% vs 97%), higher rates of prematurity (76% vs 13%), low birth weight (74% vs 18%), and increased need for neonatal hospital admission (54% vs 21%) (p<0.001). Maternal complications such as eclampsia (31% vs 19%, p=0.018) and placental abruption (20% vs 10%, p=0.022) were more frequent in the EO-PE group. However, cesarean section rates were higher in the LO-PE group (p<0.001). Conclusions: Early-onset PE is associated with more severe adverse maternal and perinatal outcomes compared to late-onset PE. Early screening, health education, and specialized management protocols for EO-PE group could be effective in mitigating associated complications.