Key result
Having ≥2 maternal comorbidities was not associated with duration of expectant management but was associated with higher odds of composite maternal morbidity (aOR 3.0; 95% CI 1.1-8.2).
Why the study?
It was unclear how the number of maternal medical comorbidities associates with the duration of expectant management and perinatal outcomes in patients with preeclampsia with severe features.
Does the number of maternal comorbidities affect the duration of expectant management in patients with severe preeclampsia?
Cohort (n=337)
No
Does the number of maternal comorbidities affect the duration of expectant management in patients with severe preeclampsia?
The number of maternal comorbidities in severe preeclampsia does not impact the duration of expectant management, but having multiple comorbidities increases the risk of adverse maternal outcomes.
Answers are grounded in this paper and cite their sources.
Comorbidity count was not linked to expectant management duration in severe preeclampsia; hypothesis-generating and should not yet change practice.
Objective This study aimed to estimate the association between number of maternal comorbidities and duration of expectant management and perinatal outcomes in patients with preeclampsia with severe features. Study Design Retrospective cohort of patients with preeclampsia with severe features delivering live, nonanomalous singletons at 23 to 342/7 weeks' gestation at a single center from 2016 to 2018. Patients delivered for an indication other than severe preeclampsia were excluded. Patients were categorized based on the number (0, 1, or ≥2) of comorbidities present: chronic hypertension, pregestational diabetes, chronic kidney disease, and systemic lupus erythematosus. The primary outcome was proportion of potential expectant management time achieved, that is, days of expectant management achieved divided by total potential expectant management time (days from severe preeclampsia diagnosis to 340/7 weeks). Secondary outcomes included delivery gestational age, days of expectant management, and perinatal outcomes. Outcomes were compared in bivariable and multivariable analyses. Results Of 337 patients included, 167 (50%) had 0, 151 (45%) had 1, and 19 (5%) had ≥2 comorbidities. Groups differed with respect to age, body mass index, race/ethnicity, insurance, and parity. The median proportion of potential expectant management achieved in this cohort was 1.8% (interquartile range: 0–15.4), and did not differ by number of comorbidities (adjusted β: 5.3 [95% confidence interval [CI]: −2.1 to 12.9] for 1 comorbidity vs. 0 and adjusted β: −2.9 [95% CI: −18.0 to 12.2] for ≥2 comorbidities vs. 0). There was no difference in delivery gestational age or duration of expectant management in days. Patients with ≥2 (vs. 0) comorbidities had higher odds of composite maternal morbidity (adjusted odds ratio: 3.0 [95% CI: 1.1–8.2]). There was no association between number of comorbidities and composite neonatal morbidity. Conclusion Among patients with preeclampsia with severe features, the number of comorbidities was not associated with duration of expectant management; however, patients with ≥2 comorbidities had higher odds of adverse maternal outcomes.
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Cozzi et al. (2023) conducted a cohort in preeclampsia with severe features (n=337). Maternal comorbidities (≥2 or 1) vs. 0 comorbidities was evaluated on proportion of potential expectant management time achieved (adjusted β: -2.9, 95% CI -18.0 to 12.2). Having ≥2 maternal comorbidities was not associated with duration of expectant management but was associated with higher odds of composite maternal morbidity (aOR 3.0; 95% CI 1.1-8.2).
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