Key result
Among small for gestational age neonates, maternal hypertension was associated with higher neonatal survival compared to normotensive mothers (93.0% vs 91.2%; adjusted OR 1.9, 95% CI 1.2-3.0).
Why the study?
Does maternal hypertension improve perinatal outcomes in small for gestational age infants?
Cohort (n=3,244)
Yes
Does maternal hypertension improve perinatal outcomes in small for gestational age infants?
Odds Ratio: 1.9 (95% CI 1.2–3)
Absolute Event Rate: 93% vs 91.2%
Among small for gestational age neonates in the NICU, maternal hypertension is paradoxically associated with improved admission physiology and survival.
Maternal hypertension was associated with higher SGA neonatal survival but should not change practice; leaves open confounding versus protective mechanisms.
OBJECTIVE: To determine whether maternal hypertension might improve perinatal outcome among small for gestational age (SGA) infants (< 10th percentile). METHODS: Our prospective cohort comprised 17 Canadian neonatal intensive care units (NICUs) and 3,244 SGA singletons. Multivariable regression was used to analyze the relation between maternal hypertension and each of the following: SNAP-II (Score of Neonatal Acute Physiology; ordinal regression) and neonatal survival and survival without severe intraventricular hemorrhage (logistic regression), adjusting for potential confounders. RESULTS: There were 698 (21.5%) neonates born to hypertensive mothers. Inversely associated with lower SNAP-II scores (healthier infant) were antenatal steroids (complete course: odds ratio [OR] 0.67, 95% confidence interval [CI] 0.54-0.83; incomplete: OR 0.71, 95% CI 0.56-0.88), lower gestational age (< 27 weeks: OR 0.06, 95% CI 0.05-0.08; 27-28 weeks: OR 0.11, 95% CI 0.07-0.17; 29-32 weeks: OR 0.28, 95% CI 0.23-0.35), 5-minute Apgar < 7 (OR 0.30, 95% CI 0.25-0.36), male gender (OR 0.80, 95% CI 0.70-0.92), and anomalies (OR 0.49, 95% CI 0.41-0.58). Maternal hypertension was associated with lower SNAP-II (healthier infant) (7.54 +/- 11.16 [hypertensive] versus 7.21 +/- 11.85 [normotensive]) on multivariable regression analysis (adjusted OR 1.25, 95% CI 1.05-1.49), as well as higher neonatal survival (93.0% versus 91.2%, and adjusted OR 1.9, 95% CI 1.2-3.0), but not survival without severe intraventricular hemorrhage (91.4% versus 87.0%, and adjusted OR 1.4, 95% CI 1.0-2.0), respectively. CONCLUSION: Among SGA neonates in NICU, maternal hypertension is associated with improved admission neonatal physiology and survival.
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Dadelszen et al. (2005) conducted a cohort in Small for gestational age (SGA) infants (n=3,244). Maternal hypertension vs. Normotensive mothers was evaluated on Neonatal survival (OR 1.9, 95% CI 1.2-3.0). Among small for gestational age neonates, maternal hypertension was associated with higher neonatal survival compared to normotensive mothers (93.0% vs 91.2%; adjusted OR 1.9, 95% CI 1.2-3.0).
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