Maternal and neonatal outcome in early- and late-onset pre-eclampsia

doi:10.1053/siny.2000.0023

Seminars in Neonatology

Volume 5, Issue 3, August 2000, Pages 197-207

https://doi.org/10.1053/siny.2000.0023 Get rights and content

Abstract

Early-onset pre-eclampsia and late-onset pre-eclampsia, by virtue of their unpredictable nature and prediliction for multi-organ involvement, are associated with substantial maternal and fetal morbidity and mortality. Recent years have seen the introduction of the concepts of care in specialized units, expectant management of pre-eclampsia, conservative management of the HELLP syndrome (haemolysis, elevated liver enzymes, low platelets), usage of magnesium sulphate and improved feto-maternal surveillance. It is important to note that these factors also influence maternal and neonatal outcome

References (78)

BM Sibai et al.
A protocol for managing severe pre-eclampsia in the second trimester
Am J Obstet Gynecol
(1990)
BM Sibai et al.
Aggressive versus expectant management of severe pre-eclampsia at 28–32 weeks gestation: a randomised controlled trial
Am J Obstet Gynecol
(1994)
KS Olah et al.
Management of severe early onset pre-eclampsia: is conservative management justified?
Eur J Obstet Gynecol Reprod Biol
(1993)
BM Sibai
The HELLP syndrome (haemolysis, elevated liver enzymes and low platelets): much ado about nothing?
Am J Obstet Gynecol
(1990)
CWG Redman
Treatment of hypertension in pregnancy
Kid Internat
(1980)
J Cockburn et al.
Final report of study on hypertension during pregnancy
Lancet
(1982)
GD Waisman et al.
Magnesium plus nifedipine potentiation of hypotensive effect in pre-eclampsia?
Am J Obstet Gynecol
(1988)
R Horton
Spinning the risks and benefits of calcium antagonists
Lancet
(1995)
CWG Redman
Fetal outcome in a trial of antihypertensive treatment in pregnancy
Lancet
(1976)
HB Kleckner et al.
The association of maternal and neonatal thrombocytopenia in high risk pregnancies
Am J Obstet Gynecol
(1977)

L Weinstein

Syndrome of haemolysis, elevated liver enzymes and low platelet counts: a severe consequence of hypertension in pregnancy

Am J Obstet Gynecol

(1982)

BE Reubinoff et al.

HELLP syndrome—a syndrome of haemolysis, elevated liver enzymes and low platelet count—complicating pre-eclampsia-eclampsia

Int J Gynecol Obstet

(1991)

JN Martin et al.

The natural history of HELLP syndrome: patterns of disease progression and regression

Am J Obstet Gynecol

(1991)

M Lopez-Llera et al.

Maternal mortality rates in eclampsia

Am J Obstet Gynecol

(1976)

B Adelusi et al.

Reproductive performance after eclampsia

Int J Obstet Gynecol

(1986)

LC Chesley et al.

The remote prognosis of eclamptic women. Sixth periodical report

Am J Obstet Gynecol

(1976)

BM Sibai et al.

Severe pre-eclampsia-eclampsia in young primigravid women: subsequent pregnancy outcome and remote prognosis

Am J Obstet Gynecol

(1986)

DA Davey et al.

The classification of hypertensive disorders of pregnancy

Am J Obstet Gynecol

(1988)

B Maharaj et al.

Management of hypertension in pregnancy

Cont Med Educ

(1991)

MA Brown et al.

Randomised trial of management of hypertensive pregnancies by Korotkoff phase IV or phase V

Lancet

(1998)

DA Calhoun et al.

Treatment of hypertensive crises

N Engl J Med

(1990)

AAJ Finnerty

Hypertensive encephalopathies

Am J Med

(1972)

DOC Anumba et al.

Management of pre-eclampsia and the HELLP Syndrome

Curr Opin Obstet Gynecol

(1999)

BM Sibai et al.

Maternal and perinatal outcome of conservative management of severe pre-eclampsia in the mid-trimester

Am J Obstet Gynecol

(1985)

HJ Odendaal et al.

Fetal and neonatal outcome in patients with severe pre-eclampsia before 34 weeks

S Afr Med J

(1987)

J Moodley et al.

Expectant management of early onset of severe pre-eclampsia in Durban, South Africa

S Afr Med J

(1993)

TR Martin et al.

The management of severe toxaemia in patients at less than 36 weeks gestation

Obstet Gynecol

(1979)

HJ Odendaal et al.

Aggressive or expectant management for patients with severe pre-eclampsia between 28–34 weeks gestation: a randomised controlled trial

Obstet Gynecol

(1990)

DJ Murphy et al.

The mortality and morbidity associated with very preterm pre-eclampsia

Cont Rev Obstet Gynaecol

(1999)

F Abroug et al.

HELLP syndrome: incidence and maternal fetal outcome: a prospective study

Intens Care Med

(1992)

D Abromovici et al.

Neonatal outcome in severe pre-eclampsia at 24–36 weeks gestation: does the HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome matter?

Am J Obstet Gynecol

(1999)

MG Van Pompus et al.

Maternal and perinatal outcome after expectant management of the HELLP syndrome compared with pre-eclampsia without HELLP syndrome

Eur J Obstet Gynaecol Reprod Biol

(1998)

W Visser et al.

Temporising management of severe pre-eclampsia with and without the HELLP syndrome

Br J Obstet Gynaecol

(1995)

Lancet

(1995)

MJ Lucas et al.

A comparison of magnesium sulphate with phenytoin for the prevention of eclampsia

N Engl J Med

(1994)

PFW Chein et al.

Magnesium sulphate in the treatment of eclampsia and pre-eclampsia: an overview of the evidence from randomised trials

Br J Obstet Gynaecol

(1996)

KB Nelson et al.

Can magnesium sulphate reduce the risk of cerebral palsy in very low birth weight infants?

Paediatrics

(1995)

Collins, R, Duley, L, Any antihypertensive therapy for pregnancy, Enkin, MWKeirse, MJNCRenfrew, MJNielson, JP,...

AM Richards et al.

Maternal deaths from neurological complications of hypertensive crises in pregnancy

S Afr Med J

(1987)

Cited by (57)

Preconception dietary inflammatory index and hypertension disorders of pregnancy: The Japan environment and children's study
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We aimed to examine the impact of preconception pro-inflammatory diet on hypertensive disorders of pregnancy.
Study design: Data from the Japan Environmental Children's Study (JECS), a nation-wide birth cohort study, were used.
Main outcome measures: Information on meal patterns before pregnancy, derived through food frequency questionnaires, was used to calculate the dietary inflammatory index. Based on the dietary inflammatory index, participants were categorized into quartiles (Q1 and Q4 representing the diet with the highest anti-inflammatory and pro-inflammatory effects, respectively), and a multiple logistic regression model was used to estimate the effect of pro-inflammatory diet on hypertensive disorders of pregnancy, early-onset-hypertensive disorders of pregnancy, late-onset-hypertensive disorders of pregnancy, and hypertensive disorders of pregnancy with/without small for gestational age birth.
After applying our inclusion criteria, 93,265 participants were eligible. The mean white blood cell count during the first trimester and urine 8-hydroxy-2′-deoxyguanosine levels during pregnancy were highest in the Q4 group (both p < 0.01). Multiple regression analysis showed that pro-inflammatory diet consumption increased the risk of both early-onset-hypertensive disorders of pregnancy (adjusted odds ratio: 1.53, 95% confidence interval: 1.06–2.20) and hypertensive disorders of pregnancy without small for gestational age birth (adjusted odds ratio: 1.26, 95% confidence interval: 1.03–1.54) among multiparous women.
Consumption of diet with a high dietary inflammatory index score before pregnancy increases maternal inflammation and oxidative stress during pregnancy. Preconception lifestyle influences the risk of hypertensive disorders of pregnancy, especially among multiparous women.
Neurodevelopmental outcomes of preterm infants born to preeclamptic mothers – A case-control study
2022, European Journal of Obstetrics and Gynecology and Reproductive Biology
Preeclampsia during pregnancy is associated with an increased risk for various neonatal morbidities.
We aimed to investigate the association between prematurity due to maternal preeclampsia and developmental outcomes.
This retrospective matched case-control study included 39 preterm infants (<32 weeks gestation) born to preeclamptic mothers between 2012 and 2016, compared with 39 infants born to mothers without preeclampsia. The two groups were matched for gestational age (±1 week), gender and plurality. Neurodevelopmental outcome was assessed using the Griffith’s Mental Developmental Scales at 6, 12 and 24 months corrected age.
The groups were comparable in terms of gestational age (30.2 weeks vs 29.8, P = 0.6), exposure to antenatal glucocorticosteroids and magnesium sulfate. The two groups differed significantly in birthweight so that cases had significantly lower birthweight, 1100 (IQR 844.5-1316.5) vs. 1370 (IQR 1174-1604.5) grams. 19/39 (48.7%) cases were small for gestational age compared with only 4/39 (10.3%) controls (P < 0.01). 16/39 of cases were born less than 1000 g, compared with only 5/39 controls (41% vs 12.8%, P < 0.01).
Early complications were similar. Compared with controls, an overall trend for better neurodevelopmental performance on Griffith's score was found for cases, especially for early (6 months) non-motor performance. All severely disabled infants (Griffith's score < 55) at 24 months assessment were among controls.
Although significantly smaller and smaller for gestational age, neurodevelopmental assessment by Griffiths' Mental Development Scales was similar for cases and controls with a trend towards better performance of cases at 6 months. Further studies are needed to determine whether the trend for better performance implies a developmental advantage.
Risk for preeclampsia following exposure to PM<inf>2.5</inf> during pregnancy
2021, Environment International
Citation Excerpt :
Approximately 4.6% of pregnancies are complicated by preeclampsia worldwide (Abalos et al., 2013), resulting in both acute and chronic adverse outcomes for the offspring and pregnant woman (Magee et al., 2014). Early-onset preeclampsia, particularly, constitutes a high risk for life-threatening maternal and fetal complications (Paruk and Moodley, 2000). Many risk factors for preeclampsia were previously found (Bartsch et al., 2016; Sibai and el-Nazer et al., 1986; Watanabe et al., 2014; Cassell et al., 2004; Duckitt and Harrington, 2005; Sutton et al., 2018), but environmental factors and specifically air pollution have not been thoroughly assessed.
Previous findings concerning the risk for preeclampsia following exposure to particulate matter are inconclusive.
We used data from all singleton pregnancies of women insured by the “Clalit health services” (CHS) maintenance organization in southern Israel that resulted in delivery or perinatal mortality at Soroka Medical Center (SMC). Daily PM_2.5 concentrations were estimated by a hybrid satellite-based model at one-squared kilometer spatial resolution. We used Cox proportional hazard models coupled with distributed lag models to examine the association between the mean exposure to PM_2.5 in every gestational week and the diagnosis of preeclampsia, adjusting for maternal age, parity, year of birth, season of birth and socio-economic status. Hazard Ratios (HR) and 95% Confidence Intervals (CI) were calculated for individual gestational weeks and for cumulative exposure until the 25th gestational week.
A total of 133,197 pregnancies ended at SMC during the study period, of which 68,126 (51.1%) were Jewish and 65,071 (48.9%) were Bedouin. For pregnancies of Jewish women, exposure to PM_2.5 from the 7th until the 14st gestational week was significantly associated with preeclampsia (maximal HR = 1.06; 95%CI: 1.01 – 1.11 during the 10th gestational week per 10 μg/m³ increase in PM_2.5). Cumulative exposure to PM_2.5 during the first 25th gestational weeks was also significantly associated with preeclampsia (HR = 2.08; 95%CI: 1.10 – 3.94 per 10 μg/m³ increase in PM_2.5). We observed no association for pregnancies of Bedouin women.
Exposure to PM_2.5 between the 7th and the 14st gestational weeks was associated with preeclampsia among Jewish women but not among Bedouin women.
LOX-1 expression is reduced in placenta from pregnancies complicated by preeclampsia and in hypoxic cytotrophoblast
2021, Pregnancy Hypertension
The lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is upregulated in the maternal vasculature in preeclampsia, and contributes to oxidative stress and endothelial dysfunction. However, its function in the placenta is unclear. This paper investigated LOX-1 expression in models of placental dysfunction and preeclampsia, and whether candidate therapeutics for preeclampsia could alter its expression.
Placentas were collected from preterm pregnancies and cases of preterm preeclampsia and fetal growth restriction. Blood was collected from participants whose pregnancies were complicated by preterm fetal growth restriction and/or preeclampsia. Primary cytotrophoblast and placental explant tissue were cultured under hypoxic (1% O₂) or normoxic (8% O₂) conditions. Cytotrophoblast were exposed to 10% preeclamptic or control serum. Cytotrophoblast and preeclamptic explant tissue were treated with 100 µM esomeprazole, lansoprazole or rabeprazole.
LOX-1 expression was assessed in all samples via qPCR.
LOX-1 expression was reduced in placentas from cases of preterm preeclampsia, but not fetal growth restriction, compared to controls. LOX-1 expression was reduced in cytotrophoblast under hypoxia, but not in explant tissue. Treatment with preeclamptic serum in vitro did not alter cytotrophoblast LOX-1 expression. Circulating LOX-1 mRNA was unaltered in patients with fetal growth restriction, preeclampsia, and fetal hypoxia, compared to controls. Treatment with esomeprazole or lansoprazole in vitro increased placental LOX-1 expression.
LOX-1 expression is reduced in preeclamptic placentas and hypoxic cytotrophoblast. Esomeprazole and lansoprazole increase placental LOX-1 expression. These findings demonstrate a role for LOX-1 in the placenta, and improve our understanding of maternal adaptations in pregnancy complications.
Maternal and neonatal outcomes of preeclamptic and normotensive women who underwent cesarean section under spinal anesthesia: A systematic review and meta-analysis
2021, International Journal of Surgery Open
Citation Excerpt :
Evidence showed that preeclampsia is associated with several maternal catastrophic problems in later life which include, ischemic heart disease, type 2 diabetes mellitus hypertension, and thromboembolism events. Besides, preeclampsia caused intrauterine retardation and preterm delivery which is associated with higher rates of infant respiratory distress syndrome, sepsis, broncho-pulmonary dysplasia, and neurodevelopmental disability in childhood [2,5,12,13]. Despite a tremendous effort made by World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA), World Bank Group, the United Nations Population Division (UNPD) and other stakeholders strived to achieve the Millennium Development goals [14]; the maternal and neonatal mortality is still very high [4,15–23].
preeclampsia is very challenging for anesthetists due to the heterogeneous clinical spectrum of the disease characterized by hypertension, risk of hypotension, high risk of aspiration, and difficult airway. Therefore, the Meta-Analysis is intended to provide evidence on maternal and neonatal outcomes of preeclamptic parturient.
A comprehensive strategy was conducted in PubMed/Medline, Science Direct, and Cochrane from January 2000 to May 2020 without language restriction. The Heterogeneity among the included studies was checked with forest plot and I² test. Observational and experimental studies reporting maternal and neonatal outcomes among preeclamptic and normotensive women were included.
The Meta-Analysis revealed that pooled incidence of hypotension was reduced by thirty-eight percent in preeclamptic as compared to normotensive parturient, RR = 0.62(95% confidence interval (CI): 0.52 to 0.75).
The Meta-Analysis revealed that the incidence of hypotension was lower in preeclamptic women when compared to normotensive women. The included studies were low to a very low quality of evidence which entails further randomized controlled trials.
This systematic review and meta-analysis was registered in research Registry (UIN of reviewregistry1068).
Circulating pregnancy hormone relaxin as a first trimester biomarker for preeclampsia
2020, Pregnancy Hypertension
Citation Excerpt :
In most cases (>75%) preeclampsia symptoms have a late-onset, developing after 34 weeks of gestation (LO-PE) [8]. Early-onset preeclampsia (EO-PE) is associated with more severe placental pathology [9,10], and a higher rate of fetal growth restriction [11,12]. Both LO- and EO-PE confer an increased risk of cardiovascular disease later in life for the mother [13,14], and her offspring [15].
Preeclampsia, a multi-system hypertensive disorder, is associated with perturbations in the maternal cardiovascular system during early pregnancy. The corpus luteal hormone relaxin, a potent vasodilator, may contribute to physiological circulatory changes especially in early gestation when circulating levels are highest. This study investigated whether first trimester circulating relaxin may be a suitable biomarker for the early prediction of preeclampsia.
Relaxin was initially measured in first-trimester samples of women who developed late-onset preeclamptic (LO-PE; delivery ≥ 34 weeks; n = 33) and uncomplicated pregnancies (n = 25) in Pittsburgh, USA. Subsequently, to expand the group numbers, relaxin was measured in women who developed LO-PE (n = 95), early-onset preeclamptic (EO-PE; delivery < 34 weeks; n = 57), and uncomplicated pregnancies (n = 469) in Utrecht, the Netherlands.
In the Pittsburgh subjects, low relaxin levels (lowest centile: <p10) showed an adjusted odds ratio (OR) of 5.29 (95%CI 1.10–25.5) for LO-PE. In the Utrecht population, low relaxin levels (<p10) demonstrated adjusted ORs of 1.45 (95%CI 0.54–3.90) and 2.03 (95%CI 1.06–3.88) for EO-PE and LO-PE respectively, the latter increasing to an adjusted OR of 3.18 (95%CI 1.41–7.20) when newborn weight was < 10%. Serum relaxin concentrations slightly improved the detection rate of a previously derived prediction model for LO-PE from 42.5% to 45.1% at a fixed 10% false-positive rate.
Relaxin shows little improvement in the performance of first trimester prediction models, which does not support its clinical implementation as a biomarker. Although this study was only correlational, the results point to a possible pathophysiologic role for low relaxin levels in pregnancies that later develop LO-PE.

View all citing articles on Scopus

^f1: Correspondence to: J. Moodley, Department of Obstetrics and Gynaecology, University of Natal Medical School, Private Bag 7, Congella, 4013, South Africa. Fax: +27 031 260 4427. Email:[email protected]

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Regular ArticleMaternal and neonatal outcome in early- and late-onset pre-eclampsia

Abstract

Am J Obstet Gynecol

Am J Obstet Gynecol

Eur J Obstet Gynecol Reprod Biol

Am J Obstet Gynecol

Kid Internat

Lancet

Am J Obstet Gynecol

Lancet

Lancet

Am J Obstet Gynecol

Am J Obstet Gynecol

Int J Gynecol Obstet

Am J Obstet Gynecol

Am J Obstet Gynecol

Int J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

The classification of hypertensive disorders of pregnancy

Am J Obstet Gynecol

Management of hypertension in pregnancy

Cont Med Educ

Randomised trial of management of hypertensive pregnancies by Korotkoff phase IV or phase V

Lancet

Treatment of hypertensive crises

N Engl J Med

Hypertensive encephalopathies

Am J Med

Management of pre-eclampsia and the HELLP Syndrome

Curr Opin Obstet Gynecol

Maternal and perinatal outcome of conservative management of severe pre-eclampsia in the mid-trimester

Am J Obstet Gynecol

Fetal and neonatal outcome in patients with severe pre-eclampsia before 34 weeks

S Afr Med J

Expectant management of early onset of severe pre-eclampsia in Durban, South Africa

S Afr Med J

The management of severe toxaemia in patients at less than 36 weeks gestation

Obstet Gynecol

Aggressive or expectant management for patients with severe pre-eclampsia between 28–34 weeks gestation: a randomised controlled trial

Obstet Gynecol

The mortality and morbidity associated with very preterm pre-eclampsia

Cont Rev Obstet Gynaecol

HELLP syndrome: incidence and maternal fetal outcome: a prospective study

Intens Care Med

Neonatal outcome in severe pre-eclampsia at 24–36 weeks gestation: does the HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome matter?

Am J Obstet Gynecol

Maternal and perinatal outcome after expectant management of the HELLP syndrome compared with pre-eclampsia without HELLP syndrome

Eur J Obstet Gynaecol Reprod Biol

Temporising management of severe pre-eclampsia with and without the HELLP syndrome

Br J Obstet Gynaecol

Lancet

A comparison of magnesium sulphate with phenytoin for the prevention of eclampsia

N Engl J Med

Magnesium sulphate in the treatment of eclampsia and pre-eclampsia: an overview of the evidence from randomised trials

Br J Obstet Gynaecol

Can magnesium sulphate reduce the risk of cerebral palsy in very low birth weight infants?

Paediatrics

Maternal deaths from neurological complications of hypertensive crises in pregnancy

S Afr Med J

Regular Article
Maternal and neonatal outcome in early- and late-onset pre-eclampsia