Hypertension in pregnancy: maternal and fetal outcomes according to laboratory and clinical features

Abstract

OBJECTIVES: To determine the predictive value of clinical and laboratory parameters for maternal and fetal complications in pregnant women with hypertension. DESIGN: Prospective data collection. SETTING: Two primary referral hospitals in the southern suburbs of Sydney between March 1987 and July 1994. SUBJECTS: 1183 pregnant women with hypertension managed conjointly by a physician and obstetrician. INTERVENTION: Uniform management protocol, plus antihypertensive medications if systolic blood pressure was persistently > or = 160 mmHg and/or diastolic blood pressure > or = 90 mmHg. MAIN OUTCOME MEASURES: Maternal and fetal complications, as defined by the Australasian Society for the Study of Hypertension in Pregnancy Consensus Statement. RESULTS: Of 825 women with pre-eclampsia (502 mild; 323 severe), univariate analysis showed that hyperuricaemia, proteinuria and severe hypertension were significantly associated with a higher rate of maternal and fetal complications. In multivariate analyses without confounders, only primiparity, low serum albumin levels and absence of diabetes were significantly associated with severe pre-eclampsia. Severe pre-eclampsia, high haemoglobin levels and low platelet count were associated with higher rates of small-for-gestational-age babies, but only low serum albumin levels were associated with increased perinatal mortality rates. Low birthweight was associated with severe hypertension and severe pre-eclampsia. CONCLUSIONS: Simple clinical and laboratory parameters are useful predictors for maternal and fetal outcomes in pregnancies complicated by hypertension.