Planned delivery or expectant management in preeclampsia: an individual participant data meta-analysis

Alice Beardmore-Gray* (Corresponding Author), Paul T. Seed, Jessica Fleminger, Eva Zwertbroek, Thomas Bernardes, Ben W. Mol, Cheryl Battersby, Corine Koopmans, Kim Broekhuijsen, Kim Boers, Michelle Y. Owens, Jim Thornton, Marcus Green, Andrew H. Shennan, Henk Groen, Lucy C. Chappell

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

10 Citations (Scopus)
1 Downloads (Pure)

Abstract

Objective: Pregnancy hypertension is a leading cause of maternal and perinatal mortality and morbidity. Between 34+0 and 36+6 weeks gestation, it is uncertain whether planned delivery could reduce maternal complications without serious neonatal consequences. In this individual participant data meta-analysis, we aimed to compare planned delivery to expectant management, focusing specifically on women with preeclampsia. Data Sources: We performed an electronic database search using a prespecified search strategy, including trials published between January 1, 2000 and December 18, 2021. We sought individual participant-level data from all eligible trials. Study Eligibility Criteria: We included women with singleton or multifetal pregnancies with preeclampsia from 34 weeks gestation onward. Methods: The primary maternal outcome was a composite of maternal mortality or morbidity. The primary perinatal outcome was a composite of perinatal mortality or morbidity. We analyzed all the available data for each prespecified outcome on an intention-to-treat basis. For primary individual patient data analyses, we used a 1-stage fixed effects model. Results: We included 1790 participants from 6 trials in our analysis. Planned delivery from 34 weeks gestation onward significantly reduced the risk of maternal morbidity (2.6% vs 4.4%; adjusted risk ratio, 0.59; 95% confidence interval, 0.36–0.98) compared with expectant management. The primary composite perinatal outcome was increased by planned delivery (20.9% vs 17.1%; adjusted risk ratio, 1.22; 95% confidence interval, 1.01–1.47), driven by short-term neonatal respiratory morbidity. However, infants in the expectant management group were more likely to be born small for gestational age (7.8% vs 10.6%; risk ratio, 0.74; 95% confidence interval, 0.55–0.99). Conclusion: Planned early delivery in women with late preterm preeclampsia provides clear maternal benefits and may reduce the risk of the infant being born small for gestational age, with a possible increase in short-term neonatal respiratory morbidity. The potential benefits and risks of prolonging a pregnancy complicated by preeclampsia should be discussed with women as part of a shared decision-making process.

Original languageEnglish
Pages (from-to)218-230.e8
Number of pages21
JournalAmerican Journal of Obstetrics and Gynecology
Volume227
Issue number2
Early online date20 Jul 2022
DOIs
Publication statusPublished - 1 Aug 2022

Bibliographical note

Funding Information:
The authors received no funding for this study. P.T.S. is partly funded by Tommy’s (registered charity number 1060508) and by Applied Research Collaboration South London (National Institute of Health and Care Research).

Funding Information:
B.W.M. is supported by a National Health and Medical Research Council Investigator grant (GNT1176437). B.W.M. reports consultancy for ObsEva. B.M.W. has received research funding from Ferring and Merck. The other authors declare no conflict of interest. The authors received no funding for this study. P.T.S. is partly funded by Tommy's (registered charity number 1060508) and by Applied Research Collaboration South London (National Institute of Health and Care Research).

Keywords

  • expectant management
  • fetal growth restriction
  • infant outcomes
  • neonatal outcomes
  • obstetrics
  • planned delivery
  • preeclampsia
  • pregnancy hypertension
  • preterm birth
  • respiratory distress syndrome

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