Neonatal Developmental and Behavioral Outcomes of Immediate Delivery Versus Expectant Monitoring in Mild Hypertensive Disorders of Pregnancy: 2-Year Outcomes of the HYPITAT-II Trial

Eva F. Zwertbroek, Maureen T.M. Franssen, Kim Broekhuijsen, Josje Langenveld, Henk Bremer, Wessel Ganzevoort, Aren J. Van Loon, Maria G. Van Pampus, Robbert J.P. Rijnders, Marko J. Sikkema, Sicco A. Scherjon, Mallory D. Woiski, Ben W.J. Mol, Anneloes L. Van Baar, Henk Groen

Research output: Contribution to journalComment/debatepeer-review

Abstract

Hypertensive pregnancy disorders complicate up to 10% of pregnancies worldwide, resulting in significant maternal and neonatal morbidity. The only definitive treatment for hypertensive disorders is delivery. This issue was addressed in the Hypertension and Preeclampsia Intervention Trial at Near Term (HYPITAT-II). The study compared immediate delivery to expectant monitoring in women with pregestational hypertension or mild preeclampsia, with a result of 5.7% of the neonates diagnosed with respiratory distress syndrome, as compared with 1.7% in the expectant monitoring group. A follow-up study attempted to assess the developmental difference at the age of 2 between children from both the immediate delivery and expectant monitoring groups of this study.

Of 704 women from the original study, 504 were approached to participate in the follow-up, and 330 agreed. Participating parents were to fill out the “The Ages and Stages Questionnaire,” which is a screening instrument to detect developmental delay in children. The questionnaire includes 5 developmental domains: communication, gross motor, fine motor, problem solving, and personal social behavior. Each of these domains includes 6 questions that can be rated at a level of 0, 5, or 10 points reflecting respectively whether the child is not yet able, sometimes is able, or is fully able to perform the behavior described. A maximum score of 60 can be achieved on each domain, and lower scores indicate less attainment of developmental milestones.

In the immediate delivery group, 28% of the infants had an abnormal ASQ score, compared with 18% in the expectant monitoring group (P = 0.045). In all of the developmental subdomains, a trend toward a higher percentage of abnormal outcomes was observed in the immediate delivery groups.

Overall, in this follow-up study of 342 children (49%) born from mothers included in the HYPITAT-II study, infants at 2 years of age had more often an abnormal ASQ score when in the immediate delivery group as compared with children in the expectant monitoring group. This finding remained consistent after an adjustment for birthweight and maternal education level, indicating that management policy remained a significant predictor of neurodevelopmental outcome of the child. The children in both management groups of the study, born preterm due to hypertensive disease, have an increased rate of abnormal neurodevelopmental scores. This finding is consistent with previous studies reporting hypertensive disorders and impaired development later in life. As reassessment of the HYPITAT-II study indicated that children born preterm had more often abnormal ASQ scores than children born at term, timing of delivery is significant and should be taken into consideration when contemplating whether to expectantly monitor or immediately deliver a child whose mother has a hypertensive pregnancy disorder. The study also found that birthweight was an independent predictor of abnormal neurodevelopment. All of these findings indicate that clinicians should consider that low birthweight, growth restriction, and early induction of labor can all have long-term negative effects on the development of a child.

The study concluded that despite relatively small gestational age differences between groups, neurodevelopmental problems at 2 years of age occur more often after immediate delivery compared with expectant monitoring in preterm hypertensive disorders of pregnancy, corrected for birth weight and maternal educational level. These findings did not include any indication of behavioral problems associated with immediate delivery. In conclusion, expectant monitoring remains the most appropriate management strategy for preterm hypertensive disorders.
Original languageEnglish
Pages (from-to)13-15
Number of pages3
JournalObstetrical and Gynecological Survey
Volume75
Issue number1
DOIs
Publication statusPublished - 31 Jan 2020

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