(609) Prediction of progression to preeclampsia with severe features in parturients with hypertensive disease of pregnancy

A retrospective analysis of prospective data in a single university-affiliated medical center between 2018-2020. All women admitted due to suspected preeclampsia (PE), gestational hypertension (GH) or superimposed PE were included. Maternal demographics and obstetric characteristics including blood pressure and lab workup at first and follow-up admissions were compared between women that eventually progressed to sPE and women without sPE. Following univariate analysis, ROC statistics and logistic regression analysis were used to evaluate each variable prediction performance and control for confounders.

Results:

Of 425 women presenting with hypertensive disease, 64 had sPE features at presentation thus excluded from analysis. Among other 361 women, 18 (5%) progressed to sPE. Women that progressed to sPE delivered smaller babies at lower gestational age with higher rates of cesarean delivery (p < 0.001 for all). Chronic hypertension, maternal diabetes, a hypertensive disorder in previous pregnancy, gestational diabetes, number of hospitalizations, lower gestational age at 1^st presentation and superimposed PE as the preliminary diagnosis were all associated with PE progression to severe features. Previous delivery within 2-5 years was the only protective variable from PE progression. Following regression analysis and adjustment to confounders, early gestational age at 1^st presentation remained the only significant variable associated with PE progression (Exp(B) 0.73, 95% CI 0.55-0.96, p=0.023) with ROC-AUC prediction performance 0.88, 95% CI 0.81-0.96, p< 0.001.

Conclusion:

For parturients with hypertensive disease during pregnancy, gestational age at the 1^st presentation is an independent predictor for future progression to PE with severe features.