In women with late preterm mild hypertensive disorders, does immediate delivery versus expectant management differ in terms of neonatal neurodevelopmental outcomes?
Yes. For women with late preterm (34–37 weeks) mild hypertensive disorders in pregnancy, immediate delivery resulted in poorer neurodevelopmental outcomes in offspring at 2 years when compared with expectant management. In this follow-up study of 342 women enrolled in the HYPITAT-II trial, expectant management until clinical deterioration or term is reached maximized childhood outcomes at age 2.
This work has several limitations, however. Randomization was not truly maintained given the less than 50% response rate of original participants. Additionally, parents completed the surveys and provider confirmation of developmental concerns or diagnoses was not obtained. Further, assessments at 2 years of age may be too early to detect subtle differences, with evaluations at 5 years more predictive of long-term outcomes; the authors stated that these data already are being collected.
Finally, while these data importantly reinforce the conclusions of the parent HYPITAT-II trial, which support expectant management for mild hypertensive disorders in the late preterm period,1 clinicians must always take care to individualize decisions in the face of worsening maternal disease.
This follow-up study of the HYPITAT-II randomized, controlled trial demonstrates poorer neurodevelopmental outcomes in offspring of late preterm mild hypertensives who undergo immediate delivery. These data support current practice recommendations to expectantly manage women with late preterm mild hypertensive disease until 37 weeks or signs of clinical worsening, whichever comes first.
