Predictive Score for Adverse Maternal and Fetal Outcomes in Women with Early-onset Gestational Hypertension

Background: Early-onset hypertension disorders of pregnancy (HDP) are associated with 20-fold higher maternal morbidity and mortality compared to late-onset hypertension during pregnancy due to differences in their underlying pathophysiology.Accurately predicting severe morbidity in these women is important for effective management to prevent adverse maternal and fetal outcomes.Existing scoring systems mainly focus on predicting preeclampsia and are not specifically designed for early-onset gestational hypertension.Objective: To develop a simple scoring system for predicting adverse maternal and fetal outcomes based on clinical and laboratory parameters in women with early-onset gestational hypertension.Methodology: This prospective observational cohort study was conducted in the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Hospital, Puducherry, South India, from January 2020 to March 2021.The prevalence of maternal morbidity is 34%, and the incidence of early-onset HDP is 0.3%.The type-1 error is considered as 0.05.The sample size was calculated as 102.All 102 participants were singleton pregnant women more than 18 years old, diagnosed with hypertension of any severity between 20 and 34 weeks of gestation with or without proteinuria, and were admitted for either evaluation, monitoring, or delivery, following exclusion criteria.A score was given to each parameter, such as age, parity, BMI, hypertension in a previous pregnancy, symptoms of imminent eclampsia, deranged laboratory parameters, the requirement of antihypertensive medications, fetal growth, and Doppler parameters.Adverse maternal and fetal parameters were recorded within 48 hours of delivery and monitored until the discharge of pregnant women.The predictive score's cut-off value for maternal and perinatal outcomes were evaluated using the area under the receiver operating characteristic (AUC-ROC) curve.Range of predictive score between a minimum 1 and a maximum 44.Univariate and multivariable analyses were performed to assess the association of maternal and fetal variables with maternal and fetal outcomes.Results: Adverse maternal outcomes occurred in 39 cases, with a predictive score cut-off established at 11.5.The area under the curve (AUC) was 0.824 (95% CI: 0.74-0.90),assessing a sensitivity of 89.7% and a specificity of 57.1%.Multivariable analysis revealed that blurring of vision, brisk deep tendon reflexes (DTR), SpO 2 < 95%, platelet count < 1.5 Lakh/cumm, and serum creatinine > 0.9 mg/dL were significantly associated with adverse maternal outcomes.The adverse fetal outcomes were observed in 69cases, with a predictive score cut-off of 9.5.The AUC was 0.64 (95% CI: 0.5-0.75),showing a sensitivity of 78% and specificity of 54.5%.Delivery after 34 weeks of gestational age (GA) was significantly associated with improved perinatal outcomes, implying decreased perinatal complications with advanced GA (aOR: 0.04, CI: 0.005-0.40,p-value: 0.005). Conclusion:The predictive score for adverse maternal and perinatal outcomes was 11.5 and 9.5, respectively.This predictive score is helpful for risk assessment and strategic planning for pregnancy termination.It is essential to prevent morbidity or mortality in both the pregnant mother and her fetus.The decision to prolong the GA for fetal benefits must be carefully weighed against the risk of end-organ dysfunction in the mother.