title: Expectant management of mild preeclampsia versus superimposed preeclampsia up to 37 weeks.
abstract: OBJECTIVE
  We sought to compare maternal and neonatal outcomes of expectantly managed pregnancies complicated by chronic hypertension with superimposed preeclampsia vs mild preeclampsia up to 37 weeks of gestation.
  
  
  METHODS
  This was a multicenter retrospective cohort study of all pregnancies complicated by chronic hypertension with superimposed preeclampsia or mild preeclampsia expectantly managed in the hospital from January 2008 through December 2011. The primary outcomes, adverse maternal and neonatal composite morbidities, were compared between these 2 groups. Frequency differences of maternal adverse outcomes were stratified by gestational age at delivery of <34 and 34-36(6/7) weeks of gestation.
  
  
  RESULTS
  We found no significant differences in rates of neonatal composite morbidity or latency periods between women with superimposed preeclampsia and mild preeclampsia. Adverse neonatal outcomes were significantly higher at <34 compared to 34-36(6/7) weeks of gestation (97-98% vs 48-50%) in both cohorts. Maternal adverse composite outcome occurred more frequently in women with superimposed preeclampsia compared to mild preeclampsia (15% vs 5%; P = .003; relative risk, 3.0; 95% confidence interval, 1.45-6.29).
  
  
  CONCLUSIONS
  Women with superimposed preeclampsia have similar neonatal outcomes but more maternal complications than women with preeclampsia without severe features who are expectantly managed <37 weeks.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati School of Medicine, Cincinnati, OH. Electronic address: miyoshay@ucmail.uc.edu.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Valent
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati School of Medicine, Cincinnati, OH; Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Emily A
authors.initials: EA
authors.lastname: DeFranco
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Alabama Children's and Women's Hospital, Mobile, AL.
authors.forename: Allessa
authors.initials: A
authors.lastname: Allison
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Salem
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH.
authors.forename: Lori
authors.initials: L
authors.lastname: Klarquist
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN.
authors.forename: Kyle
authors.initials: K
authors.lastname: Gonzales
authors.affiliation: Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH.
authors.forename: Mounira
authors.initials: M
authors.lastname: Habli
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN.
authors.forename: C David
authors.initials: CD
authors.lastname: Adair
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Alabama Children's and Women's Hospital, Mobile, AL.
authors.forename: Casey
authors.initials: C
authors.lastname: Armistead
authors.affiliation: Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, LA.
authors.forename: Yuping
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Alabama Children's and Women's Hospital, Mobile, AL.
authors.forename: David
authors.initials: D
authors.lastname: Lewis
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health, University of Texas, Houston, TX.
authors.forename: Baha
authors.initials: B
authors.lastname: Sibai
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007231:Infant, Newborn; D011225:Pre-Eclampsia / Q000628:therapy*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy*; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D012189:Retrospective Studies; D012720:Severity of Illness Index; D057832:Watchful Waiting
keywords: expectant management; hypertension; preeclampsia