title: Late preterm neonatal morbidity in hypertensive versus normotensive women.
abstract: OBJECTIVE
  We estimated risks of late preterm (LP, 34°(/7)-36(6/7) weeks) delivery and neonatal respiratory and non-respiratory morbidity in women with mild and severe hypertension, in both low-risk and high-risk (history of chronic hypertension, preeclampsia (PE), or insulin-dependent diabetes in current pregnancy) cohorts.
  
  
  METHODS
  This is a secondary analysis of two Maternal-Fetal Medicine Units Network randomized trials of aspirin to prevent PE. Women with non-anomalous singleton gestations delivered at ≥34 weeks were divided into three groups: normotensive, mild PE/gestational hypertension (GH), and severe PE/GH. Primary outcomes were respiratory (respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), or intubation) and non-respiratory (intraventricular hemorrhage, retinopathy of prematurity, small for gestational age (SGA) <10%, neonatal intensive care unit (NICU) admission, perinatal death, pulmonary hypertension, seizures, and 5 min Apgar <5) morbidity. Associations between LP delivery and risks of respiratory and non-respiratory morbidity were evaluated by fitting log-Binomial regression models before and after adjusting potential confounders.
  
  
  RESULTS
  Of 2781 women in the low-risk trial, mild and severe hypertension were diagnosed in 8.5% (n = 235) and 3.3% (n = 92), respectively. Respiratory morbidity was similar in all groups. Risks of non-respiratory morbidity were higher in the severe PE/GH group compared with normotensive women (28.3% vs. 16.8%, risk ratio 1.5, 95% confidence interval 1.1, 2.1). When restricting the analysis to late preterm infants, this risk was no longer present. Of the 1542 women in the high-risk trial, mild and severe hypertension were present in 16.6% (n = 256) and 11.9% (n = 184), respectively. Respiratory morbidity was again similar. Risks of non-respiratory morbidity were also not significantly increased in the high-risk cohort.
  
  
  CONCLUSIONS
  In both low- and high-risk women, mild PE/GH at ≥34 weeks is not associated with an increased risk of neonatal morbidity compared with normotensive women. Increased risk of composite neonatal morbidity related to severe PE/GH is confined to the subgroup of infants with non-respiratory morbidity, and disappears when including only late preterm infants.
authors.affiliation: a Department of Reproductive Medicine, Division of Perinatology , University of California , San Diego, San Diego , CA , USA.
authors.forename: Victoria M
authors.initials: VM
authors.lastname: Fratto
authors.affiliation: b Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA.|c Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , NY , USA.
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.affiliation: b Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA.|d Division of Maternal-Fetal Medicine , College of Physicians and Surgeons, Columbia University , New York , NY , USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gyamfi-Bannerman
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000503:physiopathology*; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult
keywords: Gestational hypertension; late preterm infants; preeclampsia; respiratory morbidity