Highlights
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Aim
Hypertension during pregnancy is one of the main causes of maternal and perinatal mortality and morbidity.
Between 34 +0 and 36 +6 weeks of gestation, it is unclear whether planned delivery could reduce maternal complications without serious neonatal consequences.
In this individual participant data meta-analysis (IPD-MA), we aim to compare planned delivery with expectant management, focusing specifically on women with preeclampsia.
Data sources
An electronic database was searched using a prespecified search strategy, including trials published between January 1, 2000 and December 18, 2021. Data at the individual participant level were searched for all eligible trials.
Criteria
Women with singleton or multifetal pregnancies with preeclampsia from 34 weeks of gestation were included.
Methodology
The primary maternal outcome was a composite of maternal mortality or morbidity. The primary perinatal outcome was a composite of perinatal mortality or morbidity. All available data for each prespecified outcome were analyzed by intention to treat. For the primary analyzes of IPD, we used a one-stage fixed effects model.
Results
1790 participants from six trials were included in our analysis.
Planned delivery starting at 34 weeks’ gestation significantly reduced the risk of maternal morbidity (2.6% vs 4.4%; aRR 0.59, 95% CI 0.36-0.98), in comparison with expectant management.
The primary composite perinatal outcome increased with planned delivery (20.9% vs 17.1%; aRR 1.22, 95% CI 1.01-1.47), driven by short-term neonatal respiratory morbidity . However, infants in the expectant management group were more likely to be born small for gestational age (7.8% versus 10.6%, RR 0.74, 95% CI 0.55 to 0.99).
Conclusions
Planned early delivery in women with late preterm preeclampsia provides a clear maternal benefit and may reduce the risk of being born small for the baby’s gestational age, with a possible increase in short-term neonatal respiratory morbidity.
The potential benefits and risks of prolonging a pregnancy complicated by preeclampsia should be discussed with women as part of a shared decision-making process.
What are the key findings?
• Planned delivery starting at 34 weeks in women with preeclampsia significantly reduces maternal morbidity (aRR 0.59, 95% CI 0.36 to 0.98) and babies born small for gestational age (RR 0.74, 95% CI: 0.55 to 0.99), but increases neonatal respiratory morbidity at term in the short term (aRR 1.22, 95% CI: 1.01 to 1.47).
• The risk of short-term neonatal respiratory morbidity was lower in more recent trials where prenatal steroid use was higher.
C. What does this study add to what is already known?
• This is the first IPD meta-analysis that evaluates planned delivery in women with preeclampsia at late preterm gestations.
• We have quantified the effect of planned delivery from 34 weeks onwards on infant outcomes more precisely, demonstrating a reduction in the risk of infants being born small for gestational age but an increase in short-term neonatal respiratory morbidity term.
• There is a lack of evidence to guide clinical practice in this area. Our analysis provides more precise information on the risks and benefits of planned delivery for preeclampsia without severe features starting at 34 weeks.
