The vast majority of pregnancies with fetal growth restriction (FGR) are in normotensive women. We aimed to determine whether hypertensive disorders of pregnancy (HDP) result in worse perinatal outcomes in pregnancies complicated by FGR.
This is a retrospective cohort study of non-anomalous, singleton, growth restricted fetuses - defined as estimated fetal weight (EFW) < 10th% - delivered in a single tertiary referral center from 01/2011 to 12/2016. Institutional Review Board approval was obtained. HDP included chronic hypertension, gestational hypertension, and all forms of preeclampsia. Perinatal outcomes examined include: cesarean delivery, neonatal intensive care unit (NICU) admission, and composite adverse neonatal outcomes (5 min Apgar < 7, respiratory distress syndrome, necrotizing enterocolitis, hypoglycemia, intraventricular hemorrhage grade 3, periventricular leukomalacia, and neonatal death). Multivariable logistic regression was used to calculate adjusted odds ratios (aORs) for each outcome between the groups.
594 pregnancies with FGR met inclusion criteria of which 137 (23.1%) were complicated by HDP. The rates of cesarean delivery, NICU admission, and the composite adverse neonatal outcomes were: 40.9%, 34.3% and 24.8%, respectively. HDP was independently associated with increased risk of NICU admission (aOR 2.37, 95% Confidence Interval 1.51-3.72) even after adjusting for gestational age at delivery. In contrast, HDP was not associated with increased risk of cesarean delivery or composite adverse neonatal outcomes.
Women with HDP and FGR are at a significantly increased risk of NICU admission. This information can be useful for counseling patients and helpful in anticipating the need for additional neonatal support at the time of delivery.