Preeclampsia may be prevented with scheduled induction, cesarean delivery
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- More than half of at-term preeclampsia cases may be prevented with timed birth.
- Planned labor induction or cesarean deliveries are rarely considered as an intervention for at-term preeclampsia.
Risk-stratified timed birth at term, either via labor induction or cesarean delivery, may more than halve the risk for at-term preeclampsia, a leading cause of maternal and perinatal mortality and morbidity, researchers reported.
Most preeclampsia occurs at term, defined as 37 to 42 weeks’ gestation, and is also when most maternal and a substantial proportion of associated perinatal short-term adverse outcomes occur along with increased CV risk long term for pregnant people and infants,
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Laura A. Magee, MD, FRCPC, MSc, FACP, FRCOG, professor of women’s health at King’s College London, and colleagues wrote in Hypertension. They wrote that at-term preeclampsia is “an outcome worthy of avoidance, rather than one to which we should only react when it develops.”
“The approach that we outline in our study represents personalized medicine in maternity care, tailoring care to risk,” Magee told Healio. “This means that those most likely to benefit from intervention are offered timed birth, by labor induction or elective Cesarean, as they wish. Importantly, those least likely to benefit from intervention are observed and await spontaneous onset of labor, unless problems arise.”
In a secondary analysis, Magee and colleagues analyzed data from a prospective nonintervention cohort study of singleton pregnancies without major anomalies at two U.K. maternity hospitals during routine visits with health records at 11 to 13 weeks’ gestation (57,131 pregnancies screened; 1,138 term preeclampsia cases; 73% white) and health records at 35 to 36 weeks’ gestation (29,035 pregnancies screened; 619 at-term preeclampsia cases; 80% white). Researchers determined patient-specific preeclampsia risks using two methods: the U.K. National Institute for Health and Care Excellence (NICE) guidance, and the Fetal Medicine Foundation competing-risks model. For each screening strategy, researchers evaluated the timing of birth for at-term preeclampsia prevention at gestational time points that were fixed (37, 38, 39, 40 weeks) or timing dependent on preeclampsia risk by the competing-risks model at 35 to 36 weeks. The primary outcomes were the proportion of at-term preeclampsia prevented and number needed to deliver to prevent one at-term preeclampsia case.
Pregnancy outcomes were similar in the two screening cohorts. On average, delivery was at 40 weeks, with about two-thirds after spontaneous onset of labor. Cesarean delivery was the mode of birth for 25% of women.
Preterm preeclampsia occurred more often after 11-to-13-week screening (0.8%) than after 35-to-36-week screening (0.1%); however, at-term preeclampsia occurred with similar frequency in both groups (2% and 2.1%, respectively).
Researchers found that the proportion of at-term preeclampsia prevented was the highest, and number needed to deliver lowest, for preeclampsia screening at 35 to 36 weeks rather than screening at 11 to 13 weeks.
For delivery at 37 weeks, fewer cases of preeclampsia were prevented using the NICE model (28.8%) than the competing-risks model (59.8%), whereas the number needed to deliver was higher, at 16.4 vs. 6.9, respectively.
The risk-stratified approach (at 35 to 36 weeks) had similar preeclampsia prevention (by 57.2%) and number needed to deliver (8.4); however, fewer women would be induced at 37 weeks (1.2% vs. 8.8%), according to the researchers.
The researchers noted that risk-stratified timing of birth at term is likely to more than halve the risk for at-term preeclampsia, with fewer than 10 inductions required per case avoided. However, a randomized trial is needed to evaluate the effectiveness and perinatal safety of this intervention.
“Using a personalized risk of preeclampsia to guide timed birth at term gestational age may more than halve the risk of preeclampsia at term,” Magee told Healio. “This is when the vast majority of preeclampsia cases occur. This is also when most preeclampsia-related complications occur for mothers and when a large proportion of preeclampsia-related complications occur for infants.” For more information:
Laura A. Magee, MD, FRCPC, MSc, FACP, FRCOG, can be reached at laura.a.magee@kcl.ac.uk; Twitter: @lauraamagee1.
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