PERINATAL OUTCOME IN GROWTH-RESTRICTED FETUSES - DO HYPERTENSIVE AND NORMOTENSIVE PREGNANCIES DIFFER

Objective: To test the hypothesis that fetal growth restriction (FGR) associated with a maternal hypertensive disorder results in worse peri natal outcome than FGR in pregnancies without maternal hypertension. M ethods: All consecutive, singleton, nondiabetic, small for gestational age (SGA) deliveries (birth weight at or below the tenth percentile f or gestational age) in a 15-year computerized data base were analyzed for pregnancy outcome. Perinatal outcome was compared after stratifica tion by presence or absence of hypertensive disorders and by gestation al age at delivery. Results: Eleven thousand two hundred twenty-seven SGA pregnancies were analyzed. The morbidity and mortality profiles di ffered between hypertensive and normotensive pregnancies delivered pre term and those delivered at term. Perinatal mortality was significantl y higher in the normotensive than in the hypertensive group in preterm deliveries (30.3 versus 18.7%, odds ratio [OR] 1.9 [confidence interv al (CI) 1.3-2.9]). At term, hypertensive pregnancies demonstrated sign ificantly higher mortality than normotensive pregnancies (4.6 versus 1 .9%, OR 2.42 [95% CI 1.7-3.4]). In both preterm and term gestations, c esarean rates were significantly higher in hypertensive pregnancies th an in normotensive pregnancies. Using logistic regression analysis, hy pertension was independently associated with a 39% reduction in risk o f perinatal mortality preterm, compared with a twofold increased risk of perinatal mortality at term. Conclusion: Before term, FGR in normot ensive women resulted in significantly higher perinatal mortality than FGR in hypertensive women. In contrast, at term, FGR in pregnancies c omplicated by hypertension had poorer perinatal outcomes than FGR in n ormotensive women.