Pregnancy outcomes in healthy nulliparas who developed hypertension

Objective: To determine maternal and perinatal outcomes in nulliparas with pregnancy-associated hypertension or preeclampsia. Methods: We conducted land reported elsewhere) a randomized, double-masked, placebo-controlled trial calcium supplementation of 4589 healthy nullipara s assigned at 13-21 weeks' gestation. This well-defined and characterized d ata set provided an opportunity to detail more precisely adverse maternal, fetal, and newborn outcomes in women who developed hypertension among a pro spective series of healthy nulliparas. Results: Of 4302 women observed to or beyond 20 weeks' gestation, 1073 (24. 9%) developed mild or severe pregnancy-associated hypertension or preeclamp sia. One hundred sixteen women of the 1073 with hypertension (10.8%) and 33 6 of the 3229 without hypertension (10.4%) were delivered before 37 weeks' gestation. Fetal and neonatal mortality were similar in those groups; howev er, selected maternal and newborn morbidities were significantly greater in women with hypertension. Significantly increased maternal morbidities incl uded increased cesarean deliveries, abruptio placentae, and acute renal dys function; and significantly increased perinatal morbidities included respir atory distress syndrome, ventilatory support, and fetal growth restriction. Adverse outcomes were highest in women with severe pregnancy-associated hy pertension or preeclampsia. Conclusion: Hypertension, especially severe hypertension, was associated wi th an appreciable increase in important maternal and perinatal morbidity bu t not perinatal mortality. (Obstet Gynecol 2000;95:24-8. (C) 2000 by The Am erican College of Obstetricians and Gynecologists.).