Mild gestational hypertension remote from term: Progression and outcome

OBJECTIVE: Limited information is available regarding the progression of di sease in women with mild gestational hypertension. Our purpose was to descr ibe the prognostic signs in the natural course of mild gestational hyperten sion and pregnancy outcomes in women who were remote from term with mild ge stational hypertension that was expectantly managed. STUDY DESIGN: Women with mild gestational hypertension participating in an outpatient hypertension monitoring program were studied. Inclusion criteria were patients with a singleton pregnancy between 24 and 35 weeks' gestatio n who had no proteinuria by dipstick (0 or trace) on the first 2 days of pr ogram participation. Progression to preeclampsia was the primary outcome. T he rate of progression to severe preeclampsia, obstetric complications, and neonatal outcomes were secondary measures. Data were compared by independe nt Student t and Fisher exact tests where applicable. RESULTS: A total of 748 patients were studied during the observation period ; preeclampsia (persistent proteinuria greater than or equal to1+) develope d in 343 (46%), and 72 (9.6%) had antepartum progression to severe preeclam psia. No significant differences in maternal age, race, marital status, or tobacco use were observed between those women in whom persistent proteinuri a developed and those in whom it did not develop. Gestational age of the in fants at delivery (36.5 +/- 2.4 vs 37.4 +/- 2.0 weeks), birth weight (2752 +/- 767 vs 3038 +/- 715 g), incidence of small-for-gestational-age newborns (24.8% vs 13.8%), and duration of neonatal hospital stay (7.1 +/- 10 vs 5. 0 +/- 9.3 days) differed significantly in the patients with versus those wi thout proteinuria (P < .001 for all). CONCLUSIONS: In patients with mild gestational hypertension remote from ter m, 46% ultimately had preeclampsia, with progression to severe disease in 9 .6%. The development of proteinuria is associated with an earlier gestation al age at delivery, lower birth weight, and an increased incidence of small -for-gestational age newborns.