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Delivery at 38-39 weeks optimal for women with gestational hypertension

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Rates of maternal morbidity among women with gestational hypertension are lowest when labor is induced at 38 weeks while neonatal morbidity/mortality rates are lowest with induction at 39 weeks, according to a report in the American Journal of Obstetrics and Gynecology online June 13

In this setting, therefore, “Induction of labor between 38 to 39 weeks balances the lowest maternal and neonatal M/M (morbidity/mortality),” conclude Dr. Meredith O. Cruz and colleagues at the University of Illinois College of Medicine in Chicago.

They explain that higher rates of adverse maternal events have been noted in women with gestational hypertension or mild preeclampsia who are managed expectantly compared to those who undergo induction of labor. On the other hand, risks of serious neonatal morbidity are increased with early induction.

To assess the optimal timing of delivery for women with gestational diabetes, the team examined data on 228,668 deliveries greater than 23 weeks collected from 31 centers between 2002 and 2008. This cohort included 3588 women who developed gestational hypertension at 36 weeks or later.

The researchers calculated week-specific rates of maternal and neonatal morbidity/mortality following induction of labor in the group with gestational hypertension. This showed that maternal morbidity (there were no deaths) was lowest at 89.9 cases per 1000 live births with induction at 38 weeks gestation. The rate of neonatal morbidity and mortality fell to a nadir of 10.5 per 1000 live births at 39 weeks.

Discussing the clinical implications, the authors suggest: “Induction of labor at 39 weeks gestation may be a reasonable option in a woman whose blood pressure is well-controlled with reassuring antenatal testing and an appropriate for gestational age fetus.”

The findings, they add, “may also provide future direction for a randomized controlled trial in women with gestational hypertension to provide confirmatory evidence.”

SOURCE:

What is the Optimal Time for Delivery in Women with Gestational Hypertension?

Am J Obstet Gynecol 2012.