When To Deliver When Mom's Blood Pressure Is High

Routine delivery increased the risk of neonatal RDS in women with pre eclampsia

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) High blood pressure-related disorders are among the most common pregnancy complications in the United States. Preterm delivery is often necessary to keep the mother safe and healthy.

A recent study found that among pregnant women with hypertensive (high blood pressure-related) pregnancy disorders, immediate preterm delivery late in the pregnancy increased the risk of breathing issues for the baby, but did not affect the mother's health.

The researchers recommended postponing delivery until the baby's lungs are fully developed — or until the mother or baby are at risk of severe illness — to decrease the chance of harm to the mother and baby.

"Discuss the safest delivery option with your OB/GYN."

The lead author of this study was Kim Broekhuijsen, MD, from the Department of Obstetrics and Gynecology of the University Medical Center Groningen at the University of Groningen in Groningen, Netherlands.

"Treating an elevated blood pressure in pregnancy is a common endeavor," said Andre Hall, MD, an OBGYN at Birth and Women's Care, PA in Fayetteville, NC.

"It must be determined whether the blood pressure is an issue even when the woman is not pregnant (chronic hypertension), is a problem only in pregnancy (gestational hypertension), or is a pathological elevation of blood pressure in pregnancy that involves other organs such as the kidneys ( preeclampsia)," said Dr. Hall, who was not involved in this study.

"Decisions on when to deliver are based on the results of the above determination as well as the gestational age and health of the baby. Mom's health is also considered when making this determination," he said.

The study included 704 pregnant women with gestational hypertension (high blood pressure while pregnant) or preeclampsia (high blood pressure plus proteins in urine while pregnant) between 34 to 37 weeks of pregnancy.

The participants were selected from 51 Dutch hospitals and followed from June 2009 to March 2013.

The researchers randomly assigned 353 participants to planned delivery and 351 participants to expectant monitoring.

Expectant monitoring postponed delivery until the baby was no longer at risk for breathing difficulties associated with preterm birth, or until the mother or baby were in danger of severe illness and could not wait any longer. Planned deliveries were immediate, routine deliveries.

The findings showed that 1 percent of the women in the planned delivery group experienced maternal complications, compared to 3 percent of the women in the expectant monitoring group. 

However, the risk of any maternal complications was statistically insignificant in both delivery groups.

The findings revealed that 5.7 percent of the babies in the planned delivery group experienced breathing difficulties dues to prematurity and were diagnosed with neonatal respiratory distress syndrome, compared to 1.7 percent in the expectant monitoring group.

Neonatal respiratory distress syndrome (RDS) is a condition that occurs when a baby is born before the lungs are completely developed. 

“Delivery, with the risk of breathing difficulties or other problems due to premature birth, should ideally only be chosen if it prevents worse complications,” said Dr. Broekhuijsen.

"We now have evidence suggesting that delivery of all women with these disorders does not prevent enough complications to justify the problems it causes in newborns. But if we could predict which women will develop these types of complications, we could choose delivery for them, while safely allowing pregnancy to continue [i.e. expectant monitoring] in the large majority of women. This would prevent complications due to hypertensive disorders, without causing unnecessary premature births," said Broekhuijsen.

This study was presented on February 6 at The Pregnancy Meeting, the annual meeting of the Society for Maternal-Fetal Medicine.

Review Date: 
January 31, 2014
Last Updated:
February 6, 2014