Prediction of neonatal outcomes using gestational age vs ACOG definitions of maternal disease severity in hypertensive disorders of pregnancy

Isabella Hauptman; Kevin S Gill; Tiffany Lim; Wendy J Mack; Melissa L Wilson

doi:10.1007/s00404-024-07684-y

Prediction of neonatal outcomes using gestational age vs ACOG definitions of maternal disease severity in hypertensive disorders of pregnancy

Arch Gynecol Obstet. 2024 Aug 16. doi: 10.1007/s00404-024-07684-y. Online ahead of print.

Authors

Isabella Hauptman¹, Kevin S Gill¹, Tiffany Lim¹, Wendy J Mack¹, Melissa L Wilson²

Affiliations

¹ Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, USA.
² Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, USA. melisslw@usc.edu.

PMID: 39152282
DOI: 10.1007/s00404-024-07684-y

Abstract

Purpose: Hypertensive disorders of pregnancy cause significant neonatal complications. Disease severity is often used to predict neonatal outcomes, however gestational age (GA) at delivery may be a better predictor. We aimed to assess whether disease severity or GA was more predictive of adverse neonatal outcomes.

Methods: We included 165 participants with confirmed HELLP syndrome or severe preeclampsia (sPE). Two predictive models were constructed to assess the ability of disease severity compared to GA to predict a composite adverse neonatal outcome. The composite outcome included low birth weight, SGA, IUGR, Apgar score, and neonatal death.

Results: Using severity as a predictor of binary neonatal outcome had an AUC of 0.73 (0.65-0.81), with a sensitivity (SE) of 70.3% and a specificity (SP) of 64.4%. For GA, we observed an AUC of 0.82 (0.75-0.89), with a SE of 75.7% and a SP of 76.7%.

Conclusion: For the composite neonatal outcome, GA was a better predictor than ACOG diagnosis (severity). This observation underscores the need for further research to validate these findings in larger cohorts and to determine their applicability to maternal outcomes.

Keywords: Area under the curve; Case-only study; Hypertensive disorders of pregnancy.