Objective: Our purpose was to compare maternal and perinatal outcomes of teenage and adult pregnancies with mild gestational hypertension remote from term managed with an outpatient program.
Study design: A matched cohort design was used. Maternal and perinatal outcomes of 60 teenage pregnancies with mild gestational hypertension remote from term were compared with 120 adult controls 20 to 42 years old. The groups were matched for race, gestational age, and proteinuria status at enrollment. All were monitored on an outpatient basis with four times daily automated blood pressure measurement and daily assessment of weight, proteinuria, and fetal movement.
Results: The mean gestational age at enrollment was 33.5 +/- 2.6 weeks for both groups (range 27 to 36 weeks). Only 60% of teenagers had a high school degree or equivalent compared with 76% of adults (p = 0.024). The teenagers were more likely than the adults to be of single marital status (75% vs 13%, p = 0.015). The mean gestational age at delivery (37.0 +/- 2.0 vs 37.0 +/- 2.2 weeks), mean pregnancy prolongation (23.5 +/- 19.0 vs 24.5 +/- 17.4 days), and mean birth weights (2915 +/- 669 vs 2879 +/- 678 gm) were not statistically different between the teenagers and adults (all p > 0.05). There were no stillbirths, neonatal deaths, or cases of eclampsia in either group.
Conclusions: In spite of a study population characterized by limited education, single marital status, and young age at enrollment, monitored outpatient management of mild gestational hypertension remote from term in teenage pregnancies is associated with maternal and perinatal outcomes similar to those observed in adults.
PIP: A comparison of maternal and perinatal outcomes of 60 adolescent pregnancies remote from term with mild gestational hypertension and 120 adult controls matched for race, gestational age, and proteinuria status revealed similar responses to monitored outpatient management. The mean gestational age at enrollment was 33.5 +or- 2.6 weeks for both groups. Only 60% of teenagers, compared with 76% of adults, had a high school diploma or equivalent. Participants received education on the hypertensive disease process, instruction in use of an automated physiologic data recorder, and counseling on activity limitations. Antepartum hospitalization occurred in 43% of adolescents and 39% of adults; the mean number of pregnancy prolongation days were 23.5 and 24.5, respectively. 63% of adolescents and 68% of adults delivered at gestations of 37 weeks or more. Mean birth weight was 2915 grams in the former group and 2879 grams in the latter group. There were no stillbirths, neonatal deaths, or cases of eclampsia in either group. Managed care has placed an increased emphasis on the use of outpatient treatment. Although adolescents, especially those with low educational levels, tend to be regarded as poor candidates for outpatient regimens because of compliance concerns, the findings of the present study suggest that monitored outpatient management of mild gestational hypertension is feasible in this population.