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Am J Perinatol 2020; 37(04): 398-408
DOI: 10.1055/s-0039-1679916
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Maternal and Infant Adverse Outcomes Associated with Mild and Severe Preeclampsia during the First Year after Delivery in the United States

Thanh G.N. Ton
1   Precision Health Economics, Oakland, California
,
Mihoko V. Bennett
2   Division of Neonatal and Developmental Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
,
Devin Incerti
1   Precision Health Economics, Oakland, California
,
Desi Peneva
1   Precision Health Economics, Oakland, California
,
Maurice Druzin
3   Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, California
,
Warren Stevens
4   PAREXEL International, Durham, North Carolina
,
Alexander J. Butwick
5   Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
,
Henry C. Lee
2   Division of Neonatal and Developmental Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
› Author Affiliations Funding All phases of this study were supported by rEVO Biologics Inc. The sponsor was not involved in the design of the study, the review and approval of the report, and the decision to submit the report for publication. The funding agreement ensured the authors' independence in designing the study, interpreting the data, writing, and submitting the report for publication.
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Publication History

05 July 2018

21 January 2019

Publication Date:
19 February 2019 (online)

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Abstract

Objective The burden of preeclampsia severity on the health of mothers and infants during the first year after delivery is unclear, given the lack of population-based longitudinal studies in the United States.

Study design We assessed maternal and infant adverse outcomes during the first year after delivery using population-based hospital discharge information merged with vital statistics and birth certificates of 2,021,013 linked maternal–infant births in California. We calculated sampling weights using the National Center for Health Statistics data to adjust for observed differences in maternal characteristics between California and the rest of the United States. Separately, we estimated the association between preeclampsia and gestational age and examined collider bias in models of preeclampsia and maternal and infant adverse outcomes.

Results Compared with women without preeclampsia, women with mild and severe preeclampsia delivered 0.66 weeks (95% confidence interval [CI]: 0.64, 0.68) and 2.74 weeks (95% CI: 2.72, 2.77) earlier, respectively. Mild preeclampsia was associated with an increased risk of having any maternal adverse outcome (relative risk [RR] = 1.95; 95% CI: 1.93, 1.97), as was severe preeclampsia (RR = 2.80; 95% CI: 2.78, 2.82). The risk of an infant adverse outcome was increased for severe preeclampsia (RR = 2.15; 95% CI: 2.14, 2.17) but only marginally for mild preeclampsia (RR = 0.99; 95% CI: 0.98, 1). Collider bias produced an inverse association for mild preeclampsia and attenuated the association for severe preeclampsia in models for any infant adverse outcome.

Conclusion Using multiple datasets, we estimated that severe preeclampsia is associated with a higher risk of maternal and infant adverse outcomes compared with mild preeclampsia, including an earlier preterm delivery.

Keywords

maternal morbidity - perinatal morbidity - preeclampsia - severe features

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