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Poster Session 4

Category: Hypertension

Poster Session 4

(1244) Early-Onset Severe Superimposed Preeclampsia: Diagnostic Criteria and Severe Maternal and Neonatal Morbidity

Thursday, February 12, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Sarah H. Abelman, MD (she/her/hers)

Fellow
Northwell
Bay Shore, New York, United States

Coauthor(s)

Yossi Bart, MD

MFM fellow
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Frank I. Jackson, DO (he/him/his)

Fellow
Northwell
New Hyde Park, New York, United States
Michael T. Xie, BS

Medical Student
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Bay Shore, New York, United States
Zakaria Doughan, MD

Research Assistant
Department of Obstetrics and Gynecology, McGovern Medical School at UT Health, Houston
Houston, Texas, United States
Joe Haydamous, MD (he/him/his)

PGY1
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Department of Obstetrics and Gynecology, McGovern Medical School at UT Health, Houston, Texas, United States
Ahmed Zaki Moustafa, MD, MS (he/him/his)

Assistant Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
University of Texas - Houston, Texas, United States
Baha M. Sibai, MD

Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Matthew J. Blitz, MD, MBA

Director of Clinical Research; Program Director of MFM Fellowship at SSUH
Northwell
New Hyde Park, New York, United States

Objective:
Chronic hypertension with superimposed preeclampsia is a diagnostic challenge. This study assessed whether the criteria used for diagnosis are associated with adverse maternal and neonatal outcomes.

Study Design:
This retrospective cohort study included pregnancies complicated by superimposed preeclampsia with severe features diagnosed between 23 0/7 and 33 6/7 weeks’ gestation from 2019-2024 across two health systems. Multiple gestations and fetal demises were excluded. The primary exposure was diagnostic criteria used, categorized as: 1) Severe-range blood pressure (BP) only, 2) Severe-range BP and severe lab or clinical criteria as defined by ACOG, and 3) Mild-range BP plus severe lab or clinical criteria. Maternal outcomes included composite severe maternal morbidity (SMM) and non-transfusion SMM. Neonatal outcomes included composite severe neonatal morbidity (SNM), small for gestational age (SGA), neonatal intensive care unit (NICU) stay >1 month, hypoglycemia, and 5-minute Apgar < score 7. Multivariable logistic regression was used, adjusting for age ≥35, body mass index class, nulliparity, diabetes, gestational age at delivery, and race/ethnicity. Fetal growth restriction was adjusted for in the models for neonatal outcomes (excluding SGA). Analyses were performed in R 4.3.1.

Results:
Among 431 pregnancies, diagnosis was based on only severe-range BP in 80.3%, severe-range BP plus lab/clinical criteria in 14.2%, and mild-range BP plus lab/clinical criteria in 5.6%. Composite SMM did not differ by group, but non-transfusion SMM was higher in those with severe-range BP plus lab/clinical findings (P=0.013). In 426 pregnancies with available neonatal outcomes, 53 (12.4%) delivered before 28 weeks. Neonates born to those with severe-range BP plus lab/clinical criteria had higher odds of hypoglycemia (P=0.01). No differences were observed in SNM, SGA, NICU length of stay, or 5-minute Apgar.

Conclusion:
In early-onset superimposed preeclampsia with severe features, diagnosis with severe range BP plus lab/clinical criteria was associated with increased non-transfusion SMM and neonatal hypoglycemia.