(1169) Cumulative impact of multiple severe features of preeclampsia and maternal morbidity

PEC with severe features (PEC-SF) is defined by severe hypertension and/or signs of end-organ dysfunction and increases risk of cardiovascular disease. The specific acute risks for patients with multiple severe features remain unknown. We hypothesize that compared to having 2 or fewer severe criteria, >2 criteria is associated with higher odds of maternal postpartum morbidity.

Study Design:

This retrospective cohort study included patients with antepartum PEC-SF defined by ACOG who delivered at two academic medical centers from 2016-17. The exposure was number of severe features present at delivery admission. The primary outcome was severe maternal morbidity (SMM) defined by the CDC at delivery hospitalization. A multivariable logistic regression model generated odds ratios (ORs) and 95% confidence intervals (CI) for the associations of number of severe features (<2, 3 or 4-6) with SMM, adjusting for chronic hypertension, diabetes, obesity (BMI >30) and renal disease (reference group: patients with < 2 features).

Results:

In the cohort, 774 were diagnosed with PEC-SF. 685 (88.5%) patients had < 2 severe features, 65 (8.4%) had 3 and 24 (3.1%) had 4-6. Having 3 severe features was associated with higher risk of transfusion-related SMM (OR 1.17, 95% CI 1.1-1.25) and non-transfusion SMM (OR 1.12, 95% CI 1.05-1.19) compared to < 2 severe features. 4-6 severe features conferred greater risk of transfusion-related (OR 1.55, 95% CI 1.38-1.73) and non-transfusion SMM (OR 1.57, 95% CI 1.41-1.73) (Figure 1). Blood product transfusion at time of delivery was the most frequent SMM observed across all groups. Most common non-transfusion SMM were acute renal failure, DIC, eclampsia, pulmonary edema/heart failure, and need for ventilation (Figure 2).

Conclusion:

In patients with PEC-SF, > 2 severe criteria confer incremental SMM risk at delivery, emphasizing the importance of identifying all severe features at diagnosis. Patients with > 2 severe criteria should deliver at a higher level of maternal care prepared to respond to SMM events.