(592) What to Expect of Expectant Management in Preterm Preeclampsia with Severe Features: Impact of Co-morbidities

Expectant management of preeclampsia with severe features (PSF) before 34 weeks in stable patients is primarily considered for fetal benefit. However, current guidance does not address the presence of additional medical comorbidities. As a result, the safety and impact of expectant management in this population remains unclear. We aimed to evaluate outcomes of expectant management in PSF, comparing patients with and without comorbidities.

Study Design:

This retrospective cohort study included singleton pregnancies with PSF at < 32 weeks at a single tertiary center between 2016-2025. Patients were excluded if enrollment gestational age (GA) was < 23 weeks, or if they were delivered within 24 hours of diagnosis. Group 1 included patients without comorbidities, and group 2 included patients with ≥1 comorbidity (chronic hypertension, BMI > 40 Kg/m2, pregestational diabetes, cardiac disease, renal disease, or autoimmune disease). The primary outcome was median latency (time interval from diagnosis to delivery) in days. Secondary outcomes included a composite of severe maternal morbidity and stillbirth.

Results:

A total of 304 patients met inclusion criteria, 119 without comorbidities (group 1) and 185 with at least 1 comorbidity (group 2). Patients without comorbidities were more likely to be younger, primiparous, and to have fetal growth restriction (FGR). After adjusting for age and parity, there was no difference in median latency (4 days in group 1 vs 5 days in group 2, p=0.59), or composite adverse outcomes (Table 1). Patients in group 1 were more likely to achieve 34 weeks (13% vs 5.4%, p=0.020) and to be delivered for fetal indications (36% vs 26%, p=0.043) as compared to group 2.

Conclusion:

Maternal comorbidities did not impact latency or adverse maternal outcomes. However, patients without comorbidities were more likely to reach 34 weeks gestation. They also had higher rates of FGR and delivery for fetal indications. This may reflect more severe placental dysfunction in this group and the importance of individualized fetal surveillance strategies even in the absence of maternal comorbidities.