263. Neonatal developmental and behavioral outcomes of immediate delivery versus expectant management in hypertensive disorders of pregnancy: 2-year outcomes of the HYPITAT II trial

Background In the management of hypertensive disorders(HD) in preterm pregnancy, maternal benefits of delivery need to be weighed against the neonatal consequences of preterm birth. We report 2-year child outcomes of the HYPITAT-II trial, which compared delivery versus expectant management(EM) in these women. Objective To compare effects of delivery versus EM in women with hypertension in late preterm pregnancy on neurodevelopmental and behavioral outcomes in their offspring at two years of age. Study design We studied children born in the HYPITAT-II trial, in which 704 women with a HD between 34 and 37 weeks of gestation were randomized to immediate delivery or EM. Participating women were asked to complete the Ages and Stages Questionnaire (ASQ) for developmental outcome and the Child Behavior Checklist (CBCL) for behavioral problems when their toddler was two years old. Outcomes were dichotomized and analyzed by logistic regression analysis. Results We approached 545 (77%) randomized women, of whom 344 (64%) participated. In the delivery group, 45/162 (28%) infants had an abnormal ASQ-score compared to 27/148 (18%) in the EM group (difference in percentage 9.6, CI 0.3 to 18.0); p  = 0.045. An abnormal CBCL outcome was found in 31/175 (18%) in the delivery group versus 24/166 (15%) in the EM group (difference in percentage 3.2 (CI  − 4.6 to 11.0). After correction for maternal education, management strategy remained an independent predictor of abnormal ASQ-score (OR 0.48, CI 0.24 −0.96, p  = 0.03). In multivariable analyses, birth weight, maternal education and management policy were all significantly associated with an abnormal ASQ-score. Conclusions This study suggests that early delivery in women with late preterm HD results in poorer neurodevelopmental outcome at two years of age, indicating an increased risk of developmental delay compared to EM. This should be considered in the timing of delivery in women with a late preterm HD.