Adverse Maternal Outcomes of Patients with Preeclampsia Complicated by Fetal Growth Restriction

It has been suggested that fetal growth restriction (FGR) is associated with a more severe preeclampsia phenotype. We sought to determine whether the presence of FGR among women with preeclampsia was associated with increased odds of adverse maternal outcomes compared to those without FGR. This was a retrospective study of patients with preeclampsia and singleton pregnancy who were delivered at 23 weeks' gestation or greater from January 1, 2010, to December 31, 2020. The primary outcome was a composite of maternal mortality and severe preeclampsia-associated complications. We stratified analyses based on the onset of preeclampsia (early-onset vs. late-onset). Early-onset preeclampsia was defined as the development of preeclampsia before 34 weeks' gestation. Outcomes were compared between patients with FGR and those without FGR. Adjusted odds ratios (aORs) and 95% confidence intervals (95%CI) were calculated using multivariable logistic regression, controlling for confounders. Of 559 patients, 235 (42%) had early-onset preeclampsia and 324 (58%) had late-onset preeclampsia. Rates of FGR were 40% (94/235) and 10% (32/324) in patients with early-onset and late-onset preeclampsia, respectively. In patients with early-onset preeclampsia, patients with FGR compared to those without were more likely to be delivered at earlier gestational age and were less likely to have pregestational diabetes. In this group, patients with FGR compared to those without had similar odds of the primary outcome (12.8% vs. 14.2%; aOR 0.58; 95%CI 0.25-1.35). In patients with late-onset preeclampsia, patients with FGR compared to those without were more likely to be younger and delivered at earlier gestational age. In this group, patients with FGR compared to those without had increased odds of the primary outcome (15.6% vs. 4.1%; aOR 5.80; 95%CI 1.75-19.23). In patients with late-onset preeclampsia, the presence of FGR compared increased the odds of severe maternal morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)