Timing of Delivery in Women with Pre-existing Hypertension - DOH-Net
The Diabetes, Obesity and Hypertension in Pregnancy Research Network (DOH-Net) is a multi-disciplinary research team of obstetrical, midwifery and maternal-fetal medicine specialists.
DOH-Net, research, diabetes, hypertension, obesity, pregnancy, gestational diabetes, diabetes, obesity and hypertension in pregnancy research network, Sunnybrook Health Sciences Centre, St. Michael's Hospital, McMaster University, obstetrics, midwife, maternal-fetal medicine, specialists, researchers, Toronto, Ontario, Canada, Hamilton, Greater Toronto Area, GTA
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Timing of Delivery in Women with Pre-existing Hypertension

Importance: In women with chronic hypertension, it is unclear whether routine induction of labor before 40 weeks of gestation confers benefit to mother and newborn. Objective: To test the hypothesis that routine induction of labor at 38 or 39 weeks in women with chronic hypertension decreases the risk of superimposed preeclampsia and associated complications. Design: Retrospective cohort study from April 2012-March 2016. Setting: Population-based study in Ontario, Canada. Participants: Women with chronic hypertension with singleton hospital birth at ≥380/7 weeks in Ontario, Canada (N=2,420). Women who delivered >420/7 weeks, or had non-vertex presentation, placenta previa, previous cesarean delivery, major congenital anomalies, maternal medical conditions other than chronic hypertension, or stillbirth were excluded from the study (N=3,634). Exposure: Women who underwent labor induction at 380/7 to 386/7 weeks for chronic hypertension (n=281) were compared to those managed expectantly and remained undelivered at 390/7 weeks (n=1,606). Separately, women who underwent labor induction at 390/7 to 396/7 weeks for chronic hypertension (n=259) were compared to undelivered women at 400/7 weeks (n=801). Main Outcome Measure: The rate of superimposed preeclampsia in the expectant management groups. Results: The characteristics of women in the induction and expectant management groups were similar with regard to maternal age, parity and BMI. Women managed expectantly at 38 or 39.

Ram, M., Berger, H., Ray, J. G., Lipworth, H., Geary, M., McDonald, S. D., Murray-Davis, B., Riddell, C., Hasan, H., Barrett, J., & Melamed, N. (2018). Timing of Delivery in Women with Preexisting Hypertension. American Journal of Obstetrics and Gynecology218(1), S214.

Contact for this study:
Isabel Arruda, isabel.arruda@sunnybrook.ca