Morbidity and development in childhood of infants born after temporizing treatment of early onset preeclampsia

Although immediate termination of pregnancy in cases of preeclampsia does benefit the mother, it often is not in the best interest of the fetus, especially if carried out long before term. A program of temporizing management has been adopted for use in severe early-onset preeclampsia, the goal being to correct maternal hemodynamics through plasma expansion and pharmacologic vasodilatation. Short-term benefit has been demonstrated with this approach. The question of whether this benefit is sustained was examined in 222 consecutive infants who lived at least 12 months and whose mothers had severe preeclampsia (diastolic blood pressure of 110 mm Hg or above with proteinuria of at least 0.3 g/L/24 hours after 20 weeks gestation). The mothers received the vasodilator dihydralazine in addition to pasteurized plasma. Each infant was matched for gestational age, gender, and year of birth with 2 infants whose mothers were not preeclamptic. One of them was at the gestational age at which temporizing treatment began (control group I). The other (control group II) was delivered at the same gestational age at which the preeclamptic patient was delivered. The children were evaluated at least 4 years after birth using the Child Behavior Checklist. Temporizing treatment delayed delivery by 2 weeks on average. Median birth weight was lower in the study group than in both control groups. Infants in control group I required mechanical ventilation significantly more often than did study infants or those in control group II. Bronchopulmonary dysplasia was least prevalent in control group II. Substantially more control than study mothers received corticosteroids before delivery to hasten maturation of the fetal lungs. All types of morbidity tended to occur less often in the study group than in control group I, but the only significant difference was for acute and chronic respiratory disorders (14% of study children and 37% of those in control group I). Respiratory disorders also correlated with a lower gestational age at birth. Although fewer children in the study group had minor or major handicaps, the differences were not statistically significant. Children with a single major handicap were significantly more frequent in control group I than in control group II. These findings indicate that the risk of respiratory disorders in early childhood may be less when temporizing management, prolonging gestation by 2 weeks, is adopted for women with early-onset preeclampsia.