Hauptman Isabella, Gill Kevin S, Lim Tiffany, Mack Wendy J, Wilson Melissa L
Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, USA.
Arch Gynecol Obstet. 2025 Mar;311(3):639-648. doi: 10.1007/s00404-024-07684-y. Epub 2024 Aug 16.
Hypertensive disorders of pregnancy cause significant neonatal complications. Disease severity is often used to predict neonatal outcomes, however gestational age (GA) at delivery may be a better predictor. We aimed to assess whether disease severity or GA was more predictive of adverse neonatal outcomes.
We included 165 participants with confirmed HELLP syndrome or severe preeclampsia (sPE). Two predictive models were constructed to assess the ability of disease severity compared to GA to predict a composite adverse neonatal outcome. The composite outcome included low birth weight, SGA, IUGR, Apgar score, and neonatal death.
Using severity as a predictor of binary neonatal outcome had an AUC of 0.73 (0.65-0.81), with a sensitivity (SE) of 70.3% and a specificity (SP) of 64.4%. For GA, we observed an AUC of 0.82 (0.75-0.89), with a SE of 75.7% and a SP of 76.7%.
For the composite neonatal outcome, GA was a better predictor than ACOG diagnosis (severity). This observation underscores the need for further research to validate these findings in larger cohorts and to determine their applicability to maternal outcomes.
妊娠高血压疾病会导致严重的新生儿并发症。疾病严重程度常被用于预测新生儿结局，然而分娩时的孕周（GA）可能是更好的预测指标。我们旨在评估疾病严重程度或孕周哪个更能预测不良新生儿结局。
我们纳入了165例确诊为HELLP综合征或重度子痫前期（sPE）的参与者。构建了两个预测模型，以评估与孕周相比，疾病严重程度预测复合不良新生儿结局的能力。复合结局包括低出生体重、小于胎龄儿、胎儿生长受限、阿氏评分和新生儿死亡。
将严重程度作为二元新生儿结局的预测指标时，曲线下面积（AUC）为0.73（0.65 - 0.81），灵敏度（SE）为70.3%，特异度（SP）为64.4%。对于孕周，我们观察到AUC为0.82（0.75 - 0.89），SE为75.7%，SP为76.7%。
对于复合新生儿结局，孕周比美国妇产科医师学会（ACOG）诊断（严重程度）是更好的预测指标。这一观察结果强调需要进一步研究，以在更大的队列中验证这些发现，并确定它们对母亲结局的适用性。
