Publications

INTRODUCTION: Hypertensive disorders of pregnancy (HDP) have been linked with increased risk for maternal and offspring complications in high-income settings.  However, in resource-limited settings, studies with robust measurement of HDP,  including severity and timing, and perinatal outcomes are limited. METHODS: We  analysed data from two prospective cohorts of nulliparous women in India  (n=10 570 pregnancies) and Tanzania (n=10 299 pregnancies) who were enrolled in  calcium supplementation trials and had blood pressure and proteinuria assessments  throughout pregnancy and at the time of labour and delivery. Generalised  estimating equations were used to assess the relationship between HDP severity  categories (gestational hypertension, preeclampsia without severe features and  preeclampsia with severe features) and timing of HDP onset (early-onset <34 weeks  vs late-onset ≥34 weeks gestation) with adverse perinatal outcomes. RESULTS: The  cumulative incidence of HDP was 3.7% and 4.5% in the India and Tanzania cohorts,  respectively. All HDP severity categories were associated with a significantly  higher risk for perinatal death in both cohorts (p values<0.05). Pregnancies  complicated by pre-eclampsia with severe features had the largest magnitude of  increased risk for perinatal death as compared with pregnancies without an HDP  (India RR 8.60; 95% CI 5.90 to 12.53; Tanzania RR 4.05; 95% CI 2.91 to 5.66). In  both cohorts, pre-eclampsia with and without severe features, but not gestational  hypertension, was associated with increased risks for preterm birth and low birth  weight. Pregnancies with early-onset HDP had a high absolute risk of perinatal  death (India 25.6% and Tanzania 36.9%), and the risk was markedly increased as  compared with late-onset HDP (India RR 4.79; 95% CI 2.68 to 8.54; Tanzania RR  5.79; 95% CI 3.56 to 9.41). CONCLUSION: HDP were differentially associated with  risks for perinatal outcomes by severity and timing of onset. Interventions that  prevent, reduce the severity or delay the onset of HDP may improve perinatal  outcomes in resource-limited settings. TRIAL REGISTRATION NUMBER:  ClinicalTrials.gov number, NCT03350516.