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Objective To assess the recurrence risk of late-preterm hypertensive disease of pregnancy, and to determine whether potential risk factors are predictive.Design Retrospective cohort study.Setting Three secondary and three tertiary care hospitals in the Netherlands.Population We identified women with a hypertensive disorder in the index pregnancy and delivery at 34-37 weeks of gestation, between January 2000 and December 2002.Methods Data were extracted from medical files and women were approached for additional information on subsequent pregnancies. An adverse outcome was defined as the recurrence of a hypertensive disorder in the next subsequent pregnancy.Main outcome measures Absolute risk of recurrence and a prediction model containing demographic and clinical factors predictive for adverse outcome.Results We identified 425 women who matched the criteria, of whom 351 could be contacted. Of these women, 189 (54%) had had a subsequent pregnancy. Hypertensive disorders recurred in 96 (51%, 95% CI 43-58%) women, of whom 17 (9%, 95% CI 5-14%) delivered again before 37 weeks of gestation. Chronic hypertension and maternal age were the strongest predictors for recurrence. Women undergoing recurrence had a nine-fold chance of developing chronic hypertension (37% versus 6%, OR 8.7, 95% CI 3.3-23).Conclusions Women with hypertensive disorders and late-preterm delivery have a 50% chance of recurrence, but only a 9% chance of recurrence resulting in delivery before 37 weeks of gestation. Women with chronic hypertension are prone to develop recurrence, and women with a recurrence more often developed chronic hypertension.

(BJOG. 2017;124:453–461) An economic analysis of the previously reported HYPITAT-II study was undertaken to assess the relative costs of delivering a preterm fetus versus expectant monitoring in women with nonsevere hypertensive disorders of pregnancy. The HYPAT-II study included 703 pregnant women in the Netherlands between 34 and 37 weeks gestation with preterm nonsevere hypertensive disorders. They were randomly allocated to either immediate delivery upon diagnosis (n=352) or expectant monitoring of the mother and fetus (n=351). The HYPAT-II study found that expectant monitoring was the more clinically effective strategy as it resulted in significantly fewer cases of respiratory distress syndrome in the infant with a relatively small impact on maternal health. This current study was performed simultaneously with the HYPITAT-II trial with the goal of determining which of the 2 treatments was more cost effective.

(Acta Obstet Gynecol Scand 2015;94(12):1337–1345) Increased risk of adverse pregnancy outcomes (preeclampsia/eclampsia, placental abruption, preterm delivery, growth restriction, and maternal and perinatal mortality) is noted in pregnancies complicated by chronic hypertension. The objective of this study was to assess whether planned early delivery may prevent some of these adverse outcomes. To achieve this objective, maternal and neonatal outcomes of pregnancy in women with chronic hypertension, including gestational-age–specific outcomes were studied.

Introduction If hypertensive disorders of pregnancy are diagnosed before term, the benefits of immediate delivery need to be weighed against the neonatal consequences of preterm delivery. If we are able to predict which women are at high risk of progression to severe disease, they could be targeted for delivery and maternal complications might be reduced. In addition, this may prevent unnecessary preterm births in women at low risk. Material and methods We developed a prediction model using data from the HYPITAT‐II trail, which evaluated immediate delivery vs. expectant monitoring in women with non‐severe hypertensive disorders of pregnancy between 34 and 37 weeks of gestation. Univariate and multivariate logistic regression analysis were used to identify relevant variables from clinical and laboratory parameters. The performance of the resulting prediction model was assessed by receiver operating characteristic analysis, calibration and bootstrapping, using the average predicted probabilities. Results We included 519 women, 115 (22.2%) of whom developed severe hypertensive disorders of pregnancy. The prediction model included: maternal age (odds ratio 0.92 per year), gestational age (odds ratio 0.87 per week), systolic blood pressure (odds ratio 1.05 per mmHg), the presence of chronic hypertension (odds ratio 2.4), platelet count (odds ratio 0.996), creatinine (odds ratio 1.02) and lactate dehydrogenase (odds ratio 1.003). The model showed good fit (p = 0.64), fair discrimination (area under the curve 0.76, 95% confidence interval 0.73–0.81, p < 0.001) and could stratify women in three risk groups of average, intermediate and high risk (predicted probabilities <0.22, <0.44 and >0.45, respectively). Conclusion In women with non‐severe hypertension in pregnancy near term, progression to severe disease can be predicted. This model requires external validation before it can be applied in practice.