Impact of Maternal Risk Stratification on Clinical Characteristics and Perinatal Outcomes in Singleton Pregnancies With Preeclampsia.

This retrospective study of 4143 women at Fujian Maternal and Child Health Hospital (2012-2022) investigated how maternal risk levels influence clinical characteristics and perinatal outcomes in singleton pregnancies complicated by preeclampsia. Utilizing class-imbalance-adjusted and random forest algorithms, participants were stratified into high-risk (17.38%), moderate-risk (34.08%), and low-risk (48.54%) groups. The analysis revealed that women in the high-risk category were diagnosed at a significantly earlier gestational age and faced higher rates of severe, early-onset, and preterm preeclampsia compared to the other groups. Although high-risk pregnancies were associated with increased incidences of renal impairment, hypoproteinemia, and aminotransferase abnormalities, no significant differences were observed in rates of thrombocytopenia, placental abruption, postpartum hemorrhage, or stillbirth. Regarding delivery and neonatal outcomes, the high-risk group demonstrated markedly higher rates of Cesarean sections, fetal distress, and neonatal intensive care unit (NICU) admissions. Key drivers of these adverse outcomes included chronic hypertension, chronic kidney disease, prior fetal growth restriction (FGR), and maternal age over 40 years. Ultimately, while high-risk status is a strong predictor of early-onset disease and specific maternal-neonatal complications, it does not uniformly predict all adverse fetal outcomes, suggesting that clinical management should focus heavily on the specific impacts of hypertension, renal health, and advanced maternal age.