Hemodynamic-guided antihypertensive therapy reduces low-birth-weight incidence.

BACKGROUND

Chronic hypertensive disorders in pregnancy are associated with adverse maternal and perinatal outcomes. Hemodynamic-guided management has been proposed to optimize antihypertensive therapy. This study evaluates outcomes before and after the introduction of the USCOM® device - a non-invasive hemodynamic monitor - into clinical practice for tailoring antihypertensive treatment.

METHODS

A retrospective, monocentric descriptive study was conducted at the AOU Policlinic of Modena. USCOM® was implemented in March 2022. The control group included 22 pregnant individuals with chronic hypertensive disorder (HD) from 2021, while the USCOM group included 46 individuals from 2023 who received USCOM® hemodynamic monitoring to tailor antihypertensive therapy. Patients with missing delivery data or gestational hypertension were excluded. Maternal and neonatal outcomes were collected retrospectively from electronic medical records and analyzed using SPSS v.28. Continuous variables were presented as means with standard deviations, and categorical variables as counts and percentages.

RESULTS

No significant differences in maternal characteristics were observed between groups. The USCOM group showed a significantly lower incidence of low-birthweight (<2500 g) newborns (6.5% vs. 36.4%; P=0.004) and longer gestational age (38.9 vs. 37.4 weeks; P=0.049). Although not statistically significant, trends indicated fewer extremely preterm births (<34 weeks; P=0.096) and lower Neonatal Intensive Care Unit (NICU) admissions (P=0.096). Multivariate analysis confirmed USCOM® evaluation as the only significant factor reducing the risk of low birth weight (adjusted odds ratio [aOR] 0.118, P=0.004), adjusted for parity, ethnicity, and prepregnancy Body Mass Index (BMI).

CONCLUSIONS

While larger studies are needed to confirm these findings, the implementation of USCOM® in routine clinical practice may contribute to improved neonatal outcomes in pregnancies complicated by chronic hypertensive disorders.