Antihypertensive escalation tied to higher maternal risk in preeclampsia

A retrospective cohort study of 396 singleton pregnancies expectantly managed for early-onset preeclampsia with severe features (23-33 weeks) evaluated whether escalating antihypertensive treatment correlated with adverse maternal outcomes. The study reported that each additional oral dose escalation was associated with a 4.2 percentage point increase in maternal risk, with adjusted relative risks up to 5.20 for four or more escalations and 7.92 for daily dose escalation compared with none; similar dose-dependent patterns were seen with repeated IV antihypertensive pushes, while neonatal outcomes did not differ significantly across escalation categories. The authors suggest that treatment trajectory may serve as a dynamic marker of disease progression that could complement maternal risk assessment during expectant management.

Most relevant for: Clinicians managing expectant care of singleton pregnancies with early-onset preeclampsia with severe features between 23 and 34 weeks gestation.

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