Complicações neonatais e maternas relacionadas à hipertensão em festações de desfecho prematuro: um estudo de coorte

Abstract

Introduction: Prematurity is common in pregnancies complicated by hypertension. However, studies concerning the outcome of premature children born to hypertensive mothers are conflicting. Studies regarding the quality of prenatal care given to hypertensive pregnant women are also scarce and worrying, as they reveal the poor quality of care in this risk group. Objective: To analyze the association of GH and other risk factors with the occurrence of neonatal complications such as periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity and death (Article 1) and to describe and evaluate the impact of quality of access to prenatal care, length of hospital stay and the occurrence of unfavorable maternal and neonatal outcomes (Article 2). Method: Observational, prospective study of single, preterm and comorbid newborns, in addition to hypertension, from November / 2013 to September / 2017. The study site was the Hospital Materno Infantil - HMIB in the Federal District, a public hospital, a reference hospital for high complexity cases related to pediatrics and obstetrics and gynecology. After applying the exclusion criteria, there were 1,191 preterm infants with gestational age (GA) between 24 and 36 weeks and 6 days. For the study of neonatal outcomes, taking into account the presence or absence of hypertension and other risk factors (Article 1), the sample was stratified by weight below 1,500g (n = 273). For the analysis of maternal and neonatal outcomes in the presence or absence of adequate prenatal care (Article 2), only hypertensive pregnant women (n = 261) were selected. The Kessner index was used to classify access to prenatal care as adequate or inadequate (intermediate or inadequate), thus delimiting the study groups of Article 2. The data were obtained from an interview, a pregnant woman's card and an electronic medical record . In the statistical analysis, t-Test or Mann-Whitney, ANOVA, chi square, risk calculation and 95% confidence intervals (CI) were used. After a bivariate analysis of the frequencies and averages of the neonatal outcomes between the study groups, the independent variables with p-value < 0.20 in the univariate analysis were conducted for multivariate logistic regression. Results: SHG was not confirmed as a risk factor for mortality or unfavorable outcomes in the neonatal period. Although coverage was satisfactory (98%), only 35% of hypertensive pregnant women had adequate prenatal access. Risk factors such as poor obstetrical past and gestation in adolescence did not guarantee better access to prenatal care. The children of hypertensive pregnant women with adequate prenatal care, initially considered as a control group, were more preterm, more likely to be born with very low birth weight (<1,500g) and died more than the children of pregnant women without adequate prenatal care. Bronchopulmonary dysplasia, cerebral haemorrhage, Apgar <7 at 1 minute, and neonatal death were more frequent in newborns with adequate prenatal care, but were only related to prematurity after multivariate analysis. There was no maternal death and the time of hospitalization and occurrence of eclampsia and HELLP was similar between the groups. Conclusions: SHG did not add risk to neonatal outcome. In contrast to what is observed in pregnancies of normal risk, adequate access to prenatal care was not able to guarantee a better outcome for preterm infants of hypertensive pregnant women. The analysis of the quality of prenatal care and the delivery of hypertensive pregnant women directed to care in the tertiary unit of the DF for premature termination of gestation must be intensified.