MATERNAL AND NEONATAL OUTCOMES IN HYPERTENSIVE DISORDERS OF PREGNANCY: PREDICTORS OF ADVERSE OUTCOMES

Abstract

Background: Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal and neonatal morbidity and mortality worldwide. Early identification of factors associated with adverse outcomes is essential to improve maternal and perinatal health.

Objective: To evaluate maternal and neonatal outcomes among women with hypertensive disorders of pregnancy and identify independent predictors of adverse outcomes.

Methods: A retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Pakistan Ordinance Factories (POF) Hospital, Wah Cantt, Pakistan. Medical records of 450 women diagnosed with hypertensive disorders of pregnancy between January 2023 and December 2025 were reviewed. Demographic, obstetric, clinical, laboratory, maternal, and neonatal data were extracted using a standardized data collection form. Maternal and neonatal outcomes were compared across hypertensive disorder subtypes. Independent predictors of adverse maternal and neonatal outcomes were identified using multivariable logistic regression. Adjusted odds ratios (AORs) with 95% confidence intervals (CI) were calculated, and a p-value <0.05 was considered statistically significant.

Results: The mean maternal age was 29.4 ± 5.8 years, and preeclampsia was the most common hypertensive disorder (37.8%), followed by gestational hypertension (26.7%), severe preeclampsia (20.0%), and eclampsia (15.5%). Cesarean delivery was performed in 60.0% of pregnancies. Maternal complications occurred in 36.0% of women, with ICU admission (10.7%), HELLP syndrome (8.7%), postpartum hemorrhage (9.1%), and acute kidney injury (5.8%) being the most frequent complications. Maternal mortality was 1.1%. Neonatal outcomes included preterm birth in 39.1%, low birth weight in 35.8%, NICU admission in 28.4%, stillbirth in 4.2%, and early neonatal death in 2.4%. Severe preeclampsia/eclampsia (AOR 3.48, 95% CI 2.15–5.62), gestational age at diagnosis <34 weeks (AOR 2.41, 95% CI 1.53–3.79), thrombocytopenia (AOR 2.93, 95% CI 1.78–4.82), and elevated serum creatinine (AOR 2.24, 95% CI 1.32–3.81) independently predicted adverse maternal outcomes. Gestational age <34 weeks (AOR 4.12, 95% CI 2.63–6.47) and severe preeclampsia/eclampsia (AOR 2.86, 95% CI 1.84–4.44) were the strongest predictors of adverse neonatal outcomes, whereas regular antenatal care significantly reduced the risk of both maternal and neonatal complications.

Conclusion: Hypertensive disorders of pregnancy, particularly severe preeclampsia and eclampsia, are associated with substantial maternal and neonatal morbidity. Early disease onset, laboratory evidence of organ dysfunction, and inadequate antenatal care are significant predictors of adverse outcomes. Strengthening antenatal surveillance, prompt risk stratification, timely referral, and multidisciplinary management may improve maternal and neonatal outcomes in high-risk pregnancies.