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To describe the incidence and trends of hypertensive disorders of pregnancy and adverse pregnancy outcomes in recent years in Victoria, Australia.Retrospective population-based cohort study, 2010 to 2017.State of Victoria, Australia.Population-based cohort study.Incidence of hypertensive disorders and its subtypes over time. Composite of major adverse maternal and perinatal outcome.The incidence of hypertensive disorders (n = 36,406/614,524 pregnancies with 624,193 births) and all its subtypes has been stable, (n = 4,192/73,235 = 5.7% in 2010 to 4,601/78,576 = 5.9% in 2017). Compared to no hypertension, hypertensive disorders were associated with medically-initiated birth (aOR 4.70 [4.56, 4.84]), caesarean section (aOR 1.46 [1.43, 1.50]), placental abruption (aOR 1.94 [1.69, 2.22]), maternal intensive care or high-dependency unit admission (aOR 6.80 [6.45, 7.17]), composite of major adverse maternal outcome (aOR 3.87 [3.70, 4.04]), and composite of major adverse perinatal outcome (aOR 1.63 [1.56, 1.70]). The worst maternal and perinatal outcomes were among women with superimposed and early preterm preeclampsia.The incidence of all hypertensive disorders in pregnancy has remained stable over time. Early-onset preeclampsia and superimposed preeclampsia were most strongly associated with adverse pregnancy outcomes.

Research indicates that soluble fms-like tyrosine kinase 1 (sFLT-1) and placental growth factor (PLGF) have diagnostic and prognostic significance for women with preeclampsia. However, sparse research has studied these biomarkers in women with preexisting comorbidities such as chronic hypertension, diabetes mellitus, systemic lupus erythematosus and chronic kidney disease. We undertook a prospective longitudinal cohort study to compare the sFLT-1: PlGF ratio between women with and without comorbidities who did and did not go on to develop preeclampsia. We found that women with comorbidities may develop preeclampsia with a milder elevation in sFLT-1: PlGF than do women without comorbidities. This has clinical and research implications.

To investigate the childhood school outcomes for infants born to women with hypertensive disorders during pregnancy.A retrospective population-based cohort study linking perinatal data from 2003 to 2013 to developmental scores at preparatory school and educational scores at school grades 3, 5, and 7 in Victoria, Australia. Exposures of interest were the presence of hypertensive disorders during pregnancy and iatrogenic delivery for preeclampsia. Multivariable logistic regression and generalised estimating equation models were employed.In total, 682,386 births ≥32 weeks' gestation were linked to 175,665 child developmental results and 412,834 with at least one educational result. Compared to infants born to women without a hypertensive disorder, infants born to women with a hypertensive disorder had no increased risk of poorer developmental outcomes at school entry but a significantly increased risk of poorer educational outcomes across grades 3, 5, and 7. Compared to infants born to women without preeclampsia, infants born to women iatrogenically delivered for preeclampsia had no increased risk of poorer developmental outcomes (aOR = 1.12, 95 % CI: 0.98-1.28) but a significantly increased risk of poorer educational outcomes at grades 3 (aOR = 1.23, 95 % CI: 1.09-1.38), 5 (aOR = 1.27, 95 % CI: 1.13-1.43), and 7 (aOR = 1.24, 95 % CI: 1.09-1.43).The presence of maternal hypertension in pregnancy, particularly where preeclampsia was the indication for iatrogenic delivery, is associated with impaired school educational outcomes.

To evaluate how medical comorbidities - chronic hypertension, pre-gestational or gestational diabetes and obesity - influence maternal and neonatal complications from preeclampsia.We undertook a retrospective cohort study of women delivering in Victoria, Australia, between 2009 and 2017. We compared the likelihood of having a maternal complication before delivery or neonatal complication after birth between women with and without comorbidities. We used causal mediation analysis for neonatal outcomes to separate the effects of comorbidities and of prematurity on morbidity.Pregnancy complications (eclampsia; haemolysis, elevated liver enzymes, low platelets syndrome; placental abruption; stillbirth) and neonatal complications (respiratory distress syndrome; neonatal sepsis; a 5-minute APGAR 5; neonatal intensive care unit admission).Women with comorbidities delivered at a median (interquartile range) of 37.0 (36.0-39.0) weeks gestation, earlier than women without comorbidities (38.0 (36.0-39.0) weeks, p 0.001). Women with comorbidities were less likely than those without to suffer any pregnancy complication prior to delivery (adjusted relative risk 0.78, 95% confidence interval 0.72-0.86); however, their neonates suffered more respiratory distress syndrome (aRR 1.43, 95% CI 1.31-1.57), neonatal sepsis (aRR 1.42, 95% CI 1.17-1.72) and NICU admission (aRR 1.37, 95% CI 1.23-1.53). Earlier delivery was a major contributor to worse neonatal outcomes.Medical comorbidities are associated with earlier delivery among women with preeclampsia. This is associated with fewer maternal complications, but worse neonatal outcomes.