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Optimizing Delivery Timing in Pregnant Patients With Chronic Hypertension at Term.

Ira Hamilton1, James Liu1, Labeena Wajahat1

  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio.

O&G Open
|September 26, 2025
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Summary

For pregnant patients with chronic hypertension, delivery at 39 weeks of gestation optimizes outcomes by balancing infant death, neonatal morbidity, and stillbirth risks. This timing aligns with current clinical guidelines for improved maternal and infant health.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Perinatology

Background:

  • Chronic hypertension is a common complication in pregnancy.
  • Optimal delivery timing in these pregnancies is crucial for minimizing adverse outcomes.
  • Existing guidelines recommend individualized assessment, but specific gestational age targets are debated.

Purpose of the Study:

  • To determine the optimal gestational week for delivery in term pregnancies complicated by chronic hypertension.
  • To compare the risks of delivery versus expectant management at each week of gestation from 37 to 42 weeks.

Main Methods:

  • Population-based retrospective cohort study of US births (2014-2018).
  • Included nonanomalous singleton term births in patients with chronic hypertension (excluding superimposed preeclampsia, eclampsia, and diabetes).
  • Compared rates of stillbirth, infant death, and composite neonatal morbidity (NICU admission, ventilation, low Apgar, seizures) with risks of expectant management week-by-week.

Main Results:

  • Stillbirth rates increased with gestational age, lowest at 38 weeks.
  • Infant death rates were lowest at 40 weeks, and neonatal morbidity at 39 weeks.
  • Delivery at 39 weeks showed a lower composite risk (delivery vs. expectant management) compared to other weeks.

Conclusions:

  • Delivery at 39 weeks of gestation offers the best balance of risks for infant death, neonatal morbidity, and stillbirth in term pregnancies with chronic hypertension.
  • This finding holds true for subgroup analyses including non-Hispanic Black patients and those with fetal growth restriction.
  • The results support current clinical practice guidelines recommending delivery around 39 weeks.