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Quantitative evaluation of nursing intervention efficacy in high-risk hypertensive disorders of pregnancy: A
Lanping Zhang1, Yan Long, Huilin Zhang
1Department of Obstetrics, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
Hypertensive disorders of pregnancy (HDP) contribute significantly to maternal and neonatal morbidity. Precision medicine emphasizes individualized risk prediction, while nursing interventions (NIs) address behavioral and psychosocial care. This study evaluated the clinical benefit of a structured NI compared to routine prenatal care in reducing complications among women diagnosed with HDP. This retrospective quasi-experimental study was conducted at Peking University Shenzhen Hospital. Participants were primigravida Chinese women (median age 25 years) with a confirmed diagnosis of HDP. Of 3260 screened women, 265 met the inclusion criteria: gestational hypertension (48%), preeclampsia (31%), or superimposed preeclampsia (21%). Risk was initially assessed via self-reported questionnaires starting at 15 gestational weeks until 7 days postpartum. Participants were allocated to either an NI (Women with hypertensive disorders of pregnancy received prenatal care and NIs sessions until 7 days postpartum [NI cohort], n = 122), receiving structured education and behavioral sessions, or a routine prenatal care (PR cohort, n = 143). This investigation identifies a significant association between a protocolized NI and improved obstetric trajectories, particularly in younger women and those with a higher body mass index (BMI). While these associative findings are encouraging, the non-randomized, retrospective nature of the study necessitates caution, and the results should be viewed as hypothesis-generating rather than evidence of a definitive causal effect. The study population consisted of primigravida women with a median prepregnancy BMI of 23.8 kg/m2. The NI was independently associated with significantly higher odds of spontaneous vaginal delivery (adjusted odds ratios: 2.15; 95% confidence interval: 1.84-2.51; P < .001). The intervention was independently associated with a significant reduction in the risk of neonatal intensive care unit (NICU) admissions (adjusted odds ratios: 0.28; 95% confidence interval: 0.11-0.72; P = .008). Raw delivery outcomes also favored the NI cohort regarding normal delivery rates (45% vs 17%, P < .0001) and labor duration (82% vs 49%, P < .0001). Maternal complications were comparable, and nausea was significantly lower in the NI group (18% vs 29%, P = .032). Secondary neonatal outcomes demonstrated significant reductions in low birth weight (9% vs 15%, P = .048) and respiratory distress syndrome (3% vs 9%, P = .021). A NI was most effective for women aged ≤25 years and those with a BMI>24 kg/m2.
Hypertensive disorders of pregnancy (HDP) contribute significantly to maternal and neonatal morbidity. Precision medicine emphasizes individualized risk prediction, while nursing interventions (NIs) address behavioral and psychosocial care. This study evaluated the clinical benefit of a structured NI compared to routine prenatal care in reducing complications among women diagnosed with HDP. This retrospective quasi-experimental study was conducted at Peking University Shenzhen Hospital. Participants were primigravida Chinese women (median age 25 years) with a confirmed diagnosis of HDP. Of 3260 screened women, 265 met the inclusion criteria: gestational hypertension (48%), preeclampsia (31%), or superimposed preeclampsia (21%). Risk was initially assessed via self-reported questionnaires starting at 15 gestational weeks until 7 days postpartum. Participants were allocated to either an NI (Women with hypertensive disorders of pregnancy received prenatal care and NIs sessions until 7 days postpartum [NI cohort], n = 122), receiving structured education and behavioral sessions, or a routine prenatal care (PR cohort, n = 143). This investigation identifies a significant association between a protocolized NI and improved obstetric trajectories, particularly in younger women and those with a higher body mass index (BMI). While these associative findings are encouraging, the non-randomized, retrospective nature of the study necessitates caution, and the results should be viewed as hypothesis-generating rather than evidence of a definitive causal effect. The study population consisted of primigravida women with a median prepregnancy BMI of 23.8 kg/m2. The NI was independently associated with significantly higher odds of spontaneous vaginal delivery (adjusted odds ratios: 2.15; 95% confidence interval: 1.84-2.51; P < .001). The intervention was independently associated with a significant reduction in the risk of neonatal intensive care unit (NICU) admissions (adjusted odds ratios: 0.28; 95% confidence interval: 0.11-0.72; P = .008). Raw delivery outcomes also favored the NI cohort regarding normal delivery rates (45% vs 17%, P < .0001) and labor duration (82% vs 49%, P < .0001). Maternal complications were comparable, and nausea was significantly lower in the NI group (18% vs 29%, P = .032). Secondary neonatal outcomes demonstrated significant reductions in low birth weight (9% vs 15%, P = .048) and respiratory distress syndrome (3% vs 9%, P = .021). A NI was most effective for women aged ≤25 years and those with a BMI>24 kg/m2.
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