Hematologic Vulnerability in Gestational Hypertension: Platelet-Defined Severity Phenotypes and Maternal Outcomes

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Hematology

Background:

• Gestational hypertension (GH) management often relies on blood pressure thresholds.
• These thresholds may not fully capture the biologic severity of GH.
• Thrombocytopenia (low platelet count) might indicate higher-risk GH phenotypes.

Purpose of the Study:

• To investigate if platelet-defined severity phenotypes in GH are linked to adverse maternal outcomes.
• To determine if thrombocytopenia predicts severe maternal morbidity in GH.

Main Methods:

• Retrospective cohort study of 300 pregnant individuals with GH (2020-2024).
• Participants stratified by platelet count: thrombocytopenia (<150 × 10^9/L) vs. normal (≥150 × 10^9/L).
• Primary outcome: maternal ICU admission; secondary outcomes: magnesium sulfate, cesarean delivery, preterm birth. Multivariable logistic regression used.

Main Results:

• Thrombocytopenia occurred in 10.3% of the cohort.
• Thrombocytopenia independently predicted ICU admission (aOR 3.89, p=0.024), even after adjusting for other factors.
• A dose-response relationship was observed: lower platelet counts correlated with higher ICU admission odds.

Conclusions:

• Platelet count is a valuable marker for identifying a biologically vulnerable subgroup within gestational hypertension.
• Platelet-defined phenotypes offer prognostic information independent of blood pressure thresholds.
• This approach may improve risk stratification and management of GH.