The contribution of hypertensive disorders of pregnancy to late preterm and term admissions to neonatal units in the UK 2012–2020 and opportunities to avoid admission: A population‐based study using the National Neonatal Research Database

Abstract

ObjectiveTo quantify maternal hypertensive disorder of pregnancy (HDP) prevalence in late preterm and term infants admitted to neonatal units (NNU) and assess opportunities to avoid admissions.DesignA retrospective population‐based study using the National Neonatal Research Database.SettingEngland and Wales.PopulationInfants born ≥34 weeks’ gestation admitted to NNU between 2012 and 2020.MethodsOutcomes in HDP infants are compared with non‐HDP infants using regression models.Main outcome measuresHypertensive disorder of pregnancy, primary reason for admission, clinical diagnoses and resource use.Results16 059/136 220 (11.8%) of late preterm (34+0 to 36+6 weeks’ gestation) and 14 885/284 646 (5.2%) of term (≥37 weeks’ gestation) admitted infants were exposed to maternal HDP. The most common primary reasons for HDP infant admission were respiratory disease (28.3%), prematurity (22.7%) and hypoglycaemia (16.4%). HDP infants were more likely to be admitted with primary hypoglycaemia than were non‐HDP infants (odds ratio [OR] 2.1, 95% confidence interval [CI] 2.0–2.2, P < 0.0001). 64.5% of HDP infants received i.v. dextrose. 35.7% received mechanical or non‐invasive ventilation. 8260/30 944 (26.7%) of HDP infants received intervention for hypoglycaemia alone (i.v. dextrose) with no other major intervention (respiratory support, parenteral nutrition, central line, arterial line or blood transfusion).ConclusionsThe burden of maternal HDP on late preterm and term admissions to NNU is high, with hypoglycaemia and respiratory disease being the main drivers for admission. Over one in four were admitted solely for management of hypoglycaemia. Further research should determine whether maternal antihypertensive agent choice or postnatal pathways may reduce NNU admission.