Risk of small for gestational age babies in preterm delivery due to pregnancy-induced hypertension

  • Rima Irwinda Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta
  • Budi Iman Santoso Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta
  • Raymond Surya Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta
  • Lidia Firmiaty Nembo Department of Obstetrics and Gynecology, Ende Hospital, East Nusa Tenggara, Kupang
Keywords: fetal growth, pregnancy-induced hypertension, preterm delivery, small for gestational age


BACKGROUND Pregnancy-induced hypertension (PIH) causes high maternal morbidity and mortality worldwide. This study aims to assess the impact of PIH on fetal growth according to gestational age in preterm deliveries.

METHODS A prospective cohort study using secondary data was undertaken in Ende District, East Nusa Tenggara, Indonesia from September 2014 to August 2015. The t-test was performed to compare mean birth weight based on gestational week between normotensive and PIH women, continued by linear regression. The chi-square or Fisher exact test was also conducted to determine the probability of birthing small for the gestational age (SGA) and large for gestational age (LGA) babies between normotensive and PIH women.

RESULTS A total of 1,673 deliveries were recorded in Ende Hospital over the 1-year study period, among which 182 cases involved preterm births. The PIH group had lower birth weight than normotensive women at each gestational age starting from 32–35 weeks (p=0.004; 95% CI 150.84–771.36). Normotensive women at gestational ages of 32 (p=0.05; 95% CI 0.01–0.83), 34 (p=0.37; 95% CI 0.01–4.12), and 36 (p=0.31; 95% CI 0.02– 2.95) weeks had a lower risk of birthing SGA babies than PIH women; LGA babies were recorded at gestational ages of 33 (p=1.00; 95% CI 0.07–37.73) and 35 (p=0.31; 95% CI 0.34–63.07) weeks.

CONCLUSIONS Poor perfusion of the uteroplacental is one of the reasons behind intrauterine growth restriction, which results in SGA babies born to PIH women.


Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010;376(9741):631–44. https://doi.org/10.1016/S0140-6736(10)60279-6

Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009; 33(3):130–7. https://doi.org/10.1053/j.semperi.2009.02.010

Sirait AM. Prevalensi hipertensi pada kehamilan di Indonesia dan berbagai faktor yang berhubungan (Riset Kesehatan Dasar 2007). Buletin Penelitian Sistem Kesehatan. 2012;15(2):103–9.

Browne JL, Vissers KM, Antwi E, Srofenyoh EK, Van der Linden EL, Agyepong IA, et al. Perinatal outcomes after hypertensive disorders in pregnancy in a low resource setting. Trop Med Int Health. 2015;20(12):1778–86. https://doi.org/10.1111/tmi.12606

Xiong X, Demianczuk NN, Saunders LD, Wang F, Fraser WD. Impact of preeclampsia and gestational hypertension on birth weight by gestational age. Am J Epidemiol. 2002;155(3):203–9. https://doi.org/10.1093/aje/155.3.203

Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75–84. https://doi.org/10.1016/S0140-6736(08)60074-4

Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162–72. https://doi.org/10.1016/S0140-6736(12)60820-4

World Health Organization. Born too soon: The global action report on preterm birth. 2012. [download on 1st December 2016]. Available from: http://www.who.int/pmnch/media/news/2012/201204_borntoosoon–report.pdf

Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can. 2014;36(5):416–41. https://doi.org/10.1016/S1701-2163(15)30588-0

Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C, GAPPS Review Group. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth. 2010;10(Suppl 1):S1. https://doi.org/10.1186/1471-2393-10-S1-S1

Hauth JC, Ewell MG, Levine RJ, Esterlitz JR, Sibai B, Curet LB, et al. Pregnancy outcomes in healthy nulliparas who developed hypertension. Obstet Gynecol. 2000;95(1):24–8. https://doi.org/10.1016/S0029-7844(99)00462-7

Sibai BM. Preeclampsia as a cause of preterm and late preterm (near-term) births. Semin Perinatol. 2006;30(1):16–9. https://doi.org/10.1053/j.semperi.2006.01.008

Xiong X, Mayes D, Demianczuk N, Olson DM, Davidge ST, Newburn–Cook C, et al. Impact of pregnancy-induced hypertension on fetal growth. Am J Obstet Gynecol. 1999;180(1):207–13. https://doi.org/10.1016/S0002-9378(99)70176-6

Ferrazzani S, Luciano R, Garofalo S, D'Andrea V, De Carolis S, De Carolis MP, et al. Neonatal outcome in hypertensive disorders of pregnancy. Early Hum Dev. 2011;87(6):445–9. https://doi.org/10.1016/j.earlhumdev.2011.03.005

Lisonkova S, Joseph KS. Incidence of preeclampsia: risk factors and outcomes associated with early-versus late-onset disease. Am J Obstet Gynecol. 2013;209(6): 544.e1–12. https://doi.org/10.1016/j.ajog.2013.08.019

Xiong X, Demianczuk NN, Buekens P, Saunders LD. Association of preeclampsia with high birth weight for gestational age. Am J Obstet Gynecol. 2000;183:148–55.


How to Cite
Irwinda R, Santoso BI, Surya R, Nembo LF. Risk of small for gestational age babies in preterm delivery due to pregnancy-induced hypertension. Med J Indones [Internet]. 2019May8 [cited 2024Feb.25];28(1):57-2. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/1795
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