Hypertensive Disorders of Pregnancy (HDP) present a serious complication that affects approximately 2.5 to 3.0 percent of women, increasing the risk of maternal and neonatal complications [1, 2]. Worldwide, hypertensive disorders remain the leading cause of maternal mortality related to pregnancy [1]. Hypertensive disorders of pregnancy appear as hypertensive conditions that develop at any time after 20 weeks of pregnancy, accompanied by proteinuria. Among the manifestations of these syndromes is eclampsia, which presents with a convulsive component, and HELPP syndrome, which manifests with the presence of hemolysis, elevated liver enzymes, and thrombocytopenia; HELLP is a severe form of preeclampsia and not a separate disorder [3, 4]. Hypertensive Disorders of Pregnancy cannot be prevented; therefore, the identification of maternal risk factors becomes an important obstetric mission [1]. The risk factors associated with the development of gestational hypertension, previous history of pre-eclampsia, primiparity, obesity, family history of pre-eclampsia, number of previous pregnancies (if any), and chronic medical conditions, such as hypertension and diabetes, maternal age greater than or equal to 40 years, obesity, diabetes mellitus, chronic kidney disease, systemic lupus erythematosus, presence of antiphospholipid, multiple pregnancies and high altitude. In addition, it is important to highlight the action of transplant of live kidneys, which can increase the risk of developing pre-eclampsia in the recipients by up to six-fold more than in non-transplanted women [5].  The decision to induce labor must balance maternal and neonatal risks; thus, the basic objective of obstetrics is to carefully prolong pregnancy to improve the perinatal outcome without compromising maternal safety [6, 7]. Some authors suggest that expectant control of pregnancy is associated with an increase in maternal complications in a pregnancy of 32 weeks or more [8]. The neonatal complications described here range from premature birth to fetal growth restriction. The latter is the most frequent neonatal complication in newborns (NB) with hypertensive mothers [9, 10]. Perinatal mortality rates in growth-restricted neonates are 6 to 10 times that of those with normal growth [11]. Doppler ultrasonography in fetuses of hypertensive mothers is a way of assessing the severity of intrauterine growth restriction and intrauterine monitoring allows the disease progression to be observed non-invasively [12]. Other morbidities described in newborns of mothers with hypertensive conditions include bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), sepsis, and longer duration of mechanical ventilation. Hematological changes such as thrombocytopenia and leukopenia are also frequently described in the literature [10]. Exposure to HDP may be associated with an increased risk of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder [9, 13]. These findings highlight the need for greater pediatric surveillance of newborns exposed to HDP to allow early interventions that can improve neurological outcomes. This study aimed to assess the impact of gestational hypertensive disorders on premature newborns below 34 weeks and to identify the mortality rate and morbidities at discharge and 18 months of corrected gestational age.

This prospective study was conducted in the Department of Pediatrics, Bhaskara Medical College and Hospital, Sangareddy, Telangana. Institutional Ethical approval was obtained for the study after duly following the protocol for human research. Written consent was obtained from all the participants of the study after explaining the nature of the study in vernacular language. The confidentiality of data was maintained during the study.

Inclusion criteria

1. Gestational hypertension is diagnosed by the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria [14].
2. Pre-Eclampsia
3. Eclampsia
4. Singleton gestation

Exclusion Criteria

1. Infants of diabetic mothers
2. Babies of mothers with chronic hypertension
3. Babies of mothers with known systemic illnesses such as chronic renal problems, connective tissue disorders, thyrotoxicosis, etc.
4. Multiple gestations
5. Babies with congenital malformations

Recruitment Method was done by consecutive sampling of the eligible women presenting to our antenatal clinic. Maternal data included the demographic profile of women (age, parity, BMI, race/ethnicity), types of hypertensive disorder, gestational age at the diagnosis of hypertension, gestational age at delivery, mode of delivery (vaginal, cesarean), use of antihypertensive medications (specify types and dosages if possible) Presence of any other maternal comorbidities (e.g., diabetes, obesity), and Maternal complications (e.g., HELLP syndrome, placental abruption). The neonatal data recorded includes birth weight, Apgar scores (at 1 and 5 minutes), Gestational age at birth, sex of the baby, Neonatal complications (e.g., respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis), Admission to the neonatal intensive care unit (NICU), Length of hospital stay (both maternal and neonatal), and Perinatal mortality (stillbirth and early neonatal death)

Statistical analysis: All the available data was refined segregated and uploaded to an MS Excel spreadsheet. The Statistical analysis was performed using SPSS version 26.0 in Windows format. Descriptive statistics were calculated for all variables. Chi-square tests and t-tests were used to compare categorical and continuous variables, respectively, between groups. Logistic regression was used to identify independent risk factors for neonatal complications. A p-value of <0.05 was considered statistically significant.

The study was conducted on a total of 100 newborns. Among the total, about 61% of babies were delivered by cesarean section, and 39% were delivered by labor natural. This shows a statistical significance of cesarean section (p value-0.001) among these babies born to PIH mothers in our study (Table 1).

Table 1: Frequency and Percentage wise distribution of mode of delivery

Table 2: Gestation Age-wise distribution of Mode of Delivery

Of the total LSCS deliveries, 45 deliveries were terminated prematurely for maternal indications and 16 babies were delivered term. Of the total LN deliveries, 23 babies were delivered prematurely and 16 babies were delivered at term (Table 2). Among the total 100 babies, about 63 babies (63%) belong to the low-birth-weight category. Hence one of the most common complications of PIH babies being low birth weight (p value-0.005) is statistically significant in our study also. Among the 100 babies who are of low birth weight, 77 babies fall between 1.5-2.5 kg category which contributes to a total of 100%. Only 21 babies are of very low birth weight(1-1.5kg) and 2 babies are of extremely low birth weight(<1kg). Thus, most low birth weight babies of PIH mothers are between 1.5-2.5kg in our study.

Table 3: Gestational age of the cases with low birth weight

                        *Significant

About 59% of PIH babies were preterm among the total. Hence prematurity (p value-0.035) which is another important complication of babies born to PIH mothers is statistically significant in our study (Table 3). Among the 59 preterm cases, 41 babies (60.50%) fall under the late preterm category. Hence late preterm births represent the major subset of these PIH babies.

Table 4: Distribution of SGA/IUGR babies in the study

Table 4 presents data on the distribution of babies in your study based on their weight for gestational age, categorized as either Appropriate for Gestational Age (AGA) or Small for Gestational Age/Intrauterine Growth Restriction (SGA/IUGR). 57% of the babies in the study were classified as AGA. 43% of the babies were classified as SGA/IUGR. The relatively high proportion of SGA/IUGR babies (43%) in your study is a significant finding. This indicates that a substantial portion of the pregnancies in your study experienced some degree of fetal growth restriction.

Table 5: Frequency and percentage-wise distribution of type of IUGR

Table 5 shows the types of IUGR in babies of the study. The majority of IUGR cases (76.7%) are classified as asymmetrical. Symmetrical IUGR accounts for 24.3% of the cases. The predominance of asymmetrical IUGR in your study (76.7%) suggests that placental factors may play a significant role in fetal growth restriction in this population. Asymmetrical IUGR is often associated with increased risks of perinatal complications.

The majority of IUGR babies (39 out of 43, or 90.7%) were born preterm. Asymmetrical IUGR is more common in preterm births (28 out of 39 preterm IUGR babies, or 71.8%). All term IUGR babies (4 out of 4) had asymmetrical IUGR. All babies with symmetrical IUGR (11 out of 11) were born preterm. The strong association between IUGR and preterm birth is a well-established clinical finding. The higher prevalence of asymmetrical IUGR in preterm births suggests that placental insufficiency, a common cause of asymmetrical IUGR, may be a significant factor leading to preterm delivery.

          Table 6: Frequency and Percentage wise distribution of babies with low Apgar scores

Table 6 presents data on the frequency and percentage of babies in your study who had low Apgar scores at 1 minute and 5 minutes after birth. 1-Minute Apgar Score < 7: 18% of the babies had an Apgar score of less than 7 at 1 minute. 5-Minute Apgar score < 7: 4% of the babies had an Apgar score of less than 7 at 5 minutes. The decrease in the percentage of babies with low Apgar scores from 1 minute to 5 minutes (from 18% to 4%) indicates that many babies who initially had low scores showed improvement in their condition by 5 minutes.

The Clinical Assessment of Nutritional Score (CANS) scores.  Of the babies showing a CANS Score > 25: 47% of the babies had a CANS score greater than 25. CANS Score < 25: 53% of the babies had a CANS score less than 25. The p-value of 0.012, indicates a statistically significant difference between the two groups (CANS > 25 and CANS < 25) in relation to some outcome.

Table 7: Showing the neonatal complications recorded in the study

The Neonatal Intensive Care Unit (NICU) admission in the study shows No NICU Admission: 56% of the babies were not admitted to the NICU. NICU Admission: 44% of the babies were admitted to the NICU. The 44% NICU admission rate indicates that a substantial proportion of the newborns in your study required intensive care.  Table 7 presents data on the frequency and percentage of specific neonatal complications recorded in the study. 13 babies (13%) experienced birth asphyxia. 20 babies (20%) developed (RDS) respiratory distress syndrome. MAS (Meconium Aspiration Syndrome) was found in 2 babies (2%). 13 babies (13%) developed sepsis.

Hypertensive disorders affect pregnant mothers and their newborns through serious health threats, including prenatal hypertension, preeclampsia, and eclampsia. These conditions generate lasting developmental consequences for fetal growth, together with lasting health effects for pregnant women. Pregnancy-related conditions produce vascular defects that may persist into the post-pregnancy period. The inaccurate invasion of spiral arteries by trophoblastic cells is a crucial element in the pathogenesis of preeclampsia. During pregnancy, the pathogenesis of preeclampsia after trophoblastic invasion failure results in fibrinoid material accumulation and decreased blood flow to compromise maternal-fetal oxygen exchange, leading to placental dysfunction and fetal developmental problems [15]. Hypertensive disorders result in uteroplacental insufficiency that produces negative perinatal results, including fetal death, intrauterine growth retardation (IUGR) and preterm delivery [16]. Research shows that pregnancy-induced hypertension (PIH) patients undergo cesarean section procedures with frequencies between 30.2% and 94%, based on various scientific investigations [17-19]. Variations in diagnostic capability regarding fetal distress serve as the main reason for this variability in cesarean delivery rates. The study showed low birth weight (LBW) as an expected result because 63% of infants born to preeclamptic mothers weighed less than 2.5 kilograms while other studies showed LBW percentages ranging from 53.12% to 60% [62, 63, 64]. Prevalence data show that preterm birth occurs in 59% of infants, based on multiple studies that demonstrate late preterm deliveries as the most common case [17, 19, 20, 21]. The current research demonstrated that IUGR develops frequently in preeclamptic pregnancies, since 43% of infants showed this condition most commonly with asymmetrical growth restrictions related to premature birth [20]. Hypertensive mothers give birth to infants who experience low APGAR scores because of existing complications. Our research

Data showed that 18% of infants obtained APGAR scores lower than 7 during the first minute, but this number decreased to 4% at the five-minute assessment according to other established studies. [18, 20]. Preeclampsia-induced poor placental blood flow is the primary cause of adverse effects because it causes placental tissue damage alongside fetal growth limitation [15,]. Specialized care in the NICU admitted 44% of affected infants because of RDS, MAS, and sepsis according to the findings from our study, which matches similar study results [20]. The total death rate among babies born to mothers with PIH was 4% in our study sample. Studies show that mortality rates are between 1.56% and 5% among these infants [19, 22, 23]. Hypertensive pregnancy complications have multiple adverse effects on both maternal well-being and newborns, including higher cases of C-sections and LBW, as well as premature delivery and IUGR and NICU hospitalization. Research findings demonstrate that better diagnostic procedures and management systems need improvement to reduce the hazards associated with these medical conditions.

Pregnancy-induced maternal hypertension causes changes to the placenta, which can lead to problems for the developing baby. Poor management of preeclampsia is a major cause of fetal morbidity and mortality. Babies born to moms with hypertension have a higher risk of developing several issues, so it's important to keep a careful eye on them to ensure they have a better chance of surviving and growing up well. Low birth weight and premature delivery are the leading causes of perinatal mortality among these infants. Therefore, to avoid and detect preeclampsia, all pregnant women should receive adequate prenatal care. Improving the newborn prognosis can be achieved through raising public health awareness, educating primary health care personnel, and enhancing socio-economic conditions.

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