Is outpatient surveillance of preeclampsia without severe features still safe in contemporary obese Populations?

Objective

Outpatient surveillance of preeclamptic pregnancies was studied several decades ago when rates of obesity were lower. The rate of preeclampsia and overall morbidity are higher in contemporary obese cohorts. We sought to review the safety of outpatient management of preeclampsia without severe features in a contemporary obese population.

Study design

Institutional retrospective cohort study analyzing the outcomes of 183 patients diagnosed with preeclampsia without severe features from 1/1/2010 to 12/31/2020.

Main outcome measures

Latency in days between diagnosis and time of delivery.

Results

The average BMI was 35.4 (SD 8.2), and the inpatient and outpatient groups did not have differences in BMI (34.5 vs 36.5, p = 0.12). The outpatient group was found to have significantly longer latency (20.4 vs 11.8 days, p < 0.01). After adjustment, differences in latency for the inpatient and outpatient group remained statistically significant (Mean Difference −7.0, 95 % CI −11.3 to −2.7). Additionally, the outpatient group had a higher gestational age at delivery (35.7 vs 34.2, p < 0.01), fewer total hospital days (8.3 vs 12.1 days, p < 0.01), and fewer occurrences of preterm delivery before 34 weeks gestational age (18 % vs 39 %, p < 0.01). Analysis of neonatal outcomes found the outpatient group had greater birth weights (2544.8 vs 2187.6 g, p < 0.01) and fewer total days in the NICU (24.9 vs 41.8 days, p < 0.01).

Conclusion

Outpatient management has become the expected practice when managing preeclampsia without severe features. Our study’s findings support this management strategy in the modern obese population.