Background: Severe fetal growth restriction (sFGR) and preeclampsia (PE) are major pregnancy complications that often share placental dysfunction. This study aimed to compare maternal and neonatal outcomes among sFGR cases with or without gestational hypertensive disorders (GHD), with particular emphasis on PE. Methods: A retrospective analysis was conducted on 371 singleton pregnancies with sFGR delivered at Suzhou Municipal Hospital between January 2020 and December 2024. Patients were categorized into three groups: sFGR with PE (sFGR-PE; n = 69), sFGR with gestational hypertension (sFGR-GH; n = 15), and normotensive sFGR (n = 287). Maternal characteristics, pregnancy complications, and neonatal outcomes were compared using Analysis of Variance (ANOVA), and chi-square tests, as appropriate. Multivariate logistic regression was used to obtain adjusted odds ratios (aORs). Results: The patients in PE group were older, and had higher body mass index (BMI), higher rates of gestational diabetes mellitus (GDM), and preterm delivery (p < 0.05). Neonates in the PE group had significantly lower gestational age and birth weight, and higher incidences of metabolic acidosis, and respiratory complications (p < 0.001). Multivariable regression analysis revealed that, compared with normotensive sFGR, the other two groups showed no significant increase in the risk of adverse neonatal outcomes but had a significantly higher risk of cesarean or instrumental delivery. Conclusions: Although sFGR with hypertensive disorders showed increased crude risks of adverse outcomes, multivariable analysis indicated that most adverse effects were mediated by earlier delivery and lower birthweight. Only the risk of operative delivery remained independently elevated, highlighting the importance of optimal delivery timing in these pregnancies.
Yuan et al. (Wed,) studied this question.