# Maternal and Fetal Outcomes in Early-Onset vs. Late-Onset Preeclampsia: A Retrospective Study at a Tertiary Care Institute in India

## TL;DR

This study compares maternal and fetal outcomes in early-onset and late-onset preeclampsia, finding that early-onset is more severe and leads to worse neonatal outcomes.

## Contribution

The study highlights the distinct clinical risks and outcomes of early-onset preeclampsia, particularly its association with IVF and severe neonatal complications.

## Key findings

- Early-onset preeclampsia was strongly linked to IVF treatment and severe maternal disease.
- Early-onset cases had higher rates of preterm delivery, low birth weight, and NICU admissions.
- Neonatal outcomes were significantly worse in early-onset preeclampsia compared to late-onset.

## Abstract

Background

Preeclampsia is a hypertensive disorder of pregnancy associated with significant maternal and perinatal morbidity and mortality. Distinguishing between early- and late-onset preeclampsia is crucial due to differences in pathophysiology, severity, and outcomes. This study aimed to evaluate and contrast clinical characteristics, complications, and outcomes between the two types.

Aim & objective

The aim of the study is to compare the maternal and fetal outcomes in pregnancies complicated by early-onset preeclampsia (before 34 weeks) versus late-onset preeclampsia (34 weeks or later) and identify specific clinical risks and prognostic implications associated with the timing of disease onset.

Materials & methods

A hospital-based retrospective observational study was conducted at Smt. Kashibai Navale Medical College and General Hospital, Pune, from November 2022 to October 2024. A total of 88 pregnant women diagnosed with preeclampsia were categorized into early-onset (<34 weeks) and late-onset (≥34 weeks) groups. Clinical data were extracted from medical records and analyzed using chi-square and Fisher’s exact tests to assess associations between disease onset and maternal/neonatal outcomes.

Results

Among the 88 cases, early-onset and late-onset preeclampsia were nearly evenly distributed (48.9% vs. 51.1%). Severe preeclampsia was significantly more frequent in the early-onset group (93.0% vs. 62.2%, p=0.001). Early-onset preeclampsia was strongly associated with the cases who underwent IVF (in vitro fertilization) treatment (p=0.001). Early-onset cases had significantly higher rates of preterm delivery (<34 weeks: 76.7%), extremely low birth weight (<1.5 kg: 65.1%), intrauterine death (20.9%, p=0.002), NICU (Neonatal Intensive Care Unit) admissions (p<0.001), and low APGAR scores (p<0.001). Maternal complications were more frequent in early-onset cases, although the difference was not statistically significant.

Discussion

The study affirms that early-onset preeclampsia is associated with great severity disease and significantly poorer neonatal outcomes, especially in terms of prematurity, fetal growth restriction, and neonatal morbidity. IVF emerged as a notable risk factor for early-onset pre-eclampsia. Despite higher complication rates, maternal mortality was zero in this cohort.

Conclusion

Early-onset preeclampsia poses greater risks to both mother and fetus than late-onset disease. Identifying high-risk pregnancies, especially IVF conceptions, and implementing timely interventions are essential to improving outcomes. Enhanced surveillance and preparedness of neonatal intensive care are particularly critical in early-onset cases.