Hypertension in pregnancy
The aim of this thesis is to investigate strategies to prevent health problems - both in the mother and the child - related to hypertensive disorders of pregnancy. The first part of this thesis contains studies about optimal timing of delivery when a hypertensive disorders occurs near term. The maternal benefits of early delivery have to be weight against the neonatal consequences of a preterm delivery. We present a study regarding both short term maternal and neonatal outcomes of two management strategies: immediate or deferred delivery. We also investigated what the long term consequences of these management strategies are on the development and behavior of the children at 2 and 5 years of age. This is unique data and the first study to collect these long term outcomes after a randomized trial regarding hypertension in pregnancy. In order to define optimal timing of delivery we developed a prediction model to assess the risk of progression to severe disease. Women at high risk could be delivered earlier to prevent maternal health complications. In the second part of the thesis we aim to evaluate the performance of first trimester prediction of preeclampsia to allow for early intervention to hypertensive disease. This issue was addressed in a prospective cohort study. In addition, we evaluated the reproducibility and repeatability of one of the predictors in the algorithm, the uterine artery pulsatility index. This thesis contributed to better healthoutcomes for both women and children.