Hypertensive disorders of pregnancy and the small for gestational age neonate: not a simple relationship

OBJECTIVES: Intrauterine growth restriction ( IUGR) reflected by small for gestational age (SGA) status is considered a measure of severity of hypertensive disorders of pregnancy. The purpose of this study was to ascertain whether hypertensive disorders of pregnancy and SGA correlate with severity of hypertension, suggestive of common pathophysiological pathways. STUDY DESIGN: Perinatal and hospital data from 1998-2002 were reviewed. The study identified women with singletons and hypertensive disorders of pregnancy, including those with SGA babies and those with appropriate for gestational age babies. RESULTS: Severity characteristics of hypertensive disorders did not significantly differ between groups (r < .6); however, hypertensive mothers with SGA babies had a higher incidence of a previous SGA baby ( but no difference in previous hypertension). CONCLUSION: IUGR in hypertensive disorders of pregnancy is not a measure of severity of hypertension, but reflects underlying fetal susceptibility to growth factors and/or unique (familial) growth patterns. IUGR as a gauge of severity of hypertensive disorders of pregnancy should be reassessed.