Adverse maternal outcomes in pregnancies with life-limiting fetal conditions managed expectantly: a cross-sectional study from a single tertiary fetal medicine centre in UK

Abstract

OBJECTIVES: This study aimed to (1) report adverse maternal outcomes in pregnancies complicated by life-limiting fetal conditions managed expectantly in a UK tertiary Fetal Medicine Unit; (2) assess whether specific life-limiting fetal conditions categories increase maternal complication risks; and (3) compare risks with the general population. DESIGN: Retrospective, cross-sectional study (2016-2023). METHODS: Life-limiting fetal conditions were categorized by organ system or chromosomal/genetic defect. Ultrasound findings affecting maternal outcomes were recorded. Outcomes included hypertensive disorders of pregnancy, preterm birth <37 weeks, gestational diabetes mellitus (GDM), caesarean sections, and postpartum haemorrhage (PPH). Frequencies of maternal complications were compared across life-limiting fetal conditions categories and with controls delivering structurally normal, singleton infants. RESULTS: Of 151 life-limiting fetal conditions pregnancies, 78 underwent medical termination, 59 were managed expectantly, and 14 were lost to follow-up. Among expectantly managed pregnancies, 49 % experienced preterm birth, 24 % had PPH, 14 % developed GDM, and 5 % had hypertension. Caesarean occurred in 13.6 % of cases. Hypertension was exclusive to aneuploidy life-limiting fetal conditions, while 79 % of preterm births were associated with amniotic fluid anomalies. Preterm birth risk was significantly higher in life-limiting fetal conditions pregnancies versus controls (49 % vs. 11 %; P < 0.0001; aOR 8.4; 95 % CI: 4.43-15.77). CONCLUSIONS: Life-limiting fetal conditions pregnancies carry higher risks of preterm birth, particularly with amniotic fluid abnormalities, and hypertension is more common in aneuploidy cases. Maternal interventions for fetal reasons remain frequent despite multidisciplinary care.