{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T22:58:38Z","timestamp":1784329118268,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:00:00Z","timestamp":1625788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["146442"],"award-info":[{"award-number":["146442"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009776","name":"McMaster University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009776","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011021","name":"Sunnybrook Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011021","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Since 2013, various guidelines for hypertension in pregnancy have been refined, no longer requiring proteinuria as a requisite criterion for preeclampsia. We aimed to evaluate the impact of the new definition on preterm birth (PTB) and adverse pregnancy outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Women delivering in Ontario between April 2012 and November 2016 were included. Delivery &lt;24+0\/7\u00a0weeks, major fetal anomalies or preexisting renal disease were excluded. The primary outcome was livebirth &lt;37, &lt;34 or &lt;32\u00a0weeks. Rates, adjusted rate ratios (aRR) and ratio of the rate ratio (RRR) were used to compare outcomes in the 2\u00a0years after the new Society of Obstetricians and Gynaecologists of Canada (SOGC) guideline (December 2014\u2013November 2016; period 2) vs the 2\u00a0years before (April 2012\u2013March 2014; period 1), among women with and without preeclampsia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all, 268\u00a0543 and 267\u00a0964 births in periods 1 &amp; 2, respectively, were included. Respective preeclampsia rates increased significantly from 3.9% to 4.4% (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), with no change in maternal morbidity rates. In preeclamptic women, respective rates of PTB &lt;37\u00a0weeks were 21.0% and 20.7% (aRR 1.01, 95% confidence interval [CI] 1.00\u20131.02), with significant aRR for PTB &lt;34 (0.86, 95% CI 0.77\u20130.96) and &lt;32\u00a0weeks (0.79, 95% CI 0.67\u20130.94). A similar aRR was observed in women without preeclampsia. In preeclamptic women, composite severe neonatal morbidity decreased after guideline change (aRR 0.95, 95% CI 0.91\u20130.99), a finding not observed in women without preeclampsia (RRR 0.95, 95% CI 0.91\u20130.99).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The new definition of preeclampsia was associated with increased disease rates, a modest reduction in adverse neonatal outcomes and no change in maternal outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14199","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T17:40:42Z","timestamp":1622137242000},"page":"1627-1635","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Changes in rate of preterm birth and adverse pregnancy outcomes attributed to preeclampsia after introduction of a refined definition of preeclampsia: A population\u2010based study"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6352-4846","authenticated-orcid":false,"given":"Shiri","family":"Shinar","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Mount Sinai Hospital University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nir","family":"Melamed","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Sunnybrook Health Sciences University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasim E.","family":"Abdulaziz","sequence":"additional","affiliation":[{"name":"Better Outcomes Registry &amp; Network (BORN) Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel G.","family":"Ray","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toronto Toronto Ontario Canada"},{"name":"Department of Obstetrics and Gynaecology Saint Michael\u2019s Hospital University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Riddell","sequence":"additional","affiliation":[{"name":"Better Outcomes Registry &amp; Network (BORN) Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Barrett","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Sunnybrook Health Sciences University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth","family":"Murray\u2010Davis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Midwifery Education Program McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karizma","family":"Mawjee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Saint Michael\u2019s Hospital University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4461-2178","authenticated-orcid":false,"given":"Sarah D.","family":"McDonald","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine Departments of Obstetrics &amp; Gynecology Radiology &amp; Health Research Methods Evidence &amp; Impact McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Geary","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Rotunda Hospital Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Saint Michael\u2019s Hospital University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for DOH\u2010NET (Diabetes, Obesity, Hypertension in Pregnancy Research Network), SOON (Southern Ontario Obstetrical Network) Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.3439"},{"issue":"2","key":"e_1_2_9_3_1","first-page":"330","article-title":"ACOG practice bulletin on diagnosing and managing preeclampsia and eclampsia. 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