Maternal and Neonatal Outcome among Women with Early-onset Pre-eclampsia and Late-onset Pre-eclampsia

Abstract

Severe pre-eclampsia remains a leading cause of maternal and perinatal morbidity and mortality worldwide. The clinical severity and outcomes differ substantially between early-onset and late-onset disease, necessitating comparative evaluation. Objective: To investigate and compare the clinical characteristics, maternal complications, and perinatal outcomes of early-onset and late-onset severe pre-eclampsia. Methods: This retrospective cohort study analyzed pregnant women diagnosed with severe pre-eclampsia and admitted to The First Affiliated Hospital of Xinjiang Medical University from January 2024 to November 2025. A total of 215 patients were included and categorized into early-onset severe pre-eclampsia occurring before 34 weeks of gestation and late-onset severe pre-eclampsia occurring at or after 34 weeks. Clinical features, laboratory parameters, maternal complications, delivery modes, and neonatal outcomes were extracted from medical records. Data were analyzed using cross-tabulation and chi-square tests, with a significance level set at P < 0.05. Results: Early-onset severe pre-eclampsia demonstrated significantly greater disease severity compared to late-onset disease. Pre-eclamps with severe features was more frequent in the early-onset group at 92.2% versus 61.6% (P < 0.001). Higher rates of proteinuria were observed at 85.3% versus 68.6% (P = 0.004). Electrolyte disorders occurred in 58.9% of early-onset cases compared to 26.7% in late-onset cases (P < 0.001). Anemia was present in 45.7% versus 31.4% (P = 0.035), and coagulation dysfunction in 15.5% versus 5.8% (P = 0.03). Induced abortion was significantly higher in early-onset severe pre-eclampsia at 7.7% (P = 0.009). Cesarean section was the predominant mode of delivery in early-onset cases. Neonatal outcomes were markedly worse in early-onset severe pre-eclampsia, with low birth weight observed in 95.3% versus 51.2% (P < 0.001), preterm birth in 86.8% versus 52.3% (P < 0.001), neonatal asphyxia in 18.6% versus 2.3% (P < 0.001), and NICU admission in 68.2% versus 53.5% (P = 0.029). Fetal growth restriction was more frequent in the early-onset group, but did not reach statistical significance. Conclusion: Early-onset severe pre-eclampsia is associated with substantially higher risks of severe maternal complications and adverse perinatal outcomes compared to late-onset disease. These findings emphasize the need for early identification, close surveillance, and intensive antenatal and perinatal management and care in  high risk pregnant women  to reduce maternal and neonatal morbidity and mortality.