T. Tanjim, A. S. M. Badrul Haider, H. Hossain, R. Biswas, D. Zeba
Background: Pre-eclampsia (PE) is a significant cause of maternal and perinatal morbidity and mortality worldwide. The clinical course and severity of PE can vary depending on the gestational age at onset. However, limited data from low- and middle-income countries (LMICs) including Bangladesh stratify outcomes by onset timing, hindering context-specific management. This study aimed to differentiate maternal and perinatal outcomes associated with early-onset PE (EO-PE, <34 weeks) versus late-onset PE (LO-PE, [≥]34 weeks). Methods: A retrospective cohort study was conducted at a tertiary-level hospital in Bangladesh from March to August 2023. Data were extracted from hospital records and supplemented through structured telephone interviews for women diagnosed with PE. Associations between PE onset timing and adverse outcomes were analysed using simple and multivariable logistic regression. Results: Out of 3785 admitted patients, 11.28% (n=427) was diagnosed with PE. Of them, 255 PE patients were included in the study (EO-PE: n=121; LO-PE: n=134). EO-PE was associated with more adverse perinatal outcomes compared to LO-PE, including higher rates of prematurity, low birth weight, and increased need for neonatal hospital admission. Maternal complications such as eclampsia (31% vs 19%) and placental abruption (20% vs 10%) were more frequent in the EO-PE group. In multivariable regression, EO-PE was not independently associated with maternal adverse outcomes but showed significantly higher odds of stillbirth (aOR: 17.7, 95% CI: 6.15-66.7, p<0.001) and neonatal adverse outcomes (aOR: 34.6, 95% CI: 13.7-106, p<0.001). Conclusions: Early-onset PE is associated with substantially worse adverse perinatal outcomes compared to late-onset PE. Onset-based classification, early screening, and targeted management strategies are recommended to reduce the burden of pre-eclampsia in Bangladesh and similar LMIC settings.