Maternal hypertension associated with adverse neurodevelopment outcomes in preterm infants

1. Maternal hypertensive disorders of pregnancy (HDP) was independently associated with adverse cognitive and language outcomes at 2 years’ corrected age.

2. Brain abnormalities at term-equivalent age partially mediated 24% of the total effect of HDP on lower cognitive scores.

Evidence Rating Level: 2 (Good)

Hypertensive disorders of pregnancy (HDP) include preeclampsia, gestational hypertension, and chronic hypertension existing before pregnancy. Although exposure to HDP has been linked to suboptimal neurodevelopmental outcomes in full term-born children, findings in preterm infants remain conflicting. This study thus examined the association between maternal HDP and neurodevelopment in preterm infants born at 32 weeks or less. The prospective cohort study included 395 preterm infants (≤32 weeks’ gestation) from Cincinnati Infant Neurodevelopment Early Prediction Study (CINEPS), a multisite prospective regional cohort that recruited from five Ohio neonatal intensive care units from September 2016 to November 2019. HDP was defined by maternal diagnosis of chronic or gestational hypertension or preeclampsia during pregnancy. Brain magnetic resonance imaging (MRI) was performed at term-equivalent age. Global brain abnormality score (GBAS) was used to assess preterm brain injury and disrupted brain development. Neurodevelopment was assessed by Bayley Scales of Infant and Toddler Development (BSID), Third Edition, between 22 and 26 months’ corrected age. Of the 395 infants included in the study (median [interquartile range, IQR] gestational age = 29.6 [27.6-31.4] weeks, median [IQR] birth weight = 1,230 [950-1,628] g, male [%] =210 [53.2%]), 170 (43%) were exposed to HD, and 104 of 170 (61%) were exposed to preeclampsia. In total, 341 children (87%) completed the BSID. In adjusted analyses, HDP exposure was associated with lower BSID cognitive scores (β estimate = −3.69; 95% CI, −6.69 to −0.68; P = .02) and lower language scores (β estimate = −4.07; 95% CI, −8.03 to −0.11; P = .04). Preeclampsia exposure showed similarly negative but greater associations for BSID cognitive scores (β estimate = −4.85; 95% CI, −8.63 to −1.07; P = .01) and language scores (β estimate = −6.30; 95% CI, −11.49 to −1.09; P = .02). Brain abnormalities at term-equivalent age partially mediated 24% of the total effect of HDP on lower cognitive scores (β estimate = −0.82; 95% CI, −1.72 to −0.13; P = .02). Overall, this study found that maternal HDP was independently associated with adverse cognitive and language outcomes at 2 years’ corrected age, with greater effects in preeclampsia-exposed preterm infants. These findings highlight the importance of recognizing HDP as a risk factor for adverse neurodevelopmental outcomes, underscoring the need for early identification and targeted interventions to mitigate its impact. 

Click to read the study in JAMA Network Open

Image: PD

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