Childhood neurodevelopmental outcomes following hypertensive disorders of pregnancy.

OBJECTIVE

To compare neurodevelopmental (ND) outcomes in children of mothers who experienced hypertensive disorders of pregnancy (HDP) compared to normotensive mothers using data from a prospective cohort study.

STUDY

DESIGN

Secondary analysis of ND outcomes in children (aged 4-8 years) born to women who received serial fetal growth ultrasounds in the National Fetal Growth Study. The primary and secondary outcomes were executive and motor functioning scores, respectively (NIH toolbox measures and parent reported scales from Ages and Stages Questionnaire, Behavior, and Autism Scores). The primary exposure was HDP, defined as preeclampsia (PE) or gestational hypertension (GHTN), compared to normotensive. Additionally, PE and GHTN subgroups were compared to normotensive. Linear regression models with significant covariates yielded adjusted mean differences (95% CI).

RESULTS

Of 675 children, 63 (9.3%) had HDP, of whom 28 (4.1%) had PE and 35 (5.2%) had GHTN. Those with HDP had lower gestational age at delivery (38.4 vs. 39.5 wks.), higher pre-pregnancy BMI (26.4 vs. 24.2 kg/m2), and higher prevalence of nulliparity (62.0% vs. 44.0%; all p < 0.01). After adjustments, mean scores for all ND outcomes were lower for those with in-utero exposure to HDP compared to normotensive women, but the only significant difference was in executive functioning for children between 3 and 7 years old (mean difference = -3.02, 95% CI -5.70, -0.33).

CONCLUSION

In-utero exposure to HDP is associated with increased risks for poor executive functioning, with PE potentially having a stronger association with these long-term ND outcomes than GHTN.

CLINICALTRIALS: gov Identifiers: NCT00912132.