Elevated Blood Pressure in Newborns From Hypertensive Disorders of Pregnancy During the Immediate Postnatal Period.

Hypertensive disorders of pregnancy (HDP) impact up to 22% of pregnancies. Offspring from HDP, face an increased risk of future cardiovascular disease, with elevated blood pressure reported as early as childhood. Additionally, primary vascular endothelial cells derived from HDP demonstrate dysfunction in vitro. These data suggest that HDP affect fetal development in ways that impair long-term vascular function, supporting the developmental origins of health and disease (DOHaD) theory that health risks begin before birth. However, it remains unclear at what point these physiological changes first emerge and can be detected systemically. To assess whether changes in cardiovascular function can be detected in the immediate post-natal period, we conducted a retrospective analysis of 1655 maternal-infant dyads delivered between the years 2012 and 2025. Using inverse probability weighted regression adjustment, we assessed associations between HDP and newborn heart rate (HR) and blood pressure (BP). Gestational hypertension (GH) and preeclampsia (PE) were associated with higher newborn mean arterial (+2.1 mmHg, p = 0.02; +2.9 mmHg, p = 0.04) and diastolic BP (+2.0 mmHg, p = 0.02; +2.6 mmHg, p = 0.04) compared to normotension (NT). GH was also associated with increased newborn systolic blood pressure (+2.3 mmHg, p = 0.04) and increased variability of newborn HR and diastolic BP (+1 bpm, p = 0.009; +1.4 mmHg, p = 0.001) compared to normotension. These findings suggest that subtle but measurable newborn cardiovascular alterations associated with GH and PE are present at birth. While the mechanisms remain to be elucidated, these early alterations provide additional temporal insight into the DOHaD in HDP and may reflect underlying vascular dysfunction.