Hypertensive disorders of pregnancy may increase the risk of neurodevelopmental delay in the offspring: a systematic review with meta-analysis.

Hypertensive disorders of pregnancy (HDP) are the most frequent complication of pregnancy, posing a burden on maternal and offspring health. Evidence about the potential effect of HDP on the infants' neurodevelopment is still inconsistent. We summarize the evidence about the effect of HDP on neurodevelopmental delay in the offspring. We conducted a systematic review with meta-analysis following the PRISMA (Preferred Reporting Items for Systematic reviews with Meta-Analysis) guidelines. The search was conducted in PubMed, Web of Science, and EBSCO databases. 21 publications were selected (20 cohorts and one case-control); 13/21 had data to meta-analyze. Children exposed to HDP doubled their risk of global neurodevelopment delay (OR = 2.07; 95%CI: 1.08, 3.95; n = 7214) compared to unexposed. Exposure to HDP was also related to a higher risk of delayed motor (OR = 1.25; 95%CI: 1.01, 1.56; n = 53,138) and language (OR = 1.87; 95% CI: 1.07, 3.29; n = 7581) development in the offspring. Considerable heterogeneity between studies was observed in meta-analyses of delayed global neurodevelopment (I2 = 86.9%) and language development (I2 = 68.9%), whereas heterogeneity was not relevant for delayed motor development (I2 = 13.0%). HDP could also increase the risk of cognitive development delay (OR = 1.27; 95%CI: 0.88, 1.82; I2 = 45.8%; n = 6631) in the offspring. Our results support the hypothesis that exposure to HDP might increase the risk of neurodevelopmental delay in the offspring, specifically affecting motor and language domains. Prospective studies with longer follow-up times and careful control of confounders are needed to confirm whether neurodevelopmental alterations remain at older ages, to inform decision makers about specific windows for interventions.