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TOPLINE: 

In a cohort of 395 preterm infants (median gestational age, 29.6 weeks), maternal hypertensive disorders of pregnancy (HDP) affected 43% of cases and were associated with reduced cognitive and language development scores at 2 years corrected age, with stronger negative associations observed in preeclampsia-exposed infants.

METHODOLOGY:  

• This regional prospective cohort study included 395 preterm infants (≤ 32 weeks’ gestation) from five level III and IV neonatal intensive care units in southeast Ohio between September 2016 and November 2019.
• Researchers performed structural brain MRI at term-equivalent age and assessed neurodevelopment using the Bayley Scales of Infant and Toddler Development (BSID), third edition, between 22 and 26 months corrected age.
• The analysis focused on 170 infants (43%) exposed to HDP, defined as maternal diagnosis of chronic or gestational hypertension or preeclampsia, with 104 cases specifically exposed to preeclampsia.

TAKEAWAY:  

• HDP exposure showed negative associations with BSID cognitive scores (mean difference, -3.69; 95% CI, -6.69 to -0.68; P = .02) and language scores (mean difference, -4.07; 95% CI, -8.03 to -0.11; P = .04).
• Preeclampsia exposure demonstrated stronger negative associations with cognitive scores (mean difference, -4.85; 95% CI, -8.63 to -1.07; P = .01) and language scores (mean difference, -6.30; 95% CI, -11.49 to -1.09; P = .02).
• Mediation analysis revealed that brain abnormalities at term-equivalent age partially mediated the association between HDP and cognitive scores, accounting for 24% of the total effect (mean difference, -0.82; 95% CI, -1.72 to -0.13; P = .02).

IN PRACTICE:

“In this preterm cohort study, maternal HDP was independently associated with adverse cognitive and language development, with accentuated associations observed in preeclampsia-exposed preterm infants, emphasizing the clinical importance of recognizing HDP as a risk, enabling targeted risk management strategies for closer monitoring and aggressive early intervention in affected populations,” the study authors wrote.

SOURCE:

The study was led by Nehal A. Parikh, DO, MS, of Cincinnati Children’s Hospital Medical Center It was published online on April 29 in JAMA Network Open.

LIMITATIONS:

The observational study design presents challenges in establishing causation and potential residual confounding by maternal comorbidities. HDP diagnosis relied primarily on maternal electronic medical records as determined by obstetricians, with only eight of 170 cases identified through clinical blood pressure criteria. The researchers used modified social risk scores owing to data constraints, which may have introduced differences between intended and implemented methods. A 13% attrition rate could have introduced selection bias, though multiple imputation sensitivity analyses showed similar results to original findings.

DISCLOSURES:

The study received support through National Institutes of Health grants ROI-NSO94200 and RO1-NSO96037 from the National Institute of Neurological Disorders and Stroke, and RO1 EBO29944-01 from the National Institute of Biomedical Imaging and Bioengineering to Parikh. Maria E Barnes-Davis, MD, PhD, received grant K23-NS117734 from the National Institute of Neurological Disorders and Stroke. The funders had no role in the study design, data collection, analysis, manuscript preparation, or publication decision.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.