A Retrospective Cohort Study on Mortality and Neurodevelopmental Outcomes of Preterm Very Low Birth Weight Infants Born to Mothers with Hypertensive Disorders of Pregnancy

Abstract

Objective We examined the effects of maternal hypertensive disorders of pregnancy (HDP) on the mortality and neurodevelopmental outcomes in preterm very low birth weight (VLBW) infants (BW ≤1,500 g) based on their intrauterine growth status and gestational age (GA). Study Design We included singleton VLBW infants born at <32 weeks' gestation registered in the Neonatal Research Network Japan database. The composite outcomes including death, cerebral palsy (CP), and developmental delay (DD) at 3 years of age were retrospectively compared among three groups: appropriate for GA (AGA) infants of mothers with and without HDP (H-AGA and N-AGA) and small for GA (SGA) infants of mothers with HDP (H-SGA). The adjusted odds ratios (AOR) and 95% confidence intervals (CI) stratified by the groups of every two gestational weeks were calculated after adjusting for the center, year of birth, sex, maternal age, maternal diabetes, antenatal steroid use, clinical chorioamnionitis, premature rupture of membranes, non-life-threatening congenital anomalies, and GA. Results Of 19,323 eligible infants, outcomes were evaluated in 10,192 infants: 683 were H-AGA, 1,719 were H-SGA, and 7,790 were N-AGA. Between H-AGA and N-AGA, no significant difference was observed in the risk for death, CP, or DD in any GA groups. H-AGA had a lower risk for death, CP, or DD than H-SGA in the 24 to 25 weeks group (AOR: 0.434, 95% CI: 0.202–0.930). The odds for death, CP, or DD of H-SGA against N-AGA were found to be higher in the 24 to 25 weeks (AOR: 2.558, 95% CI: 1.558–3.272) and 26 to 27 weeks (AOR: 1.898, 95% CI: 1.427–2.526) groups, but lower in the 30 to 31 weeks group (AOR: 0.518, 95% CI: 0.335–0.800). Conclusion There was a lack of follow-up data; however, the outcomes of liveborn preterm VLBW infants of mothers with HDP depended on their intrauterine growth status and GA at birth. Key Points

Mothers with hypertensive disorders of pregnancy increased risk of periventricular leukomalacia in extremely preterm or extremely low birth weight infants: A propensity score analysis

“…Another study found that the factors such as sex, gestational age, birth weight, multiple births, and antenatal steroids could affect the mortality of EP infants ( 16 ). In our study, after matching these factors, there was no significant difference in survival rate between the two groups, which was consistent with the results of Kono et al ( 7 , 8 ), but inconsistent with the results reported in Japan ( 13 ).…”

“…Over the past years, several studies have reported the effect of HDP on the clinical outcomes of preterm infants, but these conclusions are contradictory, especially in mortality (4)(5)(6)(7)(8), bronchopulmonary dysplasia (BPD) (4,5,(9)(10)(11)(12), and intraventricular hemorrhage (IVH) (4,5,10,(13)(14)(15). The inconsistency of these results may be related to different study populations and inconsistent baseline characteristics of the subjects.…”

Systemic Maternal Human sFLT1 Overexpression Leads to an Impaired Foetal Brain Development of Growth-Restricted Foetuses upon Experimental Preeclampsia

“…In a pathological study of 63 third trimester stillbirth cases, the most common form of brain injury was grey matter damage with neuronal necrosis not investigating migration capacities of progenitor cells [ 54 ]. Moreover, a study by Kono et al published interesting results for FGR from early-onset hypertension disorders of pregnancy (HDP) depending on their intrauterine growth status and gestational age at birth [ 55 ]. These results suggest that earlier onset of HDP with SGA (short for gestational age) may affect the death, cerebral palsy, and developmental delay at 3 years of age.…”

Evaluation of Postnatal Complications in Clinical and Histological Chorioamnionitis in Extremely Preterm Infants: A Japanese Cohort Study

“…Moreover, increased production of IL-1β in the placenta stimulates the hypothalamic-pituitary-adrenal axis, and steroidogenesis occurs simultaneously in the fetus. 11,28 Hence, fetal steroids increase and promote the maturation of fetal organs.…”

“…Small for gestational age (SGA) is characterized by being below the 10th percentile of sex-specific birth weight based on the Japanese neonatal anthropometric chart for gestational age. 11…”