Maternal preeclampsia and risk of bronchopulmonary dysplasia in preterm infants

O’Shea, Joyce E; Davis, Peter G; Doyle, Lex W.

doi:10.1038/pr.2011.27

Cited by 54 publications

(42 citation statements)

References 23 publications

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“…1 Several studies have addressed this issue, but results have often been conflicting. For instance, both mortality and a common complication such as bronchopulmonary dysplasia (BPD) have been found to be higher, 2-6 equal, [7][8][9][10] or lower [11][12][13] in infants born after preeclampsia compared with spontaneous preterm labor. There could be several reasons for these discrepancies, including differences in the populations studied, which often came from a single hospital, classification of antecedents of preterm birth, or adjustments made during the analysis stage.…”

Section: Resultsmentioning

confidence: 99%

Association of Maternal Hypertension and Chorioamnionitis With Preterm Outcomes

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: In very preterm infants, outcomes depend not only on the degree of immaturity, but also on the underlying pathologies that trigger preterm delivery. Studies that have addressed this issue have provided unclear results.WHAT THIS STUDY ADDS: Patterns of outcomes differ between maternal hypertension and chorioamnionitis: hypertension is associated with greater risks for bronchopulmonary dysplasia and retinopathy of prematurity, and lower risks for brain injury, necrotizing enterocolitis, early-onset sepsis. For mortality, the effect changes across gestational age weeks. abstract OBJECTIVES: We compared the relative effect of hypertensive disorders of pregnancy and chorioamnionitis on adverse neonatal outcomes in very preterm neonates, and studied whether gestational age (GA) modulates these effects. METHODS:A cohort of neonates 23 to 30 weeks' GA, born in 2008 to 2011 in 82 hospitals adhering to the Italian Neonatal Network, was analyzed. Infants born from mothers who had hypertensive disorders (N = 2096) were compared with those born after chorioamnionitis (N = 1510). Statistical analysis employed logistic models, adjusting for GA, hospital, and potential confounders. RESULTS:Overall mortality was higher after hypertension than after chorioamnionitis (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.08-1.80), but this relationship changed across GA weeks; the OR for hypertension was highest at low GA, whereas from 28 weeks' GA onward, mortality was higher for chorioamnionitis. For other outcomes, the relative risks were constant across GA; infants born after hypertension had an increased risk for bronchopulmonary dysplasia (OR, 2.20; 95% CI, 1.68-2.88) and severe retinopathy of prematurity (OR, 1.48; 95% CI, 1.02-2.15), whereas there was a lower risk for earlyonset sepsis (OR, 0.25; 95% CI,, severe intraventricular hemorrhage (OR, 0.65; 95% CI, periventricular leukomalacia (OR, 0.70; 95% CI,, and surgical necrotizing enterocolitis or gastrointestinal perforation (OR, 0.47; 95% CI, 0.31-0.72).CONCLUSIONS: Mortality and other adverse outcomes in very preterm infants depend on antecedents of preterm birth. Hypertension and chorioamnionitis are associated with different patterns of outcomes; for mortality, the effect changes across GA weeks. Pediatrics 2014;134:e154-e161 AUTHORS:

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Section: Resultsmentioning

confidence: 99%

Association of Maternal Hypertension and Chorioamnionitis With Preterm Outcomes

et al. 2014

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“…In our data, once GA was taken into account, BPD did not appear to be associated with inflammatory causes of delivery but rather with placentation disorders. The effect of preeclampsia on BPD is disputed (7)(8)(9)(10), with a population-based study in Australia and accompanying meta-analysis refuting the association (9), but with two recent single-center studies not included in the meta-analysis (7,10) lending support to the "vascular hypothesis" of BPD. It is known that an array of circulating antiangiogenic factors might play a role in preeclampsia and SGA (24) and could represent the link between abnormal placentation and a pathological development of lung blood vessels (25).…”

Section: Pregnancy Disorders and Neonatal Outcomementioning

confidence: 99%

“…Mortality, e.g., has been found to be higher (2,3), lower (4,5), or equal (6) in preeclampsia as compared with spontaneous preterm labor. The same discrepancies occur for bronchopulmonary dysplasia (BPD) (7)(8)(9)(10).…”

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confidence: 92%

“…According to our data, GA was differentially associated with the pregnancy complications leading to preterm delivery and was a strong predictor of outcomes. Adjustment for GA is widely used in observational studies examining predictors of neonatal outcomes after preterm birth (2)(3)(4)(5)(6)(7)9,10,30). Yet this approach is not uncontroversial and can lead to biased conclusions (31).…”

Section: Pregnancy Disorders and Neonatal Outcomementioning

confidence: 99%

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Pregnancy disorders leading to very preterm birth influence neonatal outcomes: results of the population-based ACTION cohort study

Gagliardi

Rusconi

Frè³

et al. 2013

Pediatr Res

100

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“…Some studies found an association with BPD, [21][22][23] but others did not. 10,24,25 Most studies focused on maternal disorders but did not look at fetal consequences of placenta-mediated pregnancy complications.…”

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confidence: 99%

Placental Complications and Bronchopulmonary Dysplasia: EPIPAGE-2 Cohort Study

et al. 2016

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OBJECTIVE: To investigate the relationship between placenta-mediated pregnancy complications and bronchopulmonary dysplasia (BPD) in very preterm infants.METHODS: National prospective population-based cohort study including 2697 singletons born before 32 weeks' gestation. The main outcome measure was moderate to severe BPD. Three groups of placenta-mediated pregnancy complications were compared with no placenta-mediated complications: maternal disorders only (gestational hypertension or preeclampsia), fetal disorders only (antenatal growth restriction), and both maternal and fetal disorders. RESULTS:Moderate to severe BPD rates were 8% in infants from pregnancies with maternal disorders, 15% from both maternal and fetal disorders, 23% from fetal disorders only, and 9% in the control group (P < .001). When we adjusted for gestational age, the risk of moderate to severe BPD was greater in the groups with fetal disorders only (odds ratio [OR] = 6.6; 95% confidence interval [CI], 4.1-10.7), with maternal and fetal disorders (OR = 3.7; 95% CI, 2.5-5.5), and with maternal disorders only (OR = 1.7; 95% CI, 1.0-2.7) than in the control group. When we also controlled for birth weight, the relationship remained in groups with fetal disorders only (OR = 4.2; 95% CI, 2.1-8.6) and with maternal and fetal disorders (OR = 2.1; 95% CI, 1.1-3.9).CONCLUSIONS: Placenta-mediated pregnancy complications with fetal consequences are associated with moderate to severe BPD in very preterm infants independently of gestational age and birth weight, but isolated maternal hypertensive disorders are not. Fetal growth restriction, more than birth weight, could predispose to impaired lung development.

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Maternal preeclampsia and risk of bronchopulmonary dysplasia in preterm infants

Cited by 54 publications

References 23 publications

Association of Maternal Hypertension and Chorioamnionitis With Preterm Outcomes

Association of Maternal Hypertension and Chorioamnionitis With Preterm Outcomes

Pregnancy disorders leading to very preterm birth influence neonatal outcomes: results of the population-based ACTION cohort study

Placental Complications and Bronchopulmonary Dysplasia: EPIPAGE-2 Cohort Study

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