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

Abstract

BackgroundAt present, the conclusions about the impact of hypertensive disorders of pregnancy (HDP) on the clinical outcomes of preterm infants are inconsistent. This study used the propensity score matching (PSM) analysis to evaluate the effect of HDP on clinical outcomes of extremely preterm or extremely low birth weight (EP/ELBW) infants.MethodsRetrospective analysis was performed on the EP/ELBW infants discharged from 26 tertiary neonatal intensive care units or died during hospitalization from 2008 to 2017, who were divided into HDP group and non-HDP group. The six covariates including sex, gestational age, birth weight, twin or multiple pregnancy, antenatal steroids administration, and conception method were matched through the PSM method at a ratio of 1:1. The survival rate at discharge and the major clinical complications were compared between the two groups.ResultsAfter matching the six covariates, compared with the non-HDP group, there was no significant difference in the survival rate at discharge (64 vs. 63.2%, p > 0.05), the incidence of bronchopulmonary dysplasia (BPD) or moderate to severe BPD in the HDP group (58.3 vs. 54.9%, p > 0.05; 5.2 vs. 6.2%, p > 0.05). The incidence of periventricular leukomalacia (PVL) in the HDP group was significantly increased (5.7 vs. 1.9%, p < 0.05).ConclusionsHDP increased the risk of PVL in EP/ELBW infants, but had no significant effect on the survival rate at discharge, or the occurrence of other complications.

Hypertensive disorders of pregnancy and adverse outcomes of twins

“…Research suggests that this association may be attributed to the heightened risk of adverse complications in twin pregnancies complicated by HDP. Previous studies have also con rmed an elevated risk of low Apgar scores in singleton infants affected by HDP, [27,53] although the impact on twin pregnancies may be less pronounced. [54] Importantly, our ndings revealed that HDP increased the risk of low Apgar scores, with preeclampsia having a more signi cant effect on twin infants compared to gestational hypertension.…”

“…In clinical practice, there are multiple causes of extremely preterm birth, and if left untreated, HDP still raises the risk of preterm birth. [27,42] However, gestational hypertension can also act as a warning sign during pregnancy. As a result, HDP patients receive closer monitoring and medical interventions to reduce the risk of pregnancy complications.…”

“…Singletons born to mothers with HDP have a higher risk of various diseases, such as neonatal respiratory distress syndrome (NRDS), [24] dependence on respiratory support, [24,25] and bronchopulmonary dysplasia (BPD). [25,26] The impact of HDP pregnancies on infant intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) [26,27] and retinopathy of prematurity (ROP)[26, 28] remains unclear. There is limited research exploring the impact of HDP on complications in twin newborns.…”

“…A systematic search identi ed one study that reported contradictory outcomes in twins compared to singletons resulting from HDP. [25][26][27][28][29] Considering the high incidence of twin pregnancies and increased risk of HDP, our study investigates the impact of HDP on twin infants and provides evidence to address the current controversies. We will include relevant factors and employ both propensity score matching (PSM) and overlapping weights (OW) models to explore the causal relationship between HDP and adverse outcomes.…”