Preeclampsia and the Risk of Bronchopulmonary Dysplasia in VLBW Infants: A Population Based Study

Abstract

BackgroundPreeclampsia remains a leading cause of maternal mortality and preterm delivery. Both preeclampsia and bronchopulmonary dysplasia (BPD) of prematurity are associated with impaired angiogenesis. However, the relationship between maternal preeclampsia and BPD remains controversial. This study aims to test whether or not preeclampsia is associated with development of BPD in a cohort of premature infants.Materials and MethodsWe conducted a retrospective cohort study assessing the association between preeclampsia and the risk of developing BPD in very-low-birth-weight (VLBW) infants registered in the Premature Baby Foundation of Taiwan from 1997 through 2006. All 21 neonatal departments in Taiwan participated in the data collection. A total of 8,653 VLBW infants were registered in the database. The exclusion criteria included congenital anomalies, chromosome anomalies, infants that died before 36 weeks post-conceptual (PCA), and those whose BPD status were unavailable. BPD was defined as oxygen dependence at 36 weeks postmenstrual age. The association between maternal preeclampsia and BPD was assessed using a multivariate-adjusted logistic regression model.ResultsIn the end, a total of 5,753 cases were enrolled in this study. The incidence of preeclampsia was 14.7% (n=847) and the overall incidence of BPD was 34.9%. Infants with maternal preeclampsia had a higher gestational age, higher incidence of cesarean section and being small for their gestational age, lower incidence of respiratory distress syndrome, patent ductus arteriosus, and sepsis. BPD occurred significantly less frequently in the maternal preeclampsia group (24.1% vs. 36.7%; adjusted odds ratio: 0.78; 95% confidence interval, 0.62–0.98). Subgroup analysis showed that the association between preeclampsia and BPD was significant only in those VLBW infants with a gestational age between 31–34 weeks.ConclusionThis data supports the association between fetal exposure to maternal preeclampsia and a reduced risk of BPD in relatively mature VLBW infants.

Fetal Doppler velocimetry and bronchopulmonary dysplasia risk among growth-restricted preterm infants: an observational study

“…[27][28][29] Our data do not show any association between BPD and pre-eclampsia when considered independently from FGR.…”

Placental Complications and Bronchopulmonary Dysplasia: EPIPAGE-2 Cohort Study

“…These were not the expected results and could help explain the contradictory findings in the literature. Indeed, previous studies found a positive association 21,23,33 or no association 10,25,34 between placentamediated complications and BPD. However, a few studies distinguished between preeclamptic women with and without FGR.…”

“…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.…”

Bronchopulmonary dysplasia: A review of pathogenesis and pathophysiology

“…However, there is no definitive evidence linking these hypertensive disorders in pregnant women with development of BPD 23,43–47 . Recently, a prospective population-based cohort study that included 2697 premature infants born before 32 wk gestation showed that the incidence of moderate to severe BPD was strongly associated with IUGR and pregnancy-induced hypertensive disorders with IUGR, but not with isolated pregnancy-induced hypertensive disorders.…”