Preeclampsia: Effect on the Fetus and Newborn

Abstract

Preeclampsia (PE) is the most common medical complication in pregnancy and a major cause of maternal and fetal morbidity and mortality. This disease is a great challenge for obstetricians because there are no effective interventions to treat or prevent it, and antenatal care involves a difficult balance between the risks for women to continue pregnancy and the risks for the baby's early birth. Fetal complications in PE are directly related to gestational age and the severity of maternal disease and include increased rates of preterm delivery, intrauterine growth restriction, placental abruption, and perinatal death. The major complications for the newborn are related to prematurity, although the data on the morbidity and outcome for preterm infants of women who have PE are conflicting, and few studies address this issue. The pathogenesis of PE involves abnormal placentation associated with immune and vascular events that result in endothelial dysfunction and clinical manifestations of PE. This disease has been associated with imbalance in angiogenic factors and oxidative stress. Nevertheless, only a limited number of studies have been carried out on fetuses and newborns that suggest that infants born from women who have PE are exposed to increased oxidative stress. Because oxidative stress and free radicals may play roles in several neonatal diseases, a direct effect of maternal disease on neonatal outcome is expected, and further research on such neonates, in the short-and long-term, is urgently needed.Objectives After completing this article, readers should be able to:1. Recognize the importance of PE. 2. Understand the pathophysiology of the disease and its related fetal effects. 3. Describe the most common fetal complications in PE. 4. Characterize the newborn whose mother has PE.

Inflammatory and oxidative stress airway markers in premature newborns of hypertensive mothers

“…Intrauterine growth restriction is a common complication of hypertensive disorders of pregnancy, and a high incidence of small for gestational age infants in preeclamptic women has been reported, ranging from 15% to more than 50% (1). This was confirmed in our study, in which 44% of premature infants of hypertensive mothers were small for gestational age.…”

“…The consequences of these disorders in the infant most notably include intrauterine growth restriction, prematurity, and increased risk of neonatal diseases (1). …”

“…Preeclampsia, the most common manifestation of hypertensive disorders, is attributed to inadequate placentation and reduced uteroplacental blood flow, causing ischemia/reperfusion and release of various mediators involved in the pathophysiology of the disease, including cytokines and products of oxidative stress (1). In pregnancies complicated by hypertensive disorders, the levels of pro-oxidant agents are increased and the levels of antioxidants are decreased in the maternal blood and placenta (2,3).…”

Hypertensive Diseases of Pregnancy Predict Parent-Reported Difficult Temperament in Infancy

“…Our results expand upon previous findings that maternal gestational hypertension was associated with an increase in behavioral problems in offspring, 1 poorer verbal ability at age 10 years, 2 and adverse developmental outcomes at 4.5 years 5 by demonstrating that effects are present in infancy. 8 Although a controlled trial of antihypertensive medications (methyldopa and labetalol) did not show adverse effects for the fetus, 34 such medications have since been implicated in later mental health problems for children. 32 This is the earliest report of behavioral difficulties after pregnancy complicated by gestational hypertension and/or preeclampsia.…”

“…4 Another recent study found that severe early-onset hypertensive complications of pregnancy, including preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), were associated with abnormal developmental outcomes (e.g., cognition, motor development) at age 4.5 years, but that study found no link between gestational hypertension and child behavior. 8 Alternatively, it is possible that these findings may reflect side effects of the drugs used to treat maternal gestational hypertension and preeclampsia, such as methyldopa and labetalol. This could be because of psychoneuroendocrine changes directly and indirectly associated with gestational hypertension and preeclampsia.…”