Introduction
Hypertensive Disorder | Definition of hypertension | Associated Features |
---|---|---|
Chronic hypertension | Onset before pregnancy or before 20 weeks’ gestation: − ≥ 140 mmHg SBP or − ≥ 90 mmHg DBP | − Mainly due to essential hypertension − 24-h ambulatory BP monitoring assists the exclusion of white-coat hypertension − Risk factor for preeclampsia, maternal CVD and FGR |
Gestational hypertension | New onset at or after 20 weeks’ gestation: − ≥ 140 mmHg SBP or − ≥ 90 mmHg DBP | − May be transient in nature, arising and settling in the 2nd-3rd trimester − 25% will progress to preeclampsia − Return to normal BP postpartum with no antenatal proteinuria or maternal end-organ dysfunction − Increased future risk of maternal CVD |
Preeclampsia | New onset at or after 20 weeks’ gestation with end-organ dysfunction: − ≥ 140 mm Hg SBP or − ≥ 90 mm Hg DBP | New onset of ≥ 1: − Proteinuria − Acute Kidney Injury − Elevated liver transaminases − Neurological complications − Thrombocytopenia − Uteroplacental dysfunction − FGR − HELLP syndrome (haemolysis, elevated liver enzymes, thrombocytopaenia) |
Eclampsia | New onset of antenatal, intrapartum or postpartum tonic–clonic, focal, or multifocal seizures without other causative conditions | Often preceded by: − Severe and persistent occipital or frontal headaches − Blurred vision − Photophobia − Altered mental status |
First Author (Year) | Study Type | Exposure (Number) | Outcomes Assessed | Main Findings at 2 Yearsa (PE versus NTP-exposed infants) | Adjusted Confounders | Comments |
---|---|---|---|---|---|---|
Szymonowicz (1987) [23] | Prospective case–control | PE (35) NTP (35) | Weight | PE lower | Nil | Cohort: preterm, VLBW infantsb ROB: Low |
Length | ND | |||||
Head circumference | ||||||
Martikainen (1989) [24] | Prospective cohort | PE (31 preterm, 40 term) NTP (128 preterm, 175 term) | Weight Length | Preterm: PE lower Term: ND | Infant sex, GA | Also assessed other HDPs Cohort stratified by hypertension exposure, prematurity and SGA status. Assessed 18-month outcomes ROB: Low |
Weight gain Length gain | Term PE: greater catch up than preterm PE infants | |||||
Head circumference | Preterm: ND Term: PE higher | |||||
Cheng (2004) [25] | Retrospective cohort | PE (28) NTP (61) | Weight | ND | Nil | Cohort: very preterm (< 32 weeks), VLBW infantsb. Small sample size ROB: Low |
Length | ||||||
Head circumference | ||||||
Silveira (2007) [26] | Prospective cohort | PE (40) NTP (46) | Weight, Weight-for-age | PE lower, slower catch-up weight in VLBW PE than VLBW NTP | GA | Cohort: preterm, VLBW infantsb. Assessed 12, 18-month outcomes ROB: Low |
Length-for-age | ND | |||||
Head circumference | PE lower | |||||
Weight-for-length | ||||||
Davis (2015) [18] | Prospective cohort | C-HTNc (89) NTP (1434) | Weight | ND | Infant sex, GA, birthweight | Grouped PE and GH causing preterm birth into C-HTN Assessed 12-month outcomes. Assessed growth and CVD risk to 20 years ROB: Low |
Length | ||||||
BMI | ||||||
Byberg (2017) [27] | Nested case–control | S-PEc (54) M/M-PEc (164) NTP (385) | Weight z-score | PE lower (all) | Infant sex, age Maternal age, BMI, antenatal smoking, education | Considered severity of PE Assessed growth to 13 years No adjustment for GA or birthweight ROB: Low |
Length z-score gain | M/M-PE boys greater, S-PE boys and all girls lower | |||||
BMI | MM-PE girls greater, S-PE girls and all boys lower | |||||
Matić (2017) [28] | Retrospective cohort | GH/PE (261) NTP (1212) | Weight | GH/PE lower | Nil | Grouped PE and GH Cohort: 2–3 year old infants born very preterm (< 29 weeks)b. Powered for chronic lung disease and neurodevelopment ROB: Low |
Length | ||||||
Head circumference | ||||||
Gunnarsdottir (2018) [29] | Retrospective cohort | S-PEc + M/M-PEc (865) NTP (22,898) | Length z-score | S-PE lower | Infant sex, GA, birthweight, SGA status, breastfeeding status Maternal age, parity, height, BMI, diabetes, smoking, education, country of birth Paternal smoking | Assessed 18-month outcomes. Assessed growth from birth to 5 years. No adjustment for paternal factors influencing length ROB: Low |
Length gain | All PE greater, especially S-PE than M/M-PE infants, partly associated with GA | |||||
Huang (2020) [30] | Prospective cohort | PE (24) NTP (168) | BMI | PE greater | Infant sex, GA, birthweight Maternal age, parity, gestational diabetes mellitus, education, marital status | Considered association of both gestational diabetes mellitus and PE on growth. Assessed 18, 24-month outcomes. Assessed growth to 6 years. Small sample size ROB: Low |
Gow (2021) [31] | Prospective cohort | PE (84) NTP (298) | Weight Weight z-score | PE lower | Infant sex, GA, NICU/SCN stay length, feeding status, labour onset, mode of delivery Maternal age, weight, BMI, parity, ethnicity, smoking, education | Assessed 6-month outcomes ROB: Low |
Weight gain | PE greater | |||||
Weight z-score gain Rapid weight gain Conditional weight gain | ND, any SGA greater than not SGA | |||||
Length Length z-score | PE lower ND | |||||
Length gain Length z-score gain | PE greater ND | |||||
BMI | ND | |||||
Jasper (2021) [32] | Retrospective cohort | PE (659) NTP (1909) | Rate of weight z-score gain | ND | Infant birthweight, GA, head circumference, multiple birth, postnatal hospitalisation, year of birth, mode of delivery, perinatal complications Maternal age, BMI, ethnicity, SES | Cohort: preterm infantsb Many perinatal exposures assessed, including PE ROB: Low |
Methods
Background
Intrauterine complications of preeclampsia and the DOHaD hypothesis
Perinatal and neonatal outcomes after preeclampsia exposure
Long-term paediatric outcomes after preeclampsia exposure
Infant growth after preeclampsia exposure
Assessment of infant body composition
Assessment of longitudinal infant growth
Results: growth outcomes of infants exposed to preeclampsia
Infant development after preeclampsia exposure
Assessment of infant development
Results: developmental outcomes of infants exposed to preeclampsia
First Author (Year) | Study Type | Exposure (Number) | Tool | Main Findings at 2 Yearsa (PE versus NTP-exposed infants) | Adjusted Confounders | Comments |
---|---|---|---|---|---|---|
Szymonowicz (1987) [23] | Case–control | PE (35) NTP (35) | BSID | MDI: PE lower PDI: ND | Nil | Cohort: preterm, VLBW infantsb ROB: Low |
Spinillo (1994) [148] | Case–control | PE (68) NTP (184) | BSID | MDI: PE lower PDI: PE lower | Maternal age, SES, education | Cohort: preterm infants, PE group had expectant management ROB: Low |
McCowan (2002) [153] | Prospective cohort | PE/GH (88) NTP (131) | BSID-II | MDI: PE/GH higher PDI: ND ND between < 32 weeks and > 32 weeks | Infant sex, GA, hospital stay, breastfeeding status, perinatal complications Maternal age, parity, ethnicity, smoking, education | Cohort: SGA infantsb Grouped PE and GH Assessed 18-month outcomes ROB: Low |
Cheng (2004) [25] | Retrospective cohort | PE (25) NTP (54) | BSID-II | MDI: PE lower (mild delay from -1 to -2 SDs), ND (severe delay), ND between SGA PE and SGA NTP PDI: ND | Infant sex, GA, birthweight, lack of prenatal steroid, PPROM, intraventricular haemorrhage Maternal/paternal education, chronic lung disease | Cohort: VLBW, very preterm (< 32 weeks) infantsb. Small sample ROB: Low |
Silveria (2007) [26] | Prospective cohort | PE (40) NTP (46) | BSID-II | MDI: ND PDI: PE higher | Nil | Cohort: VLBW infantsb Small sample. Assessed 12, 18-month outcomes ROB: Low |
Spinillo (2009) [154] | Prospective cohort | PE (185) NTP (596) | BSID-II | MDI: PE higher (female higher than male), SGA lower than non-SGA | Infant sex, GA, proportion of expected birthweight, SGA status, antenatal steroids, placental abruption, praevia, PPROM, non-reassuring fetal heart rate, chorioamnionitis, caesarean section, year of birth, umbilical artery pH = < 7.2 Maternal age, parity, education, SES, smoking | Cohort: preterm infantsb ROB: Low |
Schlapbach (2010) [152] | Case–control | PE (33) NTP (33) | BSID-II | MDI: ND PDI: ND | Infant GA, birthweight, 2-year body weight, bronchopulmonary dysplasia, mechanical ventilation | Cohort: very preterm (< 32 weeks) infantsb |
Matić (2017) [28] | Retrospective cohort | PE/GH (261) NTP (1212) | Griffiths MDS, BSID-II | ND Long-term functional disability: SGA status, earlier GA and male sex were significant | Infant sex, GA, birthweight, surfactant therapy Maternal parity | Grouped PE and GH Cohort: infants aged 2–3 years, born very preterm (< 29 weeks). Powered to assess chronic lung disease, not just neurodevelopment ROB: Low |
Degirmenci-oglu (2018) [155] | Retrospective cohort | PE (120) NTP (251) | BSID-II | MDI: PE higher PDI: ND Overall neurodevelopmental index: ND | Infant GA, birthweight, asphyxia, sepsis, intraventricular haemorrhage, necrotising enterocolitis Maternal hypothyroidism | Cohort: VLBW, very preterm (< 32 weeks) infants, but FGR infants were excludedb Assessed 18- 24-month outcomes ROB: Low |
Martikainen (1989) [24] | Prospective cohort | GH (14 preterm, 60 term) PE (31 preterm, 40 term) NTP (128 preterm, 175 term) | Denver | Term: PE/GH higher motor performance, visuo-auditory perception, and social abilities Preterm: PE lower fine motor and visuo-auditory perception, SGA lower than non-SGA | Infant sex, GA | Also assessed other HDPs. Cohort stratified by hypertension exposure, prematurity and SGA statusb. Assessed 18-month outcomes ROB: Low |
Gray (1998) [151] | Prospective cohort | GH (14) PE (79) NTP (107) | Griffiths-II, NSMDA | ND | Nil | Cohort: very preterm (24–32 weeks) infantsb ROB: Low |
Johnson (2015) [149] | Prospective cohort | Preterm (638) Term (765) | PARCA-R | Preterm: PE was independent risk factor for cognitive impairment, preterm lower than term | Infant sex, SGA status Maternal ethnicity, SES | Cohort: late preterm infants (32–36 weeks)b Assessed other perinatal variables, including PE ROB: Low |
Wade (2016) [156] | Prospective cohort | HDP (23) NTP (478) | Many tools- see study | Social cognition: HDP lower | Infant age, sex, GA, birthweight Maternal age, gestational diabetes mellitus, thyroid problems, SES, smoking status | Grouped PE with other HDPs. Small sample Assessed 18-month outcomes ROB: Low |
Warshafsky (2016) [80] | Prospective cohort | Mild PE (34) Severe PE (46) NTP (103) | ASQ | Severe PE was protective, higher GA reduced risk and FGR increased risk in both groups | Infant sex, GA, SGA status breastfeeding status, MgSO4 usage Maternal age, parity, ethnicity, smoking, SES, education | Cohort: FGR infants below 5th centile Removed the mild PE subgroup due to poor numbers. Assessed 12, 24-month outcomes ROB: Low |
Bharadwaj (2018) [157] | Case–control | PE (56) NTP (61) | DASII | Motor and mental development quotients: PE lower, maternal total antioxidant status was an independent motor development quotient predictor (PE group) | Infant GA, early onset sepsis, respiratory distress syndrome, necrotising enterocolitis Maternal total antioxidant status, Maternal and cord/baby protein carbonyl levels | No adjustment for SGA or prematurity status Assessed 12-month outcomes ROB: Low |
Chen (2020) [158] | Prospective cohort | GH (233) PE (41) NTP (3669) | GDS | Social Behaviour Development Quotient: GH lower Neurodevelopmental delay: ND | Infant sex, GA, birthweight, mode of delivery, asphyxia neonatorum Maternal age, smoking, drinking, education, folic acid supplementation | Also studied chronic hypertension Assessed 6-month outcomes ROB: Low |
Maher (2020) [159] | Prospective cohort | PE (709) NTP (10,425) | ASQ | ASQ failure: ND, ND between preterm vs term | Infant sex, SGA, prematurity Maternal age, ethnicity, BMI, gestational diabetes mellitus, education, SES | PE status determined by maternal recall. Assessed 9-month outcomes ROB: Low |