221 - Maternal hypertension during pregnancy is independently associated with an increased risk of cognitive and language impairments at two years corrected age in very preterm infants

Poster Number: 221
Publication Number: 221.143

Shipra Jain, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Ting Ting Fu, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Maria E. Barnes-Davis, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Rashmi D.. Sahay, CCHMC, Cincinnati, OH, United States; Shelley Ehrlich, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Chunyan Liu, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; mounira habli, Cincinnati Childrens Hospital, Mason, OH, United States; Nehal A. Parikh, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Whether maternal hypertensive disorders of pregnancy (HDP) are an independent risk for neurodevelopmental impairments in premature infants is controversial. Studies are limited by inappropriate control of growth restriction/birth weight as a confounder that lies on the causal pathway between HDP and neurodevelopmental outcomes, resulting in collider stratification bias. Moreover, they fail to control for significant confounders like chorioamnionitis.

Objective: Evaluate the effects of maternal HDP, especially preeclampsia (PE), on neurodevelopmental outcomes of very preterm (VPT) infants at two years corrected age using appropriate confounders.

Design/Methods: This is a secondary analysis of a regional prospective cohort study of 395 VPT infants (≤32 weeks gestation) from 5 level III/IV neonatal intensive care units from September 2016 to November 2019 (CINEPS). Infants were classified as HDP-exposed based on maternal diagnosis of chronic hypertension or gestational hypertension/PE during pregnancy. Neurodevelopment was assessed by Bayley Scales of Infant & Toddler Development (BSID), 3rd Edition, between 22-26 months corrected age. We performed multivariable linear regression analyses to identify the independent effects of HDP on cognition (primary), language, and motor development, controlling for nine clinical confounders (Table 2). In secondary analyses, we repeated the same modeling for PE exposure.

Results: Of 395 VPT infants, 43% (N=170) were HDP-exposed. The HDP and non-HDP groups were comparable except for maternal age, multiple gestations, histologic chorioamnionitis, and antenatal magnesium therapy (Table 1). Sixty-one percent (104/170) of mothers with HDP had PE. PE and non-HDP groups were also comparable except for multiple gestations, histologic chorioamnionitis, antenatal magnesium therapy, and birth hospital. Of 395, two infants withdrew, one died and 341(87%) completed BSID. Follow-up rates between groups were similar. While BSID outcomes were similar between exposed and non-exposed groups (Table 1), in adjusted models, HDP was negatively associated with cognitive (Table 2) and language (Table 3) scores. PE exposure was also associated with poor cognitive and language development in adjusted models. Neither HDP nor PE exposure correlated with motor scores (Table 3).

Conclusion(s): Maternal HDP is independently associated with adverse cognitive and language development. These effects are accentuated for infants in the PE-exposed group. This emphasizes the potential clinical implications of primary and secondary hypertension prevention efforts for at-risk women and their preterm infants.