April 02, 2020
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Preeclampsia during pregnancy increases risk for neurodevelopmental disorders among offspring

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Allen J. Wilcox

Preeclampsia in term pregnancies appeared to have lasting effects on the neurodevelopment of the child, according to results of a prospective, population-based cohort study published in JAMA Psychiatry.

“Term preeclampsia is usually a mild condition, and we usually regard it as of no consequence to the health of the baby,” Allen J. Wilcox, MD, PhD, head of the reproductive epidemiology group at the National Institute of Environmental Health Sciences, told Healio Psychiatry. “Our results suggest that something about the pathology of preeclampsia may contribute to a surprisingly broad range of neurologic problems in children, by mechanisms that at this point remain puzzling. If we could get a better understanding of these biological mechanisms, we might be able to develop preventive measures that would improve child outcomes.”

Preeclampsia — which affects about 4% of pregnancies, according to prior studies — is a disorder of abnormal placentation, dysregulated vasculature and maternal inflammation characterized by new-onset hypertension and organ dysfunction. Other research has shown associations between the disorder and cerebral palsy, ADHD and autism spectrum disorder among offspring. Further, preeclampsia is a major cause of preterm birth because its definitive treatment is delivery.

Wilcox and colleagues aimed to determine the association between preeclampsia and numerous adverse neurodevelopmental outcomes among offspring after excluding preterm births. They analyzed data of 980,560 singleton children (51.2% female) born at term between 1991 and 2009 using Norway’s Medical Birth Registry. They linked these data to other demographic, social and health information from Statistics Norway.

Associations between preeclampsia in term pregnancies and cerebral palsy, ADHD, ASD, epilepsy, intellectual disability and vision or hearing loss, determined using multivariable logistic regression, served as main study outcomes and measures.

Mean follow-up was 5.6 years.

Results showed 28,068 children (2.9%) were exposed to preeclampsia. These children were at increased risk for ADHD (adjusted OR [aOR] = 1.18; 95% CI, 1.05-1.33), ASD (aOR = 1.29; 95% CI, 1.08-1.54), epilepsy (aOR = 1.5; 95% CI, 1.16-1.93) and intellectual disability (aOR = 1.5; 95% CI, 1.13-1.97). The researchers also observed an apparent association between preeclampsia exposure and cerebral palsy (aOR = 1.3; 95% CI, 0.94-1.8).

“Although the outcomes themselves were rare among term births and the absolute increases in risk with maternal preeclampsia were small, these risk estimates were robust to adjustment for social and demographic factors,” they wrote. “Moreover, these associations suggest pathways by which prenatal conditions might increase the risk [for] neurodevelopmental disorders.” – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.