Preeclampsia: effect on newborn blood pressure in the 3 days following preterm birth: a cohort study

Abstract

Maternal hypertension and preeclampsia are associated with greater risk of hypertension in childhood, and cardiovascular events in adulthood. However, whether preeclampsia affects blood pressure (BP) in the newborn period is unclear. Previous neonatal studies were based on small sample sizes, very low birth weight or gestational age or limited duration (h). To delineate hemodynamic repercussions of maternal preeclampsia on preterm infants (gestational ages ⩾29 weeks) with/without intrauterine growth restriction (IUGR) in the first 3 postnatal days, we conducted a single-centre retrospective cohort study of singleton births at 29-35 weeks of gestation in Montreal, Canada, from 2008 to 2011. Data were obtained from medical charts. Exclusion criteria included congenital anomalies, infections, pre-pregnancy maternal hypertension and gestational diabetes. IUGR was defined as birth weight <10th percentile. Of the 338 eligible neonates, 230 were included: 75 preeclampsia-IUGR, 72 preeclampsia-only and 83 controls. The preeclampsia-IUGR group had longer gestations than the preeclampsia-only or control groups (32.4±1.8 vs. 31.3±1.6 vs. 31.7±1.6 weeks, respectively; P<0.001). Mean BPs increased over the first 3 days for all newborns (P<0.001). Infants with preeclampsia-associated IUGR had the highest systolic and diastolic BPs, even after adjustment for birth weight, and preeclampsia-only the next highest. Systolic BP progression showed significant differences between groups (P<0.05). We conclude that impact of preeclampsia on children blood pressure was manifest within days of birth, over and above coexisting IUGR. Long-term cardiovascular follow-up and targeted preventive strategies are advised for this underrecognized high-risk population.