22: A Prospective Assessment of Neurodevelopment in Children Following a Pregnancy Complicated by Severe Preeclampsia

Abstract

Preeclampsia (PE) affects 2–7% of otherwise healthy women, and is diagnosed by newly elevated BP after 20 weeks gestation, with associated proteinuria. The etiology of PE is largely unknown. Many theories have been proposed, including mechanisms involving oxidative stress, angiogenic imbalance, and immunologic intolerance between feto-placental and maternal tissue. Delivery is the only definitive cure, with other treatments focused on symptom management. Gestational hypertension occurs in 6–17% of pregnancies, and is defined as newly elevated blood pressure (BP), with the absence of proteinuria, after 20 weeks gestation in a previously normotensive individual. These hypertensive disorders of pregnancy are associated with adverse health outcomes including perinatal deaths, preterm birth, intrauterine growth restriction (IUGR), neonatal morbidity, and infants that are small for gestational age. Previous studies have demonstrated a link between PE and neurodevelopmental delay; however there has been disagreement on whether this effect is protective or harmful. Additionally the independent effects of gestational age (GA), birth weight, and PE are unclear, and the vast majority of studies have been retrospective or cross-sectional in nature. To prospectively examine whether infants of women with a PE pregnancy, compared to infants of women without a PE pregnancy, have differences in anthropometric measurements and/or neurodevelopmental performance. Women were recruited into this longitudinal prospective cohort following a pregnancy with (n=129) or without PE (n=140). Anthropometric measurements were performed on offspring at birth, one, three, and five years of age. The Ages and Stages Questionnaire (ASQ) was completed yearly, until age five. Anthropometrics did not differ between severe PE and controls after birth. The proportion of ASQ categories failed was significantly different in years 1, 3, and 4. Comparison of the distribution of number of categories failed revealed that severe PE children failed significantly more categories at year 1. A subgroup analysis indicated that preterm birth significantly contributes to this relationship, which persists through year 5. Logistic regression indicated that severe PE and IUGR are associated with increased odds of failure, while increased GA is protective. Growth delays experienced by children born to mothers with PE are not found beyond one year of age; however neurodevelopmental changes persist with preterm birth.