732: Maternal chronic hypertensive disorders during pregnancy and long-term endocrine and metabolic morbidity of the offspring

Abstract

Maternal hypertensive disorders during pregnancy are known to be associated with high rates of perinatal complications for both mother and child. We aimed to determine whether maternal chronic hypertension impacts on long-term pediatric endocrine and metabolic morbidity. Apopulation-based, prospectively analyzed, cohort study was performed which included all singleton deliveries between 1991-2014 at a single regional tertiary medical center. Exposure was defined as the presence of maternal chronic hypertension (diagnosed prior to 20 weeks’ gestation). We excluded multiple gestations, fetuses with congenital malformations, and mothers with gestational hypertensive disorder (including gestational hypertension, preeclampsia, and eclampsia). Hospitalizations of the offspring up to the age of 18 years involving endocrine and metabolic morbidity were evaluated according to a predefined set of ICD-9 codes related to these morbidities. A Kaplan-Meier survival curve was used to compare the cumulative morbidity incidence between both groups. Cox proportional hazards models were used to control for confounders. During the study period, 232,841 singleton deliveries met the inclusion criteria. Of them, 4.9%(n=2655) were exposed to maternal chronic hypertension. Total hospitalizations rate up to the age of 18 years, was doubled in the exposed group (1% vs. 0.5% in the unexposed group, p< 0.001), as were the rates per 1000 person-years with a hazard ratio of 1.82 (Table). The survival curve demonstrated significantly higher cumulative incidence of total endocrine morbidity in the exposed group (Figure, log rank p-0.002). In a Cox regression model, controlled for maternal obesity, maternal diabetes, and gestational age, maternal chronic hypertension exhibited an independent association with long-term childhood endocrine or metabolic morbidity (adjusted HR=1.5, 95%CI 1.01-2.2, p=0.045). Maternal chronic hypertension appears to be an independent and a significant risk factor for long-term pediatric endocrine and metabolic morbidities in general, and specifically for childhood obesity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)