Maternal hypertensive disorders are associated with increased use of respiratory support but not chronic lung disease or poorer neurodevelopmental outcomes in preterm neonates at

Abstract

To assess whether maternal hypertensive disorders in pregnancies result in higher respiratory requirements, risk of chronic lung disease (CLD) and poorer neurodevelopmental outcome in <29-week premature neonates. This is a multicentre, retrospective cohort study, within a geographically defined area in Australia, served by a network of 10 neonatal intensive care units (NICUs), consisting of infants <29 weeks of gestational age who were admitted to NICUs between 1998 and 2004. Outcome measures included hospital survival, perinatal complications and functional disability at 2-3 years follow-up. A total of 2549 mothers and infants were included in the study; 379 (14.9%) mothers had hypertensive disorders during pregnancy. Follow-up data were obtained for 1473 (74.8%) infants at 2-3 years. Infants exposed to pre-eclampsia had a higher need for supplemental surfactant therapy (odds ratio (OR): 2.004, 95% confidence interval (CI): 1.51-2.66), longer duration of mechanical ventilation (7.0 days vs. 4.0 days), were associated with a higher incidence of CLD (OR: 1.40, 95% CI: 1.12-1.76) and received post-natal steroids for CLD (OR: 1.82, 95% CI: 1.43-2.31) and home oxygen (OR: 1.47, 95% CI: 1.11-1.95). Multivariable analysis showed that hypertensive disease of pregnancy was not significantly associated with the development of CLD in this cohort (OR: 1.103, 95% CI: 0.845-1.441). Multivariable analysis of long-term neurodevelopmental data available for the 1473 follow-up infants showed no significant difference in outcomes with or without exposure to maternal hypertensive disease. Maternal hypertensive disease of pregnancy does not increase the risk of CLD or long-term neurodevelopmental complications in infants born at <29 weeks of gestation.