OP 9 Hypertensive disorders of pregnancy and the risk of neurodevelopmental disorders – A systematic review and meta-analysis

Abstract

Introduction Hypertensive disorders of pregnancy (HDP) such as preeclampsia affect 10%–15% of pregnancies. HDP exposure has been linked to an increased risk of attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and other neurodevelopmental disorders in children. However, findings are inconsistent and a clear consensus on the impact of HDPs on the risk of neurodevelopmental disorders is needed. Objectives Synthesise the published literature on the relationship between HDPs and the risk of neurodevelopmental disorders in the form of a systematic review and meta-analysis. Methods We included cohort, case-control and cross-sectional studies in which diagnosis of a HDP was reported and neurodevelopmental disorders were the outcome of interest based on a pre-prepared protocol. A systematic search of PubMed, CINAHL, EMBASE, PsycINFO and Web of Science was performed up to 21 February 2017 in accordance with a detailed search strategy. Two authors independently reviewed the titles and abstracts of all studies. Data abstraction was performed by two reviewers independently using a standardised data abstraction form, and study quality assessed using a bias classification tool. Meta-analyses were performed to calculate an overall pooled estimate using the generic inverse variance method. Results Thirty studies met inclusion criteria. Pooled estimates were performed for HDP-ADHD and HDP-ASD. Nine studies reported an estimate for HDP-ADHD, and using a fixed effects model based on Cochrane criteria, produced an odds ratio (OR) of 1.31 (95% CI: 1.25, 1.37). Seven studies reported an estimate for HDP-ASD, producing an OR of 1.44 (95% CI: 1.12, 1.85) using a random effects model. Fourteen studies met inclusion criteria for all other neurodevelopmental disorders and standalone estimates were reported for these. Results of a subgroup analysis examining preeclampsia (the most common HDP) did not change the ADHD OR, while the OR for a preeclampsia-ASD relationship increased to 1.73 (95% CI: 1.40, 2.15). Conclusion These data indicate that exposure to HDP is associated with a modest increase in the risk of ADHD and ASD. These findings highlight the need for greater paediatric surveillance of HDP-exposed infants to allow early intervention which is known to help improve neurodevelopmental outcome.