Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada.
PLoS One. 2021 Dec 1;16(12):e0260590. doi: 10.1371/journal.pone.0260590. eCollection 2021.
Hypertensive disorders in pregnancy (HDP) are associated with increased risk of offspring neurodevelopmental disorders, suggesting long-term adverse impacts on fetal brain development. However, the relationship between HDP and deficits in general child development is unclear. Our objective was to assess the association between HDP and motor and cognitive developmental delay in children at 36 months of age. We analyzed data from the All Our Families community-based cohort study (n = 1554). Diagnosis of HDP-gestational or chronic hypertension, preeclampsia, or eclampsia-was measured through medical records. Child development was measured by maternal-report on five domains of the Ages and Stages Questionnaire (ASQ-3). Standardized cut-off scores were used to operationalize binary variables for any delay, motor delay, and cognitive delay. We calculated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) using logistic regression, sequentially controlling for potential confounders followed by factors suspected to lie on the causal pathway. Overall, 8.0% of women had HDP and hypertension-exposed children had higher prevalence of delay than unexposed children. Hypertension-exposed children had elevated risk for developmental delay, but CIs crossed the null. The aRRs quantifying the fully adjusted effect of HDP on child development were 1.19 (95% CI 0.92, 1.53) for any delay, 1.18 (95% CI 0.86, 1.61) for motor delay, and 1.24 (95% CI 0.83, 1.85) for cognitive delay. We did not find a statistically significant association between HDP and developmental delay. Confidence intervals suggest that children exposed to HDP in utero have either similar or slightly elevated risk of any, motor, and cognitive delay at 36 months after controlling for maternal and obstetric characteristics. The observed direction of association aligns with evidence of biological mechanisms whereby hypertensive pathology can disrupt fetal neurodevelopment; however, more evidence is needed. Findings may have implications for early developmental monitoring and intervention following prenatal hypertension exposure.
妊娠高血压疾病（HDP）与后代神经发育障碍的风险增加相关，这表明其对胎儿大脑发育存在长期的不良影响。然而，HDP 与儿童整体发育迟缓之间的关系尚不清楚。我们的目的是评估 HDP 与 36 个月龄儿童运动和认知发育迟缓的关系。我们分析了基于社区的 All Our Families 队列研究（n=1554）的数据。通过病历记录来测量 HDP-妊娠期或慢性高血压、子痫前期或子痫的诊断。儿童发育通过母亲使用年龄与阶段问卷（ASQ-3）的五个领域进行报告来测量。使用标准化的截断分数来操作任何发育迟缓、运动迟缓、认知迟缓的二分类变量。我们使用逻辑回归计算调整后的风险比（aRR）和 95%置信区间（CI），依次控制潜在的混杂因素，然后是怀疑位于因果途径上的因素。总的来说，8.0%的女性患有 HDP，患有高血压的儿童比未暴露的儿童更有可能出现发育迟缓。患有高血压的儿童发育迟缓的风险增加，但置信区间未超过零值。HDP 对儿童发育的完全调整效应的 aRR 分别为：任何发育迟缓的 1.19（95%CI 0.92，1.53）、运动迟缓的 1.18（95%CI 0.86，1.61）和认知迟缓的 1.24（95%CI 0.83，1.85）。我们没有发现 HDP 与发育迟缓之间存在统计学上的显著关联。置信区间表明，在控制了母亲和产科特征后，HDP 暴露的儿童在 36 个月时任何、运动和认知发育迟缓的风险要么相似，要么略有增加。观察到的关联方向与高血压病理可能破坏胎儿神经发育的生物学机制的证据一致；然而，还需要更多的证据。研究结果可能对产前高血压暴露后的早期发育监测和干预具有重要意义。
