The association between hypertensive disorders in pregnancy and bronchopulmonary dysplasia: a systematic review
Guang-Liang Bi1, Fei-Li Chen, Wei-Min Huang
1Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
Insights
Hypertensive disorders in pregnancy (HDP) may increase the risk of bronchopulmonary dysplasia (BPD) in preterm infants. However, this association requires cautious interpretation due to significant heterogeneity and publication bias in the studies reviewed.
Area of Science:
- Neonatal Medicine
- Perinatal Health
- Respiratory Medicine
Background:
- The association between hypertensive disorders in pregnancy (HDP) and bronchopulmonary dysplasia (BPD) in preterm infants remains controversial.
- A systematic review and meta-analysis were conducted to clarify this relationship.
Purpose of the Study:
- To determine if hypertensive disorders in pregnancy (HDP) are a risk factor for bronchopulmonary dysplasia (BPD) in preterm infants.
- To synthesize evidence from existing literature through a systematic review and meta-analysis.
Main Methods:
- Comprehensive literature search across multiple databases (PubMed, Embase, Cochrane Library, etc.) with no language restrictions.
- Independent data extraction by two reviewers, followed by meta-analysis using a random-effects model to calculate pooled odds ratios (OR).
- Investigation of potential confounders using meta-regression and subgroup analysis; assessment of publication bias using funnel plots and Egger's test, with Trim and Fill method for control.
Main Results:
- Fifteen studies involving 20,779 patients were included in the analysis.
- Pooled unadjusted OR (1.29) and adjusted OR (1.59) indicated a significant association between HDP and increased BPD risk.
- Substantial heterogeneity (I²=74%) was observed, potentially due to variations in maternal complications across studies; publication bias was detected for unadjusted estimates.
Conclusions:
- Both unadjusted and adjusted analyses suggest that hypertensive disorders in pregnancy are associated with a slightly higher rate of bronchopulmonary dysplasia in preterm infants.
- The findings should be interpreted with caution due to identified substantial heterogeneity and publication bias.
- Further research may be needed to confirm the association and explore underlying mechanisms, considering confounding factors.
Background:
Whether hypertensive disorders in pregnancy (HDP) are the risk factors of bronchopulmonary dysplasia (BPD) is controversial. A systematic review was made to determine the association between HDP and BPD in preterm infants.
Methods:
We searched PubMed, Embase, Cochrane Library, ScienceDirect, Web of Science, with no language limitation, and reviewed the reference lists of the selected articles to identify additional relevant publications and contacted the authors of relevant studies for further information. The data were extracted independently by 2 reviewers who used a predetermined data extraction form. Studies were combined with an odds ratio (OR) using a random-effects model. Meta-regression and subgroup analysis were used to explore potential confounders. Funnel plots, Egger's test and Begg's test were used to investigate the publication bias. The Trim and Fill method was used to control the publication bias.
Results:
A total of 787 studies were identified and only 15 studies (20 779 patients) were included. The pooled unadjusted OR showed that HDP was significantly associated with BPD (P=0.04; OR=1.29, 95% CI=1.01-1.65). Heterogeneity was substantial (I(2)=74%) and might be partially explained by different variables in maternal complications between the control groups across the studies. The pooled adjusted OR suggested the same conclusion that HDP was a risk factor for BPD (P=0.01; OR=1.59, 95% CI=1.11-2.26). Funnel plot and Egger's test showed that there were publication bias of unadjusted estimate of association between HDP and BPD.
Conclusions:
Unadjusted analyses showed that the rate of BPD was slightly higher in the infants exposed to HDP, and adjusted analyses confirmed this finding. But this result should be interpreted cautiously because substantial heterogeneity and publication bias were identified in this review.
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