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Maternal hypertensive disorders and neurodevelopmental disorders in offspring: a population-based cohort in two

Hui Wang1,2, Krisztina D László3, Mika Gissler4,5,6

  • 1MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

European Journal of Epidemiology
|May 5, 2021
PubMed

Insights

Maternal hypertensive disorders during pregnancy, particularly early-onset pre-eclampsia, are linked to higher risks of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID) in children.

Area of Science:

  • Obstetrics and Gynecology
  • Neuroscience
  • Public Health

Background:

  • Maternal hypertensive disorders during pregnancy (HDP) are recognized risk factors for adverse offspring neurodevelopment.
  • Specific HDP subtypes, timing, and severity may differentially impact neurodevelopmental outcomes.

Purpose of the Study:

  • To investigate associations between specific maternal hypertensive disorders during pregnancy (HDP) and offspring neurodevelopmental disorders (NDDs).
  • To examine the influence of HDP onset timing and severity on these associations.
  • To assess the independence of these associations from shared familial factors.

Main Methods:

  • Large-scale cohort study utilizing Danish and Swedish national registers (n=4,489,044).
  • Maternal HDP categorized (chronic hypertension, gestational hypertension, pre-eclampsia with timing/severity stratification).
  • Offspring NDDs (ADHD, ASD, ID) identified via ICD-coded diagnoses; Cox regression and sibling analyses performed.

Main Results:

  • Maternal HDP associated with increased offspring risks of ADHD (HR 1.24), ASD (HR 1.29), and ID (HR 1.58).
  • Pre-eclampsia, especially early-onset and severe forms, showed strongest associations (e.g., severe pre-eclampsia with ID: HR 3.99).
  • Findings consistent in sibling analyses, indicating independence from shared familial factors.

Conclusions:

  • Maternal HDP, particularly early-onset pre-eclampsia, significantly increases offspring risk for ADHD, ASD, and ID.
  • These associations persist independently of shared genetic and environmental factors.
  • Highlights the importance of monitoring and managing hypertensive disorders during pregnancy for child neurodevelopmental health.

Keywords:
Attention-deficit/hyperactivity disorderAutism spectrum disorderHypertensive disorders during pregnancyIntellectual disabilityPre-eclampsiaRegister-based research

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