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Published on: November 20, 2015
Preeclampsia, Fetal Growth Restriction, and 24-Month Neurodevelopment in Very Preterm Infants
Jennifer Check1, Coral Shuster2, Julie Hofheimer3
1Department of Pediatrics, Division of Neonatology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina.
Insights
Preeclampsia did not affect preterm infant development, but fetal growth restriction (FGR) was linked to developmental delays. Further research is needed to understand their combined effects on early child development.
Area of Science:
- Neonatal development
- Perinatal medicine
- Developmental pediatrics
Background:
- Preeclampsia impacts fetal development and postnatal health.
- Fetal growth restriction (FGR) often co-occurs with preeclampsia.
- The developmental outcomes of very preterm infants exposed to preeclampsia and/or FGR are not well understood.
Purpose of the Study:
- To investigate the association between maternal preeclampsia and FGR with developmental and behavioral outcomes in very preterm infants.
- To characterize the long-term effects of these conditions on child development.
Main Methods:
- A prospective cohort study of 529 very preterm infants (born before 30 weeks' gestation) was conducted.
- Infants were assessed at 24-month follow-up using the Bayley-III for cognitive, motor, and language development.
- Behavioral outcomes were assessed using the Child Behavior Checklist/Preschool 1.5-5.
Main Results:
- Maternal preeclampsia was not associated with significant differences in Bayley-III scores or behavioral outcomes.
- Fetal growth restriction (FGR) was significantly associated with lower cognitive, language, and motor scores on the Bayley-III.
- These FGR-associated effects were observed irrespective of preeclampsia status.
Conclusions:
- Preeclampsia alone does not appear to be associated with adverse developmental or behavioral outcomes in very preterm infants.
- FGR in very preterm infants is linked to developmental delays, highlighting its importance.
- Further research is warranted to elucidate the distinct and combined roles of preeclampsia and FGR in preterm infant development.
Importance:
Preeclampsia has direct influences on a developing fetus and may impact postnatal health, and fetal growth restriction (FGR) is often seen co-occurring with preeclampsia. The development of children born very preterm after preeclampsia diagnosis with and without FGR is not well characterized.
Objective:
To examine the associations of preeclampsia and FGR with developmental and/or behavioral outcomes in a cohort of very preterm infants.
Design, Setting, And Participants:
In this cohort study, infants in the prospective Neonatal Neurobehavior and Outcomes in Very Preterm Infants study were enrolled between April 2014 and June 2016 from 9 US university-affiliated neonatal intensive care units (NICUs). Eligible infants were born before 30 weeks' gestation. Infants were excluded for any major congenital anomalies and for maternal age younger than 18 years or cognitive impairment impacting the ability to provide informed consent. Data analysis was performed from November 2023 to January 2024.
Exposure:
Maternal preeclampsia and FGR in very preterm infants.
Main Outcomes And Measures:
The Bayley-III cognition, motor, and language scores less than 85 (-1 SD) indicated developmental delay. Child Behavior Checklist/Preschool 1.5-5 T-scores greater than or equal to 64 for internalizing, externalizing, or total problems indicated clinical importance.
Results:
Of 704 infants enrolled, 529 (mean [SD] gestational age, 27.0 [1.9] weeks; 287 male [54.3%]) were studied at 24-month follow-up. A total of 94 infants' mothers had preeclampsia (23.2%), and 46 infants (8.7%) had FGR. In adjusted models, preeclampsia was not associated with Bayley-III (cognitive, B = 3.43 [95% CI, -0.19 to 6.66]; language, B = 3.92 [95% CI, 0.44 to 7.39]; motor, B = 1.86 [95% CI, -1.74 to 5.47]) or Child Behavior Checklist/Preschool 1.5-5 (internalizing, B = -0.08 [95% CI, -2.58 to 2.73]; externalizing, B = 0.69 [95% CI, -1.76 to 3.15]; total, B = 0.21 [95% CI, -2.48 to 2.91]) outcomes. FGR was associated with significantly lower Bayley-III scores (cognitive, B = -8.61 [95% CI, -13.33 to -3.89]; language, B = -8.29 [95% CI, -12.95 to -3.63]; motor, B = -7.60 [95% CI, -12.40 to -2.66]), regardless of preeclampsia status.
Conclusions And Relevance:
In this cohort study of preterm infants, preeclampsia was not associated with developmental and/or behavioral outcomes, but infants with FGR may be prone to developmental delays. These findings suggest future areas of research for understanding the roles of preeclampsia and FGR separately and together in early child development for preterm infants.
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