Child Developmental Patterns by Age 4 Years Across Subtypes of Hypertensive Disorders of Pregnancy

Exposure to hypertensive disorders of pregnancy (HDP) during the fetal stage has been linked to developmental delays in children. However, the associations between HDP subtypes and longitudinal patterns in child development remain unclear.

To investigate the associations of HDP subtypes with child developmental patterns.

This study used data from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study, a prospective cohort study recruiting pregnant individuals in Japan between July 2013 and March 2017. Mother-child pairs were included in the analysis. The data analysis was conducted from November 2023 to February 2024.

HDP and its subtypes (gestational hypertension and preeclampsia) were identified using an algorithm applied to antenatal visit records.

The latent class trajectory model was applied to child development scores at ages 6, 12, 24, 42, and 48 months to generate patterns in 5 domains (communication, gross motor, fine motor, problem solving, and personal-social). Multinomial Poisson regression analysis calculated the risk ratios (RRs) of different developmental patterns by exposure to any HDP as well as HDP subtypes. A subgroup analysis was performed by preterm birth.

Among 14 023 mother-child pairs (maternal mean [SD] age, 32.5 [4.8] years; 6754 [48.2%] female children), 1406 (10.0%) were exposed to HDP. Three patterns were identified in the 5 domains: normal, delay, and catch-up. Point estimates for delays in multiple domains of development were greater for any HDP, preeclampsia, and early-onset preeclampsia, but not all findings were statistically significant. Early-onset preeclampsia was associated with a significantly higher risk of delay pattern in problem solving domain (RR, 2.90; 95% CI, 1.43-5.89; adjusted P = .047), although the risks of delay pattern were not statistically significant in communication (RR, 1.94; 95% CI, 1.14-3.29; adjusted P = .15), gross motor (RR, 2.10; 95% CI, 1.26-3.51; adjusted P = .06), or fine motor (RR, 2.68; 95% CI, 1.26-5.71; adjusted P = .11) domains. In the term-born population, children exposed to preeclampsia and had an RR greater than 1 for the delay pattern in the problem solving domain (RR, 1.67; 95% CI, 1.92-2.74; adjusted P = .60), although this finding was not statistically significant after adjusting for multiple comparisons.

In this cohort study, fetal exposure to early-onset preeclampsia was associated with higher risk of a delayed child developmental pattern in the problem solving domain. The observations were modified by preterm birth. These findings suggest that children exposed to certain HDP subtypes during fetal life require developmental monitoring, especially if they were born preterm.