Association of borderline hypertension defined by ACC-AHA diagnostic criteria during pregnancy with neurodevelopment
Yuanyuan Zhang1,2,3, Jiangbo Du2,3,4,5, Xue You2,3
1Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
Insights
Maternal borderline hypertension in early pregnancy is linked to lower infant neurodevelopmental scores and increased risk of non-typical development. Persistent high blood pressure across trimesters worsens these effects, highlighting the need for close monitoring.
Area of Science:
- Obstetrics and Gynecology
- Developmental Pediatrics
- Cardiology
Background:
- The American College of Cardiology (ACC) and American Heart Association (AHA) updated hypertension criteria to 130/80 mmHg for adults.
- These revised criteria are not universally adopted in obstetrics, leaving uncertainty about their impact on pregnancy.
- The study investigates the implications of applying these new criteria to pregnant women and their offspring's neurodevelopment.
Purpose of the Study:
- To examine the association between maternal borderline hypertension during pregnancy and infant neurodevelopmental outcomes.
- To assess if applying the ACC/AHA hypertension definition impacts maternal health and infant development.
- To analyze the relationship between borderline hypertension in different trimesters and neurodevelopmental scores.
Main Methods:
- Secondary analysis of the prospective Jiangsu Birth Cohort (3352 mothers, 3641 children).
- Categorization of pregnant women: normotensive (<130/80 mmHg), borderline hypertensive (130-139/80-89 mmHg), or hypertensive (≥140/90 mmHg).
- Infant neurodevelopment assessed using the Bayley-III screening test; statistical models analyzed associations.
Main Results:
- Maternal borderline hypertension in the first trimester correlated with higher risk of non-typical receptive communication (RR 1.25) and lower expressive communication scores (β -0.19).
- When borderline hypertension persisted from the first into the second or third trimester, offspring showed a more significant reduction in expressive communication scores (β -0.45).
Conclusions:
- Maternal borderline hypertension, especially in the first trimester, is associated with adverse infant neurodevelopmental outcomes.
- The negative impact on neurodevelopment is amplified when borderline hypertension persists throughout pregnancy.
- Closer monitoring and management of borderline hypertension during pregnancy may support optimal infant neurodevelopment.
Background:
The American College of Cardiology (ACC) and the American Heart Association (AHA) revised the diagnostic criteria for hypertension, recommending a lower threshold of 130/80 mmHg for nonpregnant adults. However, this lower threshold has not been adopted in the global obstetrics field. It remains unclear whether applying this new definition to pregnant women would have implications for maternal health and offspring development. The present study aimed to examine potential relationships between maternal borderline hypertension and neurodevelopmental outcomes in infants.
Methods:
This study is a secondary analysis conducted within the prospective Jiangsu Birth Cohort in China. A total of 3352 mothers with blood pressure (BP) records and 3641 of their children were included. Pregnant women were categorized as normotensive (systolic BP [SBP] < 130 mmHg and diastolic BP [DBP] < 80 mmHg), borderline hypertensive (SBP 130-139 mmHg and/or DBP 80-89 mmHg), or hypertensive (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg). Infant neurodevelopment was assessed using the Bayley-III screening test. General linear mixed-effects models and Poisson generalized linear mixed models were applied to evaluate potential associations between maternal borderline hypertension in different trimesters and offspring neurodevelopment, including continuous neurodevelopmental scores and the risk of non-typical development.
Results:
Compared with offspring of normotensive mothers, those exposed to maternal borderline hypertension during the first trimester suggested a higher risk of non-typical development in receptive communication (risk ratio [RR], 1.25; 95% confidence interval [CI], 1.00, 1.55; P = 0.045), and exhibited lower expressive communication scores (β, -0.19; [95% CI, -0.38, -0.01]; P = 0.038).When borderline hypertension identified in the first trimester persisted into the second or third trimester, offspring exhibited a more significant reduction in expressive communication scores (β, -0.45; [95% CI, -0.79, -0.11]; P = 0.010).
Conclusions:
Maternal borderline hypertension, particularly when detected in the first trimester, was associated with lower infant neurodevelopmental scores and a higher risk of non-typical neurodevelopment. The impact appeared more pronounced when borderline hypertension persisted across trimesters. These findings suggest that closer monitoring and management of borderline hypertension during pregnancy may be beneficial for supporting optimal infant neurodevelopment, though further studies are needed to confirm these results.
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