MATERNAL hypertensive disorders of pregnancy (HDP), particularly preeclampsia, are independently associated with adverse cognitive and language outcomes in preterm infants at two years’ corrected age, according to a new study, with part of this risk mediated by early brain abnormalities detectable on MRI.
This study aimed to clarify the impact of maternal hypertension on the neurodevelopment of premature infants, a subject previously marked by conflicting evidence and methodological limitations. Researchers conducted a prospective cohort study involving 395 preterm infants (≤32 weeks’ gestation) across five neonatal intensive care units in southeast Ohio between 2016 and 2019. Infants were classified according to maternal HDP exposure, including chronic or gestational hypertension and preeclampsia. Structural brain MRI was performed at term-equivalent age, and neurodevelopment was assessed at 22–26 months’ corrected age using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Of the 395 infants, 170 (43%) were HDP-exposed, with 104 (61%) of these exposed to preeclampsia. The median gestational age was 29.6 weeks and median birth weight was 1230g. Neurodevelopmental follow-up was completed for 341 children (87%). Adjusted analyses showed that HDP exposure was associated with lower BSID-III cognitive scores (mean difference −3.69; 95% CI, −6.69 to −0.68; P = .02) and language scores (−4.07; 95% CI, −8.03 to −0.11; P = .04). The associations were more pronounced in those exposed to preeclampsia (cognitive: −4.85; 95% CI, −8.63 to −1.07; P = .01; language: −6.30; 95% CI, −11.49 to −1.09; P = .02). Mediation analysis revealed that early brain abnormalities on MRI accounted for 24% of the total effect of HDP on cognitive outcomes (−0.82; 95% CI, −1.72 to −0.13; P = .02)123.
These findings highlight the importance of recognising maternal hypertension as an independent risk factor for adverse neurodevelopment in preterm infants, especially when preeclampsia is present. For clinical practice, this highlights the need for enhanced surveillance and early intervention strategies in this high-risk group. Incorporating routine neuroimaging and developmental assessments may allow earlier identification of at-risk infants, enabling timely initiation of therapies such as speech and occupational interventions.
Reference
Jain S et al. Maternal hypertension and adverse neurodevelopment in a cohort of preterm infants. JAMA Netw Open. 2025;8(4):e257788.
