Childhood neurodevelopmental disorders and maternal hypertensive disorder of pregnancy

Aim: To examine the association of maternal chronic hypertension and pregnancy-induced hypertension (PIH)/preeclampsia with childhood neurodevelopmental disorders (NDDs) in a large-scale population-based cohort. Method: We conducted a linked Taiwan National Health Insurance Research Database cohort study of children born between 2004 and 2008 (n=877 233). Diagnoses of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), developmental delay, intellectual disability, cerebral palsy (CP), and epilepsy/infantile spasms were identified from birth to the end of 2015. Cox proportional hazards models were fitted with adjustment for potential confounders to estimate the effect of maternal hypertensive disorder of pregnancy on childhood outcomes. Results: Compared with the offspring of unexposed mothers, offspring of mothers with chronic hypertension or PIH/preeclampsia exhibited increased risk of developing a wide spectrum of NDDs. Chronic hypertension was associated with increased risks of ADHD (hazard ratio 1.22, 95% confidence interval [CI] 1.13–1.​31), developmental delay (1.29, 1.21–1.38), intellectual disability (1.67, 1.43–1.95), CP (1.45, 1.14–1.85), and epilepsy/infantile spasms (1.31, 1.10–1.56) in the offspring, whereas PIH/preeclampsia was associated with increased risks of ASD (1.27, 1.12–1.43), ADHD (1.23, 1.17–1.29), developmental delay (1.29, 1.24–1.35), intellectual disability (1.53, 1.37–1.71), CP (1.44, 1.22–1.70), and epilepsy/infantile spasms (1.36, 1.22–1.52) in the offspring after adjustment for potential confounders. The co-occurrence of maternal diabetes, preterm deliveries, or fetal growth restriction further increased the risk. Interpretation: Chronic hypertension or PIH/preeclampsia seems to be sufficient to increase the risk of childhood NDDs. What this paper adds Children exposed to maternal hypertensive disorders have a higher cumulative incidence of neurodevelopmental disorders (NDDs) than unexposed children. Chronic hypertension or pregnancy-induced hypertension/preeclampsia seems to be sufficient to increase the risk of childhood NDDs. Co-occurrence of maternal diabetes, preterm deliveries, or fetal growth restriction further increases the risk.