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Hypertensive disorders of pregnancy and outcomes of preterm infants of 24 to 28 weeks’ gestation

Journal of Perinatology volume 36, pages 1067–1072 (2016)Cite this article

Subjects

Abstract

Objective:

To examine the relationship between hypertensive disorders of pregnancy (HDPs) and mortality and major morbidities in preterm neonates born at 24 to 28 weeks of gestation.

Study Design:

Using an international cohort, we retrospectively studied 27 846 preterm neonates born at 240 to 286 weeks of gestation during 2007 to 2010 from 6 national neonatal databases. The incidence of HDP was compared across countries, and multivariable logistic regression analyses were conducted to examine the association of HDP and neonatal outcomes including mortality to discharge, bronchopulmonary dysplasia, severe brain injury, necrotizing enterocolitis and treated retinopathy of prematurity.

Results:

The incidence of HDP in the entire cohort was 13% (range 11 to 16% across countries). HDP was associated with reduced odds of mortality (adjusted odds ratio (aOR) 0.77; 95% confidence interval (CI) 0.67 to 0.88), severe brain injury (aOR 0.74; 95% CI 0.62 to 0.89) and treated retinopathy (aOR 0.82; 95% CI 0.70 to 0.96), but increased odds of bronchopulmonary dysplasia (aOR 1.16; 95% CI 1.05 to 1.27).

Conclusions:

In comparison with neonates born to mothers without HDP, neonates of HDP mothers had lower odds of mortality, severe brain injury and treated retinopathy, but higher odds of bronchopulmonary dysplasia. The impact of maternal HDP on newborn outcomes was inconsistent across outcomes and among countries; therefore, further international collaboration to standardize terminology, case definition and data capture is warranted.

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Acknowledgements

The Maternal-Infant Care Research Centre is supported by a team grant (FRN87518) from the Canadian Institutes of Health Research and Mount Sinai Hospital, Toronto, ON, Canada. We thank all site investigators in six countries for their support and diligent data collection. Prakesh Shah is supported by an Applied Research Chair in Reproductive and Child Health Services and Policy Research from the Canadian Institutes of Health Research (APR-126340). A list of contributing neonatal units and their investigator names are included in the Supplementary Information. Funding for iNeo has been provided by a Canadian Institutes of Health Research Chair in Reproductive and Child Health Services and Policy Research held by PSS. The Canadian Neonatal Network is funded by financial support from the Canadian Institutes of Health Research and individual participating centers. The Australian and New Zealand Neonatal Network is predominantly funded by membership contributions from participating centers. The Israel Neonatal Network very low birth weight infant database is partially funded by the Israel Center for Disease Control and the Ministry of Health. The Neonatal Research Network of Japan is partly funded by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan. The Swedish Neonatal Quality Register is funded by the Swedish Government (Ministry of Health and Social Affairs) and the body of regional health care providers (County Councils). The United Kingdom Neonatal Collaborative receives no core funding.

Author information

Author notes

  1. L Martin

    Present address: 12Current address: Campbell Family Institute for Breast Cancer Research, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,

  2. L Mirea

    Present address: 13Current address: Phoenix Children’s Hospital, Phoenix, AZ, USA.,

Authors and Affiliations

  1. Department of Pediatrics, Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada

    L Gemmell, L Martin, L Mirea, S K Lee & P S Shah

  2. Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada

    K E Murphy

  3. Department of Medicine, UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK

    N Modi

  4. Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden

    S Håkansson

  5. Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel

    B Reichman

  6. Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, New South Wales, Australia

    K Lui

  7. Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women’s Medical University, Tokyo, Japan

    S Kusuda

  8. Department of Women’s and Children’s Health, Swedish Neonatal Quality Register, Uppsala University, Uppsala, Sweden

    G Sjörs

  9. Department of Paediatrics, Australia and New Zealand Neonatal Network, University of Otago, Christchurch, New Zealand

    B A Darlow

  10. Department of Health Policy, Neonatal Research Network Japan, National Center for Child Health and Development, Tokyo, Japan

    R Mori

  11. Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada

    S K Lee & P S Shah

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Correspondence to P S Shah.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Gemmell, L., Martin, L., Murphy, K. et al. Hypertensive disorders of pregnancy and outcomes of preterm infants of 24 to 28 weeks’ gestation. J Perinatol 36, 1067–1072 (2016). https://doi.org/10.1038/jp.2016.133

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