Maternal hypertension linked to neurodevelopment risks in preterm infants
A new study from Cincinnati Children’s Hospital reveals that preterm infants exposed to maternal hypertension face higher risks of brain abnormalities and delayed cognitive development.
Maternal hypertension linked to neurodevelopment risks in preterm infants | Image Credit: © RFBSIP - © RFBSIP - stock.adobe.com.
The neurodevelopment of preterm infants is influenced by maternal hypertension, according to a recent study published on April 29, 2025, by Cincinnati Children’s Hospital.1
Preeclampsia and preterm birth risks
Preeclampsia has been linked to multiple severe complications, including stroke, kidney failure, and death. Preterm birth is also more common in mothers with preeclampsia, and the new data indicate that these preterm infants are at an increased risk of brain injury after birth and worse neurodevelopment at 2 years.1
“These reduced scores can be clinically meaningful because even slight differences can signal increased risk for later cognitive, language, or motor impairments,” said Nehal Parikh, DO, MS, a neonatologist with Cincinnati Children’s Perinatal Institute and senior author. “Since development is dynamic, even a small early disadvantage can compound over time.”1
The study was conducted to evaluate the link between maternal hypertensive disorders of pregnancy (HDP) and neurodevelopment in infants born at 32 weeks’ gestation or sooner.2 Infants were recruited from level 3 and 4 neonatal intensive care units, with exclusion criteria including chromosomal or congenital anomalies and cyanotic heart disease.
Defining HDP exposure and assessing risk factors
HDP exposure was determined based on a chronic hypertension or pregnancy-induced hypertension reported in maternal electronic health records. When diagnoses weren’t listed, investigators based stage 2 hypertension on the standard definition of systolic blood pressure over 140 mm Hg or diastolic blood pressure over 90 mm Hg.2
Placental inflammatory infiltration indicated histological chorioamnionitis, while receiving a betamethasone or magnesium sulfate dosage indicated antenatal corticosteroid and magnesium therapy. A social risk score was utilized to determine socioeconomic status.2
A 3-Tesla Philips Ingenia magnetic resonance imaging (MRI) scanner was used to obtain MRI scans. These scans were assessed for brain abnormalities based on the global brain abnormality score (GBAS), a validated tool for predicting neurodevelopment up to age 10 years.2
Neurodevelopmental assessment tools
Therapists evaluated neurodevelopment in infants aged 22 to 26 months using the Bayley Scales of Infant and Toddler Development (BSID), Third Edition. This tool can assess cognitive, motor, language, socioeconomical, and adaptive behavior, with a score of 40 to 160.2
BSID scores under 85 are considered below average, with those under 70 indicating severe neurodevelopment impairment. The BSID cognitive composite was reported as the primary outcome, while secondary outcomes included the BSID language and motor composite scores.2
Study population and group comparisons
A median gestational age of 29 weeks and birth weight of 1230 grams was reported. HDP exposure was reported in 43% of infants, pregnancy-induced hypertension (PIH) exposure in 34%, and preeclampsia exposure in 26%.2
Similar characteristics were observed between the HDP and non-HDP groups, except for multiple gestations, maternal age, antenatal magnesium therapy, and histologic chorioamnionitis, which were reported in 43% of the non-HDP group vs 20% of the HDP group. The median follow-up period was 24 months.2
The mean BSID cognitive scores among HDP-exposed and unexposed infants were 90.63 and 90.55, respectively, highlighting similar outcomes. For GBAS, the median was 5 in the HDP-exposed group vs 4 in the unexposed group. No significant differences were reported when assessing preeclampsia- or PIH-exposed infants vs unexposed infants.2
When adjusting for cofounders, a negative correlation was reported between HDP and BSID cognitive and language scores, with β estimates of -3.69 and -4.07, respectively. Similar results were reported for preeclampsia and PIH exposure, with PIH exposure negatively associated with motor scores.2
Conclusion
These results indicated a link between maternal HDP exposure and adverse cognitive and language outcomes among infants born preterm. Investigators concluded that abnormal placentation may cause greater neurodevelopmental impairments.2
“We believe early identification of brain abnormalities can allow for targeted interventions, such as early speech therapy, occupational therapy, or enriched learning environments, which can improve long-term educational, behavioral, and health outcomes, especially when preeclampsia occurs,” said Shipra Jain, MD, from the Division of Neonatology and Pulmonary Biology.1
References
- Mom’s hypertension can affect preterm infant brain and neurodevelopment. Cincinnati Children’s Hospital Medical Center. April 30, 2025. Accessed May 6, 2025. https://www.eurekalert.org/news-releases/1082407.
- Jain S, Fu TT, Barnes-Davis ME, et al. Maternal hypertension and adverse neurodevelopment in a cohort of preterm infants. JAMA Netw Open. 2025;8(4):e257788. doi:10.1001/jamanetworkopen.2025.7788
