Child Developmental Patterns across Subtypes of Hypertensive Disorders of Pregnancy: TMM BirThree Cohort Study

BackgroundExposure to hypertensive disorders of pregnancy (HDP) and subtypes during the fetal stage has been linked to developmental delays in children. Longitudinal patterns in child development may reveal etiological and pathophysiological mechanisms; however, the associations between HDP subtypes and these patterns remain unclear. ObjectiveTo investigate the association between HDP subtypes and child developmental patterns. Study designThis study included 14,044 mother-child pairs from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. The latent class trajectory model was applied to child development scores at 6, 12, 24, 42, and 48 months of age to generate patterns in five developmental domains: communication, gross motor, fine motor, problem solving, and personal/social. Multinomial Poisson regression analysis adjusted for covariates was used to calculate the risk ratios of different developmental patterns among exposure to HDP and the subtypes among all children and children born at term. ResultsThree patterns were identified in respective domains: "normal," "delay," "catch-up". Exposure to HDP was associated with a higher risk of delay pattern in gross motor (risk ratio [RR] 1.29, 95% confidence interval [CI] 1.09-1.52) and of catch-up patterns in fine motor (RR 1.12, 95% CI 1.01-1.24) and problem solving (RR 1.14, 95% CI 1.02-1.28) domains. Exposure to gestational hypertension is associated with a higher risk of catch-up pattern in the fine motor domain (RR 1.17, 95% CI 1.00-1.36). Exposure to preeclampsia (PE) is associated with a higher risk of delay pattern in gross motor, fine motor, and problem solving domains (RR 1.54, 95% CI 1.14-2.04; RR 1.70, 95% CI 1.02-2.65; RR 1.87, 95% CI 1.18-2.81). Children exposed to PE early onset has higher risks of catch-up pattern (RR 1.50, 95% CI 1.01-2.14; RR 1,64, 95% CI 1.05-2.41; RR 1.68, 95% CI 1.15-2.36; RR 1.63, 95% CI 1.11-2.30), and 2-3 folds higher risks of delay pattern (RR 1.93, 95% CI 1.08-3.15; RR 2.12, 95% CI 1.21-3.40; RR 2.70, 95% CI 1.15-5.31; RR 3.00, 95% CI 1.35-5.67) in quadruple domains. In the term-born population, except for PE, there was no association between HDP and adverse patterns. ConclusionsHDP and subtypes, particularly PE early onset, were associated with higher risks of delay child developmental pattern in multiple domains. PE was associated with a higher risk of catch-up pattern. Depending on the HDP subtype, the risks no longer linger in the term-born population.