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Pregnancy-induced hypertension and neonatal outcomes: a systematic review and meta-analysis

Journal of Perinatology volume 38, pages 46–53 (2018)Cite this article

Subjects

Abstract

Objective:

Pregnancy-induced hypertension (PIH) is associated with preterm delivery but its independent impact on neonatal outcomes remains unclear. We sought to systematically review and meta-analyze clinical outcomes of preterm infants <37 weeks’ gestation born to mothers with and without PIH.

Study Design:

Medline, Embase, PsychINFO and CINAHL were searched from January 2000 to October 2016. Studies with low-moderate risk of bias reporting neonatal outcomes based on PIH as primary exposure variable were included. Data were extracted independently by two co-authors.

Results:

PIH was associated with lower mortality (3 studies; adjusted odds ratio (aOR) 0.65; 95% confidence interval (CI) 0.54 to 0.79), lower severe retinopathy of prematurity (ROP) (2 studies; aOR 0.83; 0.72 to 0.96) and lower severe brain injury (2 studies; unadjusted OR (uOR) 0.57; 0.49 to 0.66). No association between PIH and short-term respiratory outcomes, bronchopulmonary dysplasia (BPD) or necrotizing enterocolitis (NEC) was identified. In subgroup analysis among infants <29 weeks’ gestation, BPD odds were higher (3 studies; aOR 1.15; 1.06 to 1.26), whereas mortality lower (2 studies; aOR 0.73; 0.69 to 0.77). In subgroup analysis limited to severe PIH, odds of mortality (3 studies; uOR 2.36; 1.07 to 5.22) and invasive ventilation (3 studies; uOR 3.26; 1.11 to 9.61) were higher. In subgroup analysis limited to preeclampsia, odds of BPD (3 studies; uOR 1.21; 95% CI:1.03 to 1.43) and NEC were higher (3 studies; uOR 2.79; 95% CI:1.57 to 4.96).

Conclusion:

PIH was associated with reduced odds of mortality and ROP (all infants), but higher odds for BPD (<29 weeks’ gestation). The paradoxical reduction in mortality may be due to survival bias and deserves further exploration in future studies.

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Acknowledgements

Author contributions

Abdul Razak co-conceptualized and designed the study, performed the initial screening of the articles, performed initial analyses including risk of bias assessment, drafted the manuscript and approved the final version. Anna Florendo-Chin double checked the initial screening of articles and double checked all the data extraction from included studies. Laura Banfield devised the search strategy for the systematic review based on study protocol and approved the final manuscript version. Muzafar Gani Abdul Wahab assisted in the conduct of the systematic review, provided logistical support, reviewed the study protocol and helped revise the manuscript and approved the final version. Sarah McDonald and Prakesh S Shah provided methodological and statistical expertise in data analyses and interpretation, helped revise the manuscript and approved the final version. Amit Mukerji co-conceptualized and designed the study, provided guidance in the conduct of the review and meta-analysis, oversaw the conduct of all meta-analyses, revised the initial manuscript draft and approved the final version.

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Authors and Affiliations

  1. Department of Pediatrics, McMaster University, Hamilton, ON, Canada

    A Razak, A Florendo-Chin, M G Abdul Wahab & A Mukerji

  2. Faculty of Health Science, Health Sciences Library, McMaster University, Hamilton, ON, Canada

    L Banfield

  3. Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada

    S McDonald

  4. Department of Pediatrics, University of Toronto, Toronto, ON, Canada

    P S Shah

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Correspondence to A Mukerji.

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Razak, A., Florendo-Chin, A., Banfield, L. et al. Pregnancy-induced hypertension and neonatal outcomes: a systematic review and meta-analysis. J Perinatol 38, 46–53 (2018). https://doi.org/10.1038/jp.2017.162

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