Maher GM, et al. - In view of the increasing prevalence of hypertensive disorders of pregnancy (HDP), partially due to increasing levels of obesity, metabolic syndrome, and advanced maternal age, researchers assessed the available published literature on the correlation between HDP and the risk of neurodevelopmental disorders in offspring in a systematic review and meta-analysis. Findings suggest there may be an increased risk for autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in association with HDP, thereby emphasizing the necessity for greater pediatric surveillance of infants exposed to HDP to allow early intervention that may improve neurodevelopmental outcome.

Methods

• Researchers performed a systematic search of PubMed, CINAHL, Embase, PsycINFO, and Web of Science from inception through June 7, 2017 based on a preprepared protocol; this search was supplemented by hand searching of reference lists.
• Titles, abstracts, and full-text articles were independently reviewed by two investigators.
• English-language cohort and case-control studies reporting HDP and neurodevelopmental disorders were included.
• Two reviewers independently performed data extraction and quality appraisal.
• They followed Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines.
• Main outcomes and measures included random-effects meta-analyses of estimated pooled odds ratios (ORs) for HDP and ASD and for HDP and ADHD.
• For all other neurodevelopmental disorders, they reported stand-alone estimates.

Results

• Researchers identified 1,166 studies; inclusion criteria was met by 61 unique articles.
• Estimates for ASD were reported in 20 studies; of these, 11 (including 777,518 participants) reported adjusted estimates, with a pooled adjusted OR of 1.35 (95% CI, 1.11-1.64).
• Estimates for ADHD were reported in 10 studies; of these, 6 (including 1,395,605 participants) reported adjusted estimates, with a pooled adjusted OR of 1.29 (95% CI, 1.22-1.36).
• No statistically significant differences for ASD or ADHD were noted on subgroup analyses according to type of exposure (ie, preeclampsia or other HDP).
• For all other neurodevelopmental disorders, inclusion criteria was met by 31 studies.
• For these, reports of largely inconsistent individual estimates were noted, with few patterns of association observed.