Pregnancy-related hypertension increases offspring mortality risk.

According to a BMJ study published today, a disease that causes high blood pressure in pregnancy increases offspring mortality from birth through young adulthood.

Based on data from over 2 million people in Denmark, offspring of mothers with hypertensive disease of pregnancy (HDP), which includes pre-eclampsia, eclampsia, and hypertension, have higher death rates.

HDP causes disease and mortality in up to 10% of pregnancies globally. HDP has been linked to metabolic syndrome, immunological illnesses, neurodevelopmental, and psychiatric issues in offspring later in life. HDP has not been shown to affect offspring mortality from birth through puberty.

Through fill this knowledge gap, researchers examined the link of HDP among mothers with total and cause-specific death in offspring from birth to young adulthood.

They followed 2.4 million Danish births between 1978 and 2018 until death, emigration, or 31 December 2018, whichever happened first, using Danish national health registry data.

Their primary outcome was all-cause mortality, followed by 13 specific causes of death in kids from birth to young adulthood, up to age 41.

Cardiovascular diseases, cancer, mental and behavioural disorders, neurological and musculoskeletal ailments, and birth defects caused these deaths.

Sex, mother’s age at childbirth, education, income, living situations, smoking during pregnancy, and medical history were considered.

102,095 (4.2%) of 2,437,718 offspring were exposed to HDP before birth, 68,362 (2.8%) to pre-eclampsia or eclampsia and 33,733 (1.4%) to hypertension.

781 (59 per 100,000 person-years) infants born to women with pre-eclampsia, 17 (134 per 100,000), 223 (44), and 19,119 (42 per 100,000) died during an average 19-year follow-up.

The offspring of HDP-exposed mothers had greater all-cause mortality than the non-exposed group.

All-cause mortality was 26% higher in HDP-exposed kids (55 per 100,000 person-years). Pre-eclampsia, eclampsia, and hypertension were 29% (59 per 100,000 person-years), 188% (134 per 100,000), and 12% (44 per 100,000).

Offspring of moms with severe and early-onset pre-eclampsia had more than six times the mortality risk of those without HDP. HDP kids with diabetes or low education also showed a high connection.

Several cause-specific death risks increased. In kids exposed to maternal HDP, digestive disorders and perinatal conditions more than doubled, while endocrine, nutritional, metabolic, and cardiovascular diseases rose by more than 50%.

However, maternal HDP was not linked to offspring cancer mortality.

The researchers recognise that smoking, alcohol use, poor diet quality, obesity, and sedentary lifestyle in offspring may have influenced this observational study.

Denmark’s universal health care and high-quality health services may restrict the findings’ generalizability.

This comprehensive, long-term study used high-quality national health data. After sibling analysis to account for genetic and unmeasured family characteristics, results remained constant, indicating robustness.

This study strongly suggests that maternal HDP, particularly eclampsia and severe pre-eclampsia, increases offspring’s overall mortality and cause-specific death from birth to young adulthood.

They suggest studying the physiological processes between maternal HDP and offspring mortality.


Journal Reference

Maternal hypertensive disorder of pregnancy and mortality in offspring from birth to young adulthood: national population based cohort study, The BMJ (2022). DOI: 10.1136/bmj-2022-072157

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