Preeclampsia Tied to Mental Health Risk in Children

Megan Brooks

April 27, 2020

Hypertensive disorders in women during pregnancy, especially preeclampsia, are linked to a significantly increased risk for mental health disorders in children, independently of the mental health history of either parent or of other potential risk factors, new research shows.

Researchers from Finland found a 66% higher risk for any mental disorder in children whose mothers had preeclampsia; they found a twofold higher risk for a childhood mental disorder in children whose mothers had severe preeclampsia.

"Mental disorders are very common and carry a huge burden on the society. Understanding their etiology by identifying their risk factors can lead to more effective preventive interventions for mental disorders," first author Marius Lahti-Pulkkinen, PhD, University of Helsinki, told Medscape Medical News.

"Our findings highlight that maternal hypertensive disorders may be among such risk factors, and these findings could inform the planning of preventive interventions for families at risk," Lahti-Pulkkinen added.

The study was published online April 20 in the journal Hypertension.

The PREDO Study

Links between hypertensive disorders in pregnancy and mental disorders in offspring remain unclear. To investigate, the Finnish team studied 4743 mother-child pairs in the prospective Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction (PREDO) study.

Women in early pregnancy were recruited to the study at maternity hospitals, and the children were followed from birth to ages 6.4 to 10.8 years.

Among the mothers, 200 had chronic hypertension, four had unspecified hypertension, 263 had gestational hypertension, 209 had preeclampsia during their current pregnancy, and had 333 hypertensive disorders only before their current pregnancy.

Among the offspring, 412 (8.7%) were diagnosed as having any childhood mental disorder during the follow-up. Of them, 256 had psychological developmental disorders, and 200 had behavioral and emotional disorders.

Maternal gestational and chronic hypertension as well as preeclampsia increased the risk for any childhood mental disorder. The risk increased further with increasing severity of preeclampsia. The associations of preeclampsia (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.14 – 2.42) and severe preeclampsia (HR, 2.01; 95% CI, 1.08 – 3.73) were independent of all covariates, the researchers report.

The combination of maternal hypertensive disorders, overweight/obesity, and diabetes disorders of pregnancy increased the cumulative incidence of mental disorders from 6.6% among children of mothers with none of these conditions to 22.2% in those exposed to all three maternal conditions.

Preterm and small-for-gestational-age births and neonatal intensive care unit admission partially mediated the effects of maternal preeclampsia on the mental health of offspring.

The current findings are in line with recent meta-analyses that were restricted to a few neuropsychiatric disorders, namely, autism spectrum disorder, attention deficit/hyperactivity disorder, and schizophrenia.

The Finnish investigators note that they are "the first to show that the effects of maternal hypertensive pregnancy disorders are not limited to these disorders but extend to any childhood mental, psychological development, and behavioral and emotional disorders in the offspring."

Lahti-Pulkkinen said the pathways through which hypertensive pregnancy disorders may lead to mental disorders in children may include epigenetic or genetic changes in the immune system and neurobiological stress system functioning and development.

"Such effects may be mediated via alterations in placental structure and functioning. All of these changes occur following exposure to maternal hypertensive disorders and associate with the risk of mental disorders in children," he noted.

"The findings emphasize the need for preventive interventions and treatments for maternal hypertensive disorders, since such interventions have the potential to benefit both the well-being of the expectant mother and her offspring," he added.

Clinical Implications Unclear

Reached for comment, Ali Khashan, PhD, who has studied the impact of stress on pregnancy outcome and offspring mental health, said, "These findings add to our knowledge on this topic, and the data on severity of preeclampsia and on blood pressure during pregnancy are important and add to the current evidence."

Khashan, from the Department of Epidemiology and Public Health, University College Cork, Ireland, cautioned, however, that the clinical implications of such findings "remain unclear because we do not know whether the association between hypertensive disorders in pregnancy and child mental health is causal or not. We still do not understand the role of antihypertensive medications in the observed associations, which is an important gap in the current evidence."

The study was supported by Academy of Finland, the European Union's Horizon 2020 Award for Research on European Children and Adults Born Preterm (RECAP), the European Commission Dynamics of Inequality Across the Life-course: structures and processes (DIAL) for PremLife, Erityisvaltionosuus (EVO), the University of Helsinki Funds, the Signe and Ane Gyllenberg Foundation, the Orion Research Foundation, the Emil Aaltonen Foundation, the Finnish Medical Foundation, the Jane and Aatos Erkko Foundation, the Novo Nordisk Foundation, the Päivikki and Sakari Sohlberg Foundation, the Sigrid Juselius Foundation, and the Sir Jules Thorn Charitable Trust. Lahti-Pulkkinen and Khashan have disclosed no relevant financial relationships.

Hypertension. Published online April 20, 2020. Abstract

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