Is Maternal Hypertension a Reducing Factor for Intraventricular Hemorrhage in Iranian Preterm Newborns?

Kashaki, Mandana; Saboute, Maryam; Esmaeili Allafi, Maryam; Norouzi, Elahe

doi:10.22038/ijp.2022.63523.4840

Is Maternal Hypertension a Reducing Factor for Intraventricular Hemorrhage in Iranian Preterm Newborns?

Document Type : original article

Authors

Mandana Kashaki ¹

Maryam Saboute ²

Maryam Esmaeili Allafi ³

Elahe Norouzi ⁴

¹ Associate Professor of Neonatology, Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences(IUMS), School of Medicine

² 1Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), School of Medicine, Iran University of Medical Sciences (IUMS)

³ Department of Pediatrics, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.

⁴ Pediatric growth and development research center, Iran University of Medical Sciences (IUMS), School of Medicine

10.22038/ijp.2022.63523.4840

Abstract

Background: Hypertensive disorders of pregnancy including preeclampsia can be associated with preterm birth and infant mortality and morbidity. It seems that intraventricular hemorrhage (IVH) in preterm neonates born to hypertensive mothers is less common compared to the other ones. In this study, we assessed the relationship between hypertensive disorders of pregnant mothers and the incidence of intraventricular hemorrhage in preterm neonates weighing less than 1500 grams.
Methods: In this case-control study, 305 singleton preterm neonates with a birth weight less than 1500 g were entered. The presence of IVH in all preterm neonates was assessed using brain ultrasonography and its correlation to hypertensive disorders of their mothers were evaluated.
Results: The prevalence of preeclampsia in mothers with and without pre pregnancy hypertension was 40%, and 15.09% respectively. The prevalence of IVH in preterm neonates was 26.9% (n=82). The incidence of IVH in preterm neonates of mothers with and without preeclampsia was 16.07%, and 29.31%, respectively (p=0.028). The prevalence of IVH in preterm neonates of mothers with hypertension and without hypertension was 12.5% and 29.05%, respectively (p=0.018). Preterm neonates with IVH had a lower mean birth weight, smaller gestational age and lower Apgar scores compared to preterm neonates without IVH with p values of <0.001, <0.001 and <0.01, respectively.
Conclusion: Hypertensive disorders of pregnancy increase the risk of preterm delivery, but the incidence of IVH in preterm neonates weighing less than 1500 gr is lower in infants born to mothers with hypertension including preeclampsia compared to those born to non-hypertensive mothers. And also lower gestational age, birth weight, and Apgar scores were important predicting factors for IVH in preterm neonates.

Keywords

Preeclampsia

Maternal hypertension

Intraventricular hemorrhage

Prematurity

newborn

Ballabh P. Intraventricular Hemorrhage in Premature Infants: Mechanism of Disease. Pediatr Res. 2010; 67:1–8.
Whitelaw A. Intraventricular hemorrhage and post haemorrhagic hydrocephalus: pathogenesis, prevention and future interventions. Semin Neonatol. 2001; 6:135-46.
Szpecht D, Szymankiewicz M, Nowak M, Gadzinowski J. Intraventricular hemorrhage in neonates born before 32 weeks of gestation—retrospective analysis of risk factors. Childs Nerv Syst. 2016; 32:1399–404.
Wilson-Costello D, Friedman H, Minich N, Fanaroff AA, M H. Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants in the 1990s. Pediatrics. 2005; 115:997-1003.
Murphy BP, Inder TE, Rooks V, Taylor GA, Anderson NJ, Mogridge N, Horwood LJ, Volpe JJ. Post Haemorrhagic ventricular dilatation in the premature infant: natural history and predictors of outcome. . Arch Dis Child Fetal Neonatal Ed. 2002; 87:F37–F41.
Pinto-Martin JA, Whitaker AH, Feldman JF, Van Rossem R, Paneth N. Relation of cranial ultrasound abnormalities in low-birthweight infants to motor or cognitive performance at ages 2, 6, and 9 years. . Dev Med Child Neurol. 1991; 41:826–33.
Paul DA, Kepler J, Leef KH, Siscione A, Palmer C, Stefano JL. Effect of preeclampsia on mortality, intraventricular hemorrhage, and need for mechanical ventilation in very low-birth-weight infants. Am J Perinatol. 1998; 15:381-6.
Volpe JJ. Intraventricular hemorrhage in the premature infant--current concepts. Part I. Ann Neurol. 1989; 25:3-11.
Antoniuk S, da Silva RV. Periventricular and intraventricular hemorrhage in the premature infants. Rev Neurol. 2000; 31:238-43.
Ballabh P, Braun A, Nedergaard M. Anatomic analysis of blood vessels in the germinal matrix, cerebral cortex, and white matter in developing infants. Pediatr Res. 2004; 56:117–24.
Morsing E, Maršál K, Ley D. Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia. Neonatology 2018; 114:205–11.
American College of Obstetricians and Gynecologists. Hypertension in pregnancy. http://www.acog.org/Resources-And-Publications/TaskForce-and-Work-Group-Reports/Hypertension-in-Pregnancy. Accessed November 23, 2015.
Leeman L, Dresang LT, Fontaine P. Hypertensive Disorders of Pregnancy. Am Fam Physician. 2016; 93(2):121-127.
Gudeta TA, Regassa TM. Pregnancy Induced Hypertension and Associated Factors among Women Attending Delivery Service at Mizan-Tepi University Teaching Hospital, Tepi General Hospital and Gebretsadik Shawo Hospital, Southwest, Ethiopia. Ethiop J Health Sci. 2019; 29:831–40.
Subki AH, Algethami MR, Baabdullah WM, Alnefaie MN, Azan Bagi MA, Alsolami RM, et al. Prevalence, Risk Factors, and Fetal and Maternal Outcomes of Hypertensive Disorders of Pregnancy: A Retrospective Study in Western Saudi Arabia. Oman Med J. 2018; 33:409–15.
Mendola P, Mumford SL, Männistö TI, Holston A, Reddy UM, Laughon SK. Controlled Direct Effects of Preeclampsia on Neonatal Health after Accounting for Mediation by Preterm Birth. Epidemiology. 2015; 26:17–26.
Ehsanipour F, Norouzi E, Khosravi N, Mirfakhraee H. Serum Magnesium Levels in Neonatal Jaundice: Is There any Correlation Between Hypermagnesemia and Moderate to Severe Hyperbilirubinemia in Term Newborns? J Compr Ped. 2020 May; 11(2):e94278.
Perlman JM, Risser RC, Gee JB. Pregnancy-induced hypertension and reduced intraventricular hemorrhage in preterm infants. Pediatr Neurol. 1997; 17:29-33.
Shah DM, Shenai JP, Vaughn WK. Neonatal outcome of premature infants of mothers with preeclampsia. J Perinatol. 1995; 15:264-7.
Jodeiry B, Heidarzadeh M, Sahmani-Asl S, Hoseini M, Jawaheri Zadeh H, Eliasi S, Abedini K. Study of intraventricular hemorrhage in VLBW neonates admitted in Al-Zahra Hospital, Tabriz, Iran. Niger J Med. 2012; 21:92-7.
Khaleesi N, Farahani Z, Shariat M, Rezaeizadeh G. Risk factors of intracranial hemorrhage in premature neonates. Acta Med Iran. 2014; 52:687-9.
Lee JY, Kim HS, Jung E, Shim GH, Lee HJ, Lee JA, Choi CW, Kim EK, Kim BI, Choi JH. Risk Factors for Periventricular-Intraventricular Hemorrhage in Premature Infants. J Korean Med Sci. 2010; 25:418–24.
Khodapanahandeh F, Khosravi N, Larijani T. Risk factors for intraventricular hemorrhage in very low birth weight infants in Tehran, Iran. Turk J Pediatr. 2008; 50:247-52.