Prenatal exposure to maternal hypertension and higher body mass index and risks of neurodevelopmental and psychiatric disorders during childhood

Introduction

Hypertensive disorders of pregnancy (HDP) or prepregnancy overweight/obesity are independently associated with the risk for certain neurodevelopmental and psychiatric disorders in offspring. These two conditions often co-exist but the risk from combined exposure is unknown. We investigated whether specific subtypes of maternal HDP, along with prepregnancy overweight/obesity, were associated with the distinct risk of neurodevelopmental and psychiatric disorders in offspring during childhood.

Material and Methods

This prospective, population-based cohort study used data from 652 732 singleton children born alive in Finland between 2004 and 2014 and followed until 2018. The Cox proportional hazards model was used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI).

Results

Children exposed to both chronic hypertension and obesity exhibited a 2.4–3.5-fold higher risk for mood disorders, specific developmental disorder, autism spectrum disorders, and attention-deficit/hyperactivity disorders. Similarly, exposure to both gestational hypertension and overweight increased the risk for anxiety disorders and attention-deficit hyperactivity disorders by 2.4-fold. Meanwhile, combined exposure to preeclampsia and overweight increased the risk of mood and anxiety disorders, specific developmental disorders, and other behavioral disorders, by 1.8–2.2-fold. The effect size of combined exposure to HDP and overweight/obesity was greater than that of the individual exposure to HDP subtypes or overweight/obesity. Furthermore, overweight/obesity synergistically modified these associations between the HDP subtype exposure and offspring mental disorders, except for specific developmental disorders.

Conclusions

Our findings suggest that combined exposure to different subtypes of HDP and higher prepregnancy BMI have distinct impacts on the mental health of offspring. Notably, a more pronounced effect was observed in cases where chronic hypertension and obesity coexisted. Future research should focus on exploring dose-related relationships rather than amalgamating maternal HDP for investigating the offspring outcomes.