Association of borderline hypertension defined by ACC-AHA diagnostic criteria during pregnancy with neurodevelopment in infants.

backgroundThe American College of Cardiology (ACC) and the American Heart Association (AHA) revised the diagnostic criteria for hypertension, recommending a lower threshold of 130/80 mmHg for nonpregnant adults. However, this lower threshold has not been adopted in the global obstetrics field. It remains unclear whether applying this new definition to pregnant women would have implications for maternal health and offspring development. The present study aimed to examine potential relationships between maternal borderline hypertension and neurodevelopmental outcomes in infants.

methodsThis study is a secondary analysis conducted within the prospective Jiangsu Birth Cohort in China. A total of 3352 mothers with blood pressure (BP) records and 3641 of their children were included. Pregnant women were categorized as normotensive (systolic BP [SBP] < 130 mmHg and diastolic BP [DBP] < 80 mmHg), borderline hypertensive (SBP 130-139 mmHg and/or DBP 80-89 mmHg), or hypertensive (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg). Infant neurodevelopment was assessed using the Bayley-III screening test. General linear mixed-effects models and Poisson generalized linear mixed models were applied to evaluate potential associations between maternal borderline hypertension in different trimesters and offspring neurodevelopment, including continuous neurodevelopmental scores and the risk of non-typical development.

resultsCompared with offspring of normotensive mothers, those exposed to maternal borderline hypertension during the first trimester suggested a higher risk of non-typical development in receptive communication (risk ratio [RR], 1.25; 95% confidence interval [CI], 1.00, 1.55; P = 0.045), and exhibited lower expressive communication scores (β, -0.19; [95% CI, -0.38, -0.01]; P = 0.038).When borderline hypertension identified in the first trimester persisted into the second or third trimester, offspring exhibited a more significant reduction in expressive communication scores (β, -0.45; [95% CI, -0.79, -0.11]; P = 0.010).

conclusionsMaternal borderline hypertension, particularly when detected in the first trimester, was associated with lower infant neurodevelopmental scores and a higher risk of non-typical neurodevelopment. The impact appeared more pronounced when borderline hypertension persisted across trimesters. These findings suggest that closer monitoring and management of borderline hypertension during pregnancy may be beneficial for supporting optimal infant neurodevelopment, though further studies are needed to confirm these results.