Observational studyBMC pediatrics2026
Neonatal outcomes of hypertensive pregnancy subtypes in very preterm infants: a multicenter cohort study.
Observational study in BMC pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTo evaluate whether distinct subtypes of hypertensive disorders of pregnancy (HDP), chronic hypertension (CH), pregnancy-specific hypertensive disorders (PSHD), and superimposed preeclampsia (CH + PE), are associated with differential neonatal outcomes in very preterm infants, independent of gestational age and perinatal confounders.
methodsWe conducted a multicenter retrospective cohort study using prospectively collected data from the Brazilian Neonatal Research Network, including infants with birthweights 401-1500 g and gestational age 22 + 0 to 32 + 6 weeks (2013-2020). Infants were classified according to maternal hypertensive status. Primary outcomes included major neonatal morbidities and in-hospital mortality. Associations were assessed using Poisson regression with robust variance, adjusting for gestational age, birthweight, sex, antenatal corticosteroids, and perinatal variables. Analyses were stratified by gestational age (≤ 28 and > 28 weeks).
resultsAmong 9,689 infants, 4,011 (41.4%) were exposed to HDP. PSHD and CH + PE were associated with higher risks of respiratory distress syndrome and surfactant use across models. CH + PE was additionally associated with higher mortality, particularly in infants ≤ 28 weeks. In contrast, CH was associated with lower observed risks of late-onset sepsis and, among infants > 28 weeks, severe intraventricular hemorrhage. Several crude associations were attenuated after adjustment, highlighting the confounding effect of gestational age.
conclusionsHDP subtypes were associated with distinct neonatal outcome profiles. PSHD and CH + PE were associated with higher risks of respiratory morbidity and mortality, whereas CH showed a more neutral profile and lower observed risks for selected outcomes. These findings support subtype-specific risk stratification in very preterm infants.
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