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Background <p>To 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.</p> Methods <p>We conducted a multicenter retrospective cohort study using prospectively collected data from the Brazilian Neonatal Research Network, including infants with birthweights 401–1500&#xa0;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 &gt; 28 weeks).</p> Results <p>Among 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 <b>≤</b> 28 weeks. In contrast, CH was associated with lower observed risks of late-onset sepsis and, among infants <b>&gt; </b>28 weeks, severe intraventricular hemorrhage. Several crude associations were attenuated after adjustment, highlighting the confounding effect of gestational age.</p> Conclusions <p>HDP 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.</p>

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Neonatal outcomes of hypertensive pregnancy subtypes in very preterm infants: a multicenter cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月1日

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  • Fernanda Gabriella Bezerra de Araujo,
  • Rita C. Silveira,
  • Diego Gomes Teixeira,
  • Fernanda Pegoraro de Godoi,
  • Paulyne Stadler Venzon,
  • Maria Eduarda Gurgel Cherpak,
  • Maryne´a Silva do Vale,
  • Ligia Maria Suppo de Souza Rugolo,
  • Fla´via Maria Batista da Costa,
  • Humberto Fiori,
  • Se´rgio Tadeu Martins Marba,
  • Silvia Cwajg,
  • Jose´ Luiz Muniz Bandeira Duarte,
  • Walusa Assad Gonçalves-Ferri,
  • Ma´rcia Gomes Penido Machado,
  • Daniela Marques de Lima Mota Ferreira,
  • Jose Mariano Sales Alves Junior,
  • Juliana Paula Ferraz dos Santos,
  • Milton Harumi Miyoshi,
  • Nathalia Moura de Mello e Silva,
  • Renato Soibelmman Procianoy

摘要

Background

To 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.

Methods

We 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).

Results

Among 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.

Conclusions

HDP 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.