Complications in hospitalized neonates born to mothers with HDP subtypes: a retrospective cohort study and mediation analysis.

Background: Hypertensive disorders in pregnancy (HDP), including four subtypes, are common complications significantly contributing to perinatal morbidity and mortality. Research on the impact of HDP subtypes-preeclampsia/eclampsia (PE/E) and superimposed preeclampsia (SP)-on comprehensive outcomes for hospitalized neonates is relatively limited. Additionally, PE/E and SP often result in shorter gestational age (GA), and the role of GA in the preterm birth-related complications of these HDP subtypes remains unclear.

Methods: This retrospective cohort study identified a total of 989 cases (exposed group), including 845 cases of PE/E and 144 cases of SP . We randomly selected 989 normotensive pregnant women from the same period as controls (control group). Adjusted odds ratios and 95% confidence intervals for neonatal outcomes were calculated using logistic regression. Mediation analysis was conducted to investigate the role of GA in the relationship between HDP subtypes and preterm birth-related complications.

Results: Both PE/E and SP increased the risk of adverse birth outcomes, including preterm birth, small for gestational age, low birth weight, and asphyxia, as well as hematological complications such as neutropenia, polycythemia, and thrombocytopenia. PE/E and SP also increased the risk of hypoglycemia while decreasing the risk of pathologic jaundice, with no impact on infection complications. Mediation analysis revealed that PE/E increased the risk of intraventricular hemorrhage while reducing the risk of patent ductus arteriosus and retinopathy of prematurity, both through direct effects (the disease of PE/E itself) and indirect effects (via GA). SP increased the risk of neonatal respiratory distress syndrome and intraventricular hemorrhage through indirect effects (via GA).

Conclusion: PE/E and SP are key maternal diseases influencing the outcomes of hospitalized neonates, with GA playing an important mediating role in preterm birth-related complications. Early monitoring and management of those mothers and infants are crucial to improving prognosis.