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Comment & Response
July 12, 2021

Additional Counseling Support for Mothers With Gestational Hypertensive Disorders Regarding Neurodevelopmental Outcomes in Their Children—Reply

Author Affiliations
  • 1Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
  • 2MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
JAMA Pediatr. 2021;175(10):1082. doi:10.1001/jamapediatrics.2021.2071

In Reply We thank Dr Triunfo for raising an interesting point regarding our research.1 We do not feel that our results are relevant to postnatal counseling of mothers with hypertensive disorders of pregnancy (HDP). Clinical guidelines in many countries (including those of the American College of Obstetricians and Gynecologists2) highlight the importance of postnatal blood pressure monitoring and providing advice to women who have experienced HDP to reduce their future risk of cardiovascular diseases. HDPs are associated with a 2- to 4-fold increase in risk of chronic hypertension, type 2 diabetes, and heart disease.3 While there is increasing interest in the possibility that exposure to maternal HDP also influences the long-term health of the offspring, several things would need to be in place before this possibility could be translated to postnatal advice, including the nature and magnitude of any association. The magnitude of reported associations of intrauterine HDP with future risk of autism spectrum disorders (ASDs) and attention-deficit/hyperactivity disorder (ADHD) found by us1 and others4,5 are modest (less than 1.5-fold), and in absolute terms the neurodevelopmental risks experienced by offspring are not comparable in magnitude with the HDP-associated long-term cardiovascular risks for the mothers. In our register-based study with a median follow-up of 23 years, the absolute differences in the proportion of ASDs and ADHD diagnoses observed with intrauterine HDP were only 0.5% and 0.4%, respectively. Although our sibling comparison analysis provided additional evidence that associations with ASDs and ADHD in offspring are independent of familial confounders, the analysis does not support offspring neurodevelopmental risks being an integral part of HDP counseling in light of the low relative and absolute risks observed. Furthermore, regarding the associations of HDP with future maternal cardiovascular health, evidence increasingly shows that HDP does not cause cardiovascular disease; rather, the occurrence of HDP identifies women with underlying genetic or environmental risk for future cardiovascular diseases.6 Hence current postnatal monitoring and advice is appropriately provided to those identified as being at-risk of a future condition for which preventive treatments exist.

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