Association of Maternal Preeclampsia With Infant Risk of Premature Birth and Retinopathy of Prematurity

Shulman, Julia; Weng, Cindy; Wilkes, Jacob; Greene, Tom; Hartnett, M. Elizabeth

doi:10.1001/jamaophthalmol.2017.2697

Cited by 36 publications

(43 citation statements)

References 34 publications

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“…GA at birth may be an important modifier of relationships between maternal PE and infant morbidity. Studies of VPT infants, representing a truncated GA interval similar to that of our study, have shown associations between maternal PE exposure and reduced rates of brain damage and retinopathy [7,12]. The latter population-based study also included an evaluation over the total span of GA which revealed an increased risk of ROP in relation to PE exposure.…”

Section: Discussionsupporting

confidence: 65%

Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia

2018

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Background: Very preterm (VPT) delivery after severe preeclampsia (PE) has been associated with adverse perinatal outcome. It is unclear whether fetal exposure to PE per se modifies the prevalence of neonatal morbidities associated with VPT birth. Objectives: To evaluate neonatal morbidity in VPT infants exposed to maternal PE compared to morbidity in nonexposed VPT infants. Methods: This retrospective study consisted of all inborn infants delivered before 30 gestational weeks admitted to a tertiary-level neonatal intensive care unit between 1998 and 2014: 195 infants exposed to maternal PE were compared to 957 infants without maternal PE (background group). Prevalence rates of neonatal morbidity, cerebral palsy (CP), and mortality at 2 years of age were obtained from patient records. Results: The PE group had a lower median (IQR) birth weight (795 [262] g) and a higher median gestational age (GA) (27 [3] weeks) at birth than the background group (890 [385] g and 26 [3] weeks, respectively; both p < 0.001). Exposure to maternal PE was associated with lower rates of severe intraventricular hemorrhage (IVH) (2 vs. 11%), retinopathy of prematurity requiring treatment (2 vs. 7%), mortality (9 vs. 15%), and CP (4 vs. 8%). Exposure to PE remained associated with a reduced prevalence of severe IVH (OR 0.17, 95% CI 0.05–0.57) after adjustment for GA, multiple birth, Apgar score, delivery mode, sex, and antenatal steroid treatment. Conclusion: Fetal exposure to PE is associated with a decreased rate of severe IVH following VPT birth. Studies on underlying mechanisms may provide a basis for prevention of IVH in the VPT infant.

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Section: Discussionsupporting

confidence: 65%

Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia

2018

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“…First, the confounders varied between different studies; some studies performed fully adjusted analyses, while others performed partially adjusted analyses. Moreover, maternal factors such as preeclampsia [42] and maternal diabetes [43] were seldom included as potential confounders in these studies. Second, moderate heterogeneity was found among the included studies.…”

Section: Plos Onementioning

confidence: 99%

Effect of red blood cell transfusion on the development of retinopathy of prematurity: A systematic review and meta-analysis

Zhu

Hua

et al. 2020

PLoS ONE

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Background The effect of red blood cell (RBC) transfusion on retinopathy of prematurity (ROP) is difficult to establish, because ROP may also be influenced by other factors. Therefore, we carried out a systematic review and meta-analysis to explore the relationship between RBC transfusion and the development of ROP. Methods The PubMed, Embase, Cochrane Library and Web of Science databases were searched from their inception to September 1, 2019. Observational studies that reported the relationship between RBC transfusion and ROP after adjusting for other potential risk factors were included. The combined result was analyzed by a random effect model. Heterogeneity and publication bias were tested, and sensitivity analysis was performed. Results Of the 2628 identified records, 18 studies including 15072 preterm infants and 5620 cases of ROP were included. A random effect model was used and revealed that RBC transfusion was significantly associated with ROP (pooled OR = 1.50, 95% CI: 1.27-1.76), with moderate heterogeneity among the included studies (I 2 = 44.2%). Subgroup analysis indicated that RBC transfusion was more closely related to ROP in the group with a gestational age (GA) �32 weeks (OR = 1.77, 95% CI: 1.29-2.43) but not in the groups with a GA �34 weeks (OR = 1.36, 95% CI: 0.85-2.18) or a GA <37 weeks (OR = 1.25, 95% CI: 0.86-1.82). No obvious publication bias was found based on the funnel plot and Egger's test. Removing any single study did not significantly alter the combined result in the sensitivity analysis.

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“…These data are further supported by epidemiologic data in other forms of placental insufficiency demonstrating ROP protection [184]. Shulman et al [176], further suggest that prematurity, while necessary for ROP risk, may confound the measured association between maternal preeclampsia and ROP. Certainly the etiologic basis for preterm delivery is varied in most populations, particularly the relatively smaller population delivering in the ROP risk window prior to 32 weeks gestation.…”

Section: A Novel Model Of Natural Rop Protectionmentioning

confidence: 72%

“…oxygen targets), and infant GA at birth influence the measured affect. This is highlighted in a recent publication by Shulman et al [176], who found that preterm infants with GA and BW risk for ROP (< 32 weeks and 1,500 g) demonstrated ROP protection with preeclampsia; however, infants with no GA or BW risk for ROP, GA at birth ~38 weeks, had an increased co-occurrence of ROP and preeclampsia. Thus, it is important to consider the population demographics when analyzing the relationship between preeclampsia and ROP.…”

Section: A Novel Model Of Natural Rop Protectionmentioning

confidence: 97%

“…However emerging evidence suggests that maternal preeclampsia may represent an exception with respect to ROP risk and severity, and may even represent a natural model of ROP protection, with potential to provide novel understanding of early protective ROP mechanisms. There is considerable support for this relationship in the epidemiologic literature, including recent systematic reviews and meta-analyses [18,[172][173][174][175][176][177][178][179]. Several studies dispute this protective relationship [180][181][182], or find no association [183], however, these studies are largely limited by small sample size and lack of appropriate controls (GA, BW and presence of preterm labor) and most have suggested larger analyses are needed.…”

Section: A Novel Model Of Natural Rop Protectionmentioning

confidence: 99%

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Current evidence and outcomes for retinopathy of prematurity prevention: insight into novel maternal and placental contributions

Carroll

Owen

2020

Exploration of Medicine

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Retinopathy of prematurity (ROP) is a blinding morbidity of preterm infants, which represents a significant clinical problem, accounting for up to 40% of all childhood blindness. ROP displays a range of severity, though even mild disease may result in life-long visual impairment. This is complicated by the fact that our current treatments have significant ocular and potentially systemic effects. Therefore, disease prevention is desperately needed to mitigate the life-long deleterious effects of ROP for preterm infants. Although ROP demonstrates a delayed onset of retinal disease following preterm birth, representing a potential window for prevention, we have been unable to sufficiently alter the natural disease course and meaningfully prevent ROP. Prevention therapeutics requires knowledge of early ROP molecular changes and risk, occurring prior to clinical retinal disease. While we still have an incomplete understanding of these disease mechanisms, emerging data integrating contributions of maternal/placental pathobiology with ROP are poised to inform novel approaches to prevention. Herein, we review the molecular basis for current prevention strategies and the clinical outcomes of these interventions. We also discuss how insights into early ROP pathophysiology may be gained by a better understanding of maternal and placental factors playing a role in preterm birth.

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Association of Maternal Preeclampsia With Infant Risk of Premature Birth and Retinopathy of Prematurity

Cited by 36 publications

References 34 publications

Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia

Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia

Effect of red blood cell transfusion on the development of retinopathy of prematurity: A systematic review and meta-analysis

Current evidence and outcomes for retinopathy of prematurity prevention: insight into novel maternal and placental contributions

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