Maternal hypertensive disorders during pregnancy and the mental health and cognitive functioning of the adult offspring: the Helsinki Birth Cohort Study
Year: 2014
Type: dissertation
Study design: Observational Study
Abstract: Hypertensive pregnancy disorders complicate approximately 10% of all pregnancies. They may compromise placental functioning and, thus, affect the fetal developmental milieu. It is therefore highly plausible that they have consequences for the developmental outcomes of the offspring. However, their role in the developmental plasticity phenomenon dubbed programming remains relatively unexplored. This thesis examines whether adult offspring born to mothers with hypertensive pregnancy disorders differ from their counterparts born to normotensive mothers in mental health and cognitive functioning, and whether the potential group differences vary according to sex, length of gestation, parity, and childhood socio-economic status. This thesis capitalizes on the Helsinki Birth Cohort Study. The study cohort comprises 13 345 individuals born in Helsinki between 1934 and 1944. Maternal hypertension status was defined based upon blood pressure and urinary protein measurements during pregnancy and was available for 6410 individuals. Data on mental disorders come from validated national registers extending over four decades (n = 5970 eligible for this study; Study II). Depressive symptoms were measured with a standardized questionnaire (BDI) in conjunction with a clinical follow-up study at a mean age of 62 years (n = 788; Study I) and in conjunction with a further follow-up including a more detailed psychological survey at a mean age of 64 years (n = 661; Study I). Cognitive test scores were obtained from the Finnish defence forces basic ability test taken during military service at a mean age of 20 years (n = 1196; Study III) and in a re-test at a mean age of 69 years (n = 398; Study IV). Cognitive impairment was measured with psychological questionnaires (DFQ and DEX) in conjunction with a further follow-up at a mean age of 69 years (n = 876; Study V). In comparison to the offspring born to normotensive mothers, offspring born to pre-eclamptic mothers showed higher self-reported cognitive impairment (Study V). Offspring born to mothers with hypertension without proteinuria showed a higher risk of mental disorders (Study II), although they did not differ in the severity of selfreported depressive symptoms. Maternal hypertensive pregnancy disorders as a diagnostic entity were associated with lower cognitive functioning (Sudy III and IV) and higher cognitive decline (Study IV). Sex, parity and childhood socio-economic status modified some of associations. Maternal pre-eclampsia was associated with higher self-reported depressive symptom scores in primiparous, but not in multiparous, offspring (Study I), and with a lower risk of mental disorders in male, but not female, offspring (Study II). Maternal hypertension without proteinuria was associated with self-reported cognitive impairment in female, but not male, offspring (Study V). Finally, the associations between maternal hypertensive pregnancy disorders as a diagnostic entity and lower cognitive functioning (verbal reasoning) in young adulthood were most evident in primiparous offspring and in offspring with a high childhood socio-economic status (Study III). These study findings showed that maternal hypertensive pregnancy disorders were associated with all studied mental health and cognitive functioning outcomes. Overall, maternal hypertensive disorders during pregnancy carried an increased risk of a wide spectrum of problems in mental well-being and cognitive functioning among the offspring several decades later. However, protective effects were also observed, and, in future studies, it will be important to unravel the developmental pathways and underlying biological mechanisms. Being the longest follow-up on the transgenerational consequences of maternal hypertensive disorders reported thus far, the findings highlight the role of the prenatal environment in developmental programming.
Source: Työväentutkimus Vuosikirja
Author: Soile Tuovinen
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2239763289