General Obstetrics and Gynecology: Obstetrics
Are maternal hypertension and small-for-gestational age risk factors for severe intraventricular hemorrhage and cystic periventricular leukomalacia? Results of the EPIPAGE cohort study

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Objective

The purpose of this study was to examine the relationships between different causes of preterm delivery (eg, maternal hypertension, small-for-gestational age [SGA], other) and cerebral damage (eg, cystic periventricular leukomalacia [c-PVL], grade III intraventricular hemorrhage [IVH], and intra-parenchymal hemorrhage [IPH]).

Study design

This study included 1902 very preterm singletons who were transferred to neonatal intensive care units in 9 French regions. We used logistic regression models to compare the risk of cerebral injury associated with maternal hypertension, SGA, and all other causes of preterm delivery.

Results

We found that the risk of c-PVL and grade III IVH was higher in infants born after preterm premature rupture of membranes (PPROM) with short latency or idiopathic preterm labor than in infants born to hypertensive mothers. We show that SGA and antepartum maternal hemorrhage significantly increase the risk of IPH.

Conclusion

Our results show that infants born to hypertensive mothers have a lower risk of cerebral injuries than infants born following idiopathic preterm labor and PPROM because they are less exposed to prenatal infection.

Section snippets

Material and methods

All births (including stillbirths) occurring from 22 to 32 completed weeks of gestation in all the maternity units in 9 French regions in 1997 were included. These regions covered one third of all births in France in this year.9 The EPIPAGE cohort included 3675 very preterm births (22 to 32 completed weeks of gestation); 629 were fetal deaths, 143 died during labor, and 127 died immediately after birth in the delivery room; 2776 infants were transferred to a neonatal intensive care unit (NICU).

Statistical analysis

We used the chi-square test to compare the risks of grade III IVH, IPH, and of c-PVL associated with different pregnancy complications. We used logistic regression to evaluate the relationship between pregnancy complications and grade III IVH, IPH, and c-PVL after adjustment for factors that are common causes of the exposure and the disease under study.13, 14 Thus, we first examined the relationships between cerebral injuries and pregnancy complications after adjusting for sex of the infant, a

Results

Grade III IVH and IPH respectively occurred in 3.7% and 2.9% of the 1821 infants who had at least 1 ultrasound scan (Table I). The frequency of grade III IVH and IPH was inversely related to gestational age. C-PVL was found in 5.4% of cases, and bilateral c-PVL in 3.6%.

PPROM (31%) was the most common pregnancy complication that resulted in very preterm delivery (Table II). Other common factors that precipitated delivery were idiopathic preterm labor (22%), maternal hypertension (22%), SGA (9%),

Comment

One of the strong points of our study is that we used a large, population-based, prospective cohort (EPIPAGE) of very preterm infants. All infants, including stillbirths, were born in a geographically defined area. Inclusion was based on gestational age, which excludes bias related to the recruitment of low birth weight infants when studying the relationship between hypertensive diseases and neurologic outcome.8, 20 The EPIPAGE cohort also made it possible to investigate the etiologies of

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    This study was funded by INSERM (French National Institute of Health and Medical Research), Merck-Sharp, Dohme-Chibret, la Fondation de la Recherche Médicale (The Medical Research Foundation), and la Direction Génerale de la Santé du Ministère des Affaires Sociales (The Directorate General for Health of the French Ministry for Social Affairs).

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