(840) Hypertensive Diseases of Pregnancy Are Significantly Associated with Development of Long-Term Neonatal Seizures

Hypertensive Diseases of Pregnancy (HDP) are associated with many long term maternal and child neurologic conditions. While neurodevelopmental and psychiatric conditions and maternal seizures are known to be associated with HDP, the relationship to neonatal seizures (NSz) is not well documented given the overall low rate of NSz.  Data suggest common vascular mechanisms in HDP and maternal and offspring neuropathology. The objective of this study is to address the hypothesis that HDP is associated with an increased risk of long-term NSz.

Study Design:

This case-control study uses a dataset from the Intergenerational Health Knowledgebase (N=78,726 pregnancies, IRB#20101369) an integrated datamart of all short-term and long-term EHR data of maternal, pediatric, and pregnancy care at the University of Iowa Healthcare (UIHC) system. A composite case definitions of NSz (G40, R56, P90, R25.9, R40.4) and HDP (O10-11, 13-14, 16, I 10,15) were constructed using ICD-10 codes.  Baseline characteristics were compared between cases and controls (alpha=0.05).  Logistic regression models were constructed to evaluate the association between the development of NSz ad HDP.

Results:

NSz pregnancies (N=1370) exhibited significantly higher rates of maternal BMI >40 (16% vs. 12%, p< 0.001), adverse neonatal outcomes (ANO, 59% vs. 35%, p< 0.001), HDP (37% vs. 33%, p< 0.001) in comparison to controls (N=34297). NSz and control pregnancies had similar gestational ages at delivery (37.7 ± 31.6 vs. 38.1 ± 25.6 weeks, p=0.571).  After controlling for age, gravida,  BMI, diabetes in, and race, pregnancies affected by HDP are at higher odds of developing subsequent seizures in the offspring (aOR=1.132 [1.003-1.278], p=0.045).

Conclusion:

Although overall incidence of NSz is low, our data demonstrate a clear association of a high risk of long-term NSz in neonates born from pregnancies affected by HDP. Further studies should be directed at the human and preclinical shared mechanisms that link hypertensive diseases during pregnancy and neuropathology.