Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Perinatal and Child Factors mediate the association between Preeclampsia and Offspring School Performance (#98)

Monica Zen 1 2 , Francisco Schneuer 3 , Thushari I Alahakoon 1 2 , Natasha Nassar 3 , Vincent W Lee 2 4
  1. Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, NSW, Australia
  2. University of Sydney, Western Clinical School, Westmead, NSW, Australia
  3. Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
  4. Westmead Applied Research Centre, The University of Sydney, NSW, Australia

Preeclampsia complicates 2-8% of all pregnancies and is a major cause of maternal and perinatal morbidity and mortality. It is thought that preeclampsia is adversely associated with long-term neurodevelopmental and cognitive outcome in the offspring. However, there are inconsistencies in the available epidemiologic evidence exploring the association between preeclampsia and long-term neurodevelopmental, behavioral and cognitive outcomes, with unmeasured or unrecognized confounders being a particular concern in the current literature. Therefore, the aim of this study was to investigate the association between preeclampsia diagnosed in pregnancy and subsequent impact on offspring school performance, taking into account important perinatal and child factors.

We performed a population-based cohort study using record linkage of state-wide data. We evaluated a total of 341,779 liveborn singleton children born at 28+ weeks gestation in New South Wales, Australia, who had Grade 3 record-linked education outcomes via the National Assessment Program – Literacy and Numeracy (NAPLAN) between 2009 to 2014. Of these, 22,657 (6.6%) were born to mothers with preeclampsia and were compared to those without in utero exposure. Robust multivariable Poisson models were used to determine adjusted relative risks.

Crude models demonstrated increased risk of scoring Below the National Minimal Standard in all five domains (reading, writing, spelling, grammar and punctuation, and numeracy) for children exposed to preeclampsia ranging from RR 1.13 (95%CI 1.04, 1.24) for reading to 1.19 (1.09,1.30) for numeracy. However, these differences were attenuated once adjusted for perinatal and child factors, with gestational age at birth being the most important perinatal factor, followed by small for gestational age. The poorer educational performance experienced by children born to women with preeclampsia appears largely attributable to perinatal and childhood factors, suggesting an opportunity to improve school performance in children exposed to preeclampsia by optimising these perinatal factors, in particular, gestational age at birth.