Maternal preeclampsia and early childhood development: a cohort study in British Columbia, Canada

Abstract Background Preeclampsia is a pregnancy-induced hypertensive disorder and is known to negatively impact maternal and child health. The relationship between maternal preeclampsia and child development remains underexplored, with existing studies generating mixed findings. This study aims to determine whether prenatal exposure to preeclampsia is associated with child developmental vulnerability. Methods This population-based cohort study includes 59,508 (51.4% female) singleton live births occurring between 2012 and 2017 in British Columbia (BC), Canada. The births were identified in the BC Vital Statistics Birth database and were linked to the Early Development Instrument (EDI) surveys completed by kindergarten teachers around age 5. The primary outcome assessed was child developmental vulnerability defined using the provincial cut-off score of lowest 10th percentile on any two of the five EDI domains: physical wellbeing, social competence, emotional maturity, language and cognitive development, and communication skill. Adjusted Risk Ratios (aRR) and 95% Confidence Intervals (CIs) were computed from modified Poisson regression models, adjusting for a wide range of maternal sociodemographic and comorbid factors. Results The proportion of children prenatally exposed to preeclampsia was 2.0%. Developmental vulnerability was identified in 25.8% of exposed children, compared with 18.8% of those unexposed. Exposure to preeclampsia was associated with 33% higher risk of developmental vulnerability in the adjusted model (aRR 1.33; 95% CI: 1.21, 1.46). The association was consistently observed across all EDI outcomes. Early onset preeclampsia showed 1.54-fold higher risk of developmental vulnerability (95% CI: 1.23, 1.94), while late onset preeclampsia showed a 1.30-fold higher risk (95% CI: 1.17, 1.44). Conclusions Maternal preeclampsia may increase the risk of developmental vulnerability at school entry. Further research is warranted to examine the mechanistic pathways. Key messages • By demonstrating a robust association between maternal preeclampsia and early age developmental challenges, this study provides strong evidence supporting the fetal programming of child development. • The findings underscore the need for early detection and prevention of preeclampsia as well as targeted early interventions for children prenatally exposed to this condition.