The impact of hypertensive disorders of pregnancy on cognitive outcomes in offspring: Systematic review and meta-analysis

PURPOSE: To synthesis the available research on the association between hypertensive disorders during pregnancy (HDP) and adverse cognitive outcomes in children. METHODS: PubMed, MEDLINE, Embase, Scopus, CINAHL, and PsycInfo were searched from inception to February 2026 to identify relevant studies. Effect estimates and 95% confidence intervals (CIs) were extracted and pooled using inverse variance-weighted random-effects meta-analysis. RESULTS: Thirty-nine observational studies published between 1982 and 2026, covering over 12.5 million mother-offspring pairs, were included in the final analysis. The findings indicate that HDP were associated with a 39% increased risk of Intellectual Disability (ID) (OR = 1.39, 95% CI = 1.30-1.47) and a 51% increased risk of a low Mental Developmental Index (MDI) (OR = 1.51, 95% CI = 1.09-2.09) in children. However, we observed no significant difference in mean Intelligence Quotient (IQ) scores between children of mothers with and without HDP (MD = -0.09, 95% CI = -0.45-0.26). CONCLUSIONS: The findings highlight that exposure to HDP is associated with an increased risk of ID and low MDI in offspring. Implementing targeted early screening and intervention programs for children of mothers with HDP is essential to address these developmental challenges.