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DOI: 10.1055/s-0036-1594017
Preeclampsia and the Risk of Bronchopulmonary Dysplasia in Preterm Infants Less Than 32 Weeks' Gestation
Publication History
08 August 2016
04 October 2016
Publication Date:
05 December 2016 (online)
Abstract
Objective Angiogenesis is essential for normal lung development. The objective of our study was to test the hypothesis that preeclampsia, an antiangiogenic state, is a risk factor for bronchopulmonary dysplasia (BPD).
Design Prospective cohort study of infants less than 32 weeks' gestation born to mothers with preeclampsia between January 2007 and June 2010 at a single tertiary care center. Their BPD outcome was compared with infants born to the next two normotensive mothers with a ± 1 week gestational age difference. BPD was defined as oxygen dependency at 36 weeks' postmenstrual age. Multivariable binary regression was used to estimate the risk ratio (RR) of BPD with preeclampsia exposure and adjust for confounders.
Results Of 102 infants in the preeclampsia group, 23 (23%) developed BPD and of the 217 infants in the normotensive group, 56 (26%) developed BPD. On multivariable binary regression modeling, preeclampsia was not a risk factor for development of BPD (RR: 0.5, 95% confidence interval [CI]: 0.20–1.20). Surfactant use, Score for Neonatal Acute Physiology Perinatal Extension-II score, sepsis, blood transfusion, and intrauterine growth restriction (IUGR) were significant risk factors for BPD.
Conclusion In our cohort, preeclampsia was not a significant risk factor for BPD. IUGR infants of preeclamptic and normotensive mothers were at higher risk for BPD.
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References
- 1 Baraldi E, Filippone M. Chronic lung disease after premature birth. N Engl J Med 2007; 357 (19) 1946-1955
- 2 Thebaud B. Chronic lung disease in the neonate: past, present and future. Neoreviews 2013; 14 (5) e252-e258
- 3 Jobe AH. The new BPD. Neoreviews 2006; 7 (10) e531-e545
- 4 Thébaud B. Angiogenesis in lung development, injury and repair: implications for chronic lung disease of prematurity. Neonatology 2007; 91 (4) 291-297
- 5 Hadchouel A, Franco-Montoya ML, Delacourt C. Altered lung development in bronchopulmonary dysplasia. Birth Defects Res A Clin Mol Teratol 2014; 100 (3) 158-167
- 6 Meller S, Bhandari V. VEGF levels in humans and animal models with RDS and BPD: temporal relationships. Exp Lung Res 2012; 38 (4) 192-203
- 7 Hasan J, Beharry KD, Valencia AM, Strauss A, Modanlou HD. Soluble vascular endothelial growth factor receptor 1 in tracheal aspirate fluid of preterm neonates at birth may be predictive of bronchopulmonary dysplasia/chronic lung disease. Pediatrics 2009; 123 (6) 1541-1547
- 8 Janér J, Andersson S, Haglund C, Lassus P. Pulmonary endostatin perinatally and in lung injury of the newborn infant. Pediatrics 2007; 119 (1) e241-e246
- 9 Mohamed WA, Niyazy WH, Mahfouz AA. Angiopoietin-1 and endostatin levels in cord plasma predict the development of bronchopulmonary dysplasia in preterm infants. J Trop Pediatr 2011; 57 (5) 385-388
- 10 Chaiworapongsa T, Chaemsaithong P, Yeo L, Romero R. Pre-eclampsia part 1: current understanding of its pathophysiology. Nat Rev Nephrol 2014; 10 (8) 466-480
- 11 Pratt A, Da Silva Costa F, Borg AJ, Kalionis B, Keogh R, Murthi P. Placenta-derived angiogenic proteins and their contribution to the pathogenesis of preeclampsia. Angiogenesis 2015; 18 (2) 115-123
- 12 Noris M, Perico N, Remuzzi G. Mechanisms of disease: pre-eclampsia. Nat Clin Pract Nephrol 2005; 1 (2) 98-114 , quiz 120
- 13 Reilly SD, Faye-Petersen OM. Chorioaminionitis and funisitis: their implications for the neonate. Neoreviews 2008; 9 (9) e411-e417
- 14 Kuperman AA, Kenet G, Papadakis E, Brenner B. Intraventricular hemorrhage in preterm infants: coagulation perspectives. Semin Thromb Hemost 2011; 37 (7) 730-736
- 15 Dominguez KM, Moss RL. Necrotizing enterocolitis. Clin Perinatol 2012; 39 (2) 387-401
- 16 Kramer MS, Platt RW, Wen SW , et al; Fetal/Infant Health Study Group of the Canadian Perinatal Surveillance System. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 2001; 108 (2) E35 . Doi: 10.1542/peds.108.2.e35
- 17 Bose C, Van Marter LJ, Laughon M , et al; Extremely Low Gestational Age Newborn Study Investigators. Fetal growth restriction and chronic lung disease among infants born before the 28th week of gestation. Pediatrics 2009; 124 (3) e450-e458
- 18 Klinger G, Sokolover N, Boyko V, Sirota L, Lerner-Geva L, Reichman B ; Israel Neonatal Network. Perinatal risk factors for bronchopulmonary dysplasia in a national cohort of very-low-birthweight infants. Am J Obstet Gynecol 2013; 208 (2) 115.e1-115.e9
- 19 Jensen EA, Schmidt B. Epidemiology of bronchopulmonary dysplasia. Birth Defects Res A Clin Mol Teratol 2014; 100 (3) 145-157
- 20 Christenfeld NJ, Sloan RP, Carroll D, Greenland S. Risk factors, confounding, and the illusion of statistical control. Psychosom Med 2004; 66 (6) 868-875
- 21 Schisterman EF, Cole SR, Platt RW. Overadjustment bias and unnecessary adjustment in epidemiologic studies. Epidemiology 2009; 20 (4) 488-495
- 22 Sun GW, Shook TL, Kay GL. Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis. J Clin Epidemiol 1996; 49 (8) 907-916
- 23 Torchin H, Ancel PY, Goffinet F , et al. Placental complications and bronchopulmonary dysplasia: EPIPAGE-2 cohort study. Pediatrics 2016; 137 (3) e20152163 . Doi: 10.1542/peds.2015-2163
- 24 Briana DD, Malamitsi-Puchner A. Small for gestational age birth weight: impact on lung structure and function. Paediatr Respir Rev 2013; 14 (4) 256-262
- 25 Mestan KK, Steinhorn RH. Fetal origins of neonatal lung disease: understanding the pathogenesis of bronchopulmonary dysplasia. Am J Physiol Lung Cell Mol Physiol 2011; 301 (6) L858-L859
- 26 Rozance PJ, Seedorf GJ, Brown A , et al. Intrauterine growth restriction decreases pulmonary alveolar and vessel growth and causes pulmonary artery endothelial cell dysfunction in vitro in fetal sheep. Am J Physiol Lung Cell Mol Physiol 2011; 301 (6) L860-L871
- 27 Lipsett J, Tamblyn M, Madigan K , et al. Restricted fetal growth and lung development: a morphometric analysis of pulmonary structure. Pediatr Pulmonol 2006; 41 (12) 1138-1145
- 28 Wignarajah D, Cock ML, Pinkerton KE, Harding R. Influence of intrauterine growth restriction on airway development in fetal and postnatal sheep. Pediatr Res 2002; 51 (6) 681-688
- 29 Gagnon R. Placental insufficiency and its consequences. Eur J Obstet Gynecol Reprod Biol 2003; 110 (Suppl. 01) S99-S107
- 30 Sureshbabu A, Syed MA, Boddupalli CS , et al. Conditional overexpression of TGFβ1 promotes pulmonary inflammation, apoptosis and mortality via TGFβR2 in the developing mouse lung. Respir Res 2015; 16 (1) 4 . Doi: 10.1186/s12931-014-0162-6
- 31 Ambalavanan N, Nicola T, Hagood J , et al. Transforming growth factor-beta signaling mediates hypoxia-induced pulmonary arterial remodeling and inhibition of alveolar development in newborn mouse lung. Am J Physiol Lung Cell Mol Physiol 2008; 295 (1) L86-L95
- 32 Been JV, Debeer A, van Iwaarden JF , et al. Early alterations of growth factor patterns in bronchoalveolar lavage fluid from preterm infants developing bronchopulmonary dysplasia. Pediatr Res 2010; 67 (1) 83-89
- 33 Toti P, Buonocore G, Tanganelli P , et al. Bronchopulmonary dysplasia of the premature baby: an immunohistochemical study. Pediatr Pulmonol 1997; 24 (1) 22-28
- 34 Briana DD, Liosi S, Gourgiotis D , et al. Fetal concentrations of the growth factors TGF-α and TGF-β1 in relation to normal and restricted fetal growth at term. Cytokine 2012; 60 (1) 157-161
- 35 Boutsikou T, Malamitsi-Puchner A, Economou E, Boutsikou M, Puchner KP, Hassiakos D. Soluble vascular endothelial growth factor receptor-1 in intrauterine growth restricted fetuses and neonates. Early Hum Dev 2006; 82 (4) 235-239
- 36 Hentges CR, Silveira RC, Procianoy RS. Angiogenic and antiangiogenic factors in preterm neonates born to mothers with and without preeclampsia. Am J Perinatol 2015; 32 (12) 1185-1190
- 37 Ozkan H, Cetinkaya M, Koksal N. Increased incidence of bronchopulmonary dysplasia in preterm infants exposed to preeclampsia. J Matern Fetal Neonatal Med 2012; 25 (12) 2681-2685
- 38 Srinivas SK, Edlow AG, Neff PM, Sammel MD, Andrela CM, Elovitz MA. Rethinking IUGR in preeclampsia: dependent or independent of maternal hypertension?. J Perinatol 2009; 29 (10) 680-684
- 39 Vatten LJ, Skjaerven R. Is pre-eclampsia more than one disease?. BJOG 2004; 111 (4) 298-302
- 40 Thébaud B, Lacaze-Masmonteil T. If your placenta doesn't have it, chances are your lungs don't have it either: the “vascular hypothesis” of bronchopulmonary dysplasia starts in utero. J Pediatr 2010; 156 (4) 521-523
- 41 O'Shea JE, Davis PG, Doyle LW ; Victorian Infant Collaborative Study Group. Maternal preeclampsia and risk of bronchopulmonary dysplasia in preterm infants. Pediatr Res 2012; 71 (2) 210-214
- 42 Akram Khan M, Kuzma-O'Reilly B, Brodsky NL, Bhandari V. Site-specific characteristics of infants developing bronchopulmonary dysplasia. J Perinatol 2006; 26 (7) 428-435
- 43 Hansen AR, Barnés CM, Folkman J, McElrath TF. Maternal preeclampsia predicts the development of bronchopulmonary dysplasia. J Pediatr 2010; 156 (4) 532-536
- 44 Kalay S, Cakcak B, Oztekin O , et al. The role of VEGF and its soluble receptor VEGFR-1 in preterm newborns of preeclamptic mothers with RDS. J Matern Fetal Neonatal Med 2013; 26 (10) 978-983
- 45 Schlembach D, Wallner W, Sengenberger R , et al. Angiogenic growth factor levels in maternal and fetal blood: correlation with Doppler ultrasound parameters in pregnancies complicated by pre-eclampsia and intrauterine growth restriction. Ultrasound Obstet Gynecol 2007; 29 (4) 407-413
- 46 Staff AC, Braekke K, Harsem NK, Lyberg T, Holthe MR. Circulating concentrations of sFlt1 (soluble fms-like tyrosine kinase 1) in fetal and maternal serum during pre-eclampsia. Eur J Obstet Gynecol Reprod Biol 2005; 122 (1) 33-39
- 47 Staff AC, Braekke K, Johnsen GM, Karumanchi SA, Harsem NK. Circulating concentrations of soluble endoglin (CD105) in fetal and maternal serum and in amniotic fluid in preeclampsia. Am J Obstet Gynecol 2007; 197 (2) 176.e1-176.e6
- 48 Park CW, Park JS, Shim SS, Jun JK, Yoon BH, Romero R. An elevated maternal plasma, but not amniotic fluid, soluble fms-like tyrosine kinase-1 (sFlt-1) at the time of mid-trimester genetic amniocentesis is a risk factor for preeclampsia. Am J Obstet Gynecol 2005; 193 (3 Pt 2): 984-989
- 49 Tang JR, Karumanchi SA, Seedorf G, Markham N, Abman SH. Excess soluble vascular endothelial growth factor receptor-1 in amniotic fluid impairs lung growth in rats: linking preeclampsia with bronchopulmonary dysplasia. Am J Physiol Lung Cell Mol Physiol 2012; 302 (1) L36-L46
- 50 Ness RB, Sibai BM. Shared and disparate components of the pathophysiologies of fetal growth restriction and preeclampsia. Am J Obstet Gynecol 2006; 195 (1) 40-49
- 51 Vatten LJ, Åsvold BO, Eskild A. Angiogenic factors in maternal circulation and preeclampsia with or without fetal growth restriction. Acta Obstet Gynecol Scand 2012; 91 (12) 1388-1394
- 52 Wender-Ozegowska E, Zawiejska A, Iciek R, Brązert J. Concentrations of eNOS, VEGF, ACE and PlGF in maternal blood as predictors of impaired fetal growth in pregnancy complicated by gestational hypertension/preeclampsia. Hypertens Pregnancy 2015; 34 (1) 17-23
- 53 Wathén KA, Ylikorkala O, Andersson S, Alfthan H, Stenman UH, Vuorela P. Maternal serum endostatin at gestational weeks 16-20 is elevated in subsequent pre-eclampsia but not in intrauterine growth retardation. Acta Obstet Gynecol Scand 2009; 88 (5) 593-598
- 54 Yen TA, Yang HI, Hsieh WS , et al; Taiwan Premature Infant Developmental Collaborative Study Group. Preeclampsia and the risk of bronchopulmonary dysplasia in VLBW infants: a population based study. PLoS One 2013; 8 (9) e75168 . Doi: 10.1371/journal.pone.0075168
- 55 Tsao PN, Wei SC, Su YN , et al. Placenta growth factor elevation in the cord blood of premature neonates predicts poor pulmonary outcome. Pediatrics 2004; 113 (5) 1348-1351
- 56 Redline RW, Wilson-Costello D, Hack M. Placental and other perinatal risk factors for chronic lung disease in very low birth weight infants. Pediatr Res 2002; 52 (5) 713-719
- 57 Kim YM, Chaemsaithong P, Romero R , et al. The frequency of acute atherosis in normal pregnancy and preterm labor, preeclampsia, small-for-gestational age, fetal death and midtrimester spontaneous abortion. J Matern Fetal Neonatal Med 2015; 28 (17) 2001-2009
- 58 Shah DM, Shenai JP, Vaughn WK. Neonatal outcome of premature infants of mothers with preeclampsia. J Perinatol 1995; 15 (4) 264-267
- 59 Withagen MIJ, Visser W, Wallenburg HCS. Neonatal outcome of temporizing treatment in early-onset preeclampsia. Eur J Obstet Gynecol Reprod Biol 2001; 94 (2) 211-215
- 60 Hiett AK, Brown HL, Britton KA. Outcome of infants delivered between 24 and 28 weeks' gestation in women with severe pre-eclampsia. J Matern Fetal Med 2001; 10 (5) 301-304
- 61 Zeitlin J, El Ayoubi M, Jarreau PH , et al; MOSAIC Research Group. Impact of fetal growth restriction on mortality and morbidity in a very preterm birth cohort. J Pediatr 2010; 157 (5) 733-9.e1
- 62 Been JV, Zimmermann LJ. Histological chorioamnionitis and respiratory outcome in preterm infants. Arch Dis Child Fetal Neonatal Ed 2009; 94 (3) F218-F225
- 63 Lapcharoensap W, Gage SC, Kan P , et al. Hospital variation and risk factors for bronchopulmonary dysplasia in a population-based cohort. JAMA Pediatr 2015; 169 (2) e143676 . Doi: 10.1001/jamapediatrics.2014.3676