Cerebral palsy (CP) is a group of permanent movement and posture disorders caused by non-progressive disturbances in the developing fetal or infant brain. Preeclampsia is a hypertensive disorder of pregnancy characterized by high blood pressure and signs of damage to other organ systems, often the kidneys, typically occurring after 20 weeks of gestation. The question of whether untreated preeclampsia is linked to cerebral palsy involves understanding the relationship between maternal hypertensive disorders and neurodevelopmental outcomes in children.
Extensive research has examined hypertensive disorders of pregnancy, including preeclampsia, and their impact on childhood neurodevelopmental disabilities. A comprehensive systematic review and meta-analysis pooling data from over 2.5 million pregnancies found **no statistically significant association between hypertensive disorders of pregnancy and the risk of cerebral palsy in offspring**. Specifically, the odds ratio (OR) for cerebral palsy in children born to mothers with hypertensive disorders was 1.28 (95% confidence interval [CI] 0.76 to 2.13), which was not statistically significant (p = 0.35). When focusing on preeclampsia alone, the OR was 1.58 (95% CI 0.80 to 3.14), also not statistically significant (p = 0.19). This suggests that preeclampsia, whether treated or untreated, does not have a clear, direct link to increased cerebral palsy risk in children compared to normotensive pregnancies[1].
It is important to note that while hypertensive disorders of pregnancy were not linked to cerebral palsy, they were associated with other neurodevelopmental outcomes. For example, the same meta-analysis found a significant association between hypertensive disorders and intellectual disability, with a 77% increased likelihood (OR 1.77, 95% CI 1.31 to 2.38, p < 0.001)[1]. This indicates that while cerebral palsy risk may not be elevated, other cognitive and developmental impairments could be more common in children born to mothers with hypertensive conditions during pregnancy. The pathophysiology behind preeclampsia involves abnormal placental development leading to poor blood flow and oxygen delivery to the fetus, which can cause fetal growth restriction and hypoxia. These conditions are known risk factors for brain injury in the developing fetus, which theoretically could contribute to cerebral palsy. However, the current large-scale epidemiological evidence does not support a strong or consistent link between preeclampsia and cerebral palsy, possibly because cerebral palsy often results from a complex interplay of multiple factors including prematurity, infection, and genetic predispositions[1][2]. Regarding untreated preeclampsia specifically, there is limited direct evidence isolating the effect of lack of treatment on cerebral palsy risk. Most studies consider hypertensive disorders as a whole, without differentiating treatment status. However, untreated preeclampsia can lead to severe complications such as eclampsia, placental abruption, and preterm birth, which themselves are risk factors for cerebral palsy. Therefore, while preeclampsia per se may not be directly linked to cerebral palsy, the complications arising from untreated or severe preeclampsia could increase the risk indirectly. Additional factors influencing neurodevelopmental outcomes include maternal age, socioeconomic status, and other pregnancy complications. For example, maternal age and other sociod
