Hypertensive disorders in pregnancy and risk of asthma in the offspring: a systematic review and meta-analysis.

BACKGROUND: Hypertensive disorders of pregnancy (HDP), including preeclampsia, gestational hypertension, and eclampsia, are common pregnancy complications that may have long-term consequences for offspring health. Emerging evidence suggests a potential link between maternal hypertension and childhood asthma, though findings remain inconsistent. This systematic review and meta-analysis aimed to synthesize the existing evidence on the association between HDP and asthma risk in offspring. METHODS: A comprehensive search of PubMed, Scopus, Web of Science, and EMBASE was conducted from database inception to 3 December 2024, restricted to peer-reviewed published studies. The eligibility criteria followed the PICOS framework. Observational studies (cohort, case-control, cross-sectional) assessing the association between HDP and asthma in offspring were included. Effect measures were converted to odds ratios (OR) with 95% confidence intervals (CI), and a meta-analysis was performed using random- and fixed-effects models. Heterogeneity was assessed jointly with Cochran's Q test (p < 0.10) and the I 2 statistic, and publication bias was examined through funnel plots and Egger's test. RESULTS: Twenty studies encompassing over three million mother-infant pairs were included. The pooled OR for asthma risk in offspring of mothers with HDP was 1.14 (95% CI: 1.07-1.21), indicating a significant association. Subgroup analyses revealed a positive association with both preeclampsia (OR: 1.20; 95% CI: 1.12-1.28) and gestational hypertension (OR: 1.18; 95% CI: 1.02-1.36). Heterogeneity was high in some subgroups, such as gestational hypertension (I 2 = 92.6%; p < 0.0001), suggesting variability across studies. As a secondary outcome, the association between HDP and wheezing in the offspring was assessed. The pooled OR was 1.07 (95% CI: 0.99-1.17), not reaching statistical significance, although positive trends were observed in some subtypes. CONCLUSION: Maternal HDP is associated with an approximately 14-20% increased risk of asthma in offspring, highlighting the need for targeted early-life monitoring and intervention strategies. Further research is warranted to elucidate underlying mechanisms and optimize maternal-fetal health outcomes. SYSTEMATIC REVIEW REGISTRATION: IS: CRD420251000229.