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 I2 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 (I2 = 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.