Topics for the pediatric nurse practitioner to be aware of

Exploring the show Deep Dive™ on the 24 hour program, Medical World News™

Have you explored the video content presented on the Medical World News™ Deep Dive™ links in Contemporary Pediatrics®? Internet links are provided for each topic presented. You can download the link and listen at your leisure, or while on a healthy 15-minute walk or run! These Deep Dive™ videos are enlightening and offer opportunities to improve practice and challenge us to consider the design of research studies to improve the overall health of our pediatric and adolescent populations.

I listened to the 14-minute Deep Dive™,”Into 2023 predictions for women’s health”¹ by Alison Cowan, MD, a board-certified obstetrician-gynecologist, responding to questions by Morgan Petronelli, managing editor for Contemporary OB/GYN® and Contemporary Pediatrics®. While listening, I realized how relevant this discussion is to our primary care pediatric practices. Cowan stated that approximately 80% of maternal deaths are preventable, with many related to health inequities and hypertensive disorders. Cowan reported that between 2007 and 2019, the rates of preeclampsia doubled in the United States. She also identified the value of telehealth and hybrid visits as an important step in managing hypertension during pregnancy, as patients can self-monitor their blood pressures and receive close follow-up and care management from their providers to reduce their risks of preeclampsia.

As pediatric nurse practitioners (PNPs), we know this information applies to adolescents in our practices who, when pregnant, have a high risk of preeclampsia. But what other questions can be raised by pediatric providers for the health and well-being of our pediatric populations while listening to this Deep Dive™ on predicting women’s health?

The question PNPs should consider

Pediatric histories routinely document maternal complications such as preeclampsia, gestational diabetes mellitus (GDM), and obesity in maternal history, but do PNPs follow-up with bringing this information forward in the health maintenance visits? Do PNPs create care management plans for follow-up based on the maternal history as the infant grows and develops throughout childhood? I am unsure of the answers to these questions.

The effects of prenatal complications on the long-term health of our pediatric populations

Reflecting on Cowan’s message sparked my interest in investigating the long-term outcomes of pediatric patients who are exposed to selected prenatal conditions such as hypertension with or without preeclampsia, GDM, and maternal overweight or obesity. I conducted a literature search using the CINAHL medical database, and found a limited number of research articles that followed long-term outcomes for children exposed to these prenatal intrauterine environments.

However, I found a retrospective population-based cohort study investigating childhood school outcomes in infants born to women diagnosed with prenatal hypertension and iatrogenic delivery for preeclampsia was conducted by researchers in Victoria, Australia. The researchers compared these infants to infants of women without diagnoses of hypertension or iatrogenic delivery for preeclampsia.² The researchers linked perinatal data from 2003 to 2013 to developmental scores and educational scores for children in the third, fourth, and fifth grades. The children exposed to hypertension and iatrogenic delivery for preeclampsia as compared to those without these exposures did not have poorer developmental outcomes at school entry. However, these children had a significantly increased risk of poorer educational outcomes at grades 3, 4, and 5.²

GDM is prevalent in 8% to 18% of pregnancies and some studies have shown women with GDM and the exposed infant are at-risk of developing type 2 diabetes and obesity.³ However, studies comparing outcomes for infants exposed prenatally to prepregnancy overweight and GDM are limited.⁴ A longitudinal study, the Northern Finland Birth Cohort for infants born in 1986 (N=4,168) revealed risks for these infants at 16-years old for overweight and abdominal obesity were highest in adolescents who were exposed to both maternal prepregnancy overweight and GDM.⁴

Long-term plans and anticipatory guidance

While this is just a brief snapshot of potential long-term problems that infants exposed prenatally to hypertension, preeclampsia, GDM, and maternal overweight and obesity face, it is a call to action for PNPs to review the prenatal health histories and to develop care management plans to avoid these identified childhood and adolescent problems. It is a further call to action for nurse and pediatrician researchers to design and conduct studies on the long-term effects on infant, child, and adolescent health from prenatal exposures to maternal medical problems.

References

1. Deep dive into 2023 predictions for women’s health. Medical World News Deep Dive™. https://www.medicalworldnews.com/view/deep-dive-into-2023-predictions-for-womens-health

2. Selvaratnam RJ, Wallace EM, Rolnick, DL, Davey, M. Childhood school outcomes for infants born to women with hypertension disorders during pregnancy. Pregnancy Hypertension. 2022;30:51-58. doi:10.1016/j.preghy.2022.08.003

3. O’Reilly SL, Burden C, Campoy C, et al. Bump2Baby and me: protocol for a randomized for a randomized trial of mHealth coaching for healthy gestational weight gain and improved postnatal outcomes in high-risk women and their children. Trials. 2021;22(1):963. doi:10.1186/s13063-021-05892-4

4. Pirkola J, Pouta A, Bloigu, A, et al. Risks of overweight and abdominal obesity at age 16 years associated with prenatal exposures to maternal prepregnancy overweight and gestational diabetes mellitus. Diabetes Care. 2010;33(5):1115-1121. doi:10.2337/dc09-1871