Can maternal high blood pressure cause HIE and cerebral palsy?

A:  Yes.  High blood pressure problems during pregnancy complicate 12 –22% or more of all pregnancies, and these problems significantly contribute to neonatal brain injury and death.  Types of brain injuries that can occur include hypoxic-ischemic encephalopathy (HIE), cerebral palsy (CP)intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and intellectual and developmental disabilities.


Physicians may give different names to high blood pressure problems, but they are all dangerous for the baby.  The categories of blood pressure disorders during pregnancy are:

  • High Blood Pressure During PregnancyChronic hypertension (long-term high blood pressure)
  • Gestational hypertension (high blood pressure that starts after the 20th week of pregnancy)
  • Preeclampsia (high blood pressure that starts after the 20th week of pregnancy with the presence of high protein in the urine)
  • Eclampsia (the development of grand mal seizures in a woman with preeclampsia)
  • Superimposed preeclampsia (preeclampsia complicates existing hypertension)

Infant brain damage from maternal high blood pressure is mainly caused by:

  • Changes in blood flow going to the baby caused by changes in blood flow in the placenta
  • Premature birth

Blood Flow and the Placenta

High blood pressure and related conditions during pregnancy can be damaging to the baby. This is because these conditions impact how blood flows through the placenta (the organ that supplies the umbilical cord and baby with oxygen and nutrients). The placenta is the only way that the baby can get oxygen, so these conditions can decrease the flow of oxygen-rich blood to the baby, resulting in permanent brain damage.

How High Blood Pressure During Pregnancy Affects the Placenta and Baby

When blood pressure is high during pregnancy, the mother’s blood vessels constrict. This – along with other factors – cause changes in the placental vessels that decrease the placenta’s ability to carry oxygen-rich blood to the baby. These abnormal vessels and decreased blood flow are dangerous for several reasons (all of which can cause brain damage in the baby). In addition, if there are problems that cause the placenta to have decreased blood flow (such as placental insufficiency), the mother’s body may release certain molecules that cause widespread vessel abnormalities and dysfunction, which further exacerbate poor blood flow.

Constricted Blood Vessels Can Lead to Hypoxia in the Baby

First, the decreased flow of blood in the placenta can cause the baby to be deprived of oxygen in a condition called hypoxia.  If this hypoxia is severe enough and lasts for a long enough period of time, the baby can develop brain bleeds (such as intraventricular hemorrhage) and brain damage.  In addition, hypoxia and brain bleeds can both cause hypoxic-ischemic encephalopathy (permanent brain damage caused by the death of brain cells due to a lack of oxygen, a lack of blood flow, or both).

Preeclampsia Increases Placental Abruption Risk

Second, high blood pressure conditions – especially preeclampsia – greatly increase the risk of the mother experiencing a dangerous complication called placental abruption, where the placenta either partially or completely separates from the womb (uterus).  If there is a complete separation (or if a partial separation occurs at the umbilical cord insertion site), the placenta will not be attached at all to the womb and will therefore not be able to carry any oxygen from the mother to the baby. Delivery must take place (usually by emergency C-section) as soon as a complete abruption occurs.

In the case of a partial placental separation, the severity depends on the following factors:

  • The location of the separation
  • How much of the placenta has separated from the womb
  • How long the placenta has been separated from the womb
  • The age of the baby
  • How much reserve the baby has

Preeclampsia Increases Risk of Premature Birth

Third, maternal high blood pressure increases the risk of premature birth.  When a baby is born prematurely, there is a risk for brain damage due to a number of reasons.  Premature babies have organs that are not fully developed. A premature baby’s blood vessels are also more fragile. This makes premature babies more prone to kernicterus, infection, trauma, oxygen deprivation, and HIE, all of which can cause brain damage.  The organ systems of premature infants cannot deal with insults the same way full-term infants can.  In addition, there are conditions associated with premature birth that increase the risk of birth trauma and resultant brain damage.  For these reasons, it is crucial that physicians follow standards of care that apply to premature infants, and that they prevent premature birth or quickly diagnose and treat conditions that are associated with premature birth, such as preeclampsia and maternal high blood pressure.

High Blood Pressure Increases Risk of Babies Born Small For Their Age

Finally, maternal high blood pressure increases the risk of intrauterine growth restriction (IUGR) and giving birth to a baby that is small for gestational age.  The main reason for this is because decreased blood flow in the placenta usually means there will be a decrease in the amount of oxygen and nutrients a baby receives while in the womb, which can cause decreased growth.  Babies with IUGR are at risk of developing many conditions that can cause brain damage, including hypoglycemia and HIE.

Since high blood pressure conditions can cause permanent brain damage in a baby, it is crucial for physicians to routinely test a pregnant woman’s blood pressure, and they should do so more frequently if she has certain risk factors. Treatment for hypertensive conditions must begin at the earliest possible time to avoid or minimize injury to the baby.  If the baby is at risk for premature birth, physicians should make every effort to prevent the baby from being born prematurely.

Award-Winning Birth Injury Attorneys Provide Legal Help for Preeclampsia and High Blood Pressure During Pregnancy

When an obstetrician fails to diagnose and appropriately treat preeclampsia, or fails to induce labor or perform a timely C-section, birth injuries may result. If you were diagnosed with preeclampsia (pregnancy-induced hypertension) or eclampsia and your baby experienced complications that resulted in permanent disability, please call Reiter & Walsh ABC Law Centers.

Birth injury attorney Jesse Reiter discussed preeclampsia. Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over three decades; most of his cases involve hypoxic-ischemic encephalopathy (HIE) and cerebral palsy. Partners Jesse Reiter and Rebecca Walsh are currently recognized as being two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as being one of the best medical malpractice law firms in the nation. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).

We have helped children throughout the country obtain compensation for lifelong treatment, therapy, and a secure future, and we give personal attention to each child and family we represent.

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