Adverse Childhood Experiences and Substance Use: The Mediating Role of Executive Function Deficits.

Hypertensive disorders of pregnancy (HDP), characterized by hypertension, proteinuria, edema, and other clinical manifestations, constitute a distinct category of multisystem and multi-organ disorders occurring during pregnancy [–]. Globally, approximately 5–10% of pregnant women are affected by HDP []. In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released updated guidelines recommending lower blood pressure thresholds (systolic blood pressure [SBP] 130–139 mmHg and/or diastolic BP [DBP] 80–89 mmHg) to define “stage 1 hypertension” in nonpregnant adults []. This adjustment was informed by robust cardiovascular studies showing that targeting lower BP levels reduces cardiovascular disease risk [–]. Despite these advancements, current obstetric protocols have not integrated these updated benchmarks []. Evidence on the impact of borderline hypertension (“stage 1 hypertension” as defined by the 2017 ACC/AHA guidelines) on maternal and offspring health outcomes is urgently needed to determine whether the criteria for gestational hypertension should be revised. HDP represent a leading contributor to intrauterine fetal demise and a range of adverse neonatal complications [, ]. Beyond immediate perinatal risks, HDP is associated with long-term neurobehavioral consequences in offspring, potentially mediated by vascular dysfunction and subsequent placental insufficiency, which may induce ischemic and hypoxic conditions []. Such disruptions during critical periods of fetal brain development have been linked to cognitive deficits, autism spectrum disorders, and attention-related impairments [–]. Critically, the foundational architecture of the fetal central nervous system is established prenatally through a sequence of tightly regulated events []. Major processes such as neurogenesis, neuronal migration, and polarization predominantly occur within the first half of gestation. These are followed by later events crucial for functional connectivity, including extensive axonal and dendritic growth and synaptogenesis, which accelerate during the mid-to-late stages of pregnancy [, ]. This protracted developmental timeline renders the fetal brain exquisitely sensitive to alterations in the intrauterine environment throughout pregnancy []. Growing evidence indicates that offspring of mothers with borderline hypertension during pregnancy are at higher risk of adverse perinatal outcomes, including preterm birth, small-for-gestational-age status, and neonatal intensive care unit (NICU) admission [–]. Despite these findings, the potential impact of maternal borderline hypertension on the long-term neurodevelopmental trajectory of offspring remains poorly understood and warrants further investigation. Thus, we conducted a secondary analysis within a prospective cohort study in Jiangsu, China, to investigate the associations between maternal borderline hypertension during pregnancy (as classified by the 2017 ACC/AHA guidelines) and neurodevelopmental outcomes in offspring at one year of age. Additionally, the study sought to explore whether specific trimesters of exposure to borderline hypertension represent particularly sensitive periods for offspring neurodevelopment.