Preeclampsia and Respiratory Distress Syndrome in Preterm Infants: a meta-analysis

Objective To systematically assess the association between maternal pre-eclampsia (PE) and the risk of respiratory distress syndrome (RDS) in preterm offspring.Methods A meta-analysis was performed on selected case-control studies regarding maternal pre-eclampsia and RDS in offspring involving RDS patients regardless of age or ethnicity, after searching PubMed, Web of Science, Embase, Cochrane Library, CNKI, WanFang Data, and CBM up to November 2025. The main outcome was RDS confirmed by imaging, duration of ventilation support, or related diagnostic criteria. Pre-eclampsia was defined as sBP ≥ 140 mmHg and/or dBP ≥ 90 mmHg accompanied by proteinuria, elevated creatinine, reduced platelet count, elevated liver enzymes, cerebral or visual symptoms, or persistent epigastric pain. The quality of included studies was assessed using the Newcastle-Ottawa Scale (≥6 scores). Statistical analysis was carried out using Stata 17.0 software, and heterogeneity was determined by Q test combined with I² test. In accordance with the heterogeneity test results, the appropriate model (random or fixed) was selected. Subgroup analysis was performed. Potential publication bias was assessed by funnel plots.Results A total of 12 high-quality studies involving 216,833 subjects were included. The pooled results showed that the risk of RDS in preterm offspring born to mothers with pre-eclampsia was 1.24 times that of mothers without PE (OR=1.24, 95% CI: 1.14–1.35, P<0.05). Subgroup analysis indicated that study design was an important source of heterogeneity.Conclusion Maternal pre-eclampsia may increase the risk of RDS in preterm offspring. Neonatal care providers should maintain heightened vigilance for the offspring of women with pre-eclampsia and consider implementing early interventions to reduce the incidence of RDS.