Infant Outcomes in Hypertensive Women: Are there Moderating Effects of Prenatal Care and Race/Ethnicity?

BACKGROUND: Hypertensive disorders of pregnancy is one of the leading causes of adverse infant outcomes. Black women are disproportionately affected by hypertensive disorders of pregnancy, and it associated adverse outcomes. Adequate prenatal care may improve adverse infant outcomes. However, the evidence on adequate prenatal care improving birth outcomes for women with hypertensive disorders of pregnancy especially for Blacks is limited. This study examined the role of adequate prenatal care and race/ethnicity as moderators of hypertensive disorders of pregnancy on infant outcomes. METHODS: The sample was obtained from the 2016-2019 Pregnancy Risk Assessment Monitoring Surveillance dataset from North Carolina. We compared adequate prenatal care among women with hypertensive disorders of pregnancy (n = 610) to women without(n = 2,827), and women with hypertensive disorders of pregnancy with adequate prenatal care to women hypertensive disorders of pregnancy with inadequate prenatal care. RESULTS: The weighted prevalence of hypertensive disorders of pregnancy was 14.1%. Adequate prenatal care was associated with better infant outcomes for low birth weight (AOR = 0.72; 95% CI = 0.58, 0.90) and preterm birth (AOR = 0.62; 95% CI = 0.46, 0.82). Although these effects were not moderated by Black race/ethnicity, Black women independently also had worse outcomes for preterm birth (AOR = 1.59; 95% CI = 1.11, 2.28) and low birth weight (AOR = 1.81; 95% CI = 1.42, 2.29). CONCLUSIONS: Moderation of hypertensive disorders of pregnancy effects on infant outcomes by prenatal care and race/ethnicity was not found. Women with hypertensive disorders of pregnancy who received inadequate prenatal care experienced worse adverse birth outcomes compared to women without hypertensive disorders of pregnancy. Strategies to improve prenatal care, particularly among underserved populations at risk for hypertensive disorders of pregnancy, need to be a public health priority.

The Role of Family Members in Providing Support For Malawian Women With Preterm Infants During Infant Hospitalization.

Purpose: Family support is essential for women with preterm infants during hospitalization. In low-income countries, the additional burden of infant care due to shortages in nursing staff necessitates that family members (guardians) be physically present to care for woman and the infant. The purpose of this study was to explore the types of support that Malawian women of preterm infants need during hospitalization. Methods: This descriptive qualitative study was conducted at a tertiary level hospital in southern Malawi. We recruited 15 women with preterm infants during hospitalization and conducted in-depth interviews. Data was audio-recorded, transcribed, and analyzed using NVivo. Results: The postpartum women participating this study preferred females and members of the maternal side of their family for guardians. Participants' support needs included physical, financial, emotional, and spiritual support. Barriers such as financial constraints and the lack of accommodations for guardians had left the participants without support persons physically present to help them.

Hypertension and infant outcomes: North Carolina pregnancy risks assessment monitoring system data.

This study examined the risk factors that moderate the relationship between hypertension and infant outcomes or were independent risk factors in a large and diverse sample of pregnant women with and without hypertension before conception. The sample included 2,996 women, where 197 had hypertension. Black women comprised 35.5% of the hypertension group relative to 19.7% of non-hypertension. Women with hypertension were more likely to have more preterm births (17.7% vs. 7.4%; ARR = 1.91, p <.001) and have infants with low birth weights (16.8% vs. 6.7%; ARR = 2.26, p <.001), independent of other maternal risk factors in logistic modeling. Maternal Black race versus White also was independently associated with preterm birth (ARR = 1.42, p =.045) and low birth weight (ARR = 1.72, p <.001). Maternal age and race did not significantly moderate the effects of hypertension on infant outcomes, but both Black race and hypertension status were independently associated with adverse birth outcomes.

Sociodemographic and Biological Factors of Health Disparities of Mothers and Their Very Low Birth-Weight Infants.

BACKGROUND: Black mothers and their very low birth-weight infants in the United States have increased risk of adverse neonatal and maternal health outcomes compared with White mothers and infants. Disparities in adverse birth outcomes associated with sociodemographic factors are difficult to quantify and modify, limiting their usefulness in assessing intervention effects. PURPOSE: To test hypotheses that (1) the biological factors of maternal testosterone and cortisol are associated with sociodemographic factors and (2) both factors are associated with neonatal health and maternal mental health and healthy behaviors between birth and 40 weeks' gestational age. METHODS: We used a descriptive, longitudinal design. Eighty-eight mothers and very low birth-weight neonates were recruited from a tertiary medical center in the United States. Data on sociodemographic factors and neonatal health were collected from medical records. Maternal mental health and healthy behaviors were collected with questionnaires. Maternal salivary testosterone and cortisol levels were measured using enzyme immunoassays. Data were analyzed primarily using general linear and mixed models. RESULTS: High testosterone and/or low cortisol levels were associated with younger age, less education, enrollment in a federal assistance program, being unmarried, being Black, poorer neonatal health, and delayed physical growth. Low cortisol level was related to higher levels of depressive symptoms. Black mothers had fewer healthy behaviors than White mothers. IMPLICATIONS FOR PRACTICE AND RESEARCH: Findings confirm that biological factors are associated with sociodemographic factors, and both are associated with neonatal health and maternal mental health and healthy behaviors. We propose using sociodemographic and biological factors concurrently to identify risk and develop and evaluate ante- and postpartum interventions.Video abstract available athttps://journals.na.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=59.

Universal Design for Learning: A Framework for Blended Learning in Nursing Education.

BACKGROUND: Blended learning (BL), the combining of face-to-face and online learning, is gaining prominence in nursing education in response to advances in evidence-based learning using technology, the diverse and evolving needs of nursing learners, and unpredictable events impacting nursing education. PROBLEM: Blended learning requires nursing learners and educators to adapt to new modalities and educators to re-envision learning environments. However, BL lacks an educational framework to guide implementation and is not well explored in the nursing literature. APPROACH: Universal design for learning (UDL) is applied as a framework for BL in nursing education. CONCLUSIONS: Universal design for learning provides a framework for BL to enable nursing educators, learners, and educational institutions to reimagine teaching and learning in novel ways that incorporate emerging evidence and address new challenges. Blended learning, within the context of UDL, offers opportunities for diverse and inclusive learning. Research is needed to guide the implementation of BL best practices within a UDL framework.

Experiences of Malawian Mothers During Their Infants' Hospitalization.

BACKGROUND: Hospitalization of a newborn infant is stressful for all mothers. Hospitals in Malawi have limited nursing staff and support, so mothers are the primary care providers for their hospitalized infants. Few studies have explored the experience of these mothers as both care providers and mothers. PURPOSE: The purpose of this study was to explore the experiences of mothers during the hospitalization of the infant. The goal was to increase knowledge of their primary concerns about the hospital stay. METHODS: This was a descriptive qualitative study conducted at Queen Elizabeth Central Hospital in Malawi. Mothers were interviewed prior to their infant's discharge. We used the directed content analysis approach to analyze our data. RESULTS: Twenty mothers of preterm or full-term infants were interviewed. The primary concerns were perinatal experiences, the infant's condition and care including breastfeeding, support from family members, and support and care from healthcare providers. Additionally, mothers of preterm infants were concerned about the burdens of kangaroo mother care. IMPLICATION FOR PRACTICE: In hospitals that provide limited nursing support to mothers and their infants, it is important to identify a support system for the mother and provide mothers with information on infant care. IMPLICATIONS FOR RESEARCH: Future research should identify specific supports and resources in the community and hospital settings that are associated with positive hospital experiences.

The Variability and Determinants of Testosterone Measurements in Children: A Critical Review.

AIMS: This critical review aimed to summarize: (1) the variability and determinants of testosterone (T) measurements; and (2) reference values for the variability and determinants of T measurements in children. BACKGROUND: As T is a representative androgen, it has been widely used to explain male vulnerability to child health and developmental problems. T measurements in children, however, have been challenging because of low levels, diurnal and episodic secretion patterns, limited quantity and quality of the samples, and inconsistent study findings. METHODS: The search strategy used PubMed, CINAHL, Cochrane Library, Embase, Scopus, and Google Scholar. Studies published between 2008 through 2020 that examined factors influencing T measurement were included. The final 30 studies were selected using two appraisal forms. We extracted five categories of data from the reports. FINDINGS: Variability and determinants of T measurement included assay methods, the source of samples, and child demographic and environmental characteristics. T levels were higher 1-3 months after birth and in males up to 1 year; fewer sex differences were found up to 10-12 years. Serum T levels measured by using liquid chromatography-mass spectrometry were most reliable because immunoassays overestimated the levels, especially in neonates. T levels were stable at different temperatures and durations of storage, although sample collection remained an ongoing challenge for researchers. CONCLUSION: Depending on the study aims and feasibility, mass-spectrometry, multi-methods, and multi-materials are the recent trends in T measurement. Immunoassays may be an option if the study aims for relative rather than absolute comparisons.

Development and validation of an instrument to measure scope of practice in school nurses.

AIMS: The aim of the study was to develop and psychometrically test a new instrument to measure the scope of school nursing practice. DESIGN: Methodological study. METHODS: Data were collected in Spring 2018. Frontline school nurses in the United States (N = 3099) completed the 39-item Scope of School Nursing Practice Tool (SSNPT) with two domains (current practice and importance to practice). One half of sample data (N1 = 1521) were used for exploratory factor analysis, item analysis, Cronbach's alpha, and Spearman-Brown to estimate validity and reliability of the instrument. Sample data from the other half (N2 = 1578) were retained for future analysis. RESULTS: Factor analysis resulted in a stable four-dimension solution: (A) Using the Nursing Process; (B) Applying Evidence to Improve Practice; (C) Connecting with Community; and (D) Leveraging the School and Family Team, accounting for 50.48% (current practice) and 53.31% (importance to practice) of total variance. Cronbach's alpha and Spearman-Brown ranged from .73 to .90 and .73 to .92, respectively. Item-total correlations ranged from .36 to .82. CONCLUSION: Initial psychometric properties indicate the new SSNPT is valid and reliable to assess the scope of practice of frontline school nurses. IMPACT: School nurses play a key role in population health and frequently serve as the sole provider of healthcare in schools worldwide. However, variability in school nursing practice affects the health, safety and educational outcomes of children and youth. No instrument exists that measures the scope of practice of school nurses. Frontline school nurses can use the SSNPT to assess practice, school nurse administrators can use the tool for resource utilization and school nurse researchers can use the tool to examine school nursing practices' impact on student/community health and academic outcomes. The SSNPT may provide a template for others who wish to examine specialty nursing scope of practice.

The Accuracy of Smartphone Sound Level Meter Applications (SLMAs) in Measuring Sound Levels in Clinical Rooms.

BACKGROUND: The accuracy of smartphone sound level meter applications (SLMAs) has been investigated with varied results, based on differences in platform, device, app, available features, test stimuli, and methodology. PURPOSE: This article determines the accuracy of smartphone SLMAs with and without calibration of external and internal microphones for measuring sound levels in clinical rooms. RESEARCH DESIGN: Quasi-experimental research design comparing the accuracy of two smartphone SLMAs with and without calibration of external and internal microphones. DATA COLLECTION AND ANALYSIS: Two iOS-based smartphone SLMAs (NIOSH SLM and SPL Meter) on an iPhone 6S were used with and without calibrated external and internal microphones. Measures included: (1) white noise (WN) stimuli from 20 to 100 dB sound pressure level in a sound-treated test booth and (2) sound levels in quiet in four nonsound-treated clinical rooms and in simulated background sound conditions using music at 45, 55, and 80 dBA. Chi-square analysis was used to determine a significant difference (p ≤ 0.05) in sound measures between the SLMAs and a Type 1 SLM. RESULTS: Measures of WN signals and room sound level measures in quiet and simulated background sound conditions were significantly more accurate at levels ≥ 40 dBA using the SLMAs with calibrated external and internal microphones. However, SLMA measures with and without calibration of external and internal microphones overestimated sound levels < 40 dBA. CONCLUSION: The SLMAs studied with calibrated external or internal microphones are able to verify the room environment for audiologic screening at 1,000, 2,000, and 4,000 Hz at 20 dB hearing level (American Academy of Audiology and American Speech-Language-Hearing Association) using supra-aural earphones (American National Standards Institute S3.1-1999 [R2018]). However, the tested SLMAs overestimated low-level sound < 40 dBA, even when the external or internal microphones were calibrated. Clinicians are advised to calibrate the microphones prior to using measurement systems involving smartphones and SLMAs to measure room sound levels and to monitor background noise levels throughout the provision of clinical services.

School Nursing for the 21st Century: Assessing Scope of Practice in the Current Workforce.

A gap analysis was used to examine the scope of school nursing practice in the United States. An investigator-developed 39-item self-assessment survey of scope of school nursing practice was modified from an existing validated tool, organized around the five principles of the National Association of School Nurses' Framework: Standards of Practice, Quality Improvement, Care Coordination, Community/Public Health, and Leadership and also explored barriers to practice. The survey was sent to a national convenience sample of practicing school nurses. The survey was completed by 3,108 practicing school nurses. Gaps were identified for all principles and were greatest for Quality Improvement and Community/Public Health practice. All practice items were rated more important than the ability to practice that item (p < .001). Self-identified barriers including workload, school/district expectations, and state regulations accounted for significant variances in practice across four of five principles (p < .05, p < .001). Recommendations include support for population-focused evidence-based school nursing practice.

Associations Between Hormonal Biomarkers and Preterm Infant Health and Development During the First 2 Years After Birth.

BACKGROUND: Testosterone levels have been used to examine infant boys' vulnerability to health and developmental problems, following the general theories of gender differences and the theory of extreme male brain of autism. OBJECTIVES: As testosterone is a representative androgen hormone and is higher in preterm than full-term infants, we used this steroid to determine if hypothalamic pituitary hormones, testosterone, and cortisol, were related to physical growth, health, and development of very-low-birthweight (VLBW, BW < 1,500 g) infants. METHOD: For this comparative longitudinal study, 40 VLBW infants were recruited from a neonatal intensive care unit of a tertiary medical center. Data were collected from medical record reviews, questionnaires, and assessments of infant development at 6, 12, and 24 months. We collected saliva at the three time points and measured hormones using enzyme-immunoassays. RESULTS: General and generalized mixed models showed that a 1pg/ml increment of testosterone was related to a -0.42% decrease in body weight, a -0.18% decrease in length, and a -0.10% decrease in head circumference. Cortisol levels were not associated with any outcome variable. The interactions between testosterone and time on physical growth and socioemotional development also occurred. DISCUSSION: Elevated testosterone levels can be a biological risk factor for poor infant growth and development. Theories about the effects of elevated prenatal testosterone could be useful in predicting health and developmental outcomes among VLBW infants. Research beyond the first 2 years will be needed as infants show more socioemotional and behavioral problems as they grow older.

Prenatal Glucocorticoid Treatment Completeness and Steroid Hormonal Levels as Related to Infant and Maternal Health.

This study was conducted to confirm the negative associations between testosterone and cortisol levels and health and developmental outcomes in very low-birth weight (VLBW) infants after controlling for prenatal glucocorticoid (GC) treatment. Seventy-four VLBW infant-mother pairs were recruited from a neonatal intensive care unit in the Southeastern United States. We divided the pairs into the complete (n = 58) and incomplete (n = 16) GC treatment groups. Data on infants and mothers were obtained at birth, 40 weeks' postmenstrual age, and 3 and 6 months' corrected age. Salivary testosterone and cortisol levels of the pairs were determined at 40 weeks' postmenstrual age using enzyme immunoassay. Log-linear and general linear mixed models showed that gestational age and birth weight were lower when testosterone was 1 pg/mL higher. When cortisol was 1 µg/dL higher, technology dependence at discharge was higher and motor development at 6 months was lower. Mothers with complete GC treatment had greater parity and gravida, more prenatal visits, and more medical complications. The study outcomes supported our hypothesis that steroid hormonal levels are more predictive of infant health and development than GC treatment completeness. Single dose of GC treatment might be just as effective as 2 doses, although further study with more subjects would be needed to confirm. As the associations with steroid hormonal levels lasted longer than the GC treatment associations, we recommend confirming the predictive effects of testosterone and cortisol levels after 6 months.

Comparative Evaluation of Parental Stress Experiences Up to 2 to 3 Years After Preterm and Term Birth.

BACKGROUND: Parenting stress after preterm birth (PTB) has negative long-term effects on parenting. Research about parental experiences after PTB and on parenting stress in early childhood has focused on mothers. PURPOSE: To compare parenting stress between mothers and fathers 2 to 3 years after PTB and full-term birth (FTB) and to explore their memories about their stress experience, especially after PTB. METHODS: Fifty-four mothers and fathers in Switzerland whose children were PTB and 65 parents of FTB completed the Parenting Stress Index 2 to 3 years after birth. We compared scores between PTB and FTB and between mothers and fathers. A random subset of parents took part in semistructured interviews that began with photo-elicitation. We analyzed the data thematically. We cross-validated and corroborated qualitative and quantitative findings about parenting stress 2 to 3 years after birth. RESULTS: Preterm birth is stressful for parents who cannot take a child's health for granted, but stress experiences after FTB and PTB equalize within 2 to 3 years. Mothers were the primary caregivers and suffered more stress than fathers. For parents with PTB, positive communications from healthcare workers strengthened parental coping in neonatal intensive care unit and after discharge, but parents perceived discharges as early and inconsistent. IMPLICATIONS FOR PRACTICE AND RESEARCH: Interventions and new models of care improving communication with healthcare professionals, involving parents in infant care as early as possible, increasing staff support to help parents cope better, and optimizing the management of discharge need to be implemented into practice. Their impact on parenting stress on the long term needs to be investigated.

Emotional distress in mothers of early-preterm infants, late-preterm infants, and full-term infants in Malawi.

BACKGROUND: Mothers of preterm infants, early or late, report more distress than mothers of full-term infants. Malawi has the highest preterm birth rate in the world, but nothing is known about the relation of preterm birth to maternal mental health. PURPOSE: To compare emotional distress among mothers of early-preterm, late-preterm, and full-term infants. METHODS: We recruited 28 mothers of early-preterm, 29 mothers of late-preterm, and 28 mothers of full-term infants. Emotional distress was assessed 24-72 hr following birth. One-way ANOVA and regression analysis were used to compare the three groups. FINDINGS: Mothers of early-preterm infants reported more distress symptoms than mothers of full-term infants, and scores of mothers of late-preterm infants fell between the other two groups. Having a support person present was associated with lower symptoms and caesarean birth was associated with more symptoms. DISCUSSION: Promoting maternal mental health is important following preterm birth and health care providers need to support mothers.

An Observational Study on Early Dyadic Interactive Behaviors of Mothers With Early-Preterm, Late-Preterm, and Full-Term Infants in Malawi.

BACKGROUND: Mother-infant interactions are necessary for infant growth and development. However, preterm birth is associated with less positive mother-infant interactions than full-term birth. Malawi has the highest preterm birth rate in the world, but studies of the mother-infant relationship in Malawi are limited and studies that observed mother-infant interactions could not be located. PURPOSE: This study explored mother-infant interactions among Malawian mothers of early-preterm, late-preterm, and full-term infants. METHODS: This observational study explored maternal and infant interactive behaviors. We recruited 83 mother-infant dyads (27 early-preterm, 29 late-preterm, and 27 full-term dyads). FINDINGS: Mothers of early-preterm infants looked at and rocked their infants less, and their infants looked at their mothers less, than mothers of either late-preterm infants or full-term infants. The infants in all groups were asleep most of the time, which contributed to low levels of interactive behaviors. Factors that were related to infant behaviors included marital status, maternal occupation, maternal education, infant medical complications, infant gender, history of neonatal deaths, and multiple births. IMPLICATIONS FOR PRACTICE: Our findings provide evidence about the need to encourage mothers to engage interactive behaviors with their infants. IMPLICATIONS FOR RESEARCH: Future studies of factors that contribute to positive interactions in Malawi are needed.

The Measles Outbreak: School Nurses' Population-based Care Super Power.

Population-based care is an important part of school nursing practice in the 21st century. However, many school nurses may not fully understand what population-based care means. This article outlines what population-based care entails and provides several school nursing examples.

A Pilot Study of Oxytocin in Low-Income Women With a Low Birth-Weight Infant: Is Oxytocin Related to Posttraumatic Stress?

BACKGROUND: Negative outcomes related to prematurity may lead to maternal distress. Mothers of premature/low birth-weight infants report increased posttraumatic stress (50%) and depressive symptoms (63%) compared with mothers of full-term infants. Low-income, minority mothers with greater posttraumatic stress and depression have an increased risk for premature/low birth-weight delivery compared with their white counterparts. Variations in the neuropeptide oxytocin are implicated in lactation, perinatal depression, and maternal behavior. PURPOSE: To examine the associations among posttraumatic stress, depressive symptoms, and oxytocin in a pilot sample of minority mothers with premature/low birth-weight infants in the neonatal intensive care unit (NICU). METHODS: This study employed a descriptive, correlational pilot design of 8 minority, low-income mothers with premature/low birth-weight infants. Participants answered questionnaires pertaining to posttraumatic stress, depression, lactation, and demographics and oxytocin was measured. This is a substudy that added oxytocin values. RESULTS: Four participants had elevated depressive symptoms and 5 supplied their own milk. Women who provided their own milk had lower depressive (t = 3.03, P = .023) and posttraumatic stress (t = 3.39, P = .015) symptoms compared with women not supplying their own milk. Women with elevated posttraumatic stress had higher levels of depressive symptoms (r(8) = 0.8, P = .006) and lower levels of oxytocin (r(8) = 0.77, P = .026). IMPLICATIONS FOR PRACTICE: These results are congruent with previous literature on providing human milk and maternal mental health. In addition, we found a possible relationship between postpartum posttraumatic stress and oxytocin in minority women with premature/low birth-weight infants. NICU nurses should encourage lactation and assess mothers for posttraumatic stress and depressive symptoms. IMPLICATIONS FOR RESEARCH: Research is needed to identify the biologic milieu associated with posttraumatic stress and depression in at-risk mothers.

Associations of Hormonal Biomarkers With Mental Health and Healthy Behaviors Among Mothers of Very-Low-Birthweight Infants.

OBJECTIVES: To examine the concurrent use of self-report questionnaires and hormonal biomarkers, specifically levels of testosterone and cortisol, along with demographic variables and corrected age (CA) in the assessment of mental health and healthy behaviors among mothers of very-low-birthweight (VLBW, BW < 1,500 g) infants at five time points over 2 years post birth. METHOD: Data on 40 mothers from a neonatal intensive care unit of a tertiary medical center in the southeast United States were collected from the medical record, standard questionnaires for the mother (depressive symptoms, perceived stress, anxiety, mental health status, parenting stress, and healthy lifestyle behaviors), and biochemical measurement of maternal testosterone and cortisol using enzyme immunoassay at birth, 40 weeks' postmenstrual age, and 6, 12, and 24 months CA. RESULTS: Maternal self-report of mental health improved from birth to 6 or 12 months then worsened at 24 months. Mixed linear models showed that mothers with higher testosterone levels had more depressive symptoms and smoked more, whereas mothers with higher cortisol levels had healthier behaviors and exercised more. Testosterone levels were negatively correlated with cortisol levels. Marital status, education, and health insurance were the most predictive demographic variables for the levels of hormonal biomarkers, mental health, and healthy behaviors. CONCLUSIONS: The use of self-report and biochemical measurement was effective in assessing maternal mental health and healthy behaviors over 2 years post birth, when mothers of VLBW infants tend to experience more mental health problems and parenting difficulties than mothers of normal-BW full-term infants.

Implementing Universal Design Instruction in Doctor of Nursing Practice Education.

BACKGROUND: Faculty in Doctor of Nursing Practice (DNP) programs identify challenges of increased enrollment and variances in previous student educational preparation and professional experiences that require innovative approaches to curriculum transformation. PURPOSE: This article informs nurse educators about the vibrant and inclusive approach of universal design for instruction (UDI), a framework to conceptualize and implement learning strategies in the DNP curriculum. APPROACH: UDI is guided by 9 instructional principles that anticipate diverse learners and is intentionally inclusive of multiple ways of learning. Principles of UDI were synergized into several DNP didactic courses and the scholarly project process. CONCLUSION: Integration of UDI into the DNP curriculum included precourse assessments, multiple modalities of content delivery, options to present acquired knowledge, and supporting the adult learner through the iterative work of the scholarly project.

Health, Physical Growth, and Neurodevelopmental Outcomes in Preterm Infants of Women With Hypertensive Disorders of Pregnancy.

OBJECTIVE: To compare the health, physical growth, and developmental outcomes in preterm infants of women with and without hypertensive disorders of pregnancy (HDP). DESIGN: Cross-sectional analysis of health outcomes; physical growth (head circumference, height, and weight) collected at birth and 2 months, corrected for prematurity; and cognitive, language, and motor skills of preterm infants of women with and without HDP. SETTING: Four NICUs in the United States. PARTICIPANTS: Women (n = 221) and their preterm infants who weighed less than 1,750 g were enrolled in a multicenter, randomized trial of two interventions administered by each infant's mother when the infant was no longer critically ill. METHODS: Women and their preterm infants were categorized into groups with (n = 80) and without (control, n = 141) HDP. Data were extracted from infants' medical records, and the women completed questionnaires. RESULTS: The infants of women with HDP were more likely to be small for gestational age than the infants of women without HDP (31.7% vs. 10.6%, p < .002). The proportion of infants with greater neurologic risk, patent ductus arteriosus, intraventricular hemorrhage, and days on a ventilator did not differ between the groups. Although mean infant height at 2 months was less in the HDP group than the control group, other growth and neurodevelopmental outcomes did not differ between the groups. CONCLUSION: Among preterm infants admitted to NICUs, those born to women with HDP were more likely to be small for gestational age than those born to normotensive women. Additional research is needed to optimize care for infants born to women with HDP.