— Preeclampsia or eclampsia history may be an independent risk factor for cognitive impairment.
Longitudinal data demonstrated that a history of hypertensive disorders of pregnancy (HDP) — gestational or chronic hypertension, or preeclampsia/eclampsia — was related with an increased risk of cognitive deterioration in later life.
According to Michelle Mielke, PhD, of Wake Forest University School of Medicine in Winston-Salem, North Carolina, and colleagues, among 2,200 women participating in the Mayo Clinic Study of Aging, those with any HDP experienced greater declines in global cognition and attention/executive function than those who had only normotensive pregnancies.
Only women with preeclampsia/eclampsia exhibited larger reductions in global cognition (b -0.039, P0.001), language (b -0.032, P=0.001), and attention/executive function (b -0.040, P0.001), Mielke and colleagues reported in Neurologyopens in a new tab or window.
Given that the connection between HDP and cognitive decline was unaffected by vascular risk factors or diseases, “our results suggest that HDP, particularly preeclampsia/eclampsia, is an independent risk factor for cognitive decline,” researchers concluded.
They said, “The data suggest an underlying vascular disease and microvascular contribution, which is consistent with the literature.”
Calin Prodan, MD, of the University of Oklahoma in Oklahoma City, noted in an accompanying editorialopens in a new tab or window that the findings should invite discussion of numerous significant concerns.
“First, we must include a complete and accurate pregnancy history when evaluating cognitive impairment in older women,” Prodan stated.
“Second, it is crucial to uncover the mechanisms responsible for these findings and to discover whether these processes differ based on pregnancy history, vascular risk factor profile, therapy options, and adequate control of vascular risk factors,” he added.
After 10 years, HDP has been related with comorbidities such as an increased risk of hypertension. Mielke and colleagues observed that approximately 15.3% of women experience HDP and 7.5% suffer preeclampsia during their lifetimes.
According to the researchers, studies of global and domain-specific cognitive decline and HDP have yielded mixed results, with some indicating that women with a history of gestational hypertension or preeclampsia perform worse in midlife on tests of psychomotor speed, attention/executive function, and memory. “However, other studies have shown no relationships with psychomotor speed, attention/executive function, or memory,” they noted.
Between 2004 and 2019, 2,239 women enrolled in the Mayo Clinic Study of Aging and performed a cognitive battery of nine tests in four domains (memory, attention/executive function, language, and visuospatial) every 15 months for a median of nearly 5 years.
The median age at the start of the study was 73, 82.8% of women had at least one pregnancy, and 17.2% were nulliparous. Cognitive z-scores were comparable between the HDP and normotensive groups at the baseline visit.
Adjusting for age and education, the researchers examined relationships between pregnancy history (all normotensive, any HDP, HDP subtype, or nulliparous) and cognitive decline. Other models that account for the APOE status, smoking, hypertension, dyslipidemia, body mass index, diabetes, stroke, and cardiovascular disease.
Women with gestational or chronic hypertension did not differ from women with all normotensive pregnancies in terms of global or domain-specific cognitive impairment. There was no association between preeclampsia/eclampsia and memory or visuospatial deterioration.
After correcting for age and education, the global and domain-specific cognition of nulliparous women was poorer (all P0.05). Cognitive performance was lowest among nulliparous women with 12 or fewer years of schooling or less.
Few research have considered nulliparity when studying the association between HDP and cognition, but our findings underline the necessity of include all women in such analyses, Mielke and co-authors said.
The researchers acknowledged the study’s shortcomings, which included a lack of generalizability due to the underrepresentation of various ethnicities and women with more severe cases of HDP. In addition, the study lacked sufficient information to evaluate the effects of infertility, miscarriages, or multiple births, as well as whether or how hypertension was managed.
Mielke said in a statement, “More research is required to confirm our findings.” “Yet, our findings show that regulating and monitoring blood pressure during and after pregnancy is a crucial determinant for brain health in later life.”