Preeclampsia and cognitive impairment later in life

Julie A. Fields, Vesna D. Garovic, Michelle M. Mielke, Kejal Kantarci, Muthuvel Jayachandran, Wendy M. White, Alissa M. Butts, Jonathan Graff-Radford, Brian D. Lahr, Kent R. Bailey, Virginia M. Miller

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Background Hypertension is a risk factor for cerebrovascular disease and cognitive impairment. Women with hypertensive episodes during pregnancy report variable neurocognitive changes within the first decade following the affected pregnancy. However, long-term follow-up of these women into their postmenopausal years has not been conducted. Objective The aim of this study was to examine whether women with a history of preeclampsia were at increased risk of cognitive decline 35-40 years after the affected pregnancy. Study Design Women were identified and recruited through the medical linkage, population-based Rochester Epidemiologic Project. Forty women with a history of preeclampsia were age- and parity-matched to 40 women with a history of normotensive pregnancy. All women underwent comprehensive neuropsychological assessment and completed self-report inventories measuring mood, ie, depression, anxiety, and other symptoms related to emotional state. Scores were compared between groups. In addition, individual cognitive scores were examined by neuropsychologists and a neurologist blinded to pregnancy status, and a clinical consensus diagnosis of normal, mild cognitive impairment, or dementia for each participant was conferred. Results Age at time of consent did not differ between preeclampsia (59.2 [range 50.9-71.5] years) and normotensive (59.6 [range 52.1-72.2] years) groups, nor did time from index pregnancy (34.9 [range 32.0-47.2] vs 34.5 [range 32.0-46.4] years, respectively). There were no statistically significant differences in raw scores on tests of cognition and mood between women with histories of preeclampsia compared to women with histories of normotensive pregnancy. However, a consensus diagnosis of mild cognitive impairment or dementia trended toward greater frequency in women with histories of preeclampsia compared to those with normotensive pregnancies (20% vs 8%, P =.10) and affected more domains among the preeclampsia group (P =.03), most strongly related to executive dysfunction (d = 1.96) and verbal list learning impairment (d = 1.93). Conclusion These findings suggest a trend for women with a history of preeclampsia to exhibit more cognitive impairment later in life than those with a history of normotensive pregnancy. Furthermore, the pattern of cognitive changes is consistent with that observed with vascular disease/white matter pathology.

Original languageEnglish (US)
Pages (from-to)74.e1-74.e11
JournalAmerican journal of obstetrics and gynecology
Volume217
Issue number1
DOIs
StatePublished - Jul 2017

Keywords

  • cardiovascular disease
  • cerebrovascular disease
  • cognition
  • dementia
  • hypertensive pregnancy
  • mild cognitive impairment
  • preeclampsia

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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