Hypertensive Disorders of Pregnancy and Brain Health in Midlife: The CARDIA Study

Hypertensive disorders of pregnancy, gestational hypertension (GH) and preeclampsia, (hypertensive disorders of pregnancy or HDP) are associated with an increased risk of cerebrovascular and cardiac disease later in life. Preeclampsia can affect the brain (as evidenced by cerebral edema and seizures) and some research has found long-term changes in the brains of those with a history of preeclampsia. Researchers wanted to see if there was an association between preeclampsia or GH and level of cognitive function and/or cognitive decline in midlife. They also wanted to compare brain structure between women with and without a history of HDP using brain magnetic resonance imaging (MRI).

Researchers used data from The CARDIA (Coronary Artery Risk Development in Young Adults) study that enrolled 5,155 Black and White men and women ages 18-30 in 1985 and 1986. Persons were assessed every 5 years. Women were asked about pregnancies and any complications including high blood pressure and preeclampsia at each assessment. Multiple covariates – age, race, marital status, educational level, family history of dementia, physical activity, alcohol consumption, diet quality, body mass index (BMI), cigarette smoking, high lipids, depression, elevated blood pressure, diabetes, age at first pregnancy, history of traumatic brain injury, and occurrence of cardiovascular events – were also recorded. Participants underwent cognitive testing at 25 and 30 years.

Of 1,270 women assessed, those who reported GH had significantly lower scores on cognitive testing than those who had no HDP even after adjusting for multiple covariates. On the other hand, there were no differences in cognitive performance between those with preeclampsia and those without any HDP. Persons who had preeclampsia or GH had greater cognitive decline between the 25- and 30-year assessments compared to those with no HDP. Three hundred sixty-seven persons had brain MRIs. Both those with preeclampsia and those with GH had more white matter hyperintensities (or a low density of white matter in the brain) than those without HDP. White matter consists of nerve fibers that carry electrical signals through the brain. Low densities and lesions are sometimes associated with cognitive concerns like vascular dementia and stroke. Lower densities and lesions were found to be more common and larger in women with worse cognitive performance.

Take home: This study shows a link between preeclampsia and long-term brain health. Although more research needs to be done, persons who have preeclampsia or GH experienced changes in cognitive performance or what is casually referred to as brain fog. They also had a greater rate of cognitive decline in mid-life. GH and preeclampsia were associated with more white matter lesions in their brains which can lead to serious conditions later in life. It is important to continue regular care with your primary care provider. If you notice any changes in cognition make them aware of your health history with preeclampsia or other hypertensive disorder of pregnancy. Follow up with a neurologist may be necessary.

Link:https://pubmed.ncbi.nlm.nih.gov/39162043/

Citation:Jiang X, Schreiner PJ, Gunderson EP, Yaffe K. Hypertensive Disorders of Pregnancy and Brain Health in Midlife: The CARDIA Study. Hypertension. 2024 Aug 20. doi: 10.1161/HYPERTENSIONAHA.124.22857. Epub ahead of print. PMID: 39162043.

About Research Roundup

Each quarter, our team of science writers reviews the most current research studies related to hypertensive disorders of pregnancy and summarizes those studies of greatest interest and potential impact to our community, including research studies related to risk assessment, diagnosis, prevention, and treatment. Special thanks to our volunteer research team, including Dr. Sig-Linda Jacobson, Dr. Jennifer Mitchell, and Amanda Yang, who under the leadership of Dr. Elizabeth Sutton, make Research Roundup possible, and to our Patient Advisory Council, who reviews these materials from the patient perspective.