Women with high blood pressure during pregnancy are at higher risk of future cognitive decline compared to women with normotensive pregnancies, according to a new study published in the journal Neurology.¹ The risk was particularly greater among women with pre-eclampsia.

A total of 2239 women, aged 73 years (average), from the Mayo Clinic Study of Aging between 2004 and 2019 were included in this study. Around 83% (n=1854) of the study subjects had one pregnancy, while 17% (n=385) were nulliparous. Among women with pregnancies longer than 20 weeks, 100 had gestational high BP, 147 had preeclampsia or eclampsia, while 1607 were normotensive. Four domains of cognition - memory, attention/executive function, language and visuospatial perception - were tested every 15 months for a median duration of 5 years. The objective of this research was to examine the association between hypertensive disorders of pregnancy and cognition.

The decline in global cognition and attention, executive function and language was much more among women with high BP during pregnancy compared to the nulliparous women and those who remained normotensive all through the pregnancy. Among participants with any hypertensive disorder of pregnancy, the average composite score of all memory and thinking tests showed a decrease of 0.3 points, whereas among those who did not have high BP during pregnancy, the scores showed a decline of 0.05 points.

When the different types of hypertensive disorders of pregnancy were examined, the decrease in global cognition and attention and executive function was notable only in women with preeclampsia/eclampsia than normotensive women and other hypertensive disorders. This association persisted even after adjusting for variables such as smoking, dyslipidemia, body mass index (BMI), diabetes, heart disease and stroke. No association was noted between preeclampsia/eclampsia and memory or visuospatial decline.

The decline in global or domain-specific cognition was comparable between women with gestational or chronic hypertension and those with normal BP during pregnancies.

These findings indicate preeclampsia/eclampsia as a risk factor for cognitive decline. They also highlight the need to closely monitor BP among women with hypertensive disorders of pregnancy even after childbirth for timely detection of cognitive impairment. The authors further suggest that eliciting a detailed pregnancy history should be incorporated in the evaluation of cognitive impairment in women at a later age.

Reference

1. Prodan CI, et al. Bridging the gap between hypertensive disorders of pregnancy and cognitive decline in older women. Neurology. 2023 Mar 1;10.1212/WNL.0000000000207237. doi: 10.1212/WNL.0000000000207237.