Article
Hypertensive Disorders of Pregnancy Associated With Worse Cognition
Author(s):
Women with HDP were found to perform worse on cognitive tests 15 years after delivery than their counterparts.
M. Arfan Ikram, MD, PhD
A recent study investigated women that experienced hypertensive disorders of pregnancy (HDP) 15 years after pregnancy and found that a history of HDP is independently associated with poorer working memory and verbal memory.
Women with HDP had a lower global cognition factor (g-factor) than women with a previous normotensive pregnancy (mean difference, –0.22; 90% range, –2.06 to 1.29). HDP was also negatively associated with immediate recall (–0.25; 95% CI, –0.44 to –0.06) and delayed recall (–0.30; 95% CI, –0.50 to –0.10) on the 15-word learning test (15WLT).
Study author M. Arfan Ikram, MD, PhD, adjunct professor of epidemiology, Harvard T.H. Chan School of Public Health, and professor and head of neuro-epidemiologic research, department of epidemiology, Erasmus University Medical Center Rotterdam, and colleagues wrote that “recent studies show a possible association of pre-eclampsia with cognitive impairment and even dementia, leading some to question whether cognitive impairment or dementia should be included as a potentially preventable outcome in cardiovascular disease guidelines, rather than exclusively focusing on cardiovascular disease risk reduction in women with previous HDP.”
Ikram and colleagues performed this sub-study, termed ORACLE (MEC 2015-749 NL55105.078.15), of the Generation R study, an ongoing population-based prospective birth cohort study. They analyzed data from 596 women from Rotterdam with delivery dates between April 2002 and January 2006.
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The women were an average age of 46.4 years (standard deviation [SD], 4.3) at the time of cognitive testing. The median time between pregnancy and testing was 14.7 years (90% range, 13.9–16.1). Of these women, 481 (80.7%) had a previous normotensive pregnancy, and 115 (18.0%) had HDP. Of the women with HDP, 80 (69.6%) had gestational hypertension (GH) and 35 (30.4%) had pre-eclampsia. Almost all women with pre-eclampsia (n = 33; 94.3%) developed it at term, as defined as an onset after 34 weeks of gestation. Prior to cognitive testing, 68 (11.4%) women were classified as hypertensive.
Ikram and colleagues assessed cognitive performance by measuring executive function, processing speed, verbal memory, motor function, and visuospatial ability. A g-factor was derived from these measurements.
Women with HDP performed worse on various facets of the 15WLT. The median score on the immediate recall subtask was 25.0 (90% range, 14.7–35.0) in women with HDP as compared to 28.0 by women without HDP (90% range, 17.0–36.0; P <.001). The median score on the delayed recall subtask was 8.0 (90% range, 3.0–13.0) in women with HDP as compared to 9.0 (90% range, 4.0–13.0; P <.001) in women without HDP. Women with HDP also had a worse median score on the Stroop color naming task (22.0; 90% range, 17.0–32.0) than women without HDP (21.0; 90% range, 16.0–29.0); a worse median score on the letter digit substitution task (36.0; 90% range, 26.5–46.0) than women without HDP (38.0; 90% range, 28.0–48.0; P = .01); and a worse median score on the design organization test (34.0; 90% range, 17.0–49.0) than women without HDP (38.0; 90% range, 22.0–55.1; P =.03).
Ikram et al performed sensitivity analyses that showed all associations remained significant after adjusting for cofounders. They also performed a sensitivity analysis excluding pre-eclampsia and found that all associations remained; the association between HDP and memory was mainly driven by GH.
“Not only women with a history of pre-eclampsia, but also GH should be monitored closely after their pregnancy. Whether early treatment of hypertension prevents cognitive decline in women with a history of HDP should be investigated in clinical trials. Both clinicians and women with a history of HDP should be aware of these patients' risk of cognitive impairment later in life,” Ikram and colleagues concluded.
