Hypertensive Disorders of Pregnancy and Cognitive Impairment: A Prospective Cohort Study

Neurology. 2021 Feb 2;96(5):e709-e718. doi: 10.1212/WNL.0000000000011363. Epub 2020 Dec 30.


Objective: To determine the association between hypertensive disorders of pregnancy (HDP) and cognitive impairment 15 years after pregnancy, we measured cognitive performance in 115 women with a history of HDP and in 481 women with a previous normotensive pregnancy.

Methods: This was a nested cohort study embedded in a population-based prospective cohort from early pregnancy onwards. Cognitive function was assessed with cognitive tests 15 years after the index pregnancy (median 14.7 years, 90% range [13.9-16.1]). Cognitive performance was measured in different cognitive domains: executive function, processing speed, verbal memory, motor function, and visuospatial ability. A global cognition factor (g-factor) was derived from principal component analysis.

Results: Of the women with HDP, 80 (69.6%) had gestational hypertension (GH) and 35 (30.4%) had preeclampsia. Women with HDP had a lower g-factor than women with a previous normotensive pregnancy (mean -0.22, 90% range [-2.06-1.29]). HDP was negatively associated with the 15-word learning test: immediate recall (-0.25, 95% CI [-0.44 to -0.06]) and delayed recall (-0.30, 95% CI [-0.50 to -0.10]). Women with GH perform significantly worse on their 15-word learning test than women with a previous normotensive pregnancy.

Conclusion: A history of HDP is independently associated with poorer working memory and verbal learning 15 years after pregnancy. This association is mainly driven by women with GH. Clinicians and women who experienced HDP should be aware of this risk.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antihypertensive Agents / therapeutic use
  • Case-Control Studies
  • Cognition*
  • Cognitive Dysfunction / epidemiology*
  • Cognitive Dysfunction / physiopathology
  • Cognitive Dysfunction / psychology
  • Cohort Studies
  • Depression / epidemiology
  • Depression / psychology
  • Executive Function*
  • Female
  • Humans
  • Hypertension / drug therapy
  • Hypertension / epidemiology
  • Hypertension, Pregnancy-Induced / epidemiology*
  • Memory*
  • Mental Recall
  • Middle Aged
  • Neuropsychological Tests
  • Pre-Eclampsia / epidemiology*
  • Pregnancy
  • Principal Component Analysis
  • Prospective Studies
  • Psychomotor Performance
  • Recognition, Psychology
  • Spatial Processing
  • Stroop Test


  • Antihypertensive Agents