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

Abstract

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.

Figure 1. Flowchart Showing Inclusion and Exclusion Criteria

Women were invited 3 times in pregnancy and returned to the research center with their children 5 years, 9 years, and 13 years after pregnancy. Currently, participants will be invited 17 years after pregnancy. Additional detailed measurements of fetal and postnatal growth and development have been conducted in a randomly selected subgroup of Dutch children (n = 1,232, known as the Focus cohort) and their parents at 32 weeks of gestational age and the postnatal ages of 1.5, 6, 14, 24, 36, and 48 months.

Figure 2. Associations of Women With Hypertensive Disorders of Pregnancy Compared to Women With a Previous Normotensive Pregnancy (n = 596)

Cognitive test results are converted to SD scores. Values are regression coefficients reflecting the difference in cognitive test result with 95% confidence interval (CI) derived from multiple linear regression analyses. Crude value is unadjusted. The confounder model is adjusted for ethnicity, educational level, and prepregnacy body mass index. 15WLT = 15-word learning test; G-factor = global cognition factor.