Associations of Metabolic Syndrome and Insulin Resistance With Attenuated Executive Function Post-Preeclampsia: A Nested Case-Control Study

Robert-Jan Alers; Chahinda Ghossein-Doha; Yentl Brandt; M Eline Kooi; Suzanne C Gerretsen; Jacobus F A Jansen; Walter H Backes; Vincent van de Ven; Petra P M Hurks; Marc E A Spaanderman

doi:10.1111/1471-0528.18186

Associations of Metabolic Syndrome and Insulin Resistance With Attenuated Executive Function Post-Preeclampsia: A Nested Case-Control Study

BJOG. 2025 Apr 29. doi: 10.1111/1471-0528.18186. Online ahead of print.

Authors

Robert-Jan Alers^{1

2}, Chahinda Ghossein-Doha^{2

3}, Yentl Brandt^{4

5}, M Eline Kooi^{4

5}, Suzanne C Gerretsen⁵, Jacobus F A Jansen^{5

6}, Walter H Backes^{5

6}, Vincent van de Ven⁷, Petra P M Hurks⁸, Marc E A Spaanderman^{1

2}

Affiliations

¹ Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.
² GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.
³ Cardiovascular Institute, Thorax Centre, Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands.
⁴ CARIM, School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
⁵ Department of Radiology and Nuclear Medicine, MUMC+, Maastricht, the Netherlands.
⁶ MHeNs, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
⁷ Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands.
⁸ Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands.

PMID: 40302139
DOI: 10.1111/1471-0528.18186

Abstract

Objective: Preeclampsia contributes to maternal cognitive problems, particularly involving executive functions. These higher-order cognitive functions-including working memory, organisation of materials, and task focus-are essential for adaptive, purposeful, and goal-directed behaviour. Similar cognitive problems are observed in metabolic syndrome and insulin resistance. This study investigates whether these conditions are also associated with executive function after preeclampsia.

Design: Nested case-control study.

Setting: Maastricht University Medical Centre+, a tertiary care hospital.

Population: Women 0.5 to 30 years after preeclampsia.

Methods: The Behaviour Rating Inventory of Executive Function for Adults provided a measure of executive function performance. The National Cholesterol Education Program Adult Treatment Panel III defined metabolic syndrome. The Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) quantified insulin resistance. Participants were matched on age, postpartum time, and educational attainment. Associations of attenuated executive function with metabolic syndrome, its constituents, and insulin resistance were examined with conditional logistic regression.

Main outcome measures: Odds ratios and population attributable fractions for the associations of attenuated executive function with metabolic syndrome, its constituents, and insulin resistance.

Results: In 155 matched pairs, attenuated executive function was associated with metabolic syndrome (odds ratio 4.20 (95% confidence interval 1.58-11.14)), hyperglycaemia (2.96 (1.13-7.79)), and obesity (3.86 (2.00-7.47)). Attenuated executive function related to HOMA-IR (7.26 (3.75-14.07)), and was 13% (6%-20%) attributable to metabolic syndrome and 56% (49%-67%) to insulin resistance.

Conclusions: Metabolic syndrome and insulin resistance are associated with attenuated executive function after preeclampsia. Our findings provide leads for future studies focused on improving post-preeclamptic cognitive performance.

Keywords: cognition; cognitive impairment; executive function; insulin resistance; maternal health; metabolic syndrome; obstetrical complication; postpartum; preeclampsia.

Grants and funding

Hartstichting