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Elfassy T, Kulandavelu S, Dodds L, Mesa RA, Rundek T, Sharashidze V, Paidas M, Daviglus ML, Kominiarek MA, Stickel AM, Perreira KM, Kobayashi MA, Garcia TP, Isasi CR, Lipton RB, González HM. Association Between Hypertensive Disorders of Pregnancy and Interval Neurocognitive Decline: An Analysis of the Hispanic Community Health Study/Study of Latinos. Obstet Gynecol 2024; 143:785-793. [PMID: 38574370 PMCID: PMC11098694 DOI: 10.1097/aog.0000000000005571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To evaluate whether hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and eclampsia, are associated with cognitive decline later in life among U.S. Hispanic/Latina individuals. METHODS The HCHS/SOL (Hispanic Community Health Study/Study of Latinos) is a prospective population-based study of Hispanic/Latino individuals aged 18-74 years from four U.S. communities. This analysis included parous individuals aged 45 years or older who participated in the HCHS/SOL clinic study visit 1 (2008-2011) neurocognitive assessment and subsequently completed a repeat neurocognitive assessment as part of the Study of Latinos-Investigation of Neurocognitive Aging ancillary study visit 2 (2015-2018). Hypertensive disorders of pregnancy were assessed retrospectively by self-report of any gestational hypertension, preeclampsia, or eclampsia. Cognitive functioning was measured at both study visits with the Brief Spanish-English Verbal Learning Test, Digit Symbol Substitution, and Word Fluency. A regression-based approach was used to define cognitive decline at visit 2 as a function of cognition at visit 1 after adjustment for age, education, and follow-up time. Linear regression models were used to determine whether hypertensive disorders of pregnancy or their component diagnoses were associated with standardized cognitive decline after adjustment for sociodemographic characteristics, clinical and behavioral risk factors, and follow-up time. RESULTS Among 3,554 individuals included in analysis, the mean age was 56.2 years, and 467 of individuals (13.4%) reported at least one hypertensive disorder of pregnancy. Individuals with hypertensive disorders of pregnancy compared with those without were more likely to have higher mean systolic blood pressure, fasting glucose, and body mass index. After an average of 7 years of follow-up, in fully adjusted models, gestational hypertension was associated with a 0.17-SD relative decline in Digit Symbol Substitution scores (95% CI, -0.31 to -0.04) but not other cognitive domains (Brief Spanish-English Verbal Learning Test or Word Fluency). Neither preeclampsia nor eclampsia was associated with neurocognitive differences. CONCLUSION The presence of preeclampsia or eclampsia was not associated with interval neurocognitive decline. In this cohort of U.S. Hispanic/Latina individuals, gestational hypertension alone was associated with decreased processing speed and executive functioning later in life.
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Affiliation(s)
- Tali Elfassy
- Department of Medicine, the Department of Pediatrics, the Interdisciplinary Stem Cell Institute, the Department of Public Health Sciences, the Department of Neurology, Evelyn F. McKnight Brain Institute, and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami Miller School of Medicine, and the Department of Psychology, University of Miami, Miami, Florida; the Department of Radiology, New York University Grossman School of Medicine, New York, and the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; the Department of Public Health, University of Illinois at Chicago, and the Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; the Department of Neurosciences, University of California, San Diego, San Diego, California; and the Department of Social Medicine and the Department of Biostatistics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Zakour Khadari M, Zainal H, Athirah Daud NA, Sha'aban A. Health-Related Quality of Life in Pregnant Women With Gestational Hypertension: A Systematic Review. Cureus 2024; 16:e61340. [PMID: 38947727 PMCID: PMC11214066 DOI: 10.7759/cureus.61340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
This review seeks to evaluate the levels of health-related quality of life (HRQoL) among pregnant women experiencing pregnancy-induced hypertension (PIH). It also aims to identify the specific aspects of HRQoL most impacted by PIH during pregnancy and determine the existence of effective interventions to enhance the HRQoL of these pregnant women. A systematic literature search was conducted in the following databases: PUBMED, SCOPUS, Google Scholar, and EMBASE using the following keywords: Health-related quality of life; pregnancy; pregnancy-induced hypertension; quality of life; gestational hypertension. Among the 32 studies assessed, only eight met the criteria for inclusion, exhibiting a good quality based on assessment with both AXIS (Appraisal Tool for Cross-Sectional Studies) and CASP (Critical Appraisal Skills Programme) checklists. The findings indicate a decline in HRQoL among pregnant women with gestational hypertension, notably affecting both physical and mental dimensions. Furthermore, some studies provided recommendations for interventions that healthcare professionals could employ to improve poor HRQoL levels. Limited research has focused on the HRQoL in pregnant women with PIH. Compared to their healthy counterparts, pregnant women experiencing PIH exhibit a decrease in their HRQoL. It's crucial for healthcare practitioners to proactively address the HRQoL of these pregnant women using effective strategies to mitigate this decline. This approach aims to safeguard both pregnant women and their fetuses from potential complications associated with lower HRQoL levels.
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Carey C, Mulcahy E, McCarthy FP, Jennings E, Kublickiene K, Khashan A, Barrett P. Hypertensive disorders of pregnancy and the risk of maternal dementia: a systematic review and meta-analysis. Am J Obstet Gynecol 2024:S0002-9378(24)00043-7. [PMID: 38278201 DOI: 10.1016/j.ajog.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/05/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Hypertensive disorders of pregnancy, including preeclampsia, are associated with an increased risk for maternal cardiovascular disease, stroke, and chronic kidney disease. However, their association with subsequent maternal dementia or cognitive impairment is less well understood. This study aimed to review and synthesize the published literature on hypertensive disorders of pregnancy and the subsequent risk for maternal dementia or cognitive impairment. DATA SOURCES PubMed, Web of Science, Pyschinfo, and CINAHL were searched from database inception until July 31, 2022, for observational studies of hypertensive disorders of pregnancy and maternal dementia or cognitive impairment. STUDY ELIGIBILITY CRITERIA Selected studies included the following: a population of pregnant women, exposure to a hypertensive disorder of pregnancy of interest, and at least 1 primary outcome (dementia) or secondary outcome (cognitive impairment). Two reviewers were involved in study selection. METHODS We followed the Meta-analyses of Observational Studies in Epidemiology guidelines throughout. Random-effects meta-analyses were used to calculate the overall pooled estimates. Bias was assessed using an adapted version of the validated Newcastle-Ottawa Quality Assessment tool. RESULTS A total of 25 eligible studies were identified and included 2,501,673 women. Preeclampsia was associated with a significantly increased risk for vascular dementia (adjusted hazard ratio, 1.89; 95% confidence interval, 1.47-2.43), whereas no clear association was noted between preeclampsia and Alzheimer's disease (adjusted hazard ratio, 1.27; 95% confidence interval, 0.95-1.70), nor between preeclampsia and any (undifferentiated) dementia (adjusted hazard ratio, 1.18; 95% confidence interval, 0.95-1.47). However, in an analysis restricted to women aged 65 years and older, preeclampsia was associated with an increased risk for Alzheimer's disease (adjusted hazard ratio, 1.92; 95% confidence interval, 1.35-2.73) and any dementia (adjusted hazard ratio, 1.87; 95% confidence interval, 1.21-2.91). CONCLUSION Women whose pregnancies were complicated by preeclampsia seem to be at a substantially increased future risk for vascular dementia. The longer-term risks among these women with regards to Alzheimer's disease and other forms of dementia are less clear.
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Affiliation(s)
- Cian Carey
- School of Public Health, University College Cork, Cork, Ireland
| | - Emily Mulcahy
- School of Public Health, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- Irish Centre for Maternal and Child Health Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland (Dr McCarthy)
| | - Emma Jennings
- School of Medicine, University College Cork, Cork, Ireland; Department of Geriatric Medicine, Cork University and Mallow General Hospital, Cork, Ireland
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ali Khashan
- School of Public Health, University College Cork, Cork, Ireland; Irish Centre for Maternal and Child Health Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland
| | - Peter Barrett
- School of Public Health, University College Cork, Cork, Ireland; Department of Public Health Area D (Cork & Kerry), St. Finbarr's Hospital, Cork, Ireland.
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Gray G, Scroggins DG, Wilson KT, Scroggins SM. Cellular Immunotherapy in Mice Prevents Maternal Hypertension and Restores Anti-Inflammatory Cytokine Balance in Maternal and Fetal Tissues. Int J Mol Sci 2023; 24:13594. [PMID: 37686399 PMCID: PMC10487605 DOI: 10.3390/ijms241713594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Preeclampsia is the leading cause of maternal-fetal morbidity worldwide. The concept that persistent feto-placental intolerance is important in the pathogenesis of preeclampsia (PreE) has been demonstrated by our lab and others. Arginine vasopressin (AVP) infusion during pregnancy induces cardiovascular, renal, and T helper (TH) cell alterations in mice consistent with human PreE. In addition to their conventional immuno-stimulatory role, dendritic cells (DCs) also play a vital role in immune tolerance. In contrast to conventional DCs, regulatory DCs (DCregs) express low levels of co-stimulatory markers, produce anti-inflammatory cytokines, induce T regulatory (Treg) cells, and promote tolerance. In mice, DCregs prevent pro-inflammatory responses and induce antigen-specific tolerance. Given these known functions of DCregs, we hypothesize that DCregs will prevent the development of AVP-induced PreE in mice. C57BL/6J females were infused with AVP (24 ng/h) or saline throughout gestation via an osmotic minipump. Bone-marrow-derived DCregs were injected into AVP-infused dams at the time of the pump implantation or on gestational day (GD) 7. The blood pressure of the mice was taken throughout their pregnancy. The maternal urine proteins and TH-associated cytokines in maternal and fetal tissues were measured on GD 18. The treatment with DCregs effectively prevented the elevation of maternal blood pressure, proteinuria, and fetal growth restriction that were observed in AVP-infused dams. Furthermore, we noted a reduction in the pro-inflammatory TH-associated cytokines IFNγ and IL-17, while anti-inflammatory cytokines IL-4, IL-10, and TGFβ showed an increase following DCreg treatment. These outcomes provide strong evidence supporting the potential of DCregs as a valuable therapeutic approach in addressing PreE.
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Affiliation(s)
- Gabrielle Gray
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Douglas G. Scroggins
- School of Medicine, Department of Biomedical Sciences, University of Minnesota Duluth, Duluth, MN 55812, USA
| | - Katlin T. Wilson
- School of Medicine, Department of Biomedical Sciences, University of Minnesota Duluth, Duluth, MN 55812, USA
| | - Sabrina M. Scroggins
- School of Medicine, Department of Biomedical Sciences, University of Minnesota Duluth, Duluth, MN 55812, USA
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Ibarra AJ, Butters MA, Lim G, Jeyabalan A, Li R, Balasubramani GK, Catov JM. Longitudinal cognitive evaluation before and after delivery among people with preeclampsia. Am J Obstet Gynecol MFM 2023; 5:100966. [PMID: 37084869 PMCID: PMC10876122 DOI: 10.1016/j.ajogmf.2023.100966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Cognitive impairments related to preeclampsia after pregnancy have been reported; however, it is not known if weaknesses in cognition occur before and shortly after delivery. OBJECTIVE This study aimed to assess the feasibility of longitudinal cognitive testing before and after delivery, and to investigate whether those with preeclampsia have cognitive weaknesses during the third trimester of pregnancy and at 1 and 3 months postpartum. We hypothesized that people with preeclampsia would have lower cognition scores across all time points compared with normotensive people. STUDY DESIGN This longitudinal, prospective, observational study in a single institution enrolled people (N=30) at ≥28 weeks of gestation with preeclampsia (N=16) or normotension (N=14). People with chronic hypertension, neurologic or developmental disabilities, moderate or severe depression or anxiety, or current substance use were excluded. Subjective (Everyday Cognition Scale) and objective assessment of executive function (Stroop Color-Word Interference Test, Trail-Making Test), attention and working memory (Digit Span subtest), and information processing speed (Digit Symbol Substitution Test) was conducted, and Z-scores were calculated. Baseline characteristics (eg, prepregnancy body mass index) were collected from the medical record. Generalized linear models were used to estimate associations. RESULTS We enrolled 37% (30/81) of eligible people and retained 80% (24/30) and 53% (16/30) at 1 and 3 months postpartum, respectively. People with preeclampsia reported more memory problems (ß=0.87; 95% confidence interval, 0.44-1.31), and scored worse on attention and working memory (ß=-0.94; 95% confidence interval, -1.42 to -0.45) and executive function (Stroop test ß=-0.86; 95% confidence interval, -1.53 to -0.19) domains compared with normotensive people after adjusting for time, age, education, and prepregnancy body mass index. CONCLUSION Longitudinal assessment of cognition in pregnant preeclamptic and normotensive people is feasible. People with preeclampsia reported worse subjective memory and had lower scores in attention, working memory, and executive function.
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Affiliation(s)
- Andrea J Ibarra
- Departments of Anesthesiology and Perioperative Medicine (Drs Ibarra and Lim).
| | | | - Grace Lim
- Departments of Anesthesiology and Perioperative Medicine (Drs Ibarra and Lim)
| | - Arun Jeyabalan
- Obstetrics, Gynecology and Reproductive Sciences (Drs Jeyabalan and Catov), University of Pittsburgh, Pittsburgh, PA
| | - Runjia Li
- Departments of Epidemiology (Ms Li and Dr Catov)
| | | | - Janet M Catov
- Obstetrics, Gynecology and Reproductive Sciences (Drs Jeyabalan and Catov), University of Pittsburgh, Pittsburgh, PA; Departments of Epidemiology (Ms Li and Dr Catov); Magee-Womens Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA (Dr Catov)
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McBride CA, Russom Z, Achenbach E, Bernstein IM, Dumas JA. Cardiovascular profiles associated with white matter hyperintensities in healthy young women. Front Physiol 2023; 13:979899. [PMID: 36714317 PMCID: PMC9880329 DOI: 10.3389/fphys.2022.979899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023] Open
Abstract
Women who experience hypertension in pregnancy have increased risk of both chronic hypertension and dementia. High blood pressure is associated with increased evidence of white matter hyperintensities (WMH) in brain imaging. WMH are disruptions of the white matter of the brain that occur with demyelination and axonal degeneration, are associated with vascular disease, occur more frequently in people with hypertension, and are associated with cognitive impairment. We evaluated the relationship between WMH and subclinical cardiovascular function in healthy young nulliparous women and women with a history of early-onset preeclampsia. Sixty-two reproductive-aged women were assessed during the follicular phase of the menstrual cycle after a 3-day sodium/potassium-controlled diet. Half of participants had a history of early-onset preeclampsia, and half were nulliparous. Blood was drawn to assess inflammatory markers. Cardiovascular assessments included tonometric blood pressure monitoring, volume loading to assess vascular compliance, echocardiography to assess cardiac ejection time, brachial pulse wave velocity of the brachial artery, assessing cardiovascular stiffness, and brachial artery flow mediated vasodilation to assess endothelial mediated dilatory response. T2 fluid-attenuated inversion recovery (FLAIR) MRI imaging was obtained. Two raters, blinded to cardiovascular assessments and pregnancy history, reviewed MRI scans for evidence of WMH using the Fazekas rating scale. WMHs were detected in 17 women; 45 had normal white matter structure. Participants with Fazekas score>0 had exaggerated response to volume loading compared to women with a Fazekas score of 0 and longer cardiac ejection times. Fazekas scores >0 had lower brachial flow-mediated vasodilation and increased white blood count compared to those with no evidence of WMH. Women with WMH had reduced cardiovascular compliance, and a trend towards decreased endothelial responsiveness compared to those without WMH. These data demonstrated that the relationship between cardiovascular and brain health was detectable in young, healthy, reproductive-aged women, and may play a role in later development of clinical disease. These findings may help identify women who are at risk for cognitive decline and pathological aging.
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Affiliation(s)
- Carole A. McBride
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States,*Correspondence: Carole A. McBride,
| | - Zane Russom
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Ella Achenbach
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Ira M. Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Julie A. Dumas
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, United States
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Carrasco-Wong I, González-Ortiz M, Araujo GG, Lima VV, Giachini FR, Stojanova J, Moller A, Martín SS, Escudero P, Damiano AE, Sosa-Macias M, Galaviz-Hernandez C, Teran E, Escudero C. The Placental Function Beyond Pregnancy: Insights from Latin America. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1428:287-307. [PMID: 37466779 DOI: 10.1007/978-3-031-32554-0_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Currently, more than 100,000 papers had been published studying the placenta in both physiological and pathological contexts. However, relevant health conditions affecting placental function, mostly found in low-income countries, should be evaluated deeper. This review will raise some - of what we think necessary - points of discussion regarding challenging topics not fully understood, including the paternal versus maternal contribution on placental genes imprinting, placenta-brain communication, and some environmental conditions affecting the placenta. The discussions are parts of an international effort to fulfil some gaps observed in this area, and Latin-American research groups currently evaluate that.
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Affiliation(s)
- Ivo Carrasco-Wong
- Cellular Signaling and Differentiation Laboratory (CSDL), School of Medical Technology, Medicine and Science Faculty, Universidad San Sebastián, Santiago, Chile
| | - Marcelo González-Ortiz
- Laboratorio de Investigación Materno-Fetal (LIMaF), Departamento de Obstetricia y Ginecología, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillan, Chile
| | - Gabriel Gomes Araujo
- Laboratory of Vascular Biology, Institute of Health Sciences and Health, Universidade Federal de Mato Grosso, Barra do Garcas, Brazil
| | - Victor V Lima
- Laboratory of Vascular Biology, Institute of Health Sciences and Health, Universidade Federal de Mato Grosso, Barra do Garcas, Brazil
| | - Fernanda R Giachini
- Laboratory of Vascular Biology, Institute of Health Sciences and Health, Universidade Federal de Mato Grosso, Barra do Garcas, Brazil
| | - Jana Stojanova
- Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Viña del Mar, Chile
| | - Alejandra Moller
- Escuela de Tecnología Médica, Facultad de Medicina, Universidad de Valparaíso, Viña del Mar, Chile
| | - Sebastián San Martín
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillan, Chile
- Biomedical Research Centre, School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
| | - Pablo Escudero
- Faculty of Medicine, Universidad San Sebastian, Sede Concepcion, Chile
| | - Alicia E Damiano
- Laboratorio de Biología de la Reproducción, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO)- CONICET- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Cátedra de Biología Celular y Molecular, Departamento de Ciencias Biológicas, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Martha Sosa-Macias
- Genomics Academia, Instituto Politécnico Nacional-CIIDIR Durango, Durango, Mexico
| | | | - Enrique Teran
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Carlos Escudero
- Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillan, Chile.
- Vascular Physiology Laboratory, Basic Sciences Department, Faculty of Sciences, Universidad del Bio-Bio, Chillan, Chile.
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Testo AA, McBride C, Bernstein IM, Dumas JA. Preeclampsia and its relationship to pathological brain aging. Front Physiol 2022; 13:979547. [PMID: 36324311 PMCID: PMC9618619 DOI: 10.3389/fphys.2022.979547] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/26/2022] [Indexed: 12/30/2022] Open
Abstract
The development of preeclampsia during pregnancy may have long-term effects on brain aging in women. Associations between preeclampsia and vascular dementia have been established, however the connection between preeclampsia and Alzheimer's disease has not been as thoroughly explored. Both preeclampsia and Alzheimer's disease have been associated with misfolded amyloid beta proteins and inflammation; due to these similarities, in this minireview, we examined the potential links between a history of preeclampsia and the development of dementia. We also discussed how hypertensive disorders of pregnancy may relate to both normal brain aging and dementia to highlight the need for additional research regarding the long-term cognitive effects of preeclampsia on the brain.
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Affiliation(s)
- Abigail A. Testo
- Neuroscience Graduate Program, University of Vermont, Burlington, VT, United States
| | - Carole McBride
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, United States
| | - Ira M. Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, United States
| | - Julie A. Dumas
- Department of Psychiatry Larner College of Medicine, University of Vermont, Burlington, VT, United States,*Correspondence: Julie A. Dumas,
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Fishel Bartal M, Sibai BM. Eclampsia in the 21st century. Am J Obstet Gynecol 2022; 226:S1237-S1253. [PMID: 32980358 DOI: 10.1016/j.ajog.2020.09.037] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
The reported incidence of eclampsia is 1.6 to 10 per 10,000 deliveries in developed countries, whereas it is 50 to 151 per 10,000 deliveries in developing countries. In addition, low-resource countries have substantially higher rates of maternal and perinatal mortalities and morbidities. This disparity in incidence and pregnancy outcomes may be related to universal access to prenatal care, early detection of preeclampsia, timely delivery, and availability of healthcare resources in developed countries compared to developing countries. Because of its infrequency in developed countries, many obstetrical providers and maternity units have minimal to no experience in the acute management of eclampsia and its complications. Therefore, clear protocols for prevention of eclampsia in those with severe preeclampsia and acute treatment of eclamptic seizures at all levels of healthcare are required for better maternal and neonatal outcomes. Eclamptic seizure will occur in 2% of women with preeclampsia with severe features who are not receiving magnesium sulfate and in <0.6% in those receiving magnesium sulfate. The pathogenesis of an eclamptic seizure is not well understood; however, the blood-brain barrier disruption with the passage of fluid, ions, and plasma protein into the brain parenchyma remains the leading theory. New data suggest that blood-brain barrier permeability may increase by circulating factors found in preeclamptic women plasma, such as vascular endothelial growth factor and placental growth factor. The management of an eclamptic seizure will include supportive care to prevent serious maternal injury, magnesium sulfate for prevention of recurrent seizures, and promoting delivery. Although routine imagining following an eclamptic seizure is not recommended, the classic finding is referred to as the posterior reversible encephalopathy syndrome. Most patients with posterior reversible encephalopathy syndrome will show complete resolution of the imaging finding within 1 to 2 weeks, but routine imaging follow-up is unnecessary unless there are findings of intracranial hemorrhage, infraction, or ongoing neurologic deficit. Eclampsia is associated with increased risk of maternal mortality and morbidity, such as placental abruption, disseminated intravascular coagulation, pulmonary edema, aspiration pneumonia, cardiopulmonary arrest, and acute renal failure. Furthermore, a history of eclamptic seizures may be related to long-term cardiovascular risk and cognitive difficulties related to memory and concentration years after the index pregnancy. Finally, limited data suggest that placental growth factor levels in women with preeclampsia are superior to clinical markers in prediction of adverse pregnancy outcomes. This data may be extrapolated to the prediction of eclampsia in future studies. This summary of available evidence provides data and expert opinion on possible pathogenesis of eclampsia, imaging findings, differential diagnosis, and stepwise approach regarding the management of eclampsia before delivery and after delivery as well as current recommendations for the prevention of eclamptic seizures in women with preeclampsia.
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Affiliation(s)
- Michal Fishel Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX.
| | - Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
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Thorgeirsdottir L, Andersson M, Karlsson O, Thörn SE, Oras J, Sengpiel V, Svanvik T, Elden H, Linden K, Junus K, Lager S, Enskär I, van Veen T, Wikström J, Björkman-Burtscher I, Stigsdotter Neely A, Wikström AK, Bergman L. Study protocol: establishment of a multicentre pre-eclampsia database and biobank in Sweden: GO PROVE and UP MOST, a prospective cohort study. BMJ Open 2021; 11:e049559. [PMID: 34819281 PMCID: PMC8614148 DOI: 10.1136/bmjopen-2021-049559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Pre-eclampsia, a multisystem disorder in pregnancy, is one of the most common causes of maternal morbidity and mortality worldwide. However, we lack methods for objective assessment of organ function in pre-eclampsia and predictors of organ impairment during and after pre-eclampsia. The women's and their partners' experiences of pre-eclampsia have not been studied in detail. To phenotype different subtypes of the disorder is of importance for prediction, prevention, surveillance, treatment and follow-up of pre-eclampsia.The aim of this study is to set up a multicentre database and biobank for pre-eclampsia in order to contribute to a safer and more individualised treatment and care. METHODS AND ANALYSIS This is a multicentre cohort study. Prospectively recruited pregnant women ≥18 years, diagnosed with pre-eclampsia presenting at Sahlgrenska University Hospital, Uppsala University Hospital and at Södra Älvsborgs Hospital, Sweden, as well as normotensive controls are eligible for participation. At inclusion and at 1-year follow-up, the participants donate biosamples that are stored in a biobank and they are also asked to participate in various organ-specific evaluations. In addition, questionnaires and interviews regarding the women's and partner's experiences are distributed at follow-up. ETHICS AND DISSEMINATION By creating a database and biobank, we will provide the means to explore the disorder in a broader sense and allow clinical and laboratory discoveries that can be translated to clinical trials aiming at improved care of women with pre-eclampsia. Further, to evaluate experiences and the psychological impact of being affected by pre-eclampsia can improve the care of pregnant women and their partners. In case of incidental pathological findings during examinations performed, they will be handled in accordance with clinical routine. Data are stored in a secure online database. Biobank samples are identified through the women's personal identification number and pseudonymised after identification in the biobank before analysis.This study was approved by the regional ethical review board in Gothenburg on 28 December 2018 (approval number 955-18) and by the Swedish Ethical Review Authority on 27 February 2019 (approval number 2019-00309).Results from the study will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN13060768.
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Affiliation(s)
- Lilja Thorgeirsdottir
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Malin Andersson
- Department of Anaesthesiology and Intensive Care, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ove Karlsson
- Department of Anaesthesiology and Intensive Care, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sven-Egron Thörn
- Department of Anaesthesiology and Intensive Care, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonatan Oras
- Department of Anaesthesiology and Intensive Care, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Teresia Svanvik
- Department of Obstetrics and Gynecology, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Katja Junus
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Susanne Lager
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ida Enskär
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Teelkien van Veen
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Johan Wikström
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Isabella Björkman-Burtscher
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Stigsdotter Neely
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
- Engineering Psychology, Luleå University of Technology, Luleå, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lina Bergman
- Department of Obstetrics and Gynecology, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
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11
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Srajer A, Johnson JA, Yusuf K. Preeclampsia and postpartum mental health: mechanisms and clinical implications. J Matern Fetal Neonatal Med 2021; 35:8443-8449. [PMID: 34538205 DOI: 10.1080/14767058.2021.1978067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Preeclampsia is one of the leading causes of maternal morbidity and mortality worldwide, with the short and long-term implications for maternal health being increasingly recognized. Yet the effects of preeclampsia on mental health are often overlooked, effects which can be evident both immediately postpartum and decades later. In particular, preeclampsia has been associated with increased risk and severity of cognitive impairment, psychosocial distress, and psychiatric disorders including depression, anxiety, and post-traumatic stress disorder. While these outcomes are reported, few have proposed how the pathophysiology of preeclampsia may contribute to changes in postpartum mental health. Studies have suggested that anti-angiogenic factors and pro-inflammatory cytokines released from the preeclamptic placenta may damage the blood-brain barrier endothelium, leading to long-term structural and functional cerebral changes. These changes may contribute to subsequent impairments in mental health. In addition, the pro-inflammatory profile and patterns of cerebral damage observed in preeclampsia are similar to that of psychiatric disorders and cognitive impairment, suggesting they may share common mechanisms. Yet, there is limited evidence on how these mechanisms may interact. The purpose of this review is to summarize the evidence for these pathophysiological mechanisms and propose how they may work synergistically to affect brain structure, cognition, and postpartum mental health in preeclampsia. The role of psychosocial factors, disease severity, and psychological treatment in the mental health of preeclampsia patients will also be discussed.
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Affiliation(s)
- Amelia Srajer
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jo-Ann Johnson
- Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kamran Yusuf
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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12
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Bergman L, Thorgeirsdottir L, Elden H, Hesselman S, Schell S, Ahlm E, Aukes A, Cluver C. Cognitive impairment in preeclampsia complicated by eclampsia and pulmonary edema after delivery. Acta Obstet Gynecol Scand 2021; 100:1280-1287. [PMID: 33492667 DOI: 10.1111/aogs.14100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We aimed to assess cognitive function in women with preeclampsia stratified by severity, before and after onset of disease. MATERIAL AND METHODS Prospective study performed at a referral hospital in Cape Town, South Africa. Pregnant women between 20 and 42 weeks of gestation with eclampsia, pulmonary edema and preeclampsia without severe features, and a normotensive pregnancy were approached. Women were included at diagnosis of preeclampsia or at admission for delivery (women with normotensive pregnancies). Two cognitive assessments, the Cognitive Failure Questionnaire to assess the cognitive function subjectively before inclusion in the study, and Montreal Cognitive Assessment to assess the current cognitive function objectively before discharge from the hospital after delivery, were performed. RESULTS We included 61 women with eclampsia, 28 with preeclampsia complicated by pulmonary edema, 38 with preeclampsia without severe features, and 26 with normotensive pregnancies. There was no difference in cognitive function from early pregnancy between groups. Women with eclampsia and preeclampsia complicated by pulmonary edema scored lower on the Montreal Cognitive Assessment at time of discharge compared with women with normotensive pregnancies. The results were attenuated in pulmonary edema after adjustment for confounders. CONCLUSIONS Women with preeclampsia complicated by pulmonary edema and in particular eclampsia had impaired cognitive function after onset of disease compared with women with normotensive pregnancies. The impairment did not seem to be present before onset of disease. Women with preeclampsia without severe features did not have impaired cognitive function.
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Affiliation(s)
- Lina Bergman
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.,Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lilja Thorgeirsdottir
- Department of Reproductive and Perinatal Health, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helen Elden
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Reproductive and Perinatal Health, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Hesselman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Center for Clinical Research, Uppsala University, Uppsala, Sweden
| | - Sonja Schell
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
| | - Evelina Ahlm
- Department of Obstetrics and Gynecology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Annet Aukes
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, the Netherlands
| | - Catherine Cluver
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.,Mercy Perinatal, Melbourne University, Melbourne, Australia
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13
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Adank MC, Hussainali RF, Oosterveer LC, Ikram MA, Steegers EAP, Miller EC, Schalekamp-Timmermans S. Hypertensive Disorders of Pregnancy and Cognitive Impairment: A Prospective Cohort Study. Neurology 2020; 96:e709-e718. [PMID: 33380500 DOI: 10.1212/wnl.0000000000011363] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/04/2020] [Indexed: 11/15/2022] Open
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.
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Affiliation(s)
- Maria C Adank
- From the Generation R Study Group (M.C.A., R.F.H., L.C.O., S.S.-T.), Department of Obstetrics and Gynecology (M.C.A., R.F.H., L.C.O., E.A.P.S., S.S.-T.), and Department of Epidemiology (R.F.H., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; and Department of Neurology (E.C.M.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
| | - Rowina F Hussainali
- From the Generation R Study Group (M.C.A., R.F.H., L.C.O., S.S.-T.), Department of Obstetrics and Gynecology (M.C.A., R.F.H., L.C.O., E.A.P.S., S.S.-T.), and Department of Epidemiology (R.F.H., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; and Department of Neurology (E.C.M.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Lise C Oosterveer
- From the Generation R Study Group (M.C.A., R.F.H., L.C.O., S.S.-T.), Department of Obstetrics and Gynecology (M.C.A., R.F.H., L.C.O., E.A.P.S., S.S.-T.), and Department of Epidemiology (R.F.H., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; and Department of Neurology (E.C.M.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - M Arfan Ikram
- From the Generation R Study Group (M.C.A., R.F.H., L.C.O., S.S.-T.), Department of Obstetrics and Gynecology (M.C.A., R.F.H., L.C.O., E.A.P.S., S.S.-T.), and Department of Epidemiology (R.F.H., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; and Department of Neurology (E.C.M.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Eric A P Steegers
- From the Generation R Study Group (M.C.A., R.F.H., L.C.O., S.S.-T.), Department of Obstetrics and Gynecology (M.C.A., R.F.H., L.C.O., E.A.P.S., S.S.-T.), and Department of Epidemiology (R.F.H., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; and Department of Neurology (E.C.M.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Eliza C Miller
- From the Generation R Study Group (M.C.A., R.F.H., L.C.O., S.S.-T.), Department of Obstetrics and Gynecology (M.C.A., R.F.H., L.C.O., E.A.P.S., S.S.-T.), and Department of Epidemiology (R.F.H., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; and Department of Neurology (E.C.M.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Sarah Schalekamp-Timmermans
- From the Generation R Study Group (M.C.A., R.F.H., L.C.O., S.S.-T.), Department of Obstetrics and Gynecology (M.C.A., R.F.H., L.C.O., E.A.P.S., S.S.-T.), and Department of Epidemiology (R.F.H., M.A.I.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; and Department of Neurology (E.C.M.), Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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14
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Mooij R, Kapanga RR, Mwampagatwa IH, Mgalega GC, van Dillen J, Stekelenburg J, de Kok BC. Beyond severe acute maternal morbidity: a mixed-methods study on the long-term consequences of (severe pre-)eclampsia in rural Tanzania. Trop Med Int Health 2020; 26:33-44. [PMID: 33151624 DOI: 10.1111/tmi.13507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To explore the long-term (perceived) consequences of (severe pre-)eclampsia in rural Tanzania. METHODS Women were traced for this mixed-methods study 6-7 years after the diagnosis of (severe pre-)eclampsia. Demographic and obstetric characteristics were noted, and blood pressure was recorded. Questionnaires were used to assess physical and mental health. The qualitative part consisted of semi-structured interviews (SSI). A reference group consisted of women without hypertensive disorders of pregnancy. RESULTS Of 74 patients, 25 (34%) were available for follow-up, and 24 were included. Five (20%) had suffered from (pre-)eclampsia twice. Hypertension was more common after (pre-)eclampsia than in the reference group (29% vs. 13%). Thirteen women (56%) had feelings of anxiety and depression, compared to 30% in the reference group. In SSIs, experiences during the index pregnancy were explored, as well as body functions, reproductive life course and limitations in daily functioning, which were shown to be long-lasting. CONCLUSIONS Women who suffered from (severe pre-)eclampsia may experience long-term sequelae, including hypertension, depression and anxiety. Women lack information about their condition, and some are worried to conceive again. To address their specific needs, a strategy along the continuum of care is needed for women following a complicated pregnancy, starting with a late postnatal care visit 6 weeks after giving birth.
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Affiliation(s)
- R Mooij
- Ndala Hospital, Ndala, Nzega region, Tanzania.,Department of Gynaecology and Obstetrics, Beatrix Hospital, Gorinchem, The Netherlands.,University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
| | - R R Kapanga
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - I H Mwampagatwa
- College of Health Sciences, University of Dodoma, Dodoma, Tanzania
| | - G C Mgalega
- Ndala Hospital, Ndala, Nzega region, Tanzania.,Nzega District Hospital, Nzega, Tanzania
| | - J van Dillen
- Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J Stekelenburg
- University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands.,Department of Gynaecology and Obstetrics, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - B C de Kok
- Anthropology Department, University of Amsterdam, Amsterdam, The Netherlands
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15
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Brown MA, Roberts L, Hoffman A, Henry A, Mangos G, O'Sullivan A, Pettit F, Youssef G, Xu L, Davis GK. Recognizing Cardiovascular Risk After Preeclampsia: The P4 Study. J Am Heart Assoc 2020; 9:e018604. [PMID: 33170079 PMCID: PMC7763721 DOI: 10.1161/jaha.120.018604] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background There is increased risk of hypertension, early cardiovascular disease, and premature mortality in women who have had preeclampsia. This study was undertaken to determine the upper limit of normal blood pressure (BP) 6 months postpartum and the frequency of women with prior preeclampsia who had BP above these limits, as part of the P4 (Post‐Partum Physiology, Psychology and Pediatric) follow‐up study. Methods and Results BP was measured by sphygmomanometer, 24‐hour ambulatory BP monitoring, and non‐invasive central BP at 6 months postpartum in 302 women who had normotensive pregnancy and 90 who had preeclampsia. The upper limit of normal BP (mean+2 SD) for women with normotensive pregnancy was 122/79 mm Hg for routine BP, 115/81 mm Hg for central BP, and 121/78 mm Hg for 24‐hour ambulatory BP monitoring. Traditional normal values detected only 3% of women who had preeclampsia as having high BP 6 months postpartum whereas these new values detected between 13% and 19%. Women with preeclampsia had greater body mass index (27.8 versus 25.0, P<0.001) and left ventricular wall thickness but similar augmentation index. They also had lower high‐density lipoprotein (59±15 versus 65±16 mg/dL, P=0.002), higher triglycerides (77±51 versus 61±35 mg/dL, P=0.005), and higher homeostatic model assessment score (2.1±1.8 versus 1.3±1.9, P<0.001). Conclusions Clinicians wishing to detect high BP in these women should be aware of the lower than usual upper limit of normal for this young cohort and where possible should use 24‐hour ambulatory BP monitoring to detect these changes. This may define a subgroup of women who had preeclampsia for whom targeted BP lowering therapy would be successful. Registration URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365295&isReview=true; Unique identifier: ACTRN12613001260718.
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Affiliation(s)
- Mark A Brown
- Department of Renal Medicine St George Hospital Sydney New South Wales Australia.,Department of Medicine St George and Sutherland Clinical SchoolUNSW Medicine Sydney New South Wales Australia
| | - Lynne Roberts
- Department of Medicine St George and Sutherland Clinical SchoolUNSW Medicine Sydney New South Wales Australia.,Department of Women's and Children's Health St George Hospital Sydney New South Wales Australia
| | - Anna Hoffman
- Department of Renal Medicine St George Hospital Sydney New South Wales Australia
| | - Amanda Henry
- Department of Women's and Children's Health St George Hospital Sydney New South Wales Australia.,School of Women's and Children's Health UNSW Medicine Sydney New South Wales Australia.,The George Institute for Global Health Sydney New South Wales Australia
| | - George Mangos
- Department of Renal Medicine St George Hospital Sydney New South Wales Australia.,Department of Medicine St George and Sutherland Clinical SchoolUNSW Medicine Sydney New South Wales Australia
| | - Anthony O'Sullivan
- Department of Medicine St George and Sutherland Clinical SchoolUNSW Medicine Sydney New South Wales Australia
| | - Franziska Pettit
- Department of Renal Medicine St George Hospital Sydney New South Wales Australia.,Department of Medicine St George and Sutherland Clinical SchoolUNSW Medicine Sydney New South Wales Australia
| | - George Youssef
- Department of Cardiology St George Hospital Sydney New South Wales Australia
| | - Lily Xu
- Department of Women's and Children's Health St George Hospital Sydney New South Wales Australia
| | - Gregory K Davis
- Department of Women's and Children's Health St George Hospital Sydney New South Wales Australia.,School of Women's and Children's Health UNSW Medicine Sydney New South Wales Australia
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16
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Johnson AC, Li Z, Orfila JE, Herson PS, Cipolla MJ. Hippocampal network dysfunction as a mechanism of early-onset dementia after preeclampsia and eclampsia. Prog Neurobiol 2020; 199:101938. [PMID: 33130230 DOI: 10.1016/j.pneurobio.2020.101938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/12/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
Preeclampsia is a hypertensive disorder of pregnancy that can involve dangerous neurological symptoms such as spontaneous seizures (eclampsia). Despite being diseases specific to the pregnant state, preeclampsia and eclampsia have long-lasting neurological consequences later in life, including changes in brain structure and cognitive decline at relatively young ages. However, the effects of preeclampsia on brain regions central to memory and cognition, such as the hippocampus, are unclear. Here, we present a case reporting the progressive and permanent cognitive decline in a woman that had eclamptic seizures in the absence of evidence of brain injury on MRI. We then use rat models of normal pregnancy and preeclampsia to investigate mechanisms by which eclampsia-like seizures may disrupt hippocampal function. We show that experimental preeclampsia causes delayed memory decline in rats and disruption of hippocampal neuroplasticity. Further, seizures in pregnancy and preeclampsia caused acute memory dysfunction and impaired neuroplasticity but did not cause acute neuronal cell death. Importantly, hippocampal dysfunction persisted 5 weeks postpartum, suggesting seizure-induced injury is long lasting and may be permanent. Our data provide the first evidence of a model of preeclampsia that may mimic the cognitive decline of formerly preeclamptic women, and that preeclampsia and eclampsia affect hippocampal network plasticity and impair memory.
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Affiliation(s)
- Abbie C Johnson
- Dept. of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, 05405, USA.
| | - Zhaojin Li
- Dept. of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, 05405, USA.
| | - James E Orfila
- Dept. of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Paco S Herson
- Dept. of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA; Dept. of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Marilyn J Cipolla
- Dept. of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, 05405, USA; Dept. of Pharmacology, University of Vermont Larner College of Medicine, Burlington, VT, 05405, USA; Dept. of Ob/Gyn & Repro Sciences, University of Vermont Larner College of Medicine, Burlington, VT, 05405, USA.
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17
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Machado MDSR, Bertagnolli TV, Veiga ECDA, Ferreira CJH, Duarte G, Machado JDSR, Carvalho R. Multiprofessional care promotes of quality of life in pregnant women with preeclampsia: a cross-sectional study. Clinics (Sao Paulo) 2020; 75:e1951. [PMID: 33146357 PMCID: PMC7561055 DOI: 10.6061/clinics/2020/e1951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To assess the quality of life of hospitalized pregnant women with preeclampsia (PE), and compare with a group of healthy pregnant women (HP). METHODS This was an observational cross-sectional study conducted among 58 pregnant women; 28 of them had preeclampsia and 30 were healthy. The WHOQOL-Bref questionnaire, which was divided into four aspects: physical, psychological, social, and environmental, was applied to each subject. RESULTS A statistically significant difference was observed regarding maternal age (PE 27.8±6.2 x HG 23.0±6.6, p<0.01) and gestational age (PE 224±28.1 x HG 253.8±43.7, p<0.01) in relation to the clinical and obstetric data. No significant difference was observed among groups in the physical (PE 57.7±18.9 x HG 65.7±16.6, p=0.19), psychological (PE 68.2±12.8 x HG 73.3±13.30, p=0.16), social (PE 72.0±15.8 x HG 71.7±18.7, p=0.78), or environmental (PE 61.1±11.9 x HG 59.3±15.9, p=0.88) aspects of the WHOQOL-Bref. CONCLUSION There was no difference in quality of life between the groups studied, a result possibly due to the fact that women with PE were hospitalized and received multiprofessional care.
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Affiliation(s)
- Michelle de Souza Rangel Machado
- Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (FMRP-USP), SP, BR
| | - Tawana Vicente Bertagnolli
- Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (FMRP-USP), SP, BR
| | - Eduardo Carvalho de Arruda Veiga
- Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (FMRP-USP), SP, BR
| | - Cristine Jorge Homsi Ferreira
- Departamento de Biomecanica, Medicina e Reabilitacao do Aparelho Locomotor da Faculdade de Medicina de Ribeirão Preto da Universidade de Sao Paulo (FMRP-USP), SP, BR
| | - Geraldo Duarte
- Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (FMRP-USP), SP, BR
| | | | - Ricardo Carvalho
- Departamento de Ginecologia e Obstetricia, Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (FMRP-USP), SP, BR
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Miller KB, Fields JA, Harvey RE, Lahr BD, Bailey KR, Joyner MJ, Miller VM, Barnes JN. Aortic Hemodynamics and Cognitive Performance in Postmenopausal Women: Impact of Pregnancy History. Am J Hypertens 2020; 33:756-764. [PMID: 32421781 PMCID: PMC7402228 DOI: 10.1093/ajh/hpaa081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/25/2020] [Accepted: 05/12/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Studies demonstrate an association between aortic hemodynamics and cognitive function. The impact of pregnancy history on this association is unknown. METHODS Postmenopausal women (age 59 ± 5 years; years since last pregnancy 35 ± 3) with either a history of preeclampsia (PE; n = 34) or a history of a normotensive pregnancy (NP; n = 30) underwent cognitive testing: Letter-Number Sequencing, Digit Span, Trail Making Test, and letter and category fluency. Applanation tonometry was used to derive aortic systolic and diastolic blood pressure and augmentation index. RESULTS Distribution of cognitive scores and aortic hemodynamic measures was similar between the PE and NP groups. Principal component (PC) analysis was used to reduce the 3 aortic hemodynamic measures and the 5 cognitive variables to single summary indices, each representing a weighted average of their respective constituent variables. Using a multivariable linear model based on these PCs that adjusted for pregnancy history and body mass index, the composite index of aortic hemodynamics was associated with the summary cognitive index, whether taking into account a potential interaction with pregnancy history (P = 0.035) or not (P = 0.026) (interaction P = 0.178). Multivariable modeling of individual cognitive tests revealed a differential association for letter fluency by pregnancy history (test for interaction P = 0.023); this score correlated with the aortic hemodynamic index in the PE (partial R2 = 0.20), but not the NP (partial R2 = 0.00) group. CONCLUSIONS Elevated aortic hemodynamics may negatively impact cognitive function in postmenopausal women with specific executive functions, such as letter fluency, being impacted more by a pregnancy history of PE.
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Affiliation(s)
- Kathleen B Miller
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Julie A Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronée E Harvey
- Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Brian D Lahr
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent R Bailey
- Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Joyner
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jill N Barnes
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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19
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Dayan N, Kaur A, Elharram M, Rossi AM, Pilote L. Impact of Preeclampsia on Long-Term Cognitive Function. Hypertension 2019; 72:1374-1380. [PMID: 30571227 DOI: 10.1161/hypertensionaha.118.11320] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Preeclampsia increases a woman's risk of stroke and leads to short-term cognitive complaints. Our objective was to assess the impact of preeclampsia on long-term cognitive performance. This is a retrospective cohort study using data from the Coronary Artery Risk Development in Young Adults cohort of healthy individuals (18-30 years) recruited from the general population in 3 cities in the United States, followed for 25 years (1985-2010). Psychomotor speed (Digit Symbol Substitution Test), executive function (Stroop Test), and memory (Rey Auditory Verbal Learning Test) were contrasted between women with and without preeclampsia using multivariate linear regression. We included 568 parous women (193 with preeclampsia and 375 with normotensive pregnancy) without baseline neurological disease or depression matched according to delivery period. Approximately 18 years after delivery, preeclamptic women scored significantly lower on Digit Symbol Substitution Test than women with normotensive pregnancy (73.21±14.79 versus 75.87±15.22; P=0.047) and on the third trial of Stroop Test (correct answers: 38.85±3.62 versus 39.42±1.87; P=0.014; completion time: 44.02±10.48 versus 41.62±10.61 seconds; P=0.01), but there were no differences in Rey Auditory Verbal Learning Test. These differences were attenuated after adjustment for age, body mass index, hypertension, education, and depression. Similar differences in neurocognitive scores were noted between women with other hypertensive disorders of pregnancy and normotensive pregnancy. Hypertension in pregnancy does not seem to be independently associated with neurocognitive impairment later in life.
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Affiliation(s)
- Natalie Dayan
- From the Department of Medicine and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canad (N.D., L.P.).,Centre for Outcomes Research and Evaluation, Research Institute, McGill University Healthy Centre, Montreal, Quebec, Canada (N.D., A.K., M.E., A.M.R., L.P.)
| | - Amanpreet Kaur
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Healthy Centre, Montreal, Quebec, Canada (N.D., A.K., M.E., A.M.R., L.P.)
| | - Malik Elharram
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Healthy Centre, Montreal, Quebec, Canada (N.D., A.K., M.E., A.M.R., L.P.)
| | - Amanda M Rossi
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Healthy Centre, Montreal, Quebec, Canada (N.D., A.K., M.E., A.M.R., L.P.)
| | - Louise Pilote
- From the Department of Medicine and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canad (N.D., L.P.).,Centre for Outcomes Research and Evaluation, Research Institute, McGill University Healthy Centre, Montreal, Quebec, Canada (N.D., A.K., M.E., A.M.R., L.P.)
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21
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Johnson AC, Cipolla MJ. Impaired function of cerebral parenchymal arterioles in experimental preeclampsia. Microvasc Res 2018; 119:64-72. [PMID: 29705580 DOI: 10.1016/j.mvr.2018.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 01/17/2023]
Abstract
Preeclampsia (PE), a dangerous hypertensive complication of pregnancy, is associated with widespread maternal vascular dysfunction. However, the effect of PE on the cerebral vasculature that can lead to stroke and cognitive decline is not well understood. We hypothesized that function of cortical parenchymal arterioles (PAs) would be impaired during PE. Using a high cholesterol diet to induce experimental PE in rats (ePE), we studied the function and structure of isolated and pressurized PAs supplying frontoparietal white matter (WM) tracts and cortex and compared to normal pregnant (Preg) and nonpregnant (Nonpreg) Sprague Dawley rats (n = 8/group). Myogenic reactivity and tone were similar between groups; however, constriction to intermediate-conductance calcium-activated potassium (IK) channel inhibition was diminished and dilation to inward-rectifying K+ (KIR) channel activation was impaired in PAs from ePE rats, suggesting altered ion channel function. Conducted vasodilation was significantly delayed in response to 12 mM KCl, but not 10 μM adenosine, in PAs from ePE rats versus Preg and Nonpreg rats (940 ± 300 ms vs. 70 ± 50 ms and 370 ± 90 ms; p < 0.05). Overall, dysfunction of PAs supplying frontoparietal WM and gray matter was present in ePE. If persistent these changes could potentiate neuronal injury that over time could contribute to WM lesions and early-onset cognitive decline.
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Affiliation(s)
- Abbie C Johnson
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA.
| | - Marilyn J Cipolla
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA; Department of Pharmacology, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA
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22
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Frampton GK, Jones J, Rose M, Payne L. Placental growth factor (alone or in combination with soluble fms-like tyrosine kinase 1) as an aid to the assessment of women with suspected pre-eclampsia: systematic review and economic analysis. Health Technol Assess 2018; 20:1-160. [PMID: 27918253 DOI: 10.3310/hta20870] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Pre-eclampsia (PE) prediction based on blood pressure, presence of protein in the urine, symptoms and laboratory test abnormalities can result in false-positive diagnoses. This may lead to unnecessary antenatal admissions and preterm delivery. Blood tests that measure placental growth factor (PlGF) or the ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to PlGF could aid prediction of PE if either were added to routine clinical assessment or used as a replacement for proteinuria testing. OBJECTIVES To evaluate the diagnostic accuracy and cost-effectiveness of PlGF-based tests for patients referred to secondary care with suspected PE in weeks 20-37 of pregnancy. DESIGN Systematic reviews and an economic analysis. DATA SOURCES Bibliographic databases including MEDLINE, EMBASE, Web of Science and The Cochrane Library and Database of Abstracts of Reviews of Effects were searched up to July 2015 for English-language references. Conferences, websites, systematic reviews and confidential company submissions were also accessed. REVIEW METHODS Systematic reviews of test accuracy and economic studies were conducted to inform an economic analysis. Test accuracy studies were required to include women with suspected PE and report quantitatively the accuracy of PlGF-based tests; their risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. The economic studies review had broad eligibility criteria to capture any types of economic analysis; critical appraisal employed standard checklists consistent with National Institute for Health and Care Excellence criteria. Study selection, critical appraisal and data extraction in both reviews were performed by two reviewers. ECONOMIC ANALYSIS An independent economic analysis was conducted based on a decision tree model, using the best evidence available. The model evaluates costs (2014, GBP) from a NHS and Personal Social Services perspective. Given the short analysis time horizon, no discounting was undertaken. RESULTS Four studies were included in the systematic review of test accuracy: two on Alere's Triage® PlGF test (Alere, Inc., San Diego, CA, USA) for predicting PE requiring delivery within a specified time and two on Roche Diagnostics' Elecsys® sFlt-1 to PlGF ratio test (Roche Diagnostics GmbH, Mannheim, Germany) for predicting PE within a specified time. Three studies were included in the systematic review of economic studies, and two confidential company economic analyses were assessed separately. Study heterogeneity precluded meta-analyses of test accuracy or cost-analysis outcomes, so narrative syntheses were conducted to inform the independent economic model. The model predicts that, when supplementing routine clinical assessment for rule-out and rule-in of PE, the two tests would be cost-saving in weeks 20-35 of gestation, and marginally cost-saving in weeks 35-37, but with minuscule impact on quality of life. Length of neonatal intensive care unit stay was the most influential parameter in sensitivity analyses. All other sensitivity analyses had negligible effects on results. LIMITATIONS No head-to-head comparisons of the tests were identified. No studies investigated accuracy of PlGF-based tests when used as a replacement for proteinuria testing. Test accuracy studies were found to be at high risk of clinical review bias. CONCLUSIONS The Triage and Elecsys tests would save money if added to routine clinical assessment for PE. The magnitude of savings is uncertain, but the tests remain cost-saving under worst-case assumptions. Further research is required to clarify how the test results would be interpreted and applied in clinical practice. STUDY REGISTRATION This study is registered as PROSPERO CRD42015017670. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Geoff K Frampton
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Jeremy Jones
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Micah Rose
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Liz Payne
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
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Fields JA, Garovic VD, Mielke MM, Kantarci K, Jayachandran M, White WM, Butts AM, Graff-Radford J, Lahr BD, Bailey KR, Miller VM. Preeclampsia and cognitive impairment later in life. Am J Obstet Gynecol 2017; 217:74.e1-74.e11. [PMID: 28322777 DOI: 10.1016/j.ajog.2017.03.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/07/2016] [Accepted: 03/10/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Hypertension is a risk factor for cerebrovascular disease and cognitive impairment. Women with hypertensive episodes during pregnancy report variable neurocognitive changes within the first decade following the affected pregnancy. However, long-term follow-up of these women into their postmenopausal years has not been conducted. OBJECTIVE The aim of this study was to examine whether women with a history of preeclampsia were at increased risk of cognitive decline 35-40 years after the affected pregnancy. STUDY DESIGN Women were identified and recruited through the medical linkage, population-based Rochester Epidemiologic Project. Forty women with a history of preeclampsia were age- and parity-matched to 40 women with a history of normotensive pregnancy. All women underwent comprehensive neuropsychological assessment and completed self-report inventories measuring mood, ie, depression, anxiety, and other symptoms related to emotional state. Scores were compared between groups. In addition, individual cognitive scores were examined by neuropsychologists and a neurologist blinded to pregnancy status, and a clinical consensus diagnosis of normal, mild cognitive impairment, or dementia for each participant was conferred. RESULTS Age at time of consent did not differ between preeclampsia (59.2 [range 50.9-71.5] years) and normotensive (59.6 [range 52.1-72.2] years) groups, nor did time from index pregnancy (34.9 [range 32.0-47.2] vs 34.5 [range 32.0-46.4] years, respectively). There were no statistically significant differences in raw scores on tests of cognition and mood between women with histories of preeclampsia compared to women with histories of normotensive pregnancy. However, a consensus diagnosis of mild cognitive impairment or dementia trended toward greater frequency in women with histories of preeclampsia compared to those with normotensive pregnancies (20% vs 8%, P = .10) and affected more domains among the preeclampsia group (P = .03), most strongly related to executive dysfunction (d = 1.96) and verbal list learning impairment (d = 1.93). CONCLUSION These findings suggest a trend for women with a history of preeclampsia to exhibit more cognitive impairment later in life than those with a history of normotensive pregnancy. Furthermore, the pattern of cognitive changes is consistent with that observed with vascular disease/white matter pathology.
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Affiliation(s)
- Julie A Fields
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
| | | | | | - Wendy M White
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Alissa M Butts
- Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | - Brian D Lahr
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Kent R Bailey
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN
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24
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Preeclampsia and the brain: neural control of cardiovascular changes during pregnancy and neurological outcomes of preeclampsia. Clin Sci (Lond) 2017; 130:1417-34. [PMID: 27389588 DOI: 10.1042/cs20160108] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/13/2016] [Indexed: 02/07/2023]
Abstract
Preeclampsia (PE) is a form of gestational hypertension that complicates ∼5% of pregnancies worldwide. Over 70% of the fatal cases of PE are attributed to cerebral oedema, intracranial haemorrhage and eclampsia. The aetiology of PE originates from abnormal remodelling of the maternal spiral arteries, creating an ischaemic placenta that releases factors that drive the pathophysiology. An initial neurological outcome of PE is the absence of the autonomically regulated cardiovascular adaptations to pregnancy. PE patients exhibit sympathetic overactivation, in comparison with both normotensive pregnant and hypertensive non-pregnant females. Moreover, PE diminishes baroreceptor reflex sensitivity (BRS) beyond that observed in healthy pregnancy. The absence of the cardiovascular adaptations to pregnancy, combined with sympathovagal imbalance and a blunted BRS leads to life-threatening neurological outcomes. Behaviourally, the increased incidences of maternal depression, anxiety and post-traumatic stress disorder (PTSD) in PE are correlated to low fetal birth weight, intrauterine growth restriction (IUGR) and premature birth. This review addresses these neurological consequences of PE that present in the gravid female both during and after the index pregnancy.
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25
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Siepmann T, Boardman H, Bilderbeck A, Griffanti L, Kenworthy Y, Zwager C, McKean D, Francis J, Neubauer S, Yu GZ, Lewandowski AJ, Sverrisdottir YB, Leeson P. Long-term cerebral white and gray matter changes after preeclampsia. Neurology 2017; 88:1256-1264. [PMID: 28235810 PMCID: PMC5373775 DOI: 10.1212/wnl.0000000000003765] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/22/2016] [Indexed: 01/03/2023] Open
Abstract
Objective: To determine whether changes in cerebral structure are present after preeclampsia that may explain increased cerebrovascular risk in these women. Methods: We conducted a case control study in women between 5 and 15 years after either a preeclamptic or normotensive pregnancy. Brain MRI was performed. Analysis of white matter structure was undertaken using voxel-based segmentation of fluid-attenuation inversion recovery sequences to assess white matter lesion volume and diffusion tensor imaging to measure microstructural integrity. Voxel-based analysis of gray matter volumes was performed with adjustment for skull size. Results: Thirty-four previously preeclamptic women (aged 42.8 ± 5.1 years) and 49 controls were included. Previously preeclamptic women had reduced cortical gray matter volume (523.2 ± 30.1 vs 544.4 ± 44.7 mL, p < 0.05) and, although both groups displayed white matter lesions, changes were more extensive in previously preeclamptic women. They displayed increased temporal lobe white matter disease (lesion volume: 23.2 ± 24.9 vs 10.9 ± 15.0 μL, p < 0.05) and altered microstructural integrity (radial diffusivity: 538 ± 19 vs 526 ± 18 × 10−6 mm2/s, p < 0.01), which also extended to occipital and parietal lobes. The degree of temporal lobe white matter change in previously preeclamptic women was independent of their current cardiovascular risk profile (p < 0.05) and increased with time from index pregnancy (p < 0.05). Conclusion: A history of preeclampsia is associated with temporal lobe white matter changes and reduced cortical volume in young women, which is out of proportion to their classic cardiovascular risk profile. The severity of changes is proportional to time since pregnancy, which would be consistent with continued accumulation of damage after pregnancy.
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Affiliation(s)
- Timo Siepmann
- From the Radcliffe Department of Medicine (T.S., H.B., Y.K., C.Z., J.F., S.N., A.J.L., P.L.), Department of Psychiatry (A.B.), Nuffield Department of Clinical Neurosciences (L.G.), Nuffield Department of Surgical Sciences (Y.B.S.), and Department of Cardiology (G.Z.Y.), University of Oxford; Department of Radiology (D.M.), Stoke Mandeville Hospital, Aylesbury, UK; and Department of Neurology (T.S.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Henry Boardman
- From the Radcliffe Department of Medicine (T.S., H.B., Y.K., C.Z., J.F., S.N., A.J.L., P.L.), Department of Psychiatry (A.B.), Nuffield Department of Clinical Neurosciences (L.G.), Nuffield Department of Surgical Sciences (Y.B.S.), and Department of Cardiology (G.Z.Y.), University of Oxford; Department of Radiology (D.M.), Stoke Mandeville Hospital, Aylesbury, UK; and Department of Neurology (T.S.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Amy Bilderbeck
- From the Radcliffe Department of Medicine (T.S., H.B., Y.K., C.Z., J.F., S.N., A.J.L., P.L.), Department of Psychiatry (A.B.), Nuffield Department of Clinical Neurosciences (L.G.), Nuffield Department of Surgical Sciences (Y.B.S.), and Department of Cardiology (G.Z.Y.), University of Oxford; Department of Radiology (D.M.), Stoke Mandeville Hospital, Aylesbury, UK; and Department of Neurology (T.S.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ludovica Griffanti
- From the Radcliffe Department of Medicine (T.S., H.B., Y.K., C.Z., J.F., S.N., A.J.L., P.L.), Department of Psychiatry (A.B.), Nuffield Department of Clinical Neurosciences (L.G.), Nuffield Department of Surgical Sciences (Y.B.S.), and Department of Cardiology (G.Z.Y.), University of Oxford; Department of Radiology (D.M.), Stoke Mandeville Hospital, Aylesbury, UK; and Department of Neurology (T.S.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Yvonne Kenworthy
- From the Radcliffe Department of Medicine (T.S., H.B., Y.K., C.Z., J.F., S.N., A.J.L., P.L.), Department of Psychiatry (A.B.), Nuffield Department of Clinical Neurosciences (L.G.), Nuffield Department of Surgical Sciences (Y.B.S.), and Department of Cardiology (G.Z.Y.), University of Oxford; Department of Radiology (D.M.), Stoke Mandeville Hospital, Aylesbury, UK; and Department of Neurology (T.S.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Charlotte Zwager
- From the Radcliffe Department of Medicine (T.S., H.B., Y.K., C.Z., J.F., S.N., A.J.L., P.L.), Department of Psychiatry (A.B.), Nuffield Department of Clinical Neurosciences (L.G.), Nuffield Department of Surgical Sciences (Y.B.S.), and Department of Cardiology (G.Z.Y.), University of Oxford; Department of Radiology (D.M.), Stoke Mandeville Hospital, Aylesbury, UK; and Department of Neurology (T.S.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - David McKean
- From the Radcliffe Department of Medicine (T.S., H.B., Y.K., C.Z., J.F., S.N., A.J.L., P.L.), Department of Psychiatry (A.B.), Nuffield Department of Clinical Neurosciences (L.G.), Nuffield Department of Surgical Sciences (Y.B.S.), and Department of Cardiology (G.Z.Y.), University of Oxford; Department of Radiology (D.M.), Stoke Mandeville Hospital, Aylesbury, UK; and Department of Neurology (T.S.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jane Francis
- From the Radcliffe Department of Medicine (T.S., H.B., Y.K., C.Z., J.F., S.N., A.J.L., P.L.), Department of Psychiatry (A.B.), Nuffield Department of Clinical Neurosciences (L.G.), Nuffield Department of Surgical Sciences (Y.B.S.), and Department of Cardiology (G.Z.Y.), University of Oxford; Department of Radiology (D.M.), Stoke Mandeville Hospital, Aylesbury, UK; and Department of Neurology (T.S.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Neubauer
- From the Radcliffe Department of Medicine (T.S., H.B., Y.K., C.Z., J.F., S.N., A.J.L., P.L.), Department of Psychiatry (A.B.), Nuffield Department of Clinical Neurosciences (L.G.), Nuffield Department of Surgical Sciences (Y.B.S.), and Department of Cardiology (G.Z.Y.), University of Oxford; Department of Radiology (D.M.), Stoke Mandeville Hospital, Aylesbury, UK; and Department of Neurology (T.S.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Grace Z Yu
- From the Radcliffe Department of Medicine (T.S., H.B., Y.K., C.Z., J.F., S.N., A.J.L., P.L.), Department of Psychiatry (A.B.), Nuffield Department of Clinical Neurosciences (L.G.), Nuffield Department of Surgical Sciences (Y.B.S.), and Department of Cardiology (G.Z.Y.), University of Oxford; Department of Radiology (D.M.), Stoke Mandeville Hospital, Aylesbury, UK; and Department of Neurology (T.S.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Adam J Lewandowski
- From the Radcliffe Department of Medicine (T.S., H.B., Y.K., C.Z., J.F., S.N., A.J.L., P.L.), Department of Psychiatry (A.B.), Nuffield Department of Clinical Neurosciences (L.G.), Nuffield Department of Surgical Sciences (Y.B.S.), and Department of Cardiology (G.Z.Y.), University of Oxford; Department of Radiology (D.M.), Stoke Mandeville Hospital, Aylesbury, UK; and Department of Neurology (T.S.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Yrsa Bergmann Sverrisdottir
- From the Radcliffe Department of Medicine (T.S., H.B., Y.K., C.Z., J.F., S.N., A.J.L., P.L.), Department of Psychiatry (A.B.), Nuffield Department of Clinical Neurosciences (L.G.), Nuffield Department of Surgical Sciences (Y.B.S.), and Department of Cardiology (G.Z.Y.), University of Oxford; Department of Radiology (D.M.), Stoke Mandeville Hospital, Aylesbury, UK; and Department of Neurology (T.S.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Paul Leeson
- From the Radcliffe Department of Medicine (T.S., H.B., Y.K., C.Z., J.F., S.N., A.J.L., P.L.), Department of Psychiatry (A.B.), Nuffield Department of Clinical Neurosciences (L.G.), Nuffield Department of Surgical Sciences (Y.B.S.), and Department of Cardiology (G.Z.Y.), University of Oxford; Department of Radiology (D.M.), Stoke Mandeville Hospital, Aylesbury, UK; and Department of Neurology (T.S.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Postma IR, Bouma A, de Groot JC, Aukes AM, Aarnoudse JG, Zeeman GG. Cerebral white matter lesions, subjective cognitive failures, and objective neurocognitive functioning: A follow-up study in women after hypertensive disorders of pregnancy. J Clin Exp Neuropsychol 2016; 38:585-98. [PMID: 26949992 DOI: 10.1080/13803395.2016.1143453] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Hypertensive disorders of pregnancy, like preeclampsia, are a leading cause of maternal and fetal morbidity/mortality worldwide. Preeclampsia can be complicated by the occurrence of convulsions (eclampsia). Women who experienced (pre)eclampsia more frequently report daily cognitive failures and showed increased emotional dysfunction several years later, but are not impaired on objective neurocognitive testing. In addition, women with preterm preeclampsia more often have cerebral white matter lesions (WML) on follow-up. We aimed to determine whether WML presence is related to cognitive dysfunction, anxiety, and depressive symptoms in (pre)eclamptic women. METHOD Forty-one eclamptic, 49 preeclamptic, and 47 control women who had a normotensive pregnancy completed the Cognitive Failures Questionnaire (CFQ), the Hospital Anxiety and Depression Scale (HADS), and a broad neurocognitive test battery (visual perception and speed of information processing, motor functions, working memory, long-term memory, attention, and executive functioning). All underwent cerebral magnetic resonance imaging (MRI), and WML presence was recorded. Median elapsed time since index pregnancy was 6 years. Average age was 40 years. RESULTS WML were more prevalent in women who had experienced preterm (pre)eclampsia (<37 weeks; 40%) than in controls (21%, p = .03). In (pre)eclamptic women, CFQ and HADS scores were higher than those in controls (44 ± 16.1 vs. 36 ± 11.0, p < .001, and 11 ± 6.3 vs. 8 ± 5.5, p < .001). There was no difference in objective cognitive performance as measured by neurocognitive tests. Subjective and objective cognitive functioning, anxiety, and depressive symptoms were not related to WML presence. CONCLUSION Formerly (pre)eclamptic women report cognitive dysfunction, but do not exhibit overt cognitive impairment when objectively tested on average 6 years following their pregnancy. The presence of WML is not related to objective nor to subjective cognitive impairment, anxiety, and depressive symptoms. Longitudinal studies are needed to study whether the presence of WML is a risk factor for developing objective cognitive impairment in the long term.
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Affiliation(s)
- Ineke R Postma
- a Department of Obstetrics and Gynecology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b School for Behavioural and Cognitive Neurosciences , GSMS BCN-Office, Groningen , The Netherlands
| | - Anke Bouma
- c Department of Clinical and Developmental Neuropsychology , University of Groningen , Groningen , The Netherlands
| | - Jan Cees de Groot
- b School for Behavioural and Cognitive Neurosciences , GSMS BCN-Office, Groningen , The Netherlands.,d Department of Radiology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Annet M Aukes
- e Department of Obstetrics & Gynecology , VU University Medical Center , Amsterdam , The Netherlands
| | - Jan G Aarnoudse
- a Department of Obstetrics and Gynecology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Gerda G Zeeman
- a Department of Obstetrics and Gynecology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b School for Behavioural and Cognitive Neurosciences , GSMS BCN-Office, Groningen , The Netherlands
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Hippocampal NMDAR-Wnt-Catenin signaling disrupted with cognitive deficits in adolescent offspring exposed to prenatal hypoxia. Brain Res 2016; 1631:157-64. [DOI: 10.1016/j.brainres.2015.11.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 11/17/2022]
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Abheiden CNH, van Doornik R, Aukes AM, van der Flier WM, Scheltens P, de Groot CJM. Hypertensive Disorders of Pregnancy Appear Not to Be Associated with Alzheimer's Disease Later in Life. Dement Geriatr Cogn Dis Extra 2015; 5:375-85. [PMID: 26557136 PMCID: PMC4637816 DOI: 10.1159/000439043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background After hypertensive disorders of pregnancy, more subjective cognitive complaints and white matter lesions are reported compared to women after normal pregnancies. Both have a causal relationship with Alzheimer's disease (AD). Aim To investigate if women whose pregnancy was complicated by hypertensive disorders have an increased risk of AD. Methods A case-control study in women with AD from the Alzheimer Center of the VU University Medical Center Amsterdam and women without AD. Paper and telephone surveys were performed. Results The response rate was 85.2%. No relation between women with (n = 104) and without AD (n = 129) reporting pregnancies complicated by hypertensive disorders (p = 0.11) was found. Women with early-onset AD reported hypertensive disorders of pregnancy more often (p = 0.02) compared to women with late-onset AD. Conclusion A reported history of hypertensive disorders of pregnancy appears not to be associated with AD later in life.
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Affiliation(s)
- Carolien N H Abheiden
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Rebecca van Doornik
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Annet M Aukes
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center, Department of Neurology, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands ; Department of Epidemiology and Biostatistics, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center, Department of Neurology, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
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Postma IR, de Groot JC, Aukes AM, Aarnoudse JG, Zeeman GG. Cerebral white matter lesions and perceived cognitive dysfunction: the role of pregnancy. Am J Obstet Gynecol 2014; 211:257.e1-5. [PMID: 24593937 DOI: 10.1016/j.ajog.2014.02.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 01/12/2014] [Accepted: 02/26/2014] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Women who suffered eclampsia or preterm preeclampsia are twice as likely to demonstrate cerebral white matter lesions (WML) on magnetic resonance imaging compared with age-matched women who had normotensive pregnancies, and they report more cognitive dysfunctions in everyday life. We aimed to determine whether pregnancy in and of itself has a relationship with the presence of WML and subjective cognitive dysfunction. STUDY DESIGN Eighty-one parous women who had a normotensive pregnancy were matched for age with 65 nulliparous women and all underwent cerebral magnetic resonance imaging. Presence of cerebral WML was rated and blood pressure was measured. Subjective cognitive functioning was assessed using the Cognitive Failures Questionnaire. RESULTS There was no difference in the presence (22% vs 19%) of WML between parous and nulliparous women. Age was a predictor for the presence of WML, whereas the presence of current hypertension was not. Average score on the Cognitive Failures Questionnaire was not different between both groups, nor related to WML. CONCLUSION A history of pregnancy in and of itself is not related to the presence of cerebral WML and the perception of cognitive dysfunction. Because of the relationship with preterm preeclampsia and eclampsia, future research should focus on the clinical importance and development throughout the years of such cerebral WML in young women and focus on risk factors for cardiovascular disease.
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Affiliation(s)
- Ineke R Postma
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen
| | - Jan Cees de Groot
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen
| | - Annet M Aukes
- Department of Obstetrics and Gynecology, VU Medical Center, Amsterdam
| | - Jan G Aarnoudse
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen
| | - Gerda G Zeeman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen
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Postma IR, Bouma A, Ankersmit IF, Zeeman GG. Neurocognitive functioning following preeclampsia and eclampsia: a long-term follow-up study. Am J Obstet Gynecol 2014; 211:37.e1-9. [PMID: 24495666 DOI: 10.1016/j.ajog.2014.01.042] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/07/2013] [Accepted: 01/28/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Women who suffered preeclampsia and eclampsia may report subjective cognitive difficulties in daily life, the interpretation of which is cumbersome, because these are affected by emotional factors. Previous studies only included preeclamptic women investigated shortly after pregnancy. We aimed to determine whether these subjective reports of cognitive difficulty could be interpreted as reflecting objective cognitive dysfunction. Therefore, cognitive functioning was assessed using standardized neurocognitive tests in both preeclamptic and eclamptic women several years following the index pregnancy. STUDY DESIGN Forty-six formerly eclamptic, 51 formerly preeclamptic, and 48 control women who had normotensive pregnancies, age-matched, participated in this study. Average elapsed time since index pregnancy was 7 years. Neurocognitive tests were divided into 6 domains; visual perception, motor functions, working memory, long-term memory, attention, and executive functioning. Subjective cognitive functioning was measured by the Cognitive Failures Questionnaire and anxiety/depression by the Hospital Anxiety and Depression Scale. RESULTS Both preeclamptic and eclamptic women performed worse on the motor functions domain (P < .05), without differences on the other domains. They scored worse on the Cognitive Failures Questionnaire (P < .01), the Hospital Anxiety and Depression Scale anxiety (P < .01), and depression (P < .05) subscales. CONCLUSION Women who suffered eclampsia and/or preeclampsia demonstrate no objective cognitive impairment as compared with controls. Contrary to the well-structured test setting, both groups do report more cognitive failures, which are thought to reflect neurocognitive dysfunction in complex, stressful daily-life situations. Such report of cognitive failures may be compounded by anxiety and depression. Future studies should focus on the relationship of neurocognitive functioning with structural cerebral abnormalities.
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Affiliation(s)
- Ineke Rixt Postma
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anke Bouma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Iefke Froukje Ankersmit
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Gerda Geertruida Zeeman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Long-term Consequences of the Posterior Reversible Encephalopathy Syndrome in Eclampsia and Preeclampsia. Obstet Gynecol Surv 2014; 69:287-300. [DOI: 10.1097/ogx.0000000000000069] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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