Association of Hypertensive Disorders of Pregnancy With Cognition in Later Life
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Abstract
Background and Objectives Studies of hypertensive disorders of pregnancy (HDP), including gestational or chronic hypertension (GH/CH) and preeclampsia/eclampsia (PE/E), suggest associations with early-life and mid-life cognition but have been limited by self-report or use of diagnostic codes, exclusion of nulliparous women, and lack of measurement of cognition in later life. We examined the effects of any HDP, GH/CH, PE/E, and nulliparity on cognition in later life.
Methods Participants included 2,239 women (median age 73) enrolled in the Mayo Clinic Study of Aging with medical record–abstracted pregnancy information. A cognitive battery of 9 tests was conducted every 15 months. Global cognitive and domain-specific z scores (memory, executive/attention, visuospatial, and language) were outcomes. Linear mixed-effect models evaluated associations between pregnancy history (all normotensive, any HPD, HPD subtype [GH/CH, PE/E], or nulliparous) and cognitive decline, adjusting for age and education. Additional models adjusted for APOE, smoking, hypertension, dyslipidemia, body mass index (BMI), diabetes, stroke, and heart disease. Interactions between pregnancy history and age or education on cognitive performance were examined.
Results Of the 2,239 women, 1,854 (82.8%) had at least 1 pregnancy (1,607 all normotensive, 100 GH/CH, and 147 PE/E); 385 (17.2%) were nulliparous. Cognitive performance did not cross-sectionally differ for women with a history of any HDP, GH/CH, or PE/E vs women with a history of all normotensive pregnancies; women who were nulliparous had lower global and domain-specific cognition (all p < 0.05) in age- and education-adjusted models. There was an interaction (p = 0.015) between nulliparity and education such that the lower cognitive performance was most pronounced among nulliparous women with ≤12 years of education (beta = −0.42, p < 0.001) vs 12 + years (b = −0.11, p = 0.049). Longitudinally, women with any HDP had greater declines in global cognition and attention/executive z scores compared with women with all normotensive pregnancies. When stratified by HDP type, only women with PE/E had greater declines in global cognition (beta = −0.04, p < 0.001), language (beta = −0.03, p = 0.001), and attention (beta = −0.04, p < 0.001) z scores. Adjustment for vascular risk factors, BMI, smoking, and APOE did not attenuate results.
Discussion Women with a history of HDP, especially PE/E, are at greater risk of cognitive decline in later life.
Glossary
- BMI=
- body mass index;
- CU=
- cognitively unimpaired;
- DM=
- diabetes mellitus;
- GH/CH=
- gestational or chronic hypertension;
- HDP=
- hypertensive disorders of pregnancy;
- HTN=
- hypertension;
- MCI=
- mild cognitive impairment;
- MCSA=
- Mayo Clinic Study of Aging;
- PE/E=
- preeclampsia/eclampsia;
- PRES=
- posterior reversible encephalopathy syndrome;
- REP=
- Rochester Epidemiology Project
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Associate Editor Linda Hershey, MD, PhD, FAAN.
See page 893
CME Course: NPub.org/cmelist
- Received August 23, 2022.
- Accepted in final form January 17, 2023.
- © 2023 American Academy of Neurology
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