Pre-eclampsia linked to attenuated executive functioning

Women who have a history of pre-eclampsia appear to be nine times as likely as their counterparts who had a normotensive pregnancy to experience a clinically relevant decline in executive function, with the risk persisting over decades after childbirth and despite overall improvement, according to a study.

The analysis was conducted as part of a cross-sectional case control study named Queen of Hearts, a collaboration of five tertiary referral centres within the Netherlands to investigate the long-term effects of pre-eclampsia. A total of 1,563 women between 6 months and 30 years after their first pregnancy were included.

Of the women, 1,036 had a history of pre-eclampsia and 527 had normotensive pregnancies (control). Pre-eclampsia was defined as the occurrence of new-onset hypertension after 20 weeks of gestation, along with proteinuria, foetal growth restriction, or other maternal organ dysfunction. None of the women had a history of hypertension, autoimmune disease, or kidney disease prior to their first pregnancy. The Behavior Rating Inventory of Executive Function for Adults was used to measure attenuation of higher-order cognitive functions (ie, executive function).

A lot more women in the pre-eclampsia group than in the control group had clinically significant attenuation of overall executive function (23.2 percent vs 2.2 percent; adjusted relative risk, 9.20, 95 percent confidence interval, 3.33–25.38). Of note, this between-group difference remained statistically significant over at least 19 years postpartum.

Regardless of a history of pre-eclampsia, the risk of attenuated executive functioning was higher for women with lower educational attainment, mood or anxiety disorders, or obesity. Severity of pre-eclampsia, multiple gestation, method of delivery, preterm birth, or perinatal death influenced overall executive function.