Pregnancy–Related Hypertensive Disease And Dementia Risk - EMJ

Could Pregnancy-Related Hypertensive Disease Increase Dementia Risk?

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HYPERTENSIVE disorders of pregnancy, an umbrella term for gestational hypertension, pre-eclampsia, and eclampsia, could increase the risk of vascular and all–cause dementia, according to new research. 

Karen Schliep, University of Utah School of Medicine, Salt Lake City, USA, reported data from a retrospective study of 59,668 individuals, with a mean age of 29 years, who gave birth in Utah between 1939 and 2019. Of these 59,668 individuals, 19,989 had a history of either gestational hypertension, pre-eclampsia, or eclampsia, and 4% went on to develop dementia (70% unspecified, 24% Alzheimer’s disease, and 6% vascular dementia).

The results showed that patients with pre-eclampsia/eclampsia had an increased risk of later-life vascular dementia compared to individuals with no pre-eclampsia or eclampsia history (hazard ratio [HR]: 1.58; 95% confidence interval [CI]: 1.11–2.24; p=0.011). Vascular dementia risk was also elevated in those with gestational hypertension compared to those without (HR: 2.75; 95% CI: 0.90–8.40; p=0.077). Further to this, the risk of unspecified dementia was increased in individuals with pre-eclampsia or eclampsia (HR: 1.51; 95% CI: 1.36–1.68; p<0.001) when compared to those without. 

Diagnosis of gestational hypertension did not have a significant impact on risk of non-specific dementia (HR: 1.31; 95% CI: 0.96–1.80; p=0.093), and no significant association between Alzheimer’s disease and gestational hypertension (p=0.691) or pre-eclampsia or eclampsia (p=0.700) were identified, after controlling for maternal age at first delivery. 

With an overall increased risk for all-cause dementia in those with pre-eclampsia/eclampsia (HR: 1.38; 95% CI: 1.26–1.50) and gestational hypertension (HR: 1.36; 95% CI: 1.03–1.79), compared to those with no diagnosis of hypertensive disorders of pregnancy, attention to “prenatal care and monitoring the long-term health of pregnant people” could identify an opportunity for intervention to help prevent progression to cognitive impairment or dementia later in life.

Looking to the future, Schliep and colleagues are currently working on prospective studies to determine whether gestational hypertension, pre-eclampsia, and eclampsia unmask an underlying risk for developing dementia in later life or the pathophysiology of hypertensive disorders of pregnancy predisposes to dementia.

Improved understanding of the role between hypertensive diseases of pregnancy and later-life dementia could help clinicians design prevention strategies as part of post-partum follow-up for those at risk. 

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