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 A leading cause of pre-term birth, preeclampsia is an inflammatory
blood vessel disorder that occurs in 2 percent to 10 percent of
pregnancies, usually after 20 weeks' gestation. In addition to high
blood pressure, the condition can cause abnormally high levels of
protein in the urine and fluid retention.
Based on records for more than 1 million women in Denmark,
researchers found the greatest increased risk for women with a
history of preeclampsia was for developing so-called vascular
dementia, which is thought to be caused by a series of small strokes
or impaired blood supply to the brain. The risk for Alzheimer's
disease, a different type of dementia, was only slightly higher than
among women with no preeclampsia history.
Past studies have already linked preeclampsia to cognitive
impairment and brain changes within a year of the pregnancy, the
study team notes in The BMJ. Women who experience preeclampsia are
also at higher risk of later heart disease, stroke, high blood
pressure and diabetes, they add.
"We have accumulated enough evidence that the effects of
preeclampsia on a woman's health are not confined to pregnancy,"
said the study's senior author Heather Boyd of Statens Serum Insitut
in Copenhagen.
"We now know that preeclampsia should be seen as a marker for
increased risk of vascular morbidity later in life. And awareness of
this is improving - in their latest guidelines, both the American
Heart Association and the European Society of Cardiology include
statements about considering a history of pregnancy complications
when evaluating a woman's risk of cardiovascular disease," Boyd told
Reuters Health by email.
To examine links between preeclampsia and dementia, the researchers
used national registry data to identify 1,178,005 women who had
given birth in Denmark between 1978 and 2015, just over 4 percent of
whom experienced preeclampsia during one or more pregnancies.
Women were followed for an average of 21 years. Even after adjusting
for other factors that could influence dementia risk, including
heart disease and diabetes, researchers found the risk for
late-onset (after age 65) vascular dementia was 6.5 times higher
among those with a history of preeclampsia.
Women with a preeclampsia history had about twice the risk of
early-onset dementia compared with no history. They also had a 50
percent higher risk of developing Alzheimer's disease and a 40
percent higher risk of other, nonspecific dementias.
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A history of recurrent preeclampsia in more than one pregnancy was
even more strongly associated with dementia than when it occurred in
just a single pregnancy.
"We still don't know how to identify the women with a history of
preeclampsia who are at greatest risk of cardiovascular disease,"
Boyd noted. "Asking cardiologists to see all women with a history of
preeclampsia at regular intervals for the rest of their lives would
be overkill and would rapidly swamp the healthcare system."
She recommends that women who have had severe preeclampsia,
especially early-onset preeclampsia or preeclampsia with vascular
complications, should at least have regular follow-up by their
internists.
"I certainly think that all women who have had preeclampsia need to
have good primary care," said Dr. Eliza Miller, a neurologist at
Columbia University Irving Medical Center in New York City, who
wasn't involved in the study.
"Doctors need to be aware that preeclampsia is a really important
part of a woman's medical history and it's something that all
doctors should ask their women patients about even though we don't
really know yet if there is a specific intervention we should be
doing, such as putting women on a baby aspirin early on or
cholesterol medications," she said in a phone interview.
In an accompanying editorial, Dr. Joel Ray of the University of
Toronto writes that the study "enables us to frame vascular dementia
as a stroke-like condition, with cognitive impairment being a
dominant manifestation. It follows, then, that vascular dementia
might be preventable in women with previous preeclampsia, with good
control of blood pressure, lipids, and glucose."
"What we need to figure out now is, does preeclampsia itself cause
vascular damage on a scale great enough to have lifelong
consequences? Or does having preeclampsia signal an underlying
predisposition to vascular dysfunction," Boyd said.
SOURCE: https://bit.ly/2Rt3Hxd and https://bit.ly/2QaAtmA The BMJ,
online October 17, 2018
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