Hypertensive disorders of pregnancy and cognitive impairment: A prospective cohort study

Objective: To determine the association between hypertensive disorders of pregnancy (HDP) and cognitive impairment fifteen 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 fifteen years after the index pregnancy (median 14.7 years, 90% range [13.9 to 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, n = 80 (69.6%) had gestational hypertension (GH) and n = 35 (30.4%) had pre-eclampsia. Women with HDP had a lower g-factor than women with a previous normotensive pregnancy (mean difference -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, fifteen years after pregnancy. This association is mainly driven by women with GH. Clinicians and women who experienced HDP should be aware of this risk.