Hypertensive disorders of pregnancy and the risk of maternal dementia: a systematic review and meta-analysis - 23/02/24

Doi : 10.1016/j.ajog.2024.01.013

Cian Carey, MPH ^a, Emily Mulcahy, MB ^a, Fergus P. McCarthy, PhD ^b,^c, Emma Jennings, PhD ^d,^e, Karolina Kublickiene, PhD ^f, Ali Khashan, PhD ^a,^b, Peter Barrett, PhD ^a,^g,^⁎
^a School of Public Health, University College Cork, Cork, Ireland
^b Irish Centre for Maternal and Child Health Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland
^c Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland (Dr McCarthy)
^d School of Medicine, University College Cork, Cork, Ireland
^e Department of Geriatric Medicine, Cork University and Mallow General Hospital, Cork, Ireland
^f Division of Renal Medicine, Department of Clinical Intervention, Science and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
^g Department of Public Health Area D (Cork & Kerry), St. Finbarr’s Hospital, Cork, Ireland

^∗Corresponding author: Peter Barrett, PhD.

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Abstract

Objective

Hypertensive disorders of pregnancy, including preeclampsia, are associated with an increased risk for maternal cardiovascular disease, stroke, and chronic kidney disease. However, their association with subsequent maternal dementia or cognitive impairment is less well understood. This study aimed to review and synthesize the published literature on hypertensive disorders of pregnancy and the subsequent risk for maternal dementia or cognitive impairment.

Data Sources

PubMed, Web of Science, Pyschinfo, and CINAHL were searched from database inception until July 31, 2022, for observational studies of hypertensive disorders of pregnancy and maternal dementia or cognitive impairment.

Study Eligibility Criteria

Selected studies included the following: a population of pregnant women, exposure to a hypertensive disorder of pregnancy of interest, and at least 1 primary outcome (dementia) or secondary outcome (cognitive impairment). Two reviewers were involved in study selection.

Methods

We followed the Meta-analyses of Observational Studies in Epidemiology guidelines throughout. Random-effects meta-analyses were used to calculate the overall pooled estimates. Bias was assessed using an adapted version of the validated Newcastle-Ottawa Quality Assessment tool.

Results

A total of 25 eligible studies were identified and included 2,501,673 women. Preeclampsia was associated with a significantly increased risk for vascular dementia (adjusted hazard ratio, 1.89; 95% confidence interval, 1.47–2.43), whereas no clear association was noted between preeclampsia and Alzheimer’s disease (adjusted hazard ratio, 1.27; 95% confidence interval, 0.95–1.70), nor between preeclampsia and any (undifferentiated) dementia (adjusted hazard ratio, 1.18; 95% confidence interval, 0.95–1.47). However, in an analysis restricted to women aged 65 years and older, preeclampsia was associated with an increased risk for Alzheimer’s disease (adjusted hazard ratio, 1.92; 95% confidence interval, 1.35–2.73) and any dementia (adjusted hazard ratio, 1.87; 95% confidence interval, 1.21–2.91).

Conclusion

Women whose pregnancies were complicated by preeclampsia seem to be at a substantially increased future risk for vascular dementia. The longer-term risks among these women with regards to Alzheimer’s disease and other forms of dementia are less clear.

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Key words : hypertensive disorders of pregnancy, dementia

Plan

Introduction

Objective

Materials and Methods

Data sources and search strategy

Study selection

Data extraction and assessment of risk of bias

Data synthesis and statistical analysis

Principal findings and comparison with existing literature

Strengths and limitations

Study implications

Conclusion

	The authors report no conflict of interest.
	This project was supported by the Academic Internship Track, a program funded by the Health and Safety Executive National Doctors’ Training and Planning and the Intern Network Executive (INE) and was managed on behalf of the INE by Trinity College Dublin.
	This review was registered with the International Prospective Register of Systematic Reviews on April 15, 2022, under identifier CRD42022310948.
	Because this was a systematic review and meta-analysis that used previously published data, formal ethical approval was not required. However, we followed the Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines throughout.
	Cite this article as: Carey C, Mulcahy E, McCarthy FP, et al. Hypertensive disorders of pregnancy and the risk of maternal dementia: a systematic review and meta-analysis. Am J Obstet Gynecol 2024;XX:x.ex–x.ex.