For decades, we’ve studied preeclampsia in pregnant and postpartum women. Now, these studies indicate that having preeclampsia during pregnancy may be linked to an increased risk of dementia later in life. Researchers followed 1,178,005 Danish women who had given birth between 1978 and 2015.  During that time, more than 58,000 of them had developed preeclampsia during pregnancy.  The study found that developing preeclampsia during pregnancy doubled their risk for vascular dementia at some point in their lives and quadrupled the risk of vascular dementia for women over 65.  There was also a modest association between preeclampsia and Alzheimer’s disease. No association was found between preeclampsia and other forms of dementia.

Concerning this new discovery, senior author Heather A. Boyd, a researcher at Statens Serum Institute in Copenhagen remarked, “My advice to a woman who has had preeclampsia is the same for dementia as it would be for cardiovascular risk: get the hypertension down, get the weight within normal range, and work on lowering the risk for Type 2 diabetes.” Dr. Boyd continued, “we still need to confirm this finding in other populations, and then we need to figure out what to do about it. We don’t know at this point what the intervention would be.”

Preeclampsia is a form of hypertension (high blood pressure) that is unique to human pregnancy. Hypertensive disorders are among the most common complications of pregnancy.  The link between hypertensive disorders of pregnancy clearly present, but the cause is unclear.  Proposed theories include abnormal trophoblast invasion, endothelial dysfunction, abnormal immunologic reaction, and multiple genetic factors. There are numerous clinical trials currently in the works that describe the use of various methods to prevent or reduce the incidence or preeclampsia. 

Because the cause of preeclampsia is unknown, these interventions have been used in an attempt to correct theoretical abnormalities. Randomized trials have evaluated protein or salt restrictions, while others have investigated the benefits of zinc, magnesium, fish oil, or vitamin C or E supplementation. The use of diuretics and other antihypertensive agents and the use of heparin to prevent preeclampsia in women with risk factors have also been studied.  These trials have had limited sample sizes, and results have revealed minimal to no benefit.

Studies of anti-platelet agents including low-dose aspirin have revealed a small to moderate benefit when used for prevention of preeclampsia. During your initial prenatal appointment, your physician will review your risk factors for preeclampsia and determine if you are an appropriate candidate for therapy with low-dose aspirin.

While this study in Denmark is certainly enlightening concerning possible risk factors for women with preeclampsia later in life, additional studies need to be performed in the United States to confirm that this association exists across populations. Further, if an association is found to exist across populations in the United States, more research would need to be performed to determine effective interventions to mitigate risk.

 

 

Resources

1) Nicholas Bakalar. High Blood Pressure of Pregnancy Tied to Dementia Later in Life. The New York Times. October 17, 2018
2) Gabbe et al. Obstetrics Normal and Problem Pregnancies 7thEdition. Chapter 31 Pre-eclampsia and Hypertensive Disorders.
3) Thomas Zheng. Comprehensive Handbook Obstetrics & Gynecology. Pg 117-124.

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