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Does preeclampsia increase your risk for future neurological conditions?

By Sig-Linda Jacobsen, MD

Neurological symptoms are not uncommon in those who have preeclampsia. The most common symptom is severe headache. Some patients may also experience eclampsia, or seizures during pregnancy and the postpartum period.  Until recently, it was believed that these neurological complications resolved completely after delivery.  However, imaging studies show long-term changes in the brains of those who have had preeclampsia or eclampsia.  Gestational hypertension, preeclampsia, and eclampsia are known risk factors for developing stroke and dementia later in life. There is, however, little data on the incidence of other neurological conditions particularly in the short- to medium-term after pregnancies complicated by hypertensive disorders. 

Researchers in this study utilized the Swedish Birth Registry and National Patient Register to identify 609,679 persons who had normal blood pressure readings during pregnancy and compared the incidence of new-onset neurological disease (migraines, headaches, epilepsy, sleep disorders, or mental fatigue) to those who had gestational hypertension (11,133), preeclampsia (26,7997) or eclampsia (625). Women with a diagnosis of any of the neurological outcomes mentioned above before or during pregnancy or within 42 days of giving birth were excluded from the study to avoid symptoms relating to prior medical conditions or the index pregnancy. 

The average length of follow-up was 7.7 years (range 42 days to 15 years).  After controlling for age, early pregnancy body mass index (BMI), country of birth, smoking, education level, pre-gestational and gestational diabetes, kidney disease, and lupus erythematosus, the risk of one or more neurological conditions was higher in those with any hypertensive disorder of pregnancy.  

Women who had gestational hypertension, preeclampsia, and eclampsia were found to have a 20% to 70% increased risk of developing neurological disorders—such as migraines, headaches, epilepsy, sleep disorders, or mental fatigue—in the years following childbirth. When each neurological condition was looked at separately, the strongest association was identified between eclampsia and epilepsy, showing a five-fold increased risk (odd ratio 5.75) compared to women who had a normotensive pregnancy. Gestational hypertension was associated more with an increase in migraine.

TAKE HOME:  Patients who have gestational hypertension, preeclampsia or eclampsia are at higher risk of developing new-onset neurological disorders including epilepsy, migraine, headaches, sleep disorder, or mental fatigue within months to the first 15 years after delivery.  Patients with a history of a hypertensive disorder of pregnancy should pay close attention to persisting or new-onset neurological symptoms and make sure their healthcare providers are aware of their reproductive history. Referral to a neurologist may be necessary.

The Preeclampsia Foundation partnered with the International Society for the Study of Hypertension in Pregnancy (ISSHP) and the Society for Maternal-Fetal Medicine to produce our “My Health Beyond Pregnancy” tool to help patients monitor their long-term health impacts. Use this tool to track your concerns and healthcare data. 

Gestational Hypertension, Preeclampsia, and Eclampsia and Future Neurological Disorders by Therese Friis et al.  JAMA Neurol. 2024;4426 

Citation: Friis T, Bergman L, Hesselman S, Lindström L, Junus K, Cluver C, Escudero C, Wikström AK. Gestational Hypertension, Preeclampsia, and Eclampsia and Future Neurological Disorders. JAMA Neurol. 2024 Dec 23. doi: 10.1001/jamaneurol.2024.4426. Epub ahead of print. PMID: 39714850.

Link: https://jamanetwork.com/journals/jamaneurology/article-abstract/2828349

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