A SWEDISH register-based cohort study involving 648,385 primiparous women found that gestational hypertension, preeclampsia, and eclampsia are associated with an increased risk of developing neurological disorders, such as migraine, epilepsy, and sleep disorders, within 15 years postpartum, with the strongest association observed between eclampsia and epilepsy.
Hypertensive disorders during pregnancy are well-known risk factors for stroke and dementia later in life, but their association with other neurological conditions has been unclear. This study aimed to investigate whether gestational hypertension, preeclampsia, and eclampsia are linked to an increased risk of new-onset neurological conditions. Using data from the Swedish Medical Birth Register (2005–2018), researchers excluded women with pre-existing neurological conditions or chronic hypertension, resulting in a final cohort of 648,385 women. Neurological outcomes were assessed through the National Patient Register over a mean follow-up period of 15 years.
Women with hypertensive pregnancy disorders showed a higher likelihood of neurological conditions. Gestational hypertension was associated with an adjusted hazard ratio (aHR) of 1.27 (95% CI, 1.12–1.45), preeclampsia with an aHR of 1.32 (95% CI, 1.22–1.42), and eclampsia with an aHR of 1.70 (95% CI, 1.16–2.50) for composite neurological outcomes. The most pronounced risk was observed in women with eclampsia, who had over a fivefold increased risk of epilepsy (aHR, 5.31; 95% CI, 2.85–9.89).
These findings suggest that hypertensive pregnancy disorders may predispose women to lasting neurological vulnerabilities. Current guidelines recommend postpartum follow-up for cardiovascular health in women with a history of gestational hypertension or preeclampsia. This study highlights the importance of expanding these assessments to include neurological symptoms, particularly in cases of eclampsia, to enable early detection and intervention. Future research should investigate the mechanisms underlying these associations and explore preventive strategies to reduce the neurological burden on affected women.
Katrina Thornber, EMJ
Reference
Friis T et al. Gestational Hypertension, Preeclampsia, and Eclampsia and Future Neurological Disorders. JAMA Neurol. 2024;DOI:10.1001/jamaneurol.2024.4426.
