Long-term Brain Health among Females with New Onset Hypertensive Disorders of Pregnancy

Background Hypertensive disorders of pregnancy (HDP) are key female-specific risk factors for vascular diseases. Given the association between vascular health and brain structure and function, it remains unclear whether new onset HDP is associated with later-life brain changes and cognition. Objective Our objective was to evaluate the association between a history of HDP and brain structural changes and cognition in middle-aged and older females using data available from the UK Biobank cohort. Study Design We conducted a matched case–control analysis using data from the UK Biobank. We compared females with a history of new onset HDP to females with normotensive pregnancies, matched 1:4 (case: control) on age at delivery and number of births. We included females with available brain MRI and cognitive assessments (mean ∼30 years postpartum). We used linear regression models while adjusting for known clinical and demographic covariates to assess brain volumes, white matter hyperintensities (WMH), white matter microstructural integrity, and a neurocognitive battery of tests. Results When compared to females with a history of normotensive pregnancy, females with a history of HDP had lower grey matter volume (β = -6.0 mL; 95% CI= -10.9– -1.1; p= 0.02), as well an increase in the volume of WMH (β = 0.5 mL; 95% CI= 0.1 – 0.9; p = 0.02). No significant differences were observed in white matter microstructural integrity or neurocognitive tests. Conclusions A history of HDP is associated with later life differences in brain structure decades after pregnancy, with lower brain volumes and higher WMH burden. These findings suggest that hypertension during pregnancy may present an early life vascular exposure with long term subclinical consequence on brain health.