Gestational hypertension, pre-eclampsia, and eclampsia are major hypertensive disorders that occur during pregnancy. These disorders can increase the risk of stroke and dementia in later life. Swedish registry data showed the association of these conditions with new-onset neurological disorders such as headache, migraine, epilepsy, sleep disorders, and mental fatigue in the years following childbirth.
Friis T and co-authors highlight the long-term effects of these hypertensive disorders during pregnancy and, the need for monitoring and preventive care in affected women to relieve neurological complications in the future. This work is published in JAMA Neurology, on December 23, 2024.
The authors conducted a retrospective study using Swedish medical birth register data from 2005 to 2018. In this cohort study, a total of 648,385 women with a mean age of 28.5 years (standard deviation [SD] = 5.0) at their first pregnancy were included. Women with chronic hypertension and pre-pregnancy neurological disorders were excluded. Out of 648,385 women, 11,133 women reported gestational hypertension, 26,797 with preeclampsia, and 625 with eclampsia. All these included women correlated with new-onset neurological disorders.
The risk of these disorders is higher in women with hypertensive disorders compared to women with non-hypertensive disorders. Follow-up of the study population began 42 days after their delivery and continued until the occurrence of the first event, death, emigration, or the 2019end of the 2019 year (follow-up period).
Risk analysis was calculated using Cox regression analysis (adjusted hazard ratio [aHR]) with a 95% confidence interval (CI). Gestational hypertension had aHR of 1.27 with 95% CI 1.12-1.45, demonstrating that risk increased moderately compared to women with non-hypertensive disorders. The aHR for Preeclampsia was 1.32 with a 95% CI 1.22-1.42, indicating a slightly increased risk of neurological disorders. Whereas aHR was substantially higher at 1.70 with 95% CI 1.16-2.50 in cases of eclampsia, determining that significantly increased risk of neurological disorders compared to other hypertensive disorders such as gestational hypertension and preeclampsia.
The adjusted hazard ratio (aHR) for gestational hypertension was 1.27 (95% confidence interval [CI], 1.12–1.45), indicating a modestly increased risk compared to women without this condition. For preeclampsia, the aHR was slightly higher at 1.32 (95% CI, 1.22–1.42), reflecting a similar elevated risk. In cases of eclampsia, the aHR was significantly higher at 1.70 (95% CI, 1.16–2.50), suggesting a substantially increased risk compared to gestational hypertension and preeclampsia.
Further analysis showed that there is an association between eclampsia and neurological condition, epilepsy. It was observed that women with eclampsia experienced a more than five-fold increased risk of epilepsy (aHR = 5.31; 95% CI 2.85-9.89). This result emphasizes the severe neurological conditions associated with eclampsia in women.
The authors concluded that hypertensive disorders like gestational hypertension, preeclampsia, and eclampsia were connected to an increased risk of new-onset neurological complications such as migraine, headache, epilepsy, sleep disorder, and mental fatigue months to years after childbirth. Guidelines recommend follow-up care after giving birth. These follow-up visits are most important for monitoring long-term health and diagnosing potential complications.
During these follow-up visits, healthcare providers should also assess the new neurological symptoms. Women who have experienced gestational hypertension preeclampsia, or eclampsia may be more likely to develop neurological disorders. Early diagnosis and management or treatment of these disorders can enhance the overall well-being of women.
Reference: Friis T, Bergman L, Hesselman S, et al. Gestational Hypertension, Preeclampsia, and Eclampsia and Future Neurological Disorders. JAMA Neurol. 2024. doi:10.1001/jamaneurol.2024.4426
