DOI: 10.1161/jaha.125.046304 ISSN: 2047-9980

Hypertensive Disorders of Pregnancy Associated With Cerebral Small Vessel Disease Decades Later

Hediyeh Baradaran, Sinead Culleton, Lauren Theilen, Michael W. Varner, Emily Guinto, Karen C. Schliep
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Background

Hypertensive disorders of pregnancy (HDP) are associated with elevated long‐term risks of cerebrovascular disease. Emerging data suggest a link between HDP and dementia, potentially mediated by cerebral small vessel disease. We aimed to evaluate whether women with a history of HDP have more cerebral small vessel disease compared with women without HDP.

Methods

This retrospective cohort study included 1602 women from the Utah Population Database who underwent brain magnetic resonance imaging after their index pregnancy. Magnetic resonance imaging scans were evaluated for white matter hyperintensities, remote brain infarctions, cerebral microhemorrhages, enlarged perivascular spaces, acute infarction, and cerebral volume loss. Multivariable regression models assessed the association between HDP and imaging findings, adjusting for confounding factors. Interrater reliability was evaluated using Cohen's kappa.

Results

Women with a history of HDP had higher white matter hyperintensities burden (adjusted mean difference, 0.57 [95% CI, 0.25–0.90]; P =0.001), more total remote brain infarctions (adjusted mean difference, 0.11 [95% CI, 0.00–0.21]; P =0.05) and enlarged perivascular spaces (adjusted mean difference, 0.14 [95% CI, 0.01–0.27]; P =0.03) compared with women without an HDP history. No significant differences were found in microhemorrhages or cerebral volume loss. Subgroup analysis revealed stronger associations between HDP and cerebral small vessel disease markers among women without history of midlife hypertension or stroke, and those in the earlier index pregnancy cohort; though, effect modification was not statistically significant (all Wald interaction tests P >0.10). Interrater agreement was high across imaging measures (weighted kappa range: 0.89–1.00).

Conclusions

Women with prior HDP show greater imaging evidence of cerebral microvascular injury decades after pregnancy, supporting HDP as a risk factor for later‐life cerebrovascular health.

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