Hypertensive disorders of pregnancy and markers of vascular brain pathology after 15 years: a prospective cohort study

Abstract Background Substantial evidence suggests an association between hypertensive disorders of pregnancy (HDP) and long term cerebrovascular health. We aimed to determine the associations between HDP and markers of vascular brain pathology fifteen years after pregnancy Method This was a nested cohort study embedded in a population‐based prospective cohort followed from early pregnancy. We included 538 women, 445 (82.7%) with normotensive index pregnancies and 93 (17.2%) with HDP in the index pregnancy. Fifteen years after pregnancy (median of 14.6 years 90% range 14.0; 15.7), women had a mean age of 46.5 years (SD = 4.2). These women underwent magnetic resonance imaging to assess brain tissue volumes as well as white matter hyperintensities (WMH), lacunar infarcts, and cerebral microbleeds as markers of vascular brain pathology. Result Women with prior HDP had 38% (95% CI: [8% ; 75%]) higher WMH volume compared to women with previous normotensive pregnancy. This association was driven by women with gestational hypertension, who had 48% (95% CI: [11% ; 95%]) higher WMH volume compared to women with previous normotensive pregnancy. No differences were found with infarcts or cerebral microbleeds. The development of chronic hypertension after pregnancy strengthened this result, especially in women with previous gestational hypertension. Conclusion A history of HDP was associated with more WMH burden fifteen years after pregnancy. This effect was driven by women with previous gestational hypertension. The development of chronic hypertension after pregnancy contributed to this effect. Women with a history of HDP should be evaluated and treated early for hypertension and other cardiovascular risk factors.