Hypertensive Disorders of Pregnancy (HDP) and the risk of Maternal Dementia: A Systematic Review and Meta-Analysis.

OBJECTIVE:Hypertensive disorders of pregnancy (HDP), including preeclampsia (PE) are associated with an increased risk of maternal cardiovascular disease, stroke and chronic kidney disease. However, their association with subsequent maternal dementia or cognitive impairment is less well understood. To review and synthesize the published literature on HDP and subsequent risk of maternal dementia or cognitive impairment. DATA SOURCES:PubMed, Web of Science, Pyschinfo and CINAHL from database inception until July 31st 2022, for observational studies of HDP and maternal dementia or cognitive impairment. STUDY ELIGIBILITY CRITERIA:Selected studies included the following: a population of pregnant women, exposure to a HDP of interest, and at least 1 primary outcome (dementia) or secondary outcome (cognitive impairment). Two reviewers were involved in study selection. STUDY APPRAISAL AND SYNTHESIS METHODS:We followed the Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines throughout. Random-effects meta-analyses were used to calculate overall pooled estimates. Bias was assessed using an adapted version of the validated Newcastle-Ottawa Quality Assessment tool. RESULTS:25 eligible studies were identified and included 2,501,673 women. PE was associated with a significantly increased risk of vascular dementia (aHR 1.89; 95% confidence interval 1.47, 2.43), while no clear association was noted between PE and Alzheimer's disease (aHR 1.27; 95% confidence interval 0.95, 1.70), nor PE and any (undifferentiated) dementia (aHR 1.18; 95% confidence interval 0.95, 1.47). However, in analysis restricted to women aged 65 and older, PE was associated with an increased risk of Alzheimer's disease (aHR 1.92; 95% confidence interval 1.35, 2.73) and any dementia (aHR 1.87; 95% confidence interval 1.21, 2.91). CONCLUSIONS:Women whose pregnancies were complicated by PE appear to be at a substantially increased future risk of vascular dementia. The longer-term risks for these women in regards to Alzheimer's disease and other forms of dementia are less clear.