Gestational hypertension, preeclampsia, and eclampsia associated with future neurological disorders
06 Jan 2025
bởiElaine Tan
Gestational hypertension, preeclampsia, and eclampsia were associated with an increased risk of new-onset migraine, headache, epilepsy, sleep disorder, or mental fatigue within months to years after giving birth, a Swedish study found.
The Swedish nationwide register-based cohort study included 648,385 women who were giving birth to their first infant at 22 + 0 gestational weeks or later between 1st January 2005 and 31st December 2018. Women with chronic hypertension at the index pregnancy or a diagnosis of migraine, headache, epilepsy, sleep disorder or mental fatigue before or during pregnancy or within 42 days after giving birth were excluded from the study. [JAMA Neurol 2024 doi: doi:10.1001/jamaneurol.2024.4426. Dec 23, 2024]
For the main analysis, the cohort was divided into one reference group (women with normotensive pregnancies; n=609,830) and three exposure groups: women with gestational hypertension (clinically defined as new-onset high systolic blood pressure [BP] of ≥140 mm Hg and/or diastolic BP ≥90 mm Hg measured on two subsequent occasions >4 hours apart, in the absence of proteinuria, after 20 weeks’ gestation; n=11,133); women with preeclampsia (defined as gestational hypertension accompanied by proteinuria ≥300 mg for 24 hours, ≥2 positive results on dipstick, or one positive result on dipstick on two separate occasions >4 hours apart; n=26,797) without eclampsia; and women with eclampsia (defined as tonic-clonic seizures without other aetiology, accompanied by a diagnosis of preeclampsia; n=625).
The primary outcome was a composite of new-onset medium-term neurological disorder (migraine, headache, epilepsy, sleep disorder, or mental fatigue [neurasthenia], as identified by ICD-10 codes on the Swedish National Patient Register) during a time frame ranging from 42 days to 15 years after childbirth. Secondary outcomes were the same neurological disorders as individual outcomes.
Women with gestational hypertension, preeclampsia, and eclampsia had higher incidence rates (3.6, 4.0, and 5.4 per 1,000, respectively) of developing a new-onset neurological disorder compared with women with a normotensive pregnancy (3.0 per 1,000). The adjusted hazard ratio (aHR) was 1.27 (95 percent confidence interval [CI], 1.12–1.45) for gestational hypertension, 1.32 (95 percent CI, 1.22–1.42) for preeclampsia, and 1.70 (95 percent CI, 1.16–2.50) for eclampsia. Among individual neurological outcomes, the strongest association was seen between eclampsia and future epilepsy, with >5 times increased risk of epilepsy (aHR, 5.31; 95 percent CI, 2.85–9.89) found in women with eclampsia vs women with normotensive pregnancies.
According to the authors, the study was the first to show an association between gestational hypertension and preeclampsia and a later diagnosis of migraine, as well as the association between preeclampsia and a later diagnosis of headache, suggesting that there might be a common underlying vascular component, which is plausible since preeclampsia is a risk factor for cardiovascular morbidity later in life.
The authors speculated that differing pathophysiological mechanisms may underlie these neurological disorders, depending on which hypertensive disorder the woman was exposed to. They also highlighted the need for follow-up regarding neurological disorders in women affected by these pregnancy-related complications.