From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN.
Neurology. 2023 May 9;100(19):e2017-e2026. doi: 10.1212/WNL.0000000000207134. Epub 2023 Mar 1.
Studies of hypertensive disorders of pregnancy (HDP), including gestational or chronic hypertension (GH/CH) and preeclampsia/eclampsia (PE/E), suggest associations with early-life and mid-life cognition but have been limited by self-report or use of diagnostic codes, exclusion of nulliparous women, and lack of measurement of cognition in later life. We examined the effects of any HDP, GH/CH, PE/E, and nulliparity on cognition in later life.
Participants included 2,239 women (median age 73) enrolled in the Mayo Clinic Study of Aging with medical record-abstracted pregnancy information. A cognitive battery of 9 tests was conducted every 15 months. Global cognitive and domain-specific z scores (memory, executive/attention, visuospatial, and language) were outcomes. Linear mixed-effect models evaluated associations between pregnancy history (all normotensive, any HPD, HPD subtype [GH/CH, PE/E], or nulliparous) and cognitive decline, adjusting for age and education. Additional models adjusted for APOE, smoking, hypertension, dyslipidemia, body mass index (BMI), diabetes, stroke, and heart disease. Interactions between pregnancy history and age or education on cognitive performance were examined.
Of the 2,239 women, 1,854 (82.8%) had at least 1 pregnancy (1,607 all normotensive, 100 GH/CH, and 147 PE/E); 385 (17.2%) were nulliparous. Cognitive performance did not cross-sectionally differ for women with a history of any HDP, GH/CH, or PE/E vs women with a history of all normotensive pregnancies; women who were nulliparous had lower global and domain-specific cognition (all < 0.05) in age- and education-adjusted models. There was an interaction ( = 0.015) between nulliparity and education such that the lower cognitive performance was most pronounced among nulliparous women with ≤12 years of education (beta = -0.42, < 0.001) vs 12 + years (b = -0.11, = 0.049). Longitudinally, women with any HDP had greater declines in global cognition and attention/executive z scores compared with women with all normotensive pregnancies. When stratified by HDP type, only women with PE/E had greater declines in global cognition (beta = -0.04, < 0.001), language (beta = -0.03, = 0.001), and attention (beta = -0.04, < 0.001) z scores. Adjustment for vascular risk factors, BMI, smoking, and did not attenuate results.
Women with a history of HDP, especially PE/E, are at greater risk of cognitive decline in later life.
对妊娠高血压疾病（HDP）的研究，包括妊娠期或慢性高血压（GH/CH）和子痫前期/子痫（PE/E），表明其与儿童期和中年期认知功能相关，但研究受到限制，包括仅使用自我报告或诊断代码、排除初产妇，以及缺乏对晚年认知的测量。我们研究了任何 HDP、GH/CH、PE/E 和初产妇对晚年认知的影响。
参与者包括 2239 名年龄中位数为 73 岁的女性，她们参加了梅奥诊所衰老研究，其妊娠信息从病历中提取。采用 9 项测试的认知测试包，每 15 个月进行一次。总体认知和特定领域的 z 分数（记忆、执行/注意力、视觉空间和语言）是结果。线性混合效应模型评估了妊娠史（所有正常血压、任何 HPD、HPD 亚型[GH/CH、PE/E]或初产妇）与认知衰退之间的关联，同时调整了年龄和教育因素。其他模型还调整了 APOE、吸烟、高血压、血脂异常、体重指数（BMI）、糖尿病、中风和心脏病。还检查了妊娠史与年龄或教育对认知表现的交互作用。
在 2239 名女性中，1854 名（82.8%）至少有一次妊娠（1607 名所有正常血压、100 名 GH/CH 和 147 名 PE/E；385 名初产妇）。在横断面比较中，有任何 HDP、GH/CH 或 PE/E 病史的女性与有所有正常血压妊娠史的女性的认知表现没有差异；而初产妇的总体认知和特定领域认知水平较低（所有 < 0.05），在年龄和教育调整模型中。在初产妇和教育程度之间存在交互作用（ = 0.015），表明认知表现的下降在受教育程度较低的初产妇中最为明显（教育程度为≤12 年的初产妇的 b 值为-0.42， < 0.001），而在教育程度为 12 年以上的初产妇中则为 b 值为-0.11， = 0.049）。纵向比较中，与所有正常血压妊娠的女性相比，有任何 HDP 的女性的总体认知和注意力/执行 z 分数下降更大。按 HDP 类型分层后，只有 PE/E 女性的总体认知（b 值为-0.04， < 0.001）、语言（b 值为-0.03， = 0.001）和注意力（b 值为-0.04， < 0.001）z 分数下降更大。调整血管危险因素、BMI、吸烟和后，结果没有减弱。
有 HDP 病史的女性，尤其是有 PE/E 病史的女性，晚年认知衰退的风险更高。
