Wolfova Katrin, Miller Eliza C
Department of Neurology, Columbia University, New York, New York, USA.
Department of Epidemiology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
Res Pract Thromb Haemost. 2024 Jan 30;8(1):102331. doi: 10.1016/j.rpth.2024.102331. eCollection 2024 Jan.
A State of the Art lecture titled "Impact of Adverse Pregnancy Outcomes on Brain Vascular Health and Cognition" was presented at the International Society on Thrombosis and Haemostasis Congress in 2023. Adverse pregnancy outcomes, encompassing conditions such as gestational hypertension, eclampsia, preeclampsia, preterm birth, fetal growth restriction, stillbirth, and gestational diabetes, may form part of an underrecognized pathway from early adulthood reproductive health factors to later-life vascular cognitive impairment and dementia in women. Adverse pregnancy outcomes are caused by dysregulated vascular and metabolic adaptations during pregnancy, and these pathophysiological changes may persist after delivery. Adverse pregnancy outcomes may contribute to the increased risk of cognitive impairment and dementia directly through vascular and metabolic dysregulation and subsequent development of cardiovascular diseases, or other biological processes may be at play, such as shared maternal risk factors. Extensive epidemiologic evidence has shown that many cognitive impairment and dementia cases may be prevented or delayed by strategies targeting midlife cardiovascular health. Despite the recognized importance of adverse pregnancy outcomes for cardiovascular health, the literature on associated long-term health outcomes is limited. In this State of the Art review article, we summarize the current epidemiologic evidence on the relationship between adverse pregnancy outcomes and cognitive impairment and dementia and provide an overview of the potential pathophysiological mechanisms. Finally, we summarize relevant new data on this topic presented during the 2023 International Society on Thrombosis and Haemostasis Congress.
一场题为“不良妊娠结局对脑血管健康和认知的影响”的前沿讲座于2023年在国际血栓与止血学会大会上发表。不良妊娠结局包括妊娠期高血压、子痫、先兆子痫、早产、胎儿生长受限、死产和妊娠期糖尿病等情况，可能构成从成年早期生殖健康因素到女性晚年血管性认知障碍和痴呆的一条未被充分认识的途径的一部分。不良妊娠结局是由孕期血管和代谢适应失调引起的，这些病理生理变化在分娩后可能持续存在。不良妊娠结局可能通过血管和代谢失调以及随后心血管疾病的发展直接导致认知障碍和痴呆风险增加，或者可能存在其他生物学过程，如共同的母体风险因素。大量流行病学证据表明，针对中年心血管健康的策略可以预防或延缓许多认知障碍和痴呆病例。尽管不良妊娠结局对心血管健康的重要性已得到认可，但关于相关长期健康结局的文献有限。在这篇前沿综述文章中，我们总结了当前关于不良妊娠结局与认知障碍和痴呆之间关系的流行病学证据，并概述了潜在的病理生理机制。最后，我们总结了在2023年国际血栓与止血学会大会上提出的关于该主题的相关新数据。
