Friis Therese, Bergman Lina, Hesselman Susanne, Lindström Linda, Junus Katja, Cluver Catherine, Escudero Carlos, Wikström Anna-Karin
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.
JAMA Neurol. 2025 Feb 1;82(2):142-151. doi: 10.1001/jamaneurol.2024.4426.
Gestational hypertension, preeclampsia, and eclampsia are established risk factors for stroke and dementia later in life. Whether these pregnancy complications are associated with an increased risk of new-onset neurological disorders within months to years after giving birth is not known.
To explore whether gestational hypertension, preeclampsia, and eclampsia are associated with new-onset migraine, headache, epilepsy, sleep disorder, or mental fatigue within months to years after giving birth.
DESIGN, SETTING, AND PARTICIPANTS: In this register-based cohort study, exposures were identified in the Swedish Medical Birth Register from 2005 to 2018. Follow-up was conducted using the National Patient Register, containing diagnoses from specialized inpatient and outpatient care. Follow-up started 42 days after delivery and continued until the first event, death, emigration, or the end of the follow-up period (2019). The risk was calculated with Cox regression analysis and expressed as adjusted hazard ratio (aHR) with a 95% CI. Through the Swedish Medical Birth Register, 659 188 primiparous women with singleton pregnancies between 2005 and 2018 were identified. Women with a diagnosis of chronic hypertension (n = 4271) or a prepregnancy neurological disorder (n = 6532) were excluded. The final study population included 648 385 women. Data analyses were conducted in 2023.
Gestational hypertension, preeclampsia, and eclampsia.
The primary outcome was a composite neurological outcome of migraine, headache, epilepsy, sleep disorder, or mental fatigue.
The study included 648 385 women with a mean age of 28.5 (SD, 5.0) years at the time of their first pregnancy. Women with gestational hypertension (n = 11 133), preeclampsia (n = 26 797), and eclampsia (n = 625) all had an association with increased risk for a new-onset neurological disorder compared with women with normotensive pregnancies. The aHR for gestational hypertension was 1.27 (95% CI, 1.12-1.45), 1.32 (95% CI, 1.22-1.42) for preeclampsia, and 1.70 (95% CI, 1.16-2.50) for eclampsia. When exploring individual outcomes, women with eclampsia were associated with more than a 5 times increased risk of epilepsy (aHR, 5.31; 95% CI, 2.85-9.89).
In this study, 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. Guidelines recommend follow-up after delivery for women with gestational hypertension and preeclampsia for their increased risk of cardiovascular disease. At these visits, caregivers should also pay attention to persisting or new-onset of neurological symptoms, since this group of women appears to be vulnerable to developing or experiencing neurological disorders.
妊娠期高血压、子痫前期和子痫是日后发生中风和痴呆的既定风险因素。这些妊娠并发症是否与产后数月至数年内新发神经系统疾病的风险增加相关尚不清楚。
探讨妊娠期高血压、子痫前期和子痫是否与产后数月至数年内新发偏头痛、头痛、癫痫、睡眠障碍或精神疲劳相关。
设计、设置和参与者：在这项基于登记册的队列研究中，暴露情况从2005年至2018年的瑞典医学出生登记册中确定。使用国家患者登记册进行随访，其中包含专科住院和门诊护理的诊断信息。随访从分娩后42天开始，持续到首次事件、死亡、移民或随访期结束（2019年）。风险通过Cox回归分析计算，并以调整后的风险比（aHR）和95%置信区间表示。通过瑞典医学出生登记册，确定了2005年至2018年间659188名单胎初产妇。排除患有慢性高血压诊断（n = 4271）或孕前神经系统疾病（n = 6532）的妇女。最终研究人群包括648385名妇女。数据分析于2023年进行。
妊娠期高血压、子痫前期和子痫。
主要结局是偏头痛、头痛、癫痫、睡眠障碍或精神疲劳的综合神经系统结局。
该研究纳入了648385名妇女，首次怀孕时的平均年龄为28.5（标准差，5.0）岁。与血压正常的孕妇相比，患有妊娠期高血压（n = 11133）、子痫前期（n = 26797）和子痫（n = 625）的妇女患新发神经系统疾病的风险均增加。妊娠期高血压的aHR为1.27（95%置信区间，1.12 - 1.45），子痫前期为1.32（95%置信区间，1.22 - 1.42），子痫为1.70（95%置信区间，1.16 - 2.50）。在探索个体结局时，患有子痫的妇女患癫痫的风险增加了5倍以上（aHR，5.31；95%置信区间，2.85 - 9.89）。
在本研究中，妊娠期高血压、子痫前期和子痫与产后数月至数年内新发偏头痛、头痛、癫痫、睡眠障碍或精神疲劳的风险增加相关。指南建议对患有妊娠期高血压和子痫前期的妇女进行产后随访，因为她们患心血管疾病的风险增加。在这些就诊时，护理人员还应关注持续或新发的神经系统症状，因为这组妇女似乎易患或经历神经系统疾病。
