Hussainali Rowina F, Adank Maria C, Lamballais Sander, Vernooij Meike W, Ikram M Arfan, Steegers Eric A P, Miller Eliza C, Schalekamp-Timmermans Sarah
Department of Epidemiology (R.F.H., S.L., M.W.V., M.A.I.), Erasmus MC University Medical Center Rotterdam, the Netherlands.
Generation R Study Group (R.F.H., M.C.A., S.S.-T.), Erasmus MC University Medical Center Rotterdam, the Netherlands.
Hypertension. 2025 Aug;82(8):1326-1335. doi: 10.1161/HYPERTENSIONAHA.124.24544. Epub 2025 Jun 9.
Substantial evidence suggests an association between hypertensive disorders of pregnancy and long-term cerebrovascular health. We aimed to determine the associations between hypertensive disorders of pregnancy and markers of cerebral small vessel disease 15 years after pregnancy.
This was a nested cohort study embedded in a population-based prospective cohort followed from early pregnancy. We included 538 women, 445 (82.8%) with normotensive index pregnancies, and 93 (17.2%) with hypertensive disorders in the index pregnancy. Fifteen years after the index pregnancy (median, 14.6 years; 90% range, 14.0-15.7 years), women underwent magnetic resonance imaging to assess brain tissue and white matter hyperintensity volume, lacunar infarcts, and cerebral microhemorrhages as markers of cerebral small vessel disease.
Women with prior hypertensive disorders of pregnancy had higher white matter hyperintensity volume compared with women with previous normotensive pregnancy (adjusted β, 0.32 [95% CI, 0.08-0.56]). This association was driven by women with gestational hypertension, who had higher white matter hyperintensity volume compared with women with previous normotensive pregnancy (adjusted β, 0.39 [95% CI, 0.10-0.67]). The effect was larger in those with gestational hypertension who developed chronic hypertension after the index pregnancy. No differences were found in infarcts or cerebral microhemorrhages.
In a prospective cohort of midlife Dutch women, those with a history of hypertensive disorders of pregnancy, particularly gestational hypertension, showed some signs of cerebral small vessel disease, compared with those with normotensive pregnancies. These results support epidemiological data suggesting that not only preeclampsia but also gestational hypertension is associated with long-term cerebrovascular risk.
大量证据表明妊娠高血压疾病与长期脑血管健康之间存在关联。我们旨在确定妊娠高血压疾病与妊娠15年后脑小血管疾病标志物之间的关联。
这是一项嵌套队列研究，纳入了一个基于人群的前瞻性队列，该队列从妊娠早期开始随访。我们纳入了538名女性，其中445名（82.8%）在妊娠期间血压正常，93名（17.2%）在妊娠期间患有高血压疾病。在妊娠指数期后的15年（中位数为14.6年；90%的范围为14.0 - 15.7年），女性接受了磁共振成像检查，以评估脑组织和白质高信号体积、腔隙性梗死和脑微出血，作为脑小血管疾病的标志物。
与既往血压正常的妊娠女性相比，既往患有妊娠高血压疾病的女性白质高信号体积更大（校正β值为0.32 [95%置信区间，0.08 - 0.56]）。这种关联主要由妊娠期高血压女性驱动，与既往血压正常的妊娠女性相比，她们的白质高信号体积更大（校正β值为0.39 [95%置信区间，0.10 - 0.67]）。在妊娠指数期后发生慢性高血压的妊娠期高血压女性中，这种影响更大。在梗死或脑微出血方面未发现差异。
在一组荷兰中年女性的前瞻性队列中，与血压正常的妊娠女性相比，有妊娠高血压疾病史，特别是妊娠期高血压病史的女性，表现出一些脑小血管疾病的迹象。这些结果支持了流行病学数据，表明不仅子痫前期，而且妊娠期高血压也与长期脑血管风险相关。
