妊娠高血压疾病与痴呆风险的神经影像学标志物：一项试点研究。

Hypertensive disorders of pregnancy and neuroimaging markers of dementia risk: A pilot study.

作者信息

Alshikho Mohamad J, Haghighi Noora, Ravi Rupa, Solomon Victoria A, Rangel Elizabeth, Pyne Jeffrey D, Bista Kelsang C, Chang Julia F, Lippert Rafael V, Cotton-Samuel Dejania, Cedano Sheica, De La Cruz Vasquez Nathalie, Haro Carla A, Chiu Jeremy, Chen Yufen J, Reddy Uma, McNeil Becky, Pemberton Victoria L, Yee Lynn M, Parrish Todd, Brickman Adam M, Miller Eliza C

机构信息

Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.

Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.

出版信息

Pregnancy (Hoboken). 2025 May;1(3). doi: 10.1002/pmf2.70020. Epub 2025 Apr 24.

DOI:10.1002/pmf2.70020

PMID:40881303

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12383491/

Abstract

BACKGROUND AND OBJECTIVES

Hypertensive disorders of pregnancy (HDP) are associated with a long-term risk of maternal cognitive decline. Limited data exist regarding maternal brain structure in midlife after HDP. We examined the association between prior HDP and neuroimaging markers associated with microvascular brain injury, detected on high-resolution brain MRI.

METHODS

We conducted a pilot study embedded within the nuMoM2b Heart Health Study, a multicenter prospective cohort of nulliparous US individuals recruited between 2010 and 2013 in the first trimester of pregnancy. Participants with no history of HDP, preterm birth, small-for-gestational age infant, or stillbirth in any pregnancy, and participants with HDP in the index or any subsequent pregnancy were invited to undergo brain MRI at two study sites between December 21, 2021 and September 30, 2023, using a standardized protocol on identical scanners. Imaging outcomes of interest included white matter hyperintensity (WMH) volume, regional cerebral blood flow (CBF), fractional anisotropy (FA), radial diffusivity (RD), regional grey matter volume (GMV), and cortical thinning.

RESULTS

A total of 81 participants (mean age 39 years; 27% White, 9% non-Hispanic Black, 52% Hispanic, 10% Asian) had brain MRI, of whom 27 (33%) had a history of HDP. The median time from index delivery to MRI was 11 years. Participants with HDP had lower CBF in the left medial orbitofrontal, left inferior temporal, and right superior temporal lobes (Cohen's = 0.3, cluster-wise corrected = 0.0002 for all subregions); lower FA in the left superior frontal lobe, right lateral occipital lobe, and right precuneus ( = 0.2-0.3, ≤ 0.01 for all regions); and higher RD in the bilateral medial orbitofrontal lobes ( = 0.2-0.3, < 0.001). Cortical thickness, regional GMV, and total WMH volume did not differ between groups. A subgroup analysis including only participants with preeclampsia in the exposed group showed similar results.

DISCUSSION

Midlife individuals who experienced HDP had lower regional CBF and reduced white matter microstructural integrity, compared with those with no adverse pregnancy outcomes. Our results suggest that HDP are associated with long-term impairment of white matter structure and cerebrovascular function, potentially suggesting a mechanism underlying the association of HDP with risk of cognitive decline, and requiring further study.

摘要

背景与目的

妊娠高血压疾病（HDP）与母亲长期认知功能下降风险相关。关于HDP后中年母亲脑结构的数据有限。我们研究了既往HDP与高分辨率脑MRI检测到的与微血管脑损伤相关的神经影像标志物之间的关联。

方法

我们在nuMoM2b心脏健康研究中进行了一项试点研究，该研究是一项多中心前瞻性队列研究，于2010年至2013年在美国招募了妊娠早期的未生育个体。邀请在任何一次妊娠中无HDP、早产、小于胎龄儿或死产史的参与者，以及在本次或任何后续妊娠中有HDP的参与者，于2021年12月21日至2023年9月30日期间在两个研究地点接受脑MRI检查，使用相同扫描仪上的标准化方案。感兴趣的影像结果包括白质高信号（WMH）体积、局部脑血流量（CBF）、分数各向异性（FA）、径向扩散率（RD）、局部灰质体积（GMV）和皮质变薄。

结果

共有81名参与者（平均年龄39岁；27%为白人，9%为非西班牙裔黑人，52%为西班牙裔，10%为亚洲人）进行了脑MRI检查，其中27人（33%）有HDP病史。从本次分娩到MRI的中位时间为11年。患有HDP的参与者在左侧内侧眶额、左侧颞下和右侧颞上叶的CBF较低（科恩d值 = 0.3，所有亚区域经簇校正后P = 0.0002）；在左侧额上叶、右侧枕叶外侧和右侧楔前叶的FA较低（d值 = 0.2 - 0.3，所有区域P ≤ 0.01）；在双侧内侧眶额叶的RD较高（d值 = 0.2 - 0.3，P < 0.001）。两组之间的皮质厚度、局部GMV和总WMH体积没有差异。仅包括暴露组中患有子痫前期的参与者的亚组分析显示了类似的结果。