Abstract
ABSTRACTObjective: Hypertensive disorders of pregnancy, like preeclampsia, are a leading cause of maternal and fetal morbidity/mortality worldwide. Preeclampsia can be complicated by the occurrence of convulsions (eclampsia). Women who experienced (pre)eclampsia more frequently report daily cognitive failures and showed increased emotional dysfunction several years later, but are not impaired on objective neurocognitive testing. In addition, women with preterm preeclampsia more often have cerebral white matter lesions (WML) on follow-up. We aimed to determine whether WML presence is related to cognitive dysfunction, anxiety, and depressive symptoms in (pre)eclamptic women. Method: Forty-one eclamptic, 49 preeclamptic, and 47 control women who had a normotensive pregnancy completed the Cognitive Failures Questionnaire (CFQ), the Hospital Anxiety and Depression Scale (HADS), and a broad neurocognitive test battery (visual perception and speed of information processing, motor functions, working memory, long-term memory, attention, and executive functioning). All underwent cerebral magnetic resonance imaging (MRI), and WML presence was recorded. Median elapsed time since index pregnancy was 6 years. Average age was 40 years. Results: WML were more prevalent in women who had experienced preterm (pre)eclampsia (<37 weeks; 40%) than in controls (21%, p = .03). In (pre)eclamptic women, CFQ and HADS scores were higher than those in controls (44± 16.1 vs. 36± 11.0, p < .001, and 11± 6.3 vs. 8± 5.5, p < .001). There was no difference in objective cognitive performance as measured by neurocognitive tests. Subjective and objective cognitive functioning, anxiety, and depressive symptoms were not related to WML presence. Conclusion: Formerly (pre)eclamptic women report cognitive dysfunction, but do not exhibit overt cognitive impairment when objectively tested on average 6 years following their pregnancy. The presence of WML is not related to objective nor to subjective cognitive impairment, anxiety, and depressive symptoms. Longitudinal studies are needed to study whether the presence of WML is a risk factor for developing objective cognitive impairment in the long term.
Highlights
ParticipantsPreeclamptic, and control women with normotensive pregnancies were enrolled in this retrospective cohort study as part of ongoing follow-up studies assessing long-term cerebral consequences of preeclampsia and eclampsia (Aukes et al, 2009; Aukes et al, 2012; Postma et al, 2014; Wiegman et al, 2014)
We suggested that cognitive failures in formerly eclamptic women may be interpreted as a measure of executive control of behavior, in which people who have symptoms of anxiety and depression experience cognitive failures mainly in complex and stressful daily life events
The current study adds a new, interesting question to our previously published studies: Are these white matter lesions (WML) related to cognitive functioning in women following aeclamptic pregnancy? We studied the effect of WML in a relatively large group of formerlyeclamptic women and hypothesize that WML in women who hadeclampsia may have an effect on standardized test measures of neurocognitive functioning and may be related to cognitive failures experienced in the completion of daily life activities
Summary
Preeclamptic, and control women with normotensive pregnancies were enrolled in this retrospective cohort study as part of ongoing follow-up studies assessing long-term cerebral consequences of preeclampsia and eclampsia (Aukes et al, 2009; Aukes et al, 2012; Postma et al, 2014; Wiegman et al, 2014). The task is considered a nonverbal analogue to Digit Span (WAIS–III–NL; Wechsler, 2005), which was used to measure verbal working memory and consists of sequences of numbers, which had to be repeated by the participant, first forward and backwards. The task was ended after three wrong responses of the same length, and the number of correct answers was scored. Attention Part 1 (Visual Scanning), Part 2 (Number Sequencing), and Part 3 (Letter Sequencing) of the Trail Making Test (D-KEFS) were used to measure attention (Delis et al, 2007) These conditions were designed to quantify key component skills that are required for performing the Number– Letter Switching condition described below.
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