Preeclampsia and the long term risk of developing neurological disorders requiring hospital admission.

Abstract

Preeclampsia is associated with acute neurological complications during pregnancy, but the subsequent risk of developing a neurological disorder is unclear. We determined if preeclampsia was associated with the long-term risk of neurological morbidity. We conducted a longitudinal cohort study of 1,460,098 pregnant women with and without preeclampsia in Quebec, Canada, between 1989 and 2023. The main exposure measure was preeclampsia diagnosed in any pregnancy. Outcomes included hospitalization for cerebrovascular disease, epilepsy, and other neurological disorders up to three decades after pregnancy. Using Cox regression models adjusted for confounders, we estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between preeclampsia and neurological disorders during 27,659,555 person-years of follow-up. There were 1,460,098 women in the cohort, including 73,890 (5.1%) with preeclampsia. Women with preeclampsia had a higher incidence of neurological disorders than women without preeclampsia (113.2 vs. 79.3 per 100,000 person-years). Compared with no preeclampsia, preeclampsia was associated with 1.49 times the risk of later neurological hospitalization (95% CI 1.41-1.57). Preeclampsia was primarily associated with cerebrovascular disease (HR 1.89, 95% CI 1.76-2.03) and epilepsy (HR 1.39, 95% CI 1.24-1.57). A link with other neuropathology was less apparent, although severe preeclampsia was associated with neurodegenerative disorders. Severe hypertension, including early onset (HR 2.35, 95% CI 2.06-2.68), recurrent (HR 2.47, 95% CI 2.13-2.86), and superimposed preeclampsia (HR 2.60, 95% CI 2.17-3.12), was more strongly associated with neurological hospitalization overall. Preeclampsia is associated with the long-term risk of developing cerebrovascular disease and epilepsy, but associations with other neurological disorders are less prominent.