Hypertension in Pregnancy Linked to Cerebral Small Vessel Disease 15 Years Later

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.