Keywords
Pre-eclampsia, eclampsia, pulmonary oedema, cognitive function
TWEETABLE ABSTRACT
Pre-eclampsia complicated by eclampsia or pulmonary oedema demonstrated
an acute impairment on cognitive function.
INTRODUCTION
Pre-eclampsia, defined as hypertension with end-organ dysfunction after
20 weeks of gestation, is a multisystem disorder that complicates about
4-6% of all pregnancies.1, 2 Cerebral and
cardiovascular complications, which include eclampsia and pulmonary
oedema, are some of the most severe outcomes and can result in maternal
mortality and morbidity.3 Long-term neurological
effects of pre-eclampsia and its complications include an increased risk
for white matter lesions, stroke, seizure disorders and vascular
dementia later in life.4-6 Women with previous
pre-eclampsia have also reported a poorer quality of life and social
functioning, and have an increased risk for post-traumatic stress
disorder.7, 8
The impact of pre-eclampsia and its complications on cognitive function
is a field that requires further investigation. In 2018, a systematic
review found that women with a history of pre-eclampsia reported
subjective losses in cognitive function. They also noted that there was
insufficient data to conclude about the presence or absence of objective
cognitive changes. This review excluded women with a history of
eclampsia and assessed all women together irrespective of time after
delivery.9 Later in the same year, a large
longitudinal cohort study found differences in raw neurocognitive scores
when women with and without pre-eclampsia were compared decades after
pregnancy. The differences were seen in the domains assessing
psychomotor speed and executive function but not working memory, but
after adjustment for possible confounders the associations were
attenuated.10
Whether the impairment in cognitive function observed years after
pre-eclampsia exists in closer proximity to the diagnosis of
pre-eclampsia and its relation to severity of disease is uncertain. It
is also not known whether women with pre-eclampsia have underlying
cognitive function deficits before the diagnosis of pre-eclampsia. We
therefore aimed to assess cognition subjectively and objectively with
testing performed at discharge after delivery.
METHODS
The study had ethical approval (protocol number N18/03/034, Federal Wide
assurance number 00001372, Institutional Review Board number IRB0005239)
and all included participants signed informed consent before being
enrolled in the PROVE (Pre-eclampsia Obstetric Adverse Events) biobank.
Three women previously affected by severe pre-eclampsia were consulted
about the cognitive function tests and time of testing.