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.