Pregnancy History, Hypertension, and Cognitive Impairment in Postmenopausal Women

Abstract

Purpose of review: Risks for developing cardiovascular disease and cognitive decline increase with age. In women, these risks may be influenced by pregnancy history. This review provides an integrated evaluation of associations of pregnancy history with hypertension, brain atrophy, and cognitive decline in postmenopausal women.

Recent findings: Atrophy in the occipital lobes of the brain was evident in women who had current hypertension and a history of preeclampsia. Deficits in visual memory in women with a history of preeclampsia are consistent with these brain structural changes. The blood velocity response to chemical and sympathoexcitatory stimuli were altered in women with a history of preeclampsia linking impairments in cerebrovascular regulation to the structural and functional changes in the brain. Having a history of preeclampsia should require close monitoring of blood pressure and initiation of anti-hypertensive treatment in perimenopausal women. Mechanisms by which preeclampsia affects cerebrovascular structure and function require additional study.

Keywords: Alzheimer’s disease; Gray matter; Menopause; Neurovascular control; Preeclampsia; White matter hyperintensities.

Fig. 1

Schematic summarizing studies of postmenopausal women with a history of preeclampsia. During normal pregnancy, blood pressure is reduced (green). However, during a preeclamptic pregnancy, blood pressure is elevated (red) after 20-week gestation, continues to be elevated throughout the pregnancy, and decreases back to prepregnancy levels after delivery. Aging and menopause increase risk for hypertension in women, and a history of preeclampsia augments hypertension risk. Postmenopausal women with a history of preeclampsia had impairments in neurovascular control that were associated with increased vascular activation compared with women who had a history of a normotensive pregnancy [••]. Gray matter atrophy in the occipital lobes were also observed in women with a history of preeclampsia and current controlled hypertension [••] as were increased volume of white matter lesions as early as < 10 years postpartum [71]. Brain structural changes were consistent with deficits in visual memory, as well as a trend for increased incidence of clinical cognitive impairment diagnosis with a more diffuse range (i.e., multiple domains) in cognitive impairment [••]. We hypothesize that reduced neurovascular control is a potential mechanism by which a history of a preeclamptic pregnancy may augment risk for cognitive decline later in life. It is unclear at this time whether, when, and how reduced neurovascular control may progress in women with a history of a normotensive pregnancy as they age. It was also unclear whether the changes in the occipital cortex observed in hypertensive women with a history of preeclampsia are specific to that complication of pregnancy. This figure was created in part with modified Servier Medical Art templates, which are licensed under a Creative Commons Attribution 3.0 Unported License: https://smart.servier.com