Neurology of Preeclampsia and Related Disorders: an Update in Neuro-obstetrics

Abstract

Purpose of review: Preeclampsia and related hypertensive disorders of pregnancy affect up to 10% of pregnancies. Neurological complications are common and neurologists often become involved in the care of obstetric patients with preeclampsia. Here, we review the definition(s), epidemiology, clinical features, and pathophysiology of preeclampsia, focusing on maternal neurological complications and headache as a common presenting symptom of preeclampsia.

Recent findings: Neurological symptoms are early and disease-defining features of preeclampsia. Neurological complications of preeclampsia may include headaches, visual symptoms, cerebral edema, seizures, or acute cerebrovascular disorders such as intracerebral hemorrhage or reversible cerebral vasoconstriction syndrome. A history of migraine is an independent risk factor for vascular diseases during pregnancy, including preeclampsia and maternal stroke. The pathophysiology of both preeclampsia and migraine is complex, and the mechanisms linking the two are not fully understood. Overlapping clinical and pathophysiological features of migraine and preeclampsia include inflammation, vascular endothelial dysfunction, and changes in vasoreactivity. Neurological complications are recognized as a major contributor to maternal morbidity and mortality. Pregnant and postpartum women commonly present with headache, and red flags in the clinical history and examination should prompt urgent neuroimaging and laboratory evaluation. A focused headache history should be elicited from patients as part of routine obstetrical care to identify patients at an increased risk of preeclampsia and related hypertensive disorders of pregnancy. Collaborative models of care and scientific investigation in the emerging field of neuro-obstetrics have the common goal of reducing the risk of maternal neurological morbidity and mortality from preeclampsia.

Keywords: Headache; Maternal mortality; Neuro-obstetrics; Preeclampsia; Stroke.

Fig. 1

Possible shared pathophysiological mechanisms in migraine and preeclampsia. Preeclampsia and migraine share overlapping pathophysiology, including inflammation and endothelial dysfunction. Like migraine, the cerebral effects of preeclampsia include neuroinflammation, alterations in angiogenic pathways, endothelial cell dysfunction, changes in vascular reactivity, blood–brain barrier dysfunction, and platelet activation. This may account for the epidemiological association between migraine and risk of preeclampsia; however, the specific mechanisms of this association are not well understood. Figure created with BioRender.com