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Meta-Analysis
. 2023 Feb;80(2):257-267.
doi: 10.1161/HYPERTENSIONAHA.122.19399. Epub 2022 Nov 8.

Association Between Hypertensive Disorders of Pregnancy and Dementia: a Systematic Review and Meta-Analysis

Karen C Schliep  1 , Hailey Mclean  1 , Bin Yan  1 , Fares Qeadan  2 , Lauren H Theilen  3 , Adam de Havenon  4 , Jennifer J Majersik  5 , Truls Østbye  6 , Surendra Sharma  7 , Michael W Varner  3
Affiliations
Meta-Analysis

Association Between Hypertensive Disorders of Pregnancy and Dementia: a Systematic Review and Meta-Analysis

Karen C Schliep et al. Hypertension. 2023 Feb.

Abstract

Background: Prior meta-analyses report a 2- to 4-fold increased risk of later cardiovascular disease among women with a history of hypertensive disorders of pregnancy (HDP). Given HDP's vascular underpinnings, it is hypothesized to also be a risk factor for later dementia. We aim to summarize the evidence for the impact of HDP on dementia and consider unique associations between HDP and dementia subtypes.

Methods: Observational studies on the relationship between HDP and dementia were identified from online electronic databases to July 1, 2021 (PROSPERO identifier: CRD42020185630). We included observational studies published in English. Exposure among women was any HDP and HDP subtypes: gestational hypertension, preeclampsia/eclampsia, or other/unspecified HDP. Outcome was any dementia and dementia subtypes: Alzheimer's disease, vascular dementia, or other/unspecified dementias.

Results: For our primary analyses, we included 5 cohort studies with a total of 183 874 women with and 2 309 705 women without HDP. Pooled analysis found a 38% higher risk of all-cause dementia among women with, versus without, any type of HDP (adjusted hazard ratio, 1.38 [95% CI, 1.18-1.61]; P<0.01). When examining association by HDP and dementia subtypes, we found that women with, versus without, any type of HDP had over a 3-fold higher risk of vascular dementia (adjusted hazard ratio, 3.14 [95% CI, 2.32-4.24]; P<0.01).

Conclusions: Our findings indicate that maternal history of HDP is an important risk factor for later development of vascular and all-cause dementia. Further research among more racially/ethnically diverse populations quantifying HDP's effect on all-cause dementia, and specifically vascular dementia, is warranted.

Keywords: cognitive dysfunction; dementia; eclampsia; epidemiology; hypertension.

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Figures

Figure 1:
Figure 1:
Flow diagram of the study selection process
Figure 2:
Figure 2:
Pooled Hazard Ratio (Forest Plot) for the Risk of All-Cause Dementia with All-Cause Hypertensive Disorders of Pregnancy
Figure 3:
Figure 3:
Pooled Hazard Ratio (Forest Plot) for the Risk of Alzheimer’s Disease, Vascular Dementia, and Other/Unspecified Dementia with Hypertensive Disorders of Pregnancy
Figure 4:
Figure 4:
Pooled Hazard Ratio (Forest Plot) for the Risk of All-Cause Dementia with Gestational Hypertension or Preeclampsia/Eclampsia.
See this image and copyright information in PMC

Comment in

  • Systematic Reviews to Inform Practice, May/June 2023.
    Barger MK, Howe-Heyman A, Harris NR. Barger MK, et al. J Midwifery Womens Health. 2023 May-Jun;68(3):395-403. doi: 10.1111/jmwh.13507. Epub 2023 May 22. J Midwifery Womens Health. 2023. PMID: 37212532 No abstract available.

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