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    Preeclampsia as a harbinger of longer-term cerebral damage

    A small case-control study by European researchers sheds new light on the long-term cerebral impact that preeclampsia has on mothers. Published in Neurology, the data—from magnetic resonance imaging (MRI) of the brain—suggest that changes to cerebral white and gray matter do not end with delivery.

    Eighty-three women who had a preeclamptic or normotensive pregnancies (controls) in the past 5 to 15 years were included in the analysis. The women with preeclampsia histories were aged 42.8±5.1 years versus 40.6±5.5 for those with normotensive pregnancies.

    All of the participants underwent MRI, and microstructural integrity of their brains was measured by assessing white matter structure using voxel-based segmentation of fluid-attenuation inversion recovery sequences. Voxel-based analysis was also performed of gray matter volumes to adjust for skull size.

    Recommended: Maternal death from intracranial hemorrhage

    Cortical gray matter volume was lower in the women with preeclampsia than in the controls (523.2 ±30.1 vs 544.4 ±44.7 mL, P<0.05) and both groups had white matter lesions. The changes, however, were more extensive in the women with preeclampsia, who had increased temporal lobe white matter disease (lesion volume: 23.2±24.9 vs 10.9±15.0 µL, P<0.05) and altered microstructural integrity (radial diffusivity: 538±19 vs 526±18 x 10-6 mm2/s, P<0.01), which also extended to the occipital and parietal lobes.

    In bivariate regression analysis, temporal white matter changes were significantly associated with blood pressure and serum concentration of high-density lipoprotein. However, the researchers found that in women with a history of preeclampsia, the degree of temporal white matter change was independent of their current cardiovascular risk profile (P<0.05) and increased with time from the index pregnancy (P<0.05), consistent with a persistent susceptibility after delivery.

    In women with preeclampsia, the authors said, “Clinical management at the time of pregnancy and ongoing risk factor modification after delivery are both likely to be important in reducing cerebrovascular disease later in life.” They suggested more aggressive cardiovascular prevention strategies after preeclampsia to reduce cumulative and ongoing damage and more careful attention to neurologic symptoms because the differences in cortical volumes and white matter changes may be harbingers of increased risk of cognitive complaints including disturbances of memory and concentration.   

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    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.
    Miranda Hester
    Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.


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