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

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

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.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Cohort Studies
  • Dementia, Vascular* / diagnosis
  • Dementia, Vascular* / epidemiology
  • Dementia, Vascular* / etiology
  • Female
  • Humans
  • Hypertension, Pregnancy-Induced* / diagnosis
  • Hypertension, Pregnancy-Induced* / epidemiology
  • Observational Studies as Topic
  • Pre-Eclampsia* / diagnosis
  • Pre-Eclampsia* / epidemiology
  • Pregnancy
  • Risk Factors