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Cognitive Function after Preeclampsia


The American Journal of Obstetrics & Gynecology has published new research out of the Netherlands. Translating research and providing it in a more accessible way is what we do here at #EndPreeclampsoa! Join us at our Patient Support Group to be part of the conversation.

We are frequently asked whether preeclampsia causes cognitive changes such as memory problems, challenges with word recall, being forgetful, scattered, or other similar symptoms. Previous research found no cognitive differences after delivery for those who had preeclampsia vs. those who did not have preeclampsia and that any cognitive changes could be explained by increased rates of mood disorders in those who had preeclampsia. We know that a large percentage of our preeclampsia pregnancies are traumatic, and many of us develop mood disorders such as anxiety, post-traumatic stress disorder, depression, etc. Mood disorders CAN cause these types of memory and cognition changes. Read more about preeclampsia and mood disorders here: http://bit.ly/3kJp81s and here: http://bit.ly/3Zhl6wk


You can read the new cognition research here: https://doi.org/10.1016/j.ajog.2023.02.020

What does it say: Principal findings

“Here we demonstrate that women experience disabling problems during daily life activities up to decades after preeclampsia. Clinical attenuation of higher-order cognitive functions, i.e., executive function, is substantially more likely after preeclampsia as compared to after normotensive pregnancy. Overall, about one in four women with a history of preeclampsia are expected to suffer from clinically attenuated (reduced) executive functioning within the first months after pregnancy, and up to half of women with a history of preeclampsia from working memory difficulties. Slow gradual risk normalization was observed in all assessed cognitive domains, but risks remained statistically significant elevated up to decades after pregnancy.”


“All absolute risks decreased over time after preeclampsia, and differences were no longer statistically significant after 19 (Initiate), 25 (Working memory), 15 (Plan & Organize), 23 (Task Monitor), and 11 (Organization of Materials) years after pregnancy.”


What does this mean: The principal findings show that slowly and gradually, cognitive dysfunctions normalized. 23% of preeclampsia survivors experience reduced overall executive functioning within the first year after childbirth compared to 2% of those with a normotensive pregnancy (those who did not experience a hypertensive disorder of pregnancy). This difference decreases over time but was still detectable for up to 19 years postpartum. Over 50% of preeclampsia survivors experience working memory deficits within the first year after childbirth compared to 6% of those with a normotensive pregnancy (those who did not experience a hypertensive disorder of pregnancy). This difference decreased over time but was still detectable for up to 25 years postpartum.


What does preeclampsia do that might cause these cognitive changes?

The thought is that, similar to our increased risk for cardiovascular disease, these symptoms may be from microvascular endothelial dysfunction, a hallmark of preeclampsia.”Persistent cerebral microvascular endothelial dysfunction could alter neuronal network structures that are suggested to explain cognitive performance issues. Both microvascular endothelial dysfunction and cerebral small vessel disease associate with specifically reported problems and deficits in executive functions, a set of higher-order cognitive skills important for purposeful and adapted behavior.”


Noteworthy: The study did not take into account a history of neurodivergence, brain tumors, traumatic brain injury, stroke, or autoimmune disorders that occur after pregnancy, any of which could be risk factors for preeclampsia and/or for cognitive changes.


“Conclusion

After preeclampsia, women were nine times more likely to experience clinical attenuation of higher-order cognitive functions as compared to after normotensive pregnancy. Despite overall steady improvement, Keywords: elevated risks persisted over decades after childbirth.”


And


“In conclusion, a concerningly high number of women experience clinically relevant executive dysfunction after preeclampsia in the prime of their life. As cognitive problems profoundly affect personal control, social interactions and work performance, more attention is needed to detect and support affected women.”


Questions & Answers:

Q. Can a mood disorder cause the cognitive changes I feel I’ve had after having preeclampsia?


A. Yes! Proper evaluation and treatment of mood disorders are essential. Anxiety, depression, PTSD, etc, are all potential culprits in your cognitive changes. It’s not always easy to detect that you have one of these mood changes.


Q. Besides mood disorders, what else can cause perceived cognitive changes after preeclampsia?


A. Remember that you’ve just been through pregnancy, delivery, and a serious disease that impacts your major organs and bodily functions. Not to mention you have major fluid and hormone shifts, grief, sorrow, and its associated impacts if your baby did not survive, or lack of sleep due to the baby being in the NICU, or home on a 2 or 3-hour feeding schedule. Those who are nursing or pumping have more physical demands and hormone changes. Pregnancy can unmask or trigger underlying conditions. Underlying conditions can be genetic diseases (diseases that run in families) that would normally appear later in life, but the physical strain of pregnancy causes them to appear earlier. Some examples of these underlying conditions are chronic hypertension, thyroid disease, autoimmune disorders, and metabolic disorders, etc.


Q. What can I do if I feel I’ve had cognitive changes after preeclampsia?

  1. Talk to your pregnancy care provider (OBgyn, MFM, Consultant, Midwife). They should provide some screening for mood disorders or refer you to a psychologist or therapist who can assist you in determining whether a mood disorder may be the cause. Postpartum.net is also a great resource for finding online or local mental health support and resources.

  2. Work with a therapist, psychologist, or psychiatrist to work through trauma with therapy and/or medications if appropriate. Postpartum.net has great resources online and locally around the world, so check them out!

  3. Give yourself some grace and review how you are taking care of yourself. How much are you sleeping? Are you eating regular and nutritious meals? Can you have a trustworthy person care for your baby for an hour here and there so you can get some alone time or rest? Try to go for walks and get fresh air if you’ve been cleared to do so and you are able. Make sure to attend your 6-week postpartum checkup (or any earlier scheduled appointments you may have). Tell your partner if you need support/help for household or other tasks, even if you managed them previously. If you don't have a partner, ask a parent, sibling, friend, neighbor, or someone from your social circles or help from time to time so you can have a break.

  4. Because this study suggests vascular changes due to preeclampsia may contribute to cognitive changes, you can proactively reduce other risk factors you may have or could develop. These changes are the same changes we would advise you to make to reduce cardiovascular disease risks such as heart disease and stroke.

    1. Keep your bp in normal range through lifestyle changes (for those who can) or through medications (for those where lifestyle changes don’t work).

    2. Keep your lipids/cholesterol in normal range through lifestyle changes or medication

    3. Keep your glucose levels in normal range through lifestyle changes or medication

    4. With doctor's permission, get appropriate exercise

    5. Healthy eating

    6. Get or keep your weight in a healthy range

    7. Keep your annual check-up appointments to measure all these things

    8. Join the conversation at our website: https://www.endpreeclampsia.org/groups

By controlling the things within your control, you can limit additional risk factors and be as healthy as possible should you encounter future health concerns, which is just solid advice for all adults.

“Higher scores indicate more frequent difficulties and the sum of scores, termed Global Executive Composite, is a measure of overall executive function performance. The Global Executive Composite is subdivided into the Behavioral Regulation Index and Metacognition Index. The Behavioral Regulation Index measures the ability to regulate and monitor behavior and emotional responses, and encompasses the Inhibit, Shift, Emotional Control, and Self-Monitor scales. The Metacognition Index measures the ability to plan, initiate and complete tasks, hold information in active memory, and organize problem-solving approaches in an orderly fashion. The Metacognition Index encompasses the Initiation, Working Memory, Plan & Organize, Organization of Materials, and Task Monitor scales.”


Brought to you as part of our #YouAskedWeAnswered series.




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