Impaired maternal cognitive functioning after pregnancies complicated by severe pre‐eclampsia: a pilot case‐control study

Brussé, Ingrid A.; Duvekot, Johannes J.; Jongerling, Joran; Steegers, Eric; Koning, Inge de

doi:10.1080/00016340801915127

Cited by 87 publications

(103 citation statements)

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“…In the present study, no significant differences were observed between the pregnant women and the nonpregnant women on tasks of visuospatial abilities, although women tended to have lower scores on the Mental Rotations (a spatial task) compared with controls. While there is some inconsistency, most studies found no differences in performance between pregnant women and nonpregnant controls on spatial tasks (Brussé, Duvekot, Jongerling, Steegers, & De Koning, 2008;Eidelman et al, 1993;Glynn, 2010;Sharp et al, 1993).In contrast to previous studies, women in the pregnancy group performed more poorly on a processing speed task compared with the controls (de Groot, et al, 2003;de Groot, et al, 2006;Harris et al, 1996;Vanston & Watson, 2005). A factor that may account for the inconsistency is the use of different time intervals for completion of processing speed tasks.…”

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confidence: 39%

Section: Cihr Author Manuscriptmentioning

confidence: 99%

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Hormones and cognitive functioning during late pregnancy and postpartum: A longitudinal study.

Henry¹,

Sherwin²

2012

Behavioral Neuroscience

140

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This longitudinal study investigated the possible influence of estradiol (E 2 ), progesterone (P), testosterone (T), cortisol (CORT), and prolactin (PRL) levels on cognitive functioning during late pregnancy and the early postpartum period. The performance of 55 pregnant women on a battery of neuropsychological tests, tested once during the third trimester of pregnancy and once during the early postpartum period, was compared with that of 21 nonpregnant controls matched for age and education. Women in the pregnancy group had significantly lower scores than the controls during both the pre-and postpartum visits on tasks of verbal recall and processing speed. CORT levels were significantly associated, in an inverted-U function, with verbal recall scores at both the pregnancy and at postpartum periods and with spatial abilities at postpartum only. During pregnancy, PRL levels were associated in both a linear and an inverted-U function with scores on tests of paragraph recall and in a linear function with scores on tests of executive function. At postpartum, E 2 and CORT were negatively associated in a linear fashion with attention scores. These findings provide new evidence that fluctuating hormone levels during late pregnancy and early postpartum may modulate selected cognitive abilities. Keywords pregnancy; postpartum; cognition; steroid hormones; prolactin During pregnancy and the postpartum periods, a considerable number of women experience some degree of cognitive change that has come to be colloquially called "pregnancy brain." The symptoms most frequently reported by women during these repro ductive periods are forgetfulness and memory disturbances , poor concentration, increased absentmindedness, and difficulty reading (Parsons & Redman, 1991;Poser, Kassirer, & Peyser, 1986).The pregnancy and postpartum periods are characterized by the most drastic hormonal fluctuations women experience during their reproductive lives. During pregnancy, levels of some steroid hormones such as estradiol (E 2 ) and progesterone (P) increase by up to 30-and 70-fold, respectively, in comparison to nonpregnant levels (Tulchinsky, Hobel, Yeager, & Marshall, 1972 CIHR Author Manuscript CIHR Author Manuscript CIHR Author Manuscript80% of placental steroids in the maternal circulation (Bonnar, Franklin, Nott, & McNeilly, 1975;West & McNeilly, 1979). Key steroid hormones affected in this manner are E 2 , P, and cortisol (CORT; Bonnar et al., 1975;Willcox, Yovich, McColm, & Phillips, 1985). Other hormones which fluctuate during these periods are testosterone (T) and prolactin (PRL;Bonnar et al., 1975;Pearlman, Crépy, & Murphy, 1967).Under nonstressful conditions, CORT levels follow a circadian rhythm characterized by highest levels in the morning after awakening followed by a steady decline throughout the day; lowest levels around midnight and a rise again in the early morning hours (Edwards, Evans, Hucklebridge, & Clow, 2001;Weitzman et al., 1971). A distinct feature of the CORT circadian cycle is a marked increase in secret...

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confidence: 39%

Section: Cihr Author Manuscriptmentioning

confidence: 99%

Hormones and cognitive functioning during late pregnancy and postpartum: A longitudinal study.

Henry¹,

Sherwin²

2012

Behavioral Neuroscience

140

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“…Women with a history of early onset PE report similar levels of psychosocial distress on average 14 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] years after pregnancy as measured by anxiety, (absence of) social support, and personality constructs optimism and Type D personality, when compared to a group without PE. A significantly higher level of depressive symptoms and fatigue was observed, albeit with a very small effect size.…”

Section: Discussionmentioning

confidence: 97%

“…In a systematic review on this topic, Delahaije and colleagues described six studies on anxiety, depression, and PTSD in women following PE. Two studies were prospective [13,16], and four utilized a historic cohort [15,[17][18][19]. Depressive symptoms, PTSD, or anxiety were assessed a few months up to on average seven years after pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Long-term follow-up of psychosocial distress after early onset preeclampsia: the Preeclampsia Risk EValuation in FEMales cohort study

Mommersteeg

Drost

Ottervanger

et al. 2016

Journal of Psychosomatic Obstetrics & Gynecology

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Objective: To examine long-term psychosocial distress in women with a history of early onset preeclampsia (PE) compared to a comparison group. Methods: Women with and without a history of early onset PE participating in the 'Preeclampsia Risk EValuation in FEMales' (PREVFEM) study were sent questionnaires, on average 14.1 years (SD ¼ 3.2, range 5-23 years) after the index pregnancy. In total 265 (77%) women with PE and 268 (78%) age-matched women without PE returned questionnaires (mean age 43.5, SD ¼4.6 years). Group differences were examined on indicators of psychosocial distress, depressive symptoms, anxiety, fatigue, loneliness, marital quality, trait optimism and Type D personality, and unadjusted and adjusted for a priori chosen and study-specific covariates. In secondary analyses, the effect of previously detected hypertension was examined, as well as pregnancy-related events within the PE group. Results: Women with a history of PE reported more subsequent depressive symptoms (B ¼ 0.70, 95% CI 0.09-1.32, p ¼ 0.026) and more fatigue (B ¼ 1.12, 95% CI 0.07-2.18, p ¼ 0.037) compared to the non-PE group, but the differences explained less than 1% of the variance. The differences remained after adjustment for age, BMI and education level, and additional adjustment for partner, being unemployed and physical activity. No significant differences were observed for anxiety, loneliness, marital quality, optimism, or Type D personality. These differences were not explained by fouryear previously measured elevated blood pressure in the PE group. Having had a stillborn child or early neonatal death during the index pregnancy was associated with higher depressive symptoms, anxiety, fatigue, and loneliness in the PE group, but these factors explained only a small proportion of the variance in these psychosocial distress factors. Conclusion: A history of early PE is associated with slightly higher levels of depressive symptoms and fatigue on average 14 years later, but this is unlikely to be of clinical relevance. ARTICLE HISTORY

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“…74 This is unrelated to scores of depression, anxiety or attention. 74 It is possible that women who have had severe pre-eclampsia or eclampsia have permanent white matter damage, or their memory is impaired by the emotional trauma of a severe illness.…”

Section: Pre-eclampsia and Future Mental Healthmentioning

confidence: 99%

Pre-eclampsia and long-term maternal health

Williams

2012

Obstet Med

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Summary: Pre-eclampsia is a syndrome of pregnancy, defined by the gestational-onset of hypertension and proteinuria, which resolves postpartum. This definition does not consider the variable multiorgan involvement of a syndrome that can include seizures, fulminating hepatic necrosis and a consumptive coagulopathy. These disparate clinical features are a consequence of an accelerated but transient metabolic syndrome with widespread maternal endothelial dysfunction and inflammation. A trigger to this maternal state is the relatively ischaemic placenta. As pregnancy progresses, the concentration of vaso-toxic factors released by the relatively ischaemic placenta gradually builds up in the maternal circulation. Those predisposed to endothelial dysfunction, e.g. women with risk factors for cardiovascular disease, are more sensitive to these placental derived factors and will develop preeclampsia before natural onset of labour. A woman's vulnerability to pre-eclampsia is therefore composed of a unique balance between her pre-existing maternal endothelial and metabolic health and the concentration of placental derived factors toxic to maternal endothelium. Delivery of the placenta remains the only cure.Years later, women who had pre-eclampsia are at increased risk of chronic hypertension, ischaemic heart disease, cerebrovascular disease, kidney disease, diabetes mellitus, thromboembolism, hypothyroidism and even impaired memory. This article describes how a brief, usually single episode of this acute pregnancy syndrome might both identify those vulnerable to chronic disease in later life and in some cases initiate chronic disease.

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Impaired maternal cognitive functioning after pregnancies complicated by severe pre‐eclampsia: a pilot case‐control study

Abstract: Maternal memory seems to be impaired after pregnancies complicated by severe pre-eclampsia. This effect cannot be attributed to depression and/or anxiety or method of anesthesia.

Cited by 87 publications

References 11 publications

Hormones and cognitive functioning during late pregnancy and postpartum: A longitudinal study.

Hormones and cognitive functioning during late pregnancy and postpartum: A longitudinal study.

Long-term follow-up of psychosocial distress after early onset preeclampsia: the Preeclampsia Risk EValuation in FEMales cohort study

Pre-eclampsia and long-term maternal health

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