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Hypertensive disorders of pregnancy and neuroimaging markers of dementia risk: A pilot study
Mohamad J. Alshikho, Noora Haghighi, Rupa Ravi, Victoria A. Solomon, Elizabeth Rangel, Jeffrey D. Pyne, Kelsang C. Bista, Julia F. Chang et al.. Pregnancy, 2025-04-24
Topic: Risk, prevention and care in population studies
Abstract Background and Objectives Hypertensive disorders of pregnancy (HDP) are associated with a long‐term risk of maternal cognitive decline. Limited data exist regarding maternal brain structure in midlife after HDP. We examined the association between prior HDP and neuroimaging markers associated with microvascular brain injury, detected on high‐resolution brain MRI. Methods We conducted a pilot study embedded within the nuMoM2b Heart Health Study, a multicenter prospective cohort of nulliparous US individuals recruited between 2010 and 2013 in the first trimester of pregnancy. Participants with no history of HDP, preterm birth, small‐for‐gestational age infant, or stillbirth in any pregnancy, and participants with HDP in the index or any subsequent pregnancy were invited to undergo brain MRI at two study sites between December 21, 2021 and September 30, 2023, using a standardized protocol on identical scanners. Imaging outcomes of interest included white matter hyperintensity (WMH) volume, regional cerebral blood flow (CBF), fractional anisotropy (FA), radial diffusivity (RD), regional grey matter volume (GMV), and cortical thinning. Results A total of 81 participants (mean age 39 years; 27% White, 9% non‐Hispanic Black, 52% Hispanic, 10% Asian) had brain MRI, of whom 27 (33%) had a history of HDP. The median time from index delivery to MRI was 11 years. Participants with HDP had lower CBF in the left medial orbitofrontal, left inferior temporal, and right superior temporal lobes (Cohen's d = 0.3, cluster‐wise corrected p = 0.0002 for all subregions); lower FA in the left superior frontal lobe, right lateral occipital lobe, and right precuneus ( d = 0.2–0.3, p ≤ 0.01 for all regions); and higher RD in the bilateral medial orbitofrontal lobes ( d = 0.2–0.3, p < 0.001). Cortical thickness, regional GMV, and total WMH volume did not differ between groups. A subgroup analysis including only participants with preeclampsia in the exposed group showed similar results. Discussion Midlife individuals who experienced HDP had lower regional CBF and reduced white matter microstructural integrity, compared with those with no adverse pregnancy outcomes. Our results suggest that HDP are associated with long‐term impairment of white matter structure and cerebrovascular function, potentially suggesting a mechanism underlying the association of HDP with risk of cognitive decline, and requiring further study.
Key findings
- Abstract Background and Objectives Hypertensive disorders of pregnancy (HDP) are associated with a long‐term risk of maternal cognitive decline.
- We examined the association between prior HDP and neuroimaging markers associated with microvascular brain injury, detected on high‐resolution brain MRI.
- Results A total of 81 participants (mean age 39 years; 27% White, 9% non‐Hispanic Black, 52% Hispanic, 10% Asian) had brain MRI, of whom 27 (33%) had a history of HDP.
- A subgroup analysis including only participants with preeclampsia in the exposed group showed similar results.
- Discussion Midlife individuals who experienced HDP had lower regional CBF and reduced white matter microstructural integrity, compared with those with no adverse pregnancy outcomes.
Why it matters
In this pilot study of 81 women, prior hypertensive disorders of pregnancy were examined in relation to brain MRI markers of microvascular injury about 11 years after delivery. As a small pilot, it cannot establish cause or show any treatment or prevention effect.
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Study details
- Study designprospective cohort
- Participants81
- Evidence strengthModerate
How this study scored 53/100
Published in a peer-reviewed journal, and it is a prospective cohort study, followed forward from enrollment. Scored zero for effect reported and randomised / blinded because the record does not state it. We have no data on senior author's track record, so that was left out: it earned 51 of the 96 points we could judge it on, which is 53 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Pregnancy) |
| Journal's citation record | 0 / 4 | Pregnancy: journal h-index 6 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A prospective cohort study, followed forward from enrollment |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 1 / 4 | 81 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 6 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 3.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 6 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | 3 / 3 | National Institutes of Health: institution h-index 2,723 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 7 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40881303) |
| Free to read | 2 / 2 | Free to read |
| Points | 51 / 96 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 51 of the 96 points we could judge it on is 53 out of 100. |
| Total | 53 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Alshikho, M. J., Haghighi, N., Ravi, R., Solomon, V. A., Rangel, E., Pyne, J. D., et al. (2025). Hypertensive disorders of pregnancy and neuroimaging markers of dementia risk: A pilot study. Pregnancy. https://doi.org/10.1002/pmf2.70020
Vancouver
Alshikho MJ, Haghighi N, Ravi R, Solomon VA, Rangel E, Pyne JD, et al. Hypertensive disorders of pregnancy and neuroimaging markers of dementia risk: A pilot study. Pregnancy. 2025. doi:10.1002/pmf2.70020. PMID: 40881303.
BibTeX
@article{alshikho2025-40881303,
author = {Alshikho, Mohamad J. and Haghighi, Noora and Ravi, Rupa and Solomon, Victoria A. and Rangel, Elizabeth and Pyne, Jeffrey D. and Bista, Kelsang C. and Chang, Julia F. and others},
title = {{Hypertensive disorders of pregnancy and neuroimaging markers of dementia risk: A pilot study}},
journal = {Pregnancy},
year = {2025},
doi = {10.1002/pmf2.70020},
pmid = {40881303},
url = {https://doi.org/10.1002/pmf2.70020}
}
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