Regional Distribution of Cerebral White Matter Lesions Years After Preeclampsia and Eclampsia

Obstetrics and Gynecology (Impact Factor: 4.37). 04/2014; 123(4):790-795. DOI: 10.1097/AOG.0000000000000162
Source: PubMed

ABSTRACT To assess the distribution of cerebral white matter lesions in women who had eclampsia, preeclampsia, or normotensive pregnancies. The pathophysiology of these lesions, more often seen in formerly eclamptic and preeclamptic women, is unclear but may be related to a predisposition for vascular disease, the occurrence of the posterior reversible encephalopathy syndrome, or both while pregnant. Assessing the distribution of such lesions may give insight into their pathophysiology and possible consequences.
This retrospective cohort study determined the presence, severity, and location of white matter lesions on cerebral magnetic resonance imaging scans of 64 formerly eclamptic, 74 formerly preeclamptic, and 75 parous control women.
Formerly preeclamptic and eclamptic women have white matter lesions more often (34.4% [n=47] compared with 21.3% [n=16]; P<.05) and more severely (0.07 compared with 0.02 mL; P<.05) than parous women in a control group. In all women, the majority of lesions was located in the frontal lobes followed by the parietal, insular, and temporal lobes.
White matter lesions are more common in women with prior pregnancies complicated by preeeclampsia or eclampsia compared with parous women in a control group. In no group does regional white matter lesion distribution correspond to the occipitoparietal edema distribution seen in posterior reversible encephalopathy syndrome. LEVEL OF EVIDENCE:: II.

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    ABSTRACT: Objective Women who suffered eclampsia or preterm preeclampsia are twice as likely to demonstrate cerebral white matter lesions (WML) on MRI compared to age-matched women who had normotensive pregnancies, and they report more cognitive dysfunctions in everyday life. We aimed to determine whether pregnancy in and of itself has a relationship with the presence of WML and subjective cognitive dysfunction. Study Design 81 parous women who had a normotensive pregnancy were matched for age with 65 nulliparous women and all underwent cerebral MRI. Presence of cerebral WML was rated and blood pressure was measured. Subjective cognitive functioning was assessed using the Cognitive Failures Questionnaire (CFQ). Results There was no difference in the presence (22% vs. 19%) of WML between parous and nulliparous women. Age was a predictor for the presence of WML, whereas the presence of current hypertension was not. Average CFQ score was not different between both groups, nor related to WML. Conclusions A history of pregnancy in and of itself is not related to the presence of cerebral WML and the perception of cognitive dysfunction. Because of the relationship with preterm preeclampsia and eclampsia, future research should focus on the clinical importance and development throughout the years of such cerebral WML in young women and focus on risk factors for cardiovascular disease.
    American journal of obstetrics and gynecology 09/2014; 211(3). DOI:10.1016/j.ajog.2014.02.031 · 3.97 Impact Factor
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    ABSTRACT: objective Women who suffered preeclampsia and eclampsia may report subjective cognitive difficulties in daily life, the interpretation of which is cumbersome, since these are affected by emotional factors. Previous studies only included preeclamptic women investigated shortly after pregnancy. We aimed to determine whether these subjective reports of cognitive difficulty could be interpreted as reflecting objective cognitive dysfunction. Therefore cognitive functioning was assessed using standardized neurocognitive tests in both preeclamptic and eclamptic women several years following the index pregnancy. Study Design 46 formerly eclamptic, 51 formerly preeclamptic and 48 control women who had normotensive pregnancies, age-matched, participated in this study. Average elapsed time since index pregnancy was 7 years. Neurocognitive tests were divided into 6 domains; visual perception, motor functions, working memory, long-term memory, attention and executive functioning. Subjective cognitive functioning was measured by the Cognitive Failures Questionnaire (CFQ) and anxiety/depression by the Hospital Anxiety and Depression Scale (HADS). Results Both preeclamptic and eclamptic women performed worse on the motor functions domain (p<0.05), without differences on the other domains. They scored worse on the CFQ (p<0.01), the HADS anxiety (p<0.01), and depression (p<0.05) scales. Conclusions Women who suffered eclampsia and/or preeclampsia demonstrate no objective cognitive impairment as compared to controls. Contrary to the well-structured test setting, both groups do report more cognitive failures, which are thought to reflect neurocognitive dysfunction in complex, stressful daily-life situations. Such report of cognitive failures may be compounded by anxiety and depression. Future studies should focus on the relationship of neurocognitive functioning with structural cerebral abnormalities.
    American journal of obstetrics and gynecology 07/2014; 211(1). DOI:10.1016/j.ajog.2014.01.042 · 3.97 Impact Factor


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Nov 19, 2014