Cerebral volume is unaffected after pre-eclampsia

OBJECTIVE: Pre-eclampsia, a hypertensive complication of pregnancy, has been associated with cardiovascular, cerebrovascular, and/or psychological complaints. Signs of an altered brain morphology and more white matter hyperintensities during and shortly after preeclampsia were observed in some, but not all, earlier studies. Here, cerebral volumes, the number of white matter hyperintensities and the age-related effects were compared in formerly pre-eclamptic women and women with normotensive gestational history. METHODS: Structural 7-Tesla magnetic resonance images of the cerebrum were acquired of 59 formerly pre-eclamptic women (aged 37±6 years, 0.5-16 years postpartum) and 20 women with normotensive pregnancies (aged 39±5 years, 1-18 years postpartum). Fazekas scores were obtained to assess white matter hyperintensity load. Volumes of the whole brain, gray and white matter, brain lobes, ventricular cerebrospinal fluid (CSF), and pericortical CSF were calculated after semi-automatic segmentation. Group differences were analyzed with ANCOVA and Bayes factors. Results were adjusted for age, educational attainment and total intracranial volume. Effects of age on cerebral volumes was analyzed using a linear regression analysis. RESULTS: No changes in global and local brain volumes were observed between formerly pre-eclamptic and control women. Also, no difference in white matter hyperintensity load was observed. Independent of pre-eclamptic history, gray matter volume significantly decreased with age, while ventricular and peri-cortical CSF volumes significantly increased with age. CONCLUSIONS: Volumetric changes of the cerebrum are age-related, but independent of a pre-eclamptic history in the first two decades after childbirth. No evidence for more white matter lesions after pre-eclampsia was found. This article is protected by copyright. All rights reserved

Blood-brain barrier leakage years after pre-eclampsia: dynamic contrast-enhanced 7-Tesla MRI study

OBJECTIVE: Preeclampsia, a hypertensive complication of pregnancy, relates to an increased risk of long-term cardiovascular and cerebrovascular disorders. Although the persisting susceptibility to cerebral complications after preeclampsia remains largely unclear, impaired blood-brain barrier (BBB) integrity is often proposed to precede several cerebrovascular diseases. Therefore, we investigated the integrity of the BBB years after preeclampsia. METHODS: We performed cerebral magnetic resonance imaging (MRI) at ultra-high field (7 Tesla) in 22 formerly preeclamptic women (aged 37.8 ± 5.4 years, postpartum time 6.6 ± 3.2 years) and 13 control women with normotensive pregnancies (aged 40.8 ± 5.5 years, postpartum time 9.0 ± 3.7 years) to assess the integrity of the blood-brain barrier. Permeability of the blood-brain barrier was determined by assessing leakage rate and fractional leakage volume of a gadolinium-based contrast agent, measured by dynamic contrast-enhanced MRI. Blood-brain barrier leakage measures were determined for the whole brain and lobular white and gray matter. Multivariable analyses were performed and odd's ratios were calculated to compare women with and without preeclampsia, adjusted for potentially confounding effects of age, current hypertension status and Fazekas score. RESULTS: Leakage rate and fractional leakage volume were significantly higher in formerly preeclamptic women compared to control women in the global white (p = 0.001) and gray matter (p = 0.02). Regionally, the frontal (p = 0.04) and parietal cortical gray matter (p = 0.009), and the frontal (p = 0.001), temporal (p = 0.05) and occipital white matter (p = 0.007) showed higher leakage measures in formerly preeclamptic women. The odds of a high leakage rate after preeclampsia were generally higher in white matter regions compared to gray matter regions. CONCLUSION: This observational study shows a globally impaired blood-brain barrier years after a preeclamptic pregnancy, which could be an early marker for long-term cerebrovascular disorders. This article is protected by copyright. All rights reserved

Blood-brain barrier leakage years after pre-eclampsia:dynamic contrast-enhanced 7-Tesla MRI study

OBJECTIVE: Preeclampsia, a hypertensive complication of pregnancy, relates to an increased risk of long-term cardiovascular and cerebrovascular disorders. Although the persisting susceptibility to cerebral complications after preeclampsia remains largely unclear, impaired blood-brain barrier (BBB) integrity is often proposed to precede several cerebrovascular diseases. Therefore, we investigated the integrity of the BBB years after preeclampsia. METHODS: We performed cerebral magnetic resonance imaging (MRI) at ultra-high field (7 Tesla) in 22 formerly preeclamptic women (aged 37.8 ± 5.4 years, postpartum time 6.6 ± 3.2 years) and 13 control women with normotensive pregnancies (aged 40.8 ± 5.5 years, postpartum time 9.0 ± 3.7 years) to assess the integrity of the blood-brain barrier. Permeability of the blood-brain barrier was determined by assessing leakage rate and fractional leakage volume of a gadolinium-based contrast agent, measured by dynamic contrast-enhanced MRI. Blood-brain barrier leakage measures were determined for the whole brain and lobular white and gray matter. Multivariable analyses were performed and odd's ratios were calculated to compare women with and without preeclampsia, adjusted for potentially confounding effects of age, current hypertension status and Fazekas score. RESULTS: Leakage rate and fractional leakage volume were significantly higher in formerly preeclamptic women compared to control women in the global white (p = 0.001) and gray matter (p = 0.02). Regionally, the frontal (p = 0.04) and parietal cortical gray matter (p = 0.009), and the frontal (p = 0.001), temporal (p = 0.05) and occipital white matter (p = 0.007) showed higher leakage measures in formerly preeclamptic women. The odds of a high leakage rate after preeclampsia were generally higher in white matter regions compared to gray matter regions. CONCLUSION: This observational study shows a globally impaired blood-brain barrier years after a preeclamptic pregnancy, which could be an early marker for long-term cerebrovascular disorders. This article is protected by copyright. All rights reserved