Permanent changes to mother’s brain after severe form of hypertensive disorder of pregnancy

In the brains of women recovering from eclampsia – a severe form of hypertensive disorder of pregnancy where the brain is involved – permanent changes to the brain can be demonstrated. In daily life some of the women will notice changes in their memory and ability to concentrate a few years later on, researcher Annet Aukes of the University Medical Center Groningen concludes. She has found small changes in the brains of these women which may be the result of eclampsia. These changes may also indicate predisposition for cardiovascular disease. Aukes will be awarded a PhD for this research by the University of Groningen on 23 March 2011.

A rare complication of high blood pressure during pregnancy (pre-eclampsia) is brain oedema that can lead to convulsions (eclampsia). Aukes investigated the presence of changes in the brains of women who had had eclampsia or pre-eclampsia. Small changes associated with the normal ageing process were found in the brains of women from both groups, but they occurred more often than they did in women of the same age who had had a healthy, uncomplicated pregnancy. Aukes thinks that this may be due to brain oedema. It also seems as if the changes in both groups are related to an increased risk of cardiovascular disease. She concludes that pre-eclampsia can be considered to be a sort of signal from the body that it is predisposed to cardiovascular disease.

Hypertension has a vascular effect

Some 5-10% of pregnant women in the Netherlands have to deal with higher blood pressure. Just why higher blood pressure during pregnancy can cause eclampsia is not yet clear, nor is it clear what the influence of pregnancy on the brain is.Animal models were used in this research to show that blood vessels in the brain during pregnancy regulate blood flow less adequately. Protective changes that occur in blood vessel structure as a result of hypertension do not take place during pregnancy. This makes the brain during pregnancy more susceptible to oedema and thus to eclampsia.

Long-term complications

Women recovering from eclampsia may still have developed permanent brain changes which are visible on MRI scans. General practitioners and gynaecologists often see women reporting memory and concentration problems. Until recently, this was generally attributed to having become a mother.Using questionnaires, Aukes established that women with a prior history of eclampsia scored worse than women with a healthy pregnancy on cognitive functioning in daily life.

The research was conducted in the framework of the MD/PhD programme of the UMCG Junior Scientific Masterclass. The research was funded by ZonMw, Stichting HELLP-Syndroom (HELLP Syndrom Foundation) and the Nederlandse Hartstichting (Dutch Heart Foundation).

Curriculum Vitae

Annet Aukes (1984) studied medicine at the University of Groningen. She conducted her PhD research at the UMCG department of Obstetrics & Gynaecology and at the Graduate School for Behavioral and Cognitive Neuroscience (BCN). Aukes collaborated with the departments of Neurology, Obstetrics & Gynaecology and Pharmacology of the University of Vermont, Burlington, VT, USA. Her thesis is entitled ‘Eclampsia & preeclampsia. Causes and long term consequences of maternal brain involvement’. Her supervisors were Prof. J.G. Aarnoudse and Prof. M.J. Cipolla of the University of Vermont. Dr G.G. Zeeman was co-supervisor. Aukes currently works as a physician at the department of Obstetrics & Gynaecology at Spaarne Hospital in Hoofddorp.

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