TOPLINE

Hypertensive disorders of pregnancy (HDPs) were associated with a higher risk for incident dementia among females over a span of approximately two decades. The association was significant after accounting for baseline factors but not after the additional inclusion of vascular and metabolic conditions following delivery. 

METHODOLOGY

• Researchers conducted a retrospective cohort study using data from the Korean national health insurance database to examine the association of HDPs with the risk for incident dementia later in life.
• They included about 1.37 million females (mean age, 29.2 years) who delivered in 2002-2005, 2.1% of whom had HDPs, which included hemolysis, elevated liver enzymes, low platelet count syndrome; gestational hypertension; preeclampsia; and eclampsia, and 97.9% did not.
• Incident dementia, identified using a dementia diagnosis code and at least one prescription for an antidementia medicine, was the primary outcome. 
• Females with HDPs were followed up for a median duration of 21.0 years, and those without HDPs were followed up for a median duration of 21.3 years. 
• The analysis was conducted with adjustments for maternal age at childbirth, socioeconomic status, and other obstetric factors at baseline; it additionally accounted for vascular and metabolic conditions, including stroke and diabetes, after delivery.

TAKEAWAY

• In females with vs without HDPs, the cumulative incidence of dementia per 10,000 females was 7.2 vs 2.8 (P < .001), and the incidence density of dementia per 100,000 person-years was 3.00 vs 1.05 (P < .001).
• HDPs were associated with an increased risk for dementia after adjusting for baseline factors (adjusted hazard ratio [aHR], 1.96; 95% CI, 1.19-3.23).
• However, this association with an increased risk for dementia was not significant after additionally accounting for vascular and metabolic conditions following delivery (aHR, 1.15; 95% CI, 0.70-1.91).
• Among the postdelivery conditions considered, stroke was linked to the highest risk for dementia (aHR, 22.83; 95% CI, 17.46-29.05).

IN PRACTICE

"From a clinical perspective, these results support consideration of HDPs as a marker of long-term neurologic risk. Women with a history of HDPs may benefit from closer cardiovascular risk assessment and long-term monitoring of cognitive health," the authors wrote.

SOURCE

The study was led by Ji Su Seong, MS, of the Department of Obstetrics and Gynecology in Chung-Ang University Gwangmyeong Hospital at the Chung-Ang University College of Medicine in Gwangmyeong, Republic of Korea. It was published online on September 24, 2026, in JAMA Network Open.

LIMITATIONS

The study identified HDP exposure using diagnosis codes and dementia based on data obtained from administrative claims, which could lead to potential misclassification. Participants were relatively young when the follow-up concluded, which likely led to the underestimation of the risk for dementia across their lifespan. The number of dementia events in females with HDPs was small, which limited statistical precision and prevented conducting the adjusted analysis by subtype.

DISCLOSURES

Funding was provided through a grant from the National Research Foundation of Korea, financed by the Korea government, and the Korea Health Industry Development Institute, financed by the Ministry of Health and Welfare, Republic of Korea. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.