Long-term neurological consequences of hypertensive disorders of pregnancy: Implications for postpartum monitoring and intervention

Table 5 Biomarker and mechanistic studies in women with a history of hypertensive disorders of pregnancy, including vascular imaging, molecular markers, and cardiovascular risk profiles

Ref.	Design and setting	HDP subtype	Sample (exposed/ref)	Time since index pregnancy	Biomarker/mechanistic focus main findings	Notes/adjustments
Venkatesh et al[32], 2025	Secondary analysis, HAPO follow-up study	Prior HDP	476 HDP/3250 ref	10-14 years	ASCVD risk increase in HDP (median 7.0% vs 5.8%, P < 0.001) vs normotensive/no GDM; risk additive when both present. HDL decrease, BMI increase, BP increase, HbA1c increase in exposure groups	Adjusted for BMI, BP, lipid profile
Hromadnikova et al[37], 2019	Case-control, prospective follow-up	Prior PE	101 PE/89 ref	3-11 years	Circulating microRNAs (e.g., miR-17-5p, miR-20b-5p, miR-29a-3p, miR-126-3p, miR-133a-3p, etc.) linked to CVD risk	Standardized serum profiling; corrected for age and BMI
Akhter et al[34], 2019	Case-control, vascular imaging + serum assays	Prior PE	23 PE/35 ref	Approximately 7 years	Intima increase (0.12 mm vs 0.09 mm, P < 0.0001); I/M ratio increase (P < 0.001); Endostatin increase and Apo B increase correlated with vascular remodeling (rs approximately 0.35-0.38, P < 0.01)	Independent of carotid IMT confounders; adjusted for BMI, MAP, and time since follow-up
Orabona et al[53], 2019	Echo/cardiac imaging study	EO-PE, LO-PE	30 EO-PE, 30 LO-PE/30	Approximately 2 years (6 months-4 years)	LV mass increase, concentric remodeling (60% of EO-PE; 53% of LO-PE), diastolic dysfunction in EO-PE > LO-PE	Adjusted for age and hemodynamic parameters
Siepmann et al[44], 2017	MRI + risk factor analysis	Prior PE	34 PE/40 ref	5-15 years	WM lesion volume increase (23.2 ± 24.9 μL vs 10.9 ± 15.0 μL, P < 0.05); lower FA on DTI; correlated with BP and HDL levels	Structural-functional link between microstructure and vascular status
Fields et al[51], 2017	Cognitive cohort with imaging + CVD risk factors	Prior PE	40 PE/39 ref	Approximately 35 years	Coronary artery calcification (endothelial remodeling) increase (67.5 AU vs 0.0 AU, P = 0.043) linked to cognitive impairment; ApoE ε4 ns	Adjusted for HTN, BMI, medications

HDP: Hypertensive disorders of pregnancy; Ref: Reference/control group; HAPO: Hyperglycemia and Adverse Pregnancy Outcome; ASCVD: Atherosclerotic cardiovascular disease; GDM: Gestational diabetes mellitus; HDL: High-density lipoprotein; BMI: Body mass index; BP: Blood pressure; HbA1c: Hemoglobin A1c; PE: Preeclampsia; CVD: Cardiovascular disease; I/M: Intima/media ratio; IMT: Intima-media thickness; Apo B: Apolipoprotein B; MAP: Mean arterial pressure; EO-PE: Early-onset preeclampsia; LO-PE: Late-onset preeclampsia; LV: Left ventricular; WM: White matter; DTI: Diffusion tensor imaging; FA: Fractional anisotropy; HTN: Hypertension; ApoE-4: Apolipoprotein E ε4 allele; ns: Not significant.