Pre-eclampsia is a pregnancy-specific disease, defined by the onset of hypertension and end-organ engagement after gestational week 20.(1) It affects 3-5% of all pregnancies and is a leading contributor to maternal morbidity and mortality, especially in low- and middle-income countries.(2) Acute cerebral complications of pre-eclampsia include eclampsia, cerebral oedema and intracranial haemorrhage.(3) The long-term neurological consequences for these women include increased life-time risks of vascular and Alzheimer’s dementia, stroke and epilepsy.[4], [5], [6] It is not known if the increased risk for long-term neurological consequences associated with pre-eclampsia is due to pre-existing risk factors where pre-eclampsia acts as a stress-test, or if pre-eclampsia and its complications lead to irreversible endothelial and consequently neuronal injury.(7) Studies have shown that women with prior pre-eclampsia have more temporal and frontal white matter lesions,[8], [9], [10] reduced cortical grey matter volume and total smaller brain volume,(11) when compared to women with previous normotensive pregnancies.

Several studies have investigated cognitive impairment in women with previous pre-eclampsia months to years after pregnancy, but the results are conflicting. A systematic review and meta-analysis from 2018 showed no clear evidence of cognitive impairment on standard objective tests, but a higher incidence of subjective cognitive failure in women with prior pre-eclampsia though they excluded women with eclampsia.(12) Our group has previously shown that women with pre-eclampsia complicated by pulmonary oedema and eclampsia demonstrate an acute impairment in cognitive function after delivery at the time of discharge, compared to normotensive women.(13)

Cerebral biomarkers may be useful in predicting and diagnosing neurological complications in pre-eclampsia. Tau and neurofilament light chain (NfL), which are axonal proteins, and glial fibrillary acidic protein (GFAP), which is a filament protein in astrocytes, are useful predictive and diagnostic tools in neurodegenerative disorders.(14) We and others have investigated the role of cerebral biomarkers in pre-eclampsia and have shown that plasma concentrations are increased in women with pre-eclampsia complicated by haemolysis, elevated liver enzymes and low platelets (HELLP) or neurological complications.[15], [16], [17], [18] But there is still a paucity of data regarding the correlation of cerebral biomarkers to cognitive function in pre-eclampsia. In this study, we compared plasma concentrations of cerebral biomarkers NfL, tau and GFAP among women with pre-eclampsia of different severity and women with normotensive pregnancies to their performance on objective cognitive assessments at time of discharge after delivery.