Cerebrovascular and neurocognitive risks of preeclampsia: pathogenesis, acute complications and long-term consequences for mother and fetus

Preeclampsia is one of the most significant medical and social problems of modern obstetrics. This complication of pregnancy not only threatens the life of the mother and fetus during pregnancy, but also serves as a predictor of severe cerebrovascular and cardiovascular complications in the long term. Preeclampsia causes both acute and chronic cerebrovascular diseases, which are caused by increased permeability of the blood-brain barrier, impaired cerebral autoregulation, hypercoagulation and inflammation. This literature review analyzes papers published from January 2010 to June 2025 and cited by PubMed, Scopus, MEDLINE, and eLibrary. The features of regulation of cerebral blood flow during normal pregnancy and preeclampsia are described. Cerebrovascular complications of preeclampsia during pregnancy include posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome, hemorrhagic and ischemic stroke, and cerebral venous sinus thrombosis. In the long-term postpartum period, women with a history of preeclampsia have an increased risk of neurocognitive disorders, including impaired executive function and memory. There are also significant psychosocial consequences, i.e. decrease in the quality of life and social functioning, increased levels of anxiety, depression, which reduces adaptation to stressful situations of everyday life. Chronic dysfunction of the blood-brain barrier can cause not only functional neurovascular disorders, but also morphological changes. In the long term, preeclampsia is associated with an increased risk of vascular dementia, Alzheimer's disease, and stroke. Offspring born to mothers with preeclampsia have an increased risk of neurological diseases, including cognitive impairment, attention deficit hyperactivity disorder, autism spectrum disorders, depressive disorders, epilepsy, and cerebral palsy.