PREDICTORS OF SUBCLINICAL CEREBRAL INJURY IN THE EARLY POSTPARTUM PERIOD IN PREECLAMPSIA: A SYSTEMATIC REVIEW
Abstract
Preeclampsia is a multisystem hypertensive disorder associated with significant maternal morbidity and mortality, with increasing evidence highlighting its impact on the central nervous system. Subclinical cerebral injury, characterized by structural and functional brain alterations without overt neurological symptoms, is an underrecognized complication, particularly in the early postpartum period. Objective: to systematically evaluate current evidence on the prediction of subclinical cerebral injury in women with preeclampsia during the early postpartum period and to identify key clinical, imaging, and pathophysiological predictors. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Electronic databases including PubMed, Scopus, and Web of Science were searched for studies published between 2005 and 2025. Eligible studies included observational studies, cohort studies, and clinical investigations assessing neuroimaging findings, cerebral hemodynamics, and neurological outcomes in women with preeclampsia. Results: A total of 28 studies were included in the analysis. Evidence indicates that preeclampsia is associated with impaired cerebral autoregulation, increased cerebral perfusion pressure, and disruption of the blood–brain barrier. Neuroimaging studies revealed subclinical abnormalities, including white matter lesions, cerebral edema, and microvascular injury, even in asymptomatic patients. Key predictors of cerebral involvement included severity of preeclampsia, degree of hypertension, and early disease onset. Long-term follow-up studies demonstrated an increased risk of cognitive impairment and cerebrovascular disease in women with a history of preeclampsia. Conclusion: Subclinical cerebral injury represents a significant but underrecognized component of preeclampsia, particularly in the early postpartum period. Integration of clinical assessment with neuroimaging and pathophysiological markers may improve early detection and risk stratification.
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