Brain Iron in Nucleus Accumbens and Cognitive Function in Preeclampsia

Hypertension. 2026 Jul 2. doi: 10.1161/HYPERTENSIONAHA.125.26398. Online ahead of print.

ABSTRACT

BACKGROUND: Preeclampsia is associated with long-term cognitive dysfunction, potentially linked to cerebral iron deposition. This study investigated striatal iron alterations using quantitative susceptibility mapping and their relationship with cognitive function in patients with preeclampsia.

METHODS: This cross-sectional study enrolled 321 participants, including nonpregnant and pregnant healthy controls, and patients with preeclampsia. Participants underwent the Montreal Cognitive Assessment, Trail Making Test, and 1.5 T brain magnetic resonance imaging. Striatal iron content was quantified using quantitative susceptibility mapping reconstructed with a morphology-enabled dipole inversion algorithm.

RESULTS: Preeclampsia patients showed poorer executive function (Trail Making Test part [A+B]: partial η²=0.170; part B: partial η²=0.100) and elevated nucleus accumbens magnetic susceptibility (all P<0.001). Age (β=0.744, P<0.001) and hematocrit (β=0.846, P=0.011) were independently associated with iron levels. In addition, significant interactions between nucleus accumbens susceptibility values and preeclampsia status were observed for log-transformed Trail Making Test completion times (part [A+B]: interaction β=0.388, P=0.006; part B: interaction β=0.424, P=0.003), indicating that elevated iron specifically exacerbates executive vulnerability in preeclampsia.

CONCLUSIONS: Nucleus accumbens iron level is elevated in preeclampsia and correlates with executive performance. Although the cross-sectional design limits causal conclusions, these findings highlight nucleus accumbens iron deposition as a key pathological feature underlying preeclampsia-related cerebral involvement.

PMID:42389781 | DOI:10.1161/HYPERTENSIONAHA.125.26398