Pre-eclampsia, for all that it is a disease of the first pregnancy, is a vascular disease. It is associated with vascular complications later in life, including hypertension and stroke. STOX1, a pre-eclampsia susceptibility gene, is overexpressed in late Alzheimer’s disease. It is therefore natural to ask whether pre-eclampsia is associated with dementia in later life. Previous studies have been rather underpowered. Now a massive data base study of over a million pregnancies has reported from Denmark. [1] A strong association was found between pre-eclampsia and vascular dementia (hazard ratio over three and over six for severe cases) but the hazard ratio was much lower for Alzheimer’s disease. This confirms the association between pre-eclampsia and blood vessel disease, and the weak association with Alzheimer’s disease may be the result of misclassification.

My wife reminds me that I told her that I wanted to complete my family by the age of 40. Anyway I was largely correct. A massive registry study of over 40 million pregnancies in the US shows that the babies of older dads are more likely to be born prematurely, have seizures and be small for gestational age (after correcting for mother’s age) than the progeny of younger men.[2] And the mothers were more likely than those of younger men to have gestational diabetes. These effects likely result from gene imprinting as a fellow ages. It has been known for over a century that old dads are also more likely than young ones to have children with genetic defects due to accumulation of genetic mutations in older sperm. Of course this should not preclude older men from having children – there are always risks in life and a loving dad can more than compensate in all but a very few cases.

Richard Lilford, ARC WM Director

References:

1. Basot S, Wohlfahrt J, Boyd HA. Pre-eclampsia and risk of dementia later in life: nationwide cohort study. BMJ. 2018; 363: k4109.
2. Khandwala YS, Baker VL, Shaw GM, Stevenson D, Lu Y, Eisenberg ML. Association of paternal age and perinatal outcomes between 2007 and 2016 in the United States: population based cohort study. BMJ. 2018; 363: k4372.