Brain Iron in Nucleus Accumbens and Cognitive Function in Preeclampsia

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.

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.

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.

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.