Alers et al ( : American Journal of Obstetrics and Gynecology pré-proof in press) aimed to
 determine the impact of preeclampsia on perceived maternal cognitive
 functioning decades after pregnancy.
 This study is part of a cross-sectional case control study named Queen of
 Hearts, a collaboration study of five tertiary referral centers within the
 Netherlands investigating long-term effects of preeclampsia.
 This study included 1036 women with a history of preeclampsia and 527
 women with normotensive pregnancies. Regarding overall executive function,
 23.2% (95%-confidence interval 19.0 to 28.1%) of women experienced
 clinically significant attenuation after preeclampsia compared to 2.2% (95%-
 confidence interval 0.8 to 6.0%) of controls just after childbirth; adjusted
 relative risk of 9.20 (95%-confidence interval 3.33 to 25.38). Group differences
 diminished yet remained statistically significant at least 19 years postpartum.
 Regardless of a history of preeclampsia, women with lower educational
 attainment, mood or anxiety disorders, or obesity were especially at risk.
 Neither severity of preeclampsia, multiple gestation, method of delivery,
 preterm birth, nor perinatal death related to overall executive function.
 Conclusion
 After preeclampsia, women were nine times more likely to experience clinical
 attenuation of higher-order cognitive functions as compared to after
 normotensive pregnancy. Despite overall steady improvement, elevated risks
 persisted over decades after childbirth.