In a randomized clinical trial of women with prior HypertensivePregnancy, physician-optimized postpartum blood pressure self-management was associated with larger white matter brain volumes at 9 months compared with usual care.

Women with a history of preeclampsia receiving usual care had smaller volumes in subcortical regions (putamen, accumbens, pallidum) than those with gestational hypertension, differences that were not observed in the intervention group.

---

This randomized clinical trial indicates that a postpartum blood pressure management intervention after hypertensive disorders of pregnancy may be associated with favorable brain structure during the first year post partum. The intervention was linked to larger white matter volumes across women with hypertensive pregnancy (gestational hypertension and preeclampsia). In addition, women with a history of preeclampsia in the usual care arm showed smaller subcortical brain volumes at 6 to 9 months post partum than those with gestational hypertension; these differences were not evident among women in the intervention arm.

Both women with preeclampsia and gestational hypertension experience high blood pressure during pregnancy that frequently persists post partum.²⁸ Lower white matter integrity has been reported from the peripartum period into later life.^3,12,29 Hypertension-related white matter injury^30,31 is associated with slower processing speed, executive dysfunction, and memory impairment.³¹ Although cognitive impact may not be obvious in the early postpartum period, white matter changes predict later cognitive decline and dementia,³² and converging longitudinal evidence suggests that reductions in white matter volume and integrity track cognitive decline, supporting the interpretation that better-preserved white matter is beneficial.³³

Whether postpartum white matter changes are preventable or reversible had not been investigated. In this randomized clinical trial, a short-term blood pressure control intervention was associated with larger brain volumes several months later, when most participants were no longer taking antihypertensive medication. This is consistent with the postpartum period as a critical window for pregnancy-associated brain volume and blood pressure changes. Because baseline brain MRIs were not acquired, we cannot distinguish recovery of pregnancy-related changes from a slower postpregnancy decline relative to usual care.

For decades, schizophrenia and bipolar disorder (BD) were treated as distinct and unrelated psychiatric disorders. Schizophrenia is a psychiatric disorder characterized by altered thinking and emotional patterns, hallucinations, false or irrational beliefs (i.e., delusions), cognitive deficits, and disorganized speech. BD, on the other hand, is marked by extreme mood swings, ranging between periods of high-energy (i.e., mania or hypomania) and depressive episodes.

While the symptoms of schizophrenia and BD are markedly different, many patients diagnosed with either of these conditions experience psychosis at least once in their lifetime. Psychosis is a mental state that causes people to lose touch with reality, experiencing hallucinations, delusions, disorganized speech, and irrational thinking patterns.

More recently, studies found that patients diagnosed with schizophrenia and BD sometimes share other overlapping symptoms, as well as common patterns in their genes and brain organization. This inspired the idea that these disorders are part of a shared psychosis spectrum, which would explain their common features and characteristics.