Brain Iron in Nucleus Accumbens and Cognitive Function in Preeclampsia

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 η 2 =0.170; part B: partial η 2 =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.