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Hypertension is one of the most common medical complications of pregnancy that affects both fetal and maternal health and is often life threatening.1,2 Multiple maternal organs are affected by hypertension in pregnancy, including the brain in the form of eclampsia.1–4 Eclampsia is a leading cause of maternal death, with classic neurologic symptoms that include headaches, nausea, vomiting, cortical blindness, coma, and convulsions.5–9 Although numerous organs are affected by hypertension in pregnancy, cerebrovascular involvement is the direct mechanism of death in ≈40% of patients.6,7 The major cerebrovascular changes in eclampsia have been shown to be similar to those described for hypertensive encephalopathy, including loss of cerebral blood flow (CBF) autoregulation, hyperperfusion, and edema.8–12 In support of this concept, clinical and neuroimaging findings during eclampsia are consistent with edema, which is thought to result from a rapid rise in blood pressure that causes forced dilatation of cerebral vessels, breakthrough of autoregulation, and blood–brain barrier (BBB) disruption.12–15 In fact, the neurologic symptoms of eclampsia are often interpreted as a form of hypertensive encephalopathy.8,16–18It is well known that pregnancy is associated with significant cardiovascular adaptation of both local and systemic circulations.2,19–22 Although the vascular changes that occur during pregnancy have been the subject of intense study in many organs, the effect of pregnancy and hypertension during pregnancy on the cerebral circulation is just coming to be understood. This review focuses on structural and functional changes in the cerebral circulation during normal pregnancy and the postpartum state that may contribute to the development of eclampsia, including changes in CBF autoregulation and cerebrovascular resistance (CVR) that enhance BBB permeability and hydrostatic brain edema. In addition, how hypertension during pregnancy, being somewhere between acute and chronic hypertension, affects the cerebral circulation is discussed.Eclampsia is defined in the …

Cerebrovascular Function in Pregnancy and Eclampsia